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Release of gentamicin from acrylic bone cement
L Bunetel1, A Segui, M Cormier
1Laboratoire de Bactériologie, Faculté de Pharmacie, Hôpital Sud, Rennes, France.
Clinical Pharmacokinetics
|October 1, 1989
Summary
Gentamicin bone cement provides high local concentrations after hip surgery, exceeding minimum inhibitory levels for pathogens. However, low systemic blood levels suggest potential vulnerability to systemic infections.
Area of Science:
- Orthopedic Surgery
- Pharmacokinetics
- Biomaterials
Background:
- Bone cement, such as Palacos R with gentamicin, is frequently used in total hip arthroplasty to prevent infection.
- Understanding gentamicin release and systemic absorption is crucial for optimizing treatment and patient outcomes.
Purpose of the Study:
- To investigate the pharmacokinetics of gentamicin released from Palacos R plus gentamicin bone cement following total hip arthroplasty.
- To determine local and systemic gentamicin concentrations and elimination profiles.
Main Methods:
- Pharmacokinetic analysis of gentamicin in drainage fluid and urine from 10 patients undergoing total hip arthroplasty.
- Blood samples analyzed at 3 and/or 5 hours post-implantation.
- Data analyzed using the SIAM computer program to establish mean excretion curves.
Main Results:
- High gentamicin concentrations were observed in surgical drainage fluids.
- Gentamicin elimination exhibited biphasic kinetics in both drainage fluid (t1/2 rapid: 2.97h, slow: 13.5h) and urine (t1/2 rapid: 7.16h, slow: 47.12h).
- Mean systemic release was 5.78% of the implanted dose, with a peak blood concentration of 0.12 mg/L.
Conclusions:
- Local gentamicin concentrations at the surgical site exceed minimum inhibitory concentrations for common pathogens.
- Low systemic gentamicin levels suggest that while local infection may be controlled, systemic protection might be insufficient.