Antibiotic Elution from Vancomycin Embedded Polymethyl Methacrylate Cement used in Orthopedic Surgery

Periprosthetic joint infection (PJI) is a complication leading to failure of total joint replacement with current occurrence of 1-2%. Numerous studies demonstrated effective strategies for PJI prevention and treatment, including perioperative usage of antibiotics, adjustment of comorbidities and one-stage or two-stage revision. Antibiotic-impregnated bone cement (AIBC) is one of the most effective biomaterials used both for the prevention and treatment of PJI. Vancomycin, due to current trends in microbial distribution, is one of the most frequently used agents in bone cement; it is a glycopeptide antibiotic active against most gram-positive pathogens encountered in musculoskeletal infections. The purpose of this article is to analyze the validity of our current surgical protocols regarding antibiotic elution from Vancomycin embedded Polymethyl methacrylate (PMMA) bone cement, using a hand mixed technique.Web of Science, Google Scholar and Science Direct databases were searched for articles regarding [vancomycin elution from PMMA] within the timeframe January 2009 until September 2019. The 63 studies validated after applying inclusion and exclusion criteria, were retrieved in full text format and the following information was considered: method of elution, results expressed in cumulative dose, use of a commercially available PMMA product.Vancomycin elutions from antibiotic embedded PMMA are above the Minimum Inhibitory Concentration (MIC) for the targeted bacteria involved in PJI's and have a sustainable release for at least one week. For prevention purposes, while not altering the structural resistance of the bone cement, a 0,5 g dose of Vancomycin can be added to the mix, while for the management of infections a 2 to 4 grams dose is recommended.Cumulative release of vancomycin from AIBC is effective in eradicating bacteria in their planktonic form. Based on current study, elutions are bactericidal for at least 16 days, which is an important term for surgical planning of re-interventions.