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Kinetics of Elution of Gentamicin from a Gentamicin-Loaded PMMA Bone Cement

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Document pages: 11 pages

Abstract: Antibiotic-loaded poly (methyl methacrylate)bone cement (ALBC) is widely used for anchoring joint replacements as a meansof reducing the potential for peri-prosthetic joint infection (primary cases)and treating a patient who has an infected joint replacement (revision cases).One shortcoming of the cement is the high maximum exothermic temperature experiencedupon polymerization (Tmax), a phenomenon that, it has been postulated,may cause or be implicated in thermal necrosis of peri-prosthetic tissues.There are many reports in the literature on methods of reducing Tmax,with one such study involving the addition of a phase change material(microencapsulated paraffin) (MEPAR) to the cement powder or adding a chain-stoppingchemical (1-dodecyl mercaptan) (DDM) to the liquid. In that report, the results of gentamicin elution tests were presented. In the present work,those results were used to calculate various indices of gentamicin elutionkinetics, namely 1) diffusion coefficient (Dgent); and 2) values ofthe coefficients in four equations that are widely used to model antibioticelution from ALBCs. We found 1) the difference in Dgent of either aMEPAR- or DDM-containing formulation, on the one hand, and that of the controlcement, on the other, was not significant; and 2) a consistent trend in thevalue of only one coefficient in one of the four model equations, with thischange suggesting insignificant difference in gentamicin elution mechanismbetween an experimental cement formulationand the control cement. The implications of these findings for guidingselection of additives that simultaneously produce significant reduction of Tmax but minimal effect on gentamicin elution kinetics are discussed. Thisguide is a novel contribution to the literature.

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