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PubMed2004

Backgrounds of antibiotic-loaded bone cement and prosthesis-related infection.

Antibiotic-loaded bone cement has been in use for over 30 years for the fixation of total joint arthroplasties, although its mechanism of action is still poorly understood. This review presents the backgrounds of bone cements, prosthesis-related infection and antibiotic-loaded bone cements. It is shown that antibiotic-loaded bone cement has a significant effect on bacteria, particularly in animal and clinical studies. However, recently, antimicrobial resistance among bacteria has been ascribed to the antibiotic-loaded bone cement. The unresolved issues both regarding the action of antibiotic-loaded bone cement and the nature of the antimicrobial resistance necessitate further research into the interaction of antibiotic-loaded bone cement and bacteria.

Animals↗
PubMed1987

Bone-particle-impregnated bone cement: an in vitro study.

Bone-particle-impregnated bone cement specimens (up to 30% by weight) were characterized by various test methods. The experimental bone cement showed decreased crack propagation rates and increased Young's modulus, while the ultimate tensile strength and impact strength were decreased. The viscosity could be adjusted by adding initiators lost when substituting the PMMA powder with bone particles. The present study warranted further in vivo experiments on the possibility of tissue ingrowth for which the new bone cement was developed.

Biocompatible Materials↗
PubMed2006

Improved mechanical properties of acrylic bone cement with short titanium fiber reinforcement.

Acrylic bone cements are widely used in total joint arthroplasties to grout the prosthesis to bone. The changes in the tensile properties and fracture toughness of polymethylmethacrylate (PMMA) bone cements obtained by the addition of control and heat treated short titanium fibers are studied. Heat treatment of titanium fibers is conducted to precipitate titania particles on the fiber surface, which may improve the biocompatibility of the metal. Control (non-heat treated) and heat treated short titanium fibers (250 microm long and 20microm diameter) were used as reinforcements at 3 volume %. X-ray diffraction indicated the presence of a rutile form of titania due to the heat treatments. Results indicate that the tensile and fracture properties of unfilled bone cement were improved by the addition of control and heat-treated fibers. The fracture properties of bone cements reinforced with control titanium fibers were at least 10% higher than those reinforced with heat treated titanium fibers. Therefore, we recommend further studies on the use of non-heat treated titanium fibers to reinforce acrylic bone cement.

Coated Materials, Biocompatible↗
PubMed1991

A method for histological preparation of undecalcified bone sections containing acrylic bone cement.

An improved and time reducing method is presented for the histological evaluation of bone containing polymethylmethacrylate (PMMA) bone cement. The undecalcified bone was embedded in epoxy resin and section of 50-100 microns thickness were produced using a commercially available cutting grinding system. The sections were stained with Stevenel's blue and van Gieson picrofuchsin or a modified hematoxylineosin. PMMA bone cement was not dissolved and remained enabling examination in situ of an intact cement bone interface and tissue reaction without decalcification.

Animals↗
PubMed2003

Multi-axial fatigue failure of orthopedic bone cement - experiments with tubular specimens.

Bone cement is subjected to multi-axial cyclic loading when used to fixate orthopedic prostheses for joint arthroplasty. In this study, tubular specimens of poly(methylmethacrylate) (PMMA) bone cement are subjected to internal pressure and cyclic axial loading to ascertain the influence of multi-axial loading on fatigue life. As expected, it was found that the probability of survival of specimens under multi-axial loading was very much reduced relative to specimens loaded uniaxially. Furthermore, the variability of the fatigue life was increased by multi-axial loading. In conclusion, the results point to the importance of characterizing the behavior of bone cements under the multi-axial fatigue experienced in vivo, and of the importance of accounting for the multi-axial stress state when predicting implant longevity.

Journal Article↗
PubMed2003

A bioactive bone cement containing Bis-GMA resin and A-W glass-ceramic as an augmentation graft material on mandibular bone.

