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PubMed2006

Validation of the small-punch test as a technique for characterizing the mechanical properties of acrylic bone cement.

This paper examines the validity of using the small-punch test technique as a means of quantifying the mechanical properties of acrylic bone cement under different test conditions. The elastic moduli calculated using the small-punch test method were compared with data measured using the international standard for acrylic bone resin, ISO 5833. Conclusions from the study indicate that the small-punch test is a reproducible miniature specimen test method that can be used to characterize the mechanical properties of retrieved acrylic bone cement as used in total joint replacement surgery. Moreover, the test conditions were found to influence the elastic modulus of acrylic bone cement. The test temperature had a greater effect on the elastic behaviour of the bone cement than the test medium.

Bone Cements↗
PubMed1975

Direct effects of acryl bone cement monomer on isolated heart muscle.

Experiments were carried out in isolated dog heart muscle to determine the direct effect of acryl bone cement monomer on the myocardial contractility. The monomer caused a dose-dependent decrease in the maximum velocity of shortening (Vmax) and the maximum force development (Fm), consequently resulting in a leftward shift of the force-velocity relation curves. There was also a concomitant decrease in work, power, the maximum rate of force development (max dF/dt) and time to peak force (TPF) from the onset of force development. These results indicate that acryl bone cement monomer exerts a direct negative inotropic effect on the myocardium and that the myocardial depression due to free monomer absorbed from the mixed bone cement into the systemic circulation during operation seems to be one of the major causes of the cardiovascular complications associated with the clinical application of bone cement.

Animals↗
PubMed1988

Centrifugation of antibiotic impregnated bone cement.

Centrifugation is used to increase the strength of bone cement in total joint arthroplasty. Antibiotics have been incorporated into cement for the treatment and prophylaxis of infection. To determine the effect of centrifugation on antibiotic containing cement, tobramycin and cefamandole impregnated Surgical Simplex P polymethylmethacrylate was centrifuged using manufacturers' techniques. The concentration of antibiotics was measured throughout the cement column by a zone of inhibition bioassay. No difference in the distribution of the antibiotics could be demonstrated as compared to hand mixed controls. Centrifugation decreased the number of large air inclusions overall, however, a significant number were noted to remain at the top of the centrifugation gradient. It was concluded that centrifugation of an antibiotic impregnated bone cement, utilizing this technique, may be used without disturbing the antibiotic distribution. Discarding the top 1 cm of liquid centrifuged column to remove residual air inclusions is recommended.

Biological Assay↗
PubMed1994

Radiolucency at the bone-cement interface in total knee replacement. The effects of bone-surface preparation and cement technique.

Three hundred and sixty-three knees (221 patients) that had been treated with total arthroplasty between 1975 and 1985 were divided into three groups on the basis of the preparation of the surface of the bone and the technique of the cement application. Group 1 (155 knees) was treated with irrigation of the bone surfaces with a syringe and manual packing of the bone cement. Group 2 (sixty-one knees) had high-volume, high-pressure lavage of the bone surfaces and manual packing of the cement. Group 3 (147 knees) had high-volume, high-pressure lavage and pressure injection of low-viscosity methylmethacrylate cement. Radiolucency was evaluated at each follow-up interval, and the findings were subjected to chi-square analysis and Kaplan-Meier survival analysis. Chi-square analysis of the data at one and three years indicated a significantly higher frequency of lines at the bone-cement interface in the femur and tibia in Group-1 knees compared with those in Groups 2 and 3. The survival curves showed increasing rates of radiolucency adjacent to the tibial components of the knees that had been prepared with lavage that was not high-volume and high-pressure and that had been prepared with finger-packing of cement (Group 1). This may partially explain the clinical problem of loosening of tibial components despite acceptable alignment. This study demonstrates that proper preparation of the cancellous bone and pressurization of the cement reduce the initial occurrence of a radiolucent line, which may have a positive effect on the ultimate failure of at least the tibial component.

Aged↗
PubMed1999

The in vitro elution characteristics of antibiotic-loaded CMW and Palacos-R bone cements.

An in vitro study was carried out comparing the elution characteristics of Palacos-R and CMW acrylic cements. Three groups of 6 antibiotic-loaded cement disks were prepared, incorporating 1.0 g vancomycin and 2.4 g tobramycin per 40 g packet of cement. Palacos-R bone cement was used for group 1, CMW 1 for group 2, and CMW 3 for group 3. The disks were placed in saline baths for 9 weeks. The baths were periodically sampled and elution rates calculated. CMW 1 released 24% less tobramycin and 36% less vancomycin than Palacos-R over the total study period (P < .05). CMW 3 released 34% less tobramycin and 38% less vancomycin than Palacos-R (P < .05). There was no significant difference in antibiotic release between CMW 1 and CMW 3. The in vitro elution characteristics of Palacos-R are superior to CMW.

