Abdullah GÖĞÜŞ, Şenol AKMAN, S. Bora GÖKSAN, Ergün BOZDAĞ

Antibiyotikli kemik çimentosunun 0 ve 15. günlerde mekanik dayanımı: Surgical Simplex P kemik çimentosu ve teikoplanin ile biyomekanik çalışma

Amaç: Mekanik dayanım açısından 40 gr belirli bir kemik çimentosuna katılabilecek belirli bir antibiyotiğin maksimum dozu "0. gün" ve antibiyotik salınımı sonrası "15. gün" için araştırıldı. Çalışma planı: 40 g Surgical Simplex P kemik çimentosuna 0, 400, 800,1200,1600, 2000, 3200 ve 4000 mg teikoplanin katılarak sekiz deney grubu oluşturuldu. Kompresyon ve dört nokta eğme mekanik dayanım testleri için üçüncü kuşak sement hazırlama ve uygulama koşullarında örnekler elde edildi. Her bir konsantrasyon için "0. gün" ve "15. gün" için 10'ar örnek oluşturuldu. Örneklerin mekanik dayanım testleri ASTM ve ISO standartlarına göre "0. gün" ve 37$\circ$ C su banyosunda antibiyotik salınımı sonrası "15. gün"de yapıldı. Değişik antibiyotik konsantrasyonları 0 mg kontrol grubu ile, ayrıca aynı antibiyotik konsantrasyonlarının 0. gün ve 15. gün mekanik test sonuçları karşılaştırıldı. Sonuçlar: Kompresyon testlerinde "0. gün" grubu içinde anlamlı farklılık bulunmadı; "15. gün" grubunda ise 800 mg'den itibaren anlamlı dayanım azalması saptandı. Her iki grupta tüm konsantrasyonlarda elde edilen mekanik dayanım değerleri ASTM alt limiti olan 70 MPa'nın üzerindeydi. Dört nokta eğme testinde "0. gün" grubunda 1200 mg'den itibaren, "15. gün" grubunda ise 400 mg'den itibaren anlamlı dayanım azalması saptandı. "15. gün" grubundan 4000 mg ISO'nun alt limiti olan 50 MPa'nın altında kalırken, 3200 ve 2000 mg gruplarında 50 MPa'ya çok yakın sonuçlar elde edildi. Çıkarımlar: Deney sonuçları, üçüncü kuşak çimento hazırlama ve uygulama koşullarında, 40 gr Surgical Simplex P kemik çimentosuna güvenle katılabilecek en yüksek teikoplanin dozunun 1600 mg olduğunu gösterdi.

Anahtar Kelimeler:

Teikoplanin, Yüzey özellikleri, Kemik çimentosu, Antibiyotikler, Gerilme kuvveti, Stres, mekanik

Mechanical strength of antibiotic-impregnated bone cement on day 0 and day 15: A biomechanical study with surgical simplex P and teicoplanin

Objectives: To determine the maximum amount of a specific antibiotic added to 40 g acrylic bone cement in terms of the effect on mechanical properties of the bone cement on Day 0 and after antibiotic release on Day 15. Methods: In an experimental design, eight teicoplanin doses (0, 400 mg, 800 mg, 1200 mg, 1600 mg, 2000 mg, 3200 mg and 4000 mg) were added to bone cement (Surgical Simplex P). Specimens were prepared using the third generation cementing technique to determine the compressive strength and four-point bending strength according to ASTM and ISO standards, respectively. For each concentration, 10 samples were prepared for Day 0 and Day 15. Mechanical tests were performed on Day 0 and after antibiotic leaching in water at 37$\circ$ C on Day 15. 0 mg specimens served as controls and mechanical strengths for each antibiotic concentration on Day 0 and Day 15 were compared. Results: In compression tests, Day 0 samples showed no significant differences, whereas Day 15 samples starting with 800 mg exhibited significant decreases in compressive strength. However, the compressive strengths were above the minimum standard of 70 MPa set by ASTM at all concentrations and in all groups. Four-point bending tests demonstrated significant decreases in strength starting with 1200 mg in Day 0 samples, and with 400 mg in Day 15 samples. Four-point bending strengths of 2000 mg, 3200 mg, and 4000 mg samples decreased below, or approximated closely the minimum standard of 50 MPa set by ISO on Day 15. Conclusion: Our results suggest that the maximum amount of teicoplanin dose to be safely added to 40 g of Surgical Simplex P is 1600 mg when third generation cement mixing and application techniques are employed.

