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PubMed1998

Revision of failed cementless total knee implants with cement.

Between 1986 and 1996, 268 revision total knee replacements were performed. Revisions for aseptic loosening were reviewed prospectively. Sixty-three patients had implants revised for aseptic loosening. Thirty-six of the patients had revisions of cemented constructs, whereas 27 of the patients had revisions of cementless constructs. The average time before revision for the cemented group was 86 months. The average time to revision for the cementless group was only 43 months. Fifty-two percent of the patients in the cementless group had revision of their implants within 2 years of their index arthroplasty. The average pain free interval for the cementless group was only 11 months with 63% of the patients having no pain relief after their index arthroplasty. The average postoperative score for the cementless group was 88, whereas the average postoperative score for the cemented group was 82. Revision of failed cementless total knee implants with cement is a reliable procedure. Results are similar to those of cemented knees revised with cement.

Arthralgia↗
PubMed2000

A biomechanical comparison of Schuhli nuts or cement augmented screws for plating of humeral fractures.

Schuhli locking nuts can be used in poor quality cortical bone to enhance fixation stability as an alternative to cement augmented screws. This study compared the fixation strength and stability of plate constructs using Schuhli locking nuts with standard screws and cement augmented screws for fixation of simulated humeral shaft fractures in a test model with osteoporosis. The constructs were tested in axial compression, 4-point bending, and torsion to determine fixation stability. The humeri were cycled in torsion (4.5 Nm) for 1000 cycles to simulate upper extremity use during the early postoperative period and retested for stability. The Schuhli locking nuts and cement augmented screws had significantly greater fixation stability than the standard screws before (range, 6-14 times greater) and after cycling in torsional loading (range, 3-3.6 times greater). Although cement augmented screws and Schuhli augmentation showed increased fixation stability compared with the standard screws in axial and 4-point bending before cycling (range, 1.3-1.4 times greater), this was not significant. Compared with Schuhli fixation, cement augmented screws showed no significant difference in fixation stability in all loading modes before and after cycling. Schuhli locking nuts offer the stability of cement augmentation while avoiding its potential adverse effects on fracture healing with extravasation and thermal necrosis.

Biomechanical Phenomena↗
PubMed2003

Antibacterial effect of a hydraulic calcium phosphate cement for dental applications.

Calcium hydroxide is currently used in dentistry for endodontic treatment where its main advantage consists of its antibacterial and anti-inflammatory potency. However, it also has some drawbacks such as pulp necrosis, slight solubility, slow and low hardening, and retraction on drying. Since the studies conducted by Brown and Chow (IADR 1983, abst. 207), calcium phosphate-based cements (CPC) have attracted considerable interest in bone reconstruction because of their good osteoconductivity. By mixing calcium bis-dihydrogenphosphate monohydrate (MCPM) and calcium oxide with sodium phosphate buffer in the form of liquid phase, we obtained a CPC with better mechanical properties than calcium hydroxide. The setting reaction produced a mixture of calcium-deficient hydroxyapatite and calcium hydroxide, making this cement more suitable for dental applications than orthopedic ones. The presence of calcium hydroxide a priori confers antibacterial properties to this cement, which were investigated in agar plates (diffusion method) against Streptococcus mutans, Lactobacillus acidophilus, Candida albicans (clinical isolates) and a preparation of polymicrobial flora isolated from dental plaque. The cement samples tested were prepared at calcium-to-phosphate molar ratios (Ca/P) ranging from 1.67 to 2.75. A pure calcium hydroxide paste was used as reference material. Clear and reproducible bacterial growth inhibition was observed for cement samples with Ca/P > or = 2 against all the microorganisms tested. MCPM-CaO-based cement is therefore a potential candidate for pulp capping and cavity lining.

Anti-Infective Agents, Local↗
PubMed2002

An in vivo comparison of the potential for extravertebral cement leak after vertebroplasty and kyphoplasty.

