Deactivation of Palacos R Bone Cement with the Addition of Rifampin Antibiotic Powder An In-Vivo Experience -Case Report

Use of antimicrobial impregnated polymethylmethacrylate (PMMA) bone cement in the treatment of orthopaedic infections is widely accepted. 1 Antibiotic powder is routinely added to PMMA, and formed into beads or spacers when treating infected bone or periprosthetic infections.  Antibiotics placed into the PMMA elute via a water diffusion process. 2 This results in high local doses of the antimicrobial agent with reduced systemic toxicity. 3 Two stage reimplantation protocols utilizing antibiotic loaded PMMA cement generally provide the highest rates of successful treatment. 4,5 With the increasing number of resistant organisms, success of this treatment protocol requires antimicrobial therapy targeted at the specific organism found.  There exists a great deal of data on the use of certain antimicrobial agents in PMMA cement. 1,6,7 However, there are few published reports of the addition of rifampin.  This is the first clinical report on the failure of Palacos ® R cement (Heraeus Kulzer GmbH, Wehrheim, Germany) to set when rifampin is added.