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PubMed2004

Practical applications of antibiotic-loaded bone cement for treatment of infected joint replacements.

The use of antibiotic-loaded bone cement is an accepted treatment method for infected joint arthroplasties. It is helpful to separate the use of antibiotic-loaded bone cement as a method of prophylaxis as compared with the treatment of an established infection. A low dose of antibiotic-loaded bone cement (< or = 1 g of antibiotic per batch of cement) should be used for prophylaxis, and high-dose antibiotic-loaded bone cement (> 1 g antibiotic per batch of cement) is indicated for treatment. The only commercially available antibiotic-loaded bone cement products are low dose, with the use of tobramycin or gentamicin as an antibiotic selection. High-dose antibiotic-loaded bone cement requires hand mixing by the surgeon to facilitate the use of high dosages and choices of multiple antibiotics. Treatment of infected hip and knee arthroplasties with high-dose antibiotic-loaded bone cement is aided by the use of spacers of various shapes and sizes. These spacers, whether they are static or articulating (mobile), are meant to provide local delivery of antibiotics, stabilization of soft tissues, facilitation of an easier reimplantation, and improved clinical outcomes.

Anti-Bacterial Agents↗
PubMed1979

Silver polymethyl methacrylate antibacterial bone cement.

An improved antibacterial bone cement was sought based on the addition of low concentrations of inorganic silver compounds to polymethyl methacrylate. Composites with AgCl, Ag-AgCl, Ag2O, Ag2SO4 and Ag3PO4 in concentrations of 0.05% to 1% by weight, were tested in vitro against bacterial cultures. All were effective, but Ag2SO4 was especially so, even after 7 weeks of incubation in normal saline. Compressive strength of the cement was not affected by these additions, except in the case of Ag2O. Biocompabibility tests in rabbit muscle for up to 12 weeks showed no significant difference between the Ag -PMM and plain PMM in tissue reactivity, both being minimal. These features, coupled with the broad spectrum of antibacterial activity and low allergic potential of silver, make Ag-PMM an attractive alternative to conventional organic antibiotic/bone cement composites.

Acrylic Resins↗
PubMed1977

Reaction of bone to the acute chemical trauma of bone cement.

The acute chemical trauma of bone cement was investigated in the rabbit tibia. With the experimental model used, the surgical trauma and the thermal effects of the cement could be minimized. Each animal received one implant of polymerized cement as a control and one implant of polymerizing dough as the test material. The animals were observed for up to seventy days and the specimens were then studied by various techniques of histology, microangiography, fluorochrome labeling, and microradiography. With this experimental method the monomer trauma did not add to the minimized surgical trauma. Moreover, no detectable influence on bone regeneration was noted. In view of this minor effect, we suggest that the surgical preparation of the implant bed and the very procedure of inserting bone cement are more important for the acute tissue trauma than is monomer leakage alone.

Animals↗
PubMed2005

Bioactive bone cements containing nano-sized titania particles for use as bone substitutes.

Three types of bioactive polymethylmethacrylate (PMMA)-based bone cement containing nano-sized titania (TiO2) particles were prepared, and their mechanical properties and osteoconductivity are evaluated. The three types of bioactive bone cement were T50c, ST50c, and ST60c, which contained 50 wt% TiO2, and 50 and 60 wt% silanized TiO2, respectively. Commercially available PMMA cement (PMMAc) was used as a control. The cements were inserted into rat tibiae and allowed to solidify in situ. After 6 and 12 weeks, tibiae were removed for evaluation of osteoconductivity using scanning electron microscopy (SEM), contact microradiography (CMR), and Giemsa surface staining. SEM revealed that ST60c and ST50c were directly apposed to bone while T50c and PMMAc were not. The osteoconduction of ST60c was significantly better than that of the other cements at each time interval, and the osteoconduction of T50c was no better than that of PMMAc. The compressive strength of ST60c was equivalent to that of PMMAc. These results show that ST60c is a promising material for use as a bone substitute.

