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Vet Comp Orthop Traumatol 2016; 29(05): 394-401
DOI: 10.3415/VCOT-16-01-0005
Original Research
Schattauer GmbH

Biomechanical evaluation of polymethyl methacrylate with the addition of various doses of cefazolin, vancomycin, gentamicin, and silver microparticles

Michael G. Ficklin
1   VCA Animal Specialty Center of South Carolina, Columbia, SC, USA
,
Kevin A. R. Kunkel
1   VCA Animal Specialty Center of South Carolina, Columbia, SC, USA
,
Jonathan T. Suber
1   VCA Animal Specialty Center of South Carolina, Columbia, SC, USA
,
Patrick D. Gerard
2   Department of Mathematical Sciences, Clemson University, Clemson, SC, USA
,
Michael P. Kowaleski
3   Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA, USA
› Author Affiliations
Further Information

Publication History

Received: 11 January 2016

Accepted: 22 June 2016

Publication Date:
19 December 2017 (online)

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Summary

Objectives: Numerous studies have examined the biomechanics of polymethyl methacrylate (PMMA) with added antibiotics, but direct comparison between studies is difficult. Our purpose was to evaluate the effects of the addition of antibiotic drugs and silver on compressive and bending strength of PMMA. Our null hypothesis was that there would be no significant difference in the compressive strength or bending strength of PMMA with the addition of silver or varying amounts of antibiotic drugs.

Methods: Polymethyl methacrylate was mixed with cefazolin, gentamicin, vancomycin, or silver; the control was PMMA alone. Antibiotic groups contained 20 g PMMA and 0.5 g, 1 g, 2 g, or 3 g of antibiotic. Silver groups had 0.25 g silver powder alone added to 20 g PMMA or silver with PMMA and 0, 0.5 g or 1 g of antibiotic. Samples underwent four-point bending and compression testing in air at room temperature and prevailing humidity. Pairwise comparisons between groups and to the ASTM and ISO standards were performed.

Results: Compression: All antibiotic and silver groups were weaker than the control. Samples with cefazolin tended to be stronger than other antibiotic groups with equivalent doses of antibiotic. All groups were above the ASTM standard, except 3 g vancomycin. Four-point bending: The addition of antibiotics did not significantly affect bending strength in groups with lower doses of antibiotics. The silver + PMMA group was weaker than the control. No groups were significantly below the ISO standard except the 3 g vancomycin group.

Clinical significance: The addition of antibiotic or silver decreased the biomechanical strength in all samples, but not below the ASTM or ISO standard for most groups. The addition of cefazolin appears to affect strength the least, while high doses of vancomycin alter strength the most.

