PALACOS® +G*: Antibiotic Loaded Bone Cements

Engineered for High Release and Low Revisions.

PALACOS® is known for eluting a higher proportion of antibiotic to surrounding tissue compared to other cement brands.1 The initial high dose released through PALACOS® ALBCs correlates with the phase of highest infection risk, and enables the effective elimination of bacterial pathogens.2-4 PALACOS® cements with industrially loaded antibiotics also mitigate mechanical compromise, which can be caused by the manual addition ("admixing") of antibiotics.5,6

All PALACOS® cements (low viscosity, medium viscosity, high viscosity and fast) are available with added gentamicin for optimal surgeon flexibility and antibiotic prophylaxis.

* In the United States, PALACOS® R+G, PALACOS® MV+G, PALACOS® LV+G and PALACOS® fast R+G are indicated for use in the second stage of a two stage revision for the total joint arthroplasty after the initial infection has been cleared.

PALACOS®+G* for PJI Prevention and Treatment

In 1987, over 20 antibiotics were tested within PALACOS® R for their in vitro elution rates. Of the antibiotics tested, gentamicin alone demonstrated superior elution kinetics. In fact, it was shown that PALACOS® R eluted nearly 1000 µg more gentamicin over 10 days than tobramycin, and 2000 µg more than vancomycin.7

As a broad-spectrum antibiotic, gentamicin is effective against 70% of the bacteria that cause periprosthetic joint infections.8 In addition to superior elution rates and a broad spectrum of efficacy, gentamicin’s ability to withstand the heat of polymerization9 makes it the ideal candidate for bone cements.

This makes gentamicin the antibiotic of choice for all PALACOS® antibiotic loaded bone cements (PALACOS® R+G*, PALACOS® MV+G*, PALACOS® LV+G*, PALACOS® fast R+G*).

* In the United States, PALACOS® R+G, PALACOS® MV+G, PALACOS® LV+G and PALACOS® fast R+G are indicated for use in the second stage of a two stage revision for the total joint arthroplasty after the initial infection has been cleared.

A 2011 study from the University of Wisconsin found that of the six cements measured, only PALACOS® R+G* eluted above the Staph. aureus MIC for five days after preparation.10 This finding was repeated in 2019 when researchers at the University of Arkansas found that “no cement exhibited greater elution profiles [of vancomycin, tobramycin and daptomycin] than those of PALACOS®”.11

* In the United States, PALACOS® R+G is indicated for use in the second stage of a two stage revision for the total joint arthroplasty after the initial infection has been cleared.

Recent data recorded in the National Joint Registry showed that PALACOS® R+G* has a significantly lower revision risk in comparison to other cement brands in the NJR.12 Further research by a recent retrospective study from Spain showed that routine use of PALACOS® R+G* may be effective in preventing PJI - resulting in increased cost-efficiencies for surgeons and facilities.13

* In the United States, PALACOS® R+G is indicated for use in the second stage of a two stage revision for the total joint arthroplasty after the initial infection has been cleared.

1 Modified from Furnes et.al: properties of bone cement: which bone cement should we choose for Primary THA, in: Breusch S.J., Malchau H.; The well-cemented total hip arthroplasty. Springer 2005; 104.

2 Kuehn K.D: PMMA Cements. Springer 2014; 147.

3 Webb, J.CJ., Spencer, R.F The role of polymethacrylate bone cement in modern orthopaedic surgery. JBJS, 2007, 89B-7:855.

4 Gristina A. et. al. Infections from biomaterials and implants: a race for the surface. Medical Progress through Technology 1988; 14:204-5:218.

5 Dunne N, et al. In vitro study of the efficacy of acrylic bone cement loaded with supplementary amounts of gentamicin: effect on mechanical properties, antibiotic release, and biofilm formation. Acta Orthop 2007; 78(6): 774-85.

6 Postak PD, Greenwald AS. The influence of antibiotics on the fatigue life of acrylic bone cement. J Bone Joint Surg Am 2006; 88 Suppl 4; 148-55.

7 Wahlig H. Kinetics of the liberation of antibiotics from bone cements--results of comparative studies in vitro and in vivo. Aktuelle Probl Chir Orthop. 1987;31:221-226.

8 Zimmerli W. Bone and Joint Infections. 2015; 132.

9 Kuehn, KD. PMMA Cements. Springer, 2014. p 131-132.

10 Meyer, J. et al. Vacuum-mixing significantly changes antibiotic elution characteristics of commercially available antibiotic-impregnated bone cements. JBJS, 2011; 93:2049-56.

11 Meeker DG, et al. Comparative study of antibiotic elution profiles from alternative formulations of polymethylmethacrylate bone cement.  J Arthroplasty 2019; 34: 1458-61.

12 NJR Supplier Feedback Report, 2020.**

13 Sanz-Ruiz, P., et al. Is the commercial antibiotic-loaded bone cement useful in prophylactic and cost saving after knee and hip joint arthroplasty? JOA, 2016; 32:1095-1099.

** We thank the patients and staff of all the hospitals in England, Wales, Northern Ireland and the Isle of Man who have contributed data to the National Joint Registry. We are grateful to the Healthcare Quality Improvement Partnership (HQIP), the NJR Steering Committee and staff at the NJR Centre for facilitating this work. The views expressed represent those of Heraeus Medical GmbH and do not necessarily reflect those of the National Joint Registry Steering Committee or the Health Quality Improvement Partnership (HQIP) who do not vouch for how the information is presented.