STUDY DESIGN: A prospective in vivo study was conducted during the performance of kyphoplasty for the treatment of osteoporotic vertebral compression fractures, comparing extravertebral contrast extravasation with kyphoplasty and vertebroplasty. OBJECTIVE: To determine the frequency and pattern of extravertebral contrast extravasation after intravertebral injection during kyphoplasty and vertebroplasty, which have implications for cement leakage during these procedures. SUMMARY OF BACKGROUND DATA: Vertebroplasty involves the injection of cement directly into the cancellous bone of a fractured vertebral body in an attempt to stabilize the fracture. High rates of extravertebral cement leakage have been noted. Injection of contrast into the vertebral body under fluoroscopy has been recommended in an attempt to predict and minimize cement leakage. An alternative procedure, balloon kyphoplasty, involves the percutaneous placement of an inflatable bone tamp into the fractured vertebral body. As the tamp is inflated, vertebral body height is restored and a cavity is created within the vertebral body, allowing for low-pressure cement filling of the cavity. METHODS: During 20 kyphoplasty surgeries for vertebral compression fractures, contrast studies were performed. Immediately after positioning of an 11-gauge biopsy needle within the midvertebral body, 5 mL of Omnipaque was injected, mimicking vertebroplasty injection. Cinefluoroscopic images were obtained during injection. After bilateral fracture reduction and intravertebral cavity creation using inflatable bone tamps (kyphoplasty), contrast was injected again, mimicking cement injection during kyphoplasty. Scoring of the extravertebral contrast leakage was based on filling of the inferior vena cava and epidural vessels, as well as direct contrast extension through the vertebral cortex. RESULTS: The mean contrast leak scores for vertebroplasty- and kyphoplasty-stage injections were, respectively, 4.3 and 0.8 of 6 (P = 0.0001). The scores for epidural vessel and inferior vena cava filling and transcortical contrast leak each was significantly lower for kyphoplasty- than for vertebroplasty-stage injections (P = 0.0001 each). CONCLUSIONS: The findings showed less vascular and transcortical extravasation of injected contrast with kyphoplasty than with vertebroplasty. Although leakage of contrast may not correlate precisely with polymethylmethacrylate leakage, the authors believe this study highlights the relative safety of these procedures.

Aged↗
PubMed2006

Alendronate in bone cement: fatigue life degraded by liquid, not by powder.

Bisphosphonates have the potential to reduce osteolysis, a phenomenon that has been postulated to play a key role in aseptic loosening of total joint replacements. Bisphosphonates may contribute to the in vivo longevity of total joint replacements. Some authors have suggested there are decreases in flexural strength and flexural modulus of the cured cement when a liquid form of disodium pamidronate is added to a commercially available acrylic bone cement (Palacos R). We proposed that it is comparatively easier to blend a bisphosphonate in powder form into an acrylic bone cement than it is when the drug is in liquid form; and that the cement's fatigue life is decreased when the bisphosphonate is added in liquid rather than in solid form. The bisphosphonate and bone cement used were alendronate sodium and Cemex XL, respectively. The fatigue tests were done using phosphate buffered saline solution at 37 degrees +/- 1 degrees C. The data supported both hypotheses. Our findings should guide orthopaedic surgeons when using bisphosphonate-impregnated acrylic bone cements in total joint replacements. Bisphosphonates are endogenous pyrophosphate analogs in which a carbon atom replaces the central oxygen atom. These therapeutic agents may be classified into nitrogen and non-nitrogen containing types. Some examples are alendronate, pamidronate, ibandronate, risedronate, etidronate, clodronate, and zoledronate. There are many targets and mechanisms of action of this family of drugs, therefore making them efficacious against diverse clinical conditions such as osteoporosis, periprosthetic bone loss subsequent to total joint replacement, tumor cell proliferation, apoptosis and angiogenesis, Charcot neuroarthropathy, rheumatoid arthritis, ankylosing spondylitis and spondyloarthropathies, and arterial calcification. It has been proposed that some bisphosphonates are effective against the mechanisms that have been suggested as being implicated in aseptic loosening of total joint replacements, these being osteoclast-mediated bone resorption and wear particle-induced osteolysis. A meta-analysis of randomized controlled trials showed that alendronate and pamidronate had beneficial effects maintaining periprosthetic bone for as much as 1 year after a total joint replacement.

Alendronate↗
PubMed2006

A cemented caval vein filter: case report.

