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Orthopaedic Proceedings
Vol. 100-B, Issue SUPP_17 | Pages 44 - 44
1 Dec 2018
Stravinskas M Tarasevicius S Vitkauskiene A Nilsson M Lidgren L
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Aim

In vivo studies have shown a preventive and curative effect of using an injectable vancomycin containing biphasic ceramic in an osteomyelitis model. No clinical long term pharmacokinetic release study has been reported. Inadequate concentration in target tissues results in treatment failure and selection pressure for antibiotic-resistant organisms.

Our hypothesis was that vancomycin in the first week would reach high local concentrations but with low systemic levels.

Method

9 patients (6 women, 3 men) with trochanteric hip fractures classified as A1 and A2 according to the AO-classification all had internal fixations. The mean age was 75.3 years (± S.D. 12.3 years, range 44–84y). An injectable ceramic with hydroxyapatite embedded in a calcium sulphate matrix containing 66mg vancomycin per mL augmented the fixation. A mean of 9.7 mL (± S.D. 0.7 mL, range 8–10mL) was used. The elution of vancomycin was followed by collecting drain fluid, blood (4 days) and urine (4 weeks)


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_23 | Pages 17 - 17
1 Dec 2016
Stravinskas M Horstmann PF Hettwer W Nilson M Tarasevicius S Petersen MM Lidgren L
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Aim

The demand for a synthetic bone substitute that can build bone and at the same time kill bacteria is high. The aim of this study was to compare the elution of gentamicin from a new synthetic bone substitute in vitro with the performance in clinical applications.

Method

Gentamicin release was measured from a synthetic bone graft substitute, comparing in vitro and clinical conditions:

elution in Ringers solution. The bone graft substitute contained 175mg gentamicin per 10mL. The material was introduced either as paste or as pre-set beads with a high or low surface areas, >100cm2 and 24cm2 respectively. The gentamycin release was measured by daily collection of samples.

elution in patients treated for trochanteric hip fractures(n=6) or uncemented hip revisions(n=5) 7,3±1,1mL of substitute was implanted and drainage was collected at 6h,12h,24h,30h,36h post-op. Blood serum was collected every hour for the first 6h and thereafter every 6h until 4 days post-op, urine – daily for the first 7 days post-op.

elution in patients treated after bone tumor resection(n=8), 12,1±5,5mL of substitute was implanted and both drainage and blood serum were collected daily until 2 days post-op.

Gentamicin concentrations were analyzed using antibody technique.