The Effects of Different Mixing Speeds on the Elution and Strength of High-Dose Antibiotic-Loaded Bone Cement Created With the Hand-Mixed Technique

We evaluated the effects of the mixing speed of hand-mixed bone cement and the different phases of antibiotic mixing on the elution, mechanical properties, and porosity of antibiotic-loaded bone cement. Vancomycin-loaded Palacos LV bone cement was prepared at two hand-mixing speeds, normal and high-speed, and with antibiotic addition during three phases (directly mixing with the PMMA powder, in the liquid phase, and in the dough phase). The cumulative antibiotic elution over 15 days in the high-speed group was increased by 24% compared with the normal-speed group (P < 0.001). The delayed antibiotic addition produced higher vancomycin elution (P < 0.05), but no difference was observed between the liquid and dough phases (P > 0.05). Our study demonstrated that bone cement prepared with high-speed hand mixing and delayed antibiotic addition can exhibit increased vancomycin release.