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PubMed1996

A study of laser-based removal of polymethylmethacrylate bone cement.

Complications are often produced with the removal of bone cement from the femoral cavity in the treatment of a failed hip prosthesis. Apart from being slow and difficult the conventional process runs the risk of producing damage to the femur. Ultrasonic techniques have been suggested to achieve these ends but removal of the cement by this approach is not entirely easy. The alternative laser-based approach would seem to have significant advantages over conventional techniques. The laser is capable of delivering energy to a specific region or surface under close control. The choice of laser is determined by its ability to ablate the cement and the ease with which it can be delivered to the base of the femur cavity. This paper examines several laser wavelengths: CO2 (10.6 microns), excimer (248 nm), Hol:YAG (2.12 microns), and presents polymethylmethacrylate (PMMA) vaporization thresholds for each laser.

Absorption↗
PubMed2004

Prophylactic use of antibiotic bone cement: an emerging standard--in opposition.

Antibiotic-loaded bone cement (ABLC) is an effective delivery method of local antibiotics. ABLC for treatment should be high dose (>3.6 g per 40 g cement) for beads or spacers and 1 to 2 g antibiotic per 40 g cement for prosthesis fixation. Multiple antibiotics are required for treatment, with antibiotics being individualized according to culture susceptibilities. This approach requires hand mixing because there are no commercial high-dose products. ABLC should be low dose (< or =1 g per 40 g cement) for prophylaxis purposes. Concerns with toxicity and cement mechanical properties are inconsequential with low-dose ABLC. Available clinical evidence supports low-dose ABLC for prophylaxis in revisions and high-risk primary joints, but concerns of emerging drug-resistant organisms probably outweigh routine use of low-dose ABLC in all uncomplicated primary arthroplasties.

Anti-Bacterial Agents↗
PubMed2000

The use of hydroxyapatite bone cement for sinus floor augmentation with simultaneous implant placement in the atrophic maxilla. A report of 10 cases.

BACKGROUND: Dental implant placement associated with sinus floor augmentation in a severely atrophic maxilla can be performed in a 1- or 2-stage surgical procedure, depending on the height of the residual alveolar bone. A minimum of 4 to 5 mm is recommended for a 1-stage procedure. METHODS: This clinical study describes the use of hydroxyapatite (HA) bone cement to stabilize HA-coated cylindrical implants placed simultaneously during sinus augmentation in 100 patients where insufficient bone volume did not allow primary implant stability. A total of 26 HA-coated dental implants were inserted in 100 grafted sinuses of 10 patients. RESULTS: None of the cases presented any difficulty in achieving initial stabilization and parallelism. No clinical complications of the sinuses were evident. Prior to exposure, radiographic evaluation revealed the implants embedded in a densely homogeneous radiopaque mass. At second-stage surgery, there was no clinical evidence of crestal bone loss around the implants. All implants were clinically osseointegrated. All patients received fixed implant-supported prostheses. Mean follow-up was 18 months (range 12 to 24 months). CONCLUSIONS: According to this preliminary study, the hydroxyapatite bone cement appears to hold great promise as a grafting alloplastic material for sinus floor augmentations. Its main advantage is its ability to provide initial stability required for osseointegration and proper implant location and parallelism. Further clinical and histological studies are required before it can be recommended for routine use in sinus lift procedures.

Adult↗
PubMed2006

Injectable bone cements for use in vertebroplasty and kyphoplasty: state-of-the-art review.

Vertebroplasty (VP) and kyphoplasty (KP) are minimally invasive surgical procedures that have recently been introduced for the medical management of osteoporosis-induced vertebral compression fractures. The aim of VP is to stabilize the fractured vertebral body, while the goals of KP are to stabilize the fractured vertebral body and to restore its height to as near its prefracture level as possible. Both procedures involve injection of the setting dough of an injectable bone cement (IBC) into the fractured vertebral body, thereby highlighting the indispensable role that the IBC plays. Although there is a very large literature on IBCs, no detailed critical review of it has been published. Such a review is the subject of the present work, which is in seven parts. The review opens with a succinct introduction to VP and KP. The topics covered in the parts that follow are: (1) a listing of the 18 most desirable properties of an IBC (e.g., easy injectability, high radiopacity, and a resorption rate that is neither too high nor too low); (2) descriptions of the four classes of IBCs (calcium phosphates, acrylic bone cements, calcium sulfates, and composites); (3) concerns that have been raised with regard to the use of IBCs (such as the potential for thermal necrosis of tissue at the peri-augmentation site, when an acrylic bone cement is used); (4) explicative summaries of the main findings of literature studies on the influence of nine factors (such as powder particle size, powder-to-liquid ratio, and the method used to mix the powder and the liquid) on the values of various properties of IBCs; (5) explicative summaries of the main findings of literature studies on five fundamental matters, such as the aging mechanism of the powder, the thermokinetics of a setting dough, and the influence of the type of IBC used on various ex vivo biomechanical performance measures of VP- and KP-augmented vertebral bodies; and (6) descriptions of topics in six areas for future research, such as the determination of an overall index of the fatigue performance of an IBC and the development of internationally recognized standardized testing protocols to employ when a synthetic cancellous bone void model is used in the rapid in vitro screening of IBCs. The review ends with a summary of the most salient points and observations made.

