{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T22:39:16Z","timestamp":1778279956448,"version":"3.51.4"},"reference-count":26,"publisher":"British Editorial Society of Bone & Joint Surgery","issue":"11","license":[{"start":{"date-parts":[[2015,11,1]],"date-time":"2015-11-01T00:00:00Z","timestamp":1446336000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/online.boneandjoint.org.uk\/TDM"}],"content-domain":{"domain":["online.boneandjoint.org.uk"],"crossmark-restriction":true},"short-container-title":["The Bone &amp; Joint Journal"],"published-print":{"date-parts":[[2015,11]]},"abstract":"<jats:p> We investigated whether the indentation of bone cement spacers used in revision of infected joint arthroplasty with a MacDonald dissector increased the elution of antibiotic in vitro. A total of 24 cement discs containing either 0.17 g (0.88% w\/w), 0.25 g (1.41% w\/w), or 0.33 g (1.75% w\/w) gentamicin of constant size were made. Of these, 12 were indented with the dissector. Each disc was immersed in ammonium acetate buffer in a sealed container, and fluid from each container was sampled at zero, one, three, six, 24, 48 and 72 hours and at one, and two weeks. The concentration of gentamicin in the fluid was analysed using high performance liquid chromatography mass spectrometry. <\/jats:p><jats:p> The fluid sampled at 72 hours from the indented discs containing 0.17 g gentamicin (0.88% w\/w) contained a mean of 113 mcg\/ml (90.12 to 143.5) compared with 44.5 mcg\/ml (44.02 to 44.90) in the fluid sampled from the plain discs (p = 0.012). In discs containing 0.33 g gentamicin (1.75% w\/w), the concentration eluted from the indented discs at 72 hours was a mean of 316 mcg\/ml (223 to 421) compared with a mean of 118 mcg\/ml (100 to 140) from the plain discs (p &lt; 0.001). <\/jats:p><jats:p> At two weeks, these significant differences persisted. At nine weeks the indented discs eluted a greater concentration for all gentamicin doses, but the difference was only significant for the discs containing 0.17 g (0.88% w\/w, p = 0.006). However if the area under the curve is taken as a measure of the total antibiotic eluted, the indented discs eluted more gentamicin than the plain discs for the 0.17 g (0.88% w\/w, p = 0.031), the 0.25 g (1.41% w\/w, p &lt; 0.001) and the 0.33 g (1.75% w\/w, p &lt; 0.001) discs. <\/jats:p><jats:p> When preparing antibiotic spacers for use in staged revision arthroplasty surgery we recommend indenting the spacer with a MacDonald dissector to increase the elution of antibiotic. <\/jats:p><jats:p> Cite this article: Bone Joint J 2015;97-B:1519\u201324. <\/jats:p>","DOI":"10.1302\/0301-620x.97b11.35618","type":"journal-article","created":{"date-parts":[[2015,11,3]],"date-time":"2015-11-03T12:21:22Z","timestamp":1446553282000},"page":"1519-1524","update-policy":"https:\/\/doi.org\/10.1302\/crossmark-policy","source":"Crossref","is-referenced-by-count":11,"title":["The cement spacer with multiple indentations"],"prefix":"10.1302","volume":"97-B","author":[{"given":"S.","family":"Salih","sequence":"first","affiliation":[{"name":"Sheffield Teaching Hospitals NHS Foundation\rTrust, Herries Road, Sheffield\rS5 7AU, UK."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.","family":"Paskins","sequence":"additional","affiliation":[{"name":"Sheffield Hallam University, Howard\rStreet, Sheffield S1 1WB, UK."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T.","family":"Nichol","sequence":"additional","affiliation":[{"name":"Sheffield Hallam University, Howard\rStreet, Sheffield S1 1WB, UK."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T.","family":"Smith","sequence":"additional","affiliation":[{"name":"Sheffield Hallam University, Howard\rStreet, Sheffield S1 1WB, UK."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.","family":"Hamer","sequence":"additional","affiliation":[{"name":"Sheffield Teaching Hospitals NHS Foundation\rTrust, Herries Road, Sheffield\rS5 7AU, UK."