The potential of a bioactive bone cement (BABC) as an onlay graft material for the mandible with and without the periosteum was investigated in rabbits. Its matrix consists of bisphenol-alpha-glycidyl methacrylate (Bis-GMA) and triethylene-glycol dimetacrylate (TEGDMA) and its filler is silane-treated CaO-SiO2-P2O5-MgO-CaF2 glass (A-W glass-ceramic) powder. The BABC was pasted onto the mandible under the periosteum in Group 1, and onto the mandible with the periosteum removed in Group 2 and allowed to set in situ. In both groups, the cement-bone interface was filled by new bone at 4, 12 and 48 weeks, and bone grew from adjacent bone tissue into the cement-soft tissue interface at 12 and 48 weeks. There were no differences in the rate of bone formation between the groups. The shearing strength increased progressively from 0.25+/-0.10 MPa (mean+/-SD) at week 1 to 7.98+/-0.62 MPa at week 48. The results suggest that the BABC has good handling properties, a high bonding strength and good biocompatibility, and that it has potential for clinical application as a substitute material for autogenous bone transplantation.

Alveolar Ridge Augmentation↗
PubMed2007

Influence of initial component temperature on the apparent viscosity and handling characteristics of acrylic (PMMA) bone cement.

The flow and polymerization characteristics of poly(methylmethacrylate) (PMMA) bone cement can be changed by manipulating the temperature of the bone cement components or the environment that they are prepared in. To quantify the effects of the initial component temperature (T(ic)) of acrylic bone cement on the rheological and handling characteristics, ASTM F451-99a compliant methods and clinically relevant testing methods were utilized. A rheometer was designed and fabricated using the dimensions of a clinical, commercially available, cement gun and nozzle. The influence on the apparent viscosity and handling characteristics (setting time, working time, and peak exotherm temperature) for a high viscosity (HV) commercially-available acrylic bone cement, Palacos R, were determined. The values of T(ic) used were 23 degrees C (room), 6 degrees C (refrigerator), and -14 degrees C (freezer). Using the apparent viscosity of a medium viscosity (MV) bone cement as a benchmark (Simplex P at room temperature), it was found that by adjusting the T(ic) the HV cement was able to mimic the flow characteristics of the MV cement. Lowering the T(ic) lowered the apparent viscosity of the bone cement. The effects of T(ic) on the polymerization of bone cement were studied in dynamic and static conditions. The dynamic test recorded temperature and torque from stirring resistance. Setting times were also determined using the ASTM exotherm mold method. The setting times determined by the dynamic testing conditions were consistently shorter than those determined by the ASTM method. Lowering the T(ic) increased the working and setting times; however, it did not have a significant effect on the peak exotherm temperature.

Bone Cements↗
PubMed2001

Effects of ceramic component on cephalexin release from bioactive bone cement consisting of Bis-GMA/TEGDMA resin and bioactive glass ceramics.

The purpose of this study was to elucidate the effect of amount of ceramic cement powder on drug release from bioactive bone cement. The associated bone-bonding strength was also investigated. The bioactive bone cement under investigation consisted of bisphenol-alpha-glycidyl methacrylate (Bis-GMA), triethylene-glycol dimethacrylate (TEGDMA) resin and a combination of apatite- and wollastonite-containing glass-ceramic (A-W GC) powder. A-W GC powder (50%, 70% and 80% w/w) containing 5% cephalexin (CEX) powder hardened within 5 min after mixing with Bis-GMA/TEGDMA resin. The compressive strength of the cement with or without drug increased with increasing the amount of ceramic powder. The compressive strength of the 80% ceramic cement without the incorporation of cephalexin was 194 MPa. This compressive strength was about 3 times higher than that for polymethylmethacrylate cement. After the cement was implanted in the proximal metaphysis of the tibiae of male rabbits, the failure load for the cement was found to increase with increasing of the amount of ceramic powder. This finding suggested that the cement formed a bonding with bone. In vitro CEX release from bioactive bone cement pellets in a simulated body fluid at pH 7.25 and 37 degrees C continued for more than 2 weeks. Drug release profile followed the Higuchi equation initially, but not at later stages. The drug release rate increased with increasing amount of ceramic powder in the mixture. Since the pore volume of the cement increased with increasing of amount of ceramic powder, the drug diffused in the pores between the ceramics particle and polymer matrix. As hydroxyapatite precipitated on the cement surface, the drug release rate decreased, as observed at the later release stage. These results suggest that varying the amount of ceramic powder in the cement system could control the drug release rate from bioactive bone cement.

