Evaluation and testing of polymethylmetacrylic (PMMA) bone cements with admixed Amphotericin B
Abstract Background Amphotericin is admixed to Polymethylmethacrylic (PMMA) spacers for fungal periprosthetic joint infections (PJI) during two-stage exchanges. We aimed to analyse the mechanical properties of PMMA cement with admixed Amphotericin B. Materials and methods We tested Amphotericin in P...
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BMC
2025-02-01
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| Series: | Journal of Orthopaedic Surgery and Research |
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| Online Access: | https://doi.org/10.1186/s13018-025-05565-x |
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| author | Florian A. Frank Barbara Krampitz Julia Steiner Rainer Strathausen Mario Morgenstern Martin Clauss Klaus-Dieter Kühn |
| author_facet | Florian A. Frank Barbara Krampitz Julia Steiner Rainer Strathausen Mario Morgenstern Martin Clauss Klaus-Dieter Kühn |
| author_sort | Florian A. Frank |
| collection | DOAJ |
| description | Abstract Background Amphotericin is admixed to Polymethylmethacrylic (PMMA) spacers for fungal periprosthetic joint infections (PJI) during two-stage exchanges. We aimed to analyse the mechanical properties of PMMA cement with admixed Amphotericin B. Materials and methods We tested Amphotericin in PMMA cement mechanically, its elution properties in vitro and present two cases of fungal PJI treated with Amphotericin B powder in Copal cement in vivo. Results Sterile Amphotericin B is not available as a pure substance but only as powder for infusions. PMMA mixed with such pharmaceutical Amphotericin B formulations colored the cement orange. Compression strength was slightly decreased, bending and impact strength significantly decreased whereas bending modulus was increased. Drug elution was high within the first 24 h and decreased over time until day 5. Amphotericin B in combination with Copal was successfully used in two cases with Candida ssp. infections. No negative side effects, especially no nephrotoxic effects, were observed. Sterile Amphotericin B powder for preparing an infusion solution contains only small amounts of pure drug. In vivo polymicrobial Candida-infections with bacterial co-infection were successfully treated using the combination of Copal cements with added Amphotericin B without systemic nephrotoxic impact. Conclusions The addition of Amphotericin B to PMMA cement affects the cement’s properties in vitro whereas in vivo the combination with Copal is clinically successful in treating complex cases of fungal PJI. Level of evidence Level IV. |
| format | Article |
| id | doaj-art-5c72cb586aaa443bab440dffbdc4318f |
| institution | Kabale University |
| issn | 1749-799X |
| language | English |
| publishDate | 2025-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj-art-5c72cb586aaa443bab440dffbdc4318f2025-02-09T12:47:04ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2025-02-0120111310.1186/s13018-025-05565-xEvaluation and testing of polymethylmetacrylic (PMMA) bone cements with admixed Amphotericin BFlorian A. Frank0Barbara Krampitz1Julia Steiner2Rainer Strathausen3Mario Morgenstern4Martin Clauss5Klaus-Dieter Kühn6Centre for Musculoskeletal Infections (ZMSI), University Hospital of BaselHeraeus MedicalDepartment of Orthopaedics and Traumatology, Medical University of GrazHeraeus MedicalCentre for Musculoskeletal Infections (ZMSI), University Hospital of BaselCentre for Musculoskeletal Infections (ZMSI), University Hospital of BaselDepartment of Orthopaedics and Traumatology, Medical University of GrazAbstract Background Amphotericin is admixed to Polymethylmethacrylic (PMMA) spacers for fungal periprosthetic joint infections (PJI) during two-stage exchanges. We aimed to analyse the mechanical properties of PMMA cement with admixed Amphotericin B. Materials and methods We tested Amphotericin in PMMA cement mechanically, its elution properties in vitro and present two cases of fungal PJI treated with Amphotericin B powder in Copal cement in vivo. Results Sterile Amphotericin B is not available as a pure substance but only as powder for infusions. PMMA mixed with such pharmaceutical Amphotericin B formulations colored the cement orange. Compression strength was slightly decreased, bending and impact strength significantly decreased whereas bending modulus was increased. Drug elution was high within the first 24 h and decreased over time until day 5. Amphotericin B in combination with Copal was successfully used in two cases with Candida ssp. infections. No negative side effects, especially no nephrotoxic effects, were observed. Sterile Amphotericin B powder for preparing an infusion solution contains only small amounts of pure drug. In vivo polymicrobial Candida-infections with bacterial co-infection were successfully treated using the combination of Copal cements with added Amphotericin B without systemic nephrotoxic impact. Conclusions The addition of Amphotericin B to PMMA cement affects the cement’s properties in vitro whereas in vivo the combination with Copal is clinically successful in treating complex cases of fungal PJI. Level of evidence Level IV.https://doi.org/10.1186/s13018-025-05565-xAmphotericin BPMMACandidaFungal PJIISO 5833 |
| spellingShingle | Florian A. Frank Barbara Krampitz Julia Steiner Rainer Strathausen Mario Morgenstern Martin Clauss Klaus-Dieter Kühn Evaluation and testing of polymethylmetacrylic (PMMA) bone cements with admixed Amphotericin B Journal of Orthopaedic Surgery and Research Amphotericin B PMMA Candida Fungal PJI ISO 5833 |
| title | Evaluation and testing of polymethylmetacrylic (PMMA) bone cements with admixed Amphotericin B |
| title_full | Evaluation and testing of polymethylmetacrylic (PMMA) bone cements with admixed Amphotericin B |
| title_fullStr | Evaluation and testing of polymethylmetacrylic (PMMA) bone cements with admixed Amphotericin B |
| title_full_unstemmed | Evaluation and testing of polymethylmetacrylic (PMMA) bone cements with admixed Amphotericin B |
| title_short | Evaluation and testing of polymethylmetacrylic (PMMA) bone cements with admixed Amphotericin B |
| title_sort | evaluation and testing of polymethylmetacrylic pmma bone cements with admixed amphotericin b |
| topic | Amphotericin B PMMA Candida Fungal PJI ISO 5833 |
| url | https://doi.org/10.1186/s13018-025-05565-x |
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