Influence of Tranexamic Acid on Elution Characteristics and Compressive Strength of Antibiotic-Loaded PMMA-Bone Cement with Gentamicin

Purpose: The topical application of tranexamic acid (TXA) into the joint space during total joint arthroplasty (TJA) with no increase of complications, has been widely reported. We investigated the influence of TXA on antibiotic release, activity of the released antibiotic against a clinical isolate of S. aureus, and compressive strength of a widely used commercially prepared gentamicin-loaded cement brand (PALACOS R + G). Method: 12 bone cement cylinders (diameter and height = 6 and 12 mm, respectively) were molded. After curing in air for at least 1 h, six of the cylinders were completely immersed in 5 mL of fetal calf serum (FCS) and the other six were completely immersed in a solution consisting of 4.9 mL of FCS and 0.1 mL (10 mg) of TXA. Gentamicin elution tests were performed over 7 d. Four hundred µL of the gentamicin eluate were taken every 24 h for the first 7 d without renewing the immersion fluid. The gentamicin concentration was determined in a clinical analyzer using a homogeny enzyme immuno-assay. The antimicrobial activity of the eluate, obtained after day 7, was tested. An agar diffusion test regime was used with Staphylococcus aureus. Bacteria were grown in a LB medium and plated on LB agar plates to get a bacterial lawn. Fifty µL of each eluate were pipetted on 12-mm diameter filter discs, which were placed in the middle of the agar gel. After 24 h of cultivation at 37 °C, the zone of inhibition (ZOI) for each specimen was measured. The compressive strength of the cements was determined per ISO 5833. Results: At each time point in the gentamicin release test, the difference in gentamicin concentration, obtained from specimens immersed in the FCS solution only and those immersed in the FCS + TXA solution was not significant (p = 0.055–0.522). The same trend was seen in each of the following parameters, after 7 d of immersion: (1) Cumulative gentamicin concentration (p < 0.297); (2) gentamicin activity against S. aureus (strongly visible); (3) ZOI size (mostly > 20 mm) (p = 0.631); and (4) compressive strength (p = 0.262). Conclusions: For the PALACOS R + G specimens, the addition of TXA to FCS does not produce significant decreases in gentamicin concentration, in the activity of the gentamicin eluate against a clinical isolate of S. aureus, the zone of inhibition of S. aureus, and in the compressive strength of the cement, after 7 d of immersion in the test solution.

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Comparison of Elution Characteristics and Compressive Strength of Biantibiotic-Loaded PMMA Bone Cement for Spacers: Copal® Spacem with Gentamicin and Vancomycin versus Palacos® R+G with Vancomycin

BioMed Research International ◽

10.1155/2018/4323518 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5 ◽

Cited By ~ 5

Author(s):

Sebastian P. Boelch ◽

Kilian Rueckl ◽

Clara Fuchs ◽

Martin Jordan ◽

Markus Knauer ◽

...

Keyword(s):

Compressive Strength ◽

Bone Cement ◽

Compression Test ◽

Fetal Calf Serum ◽

Calf Serum ◽

Cement Powder ◽

Pmma Bone Cement ◽

Gentamicin Concentration

Purpose. Copal® spacem is a new PMMA bone cement for fabricating spacers. This study compares elution of gentamicin, elution of vancomycin, and compressive strength of Copal® spacem and of Palacos® R+G at different vancomycin loadings in the powder of the cements. We hypothesized that antibiotic elution of Copal® spacem is superior at comparable compressive strength. Methods. Compression test specimens were fabricated using Copal® spacem manually loaded with 0.5 g gentamicin and additionally 2 g, 4 g, and 6 g of vancomycin per 40 g of cement powder (COP specimens) and using 0.5 g gentamicin premixed Palacos® R+G manually loaded with 2 g, 4 g, and 6 g of vancomycin per 40 g of cement powder (PAL specimens). These specimens were used for determination of gentamicin and vancomycin elution (in fetal calf serum, at 22°C) and for determination of compressive strength both prior and following the elution tests. Results. Cumulative gentamicin concentrations (p < 0.005) and gentamicin concentration after 28 days (p ≤ 0.043) were significantly lower for COP specimens compared to PAL specimens. Cumulative vancomycin concentrations were significantly higher (p ≤ 0.043) for COP specimens after the second day. Vancomycin concentrations after 28 days were not significantly higher for the Copal specimens loaded with 2 g and 4 g of vancomycin. Compressive strength was not significantly different between COP specimens and PAL specimens before elution tests. Compressive strength after the elution tests was significantly lower (p = 0.005) for COP specimens loaded with 2 g of vancomycin. Conclusion. We could not demonstrate consistent superior antibiotic elution from Copal® spacem compared to Palacos® R+G for fabricating gentamicin and vancomycin loaded spacers. The results do not favor Copal® spacem over Palacos® R+G for the use as a gentamicin and vancomycin biantibiotic-loaded spacer.