Keywords:

Teicoplanin, Surface Properties, Bone Cements, Antibiotics, Tensile Strength, Stress, Mechanical,

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1.Buchholz HW, Elson RA, Heinert K. Antibiotic-loaded acrylic cement: current concepts. Clin Orthop 1984;(190):96-108.
2. Murray WR. Use of antibiotic-containing bone cement. Clin Orthop 1984;(190):89-95.
3. Welch AB. Antibiotics in acrylic bone cement. In vivo studies. J Biomed Mater Res 1978;12:843-55.
4. Hoff SF, Fitzgerald RH Jr, Kelly PJ. The depot administration of penicillin G and gentamicin in acrylic bone cement. J Bone Joint Surg [Am] 1981;63:798-804.
5. Greene N, Holtom PD, Warren CA, Ressler RL, Shepherd L, McPherson EJ, et al. In vitro elution of tobramycin and van - comycin polymethylmethacrylate beads and spacers from Simplex and Palacos. Am J Orthop 1998;27:201-5.
6. Klekamp J, Dawson JM, Haas DW, DeBoer D, Christie M. The use of vancomycin and tobramycin in acrylic bone cement: biomechanical effects and elution kinetics for use in joint arthroplasty. J Arthroplasty 1999;14:339-46.
7. Marks KE, Nelson CL, Lautenschlager EP. Antibiotic-impregnated acrylic bone cement. J Bone Joint Surg [Am] 1976;58:358-64
8. Masterson EL, Masri BA, Duncan CP. Treatment of infection at the site of total hip replacement. Instr Course Lect 1998;47:297-306.
9. Weis E, Jansen B. Teicoplanin-loaded PMMA beads for the treatment of soft tissue and osseous infections. J Hosp Infect 1994;27:322-4.
10. Punar M, Özsüt H, Eraksoy H, Dilmener M, Çalangu S. Ortopedi ve Travmatoloji Kliniği'ndeki nozokomiyal infeksiyon etkenleri ve antibiyotiklere duyarlılıkları. Acta Orthop Traumatol Turc 1995;29:291-3.
11. Çetin S, Özsüt H, Eraksoy H, Dilmener M, ‚alangu S. Ortopedik yabancı cisim ve protez infeksiyonları. In: Eraksoy H, Yenen Ş, editörler. 5. Ulusal Ünfeksiyon HastalÝklarÝ Kongresi, Kongre Kitabı; 1995, Üstanbul. s. 73.
12. Göksan SB, Şener N, Tözün R, Göksan MA. Antibiyotikli kemik çimentosunun mekanik dayanımı: Cemex kemik çimentosu, teikoplanin ve tobramisin ile biyomekanik çalışma. Acta Orthop Traumatol Turc 1997;31:245-9.
13. Baker AS, Greenham LW. Release of gentamicin from acrylic bone cement. Elution and diffusion studies. J Bone Joint Surg [Am] 1988;70:1551-7.
14. Davies JP, Harris WH. Effect of hand mixing tobramycin on the fatigue strength of Simplex P. J Biomed Mater Res 1991;25:1409-14.
15. Davies JP, O'Connor DO, Burke DW, Harris WH. Influence of antibiotic impregnation on the fatigue life of Simplex P and Palacos R acrylic bone cements, with and without centrifugation. J Biomed Mater Res 1989;23:379-97.
16.Wilkinson JM, Eveleigh R, Hamer AJ, Milne A, Miles AW, Stockley I. Effect of mixing technique on the properties of acrylic bone-cement: a comparison of syringe and bowl mixing systems. J Arthroplasty 2000;15:663-7.
17. Lidgren L, Bodelind B, Moller J. Bone cement improved by vacuum mixing and chilling. Acta Orthop Scand 1987;58:27-32.
18. American Society for Testing and Materials: Standard specification for acrylic bone cement F 451-99a, In: Annual Book of ASTM Standards. 1999. p. 56-62.
19. Kühn KD. Bone cements. Up-to-date comparison of physical and chemical properties of commercial materials. Berlin, Heidelberg: Springer Verlag; 2000. p. 126-30.
20. Penner MJ, Masri BA, Duncan CP. Elution characteristics of vancomycin and tobramycin combined in acrylic bonecement. J Arthroplasty 1996;11:939-44.
21. Kuechle DK, Landon GC, Musher DM, Noble PC. Elution of vancomycin, daptomycin, and amikacin from acrylic bone cement. Clin Orthop 1991;(264):302-8.
22. Duncan CP, Masri BA. The role of antibiotic-loaded cement in the treatment of an infection after a hip replacement. Instr Course Lect 1995;44:305-13.
23. Lautenschlager EP, Jacobs JJ, Marshall GW, Meyer PR Jr. Mechanical properties of bone cements containing large doses of antibiotic powders. J Biomed Mater Res 1976;10:929-38.
24. Nelson RC, Hoffman RO, Burton TA. The effect of antibiotic additions on the mechanical properties of acrylic cement. J Biomed Mater Res 1978;12:473-90.
25.Wright TM, Sullivan DJ, Arnoczky SP. The effect of antibiotic additions on the fracture properties of bone cements. Acta Orthop Scand 1984;55:414-8.
26. Lautenschlarger EP, Marshall GW, Marks KE, Schwartz J, Nelson CL. Mechanical strength of acrylic bone cements impregnated with antibiotics. J Biomed Mater Res 1976;10:837-45.
27. Klemm KW. Antibiotic bead chains. Clin Orthop 1993;(295):63-76.
28. Penner MJ, Duncan CP, Masri BA. The in vitro elution characteristics of antibiotic-loaded CMW and Palacos-R bone cements. J Arthroplasty 1999;14:209-14.