{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T23:03:24Z","timestamp":1790204604195,"version":"4.1.0"},"reference-count":47,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"18","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,9,18]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The use of antibiotic-loaded bone cement (ALBC) to help reduce the risk of infection after primary total knee arthroplasty (TKA) is controversial. There is a paucity of in vivo data on the elution characteristics of ALBC. We aimed to determine whether the antibiotic concentrations of 2 commercially available ALBCs met the minimum inhibitory concentration (MIC) and minimum biofilm eradication concentration (MBEC) for common infecting organisms.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Forty-five patients undergoing TKA were randomized to receive 1 of the following: bone cement without antibiotic (the negative control; n = 5), a commercially available formulation containing 1 g of tobramycin (n = 20), or a commercially available formulation containing 0.5 g of gentamicin (n = 20). Intra-articular drains were placed, and fluid was collected at 4 and 24 hours postoperatively. An automated immunoassay measuring antibiotic concentration was performed, and the results were compared against published MIC and MBEC thresholds.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The ALBC treatment groups were predominantly of White (65%) or Black (32.5%) race and were 57.5% female and 42.4% male. The mean age (and standard deviation) was 72.6 \u00b1 7.2 years in the gentamicin group and 67.6 \u00b1 7.4 years in the tobramycin group. The mean antibiotic concentration in the tobramycin group was 55.1 \u00b1 37.7 \u03bcg\/mL at 4 hours and 19.5 \u00b1 13.0 \u03bcg\/mL at 24 hours, and the mean concentration in the gentamicin group was 38.4 \u00b1 25.4 \u03bcg\/mL at 4 hours and 17.7 \u00b1 15.4 \u03bcg\/mL at 24 hours. Time and antibiotic concentration had a negative linear correlation coefficient (r = \u22120.501). Most of the reference MIC levels were reached at 4 hours. However, at 24 hours, a considerable percentage of patients had concentrations below the MIC for many common pathogens, including\n                      <jats:italic toggle=\"yes\">Staphylococcus epidermidis<\/jats:italic>\n                      (gentamicin: 65% to 100% of patients; tobramycin: 50% to 85%), methicillin-sensitive\n                      <jats:italic toggle=\"yes\">Staphylococcus aureus<\/jats:italic>\n                      (gentamicin: 5% to 90%; tobramycin: 5% to 50%), methicillin-resistant\n                      <jats:italic toggle=\"yes\">S<\/jats:italic>\n                      .\n                      <jats:italic toggle=\"yes\">aureus<\/jats:italic>\n                      (gentamicin: 5% to 65%; tobramycin: 50%), Streptococcus species (gentamicin: 10% to 100%), and\n                      <jats:italic toggle=\"yes\">Cutibacterium acnes<\/jats:italic>\n                      (gentamicin: 10% to 65%; tobramycin: 100%). The aforementioned ranges reflect variation in the MIC among different strains of each organism. Gentamicin concentrations reached MBEC threshold values at 4 hours only for the least virulent strains of\n                      <jats:italic toggle=\"yes\">S<\/jats:italic>\n                      .\n                      <jats:italic toggle=\"yes\">aureus<\/jats:italic>\n                      and\n                      <jats:italic toggle=\"yes\">Escherichia coli.<\/jats:italic>\n                      Tobramycin concentrations did not reach the MBEC threshold for any of the bacteria at either time point.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>The elution of antibiotics from commercially available ALBC decreased rapidly following TKA, and only at 4 hours postoperatively did the mean antibiotic concentrations exceed the MIC for most of the pathogens. Use of commercially available ALBC may not provide substantial antimicrobial coverage following TKA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level I<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.23.01412","type":"journal-article","created":{"date-parts":[[2024,7,25]],"date-time":"2024-07-25T14:04:51Z","timestamp":1721916291000},"page":"1664-1672","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":8,"title":["In Vivo Intra-Articular Antibiotic Concentrations at 24 Hours After TKA Fall Below the Minimum Inhibitory Concentration for Most Bacteria"],"prefix":"10.2106","volume":"106","author":[{"given":"Juan D.","family":"Lizcano","sequence":"first","affiliation":[{"name":"Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2056-7579","authenticated-orcid":false,"given":"Diana","family":"Fern\u00e1ndez-Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7337-3321","authenticated-orcid":false,"given":"Graham S.","family":"Goh","sequence":"additional","affiliation":[{"name":"Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7593-2211","authenticated-orcid":false,"given":"David E.","family":"DeMik","sequence":"additional","affiliation":[{"name":"Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2335-199X","authenticated-orcid":false,"given":"Andrew J.","family":"Hughes","sequence":"additional","affiliation":[{"name":"Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6985-5870","authenticated-orcid":false,"given":"Javad","family":"Parvizi","sequence":"additional","affiliation":[{"name":"Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6973-3865","authenticated-orcid":false,"given":"P. Maxwell","family":"Courtney","sequence":"additional","affiliation":[{"name":"Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1016-5311","authenticated-orcid":false,"given":"James J.","family":"Purtill","sequence":"additional","affiliation":[{"name":"Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4379-3392","authenticated-orcid":false,"given":"Matthew S.","family":"Austin","sequence":"additional","affiliation":[{"name":"Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2024,7,25]]},"reference":[{"issue":"24","key":"bib1-20250430","doi-asserted-by":"crossref","first-page":"933","DOI":"10.5435\/JAAOS-D-17-00842","article-title":"What Are the Contemporary Etiologies for Revision Surgery and Revision After Primary, Noncemented Total Hip Arthroplasty?","volume":"27","author":"Ledford","year":"2019","journal-title":"J Am Acad Orthop Surg."},{"issue":"1","key":"bib2-20250430","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1186\/1471-2474-14-222","article-title":"A systematic review of the evidence for single stage and two stage revision of infected knee replacement","volume":"14","author":"Masters","year":"2013","journal-title":"BMC Musculoskelet Disord."},{"issue":"7","key":"bib3-20250430","doi-asserted-by":"crossref","first-page":"1693","DOI":"10.1007\/s11999-009-0847-1","article-title":"Hand-mixed and premixed antibiotic-loaded bone cement have similar homogeneity","volume":"467","author":"McLaren","year":"2009","journal-title":"Clin Orthop Relat Res."},{"key":"bib4-20250430","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1097\/01.blo.0000144476.43661.10","article-title":"Systemic safety of high-dose antibiotic-loaded cement spacers after resection of an infected total knee arthroplasty","volume":"427","author":"Springer","year":"2004","journal-title":"Clin Orthop Relat Res."},{"key":"bib5-20250430","article-title":"Antiobotic-Loaded Bone Cement in Asceptic Total Joint Replacement: Whys, Wherefores, & Caveats","author":"Jiranek","year":"2005"},{"issue":"7S","key":"bib6-20250430","doi-asserted-by":"crossref","first-page":"S188","DOI":"10.1016\/j.arth.2019.03.006","article-title":"Antibiotic-Loaded Bone Cement in Primary Total Knee Arthroplasty: Utilization Patterns and Impact on Complications Using a National Database","volume":"34","author":"Chan","year":"2019","journal-title":"J Arthroplasty."},{"issue":"2","key":"bib7-20250430","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1002\/jor.24616","article-title":"Hospital for Special Surgery 2019 Biofilm Symposium Workgroup. 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