STUDY DESIGN: Case report. OBJECTIVE: To present a previously undescribed complication of bone cement use during spinal surgery. SUMMARY OF BACKGROUND DATA: Surgical cement reaching the circulation is a frequently described complication. The placement of caval vein filters is a routine measure in specific patients to prevent thrombotic material, usually from deep venous thrombosis in the lower extremities, from reaching the pulmonary circulation. A case of bone cement getting trapped in the caval filter rendering it unremovable has not been published. METHODS: A 66-year-old patient underwent dorsal spondylodesis of the lumbar spine for superinfected metastasis with instability. Because of deep venous thrombosis of both femoral and iliac veins, a caval filter had been placed before surgery. Bone cement from the surgical procedure migrated into the venous bloodstream and got caught in the caval filter, thus rendering the filter unremovable. RESULTS: Surgical removal of the filter was necessary. CONCLUSION: If caval filters are present in patients undergoing surgery involving the use of bone cement, the possibility of cement being caught by the filter must be considered.

Aged↗
PubMed2005

A comparison of resistance to fracture among four commercially available forms of hydroxyapatite cement.

Hydroxyapatite cement is a relatively new biomaterial that has found widespread use in craniomaxillofacial surgery. Despite its common usage, complication rates as high as 32% have been reported. When failed implants are removed, implant fracture has been cited as a potential cause of failure. The purpose of this study was to evaluate resistance to fracture among 4 commercially available hydroxyapatite cement formulations. The materials tested included Norian Craniofacial Repair System (carbonated apatite cement) (AO North America, Devon, PA), Norian CRS Fast Set Putty (carbonated apatite cement) (AO North America), BoneSource (hydroxyapatite cement) (Stryker Leibinger, Portage, MI), and Mimix (hydroxyapatite cement) (Walter Lorenz Surgical, Inc, Jacksonville, FL). To ensure consistency, all materials were embedded in acrylic wells. Each material was placed into a well 2.54 cm in diameter and 0.953 cm in thickness. The materials were prepared per manufacturer specifications. All materials were incubated at 37.0 degrees C, in 6% CO2, 100% humidity for 36 hours. Using the Bionix MTS Test System, a 12-mm-diameter probe applied incremental force to the center of the disk at a rate of 0.1 mm per second. The transmitted force was measured using a Bionix MTS Axial-Torsional Load Transducer for each disk. The force which resulted in fracture was recorded for each material. Ten disks of each material were processed by this method, for a total of 40 disks. The significance of resistance to fracture for the 4 compounds was analyzed using 1-way analysis of variance with post hoc Scheffe method. Mean fracture force with related P values was plotted for direct comparison of group outcomes. Material type contributed significantly to variance in fracture force for the biomaterials studied. Norian CRS required the greatest mean fracture force (1385 N, SD+/-292 N), followed by Norian CRS Fast Set Putty (1143 N, SD+/-193 N). Mimix required a mean fracture force of 740 N, SD+/-79 N. BoneSource required a mean fracture force of 558 N, SD+/-150 N. Mimix and BoneSource required significantly less force for fracture when compared with Norian CRS and Fast Set Putty (P<0.01). Comparisons of fracture load resistance between 4 commonly used bone substitute materials have not been previously reported. Increasing biomaterial strength may reduce complications resulting from reinjury to cranioplasty sites. In this model, Norian CRS and Norian CRS Fast Set Putty demonstrated a significantly greater resistance to fracture when compared with BoneSource and Mimix.

Analysis of Variance↗
PubMed2004

Audiometric evaluation of an attempt to optimize the fixation of the transducer of a middle-ear implant to the ossicular chain with bone cement.

Typically, an implantable hearing device consists of a transducer that is coupled to the ossicular chain and electronics. The coupling is of major importance. The Vibrant Soundbridge (VSB) is such an implantable device; normally, the VSB transducer is fixed to the ossicular chain by means of a special clip that is crimped around the long process of the incus. In addition to crimping, bone cement was used to optimize the fixation in six patients. Long-term results were compared to those of five controls with crimp fixation alone. To assess the effect of bone cement (SerenoCem, Corinthian Medical Ltd, Nottingham, UK) on hearing thresholds, long-term post-surgery thresholds were compared to pre-surgery thresholds. Bone cement did not have any negative effect. Next, to test the hypothesis that aided thresholds might be better with the use of bone cement, aided thresholds were studied. After correction for the severity of hearing loss, only a small difference was found between the two groups at one frequency, viz. 2 kHz. It was concluded that there was no negative effect of using bone cement; however, there is also no reason to use bone cement in VSB users on a regular basis.