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The bactericidal effect of vancomycin is not altered by tranexamic acid, adrenalin, dexamethasone, or lidocaine in vitro

Scientific Reports ◽

10.1038/s41598-021-90302-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Christiane Schwerdt ◽

Eric Röhner ◽

Sabrina Böhle ◽

Benjamin Jacob ◽

Georg Matziolis

Keyword(s):

Staphylococcus Aureus ◽

Tranexamic Acid ◽

Total Joint Arthroplasty ◽

Staphylococcus Epidermidis ◽

Joint Infection ◽

Bactericidal Effect ◽

Joint Arthroplasty ◽

Zone Of Inhibition ◽

Agar Diffusion Test

AbstractOne of the most challenging complications of total knee arthroplasty (TKA) is periprosthetic joint infection (PJI). There is growing evidence of a good anti-infective effect of intrawound vancomycin powder in total joint arthroplasty. At the same time, various different locally applied substances have become popular in total joint arthroplasty. The objective of this study was therefore to investigate a possible inhibition of the bactericidal effect of vancomycin by tranexamic acid, adrenalin, lidocaine, or dexamethasone. The bactericidal effect of vancomycin was quantified using the established method of the agar diffusion test. The plates were incubated with Staphylococcus aureus or Staphylococcus epidermidis and four wells were stamped out. The wells were filled with vancomycin alone, the tested substance alone or a mixture of the two. The fourth well remained empty as a control. The plates were incubated overnight at 37 °C and the zone of inhibition in each field was measured on the next day. All tests were run three times for each pathogen and mean values and standard deviations of the measurements were calculated. Differences between the substances were tested using the t-test at a level of significance of 0.05. The bacterial growth was homogeneous on all plates. The baseline value for the zone of inhibition of vancomycin was on average 6.2 ± 0.4 mm for Staphylococcus aureus and 12 ± 0.3 mm for Staphylococcus epidermidis. In all other substances, no inhibition was detected around the well. The combination of vancomycin and each other substance did not show any different result compared to vancomycin alone. The bactericidal effect of vancomycin on staphylococci is not altered by tranexamic acid, adrenalin, dexamethasone, or lidocaine in vitro.

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Development of Novel Bioactive PMMA-Based Bone Cement and its In Vitro and In Vivo Evaluation

Key Engineering Materials ◽

10.4028/www.scientific.net/kem.309-311.801 ◽

2006 ◽

Vol 309-311 ◽

pp. 801-804 ◽

Cited By ~ 3

Author(s):

S.B. Cho ◽

Akari Takeuchi ◽

Ill Yong Kim ◽

Sang Bae Kim ◽

Chikara Ohtsuki ◽

...

Keyword(s):

Mechanical Property ◽

Compressive Strength ◽

Bone Cement ◽

The Novel ◽

In Vivo Evaluation ◽

Natural Bone ◽

Pmma Bone Cement ◽

Rabbit Tibia

In order to overcome the disadvantage of commercialized PMMA bone cement, we have developed novel PMMA-based bone cement(7P3S) reinforced by 30 wt.% of bioactive CaO-SiO2 gel powders to induce the bioactivity as well as to increase mechanical property for the PMMA bone cement. The novel 7P3S bone cement hardened after mixing for about 7 minutes. For in vitro evaluation, apatite forming ability of it was investigated using SBF. When the novel 7P3S bone cement was soaked into SBF, it formed apatite on its surfaces within 1 week Furthermore; there is no decrease in its compressive strength within 9 weeks soaking in SBF. It is though that hardly decrease in compressive strength of 7P3S bone cement in SBF is due to the relative small amount of gel powder or its spherical shape and monosize. In vivo evaluation of the novel 7P3S bone cement was carried out using rabbit. After implantion into rabbit tibia for several periods, the interface between novel bone cement and natural bone was evaluated by CT images. According to the results, the novel bone cement directly contact to the natural bone without fibrous tissue after implantation for 4 weeks. This results indicates that the newly developed 7P3S bone cement can bond to the living bone and also be effectively used as bioactive bone cement without decrease in mechanical property.

