Setting times
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A new acoustic method to determine the setting time of calcium sulfate bone cement mixed with antibiotics
Key points
- ✔ STIMULAN Kit and STIMULAN Rapid Cure set when combined with antibiotics
- ✔ Most antibiotics delay the setting time, with variability depending on the type and concentration of the antibiotics
- ✔ Understanding setting times is crucial for surgical handling and ensuring the performance of antibiotic-loaded bone grafts
- ✔ A pre-mixing technique reduces or inhibits the retarding effect of certain antibiotics on the setting time
- ✔ Limitations include in vitro laboratory testing with antibiotics under controlled conditions, and results do not imply clinical efficacy or safety
Setting time of 10 cc pack of STIMULAN using 6 ml of solution for STIMULAN Rapid Cure and 5 ml of solution for standard STIMULAN Kit
| Antibiotic | Form | Dosage | Liquid used | Mixing time/technique | STIMULAN Rapid Cure (Set time mm:ss) | Standard set STIMULAN Kit (Set time mm:ss) |
|---|---|---|---|---|---|---|
| None | – | – | Mixing solution | 30s | 3:30 | 7:33 |
| Gentamicin | Liquid | 240mg (6ml) | Gentamicin liquid | 30s | 5:04 | |
| Gentamicin | Liquid | 200mg (5ml) | Gentamicin liquid | 30s | 12:30 | |
| Tobramycin | Liquid | 240mg (6ml) | Tobramycin liquid | 30s | 8:12 | |
| Tobramycin | Liquid | 200mg (5ml) | Tobramycin liquid | 30s | 20:51 | |
| Vancomycin | Powder | 500mg | Mixing solution | 30s | 3:19 | 7:46 |
| Vancomycin + Gentamicin | Powder / Liquid | 500mg / 240mg (6ml) | Gentamicin liquid | 30s | 3:39 | 10:57 |
| Vancomycin + Tobramycin | Powder / Liquid | 500mg / 240mg (6ml) | Tobramycin liquid | 30s | 7:13 | 22:17 |
| Tobramycin | Powder | 1000mg | Mixing solution | Pre-mix for 40s then add ABX. Stir for 30s | 12:14 | 13:14 |
| Vancomycin + Tobramycin | Powder / Powder | 1000mg / 240mg | Mixing solution | 30s | 26:08 | 42:58 |
| Vancomycin + Tobramycin | Powder / Powder | 1000mg / 1200mg | Mixing solution | Pre-mix for 40s then add ABX. Stir for 30s | 9:00 | 13:25 |
Summary
The study by Cooper et al. (2014) titled: A new acoustic method to determine the setting time of calcium sulfate bone cement mixed with antibiotics, introduced a novel acoustic method for determining the setting time of calcium sulfate, particularly when mixed with antibiotics. This approach offered a reliable and repeatable alternative to traditional methods, such as the Vicat needle test. The research specifically examined the commercially available synthetic calcium sulfate, Stimulan, in both its standard (Kit) and Rapid Cure forms.
The findings indicate that the majority of antibiotics tested retarded the setting reaction of the calcium sulfate. This retardation is significant as it can influence the performance of the material in clinical applications. Therefore, understanding and accurately measuring setting times is crucial for ensuring the efficacy and safety of antibiotic-loaded calcium sulfate.
The new acoustic method proposed not only correlated well with established techniques but also offered additional benefits, making it a promising tool for future clinical and laboratory applications.
In summary, the study provided valuable insights into the setting behaviour of STIMULAN mixed with antibiotics.
Publication
The cited publication includes authors (J.J.C., M.J.D., and P.A.L.) who are, or formerly were, employees of Biocomposites and contributed to study design, data collection, data analyses, interpretation of data, and/or in the writing of the manuscript.
Research was funded by Biocomposites.
https://pubmed.ncbi.nlm.nih.gov/24979245/
Statements
Key Points and Summary prepared by Biocomposites Ltd. The new/unapproved uses of STIMULAN described in this scientific article have not been approved/cleared by the (US) FDA and the safety and effectiveness for the new/unapproved use has not been established.
The (US) FDA approved/cleared use of STIMULAN is available here. These Instructions for Use specify the approved/cleared intended use, indications, contraindications, warnings and precautions.