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New method for antibiotic release from bone cement (polymethylmethacrylate): Redefining boundaries
E Carbó-Laso1, P Sanz-Ruiz2, J C Del Real-Romero3
1Servicio de Cirugía Ortopédica y Traumatología, Hospital General Universitario Gregorio Marañón, Madrid, España.
Introduction:
The increasing antimicrobial resistance is promoting the addition of antibiotics with high antistaphylococcal activity to polymethylmethacrylate (PMMA), for use in cement spacers in periprosthetic joint infection. Linezolid and levofloxacin have already been used in in-vitro studies, however, rifampicin has been shown to have a deleterious effect on the mechanical properties of PMMA, because it inhibits PMMA polymerization. The objective of our study was to isolate the rifampicin during the polymerization process using microencapsulation techniques, in order to obtain a PMMA suitable for manufacturing bone cement spacers.
Material And Method:
Microcapsules of rifampicin were synthesized with alginate and PHBV, using Rifaldin®. The concentration levels of rifampicin were studied by UV-visible spectrophotometry. Compression, hardness and setting time tests were performed with CMW®1 cement samples alone, with non-encapsulated rifampicin and with alginate or PHBV microcapsules.
Results:
The production yield, efficiency and microencapsulation yield were greater with alginate (P = .0001). The cement with microcapsules demonstrated greater resistance to compression than the cement with rifampicin (91.26±5.13, 91.35±6.29 and 74.04±3.57 MPa in alginate, PHBV and rifampicin, respectively) (P = .0001). The setting time reduced, and the hardness curve of the cement with alginate microcapsules was similar to that of the control.
Discussion And Conclusions:
Microencapsulation with alginate is an appropriate technique for introducing rifampicin into PMMA, preserving compression properties and setting time. This could allow intraoperative manufacturing of bone cement spacers that release rifampicin for the treatment of periprosthetic joint infection.
Insights
Microencapsulation of rifampicin in alginate preserves polymethylmethacrylate (PMMA) properties for bone cement spacers. This technique allows for effective antibiotic delivery to combat periprosthetic joint infections.
Area of Science:
- Biomaterials Science
- Polymer Chemistry
- Infectious Disease Treatment
Background:
- Rising antimicrobial resistance necessitates improved antibiotic delivery in orthopedic surgery.
- Polymethylmethacrylate (PMMA) bone cement spacers are used for periprosthetic joint infections.
- Rifampicin's efficacy is hindered by its negative impact on PMMA mechanical properties due to polymerization inhibition.
Purpose of the Study:
- To develop a method for incorporating rifampicin into PMMA bone cement spacers.
- To overcome rifampicin's inhibitory effect on PMMA polymerization using microencapsulation.
- To create PMMA bone cement with preserved mechanical integrity for infection treatment.
Main Methods:
- Synthesized rifampicin microcapsules using alginate and poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV).
- Incorporated microcapsules into CMW®1 PMMA bone cement.
- Evaluated mechanical properties: compression, hardness, and setting time.
Main Results:
- Alginate microcapsules showed higher production, efficiency, and encapsulation yields.
- PMMA with alginate or PHBV microcapsules exhibited significantly improved compression resistance compared to non-encapsulated rifampicin.
- Setting time was reduced, and hardness with alginate microcapsules was comparable to the control.
Conclusions:
- Alginate microencapsulation is a viable technique for incorporating rifampicin into PMMA.
- This method preserves crucial mechanical properties of PMMA bone cement.
- Enables intraoperative fabrication of effective rifampicin-eluting bone cement spacers for periprosthetic joint infection treatment.