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A PMMA bone cement composite that functions as a drug-refillable depot for localized, multi-window chemotherapeutic treatment of bone cancer

10.1101/2021.06.13.448250 ◽

2021 ◽

Author(s):

Erika L Cyphert ◽

Nithya Kanagasegar ◽

Ningjing Zhang ◽

Greg D Learn ◽

Horst A von Recum

Keyword(s):

Compressive Strength ◽

Bone Cement ◽

Cancer Cells ◽

Targeted Delivery ◽

Bone Tumors ◽

Composite System ◽

Cement Composite ◽

International Standards ◽

Pmma Bone Cement

Standard chemotherapy for primary and secondary bone tumors typically involves systemic administration of chemotherapeutic drugs, such as doxorubicin (DOX). However, non-targeted delivery increases dose requirements, and results in off target toxicity and suboptimal chemotherapeutic efficacy. When chemotherapy is ineffective, substantial resection of tissue and/or total amputation become necessary, a debilitating outcome for any patient. In this work, we developed a proof of concept, nonbiodegradable, mechanically robust, and refillable composite system for chemotherapeutic (i.e. DOX) delivery comprised of poly(methyl methacrylate) (PMMA) bone cement and insoluble polymeric γcyclodextrin (γCD) microparticles. The porosity and compressive strength of DOX-filled PMMA composites were characterized. DOX filling capacity, elution kinetics, cytotoxicity against primary osteosarcoma and lung cancer cells, and refilling capacity of composites were evaluated. PMMA composites containing up to 15wt% γCD microparticles provided consistent, therapeutically-relevant release of DOX with ~100% of the initial DOX released after 100 days. Over the same period, only ~6% of DOX was liberated from PMMA with free DOX. Following prolonged curing, PMMA composites with up to 15wt% γCD surpassed compressive strength requirements outlined by international standards for acrylic bone cements. Compared to DOX filled PMMA, DOX filled PMMA/γCD composites provided long term release with decreased burst effect, correlating to long term cytotoxicity against cancer cells. Refillable properties demonstrated by the PMMA composite system may find utility for treating local recurrences, limiting chemoresistance, and altering drug combinations to provide customized treatment regimens. Overall, findings suggest that PMMA composites have the potential to serve as a platform for the delivery of combinatorial chemotherapeutics to treat bone tumors.

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Effect of Calcium Acetate Content on Apatite-Forming Ability and Mechanical Property of PMMA Bone Cement Modified with Quaternary Ammonium

Materials ◽

10.3390/ma13214998 ◽

2020 ◽

Vol 13 (21) ◽

pp. 4998

Author(s):

Haiyang Wang ◽

Toshinari Maeda ◽

Toshiki Miyazaki

Keyword(s):

Compressive Strength ◽

Bone Cement ◽

Setting Time ◽

Antibacterial Properties ◽

Calcium Acetate ◽

The Body ◽

Apatite Formation ◽

Pmma Bone Cement ◽

Pmma Cement

Polymethyl methacrylate (PMMA)-based bone cement is a popular biomaterial used for fixation of artificial joints. A next-generation bone cement having bone-bonding ability, i.e., bioactivity and antibacterial property is desired. We previously revealed that PMMA cement added with 2-(tert-butylamino)ethyl methacrylate, γ-methacryloxypropyltrimethoxysilane and calcium acetate showed in vitro bioactivity and antibacterial activity. This cement contains calcium acetate at 20% of the powder component. Lower content of the calcium acetate is preferable, because the release of a lot of calcium salt may degrade mechanical properties in the body environment. In the present study, we investigate the effects of calcium acetate content on the setting property and mechanical strength of the cement and apatite formation in simulated body fluid (SBF). The setting time increased and the compressive strength decreased with an increase in calcium acetate content. Although the compressive strength decreased after immersion in SBF for 7 d, all the cements still satisfied the requirements of ISO5833. Apatite was formed in SBF within 7 d on the samples where the calcium acetate content was 5% or more. Therefore, it was found that PMMA cement having antibacterial properties and bioactivity can be obtained even if the amount of the calcium acetate is reduced to 5%.

