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PubMed2002

Bone cement or bone substitute augmentation of pedicle screws improves pullout strength in posterior spinal fixation.

Pedicle screws are widely used to fix posterior spinal implants. However, in some situations, such as at the ends of long constructs in scoliosis correction, the screws may pull out of the pedicles. This limits the use of pedicle screw fixation where bone quality is poor. The aim of this study was to investigate the effect of using either a low-viscosity bone cement (Palacos LV) or a bone augmentation material (Cortoss) on the pullout strength of typical pedicle screws (5 mm USS Schanz screws). Ten lumbar calf vertebrae were implanted with pedicle screws. One screw was inserted as normal, and the contralateral screw was augmented with Palacos LV or Cortoss. A plate was then cemented to the posterior surface of each pedicle and the screws were pulled out using a tensile testing machine. The pullout strength of the non-augmented screws was 1203+/-260 N, while the pullout strength of the augmented screws was 1970+/-220 N (Palacos LV) and 2021+/-342 N (Cortoss). Both Palacos LV and Cortoss significantly increased the pullout strength (p=0.0213 and p=0.0029, respectively). There was no significant difference between the Palacos LV and Cortoss groups (p=0.79).

Journal Article↗
PubMed1997

Radio-opaque agents in bone cement increase bone resorption.

A heavy infiltrate of foreign-body macrophages is commonly seen in the fibrous membrane which surrounds an aseptically loose cemented implant. This is in response to particles of polymethylmethacrylate (PMMA) bone cement and other biomaterials. We have previously shown that monocytes and macrophages responding to particles of bone cement are capable of differentiating into osteoclastic cells which resorb bone. To determine whether the radio-opaque additives barium sulphate (BaSO4) and zirconium dioxide (ZrO2) influence this process, particles of PMMA with and without these agents were added to mouse monocytes and cocultured with osteoblast-like cells on bone slices. Osteoclast differentiation, as shown by the presence of the osteoclast-associated enzyme tartrate-resistant acid phosphatase (TRAP) and lacunar bone resorption, was observed in all cocultures. The addition of PMMA alone to these cocultures caused no increase in TRAP expression or bone resorption relative to control cocultures. Adding PMMA particles containing BaSO4 or ZrO2, however, caused an increase in TRAP expression and a highly significant increase in bone resorption. Particles containing BaSO4 were associated with 50% more bone resorption than those containing ZrO2. Our results suggest that radio-opaque agents in bone cement may contribute to the bone resorption of aseptic loosening by enhancing macrophage-osteoclast differentiation, and that PMMA containing BaSO4 is likely to be associated with more osteolysis than that containing ZrO2.

Acid Phosphatase↗
PubMed1982

[The influence of bone cement on the bone].

The investigation on the effects of bone cement on bone was undertaken in the present study. The experiments were conducted on the following 4 group of rabbits, A, B, C, and D. In group A the femoral medullary cavity was reamed, leaving the part of the endosteum of the cortex and bone marrow. In group B reaming of the medullary cavity was extensively performed to remove whole bone marrow and the part of endosteum of the cortex. The medullary spaces produced after the reaming both in group A and B were completely filled with bone cement. In group C, reaming was performed in the same manner as in group B, and the medullary space was kept empty as a control, furthermore, in order to compare the effects of the metal and bone cement on bone intermedullary nails were inserted into the medullary space after the same reaming as in group B. In comparison, the bone specimens were obtained from these 4 groups at intervals after the surgical treatments, the contact microradiographic and histopathological studies were carried out. The most important finding was the action of bone cement causing atrophy and degeneration of bone tissue over a prolonged period of time. The degree of these changes was found to vary depending upon the extent to which the medullary cavity was reamed prior to the introduction of bone cement. In the extensively reamed group, a considerable number of Howship's lacunae were observed along with cancellization of the cortex and, atrophy and degeneration of bone cells, even one year after the treatment. From this study, it was strongly indicated that the effects of bone cement on bone may be caused not only by the heat generated during polymerization, but also by some other factors responsible for the degeneration and atrophy of the bone over a long period of time.

Animals↗
PubMed1982

[Histological examinations of remodelling proceedings on the cement-bone surface of endoprosthesis after implantation from 3-10 years ].