Acrylic Resins↗
PubMed2002

Noninvasive in vivo EPR monitoring of the methyl methacrylate polymerization during the bone cement formation.

The curing of poly(methyl methacrylate) (PMMA) bone cement is done by a free radical polymerization. As the amount of free radicals present is a marker of the amount of unpolymerized chains present in the polymer, it is assumed that this could be related to the mechanical properties such as strength or density. In this study, the direct observation of the free radicals produced during the PMMA bone cement formation was obtained for the first time in vivo using low-frequency EPR spectrometers (1.2 GHz). Low frequency permits measurements in live animals due to the increased microwave penetration. The amount of polymerization radicals was carried out noninvasively over days on the same animals. The decay rates obtained in vitro and in vivo were compared: the decay rates were significantly lower when the curing process occurred in vivo compared to the situation in vitro. As the kinetics are rather different in vitro and in vivo, this emphasizes the value of the present method that permits the noninvasive monitoring of the curing process directly in vivo.

Biocompatible Materials↗
PubMedDate not supplied

[Thromboembolic complications related to the use of bone cement in hip arthroplasty--pathogenesis and prophylaxis].

INTRODUCTION: Cemented total hip arthroplasty (THA) has to be considered a high-risk procedure with respect to cardiovascular complications. The insertion of cement and prosthesis may lead to intravasation of fat and bone marrow into the circulation. METHODS: This article represents a review on the relevant literature about thromboembolic complications associated with the use of bone cement in THA. RESULTS/DISCUSSION: The method of canal preparation and lavage is of paramount importance to reduce the potential embolic load. Additionally, thorough cleaning of the intramedullary cavity (using jet lavage) improves the cement penetration into the bone and increases the shear strength of the bone-cement interface. Modern cementing techniques include the use of high pulsatile lavage, a cement restrictor and cement pressurization. With the application of these techniques a sufficient drainage of the medullary canal should be guaranteed to minimise the risk for thromboembolic complications. During the insertion of cementless implants the intravasation of embolic material seems to be less, but it is likewise possible to have a thromboembolic complication during cementless THA. However, it is not justified as a consequence to use the thromboembolic risk as the main indication for implant choice, in particular as the overall risk of a serious fatal complication is low.

Arthroplasty, Replacement, Hip↗
PubMed2001

Rheological properties of PMMA bone cements during curing.

The rheological behaviour of poly(methyl methacrylate) bone cements has been characterised during the curing phase using an oscillating parallel plate rheometer. Viscosity has been measured as a function of time for a range of commercial cements showing different viscosity-time profiles. Measurements have been made over a range of temperatures from 19-25 degrees C, and the results show a strong dependence of rate of viscosity rise on temperature. Viscoelastic parameters, such as storage modulus, loss modulus and phase angle have been obtained and show the change from primarily viscous to elastic behaviour as the cements set. It is suggested that these parameters more completely describe the rheological behaviour of bone cements than viscosity alone and may provide a better measure of handling and setting characteristics.

Bone Cements↗
PubMed2000

Studies on poly(propylene fumarate-co-ethylene glycol) based bone cement.

Poly(propylene fumarate-co-ethylene glycol) random (PPF-1) and block (PPF-2) copolymer oligomers were prepared. Comparing the setting characteristics of PPF-1 and PPF-2 with comonomer n-vinyl pyrrolidone (n-VP) and swelling characteristics of cured PPF-1 and PPF-2, lower setting temperature and setting time was observed with the former leading to higher swelling coefficient and lower cross link density in the cured PPF-1. Due to the high swelling coefficient and low setting exothermic temperature associated with PPF-1, the bone cement was prepared from PPF-1, n-VP and hydroxyapatite (HAP). The in vitro degradation studies reveal lesser weight loss and deformation of PPF-1/n-VP/HAP based cured resin in Ringer's solution and phosphate buffered saline in comparison with that of PPF-1/n-VP cured resin. Though the bone cement composite has adequate mechanical properties with HAP, the compressive strength and modulus of the composite aged in Ringer's solution and PBS reduced appreciably which is due to extensive hydration and plasticization by the PEG unit. However, the bone-binding and bond strength of the bone cement determined as the load for separation of bones was found to be similar to that of fast setting calcium phosphate-atelocollagen (5%) bone cement. The bone cement PPF-1/n-VP/HAP could be used as scaffold for correcting the bone defects.