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Bioactive PMMA-Based Cement Incorporated with Nano-Sized Rutile Particles

Key Engineering Materials ◽

10.4028/www.scientific.net/kem.309-311.797 ◽

2006 ◽

Vol 309-311 ◽

pp. 797-800 ◽

Cited By ~ 2

Author(s):

Masami Hashimoto ◽

Hiroaki Takadama ◽

Mineo Mizuno ◽

Tadashi Kokubo ◽

Koji Goto ◽

...

Keyword(s):

Mechanical Properties ◽

Compressive Strength ◽

Simulated Body Fluid ◽

Mechanical Strength ◽

Bone Cement ◽

Body Fluid ◽

Bone Substitutes ◽

Hardened Cement ◽

Pmma Bone Cement

Bioactive bone cement with mechanical properties higher than that of commercial polymethylmethacrylate (PMMA) bone cement are strongly desired to be developed. In the present study, PMMA-based cement incorporated with nano-sized rutile particles was prepared. The PMMA-based cement (rutile content was 50 wt%) shows the compressive strength (136 MPa) higher than that of commercial PMMA bone cement (88 MPa). The hardened cement formed apatite on the surface in a simulated body fluid within 3 days. Therefore, this PMMA-based cement incorporated with rutile particles might be useful as cement for fixation of prostheses as well as self-setting bone substitutes, because of its high apatite forming ability and mechanical strength.

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A Study of Mechanical Properties of Bone Cement Containing Micro- and Nano- Hydroxyapatite Particles

Key Engineering Materials ◽

10.4028/www.scientific.net/kem.766.117 ◽

2018 ◽

Vol 766 ◽

pp. 117-121

Author(s):

Phanrawee Sriprapha ◽

Chaiy Rungsiyakull ◽

Kamonpan Pengpat ◽

Tawee Tunkasiri ◽

Sukum Eitssayeam

Keyword(s):

Mechanical Properties ◽

Compressive Strength ◽

Bone Cement ◽

Hot Water ◽

Cylindrical Shape ◽

Bovine Bone ◽

Steel Mold ◽

Micro Particles ◽

Porosity Reduction ◽

Pmma Bone Cement

In this research, mechanical properties of bone cement containing micro-and nanohydroxyapatite (HAp) particles were studied. The bone cement was prepared from mixing between polymethyl methacrylate (PMMA) and methyl methacrylate (MMA). Hydroxyapatite powder was prepared from bovine bone. The bone was heated in hot water at 200 oc for the elimination of tissue, after which the bone was dried and calcined at 800 oc for 3 hrs. The calcined bone than was crushed into powder and ball-milled for 24 hrs. The micro-HAp particle was then obtained. The micro particles were then further milled employing the Vibro-milling machine for 2 hrs. The micro-and nanoHAp sizes are about 0.5 μm and 140 nm, respectively. The both size powders were treated with γ-methacrylic-propyl-tri-methoxy silane. The acetic acid was added to control the pH of the solution, until it reached 2.9 before they were mixed into the bone cement with equally wt%. The mixture was casted using the 304 stainless steel mold in order to obtain a cylindrical shape. The low vacuum scanning electron microscope (LV-SEM) and x-ray diffractometer (XRD) were employed to characterize the samples. The porosity of PMMA could be reduced by HAp particle additives. From compressive strength test, it was found that the mixture of bone cement and nanoHAp particle has shown higher compressive strength than pure PMMA bone cement that affected by porosity reduction and force distribution by HAp particles.

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Polymethylmethacrylate Composite Bone Cement Adding with Tetracalcium Phosphate

Key Engineering Materials ◽

10.4028/www.scientific.net/kem.696.89 ◽

2016 ◽

Vol 696 ◽

pp. 89-92

Author(s):

Ren Jei Chung ◽

Keng Liang Ou ◽

Han Wen Liang

Keyword(s):

Compressive Strength ◽

Low Temperature ◽

Bone Cement ◽

Potential Candidate ◽

Micro Ct ◽

Thermal Tests ◽

Tetracalcium Phosphate ◽

Pmma Bone Cement ◽

Ct Evaluation ◽

Pmma Cement

Polymethylmethacrylate (PMMA) cement has been used in orthopedics for more than 70 years. The advantages of PMMA bone cement include high compressive strength, stickiness, deformable ability and rapid self-setting. But the heat produced during polymerization would hinder the recovery. In order to improve the properties, in this research we added tetracalcium phosphate (TTCP) into polymethylmethacrylate cement as TP cement. A serious of characterizations including thermal property study, compression strength and micor-CT evaluation were carried out. According to the results, the polymerization heat was significantly reduced for the TP cement. The compressive strength was also enhanced with TTCP addition. TP-10 had better properties. As to thermal tests, TP-40 showed better results. Micro CT was used to monitor the composition inside the materials, and the results showed that TTCP was well dispersed in the PMMA matrix. The composite PMMA bone cement adding with tetracalcium phosphate seemed to be a potential candidate as low temperature product.