The prosthesis loosening represents the main complication of an endoprosthesis. When using bone cement for an anchorage, the most important factors of loosening are the impairment of tissue during toxical and thermic influence, foreign body reaction on the abraded material of the prosthesis, the resorption effect through foreign body giant cells as well as the parallel effect of monomer impoverishment and the dissapearance of polymerization matrix material. Histological examinations of the reparation proceedings of not loosened cement-bone surfaces at total endoprostheses are rarely found in literature, and the extent of a long term effect of the cement on the bone layer has not been sufficiently ascertained. To obtain an insight into the reaction of the bone tissue to the bone cement, the bone-cement surface was examined histologically after 3-10 years TEP-implantation.

Aged↗
PubMed1997

Release of tobramycin from tobramycin-containing bone cement in bone and serum of rabbits.

Tobramycin release from tobramycin-containing bone cement was studied in vivo in a rabbit model. After insertion of cement into the right femur, tobramycin concentration as a function of time for up to 28 days was measured in serum and bone of rabbits. Tobramycin release in the femoral cortex adjacent to the cement was found to exceed the minimal inhibitory concentration for Staphylococcus aureus Wood 46. Serum tobramycin concentrations were below the systemic toxicity threshold.

Journal Article↗
PubMed1994

The effect of bleeding on the cement-bone interface. An experimental study.

A model was developed to simulate bleeding from cancellous bone at the physiologic pressures and flow rates that can occur during total hip arthroplasty. The consequences of simulated bleeding on the penetration of bone cement into cancellous bone, the shear strength of the cement-bone interface, and the shear strength of bone cement were investigated. In the presence of active bleeding, the shear strength of the cement-bone interface was reduced significantly in 50% of interfaces in which cements of lower viscosity were used. The simulated bleeding did not exert a detrimental effect on the depth of cement penetration.

Animals↗
PubMed1992

Revision of cemented fixation and cement-bone interface strength.

Interfacial shear strength between poly(methyl methacrylate) (PMMA) bone cement and cancellous bone was measured in bone samples from human proximal femora. Samples were prepared with fresh cement-bone, fresh cement inside a mantle of existing cement and with fresh cement-revised bone surfaces. Push-out tests to measure shear strength caused failure only at bone-cement interfaces; revised bone interfaces were 30 per cent weaker (P < 0.02) than primary interfaces. The clinical relevance is that revision of cemented joint arthroplasties may necessitate removal of components with sound cement-bone fixation. The practice of removing all traces of PMMA cement may not yield the optimal fixation; adhesion of fresh cement to freshly prepared surfaces of the existing cement might also be considered where circumstances are favourable.

Bone Cements↗
PubMed1987

A study of the bone-cement interface in upper limb prostheses not subjected to loading.

The appearance of a radiolucent band at the cement-bone interface is a frequent finding in lower limb prostheses. This is still a controversial subject, but almost certainly has a multifactorial basis. Stress related to loading may be one of the causal factors. The authors therefore studied the evolution and behaviour of this radiolucent line at the bone-cement interface in 31 upper limb prostheses not subjected to significant loading or stress. These were special prostheses designed to replace the upper humerus after the radical excision of bone tumours. The development of a radiolucent band was not significantly different from the usual conditions in which loading is present but in our cases it was nonprogressive and there was never any evidence of loosening of the prosthesis.

Adult↗
PubMed1990

Prechilling and vacuum mixing not suitable for all bone cements. Handling characteristics and exotherms of bone cements.

Nine bone cements were tested for handling characteristics, intrusion, doughing time, setting time, and exothermic temperature. Comparative studies were made of manual mixing and vacuum mixing of cement components stored at room temperature or chilled to 5 degrees C. Vacuum mixing of cement packages stored at room temperature was inapplicable except for the low-viscosity brands, as the cements became too viscous to mold test specimens. Prechilling and vacuum mixing prolonged the setting time and preserved a lower viscosity during the handling period. Palacos R and Palacos G were most suitable for this method, whereas a considerable increase in exothermic temperature was experienced with the other brands. The method might, however, be considered for Zimmer and Cerafix also, as the exotherm was of the same magnitude as for Palacos brands.

