Bioavailability of Gentamicin and Vancomycin Released from Bone Cement in Patients Undergoing a Septic One-Stage THA Revision

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Authors: Gehrke T,  Kendoff D,  Stangenberg P, Frommelt L, Vogt S,  Büchner H, Bösebeck H.
Endo Klinik, Hamburg, Germany

Title: Bioavailability of Gentamicin and Vancomycin Released from Bone Cement in Patients Undergoing a Septic One-Stage THA Revision

Background: Limited data on the bioavailability of gentamicin and vancomycin released from a new bone cement after septic revisions of hip endoprostheses are available.

Hypothesis/Purpose: To determine the concentrations of gentamicin and vancomycin in plasma and urine of patients receiving a novel bone cement during one-stage revision in periprosthetic hip infections.

Methods: In a prospective open clinical trial, 20 patients with a one staged THA were treated with a new industrial manufactured bone cement with a combined antibiotic content of gentamycin and vancomycin, between 2009 and 2011.

The concentrations of gentamicin and vancomycin in plasma and urine were measured In addition, the concentrations of both antibiotic agents was measured in the in the wound secretion.

Results: The mean maximum gentamicin plasma concentration at 5.85 hours was 209.65 ng/mL (78.10 to 485.08 ng/mL).  For vancomycin a mean maximum plasma concentration of 134.64 ng/mL (29.40 to 739.64 ng/mL) was determined at 20.03 hours.  Slow absorption of both antibiotics from the cement resulted in plasma concentrations well below toxic levels. 

Small amounts of both antibiotics were excreted via the urine within the first 10 post-operative days and their amounts in the wound exudate were low as well. 

No reinfection was observed at the end of the hospital stay or during the follow-up period up to 7 months post-surgery.

Discussion: The results point to the safety and effectiveness of a one-stage revision procedure of infected THA with a gentamicin- and vancomycin-impregnated bone cement.

Conclusion: An industrially manufactured bone cement impregnated with gentamicin and vancomycin leads to low concentrations of both antibiotics in plasma and urine.  This new cement provided sufficient antibiotic protection and neither local nor systemic adverse effects were observed.