A new type of metallic silver bone cement was previously shown to be effective against both antibiotic sensitive and resistant bacteria.

In this study the efficacy of silver bone cement in preventing methicillin- sensitive Staphylococcal infections was compared with plain and tobramycin-containing bone cement, in a rabbit contaminated implant bed model.

In 48 rabbits 0.6%-silver, 1%-silver, plain or tobramycin-loaded (tobra) PMMA bone cement (Simplex^®P; Howmedica, Ireland) was injected into the medullary canal of the right femur after contamination of the implant bed with 105, 106 or 107 colony forming units (CFU) of Staphylococcus aureus. After 14 days bone was collected, homogenised and plated on blood agar plates. After an overnight incubation the number of CFU’s was counted. Bone was also collected for pathological analysis.

The plain and silver cement rabbits were all infected, whereas with tobra cement only 2 rabbits (17%) were infected (p< 0.001). The number of bacteria cultured from bone adjacent to the cement, was 6.4±0.3 and 6.1±0.3 for the 0.6% and 1%-silver rabbits. For the rabbits with plain and tobra cement this was 6.2±0.2 (p> 0.95) and 0.0±0.0 (p< 0.001). Two tobra rabbits had a positive culture of a distal bone sample. Histological sections of plain, 0.6% and 1%-silver cement rabbits all showed signs of infection; these signs were absent in the tobra rabbits.

Silver cement was not effective in preventing infection. However, in the current model bacteria are present directly at and distant from the implant surface, whereas silver cement predominantly exhibits an antimicrobial effect at the direct cement surface. The non-eluting silver cement seems less useful in situations where there are also bacteria present in surrounding tissues, like revision surgery. Whether silver cement has relevance in preventing bacterial colonization of cement, for instance in late haematogenous infections, or not remains to be seen.

We applied joint distraction using an Ilizarov apparatus in 11 patients with post-traumatic osteoarthritis of the ankle to try to delay the need for an arthrodesis. Distraction for three months resulted in clinical improvement in pain and mobility for a mean of two years, with an increase in the joint space. We considered that these effects may be produced by the absence of mechanical stress on the cartilage combined with the intra-articular hydrostatic pressures during distraction. We measured these pressures during walking with distraction, and found levels very similar to those reported to improve osteoarthritic cartilage when applied in vitro.