THE IMPORTANCE OF PALACOS R WITH GENTAMICIN IN ARTHROPLASTIES

Abstract

From 1970, when Buchholz started incorporating antibiotics in bone cements, until now, many studies have been published supporting the beneficial effects of Palacos R with gentamicin in prevention and therapy of infections in orthopaedic surgery.

Despite the continuously increasing rates of genta-micin-resistant strains, the empirical use of gentamicin was reduced only as far as its systemic administration is concerned, while its local use in addition to bone cements has increased. The latter is justified by the gradual release of the antibiotic and its low toxicity.

We studied during the period of August 2000 to August 2001, 668 operations which were performed with P-G in 6 orthopaedic clinics of KAT hospital (129 total hip arthroplasties, 258 total knee arthroplasties, 29 hip revisions, 11 knee revisions and 241 hip hemiarthroplasties) and 137 operations with simple cement, out of total 1346 operations. All the above surgeries were performed either in 5 classical operational fields or in 2 controlled ventilation ones. The rate of infection was 1,02% in total, and does not differ from the infection rate of the 3rd orthopaedic department of the same hospital that performs the same operations in the same operating rooms without the usage of P-G, with the exception of revisions that P-G was used.

We believe that the high gentamicin-resistant rates of nosocomial microorganisms in combination with the non-complete inhibition of biofilm formation, the negative effect that gentamicin has on bone regeneration and the entailed risk of emergence of resistant organisms to gentamicin because of the continuous and long lasting release of the antibiotic in subtherapeutic concentrations, does not justify the use of Palacos R with gentamicin as prevention of infections. Perhaps the development of other bone-loaded antibiotics, that do not affect the strength of the cement, would be better accepted than gentamicin in the future.