Absorbable Implants↗
PubMed2004

A fatigue damage model for the cement-bone interface.

Loss of fixation at the cement-bone interface can contribute to clinical loosening of cemented total hip replacements. In this study, the fatigue damage response was determined for cement-bone constructs subjected to shear fatigue loading. A typical three-phase fatigue response was observed with substantial early damage, followed by a long constant damage rate region and a final abrupt increase in damage to fracture. All of the damage resulted from creep (permanent) deformation during fatigue loading and there was no loss in cyclic stiffness. Using a Von Mises equivalent stress/strain concept, a general damage model was developed to describe the fatigue creep response of the cement-bone interface under either shear or tensile fatigue loading. Time to failure was highly correlated (r2=0.971) with equivalent creep strain rate and moderately related (r2=0.428) with equivalent initial strain for the two loading regimes. The equivalent creep strain at failure (0.052+/-0.018) was found to be independent of the applied equivalent stress. A combination of the creep damage model (to describe the damage process) with a constant final equivalent strain (as a failure criteria) could be used to assess the cement-bone failure response of cemented implant systems.

Bone Cements↗
PubMed2001

The effect on the fatigue strength of bone cement of adding sodium fluoride.

New bone cements that include several additives are currently being investigated and tested. One such additive is sodium fluoride (NaF), which promotes bone formation, facilitating implant integration and success. The influence of NaF on the fatigue performance of the cement as used in biomedical applications was tested in this paper. In fact fatigue failure of the cement mantle is a major factor limiting the longevity of a cemented implant. An experimental bone cement with added NaF (12 wt%) was investigated. The fatigue strength of the novel bone cement was evaluated in comparison with the cement without additives; fatigue tests were conducted according to current standards. The load levels were arranged based on a validated, statistically based optimization algorithm. The curve of stress against number of load cycles and the endurance limit were obtained and compared for both formulations. The results showed that the addition of NaF (12 wt%) to polymethylmethacrylate (PMMA) bone cement does not affect the fatigue resistance of the material. Sodium fluoride can safely be added to the bone cement without altering the fatigue performance of the PMMA bone cement.

Compressive Strength↗
PubMed2002

Does sodium fluoride in bone cement affect implant fixation? Part I: bone tissue response, implant fixation and histology in nine rabbits.

The addition of sodium fluoride to poly (methyl-methacrylate) (PMMA) bone cement may theoretically improve the fixation of joint replacement. This hypothesis was tested in an animal model using nine mature healthy lop-eared rabbits. A femoral prosthesis was inserted in both knees to resurface the patellofemoral articulation. The same acrylic cement, with and without sodium fluoride, was randomised between the two sides for prosthetic fixation. Two screw shaped implants machined from cured rods of either cement were also inserted bilaterally into the proximal tibia. Qualitative and quantitative histomorphometry of the bone tissue response surrounding the cement in the femur and the intact tibial implants revealed similar results regardless of sodium fluoride addition. Six weeks after surgery removal, torque did not significantly differ between the two sides. Our findings indicate that addition of sodium fluoride to PMMA has little effect on implant stability and bone remodeling in rabbits in the short-term.

Journal Article↗
PubMed1988

Antibiotic release from an experimental biodegradable bone cement.