Animals↗
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 to improve the biocompatibility of the metal. Control and heat treated short titanium fibers (250 micro long and 20 micro 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. The tensile and fracture properties were improved by the addition of fibers. Bone cements reinforced with titanium fibers heated at 550 degrees C for 1 h followed by 800 degrees C for 30 minutes show the largest increase in fracture toughness along with the smallest changes in elastic modulus and needs to be further investigated.

Benzoyl Peroxide↗
PubMed1980

New clinico-pathophysiological studies on the bone cement implantation syndrome.

Implantation of endoprostheses with bone cement is followed by alterations of the circulation. Intoxication, caused by the monomer of bone cement or pulmonary embolism by intramedullary contents constitute the two mostly accepted pathophysiological hypotheses. Because of the lack of pulmonary and circulatory physiological data a clinical decision concerning the value of the hypotheses was not possible until now. Hip prosthesis implantation was analyzed in 15 patients by measuring equipment controlled by an on-line-computer. The device allowed a high rate of data retrieval. The bone cement implantation syndrome reveals itself as cardiorespiratory sequelae of a disseminated pulmonary embolism which is originating in intramedullary contents, squeezed intravasal. Usual prophylactic methods are revisited.

Adult↗
PubMed2003

Biocompatibility and other properties of acrylic bone cements prepared with antiseptic activators.

Acrylic bone cements prepared with activators of reduced toxicity have been formulated with the aim of improving the biocompatibility of the final material. The activators used were N,N-dimethylaminobenzyl alcohol (DMOH) and 4,4'-dimethylamino benzydrol (BZN). The toxicity, cytotoxicity, and antiseptic action of these activators were first studied. DMOH and BZN presented LD50 values 3-4 times higher than DMT, were less cytotoxic against polymorphonuclear leucocytes, and possessed an antimicrobial character, with a high activity against the most representative microorganisms involved in postoperative infections. The properties of the acrylic bone cements formulated with DMOH and BZN were evaluated to determine the influence of these activators on the curing process and the physicochemical characteristics of the cements. A decrease of the peak temperature was observed for the curing with DMOH or BZN with respect to that of one commercially available formulation (CMW 3). However, residual monomer content and mechanical properties in tension and compression were comparable to those of CMW 3. The biocompatibility of acrylic bone cements containing DMOH or BZN was studied and compared with CMW 3. To that end, intramuscular and intraosseous implantation procedures were carried out and the results were obtained from the histological analysis of the surrounding tissues at different periods of time. Implantation of rods of cement into the dorsal muscle of rats showed the presence of a membrane of connective tissue, which increased in collagen fibers with time of implantation, for all formulations. The intraosseous implantation of the cements in the dough state in the femur of rabbits, revealed a higher and early osseous neoformation, with the presence of osteoid material surrounding the rest of the cured material, for the cement prepared with the activator BZN in comparison with that obtained following the implantation of the cement cured with DMOH or DMT (CMW 3).

Alcohols↗
PubMed1989

[An in vivo study of inorganic bone particle-impregnated bone cement].

According to definite proportion by weight, inorganic bone particles were impregnated into bone cement and then used for the fixation of implanted artificial femoral head in a series of canines. Upon successive observations, new bone was seen to have already been growing into the bone cement one month post operatively, and active growth going on with bone tissue passing through the whole layer of cement three months after operation. In the fifth month's specimens, most of the inorganic bone particles were replaced by new bone tissue while slices of one year post operation showed that the bone tissue was mature and the activity of bone formation ceased. The biological fixation effect produced by bone ingrowth was found to have increased the shearing strength of cement-bone interface to 1.4-3.6 times of the control side and the stability of prosthesis was improved obviously. The bone-particle-impregnated bone cement has already been using in our clinical practice since 1987.

Animals↗
PubMed1984

A crack model of a bone cement interface.

