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Manual prefabrication and sterilisation of non-commercial antibiotic-loaded cement may reduce operative time and cost; however, the effects of sterilisation and storage on antimicrobial efficacy remain unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Manually prefabricated PMMA cement containing vancomycin (2\u00a0g or 4\u00a0g) underwent formaldehyde gas sterilisation (FO) and storage for one, four or seven\u00a0days. Antibiotic elution was evaluated over 28\u00a0days. Antimicrobial activity against\n                      <jats:italic>Staphylococcus aureus<\/jats:italic>\n                      ATCC 25923 was assessed using minimum inhibitory dilution (MID) testing at predefined time points. Given the small number of specimens per subgroup, all comparisons should be interpreted as preliminary and hypothesis-generating.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      FO sterilisation significantly reduced antimicrobial activity during the early elution phase. In the 4\u2014g vancomycin group, Day 1 MID values were significantly higher in one\u00a0day storage sterilised specimens than in specimens stored for four or seven\u00a0days (1024\u00a0\u00b5g\/mL vs. 213\u00a0\u00b5g\/mL and 213\u00a0\u00b5g\/mL, respectively;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.001). Differences persisted at early time points but were no longer significant during the sustained elution phase (Days 14\u201328;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&gt;\u20090.05). Overall, sterilised cement containing 4\u00a0g of vancomycin demonstrated higher MID values than 2\u00a0g cement during the early and mid-elution phases (Days 1\u201314;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.01). MID values in all sterilised specimens remained several-fold above inhibitory thresholds for\n                      <jats:italic>S. aureus<\/jats:italic>\n                      throughout the 28-day period.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      FO sterilisation transiently reduces vancomycin antimicrobial activity during the early elution phase (Days 1\u20137) but does not affect sustained antimicrobial efficacy compared with non-sterilised cement. Based on these findings, vancomycin-loaded PMMA cement containing 4\u00a0g of antibiotic may be sterilised and stored for up to seven\u00a0days while maintaining MIC values several-fold above inhibitory thresholds for\n                      <jats:italic>Staphylococcus aureus<\/jats:italic>\n                      throughout the 28-day elution period.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00264-026-06829-9","type":"journal-article","created":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T14:22:41Z","timestamp":1779200561000},"page":"1223-1232","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Pre-sterilization of vancomycin-loaded cement spacers: impact on antibacterial efficacy against Staphylococcus aureus"],"prefix":"10.1007","volume":"50","author":[{"given":"Kulapat","family":"Chulsomlee","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pisut","family":"Pongchaikul","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rungroj","family":"Sadchaphaiboonkit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinnipa","family":"Arunothai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paninee","family":"Mongkolsuk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nithid","family":"Sri-utenchai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,19]]},"reference":[{"key":"6829_CR1","doi-asserted-by":"publisher","first-page":"4","DOI":"10.21037\/aoj-20-84","volume":"7","author":"M Franceschini","year":"2022","unstructured":"Franceschini M, Pedretti L, Cerbone V, Sandiford NA (2022) Two stage revision: indications, techniques and results. 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The original article has been updated accordingly.","order":7,"name":"change_details","label":"Change Details","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}]}}