JectOS® versus PMMA vancomycin-loaded cement: The biomechanical and antimicrobial properties

Injectable bone cements are frequently used in orthopedic and spinal surgeries to fill bone voids. These materials can be loaded with antibiotics to locally combat infections. However, nonbiodegradable cements may become problematic after antibiotic release. Prior research has shown that PMMA, a common bone cement, can deliver antibiotics but lacks biodegradability. This gap motivated a search for alternatives that degrade over time while maintaining antimicrobial efficacy. JectOS is a partially biodegradable cement that could serve as a long-term antibiotic carrier. The literature lacks comparative data on JectOS versus PMMA in terms of biomechanical and antimicrobial properties. No prior work had resolved how vancomycin concentrations affect JectOS's compressive strength. The need for biodegradable antibiotic carriers remains unmet in clinical settings. This study aimed to address these uncertainties through controlled in vitro testing.

This study aimed to compare the biomechanical and antimicrobial properties of JectOS and PMMA when loaded with vancomycin. Bone defects often require temporary fillers that can release antibiotics. JectOS is a biodegradable option that could replace PMMA in such applications. The specific problem is whether JectOS can maintain sufficient compressive strength after vancomycin addition. The motivation is to find a material that degrades safely while delivering high local antibiotic concentrations. Vancomycin is a broad-spectrum antibiotic effective against methicillin-resistant strains. The study sought to evaluate how vancomycin affects JectOS's mechanical properties. It also aimed to assess how well JectOS compares to PMMA in antimicrobial performance. The goal was to determine if JectOS is suitable for contained bone defects where mechanical strength is not critical.

Vancomycin was added to JectOS at three concentrations: 2.5%, 5%, and 10%. The same concentrations were applied to PMMA as a control. Cement samples were molded into standardized cylindrical shapes for testing. Compressive strength was measured using a mechanical testing device. Zone of inhibition tests were performed on methicillin-resistant strain cultures. The study used in vitro methods to simulate clinical conditions. No in vivo trials were conducted. The results were compared to historical PMMA-vancomycin data. The study focused on quantifying mechanical and antimicrobial outcomes.

Compressive strength decreased with vancomycin addition in JectOS. At 2.5%, 5%, and 10%, strengths were 8.01 MPa, 7.52 MPa, and 7.23 MPa, respectively. These values were 24.6%, 29.2%, and 31.9% lower than the baseline. No significant difference in strength was observed across vancomycin concentrations. Zone of inhibition diameters for JectOS-vancomycin were 24.7 mm, 25.9 mm, and 26.8 mm at the respective concentrations. PMMA-vancomycin showed smaller inhibition zones. JectOS outperformed PMMA in antimicrobial activity. The study found that JectOS has poor mechanical performance but superior drug elution.

JectOS-vancomycin cement is suitable for void filling in bone defects where mechanical strength is not required. The authors suggest that JectOS can deliver high local vancomycin concentrations. The study shows that vancomycin significantly reduces JectOS's compressive strength. However, the antimicrobial performance of JectOS is better than PMMA. The authors recommend JectOS for contained defects that do not need structural support. They propose that JectOS's biodegradability is an advantage over PMMA. The findings suggest JectOS is a viable alternative to PMMA in antibiotic delivery. The authors emphasize the importance of selecting materials based on clinical needs.