An experimental biodegradable bone cement [poly(propylene fumarate)-methylmethacrylate] (PPF-MMA) has been compared in vivo with polymethylmethacrylate (PMMA) as a carrier agent for local release of antibiotics. This approach is potentially applicable to the treatment of chronic osteomyelitis where the clinical goal is to achieve sustained high concentrations of antibiotics locally in the infected bone. In our experiments, gentamicin- and vancomycin-impregnated cylindrical PMMA and PPF-MMA cement specimens were implanted subcutaneously in rats, and blood and wound fluid samples were obtained over a 2-week period. Antibiotic levels were determined using immunoassays, and microbiologic activity was confirmed with agar diffusion techniques. The biodegradable PPF-MMA cement achieved and maintained considerably higher wound antibiotic levels than did PMMA cement. Vancomycin levels for the PPF-MMA cement were greater than 20 times those for the PMMA cement at all sampling times from 24 h to 14 days. For both cements, the serum antibiotic concentrations remained safely below maximum levels recommended for parenteral therapy. Mechanical testing of the PPF-MMA cement showed that admixture of 3% by weight of antibiotic did not adversely affect material properties. We conclude that this experimental biodegradable bone cement (PPF-MMA) can be used as a carrier to achieve high sustained local levels and low serum levels of antibiotics. Because it is biodegradable and thus does not require a secondary procedure for removal, it has special potential for use in treatment of chronic osteomyelitis.

Administration, Topical↗
PubMed2003

The use of acrylic bone cement for suture anchoring.

Healing of tendon or ligament sutured to bone depends among other parameters on the mechanical stability of the suture fixation in or to the bone. The authors propose a method of anchoring suture material using bone cement as a substitute for conventional suture anchors. Conditions for secure fixation of suture material in bone cement were assessed and the technique of anchoring suture material with acrylic cement in bone was developed. Mechanical testing and microcomputed tomography of the suture-cement-bone compound were done. It was found that the suture always should be knotted before embedding it at least 2 mm deep in the bone cement. The holes drilled into the bone in which the sutures are secured with cement should be at least 3.5 mm in diameter and 10 mm deep; in cortical bone a tapped thread is required. Sutures can be secured safely using cement anchors which provide higher pull-out strength of a factor two to five than conventional metallic suture anchors of comparable size. They also adapt to anatomic situations where conventional anchors cannot be used and are more favorable in osteoporotic bone. Cement anchoring of sutures seems to be a cost-effective and valuable alternative when there is poor bone quality or extraordinarily high mechanical load.

Bone Cements↗
PubMed2005

Development of high-viscosity, two-paste bioactive bone cements.

Self-curing two-paste bone cements have been developed using methacrylate monomers with a view to formulate cements with low polymerization exotherm, low shrinkage, better mechanical properties, and improved adhesion to bone and implant surfaces. The monomers include bis-phenol A glycidyl dimethacrylate (bis-GMA), urethane dimethacrylate (UDMA) and triethylene glycol dimethacrylate (TEGDMA) as a viscosity modifier. Two-paste systems were formulated containing 60% by weight of a bioactive ceramic, hydroxyapatite. A methacroyloxy silane (A174) was used as a coupling agent due to its higher water stability in comparison to other aminosilanes to silanate the hydroxyapatite particles prior to composite formulation. A comparison of the FT-infrared spectrum of hydroxyapatite and silanated hydroxyapatite showed the presence of the carbonyl groups ( approximately 1720 cm(-1)), -C=C-( approximately 1630 cm(-1)) and Si-O- (1300-1250 cm(-1)) which indicated the availability of silane groups on the filler surface. Two methods of mixing were effected to form the bone cement: firstly by mixing in an open bowl and secondly by extruding the two pastes by an auto-mixing tip using a gun to dispense the pastes. Both types of cements yielded low polymerization exotherms with good mechanical properties; however, the lower viscosity of UDMA allowed better extrusion and handling properties. A biologically active apatite layer formed on the bone cement surface within a short period after its immersion in simulated body fluid, demonstrating in vitro bioactivity of the composite. This preliminary data thus suggests that UDMA is a viable alternative to bis-GMA as a polymerizable matrix in the formation of bone cements.