This paper is concerned with the fracture mechanics of a bone-cement interface that includes a cohesive zone effect on the crack faces. This accounts for the experimentally observed strengthening mechanism due to the mechanical interlock between the crack faces. Edge crack models are developed where the cohesive zone is simulated by a continuous or a discrete distribution of linear or nonlinear springs. It is shown that the solution obtained by assuming a homogeneous material is fairly close to the exact solution for the bimaterial interface edge crack problem. On the basis of that approximation, the analysis is conducted for the problem of two interacting edge cracks, one at the interface, and the other one in the cement. The small crack that was observed to initiate in the cement, close to the bone-cement interface, does not affect much the mode I stress-intensity factor at the tip of the interface crack. However it may grow, leading to a catastrophic breakdown of the cement. The analysis and following discussion point out an interdependency between bone-cement interface strength and cement strength not previously appreciated. The suggested crack models provide a framework for quantifying the fracture mechanisms at the bone-cement interface.

Biomedical Engineering↗
PubMed2004

Phosphoserine--a convenient compound for modification of calcium phosphate bone cement collagen composites.

Temporary bone replacement materials on the basis of calcium phosphates and hydroxyapatite (HAP) are used in surgery for filling bone defects. Components which are able to control the nucleation and crystal growth of HAP through their functional groups and which can additionally activate bone cells may be helpful in the development of materials with enhanced remodelling in vivo. In this study, the influence of O-phospho-L-serine (PS) on the materials properties of calcium phosphate bone cement composites was investigated. For up to an addition of 25 mg/g PS a strong increase in the stability of the cements under load was determined. The material was studied by scanning electron microscopy and transmission electron microscopy. A more dense microstructure and a plate-like morphology of the HAP-crystals were detected in the modified composites compared with the non-modified samples. By X-ray powder diffraction an inhibition of the dissolution of alpha-tricalcium phosphate (alpha-TCP) and dicalciumphosphate anhydrous (DCPA) particles was found. alpha-TCP and DCPA are the main constituents of the cement precursor. The results of cell culture studies using rat calvaria osteoblasts demonstrate a good viability of the cells on the PS-modified material. Furthermore, the proliferation and differentiation were found to be enhanced on the PS-modified material.

Animals↗
PubMed2000

Modulation of pro- and anti-apoptotic genes in lymphocytes exposed to bone cements.

The ability of bone cements to modify the apoptotic program in activated immune cells and the mechanisms by which they act were evaluated. Mononuclear cells were collected from healthy individuals, cultured for 4 and 24 h with phytohemoagglutinina-P and cement extracts and then tested to assess: (a) cell viability; (b) early apoptotic events, by Annexin V/propidium iodide staining; and (c) the expression of pro- (p53, c-myc, ICE) and anti-apoptotic (bcl-2) genes. After 4 h three cements were able to increase significantly the percentage of apoptotic cells, while after 24 h no differences were found. The proportion of dead cells was not significantly changed at either culture time. The simultaneous expression of both pro-apoptotic (ICE, c-myc, p53) and antiapoptotic genes (bcl-2) was investigated only with regard to the materials which induced significant changes in apoptosis: two cements induced the p53 expression, while the third down-regulated bcl-2. As apoptosis regulates the balance of immune response, the authors recommend that the interaction between materials and immune cells should be assessed, so that the use of pro-apoptotic materials may be avoided in patients with immune defects.

Annexin A5↗
PubMed1989

An investigation into the effect of cyclic loading and frequency on the temperature of PMMA bone cement in hip prostheses.

A titanium alloy hip prosthesis was inserted in a Tufnol tube representing the upper part of the femur. The prosthesis was cemented in the model femur using PMMA bone cement. Five thermocouples were embedded in the bone cement and the assembly was subjected to cyclic loading with a range of 0.3-4.5 kN at a frequency of 6 Hz. Temperature measurements over a 48 hour period indicated that the temperature rise in the bone cement was less than 4 degrees C. It is concluded that such tests can be carried out at 6 Hz without significantly affecting the mechanical properties of PMMA bone cement.