Adult↗
PubMed1975

Linear dimensional change during setting of a zinc phosphate cement. A methodological study.

A method for studying the linear dimensional changes of dental cements during setting has been described. The measurements started 3 min after commencing the mix with specimens placed on a mercury bath. Measurements were performed at 37 degrees C and under various environmental humidity. The specimens were made of a fine grain zinc phosphate cement with high powder/liquid ratio (3/1:g/ml) and low powder/liquid ratio (2/1:g/ml), and the measurements showed that the cement contracted during setting under both wet and dry conditions. Under wet conditions cements with both high and low powder/liquid ratio showed the same contraction, with 0-43% after 30 min reaching a maximum of 0-66% after 1 day. Under dry conditions the contraction was more pronounced, and somewhat dependent on the powder/liquid ratio. The cement with the high powder/liquid ratio showed 1-33% contraction after 30 min with a maximum of 3-83% after 7 days, whereas the corresponding values for cement with low powder/liquid ratio were 0-79% and 4-76%.

Chemical Phenomena↗
PubMed1993

The use of intermediary resins when bonding glass polyalkenoate (ionomer) cement to composite resin.

This study was designed to examine the effects of three different types of glass polyalkenoate lining cement combined with three different types of bonding resin and varying surface treatments on the seal between the lining cement and the composite resin as used in the so called 'laminate' technique. The seal was assessed using a radioisotope and autoradiographic technique. Results showed that all the cements behaved in a manner specific to them. The seal of all systems examined could be improved, or at least, not compromised, by modification of the surface of the cement prior to attachment of the resin. Only one type of intermediate resin gave a reliable seal when applied to an unmodified surface of any of the cements under investigation. It is concluded that all the glass polyalkenoate cements tested behave differently when used beneath composite resin. Recommendations about the laminate restoration technique must be related to the specific combinations of materials used.

Composite Resins↗
PubMed1994

The attenuation of radiation by porcelain and its effect on polymerization of resin cements.

The influence of porcelain thickness and opacity on the polymerization of two dual activated (microfine and hybrid) and one light irradiated (hybrid) resin cements was assessed by hardness measurements. The surface microhardness values of the upper and lower surface of 1 mm thick resin cement specimens were determined. Specimens were polymerized using 40s irradiation beneath different thicknesses and opacities of porcelain discs. The results showed that increasing the thicknesses and opacity of the porcelain produced a statistically significant decrease in microhardness of the resin-based cements. The effect of attenuation is less for the microfine cement than for the hybrids. In the case of hybrid cements, the light activated material performed better than the dual activated cement.

Acrylic Resins↗
PubMed1988

Detection of embolized material in the right atrium during cementation in hip arthroplasty.

Precordial Doppler ultrasound, hemodynamic changes and end-tidal carbon dioxide (ETCO2) were monitored in 36 patients undergoing hip surgery in general anesthesia. Changes in Doppler ultrasound indicative of embolization were recognized in 22 out of 36 patients during femoral cementation. The character of the ultrasound was suggestive of air emboli, though simultaneous embolization of bone marrow could not be excluded. Embolization was associated with a fall in arterial oxygen tension (PaO2). Both embolization and reduction of PaO2 were influenced by the cementation technique. Digital anterograde insertion and insertion by syringe of acrylic bone cement into the femoral cavity caused ultrasound changes in 92% and 75% respectively, whereas retrograde insertion of low viscosity bone cement was accompanied by ultrasound activity in only one patient (9%). The blood levels of monomeric methylmethacrylate (MMA) released from the low viscosity bone cement ranged from 0.04 to 7.01 micrograms/ml-1. Doppler ultrasound monitoring gave valuable help during cementation, as the ultrasound change immediately signalled a warning of embolism and an imminent decrease in PaO2.