Biomimetic Materials↗
PubMed2004

The strength of acrylic bone cement cured under thumb pressure.

In this investigation, the static tensile strength of bone cement was quantified after mixing it in an open bowl or in a commercially available vacuum mixer and molding it under pressures consistent with values obtained by finger/digital application, as it is used in surgery. Pressure, held for a brief time span on cement in its lower viscosity state, has been demonstrated to increase penetration of the cement into bone. Clinically, bone cement is pressurized by digital pressure, specialized instruments, or by implant design. Specimens were cured under constant pressures of up to 100kPa, which is in the range reported for thumb pressurization of plugged proximal femurs and instrumented pressurization of acetabular sockets. The results showed that application of constant pressure during the polymerization of open bowl mixed bone cement significantly improved its mechanical properties. Application of 100kPa constant pressure to the open bowl mixed bone cement while it cured increased its ultimate strength to a value similar to vacuum mixed cement. Curing under pressure showed no significant effect on the tensile properties of vacuum mixed cement. Curing under pressure did not significantly reduce the size of the largest pores in the tensile specimens.

Humans↗
PubMed1982

The viscosity of acrylic bone cements.

The viscosity of the acrylic bone cement used in total joint arthroplasty is an important material property for determination of the proper handling characteristics and interlock with bone. In this article the rheological properties of the three leading bone cements were determined over a three-decade range of shear rates. In addition, four other cements were tested at a single shear rate. The results indicate that all the acrylic bone cements are non-Newtonian, pseudoplastic materials with significant differences between them. It is shown that the viscosity increases at different rates with respect to increases in time. For the majority of cements there is a steady or increasing rate of viscosity change with time.

Biomechanical Phenomena↗
PubMed1979

[Temporary plugging of cystic bone tumors by bone cement (author's transl)].

Methylmethacrylate bone cement was used to refill bony defects following excisional biopsy of supposed benign or semimalign bone tumors. This procedure offers several advantages: the anatomical situation at the site of the lesion will not be altered, that means the functions of the joint and the continuity and stability of the bone will be preserved; the histological examination of the tissue is possible without a hurry; the follow up of the lesion is easily possible by X-ray-examination; further therapeutic procedures can follow without restriction, for example if the histology discovered an unsuspected malignant tumor or if the follow-up revealed a recurrency. In addition a favorable effect is the necrosis of tumor cells, eventually left behind in the bone, by the action of zytotoxic monomer and heat, originated during the polymerisation of the methylmethacrylate. In benign or semimalignant bone tumors the cement has to be removed after an adequate observation period; at this occasion the cavity again is curetted and then filled with autologous bone grafts. Since 1972 we treated 13 bone lesions by this method of "temporary bone cement plugging". The lesions were 5 giant cell tumors, 2 aneurysmal bone cysts, 2 simple bone cysts, 1 osteosarcoma, 1 malignant lymphoma, and 2 metastases of hypernephroid carcinoma. In the case of osteosarcoma an amputation was performed just after the diagnosis was made. In the other cases no local recurrances up to now were seen.

Adult↗
PubMed2007

Biocompatibility of a new radiopaque iodine-containing acrylic bone cement.

Radiopacity in the vast majority of the commercially available acrylic bone cements that are used clinically is provided by particles of either BaSO(4) or ZrO(2). Literature reports have shown these agents to have a detrimental effect on some mechanical properties of the cements as well as on its biological response. We, therefore, have developed a new type of bone cement, for which radiopacity results from the presence of an iodine-containing methacrylic copolymer. The focus of the present work was the comparison of the biocompatibility of this new cement and a commercially available cement that contains barium sulfate. In vitro experiments show that both cements are cytocompatible materials, for which no toxic leachables are found. Implantation of the cements in a rabbit for three months resulted in the occasional presence of a thin fibrous tissue at the cement-bone interface, which is common for acrylic bone cements. Consideration of all the results led to the conclusion that the new cement is as biocompatible as the BaSO(4)-containing one.

Animals↗