In vitro study of the efficacy of acrylic bone cement loaded with supplementary amounts of gentamicin: Effect on mechanical properties, antibiotic release, and biofilm formation

Background: Infection remains a severe complication following a total hip replacement. If infection is suspected when revision surgery is being performed, additional gentamicin is often added to the cement on an ad hoc basis in an attempt to reduce the risk of recurrent infection.

Methods and results: In this in vitro study, we determined the effect of incorporating additional gentamicin on the mechanical properties of cement. We also determined the degree of gentamicin release from cement, and also the extent to which biofilms of clinical Staphylococcus spp. isolates form on cement in vitro. When gentamicin was added to unloaded cement (1–4 g), there was a significant reduction in the mechanical performance of the loaded cements compared to unloaded cement. A significant increase in gentamicin release from the cement over 72 h was apparent, with the amount of gentamicin released increasing significantly with each additional 1 g of gentamicin added. When overt infection was modeled, the incorporation of additional gentamicin did result in an initial reduction in bacterial colonization, but this beneficial effect was no longer apparent by 72 h, with the clinical strains forming biofilms on the cements despite the release of high levels of gentamicin.

Interpretation: Our findings indicate that the addition of large amounts of gentamicin to cement is unlikely to eradicate bacteria present as a result of an overt infection of an existing implant, and could result in failure of the prosthetic joint because of a reduction in mechanical performance of the bone cement.

Carbonation and pH in Mortars Manufactured with Supplementary Cementitious Materials

An investigation of carbonation in mortars and methods of measuring the degree of carbonation and pH change is presented. The mortars were manufactured using ordinary portland cement, pulverized fuel ash, ground granulated blast-furnace slag, metakaolin, and microsilica. The mortars were exposed to a carbon dioxide-rich environment 5% CO2 to accelerate carbonation. The resulting carbonation was measured using phenolphthalein indicator and thermogravimetric analysis. The pH of the pore fluid and a powdered sample, extracted from the mortar, was measured to give an accurate indication of the actual pH of the concrete. The pH of the extracted powder mortar sample was found to be similar to the pH of the pore fluid expressed from the mortars. The thermogravimetric analysis suggested two distinct regions of transport of CO2 within mortar, a surface region where convection was prevalent and a deeper region where diffusion was dominant. The use of microsilica has been shown to decrease the rate of carbonation, while pulverized fuel ash and ground granulated blast-furnace slag have a detrimental effect on carbonation. Metakaolin has little effect on carbonation.