Aged↗
PubMed1992

The effect of irrigating solutions on the strength of the cement-bone interface.

Irrigating solutions are commonly used in the preparation of bony surfaces before total joint replacement components are cemented. Using an experimental cemented arthroplasty model, metal pseudo-prostheses were cemented to a cadaveric bone surface prepared with a specific irrigating solution. A tension load was then applied to the prosthesis until failure occurred at the cement-bone interface. A quantitative analysis of the effect of three commonly used irrigating solutions on the strength of the cement-bone interface is presented. Sixty trials were performed with normal saline, povidone iodine and hydrogen peroxide. Irrigation with hydrogen peroxide afforded statistically superior cement fixation in this arthroplasty model when compared with either normal saline or povidone iodine (P less than 0.01 Chi-squared test).

Animals↗
PubMed1996

Fatigue of resin cement-base metal alloy bond strength.

PURPOSE: Strong durable bonds between resin cements and metal alloys are critical to the success of resin-bonded, resin-veneered, or resin-retained prostheses. However, few comprehensive, comparative evaluations of materials or the fatigue effects of thermal cycling have been reported. The rate of strength loss may be a more important predictor of long-term success than bond strength. The purpose of this study was to investigate the effects of artificial aging by thermal cycling and resin cement type on the bond strengths to a base metal alloy. MATERIAL AND METHODS: This study investigated the effect of the number of thermal cycles (0, 1, 10, 100, 1,000, and 10,000) on the bond strengths of nine fixed prosthodontic resin cements. Specimens were assigned randomly to thermal cycle number/cement type test groups. Cylinders of a base metal alloy were bonded in an end-to-end configuration. One end of each bonded specimen was insulated, and the specimen was thermal cycled. Then, the bonds were tested in shear and bond strengths calculated. RESULTS: Two-way ANOVA revealed that the effects of cement type, the number of thermal cycles, and their interaction all significantly affected bond strength (p < .0001). Multiple range analysis showed that some cements had significant trends to lose bond strength with thermal cycling (p < .05), while others did not (p > .05). CONCLUSIONS: Both the type of resin cement and the amount of thermal cycling influenced bond strength to a base metal alloy. Some materials displayed more rapid loss of bond strength than others.

Analysis of Variance↗
PubMed2003

Efficacy of a resin coating on bond strengths of resin cement to dentin.

PURPOSE: The aims of this study were to (1) evaluate the effect of a resin coating consisting of a dentin bonding system and a flowable resin composite on the microtensile bond strength (micro-TBS) of a resin cement to dentin in indirect composite restorations and (2) compare the bond strengths of direct and indirect composite restorations. MATERIALS AND METHOD: Occlusal surfaces of human premolars were ground to obtain flat dentin surfaces and were divided into seven groups. For indirect restorations, the dentin surfaces of the experimental groups were bonded with a dentin bonding system (DBS), Clearfil SE Bond (SE) or Single Bond (SB) with and without a flowable resin composite, Protect Liner F (PLF), temporized for one day and cemented with a resin cement (Panavia F) according to the manufacturer's instructions. The dentin surfaces of the control group were temporized without prior treatment, and indirect composite (Estenia) was bonded with Panavia F. For the direct restorations, either SE or SB was applied to the dentin surface and the entire surface was built up with direct composite (Clearfil AP-X). After 24 hours in water storage, micro-TBS was measured at a crosshead speed of 1 mm/min. The data were analyzed with one-way analysis of variance and Fisher's protected least significant difference test (p < .05). RESULTS: The original bond strength of the resin cement (Panavia F) to dentin significantly improved with the use of a resin coating technique in indirect restorations (p < .05). The combination of DBS + PLF showed significantly higher bond strengths compared with the single use of DBS. The combination of SE + PLF as a resin coating provided the highest bond strengths in indirect restorations (p < .05). However, the best bond strengths were observed when SE and SB were used for direct composite restorations (p < .05). CONCLUSIONS: The application of a resin coating consisting of a dentin bonding system and a flowable resin composite on the dentin following cavity preparation significantly improved the micro-TBS of the resin cement Panavia F to dentin in indirect restorations. However, the bond strengths of indirect composite restorations were significantly lower than those of direct composite restorations even with the resin coating technique. CLINICAL SIGNIFICANCE: Indirect composite restorations may require a resin coating to improve the bonding performance of the resin cement Panavia F to dentin. However, adhesive systems with direct composite restorations still provide superior bond strengths compared with indirect restorations.

