Variations in the density of bone cement after centrifugation.

Barium sulfate added to bone cement to provide radiopacity has a density about four times greater than that of polymerized radiolucent bone cement. Because centrifugation might make a clinically significant change in the distribution of barium sulfate, this process was studied. Radiolucent and radiopaque Simplex-P bone cement (Howmedica, Inc., Rutherford, New Jersey) were mixed with and without cooling and centrifuged for two or four minutes at 2,000 g or 1,000 g (gravity acceleration). The density of sections of the hardened bone cement was measured using the Archimedes principle. Erythromycin and colistin were added to cement batches to test whether or not centrifugation affected the distribution of antibiotics. Direct and radiographic observation and density measurements (cooled specimens, 2,000 g, p less than 0.01) verified that barium sulfate does accumulate at the bottom of the centrifugation tubes. Thin sections of the bone cement revealed that only larger particles (20-100 micron) of barium sulfate were deposited at the bottom. No evidence of redistribution of antibiotics after centrifugation was seen. It is recommended that Simplex-P bone cement be reformulated to eliminate concern about inhomogeneities that arise from centrifugation. Further, it is recommended that cooled, centrifuged antibiotic cement be used for long-stem revision hip surgery, where longer setting times are necessary, and room temperature cement for "fresh" hip surgery. A total centrifuge time of two minutes with a 2,000 g maximum force is recommended.