Bone Cements↗
PubMed2004

Preparation and characterization of a novel bioactive bone cement: glass based nanoscale hydroxyapatite bone cement.

A novel type of glass-based nanoscale hydorxypatite (HAP) bioactive bone cement (designed as GBNHAPC) was synthesized by adding nanoscale hydroxyapatite (HAP) crystalline (20-40 nm), into the self-setting glass-based bone cement (GBC). The inhibition rate of nanoscale HAP and micron HAP on osteosarcoma U2-OS cells was examined. The effects of nanoscale HAP on the crystal phase, microstructure and compressive strength of GBNHAPC were studied respectively. It was concluded that nanoscale HAP could inhibit the cell proliferation, while micron HAP could not, and that nanoscale HAP could be dispersed in the cement evenly and the morphology did not change significantly after a longer immersion time. XRD and FTIR results show nanoscale HAP did not affect the setting reaction of the cement. Furthermore, GBNHAPC had a higher compressive strength (92 MPa) than GBC. It was believed that GBNHAPC might be a desirable biomaterial that could not only fill bone defects but also inhibit cancer cell growth.

Bone Cements↗
PubMed2002

Residual stress effects on fracture energies of cement-bone and cement-implant interfaces.

The effects of residual stresses, which are caused by the temperature difference arising after polymerisation of bone cement, on the fracture energies of cement bone and cement-implant interfaces have been examined by using both experimental and numerical works. Only fracture loads of the test specimen having interfacial cracks have been measured in the experimental stage. The values of fracture loads and temperature difference after polymerisation have been applied to finite element models of the test specimens to calculate critical J-integral values of these both interfaces in the numerical stage. In addition, fracture energies of bone and cement, have been obtained by experimentally, using three-point bending test method The results have shown that residual stresses can produce changes in the fracture energies of these bimaterial systems, especially in cement implant interface and J(Ic) values of interfaces are considerably smaller than the experimentally determined J(Ic) values of cement and bone.

Biocompatible Materials↗
PubMed2000

Attenuation of acoustic emission body waves in acrylic bone cement and synthetic bone using wavelet time-scale analysis.

This article addresses acoustic emission (AE) wave attenuation in acrylic bone cement and wave attenuation due to the existence of material interface between acrylic bone cement and sawbone. In this article, a series of tests were performed using standard pencil lead break sources. The attenuation features inside acrylic bone cement and sawbone materials and the attenuation due to the existence of material interfaces such as cement-cement and cement-sawbone were studied. In addition, the discrete wavelet-based signal energy decomposition method was introduced to examine detail breakdown of signal energy distribution of attenuation. From the tests, it was observed that the attenuation of AE signal was linear with respect to the wave travel distance for both energy and amplitude. Furthermore, AE energy attenuation was more sensitive than AE amplitude attenuation. In the analysis of attenuation due to material interfaces, the couplant plays a major role in reducing the attenuation at the interfaces. The attenuation at an interface composed by different material is less compared with an interface composed by the same material.

Acoustics↗
PubMed1995

Blood perfusion and remodelling activity in canine tibial diaphysis after filling with a new bone cement compared to bone wax and poly(methyl methacrylate) cement.

Six dogs each had one tibia filled with standard poly(methyl methacrylate) (PMMA) bone cement and the contralateral tibia filled with a new methyl methacrylate-n-decyl methacrylate-isobornyl methacrylate (MMA-DMA-IBMA) bone cement (Boneloc) with lowered polymerization heat and monomer leakage. An additional six dogs each had one tibia filled with MMA-DMA-IBMA and the contralateral tibia filled with bone wax. There was a higher diaphyseal blood flow, measured with a microsphere technique, in the legs filled with MMA-DMA-IBMA than in those filled with PMMA. The wax-filled bones presented higher blood perfusion than those with MMA-DMA-IBMA. We found a tendency towards higher 99mtechnetium-labelled methylene diphosphonate (99mTcMDP) uptake, and autoradiograms revealed a tendency towards larger subperiosteal apposition and more blackening, both at the subperiosteal apposition and the cortex, in the bones filled with new bone cement in the first series, but in wax-filled bone in the second series. It is concluded that the new bone cement, compared to standard acrylic bone cement, seems to inhibit the vascular response and bone remodelling activity less, making earlier remodelling possible. However, the new bone cement still seems to inhibit bone blood perfusion compared to bone wax.