Keywords

PMMA - polymethyl methacrylate - silver - biomechanical strength - antibiotics
 

  • References

  • 1 Aikawa T, Shibata M, Fujita H. Modified ventral stabilization using positively threaded profile pins and polymethylmethacrylate for atlantoaxial instability in 49 dogs. Vet Surg 2013; 42: 683692.
    PubMedSearch in Google Scholar
  • 2 Dassler CL, Schulz KS, Kass P. et al. The effects of femoral stem and neck length on cement strains in a canine total hip replacement model. Vet Surg 2003; 32: 3745.
    PubMedSearch in Google Scholar
  • 3 Guiot LP, Allman DA. Median sternotomy and ventral stabilisation using pins and polymethylmethacrylate for a comminuted T5 vertebral fracture in a miniature schnauzer. Vet Comp Orthop Traumatol 2011; 24: 7683.
    PubMedSearch in Google Scholar
  • 4 Hicks DG, Pitts MJ, Bagley RS. et al. In vitro biomechanical evaluations of screw-bar-polymethylmethacrylate and pinpolymethylmethacrylate internal fixation implants used to stabilize the vertebral motion unit of the fourth and fifth cervical vertebrae in vertebral column specimens from dogs. Am J Vet Res 2009; 70: 719726.
    PubMedSearch in Google Scholar
  • 5 Jones LC, Frondoza C, Hungerford DS. Effect of PMMA particles and movement on an implant interface in a canine model. J Bone Joint Surg Br 2001; 83: 448458.
    PubMedSearch in Google Scholar
  • 6 Lanz I O, Lewis DD, Madison JB. et al. A biomechanical comparison of screw and wire fixation with and without polymethylmethacrylate reenforcement for acetabular osteotomy stabilization in dogs. Vet Surg 1999; 28: 161170.
    PubMedSearch in Google Scholar
  • 7 Palmisano MP, Dyce J, Olmstead ML. Extraosseous cement granuloma associated with total hip replacement in 6 dogs. Vet Surg 2003; 32: 8090.
    PubMedSearch in Google Scholar
  • 8 Bourne RR. Prophylactic use of antibiotic bone cement: an emerging standard - in the affirmative. J Arthroplasty 2004; 19 (4 suppl 1) 69-72.
    CrossrefPubMedSearch in Google Scholar
  • 9 Streppa HK, Singer MJ, Budsberg SC. Applications of local antimicrobial delivery systems in veterinary medicine. J Am Vet Med Assoc 2001; 219: 40-48.
    CrossrefPubMedSearch in Google Scholar
  • 10 Penner MJ, Duncan CP, Masri BA. The in vitro elution characteristics of antibioticloaded CMW and PalacosR bone cements. J Arthroplasty 1999; 14: 209214.
    PubMedSearch in Google Scholar
  • 11 Phillips H, Boothe DM, Shofer F. et al. In vitro elution studies of amikacin and cefazolin from polymethylmethacrylate. Vet Surg 2007; 36: 272278.
    PubMedSearch in Google Scholar
  • 12 Pelletier MH, Malisano L, Smitham PJ. et al. The compressive properties of bone cements containing large doses of antibiotics. J Arthroplasty 2009; 24: 454460.
    PubMedSearch in Google Scholar
  • 13 Klekamp J, Dawson JM, Haas DW. et al. The use of vancomycin and tobramycin in acrylic bone cement: biomechanical effects and elution kinetics for use in joint arthroplasty. J Arthroplasty 1999; 14: 339346.
    PubMedSearch in Google Scholar
  • 14 Krackow KA, Rauh MA, Meredith RM. et al. Antibiotic-laden cement: technique for uniform manual mixing. J Arthroplasty 2005; 20: 941-942.
    CrossrefPubMedSearch in Google Scholar
  • 15 Dunnett CW. A multiple comparisons procedure for comparing several treatments with a control. Journal of the American Statistical Association 1955; 50: 1096-1121.
    CrossrefPubMedSearch in Google Scholar
  • 16 Alt V, Bechert T, Steinrucke P. et al. An in vitro assessment of the antibacterial properties and cytotoxicity of nanoparticulate silver bone cement. Biomaterials 2004; 25: 4383-4391.
    CrossrefPubMedSearch in Google Scholar
  • 17 Alt V, Bechert T, Steinrucke P. et al. In vitro testing of antimicrobial activity of bone cement. Antimicrob Agents Chemother 2004; 48: 4084-4088.
    CrossrefPubMedSearch in Google Scholar
  • 18 Torres BT, Budsberg SC. Revision of cemented total hip arthroplasty with cementless components in three dogs. Vet Surg 2009; 38: 81-86.
