Role of fast-setting cements in arthroplasty: A comparative analysis of characteristics

AIM To evaluate the behaviour of two fast-setting polymethylmethacrylate(PMMA) cements CMW~? 2 G and Palacos~? fast R + G, as reference: Standard-setting Palacos~? R + G.METHODS The fast-setting cements CMW~? 2 G and Palacos~? fast R + G were studied, using standard-setting high viscosity Palacos~? R + G as a reference. Eleven units(of two batch numbers) of each cement were tested. All cements were mixed as specified by the manufacturer and analysed on the following parameters: Handling properties(mixing, waiting, working and hardening phase) according to Kuehn, Mechanical properties according to ISO 5833 and DIN 53435, Fatigue strength according to ISO 16402, Benzoyl Peroxide(BPO)-Content by titration, powder/liquid-ratio by weighing, antibiotic elution profile by High Performance Liquid Chromatography. All tests were done in an acclimatised laboratory with temperatures set at 23.5 ℃± 0.5 ℃ and a humidity of > 40%. RESULTS Palacos~? fast R + G showed slightly shorter handling properties(doughing, hardening phase, n = 12) than CMW~? 2 G, allowing to reduce operative time and to optimise cemented cup implantation. Data of the quasistatic properties of ISO 5833 and DIN 53435 of both cements tested was comparable. The ISO compressive strength(MPa) of Palacos~? fast R + G was significantly higher than CMW~? 2 G, resulting in ANOVA(P < 0.01) and two sample t-test(P < 0.01) at 0.05 level of significance(n = 20). Palacos~? fast R + G showed a higher fatigue strength of about 18% mean(ISO 16402) of 15.3 MPa instead of 13.0 MPa for CMW~? 2 G(n = 5 × 10~6 cycles). Palacos~? fast R + G and CMW~? 2 G differed only by 0.11%(n = 6) with the former having the higher content. The BPO-content of both cements were therefore comparable. CMW~? 2 G had a powder/liquid ratio of 2:1, Palacos~? fast R + G of 2.550:1 due to a higher powder content. Despite its higher gentamicin content, CMW~? 2 G showed a significantly lower antibiotic elution over time than Palacos~? fast R + G(n = 3). CONCLUSION Both cements are compliant with international standards and are highly suitable for their specified surgical indications, affording a time-saving measure without detriment to the mechanical properties.

Dual antibiotic loaded bone cement in patients at high infection risks in arthroplasty: Rationale of use for prophylaxis and scientific evidence

In view of the demographic changes and projected increase of arthroplasty procedures worldwide,the number of prosthetic joint infection cases will naturally grow.Therefore,in order to counteract this trend more rigid rules and a stricter implementation of effective preventive strategies is of highest importance.In the absence of a"miracle weapon"priorities should lie in evidence-based measures including preoperative optimization of patients at higher infection risks,the fulfilment of strict hygiene rules in the operating theatre and an effective antibiotic prophylaxis regimen.Instead of a"one size fits all"philosophy,it has been proposed to adjust the antibiotic prophylaxis protocol to major infection risks taking into account important patient-and procedure-related risk factors.A stronger focus on the local application mode via use of high dose dual antibioticloaded bone cement in such risk situations may have its advantages and is easy to apply in the theatre.The more potent antimicrobial growth inhibition in vitro and the strong reduction of the prosthetic joint infection rate in risk for infection patients with aid of dual antibiotic-loaded bone cement in clinical studies align with this hypothesis.