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In vitro analysis of antifungal impregnated polymethylmethacrylate bone cement
David Silverberg1, Pradeep Kodali, Joseph Dipersio
1Department of Orthopaedics, Summa Health System, Akron, OH 44310, USA.
Abstract:
Fungal infection is a rare but devastating complication of total joint arthroplasty. Many patients require removal of the components and resection arthroplasty for cure; however, revision arthroplasty with medicated polymethylmethacrylate bone cement may be used to salvage the joint. Some studies have documented the efficacy of mixing antibiotics with polymethylmethacrylate, but the efficacy of antifungal drugs when mixed with polymethylmethacrylate is unknown. An in vitro agar diffusion method was used in the current study to investigate this potential, and several clinically important conclusions resulted: (1) after incorporation into bone cement, fluconazole and amphotericin B remained active whereas 5-flucytosine did not, (2) inhibitory activity improved with greater drug concentrations, and (3) more drug eluted from Palacos R than Simplex P cement.
Insights
Antifungal drugs like fluconazole and amphotericin B show activity when mixed with bone cement for joint replacement infections. Drug concentration and cement type affect antifungal efficacy in treating fungal joint arthroplasty complications.
Area of Science:
- Orthopedics
- Infectious Diseases
- Biomaterials Science
Background:
- Fungal infections are a rare but severe complication following total joint arthroplasty.
- Treatment often necessitates component removal and resection arthroplasty, though revision with medicated bone cement is an alternative.
- The efficacy of antifungal drugs within polymethylmethacrylate bone cement remains largely uninvestigated.
Purpose of the Study:
- To evaluate the in vitro activity of common antifungal agents when incorporated into polymethylmethacrylate bone cement.
- To determine the influence of drug concentration and bone cement type on antifungal efficacy.
Main Methods:
- An in vitro agar diffusion method was employed to assess antifungal activity.
- Fluconazole, amphotericin B, and 5-flucytosine were incorporated into two types of bone cement: Palacos R and Simplex P.
- Drug elution and zone of inhibition were measured.
Main Results:
- Fluconazole and amphotericin B retained significant antifungal activity after incorporation into bone cement.
- 5-flucytosine demonstrated no significant antifungal activity in the tested bone cement formulations.
- Higher drug concentrations resulted in increased inhibitory activity against fungal growth.
- Greater amounts of antifungal drug eluted from Palacos R cement compared to Simplex P cement.
Conclusions:
- Fluconazole and amphotericin B are potentially effective antifungal agents for use in medicated bone cement for treating fungal joint arthroplasty infections.
- The efficacy of these antifungals is concentration-dependent and influenced by the type of polymethylmethacrylate bone cement used.
- Further in vivo studies are warranted to confirm the clinical utility of these findings.