    CrossrefPubMedSearch in Google Scholar
  • 19 Dyce J, Olmstead ML. Removal of infected canine cemented total hip prostheses using a femoral window technique. Vet Surg 2002; 31: 552-560.
    CrossrefPubMedSearch in Google Scholar
  • 20 Oei JD, Zhao WW, Chu L. et al. Antimicrobial acrylic materials with in situ generated silver nanoparticles. J Biomed Mater Res B Appl Biomater 2012; 100: 409-415.
    PubMedSearch in Google Scholar
  • 21 Sodagar A, Kassaee MZ, Akhavan A. et al. Effect of silver nano particles on flexural strength of acrylic resins. J Prosthodont Res 2012; 56: 120-124.
    CrossrefPubMedSearch in Google Scholar
  • 22 Ewald A, Hosel D, Patel S. et al. Silver-doped calcium phosphate cements with antimicrobial activity. Acta Biomater 2011; 7: 4064-4070.
    CrossrefPubMedSearch in Google Scholar
  • 23 Chen AF, Parvizi J. Antibiotic-loaded bone cement and periprosthetic joint infection. J Long Term Eff Med Implants 2014; 24: 89-87.
    CrossrefPubMedSearch in Google Scholar
  • 24 Carter DR, Gates I E, Harris WH. Strain-controlled fatigue of acrylic bone cement. J Biomed Mater Res 1982; 16: 647-657.
    CrossrefPubMedSearch in Google Scholar
  • 25 Marks KE, Nelson CL, Lautenschlager EP. Antibiotic-impregnated acrylic bone cement. J Bone Joint Surg Am 1976; 58: 358-364.
    CrossrefPubMedSearch in Google Scholar
  • 26 Baleani M, Persson C, Zolezzi C. et al. Biological and biomechanical effects of vancomycin and meropenem in acrylic bone cement. J Arthroplasty 2008; 23: 1232-1238.
    CrossrefPubMedSearch in Google Scholar
  • 27 Pikal MJ, Shah S. Moisture transfer from stopper to product and resulting stability implications. Dev Biol Stand 1992; 74: 165-177.
    PubMedSearch in Google Scholar
  • 28 Weisman DL, Olmstead ML, Kowalski JJ. In vitro evaluation of antibiotic elution from polymethylmethacrylate (PMMA) and mechanical assessment of antibiotic-PMMA composites. Vet Surg 2000; 29: 245-251.
    CrossrefPubMedSearch in Google Scholar
  • 29 Paz E, Sanz-Ruiz P, Abenojar J. et al. Evaluation of elution and mechanical properties of high-dose antibiotic-laden bone cement: comparative “in vitro” study of the influence of vancomycin and cefazolin. J Arthroplasty 2015; 30: 1423-1429.
    CrossrefPubMedSearch in Google Scholar
  • 30 Kim J, Pitts B, Stewart PS. et al. Comparison of the antimicrobial effects of chlorine, silver ion, and tobramycin on biofilm. Antimicrob Agents Chemother 2008; 52: 1446-1453.
    CrossrefPubMedSearch in Google Scholar
  • 31 Braydich-Stolle L, Hussain S, Schlager JJ. et al. In vitro cytotoxicity of nanoparticles in mammalian germline stem cells. Toxicol Sci 2005; 88: 412-419.
    CrossrefPubMedSearch in Google Scholar
  • 32 Sodagar A, Kassaee MZ, Akhavan A. Effect of silver nano particles on flexural strength of acrylic resins. J Prosthodont Res 2012; 56: 120-124.
    CrossrefPubMedSearch in Google Scholar
  • 33 Ghaffari T, Hamedirad F, Ezzati B. In vitro comparison of compressive and tensile strengths of acrylic resins reinforced by silver nanoparticles at 2% and 0.2% concentrations. J Dent Res Dent Clin Dent Prospects 2014; 8: 204-209.
    PubMedSearch in Google Scholar
  • 34 Hamedi-Rad F, Ghaffari T, Rezaii F. et al. Effect of nanosilver on thermal and mechanical properties of acrylic base complete dentures. J Dent (Tehran) 2014; 11: 495-505.
    PubMedSearch in Google Scholar
  • 35 Duey RE, Chong AC, McQueen DA. et al. Mechanical properties and elution characteristics of polymethylmethacrylate bone cement impregnated with antibiotics for various surface area and volume constructs. Iowa Orthop J 2012; 32: 104-115.
    PubMedSearch in Google Scholar
  • 36 Kelm J, Regitz T, Schmitt E. et al. In vivo and in vitro studies of antibiotic release from and bacterial growth inhibition by antibiotic-impregnated polymethylmethacrylate hip spacers. Antimicrob Agents Chemother 2006; 50: 332-335.
    CrossrefPubMedSearch in Google Scholar