Animals↗
PubMedDate not supplied

[A new method to optimize the adhesion between bone cement and acetabular bone in total hip arthroplasty].

AIM: In cemented total hip arthroplasty cup loosening occurs earlier than stem loosening in most of the cases. This is mainly caused by the lack of stabile adhesion between the hydrophobic bone cement and the hydrophilic bone surface of the acetabulum. The aim of this study was to develop a multilayer amphiphilic bonding system which prevents the hydrolytic debonding at the bone cement-bone interface, thus optimizing the compound stability. METHOD: In a first series of tests a standardized three-point-bending test was performed to determine the compound stability of the bone cement-bone interface. The bony test specimens were immersed into physiologic NaCl solution to simulate the hydrolytic in situ conditions and contaminated with blood to simulate the intraoperative bleeding of prepared acetabular bone surfaces. In a second series of tests polyethylene cups were implanted into the acetabular cavity of sheep using the current cementing technique. Acetabular bone stock was prepared differently (subchondral sclerotic zone preserved vs. removed, additional drilling into the acetabular roof, with vs. without the multilayer bonding system) in intra-individual comparison of both acetabular sides. To ascertain the bone cement-bone stability a torsional-turn out test was performed on an universal testing machine. RESULTS: In the three-point-bending tests the compound stability between bone cement and bone was 50- to 100-times higher with the use of the multilayer system. In the torsional-turn out tests the compound stability showed in mean a 1.8-fold increase of the interface strength in case of preconditioned acetabular cavities with the multilayer bonding system. CONCLUSION: The developed multilayer bonding system optimizes the interface strength between acetabular bone stock and bone cement significantly for cemented cups in total hip arthroplasty. In contrast to cementing techniques with complete removal of the subchondral sclerotic zone (in order to optimize micro-interlocking) the biologically effective and load bearing acetabular bone stock can be preserved using the newly developed multilayer bonding system. This aspect might be highly important especially with regard to possible acetabular bone defects caused by the process of aseptic cup loosening.

Acetabulum↗
PubMed1983

Penetration of acrylic bone cements into cancellous bone.

The depth of penetration of five commercial acrylic bone cements into cancellous bone was measured in vitro. Under standard, idealized conditions, cement penetration was found to vary significantly with different cements. Penetration was critically influenced by the coarseness of the cancellous bone and increased directly with the effective volume of the "cells" within the osseous matrix. An inverse correlation was determined between the mean cement viscosity during flow into the bone and final penetration depth. The dough time, set time and working time of each acrylic formulation was found to have no significant effect upon the depth of cement penetration. It is suggested that in addition to the techniques adopted for introduction of cement to the bone, the selection of the bone cement itself may critically influence the incidence of late loosening following total joint replacement.

Acrylic Resins↗
PubMed1997

Bone bonding ability of bioactive bone cements.

The bone bonding ability of three types of bioactive bone cement A, B, and C consisting of glass or glass ceramic powder and bisphenol-alpha-glycidyl methacrylate resin was evaluated. Type A contained MgO-CaO-SiO2-P2O5-CaF2 glass powder; Type B, MgO-CaO-SiO2-P2O5-CaF2 glass ceramic powder; and Type C, MgO free CaO-SiO2-P2O5-CaF2 glass powder. Rectangular plates (2 x 10 x 15 mm) of Types A, B, C, and polymethylmethacrylate cements were implanted into the tibial metaphyses of male rabbits and the failure load measured by mechanical failure testing (detaching test) 10 and 25 weeks after implantation. The failure loads of Types A, B, C, and polymethylmethacrylate cements were respectively, 29.52, 41.48, 28.22, and 0.29 N at 10 weeks and 33.42, 41.27, 33.64, and 0.20 N at 25 weeks. Examination of the bone cement interface revealed that all the bioactive bone cements achieved direct bone contact with the bone. These results showed that all three types of bioactive bone cement have the ability to bond to bone, and the cement containing glass ceramic powder revealed higher bonding strength than did those containing glass powder.

Animals↗