The Cemex® Advantage

Antibiotic Friendly

If you are going to utilize antibiotic-impregnated bone cement, make it a worthwhile decision. You would never waste antibiotics, but combining antibiotics with high temperature cements, like Simplex P, would be rendering them useless. The final result would be a mechanically weakened structure with no pharmacological effectiveness.¹

All antibiotics are thermal sensitive and are afforded significantly higher levels of efficacy as a result of a lower polymerization temperature in bone cement.¹ A study reporting the treatment outcome of a two-stage revision THA for infected hip arthroplasty, including hemiarthroplasty, using an antibiotic-impregnated cement spacer for the interval between the first and second stages, showed that Cemex® may be a significantly better option for thermal sensitive antibiotics.¹ Specifically, the initial elution data showed 182 mg/mL and 77 mg/mL for the low- (e.g. Cemex) and high-temperature (e.g. Surgical Simplex P) cements, respectively. This represents a 2.4-fold increase in vancomycin (VCM) release from Cemex relative to Simplex P.¹ Therefore, the thermal stability of VCM during polymerization is an important consideration; the efficacy of VCM has been shown to decrease by 87 percent of its initial level after treatment at 60ºC for six months.²

Safety First

The more liquid a bone cement contains, the more toxic it is to patients, surgeons and O.R. staff.³ Cemex uses 33 percent less liquid than best-selling bone cements like Simplex P or Palacos. Why put your health and that of your patient at risk?

One of the most frequent side effects of cementation is a decrease in blood pressure, which is caused by the release, or leakage, of monomer into the blood stream. Because Cemex has a lower liquid content than competitor cements, it is less toxic to patients.³ Additionally, the reduced liquid content makes Cemex safer for the surgeon and O.R. staff. Exposure to high levels of monomer could be toxic to patients and O.R. staff.

Less Heat

Cemex produces more than 20 percent less heat than Simplex P or Palacos.⁴ That’s the difference between warm water and boiling water.

Every gram of monomer (liquid component) generates heat equal to 130 Kcal. Because of its unique powder component, Cemex requires 33 percent less liquid than other bone cements, thereby substantially reducing the maximum temperature reached during the chemical reaction.⁵ The reduced polymerization temperature may reduce the potential for bone and tissue necrosis.

Envision Less Revision

Bone cement with less monomer minimizes the shrinkage phenomena and the likelihood of a revision.

When cement hardens, one of the effects of the chemical reaction is that the cement contracts or “shrinks.” This shrinkage is proportional to the amount of liquid present in the cement mixture. By using less liquid than traditional bone cements, Cemex shrinks 67 percent less than its competitors.⁶ The shrinkage phenomena is most clearly evidenced with the loosening of the prosthesis and early implant failure.

References

1. Takahira N, Itoman M, Higashi K, Uchiyama K, Miyabe M, Naruse K. Treatment outcome of two-stage revision total hip arthroplasty using antibioticimpregnated cement spacer. J Orthop Sci. 2003;8(1):26-31.
2. Mizunuma H, Hidaka N, Higashitani M, et al. Physical and chemical characteristics of vancomycin hydrochloride. Antibiot Chemother. 1992;8:1142-50.
3. Bertazzoni Minelli E, Caveiari C, Benini A. Release of antibiotics from polymethylmethacrylate cement. J Chemother. 2002 Oct;14(5):492-500.
4. Internal report – September 2000 Tecres S.p.A.
5. Nivbrant B, Karrholm J, Rohrl S, Hassander H, Wesslen B. Bone cement with reduced proportion of monomer in total hip arthroplasty: preclinical evaluation and randomized study of 47 cases with 5 years’ follow-up. Acta Orthop Scand. 2001 Dec;72(6):572-84.
6. Debrunner HU. Volume changes of bone cement. Arch Orthop Unfallchir. 1975;81(1):37-44.