Bone Cements↗
PubMed1992

Cement removal in revision hip arthroplasty. Experience with bone cement added to the cavity in 20 cases.

A new technique for cement removal is presented where bone cement is added to the cavity after removal of a femoral component. The old and new segments of cement are then removed together by using a threaded extractor. In 16 of 20 patients, the method was successful; the entire cement mass was extracted in 35 (25-50) min without complications or bone loss. In 4 of the patients, the technique had to be combined with traditional methods for cement removal.

Aged↗
PubMed1997

Examination of hydroxyapatite filled 4-META/MMA-TBB adhesive bone cement in vitro and in vivo environment.

Bone response to hydroxyapatite (HA) fillers in the cured-4-methacryloyloxye-thyl trimellitate anhydride (4-META)/methyl methacrylate (MMA)-tri-n-butyl borane (TBB) adhesive bone cement was examined mechanically and histologically. A two-component system, consisting of powder and liquid, was formulated. The liquid portion was 5% 4-META dissolved in MMA and TBB; the powder was composed of 50 wt% poly (MMA) (PMMA) and 50 wt% dense HA fillers. The results indicated that the tensile strength decreased with the increase of HA filler size. The bone-bonding behavior of the improved cement was examined by optical microscopy and scanning electron microscopy. Seventy-two implants in six dogs for up to 24 weeks showed 4-META cement filled with HA was stable in the cement-bone interface. Histologic examinations showed that the exposed HA particles at the surface of the cured cement were generally associated with intimate attachment to bone without fibrous tissue, as well as interdigitation of cement to bone. The results suggest the importance of HA fillers in inducing bone apposition that improves cement binding to bone for long-term stability, thereby complementing rapid initial bone fixation of the cement.

Animals↗
PubMed1997

Polymerization of acrylic bone cement using differential scanning calorimetry.

The polymerization of acrylic bone cement using differential scanning calorimetry (DSC) was investigated. The polymerization reaction of the acrylic bone cement was found to be an approximately first order reaction. Two kinds of reaction rate constants for the polymerization reaction were observed. Both rate constants were calculated before and after the peak time. The effects of the addition of tricalcium phosphate (TCP) on the polymerization reaction of standard Surgical Simplex-P Radiopaque Bone Cement have been investigated by DSC. The TCP content had a strong retardation effect on the rate constants. The thermal stability of the acrylic bone cement was also studied by thermogravimetric analysis.

Acrylates↗
PubMed2001

Boneloc bone-cement: experience in hip arthroplasty during a 3-year period.

Polymethyl methacrylate (PMMA) bone-cement was introduced in the 1960s for fixation of total hip arthroplasty replacement components. Long-term results of cement fixation for hip and knee arthroplasty have been extremely good. Although the use of PMMA bone-cement has enabled long-term survival of joint arthroplasty implants, there has been concern about aseptic loosening. This concern led to the introduction of Boneloc bone-cement (Biomet, Warsaw, IN) in the early 1990s. It was hoped that with the improved physical and chemical characteristics of Boneloc, there would be less aseptic loosening in the long-term. A clinical trial was conducted to evaluate Boneloc bone-cement in cementing the femoral component of the Bimetric total hip arthroplasty prosthesis in 33 hips in 32 patients. On follow-up, 7 stems (24%) developed definite loosening, and 3 stems (10%) were possibly loose. Of the 7 definite loose stems, 5 (17%) were revised because of increasing pain or progressive loosening. Despite the biologic advantages of Boneloc, this study suggests that the chemicals substituted in Boneloc bone-cement led to an alteration in its mechanical properties. These properties proved to be inferior to conventional PMMA bone-cement. There is possible time-dependent deterioration of mechanical properties leading to early aseptic loosening. The conventional PMMA bone-cement has stood the test of time. Research and experimental studies should continue to improve the mechanical properties of Boneloc before further human trials.

Arthroplasty, Replacement, Hip↗