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"42","reference":[{"key":"r1","first-page":"511","volume":"41","author":"Buchholz HW","year":"1970","journal-title":"Chirurg"},{"key":"r2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.59B2.873980"},{"key":"r3","unstructured":"No authors listed. National Joint Registry for England, Wales and Northern Ireland: 11th Annual Report, 2014. http:\/\/www.njrcentre.org.uk\/njrcentre\/Portals\/0\/Documents\/England\/Reports\/11th_annual_report\/NJR%2011th%20Annual%20Report%202014.pdf (date last accessed 08 July 2015)."},{"key":"r4","unstructured":"No authors listed. National Joint Registry for England and Wales: 6th Annual Report, 2009. http:\/\/www.njrcentre.org.uk\/NjrCentre\/Portals\/0\/Sixth%20annual%20NJR%20report.pdf (date last accessed 08 July 2015)."},{"key":"r5","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.95B11.32906"},{"key":"r6","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-198870100-00015"},{"key":"r7","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-200403000-00042"},{"key":"r8","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.L.00014"},{"key":"r9","doi-asserted-by":"publisher","DOI":"10.1016\/S0883-5403(05)80145-7"},{"key":"r10","doi-asserted-by":"publisher","DOI":"10.1080\/00016470310018180"},{"key":"r11","doi-asserted-by":"publisher","DOI":"10.3109\/17453670902884700"},{"key":"r12","doi-asserted-by":"publisher","DOI":"10.1016\/S0883-5403(98)90179-6"},{"key":"r13","first-page":"311","volume":"124","author":"Wroblewski BM","year":"1977","journal-title":"Clin Orthop Relat Res"},{"key":"r14","doi-asserted-by":"publisher","DOI":"10.1002\/jbm.b.31281"},{"key":"r15","doi-asserted-by":"publisher","DOI":"10.1016\/S0142-9612(00)00082-X"},{"key":"r16","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.64B4.7096423"},{"key":"r17","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.88B2.17058"},{"key":"r18","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.96B10.33799"},{"key":"r19","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-012-2332-5"},{"key":"r20","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.J.01777"},{"key":"r21","first-page":"104","volume":"32","author":"Duey RE","year":"2012","journal-title":"Iowa Orthop J"},{"key":"r22","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-197860070-00019"},{"key":"r23","doi-asserted-by":"publisher","DOI":"10.3109\/17453678008990768"},{"key":"r24","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.01588-10"},{"key":"r25","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/48.suppl_1.5"},{"key":"r26","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2672.2012.05288.x"}],"container-title":["The Bone &amp; Joint Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/online.boneandjoint.org.uk\/doi\/pdf\/10.1302\/0301-620X.97B11.35618","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/online.boneandjoint.org.uk\/doi\/full-xml\/10.1302\/0301-620X.97B11.35618","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/online.boneandjoint.org.uk\/doi\/pdf\/10.1302\/0301-620X.97B11.35618","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,10,19]],"date-time":"2021-10-19T04:57:30Z","timestamp":1634619450000},"score":1,"resource":{"primary":{"URL":"https:\/\/online.boneandjoint.org.uk\/doi\/10.1302\/0301-620X.97B11.35618"}},"subtitle":["increasing antibiotic elution using a cement spacer \u2018teabag\u2019"],"short-title":[],"issued":{"date-parts":[[2015,11]]},"references-count":26,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2015,11]]}},"alternative-id":["10.1302\/0301-620X.97B11.35618"],"URL":"https:\/\/doi.org\/10.1302\/0301-620x.97b11.35618","relation":{},"ISSN":["2049-4394","2049-4408"],"issn-type":[{"value":"2049-4394","type":"print"},{"value":"2049-4408","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,11]]},"assertion":[{"value":"2014-12-09","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2015-07-02","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2015-11-01","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}