Clarifying the Effect of Cement Mixing Technique on Antibiotic Elution: Higher Porosity Increases, Not Decreases, Release

Articles in Press

Document Type : LETTER TO THE EDITOR

Authors

1 Tehran University of Medical Sciences Joint Reconstruction Research Center

2 Orthopedic Research Center, Shahid Kamyab Hospital, Mashhad University of Medical Sciences, Mashhad, Iran

3 Department of Orthopedic Surgery, Shiraz University of Medical Sciences, Shiraz, Iran

10.22038/abjs.2026.96268.4317

Abstract

In their review on antibiotic-impregnated cement spacers, Shahpari et al. present an internally contradictory account of how cement mixing technique affects antibiotic elution. They correctly state that porosity increases elution and that hand mixing produces a more porous cement with intact antibiotic crystals, yet conclude that hand mixing decreases the overall elution rate. This conclusion conflates inconsistent elution with reduced elution. Inhomogeneous distribution in hand-mixed cement may produce non-uniform release kinetics, but the increased porosity raises the overall elution rate, whereas vacuum mixing lowers porosity and reduces release while improving mechanical strength. Multiple in vitro studies and systematic reviews confirm that hand mixing increases antibiotic elution relative to vacuum mixing. We propose a corrected statement and highlight the clinical relevance for surgeons selecting a mixing technique when preparing antibiotic-loaded spacers for two-stage revision arthroplasty.

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The Archives of Bone and Joint Surgery

Articles in Press, Accepted Manuscript
Available Online from 20 June 2026

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History

  • Receive Date: 15 June 2026
  • Revise Date:
  • Accept Date: 17 June 2026

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