Comparaison des caractéristiques d’élution et des propriétés mécaniques des ciments osseux acryliques avec et sans revêtement superficiel par de la vancomycine (RSV) en phase tardive de polymérisation - 08/05/21

Comparison of elution characteristics and mechanical properties of acrylic bone cements with and without superficial vancomycin coating (SVC) in the late phase of polymerization

Doi : 10.1016/j.rcot.2021.03.035

Viktor Labmayr ^a,^⁎ , Markus H. Lerchbaumer ^b, Klaus-Dieter Kuehn ^a, Clemens Kittinger ^c, Florian Amerstorfer ^a, Andreas Leithner ^a, Mathias Glehr ^a
^a Department of orthopaedics and trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Autriche
^b Department of Radiology, Charité–Universitaetsmedizin Berlin, 10117 Berlin, Allemagne
^c Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Neue Stiftingtalstrasse 2, 8010 Graz, Autriche

^⁎Auteur correspondant.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Saturday 08 May 2021
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Abstract

Introduction

Antibiotic-loaded bone cements (ALBCs) are used as spacers in two-stage revision arthroplasty for periprosthetic joint infection. We previously described a new technique applying vancomycin powder coating to custom-made cements. To our best knowledge, this method of superficial vancomycin coating (SVC) has not been assessed. We therefore performed an in-vitro study to determine: 1) whether manually applied SVC strengthened the cements’ antibiotic effect; and 2) whether the mechanical requirements for the cements were fulfilled.

Hypothesis

SVC increases the antibiotic effect of cement within the first 24hours.

Methods

Cuboid blocks were produced from two commercially available acrylic ALBCs (Palacos R+G and Copal G+V) with and without SVC. Each block was eluted in phosphate-buffered saline at 37°C. Eluates obtained at 1, 2, 3, 4, 5, 10, 15, 30 and 60minutes and 3, 6 and 24hours were evaluated against Staphylococcus aureus (Palacos, Copal) and methicillin-resistant Staphylococcus aureus (MRSA) (Copal) using zone of inhibition tests. Mechanical test results (bending modulus, bending strength) were compared to ISO requirements (≥1800MPa, ≥50MPa).

Results

Palacos with SVC produced significantly greater zones of inhibition against Staphylococcus aureus than Palacos without SVC (p=0.002). Copal with SVC showed greater zones of inhibition against both Staphylococcus aureus and MRSA (p=0.002). The antibiotic effect was enhanced by SVC in both cements at every time point within 24hours. The bending modulus and bending strength of Palacos with SVC (2089±166MPa, 60.8±2.6 MPA) and Copal with SVC (2283±195MPa, 56.9±2.4MPa) were significantly above ISO requirements.

Conclusion

SVC boosts the antibiotic effect of ALBCs in the first 24hours, while maintaining sufficient stability. These findings endorse SVC as a promising additive in septic revision surgery.

Level of evidence

III; case control study.

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Keywords : Septic revision, Vancomycin, Antibiotics, Bone cement, Periprosthetic joint infection

☆	Cet article peut être consulté in extenso dans la version anglaise de la revue Orthopaedics & Traumatology : Surgery & Research sur Science Direct (sciencedirect.com) en utilisant le DOI ci-dessus.