The effect of N -acetylcysteine on mechanical fatigue resistance of antibiotic-loaded bone cement
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RESEARCH ARTICLE
Open Access
The effect of N-acetylcysteine on mechanical fatigue resistance of antibiotic-loaded bone cement Erhan Sukur1*, Abdulhalim Akar1, Huseyin Nevzat Topcu2, Ozgur Cicekli1, Alauddin Kochai1 and Mehmet Turker1
Abstract Background: This biomechanical study evaluates the effect of N-acetylcysteine alone and in combination with the most commonly used antibiotic-loaded bone cement mixtures. Methods: We mixed eight bone cement mixture groups including combinations of N-acetylcysteine, gentamicin, teicoplanin, and vancomycin and applied a four-point bending test individually to each sample on days 1 and 15 using an MTS Acumen test device. Results: The result was less than 50 MPa—the limit declared by the ISO (International Standards Organization)—in only the “gentamicin + bone cement + N-acetylcysteine” group. Mechanical fatigue resistance of the bone cement decreased significantly with the addition of N-acetylcysteine both on day 1 and day 15 (p < 0.001). With the addition of N-acetylcysteine into the “gentamicin + bone cement” and “vancomycin + bone cement” mixtures, a significant decrease in mechanical fatigue resistance was observed both on day 1 and day 15 (p < 0.001). In contrast, with the addition of N-acetylcysteine into the “teicoplanin + bone cement” mixture, no significant difference in mechanical fatigue resistance was observed on days 1 and 15 (p = 0.093, p = 0.356). Conclusion: Preliminary results indicate that adding N-acetylcysteine to teicoplanin-loaded bone cement does not significantly affect the cement’s mechanical resistance, potentially leading to a new avenue for preventing and treating peri-prosthetic joint infection. N-acetylcysteine may, therefore, be considered as an alternative agent to be added to antibiotic-loaded bone cement mixtures used in the prevention of peri-prosthetic joint infection. Keywords: N-acetylcysteine, Antibiotic-loaded, Bone cement, Peri-prosthetic joint infection
Background Peri-prosthetic joint infection (PJI) is one of the most feared and devastating complications following total joint arthroplasty (TJA). PJI treatment through antibiotics is complex and challenging on account of biofilm formation, which tends to protect pathogens from the effects of systemic antibiotics as well as host immune system [1]. Antibiotic-loaded bone cement (ALBC) prophylaxis promises to be an effective strategy towards reducing the risk of infection following TJA [2] and is commonly used for high-dose local delivery of antibiotics to the * Correspondence: [email protected] 1 Department of Orthopedics and Traumatology, Sakarya University Research and Training Hospital, 54050 Sakarya, Turkey Full list of author information is available at the end of the article
surgical site to inhibit biofilm formation and thereby avoiding the occurrence of systemic side effects caused by an over-dosage of antibiotics [1, 3]. For the prophylactic use of ALBC, the antibiotic should not be used at high doses because increasing quantities of antibiotic powder may reduce the comp
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