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Influence of HRGO Nanoplatelets on Behaviour and Processing of PMMA Bone Cement for Surgery

Polymers ◽

10.3390/polym13122027 ◽

2021 ◽

Vol 13 (12) ◽

pp. 2027

Author(s):

Jaime Orellana ◽

Ynés Yohana Pastor ◽

Fernando Calle ◽

José Ygnacio Pastor

Keyword(s):

Graphene Oxide ◽

Methyl Methacrylate ◽

Bone Cement ◽

Reduced Graphene Oxide ◽

Sintering Temperature ◽

Structural Function ◽

Mechanical And Thermal Properties ◽

Poly Methyl Methacrylate ◽

Pmma Bone Cement ◽

Reduced Graphene

Bone cement, frequently based on poly (methyl methacrylate), is commonly used in different arthroplasty surgical procedures and its use is essential for prosthesis fixation. However, its manufacturing process reaches high temperatures (up to 120 °C), producing necrosis in the patients' surrounding tissues. To help avoid this problem, the addition of graphene could delay the polymerisation of the methyl methacrylate as it could, simultaneously, favour the optimisation of the composite material's properties. In this work, we address the effect of different percentages of highly reduced graphene oxide with different wt.% (0.10, 0.50, and 1.00) and surface densities (150, 300, 500, and 750 m2/g) on the physical, mechanical, and thermal properties of commercial poly (methyl methacrylate)-based bone cement and its processing. It was noted that a lower sintering temperature was achieved with this addition, making it less harmful to use in surgery and reducing its adverse effects. In contrast, the variation of the density of the materials did not introduce significant changes, which indicates that the addition of highly reduced graphene oxide would not significantly increase bone porosity. Lastly, the mechanical properties (strength, elastic modulus, and fracture toughness) were reduced by almost 20%. Nevertheless, their typical values are high enough that these new materials could still fulfil their structural function. In conclusion, this paper presents a way to control the sintering temperature, without significant degradation of the mechanical performance, by adding highly reduced graphene oxide so that local necrosis of bone cement based on poly (methyl methacrylate) used in surgery is avoided.

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Enhancing the mechanical properties and cytocompatibility of magnesium potassium phosphate cement by incorporating oxygen-carboxymethyl chitosan

Regenerative Biomaterials ◽

10.1093/rb/rbaa048 ◽

2020 ◽

Author(s):

Changtian Gong ◽

Shuo Fang ◽

Kezhou Xia ◽

Jingteng Chen ◽

Liangyu Guo ◽

...

Keyword(s):

Mechanical Properties ◽

Compressive Strength ◽

Physicochemical Properties ◽

Bone Cement ◽

Ph Value ◽

Setting Time ◽

Potassium Phosphate ◽

Carboxymethyl Chitosan ◽

Bioactive Substances ◽

Magnesium Potassium Phosphate Cement

Abstract Incorporating bioactive substances into synthetic bioceramic scaffolds is challenging. In this work, oxygen-carboxymethyl chitosan (O-CMC), a natural biopolymer that is nontoxic, biodegradable and biocompatible, was introduced into magnesium potassium phosphate cement (K-struvite) to enhance its mechanical properties and cytocompatibility. This study aimed to develop O-CMC/magnesium potassium phosphate composite bone cement (OMPC), thereby combining the optimum bioactivity of O-CMC with the extraordinary self-setting properties and mechanical intensity of the K-struvite. Our results indicated that O-CMC incorporation increased the compressive strength and setting time of K-struvite and decreased its porosity and pH value. Furthermore, OMPC scaffolds remarkably improved the proliferation, adhesion and osteogenesis related differentiation of MC3T3-E1 cells. Therefore, O-CMC introduced suitable physicochemical properties to K-struvite and enhanced its cytocompatibility for use in bone regeneration.

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