Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Abramowicz, M.
Spacer comparisons and novel antibiotic additions to PMMA cements considering their viability in endoprosthetic procedures
Humanmedizin; [ Diplomarbeit ] Medizinische Universität Graz; 2022. pp. 81
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Kühn Klaus-Dieter
- Leithner Andreas
- Altmetrics:
- Abstract:
- Introduction: Prosthetic joint infections (PJI) are a severe complication of total joint arthroplasties that are often treated in 2-stage revision surgeries using antibiotic-loaded bone cements and PMMA spacers. Because antibiotic resistance is becoming more prevalent, new ALBC alternatives and improved spacers are needed to treat these multi-resistant and polymicrobial infections. This thesis investigated novel ALBC combinations and compared 2 commercially available spacers to expand PJI treatment alternatives. Material and Methods: Part 1 analysed the mechanical and microbiological properties of novel ALBC combinations. Moderate (2 g) and high (6 g) doses of Vancomycin were manually added to revision bone cements (Copal® G+V and G+C), and 0,5 g and 1 g of Tigecycline were manually added to Palacos® R and R+G bone cements. Mechanical tests according to standardised norms (ISO-5833:2002 and DIN53435:2018-09) and microbiological tests (inhibition zone assays) against common PJI pathogens were performed. Part 2 compared two commercially available spacers by Heraeus (Copal® Exchange G) and Tecres (Cemex® Spacer-K). To compare the inhibition zones of the 2 spacers and determine which characteristics are more desirable in a spacer, the non-articulating surfaces of both products were covered with an antibiotic free bone cement. Results: The ALBC combinations showed lower mechanical stability than the plain, commercially available cements, yet all passed the minimum requirements of the standardised norms, except for Copal® G+V +6 g Vancomycin. The Vancomycin loaded bone cements were effective against all the tested pathogens and displayed a constant efficacy throughout 42 days. The Tigecycline loaded bone cements were also effective against multi-resistant pathogens and showed good efficacy for a minimum of 7 days. Even though the Tecres Spacer had larger inhibition zones after 1 hour, the Heraeus Spacer consistently had larger inhibition zones across the 42 days. Discussion: Tigecycline can be safely added to bone cements and shows good efficacy against multi-resistant pathogens. Even though higher concentrations of Vancomycin reduce mechanical stability, they improve antimicrobial efficacy. Copal® GC +6 g Vancomycin was the only combination with >10% antibiotics to fulfil the standards. Despite its smoother surface, the Heraeus spacer appears to be a better option for 2-stage revision surgery, as it exibits larger inhibition zones after 24 h and maintains consistently large inhibition zones over 6 weeks.