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An Improved Mechanical Testing Method to Assess Bone-implant Anchorage
Published on: February 10, 2014
Evaluation and testing of polymethylmetacrylic (PMMA) bone cements with admixed Amphotericin B
Florian A Frank1,2, Barbara Krampitz3, Julia Steiner4
1Centre for Musculoskeletal Infections (ZMSI), University Hospital of Basel, Basel, 4031, Switzerland. florian.frank@t-online.de.
Background:
Amphotericin is admixed to Polymethylmethacrylic (PMMA) spacers for fungal periprosthetic joint infections (PJI) during two-stage exchanges. We aimed to analyse the mechanical properties of PMMA cement with admixed Amphotericin B.
Materials And Methods:
We tested Amphotericin in PMMA cement mechanically, its elution properties in vitro and present two cases of fungal PJI treated with Amphotericin B powder in Copal cement in vivo.
Results:
Sterile Amphotericin B is not available as a pure substance but only as powder for infusions. PMMA mixed with such pharmaceutical Amphotericin B formulations colored the cement orange. Compression strength was slightly decreased, bending and impact strength significantly decreased whereas bending modulus was increased. Drug elution was high within the first 24 h and decreased over time until day 5. Amphotericin B in combination with Copal was successfully used in two cases with Candida ssp.
Infections:
No negative side effects, especially no nephrotoxic effects, were observed. Sterile Amphotericin B powder for preparing an infusion solution contains only small amounts of pure drug. In vivo polymicrobial Candida-infections with bacterial co-infection were successfully treated using the combination of Copal cements with added Amphotericin B without systemic nephrotoxic impact.
Conclusions:
The addition of Amphotericin B to PMMA cement affects the cement's properties in vitro whereas in vivo the combination with Copal is clinically successful in treating complex cases of fungal PJI.
Level Of Evidence:
Level IV.
Insights
Admixing Amphotericin B into Polymethylmethacrylic (PMMA) cement alters its mechanical properties but is clinically successful for treating fungal periprosthetic joint infections (PJI) when combined with Copal cement.
Area of Science:
- Orthopedic surgery
- Biomaterials science
- Infectious diseases
Background:
- Fungal periprosthetic joint infections (PJI) are often treated with antibiotic-loaded cement spacers.
- Polymethylmethacrylic (PMMA) cement is commonly used, but its mechanical properties with antifungal agents require evaluation.
- Amphotericin B is a potential antifungal agent for PJI treatment.
Purpose of the Study:
- To analyze the mechanical properties of PMMA cement admixed with Amphotericin B.
- To evaluate the in vitro elution of Amphotericin B from PMMA cement.
- To report clinical outcomes of fungal PJI treated with Amphotericin B in Copal cement.
Main Methods:
- Mechanical testing (compression, bending, impact strength, bending modulus) of PMMA with Amphotericin B.
- In vitro drug elution studies over 5 days.
- Clinical case reports of fungal PJI treated with Amphotericin B and Copal cement.
Main Results:
- PMMA cement admixed with pharmaceutical-grade Amphotericin B showed altered mechanical properties, including decreased strength and increased modulus.
- High elution of Amphotericin B was observed in the first 24 hours, decreasing over 5 days.
- Two cases of fungal PJI (Candida spp.) treated with Amphotericin B in Copal cement showed successful outcomes without nephrotoxicity.
Conclusions:
- Amphotericin B addition impacts PMMA cement's in vitro mechanical characteristics.
- The combination of Amphotericin B with Copal cement is clinically effective for treating complex fungal PJI.
- No systemic nephrotoxic side effects were observed in treated patients.
