Razavi Journal of Medicine

Razavi Journal of Medicine

Development and Characterization of a Gentamicin–Vancomycin-Loaded PMMA Bone Cement for Dynamic Articulating Spacer Fabrication

Articles in Press

Document Type : Original Article

Authors
Reza Ganji 1
Morteza Pishghadam 2
Mohamad Amin Younessi Heravi 3
1 Department of Orthopedic Surgery, School of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran.
2 Department of Radiology, MedStar Washington Hospital Center, Washington, DC, USA
3 Department of Medical Physics and Radiology, School of Allied Medical Sciences, North Khorasan University of Medical Sciences, Bojnurd, Iran.
10.30483/rjm.2026.254803.1548
Abstract
Background: Periprosthetic joint infection (PJI) is a serious complication of total joint arthroplasty commonly managed by two-stage revision using antibiotic-loaded articulating spacers.

Objective: This study evaluated a dual-antibiotic-loaded PMMA bone cement developed for the fabrication of dynamic spacers.

Methods: In this in vitro experimental study, 4 g of vancomycin hydrochloride was incorporated into a commercially available gentamicin-loaded PMMA bone cement (CEMEX® GENTA). A reusable silicone mold was developed to fabricate anatomically accurate femoral spacer components. The developed cement was compared with the standard formulation regarding macroscopic appearance, color characteristics, polymerization behavior, setting time, maximum polymerization temperature, compressive strength, tensile strength, electrical resistance, and molding performance according to ISO 5833. Statistical analysis was performed using the independent-samples t-test (p < 0.05).

Results: The addition of vancomycin slightly increased cement opacity without affecting surface morphology or dimensional accuracy. The developed cement exhibited a significantly shorter setting time (p = 0.03), whereas no significant differences were observed in doughing time, maximum polymerization temperature, compressive strength, tensile strength, electrical resistance, or molding performance (p > 0.05). Both formulations demonstrated excellent moldability and produced anatomically accurate femoral spacer components.

Conclusions: The developed dual-antibiotic-loaded PMMA bone cement preserved the essential physicochemical, mechanical, and molding properties of the original cement while enabling the fabrication of dynamic articulating spacers using a reusable silicone mold. This approach represents a promising strategy for the fabrication of temporary spacers in the management of periprosthetic joint infection.
Keywords
Polymethyl methacrylate (PMMA)
Antibiotic-loaded bone cement
Gentamicin
Vancomycin
Dynamic articulating spacer
Periprosthetic joint infection
Subjects

Acknowledgements: The authors sincerely thank all participants in this study and the Orthopedic Department of North Khorasan University of Medical Sciences for their valuable support and cooperation throughout this project. 


Availability of data and materials: The data that support the findings of this study are available from the corresponding author upon reasonable request. Conflicts of interest: The authors declare no conflict of interest.

 
Conflicts of interests: The authors declare no conflicts of interest.


Consent for publication: Not applicable. 


Ethics approval and consent to participate: This experimental study was approved by the Ethics Committee of North Khorasan University of Medical Sciences, Bojnurd, Iran (IR.NKUMS.REC.1403.069).  The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki.


Financial disclosure: This study was supported by a grant from North Khorasan University of Medical Sciences (Grant number: NKUMS 4030042). 


Author contributions: All authors contributed to the Study design, Methodology, data collection, analysis, and interpretation. All authors approved the final manuscript and agree to be accountable for all aspects of the work.

Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

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Razavi Journal of Medicine

Articles in Press, Accepted Manuscript
Available Online from 23 July 2026