JBJS, March 1, 2005, Volume 87, Issue 3

Liquid Gentamicin in Bone Cement: A Laboratory Study of a Potentially More Cost-Effective Cement Spacer

Richard M. Seldes, MD Raz Winiarsky, MD Louis C. Jordan, MD Todd Baldini, BS, MS Barry Brause, MD Frank Zodda, MS Thomas P. Sculco, MD

Background: Liquid gentamicin is approved by the Food and Drug Administration, is readily available, and is much less costly than tobramycin, the more commonly used antibiotic in cement spacers. The purpose of the present study was to test the mechanical properties, elution characteristics, and antibacterial activity of liquid gentamicin in an acrylic bone cement spacer.

Methods: Standardized specimens consisting of Palacos cement combined with liquid gentamicin, powdered tobramycin, or no antibiotic were fashioned, and the three groups were tested with regard to compressive and tensile strength, elution characteristics (with use of radioimmunoassays), and antibacterial activity (with use of bioassays).

Results: The ultimate compression strength decreased by 49% (from 64.65 ± 3.89 MPa to 32.96 ± 3.33 MPa) and the ultimate tension strength decreased by 46% (from 35.85 ± 2.97 MPa to 19.20 ± 0.36 MPa) when the specimens containing 480 mg of liquid gentamicin were compared with the controls. The addition of tobramycin had no significant effect compared with the controls. The majority of gentamicin was released from the cement during the initial twenty-four hours (mean concentration, 26.4 mcg/mL). The mean concentrations at three and six weeks were 4.15 and 0.65 mcg/mL, respectively. The bioassays confirmed the bactericidal activity of the gentamicin released from the cement.

Conclusions: Liquid gentamicin in bone cement is potent and bactericidal. Although the mechanical properties of the cement are significantly diminished by the addition of liquid gentamicin, the temporary nature of the cement spacer makes its use potentially worthwhile given the substantial cost savings to the hospital and the patient.

Clinical Relevance: Substantial health-care dollars could be saved by the use of liquid gentamicin in cement spacers that are employed for the treatment of infection following total joint arthroplasty. Additional studies are needed to determine the clinical efficacy and safety of such treatment.

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