{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T19:03:19Z","timestamp":1789498999646,"version":"build-2803163510"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\n Background:<\/jats:title>\n High-dose vancomycin is routinely mixed into polymethylmethacrylate (PMMA) spacers for chronic periprosthetic joint infection (PJI). The precise manner by which to maximize elution remains unknown, and the impact of PMMA-antibiotic mixing sequences remains unexplored.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n \n Sixty PMMA discs (5 formulations consisting of 2 PMMA brands, 2 viscosities, presence or absence of premixed gentamicin) were mixed with 4 g of vancomycin using either a polymer-first or monomer-first sequence. Vancomycin elution was quantified over 28 days, antimicrobial activity against methicillin-sensitive\n Staphylococcus aureus<\/jats:italic>\n was tested, and micro-computed tomography scans were performed to assess porosity. Elution amounts were compared with Holm-corrected t tests and are reported as the mean \u00b1 standard error.\n <\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n Vancomycin retained bactericidal activity across all formulations. Monomer-first mixing of Palacos MV (medium-viscosity) yielded the greatest cumulative elution (2,897 \u00b1 64 \u00b5g\/mL), 120% greater than monomer-first mixing of Simplex P. A monomer-first sequence increased vancomycin elution from medium-viscosity Palacos MV by 57% compared with high-viscosity Palacos R. Polymer-first mixing of Simplex P yielded the greatest immediate elution over the first hour (415 \u00b1 33 \u00b5g\/mL), as well as a 52% greater cumulative elution amount over 28 days versus its monomer-first sequence. Premixed gentamicin only increased vancomycin elution for high-viscosity formulations. No significant differences were seen in porosity.<\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n The cement brand and mixing sequence significantly influenced elution of high-dose vancomycin from PMMA. Palacos MV mixed monomer-first produced the greatest cumulative antibiotic delivery, whereas polymer-first Simplex P maximized initial release. The mixing methods did not deleteriously affect PMMA integrity or antimicrobial activity.<\/jats:p>\n <\/jats:sec>\n \n Clinical Relevance:<\/jats:title>\n Clinicians should consider their choice of PMMA brand, viscosity, and mixing sequence when preparing high-dose spacers in revision arthroplasty for PJI. Maximizing cumulative elution may be a clinically favorable strategy to improve PJI eradication.<\/jats:p>\n <\/jats:sec>","DOI":"10.2106\/jbjs.25.00745","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T18:08:15Z","timestamp":1789495695000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Cement Brand and Mixing Sequence Determine Vancomycin Elution from High-Dose PMMA Spacers"],"prefix":"10.2106","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7242-5348","authenticated-orcid":false,"given":"Mohammed","family":"Hammad","sequence":"first","affiliation":[{"name":"Research Institute, Hospital for Special Surgery, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2060-5368","authenticated-orcid":false,"given":"Christina A.","family":"Chao","sequence":"additional","affiliation":[{"name":"Research Institute, Hospital 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