Hand-mixed and premixed antibiotic-loaded bone cement have similar homogeneity

Alex C. McLaren, Matt Nugent, Kostas Economopoulos, Himanshu Kaul, Brent Vernon, Ryan McLemore

Research output: Contribution to journalArticlepeer-review

44 Scopus citations


Since low-dose antibiotic-loaded bone cement (ALBC) was approved by the FDA for second-stage reimplantation after infected arthroplasties in 2003, commercially premixed low-dose ALBC has become available in the United States. However, surgeons continue to mix ALBC by hand. We presumed hand-mixed ALBC was not as homogeneous as commercially premixed ALBC. We assessed homogeneity by determining the variation in antibiotic elution by location in a batch, from premixed and hand-mixed formulations of low-dose ALBC. Four hand-mixed methodologies were used: (1) suspension-antibiotic powder in the liquid monomer; (2) no-mix-antibiotic powder added but not mixed with the polymer powder before adding monomer; (3) hand-stirred-antibiotic powder stirred into the polymer powder before the monomer was added; and (4) bowl-mix-antibiotic powder mixed into polymer powder using a commercial mixing bowl before the monomer was added. Antibiotic elution was measured using the Kirby-Bauer bioassay. None of the mixing methods had consistently dissimilar homogeneity of antibiotic distribution from the others. Based upon our data we conclude hand-mixed low-dose ALBC is not less homogeneous than commercially premixed formulations.

Original languageEnglish (US)
Pages (from-to)1693-1698
Number of pages6
JournalClinical Orthopaedics and Related Research
Issue number7
StatePublished - Jul 2009

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine


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