Biocompatible Materials↗
PubMed2003

Effect of choice of surgical gloves on dough time measurements of acrylic bone cement.

In this study we investigated the effect of the brand of surgical gloves on the dough time determination for acrylic bone cements. Four different brands of powder-free latex surgical gloves were tested. Two commercial bone cements, Surgical Simplex P and Palacos R, were used for dough time measurement following standard test methods for acrylic bone cements (ASTM F-451 and ISO 5833). The results show that the measured dough time depended largely on the brand of gloves used, and could vary by nearly 250%. The surface morphological structures of gloves, determined by SEM, probably contribute to the differences in the measured dough time. This study provides experimental evidence that supports the need to describe the type of gloves used, in detail, when dough time is reported. It also illustrates the importance of the glove brand, when bone cement is to be handled as a dough in the clinical setting.

Biocompatible Materials↗
PubMed1999

The use of vancomycin and tobramycin in acrylic bone cement: biomechanical effects and elution kinetics for use in joint arthroplasty.

We examined the effects of vancomycin on the compressive strength and fatigue life of bone cement and the pharmacokinetics and antimicrobial activity against methicillin-resistant Staphylococcus aureus of vancomycin eluted from bone cement, both alone and in combination with tobramycin. Two cements, Palacos and Simplex, were tested. Three antibiotic preparations were tested: lyophilized vancomycin (vancomycin-L), vancomycin powder (vancomycin-P), and tobramycin powder (Lilly, Indianapolis, IN). Although antibiotics did not significantly affect compressive strength, the fatigue life of bone cement was significantly decreased with vancomycin. Thus, fatigue testing revealed effects on cement strength not apparent by compression testing. Vancomycin-P had a substantially less detrimental effect on fatigue strength than vancomycin-L. Vancomycin-P elutes less efficiently than tobramycin. Although relatively little vancomycin-P eluted from bone cement, it retained biologic activity.

Anti-Bacterial Agents↗
PubMed1988

Mechanical versus manual mixing of bone cement.

Conventional mixing of three different bone cements (CMW, Simplex P, and Zimmer LVC) was compared with a mechanical technique with respect to porosity and density. Density was increased in all the mechanically mixed cements, and the percentage porosity was diminished for CMW and Simplex P.

Acrylic Resins↗
PubMed2004

[Nanoparticulate silver. A new antimicrobial substance for bone cement].

BACKGROUND: Multiresistant bacteria have become an important problem in prosthetic joint infections. Their frequent resistance against gentamicin, which is commonly used in antibiotic-loaded bone cements, makes a new prophylaxis necessary. METHODS: PMMA-cement was loaded with 1% nanoparticulate silver and its antibacterial activity tested in vitro against gentamicin-resistant MRSE and MRSA strains as well as being compared to the activity of plain and gentamicin-loaded bone cements. A quantitative elution testing was also done to study the potentially cytotoxic effects of NanoSilver cement. RESULTS: Unloaded and PMMA-cement loaded with 2% gentamicin did not exhibit any antibacterial activity against MRSE and MRSA. At 1%, NanoSilver cement completely inhibited the proliferation of MRSA and MRSE. NanoSilver bone cement did not show any significant differences compared to the non-toxic control group. CONCLUSIONS: If these promising in vitro results can be confirmed in vivo, NanoSilver bone cement may be of considerable value in total joint arthroplasty.

Animals↗
PubMed1983

Tensile fatigue failure of acrylic bone cement.

Tensile fatigue tests of acrylic bone cement were conducted under strain control in a wet environment at 37 degrees C. A constant strain rate of 0.02s-1 was used, resulting in physiologic loading frequencies. Comparison of the tensile fatigue data with the results of previous tension-compression fatigue tests indicates that fatigue failure is governed primarily by the maximum cyclic tensile strain. The compressive portion of the loading cycle has little effect on the number of cycles to failure. A new empirically derived equation is introduced to describe the influence of mean strain and strain amplitude on fatigue endurance. The results emphasize the critical role tensile strains may play in cement failure and loosening of total joint replacements.

Bone Cements↗
PubMed2005

SRS cancellous bone cement augmentation of calcaneal fracture fixation.

