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


  • Edward McPherson, MD FACS



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.


Zalavras CG, Patzakis MJ, Holtom P. Local antibiotic therapy in the treatment of open fractures and osteomyelitis. Clin Orthop Relat Res. 427:86-93, 2004 Oct

Kuhn KD: Bone cements: Up-to-date comparison of physical and chemical properties of commercial materials. Springer-Verlag, Berlin 2000

Anguita-Alonso P. Rouse MS. Piper KE. Jacofsky DJ. Osmon DR. Patel R: Comparative study of antimicrobial release kinetics from polymethylmethacrylate. Clin Orthop Relat Res. 445:239-44, 2006 Apr

Hanssen AD. Rand JA: Instructional Course Lectures, The American Academy of Orthopaedic Surgeons-Evaluation and treatment of infection at the site of a total hip or knee arthroplasty. J Bone Joint Surg Am. 80:910-22, 1998

Mcpherson EJ: Periprosthetic Total Knee Infection. p 293. In Calhoun JH, Mader JT (eds): Musculoskeletal infections. Marcel Dekker Inc, New York, 2003

Springer BD. Lee GC. Osmon D. Haidukewych GJ. Hanssen AD. Jacofsky DJ: Systemic safety of high-dose antibiotic-loaded cement spacers after resection of an infected total knee arthroplasty. Clin Orthop Relat Res. 427:47-51, 2004 Oct

Anagnostakos K. Kelm J. Regitz T. Schmitt E. Jung W: In vitro evaluation of antibiotic release from and bacteria growth inhibition by antibiotic-loaded acrylic bone cement spacers. J Biomed Mater Res B Appl Biomater. 72(2):373-8, 2005 Feb

dos Santos Fde J. Ximenes VF. da Fonseca LM. de Faria Oliveira OM. Brunetti IL: Horseradish peroxidase-catalyzed




How to Cite

McPherson, MD FACS, E. (2011). Deactivation of Palacos R Bone Cement with the Addition of Rifampin Antibiotic Powder An In-Vivo Experience -Case Report. Reconstructive Review, 1(1).



Case Report