Analysis of Variance↗
PubMed2004

In vitro testing of antimicrobial activity of bone cement.

The purpose of this study was to establish a reliable and cost-effective microplate proliferation assay for in vitro antimicrobial testing of bone cement samples. Cement samples devoid of antimicrobial agents, loaded with 2% gentamicin or with different concentrations of high-porosity silver, were incubated in a 96-well microplate with several staphylococcal, Pseudomonas aeruginosa, and Enterococcus faecium isolates exhibiting different susceptibilities to gentamicin. After being rinsed, the samples were brought into a soy medium in which adherent cells on the cement surface either were killed by the antimicrobial surface or started to release clonal counterparts. The medium was monitored in real time by recording a time proliferation curve for each well. Microplate testing revealed no antibacterial effect of plain bone cement. The antibacterial activity of gentamicin-loaded bone cement was shown by the microplate test to depend on the gentamicin susceptibilities of the strains. The effect of high-porosity silver was dose dependent. Bactericidal activity against all tested strains was found for bone cement loaded with 1% high-porosity silver. The accuracy of this new proliferation assay was shown by the high correlation between the types of proliferation curves and antibiotic susceptibility. In contrast to routine agar diffusion testing, it assesses the dynamic response of microorganisms to antimicrobial agents in biomaterials and allows high-throughput screening and detection of antimicrobial properties of poorly water-soluble compounds like silver.

Anti-Bacterial Agents↗
PubMedDate not supplied

Effects of cement bases on the stresses and deflections in composite restorations.

A model was used to investigate stresses and deflections in cement bases and in a composite restorative material induced in a posterior Class I restoration. Deflections in the composite were highest when it was supported by a base with a low modulus; however, the maximum tensile stress (12 MN/meter2) occurring in the composite restoration at the interface with the base was well below the maximum tensile strength of most composite materials (30 to 40 MN/ meter2). Tensile and shear stresses occurring in the cement bases were of sufficient magnitude to exceed the strength of the cement when a 1.5-mm layer of zinc phosphate cement (base consistency) was supported by a 0.5-mm layer of ZOE lining material. Lowest values of stress were observed when a 2-mm layer of a zinc polyacrylate base was used to support the composite restoration. An ideal situation would be to have a cement base with a modulus of elasticity equal to that of the composite material. Finally, the maximum stress and deflection values obtained here can be easily exceeded in a clinical situation when wider variations can be easily introduced, making the choice of a cement with the proper modulus even more critical.

Composite Resins↗
PubMedDate not supplied

Cement coating of osteoarticular allografts in rats to prevent the immune response.

Recently, more attention is being paid to the treatment of the articular surface defect in the young, active individual. Resurfacing or "shell" allografts are being considered as one of the alternatives for treatment. The immune response by the host may be the chief obstacle to the successful use of fresh osteoarticular allografts. Since proteins on the surfaces of allograft bone cells are considered to be the principal antigens eliciting the immune response, we hypothesized that mechanical masking of these cells by a biodegradeable blocking agent might prevent the immune response. Osteoarticular allografts of the distal femur were performed in rats and the cut surfaces of the graft were coated with cement before implantation. In a preliminary experiment, six biodegradeable cement materials were tried (bone wax, zinc polycarboxylate, collodion, fibrin adhesive, zinc oxide, and isobutyl-cyanoacrylate). Of these, the zinc oxide cement and isobutyl-cyanoacrylate were effective in inhibiting the immune response observed in control rat distal femur allografts. A second experiment was performed using nine rats with zinc oxide and nine rats with isobutyl-cyanoacrylate cements. These were compared with 20 control rats that had allografts without cement coating. Eighteen of the control rats (90%) developed an immune response, while only 22% (2/9) of the rats with zinc oxide coating and 33% (3/9) of the rats with isobutylcyanoacrylate developed an immune response. In a third experiment distal femur allografts were performed in 13 rats using only the liquid component of the zinc oxide cement.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

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