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.

Liquid monomer-powder particle interaction in acrylic bone cement

It is known that the method used to mix the liquid monomer and powder of PMMA bone cement influences the quality of the cement that is used in total joint replacements. Mixing theory indicates that the interaction between the liquid monomer and the powder is affected by a number of parameters, such as cement viscosity and degree of agitation, with this knowledge utilized in the design of cement mixing devices. Therefore, the objectives of this study were to: (i) obtain information on the interaction of the liquid monomer and the powder in the case of an PMMA bone cement, (ii) show how this knowledge can be applied to the design of an automated cement mixing device, and (iii) compare the porosity, bending modulus, and bending strength of one commercially-available cement prepared using the automated mixer and prepared using a conventional mixer that is in current clinical use. Experimental data indicated that increasing the velocity and decreasing the viscosity of the systems produced cement that improved mechanical properties, which may contribute to better mechanical integrity and, hence, reduced tendency for aseptic loosening, of cemented hip implants.

Forensic analysis of architectural finishes using Fourier transform infrared and Raman spectroscopy, Part I: The resin bases

The ability of Raman spectroscopy and Fourier transform infrared (FT-IR) microscopy to discriminate between resins used for the manufacture of architectural finishes was examined in a study of 39 samples taken from a commercial resin library. Both Raman and FT-IR were able to discriminate between different types of resin and both split the samples into several groups (six for FT-IR, six for Raman), each of which gave similar, but not identical, spectra. In addition, three resins gave unique Raman spectra (four in FTIR). However, approximately half the library comprised samples that were sufficiently similar that they fell into a single large group, whether classified using FT-IR or Raman, although the remaining samples fell into much smaller groups. Further sub-division of the FT-IR groups was not possible because the experimental uncertainty was of similar magnitude to the within-group variation. In contrast, Raman spectroscopy was able to further discriminate between resins that fell within the same groups because the differences in the relative band intensities of the resins, although small, were larger than the experimental uncertainty.