BACKGROUND: The proper treatment of intraarticular calcaneal fractures remains controversial. The goal of operative treatment is to achieve anatomic reduction with stable internal fixation. One method for stabilizing fracture constructs is the use of calcium phosphate bone cement. The goal of this study was to evaluate a series of patients who had open reduction and internal fixation of intra-articular calcaneal fractures with calcium phosphate bone cement augmentation. METHODS: Fifteen patients had open reduction and internal fixation through an extensile lateral approach with standard low-profile hardware. The walls of the bone defect beneath the posterior facet were impacted with a curette and the void filled with SRS bone cement. Preoperative and postoperative plain radiographs and computed tomography (CT) were obtained on each patient. The most recent radiographs were assessed for maintenance of reduction. RESULTS: Nine patients were followed for an average of 13 (6 to 60) months. Six patients had less than 6 months followup. There were five type IIA, five type IIB, four type IIC, and one type IIIB-C fractures. All 15 fractures were noted on postoperative CT to have less than 2-mm of step-off with complete cement fill of the bony void. None of the patients developed a soft-tissue reaction to the cement. The first six patients were allowed to bear weight 6 weeks after injury, and the following nine patients were allowed to bear weight at 3 weeks after injury. No patient had any visible loss of reduction on most recent radiographs. Followup CT at 7 months in one patient and 12 and 51 months in another patient revealed no change in the bone-cement interface or amount of cement remaining. One patient's CT at 12 months revealed apparent fragmentation of the cement mass without loss of reduction. There was one major wound complication necessitating cement and hardware removal and free flap coverage. CONCLUSION: In this small series, patients had no evidence of soft-tissue reaction or loss of reduction with early weightbearing after open reduction and internal fixation augmented with calcium phosphate bone cement.

Adult↗
PubMed2001

Infection of orthopedic implants and the use of antibiotic-loaded bone cements. A review.

Infections by bacteria are a serious complication following orthopedic implant surgery, that can usually only be cured by removing the implant, since the biofilm mode of growth of infecting bacteria on an implant surface protects the organisms from the host immune system and antibiotic therapy. Over the past few decades, attempts have been made to prevent and cure orthopedic implant infections by incorporating antibiotics in polymethylmethacrylate bone cements, in primary and revision surgery. However, the clinical efficacy of antibiotic-releasing bone cements is not accepted by all and the long-term exposure to low doses from antibiotic-releasing bone cements in patients is strongly related to the emerging threat of antibiotic resistance in medicine today. In this article, we start by reviewing the mechanisms governing the formation of an infectious biofilm on orthopedic implant materials, the release mechanisms and properties of clinically-used, antibiotic-loaded bone cements. The clinical efficacy of antibiotic-loaded bone cements is evaluated analyzing separatedly the prophylactic and therapeutic uses of these products.

Antibiotic Prophylaxis↗
PubMed1995

Dynamic creep behavior of acrylic bone cement.

Recent studies concerning the fixation of cemented total hip arthroplasty (THA) have led to new hypotheses about the dynamic, long-term failure mechanisms leading to prosthetic loosening. As a result, the long-term mechanical behavior of acrylic bone cement has gained more interest since little is known about these properties. In this study, the dynamic, compressive creep deformation of acrylic bone cement was examined. An amount of creep was found, with creep strains exceeding the elastic strain during 14 x 10(6) loading cycles. There was a linear relationship between the logarithmic values of the number of loading cycles and the creep strain. The effect of stress level on the amount of creep was different from that in results of static experiments reported in the literature. Comparing the results with tensile creep experiments revealed that bone cement under a tensile load creeps much quicker than under a compressive one. Young's modulus was significantly higher when the material was loaded at higher strain rates. The bone cement became stiffer with an increasing number of loading cycles. The creep behavior of bone cement is important for the long-term behavior of cemented THA. It enables subsidence of the stem and attenuation of stress peaks in the cement mantle.

Acrylates↗
PubMed2005

The role of polymethylmethacrylate bone cement in revision arthroplasty of the hip.

When restoration of bone stock is necessary in revision arthroplasty of the hip using morselized or structural allograft bone, cement is used. Cement strengthens allograft bone, impairs its resorption, allows anatomic positioning of components (ie, cementing the cup in a protective ring), and allows delivery of antibiotics. Allograft bone provides a perfect lattice for cementation and also allows a cementless reconstruction as far as host bone is concerned.

Arthroplasty, Replacement, Hip↗