Bone Cements↗
PubMed2000

Improved orthopaedic bone cement formulations based on rubber toughening.

Poly(methylmethacrylate) (PMMA) bone cements have been used for the fixation of hip and knee implants since the early 1960s. Aseptic loosening, related to fracture of the PMMA, continues to be the primary mode of failure for these prostheses. Failed prostheses must be replaced causing additional expense and patient trauma. Furthermore, the average lifetime of the revised prosthesis is significantly lower than that of a primary prosthesis. Recent work by Moseley and co-workers led to the development of a promising new rubber toughened cement. It is comprised of a matrix of the traditional PMMA with dispersed rubber particles to modify mechanical properties and, in particular, improve fracture toughness. The fracture toughness of the experimental material was 167% greater than the toughness of a nontoughened control; however, the elastic modulus and compressive strength were reduced. The reductions in properties should not pose a clinical problem based on results of the implant model reported by Moseley. More serious concerns were mixing and delivery problems and high residual monomer concentrations. The formulation and chemical/mechanical characterization of new toughened acrylic formulations that have residual monomer levels equivalent to Simplex and better mixing properties are reported.

Bone Cements↗
PubMed2004

Optimization of the formulation and mechanical properties of starch based partially degradable bone cements.

Previous studies have shown the possibility of developing in-situ polymerizable hydrogels that disclose a range of properties that might allow for their use as bone cements. Their main advantage is to be partially degradable, which is important to allow bone ingrowth (better fixation). In addition, their uptake of water makes them less agressive for the tissues, disclosing better fatigue properties and ideal for release of drugs when in service. This work reports a statistical study of the formulation of partially degradable acrylic bone cements that include on their composition corn starch/cellulose acetate blends (SCA). The aim was to optimize a set of properties (mechanical, swelling/degradation and curing) by changing the values of some parameters such as SCA amount and particle size and molar ratio of the acrylic monomers. Statistical tests demonstrated that the most important parameter was the molar ratio of monomers, with the SCA percentage also playing a role. It was possible to develop formulations with mechanical properties in the range of ASTM specifications and with polymerization temperatures lower than those of commercial acrylic cements. Some formulations were subsequently selected for tensile and dynamic mechanical thermal analysis (DMA) tests, under dry and wet conditions.

Biodegradation, Environmental↗
PubMed2004

The effect of glycine filler on the elution rate of gentamicin from acrylic bone cement: a pilot study.

Elution of antibiotics from acrylic bone cement (polymethylmethacrylate [PMMA]) is dependent on the access of fluid to the depths of the cement that contains the antibiotic. Commercially prepared antibiotic beads that are porous have higher elution rates than hand-mixed, nonporous antibiotic PMMA mixtures. To increase the elution of gentamicin from hand-mixed PMMA, glycine was added as a filler to produce porosity. Elution of gentamicin from the antibiotic PMMA-glycine mixture increased with increasing amounts of glycine. With 3.6 g gentamicin powder and 14 g of crystalline glycine per batch of Palacos PMMA, the elution of gentamicin from the PMMA at 2 days was, similar to the previously documented elution of gentamicin from commercially prepared porous Septopal PMMA beads. With further investigation it may be possible to identify a specific filler and a volume of filler that can be hand mixed in antibiotic PMMA to produce the elution behavior that is needed for specific clinical requirements.

Anti-Bacterial Agents↗
PubMed1997

Respiratory complications of bone cement insertion during total hip replacement under spinal anaesthesia.

A report is made of respiratory complications which occurred following the insertion of Palacos bone cement during Howse total hip replacement under spinal anaesthesia in a 78-year-old female patient. Persistent cough and tachypnoea developed 30 s after the insertion of bone cement into the acetabulum and femur and persisted for 2-3 min producing considerable passive movement of the pelvis and femur. The probable cause, disadvantages and prevention of these complications are discussed.

Aged↗
PubMed1978

[Investigations of pathogenesis of reactions in circulation and respiration during the implantation of bone cements. animal experiments (author's transl)].

This paper shows the effects of the increase in pressure in the medullary cavity in the blood circulation and the respiration observed during implantation of bone cement with animal experiments. The pathomechanism is also examined. The reactions of the respiration and the circulation, when observed, resulted in the intramedullary increase in pressure. These are nerval reflexes caused by the innervation in the medullary cavity and are not reactions of the monomer, which may come into the circulation during the polimerization of bone cement. These reactions are very different from those caused by the fatal obstruction of the pulmonary blood vessels through bone marrow ingredients. This is the effect of an insufficient prevention of increase in medullary pressure during cement implantation.

Animals↗
PubMed1995

Water absorption characteristics of modified hydroxyapatite bone cements.

Water absorption characteristics of a range of modified hydroxyapatite (HA)-reinforced poly(ethyl methacrylate)-n-butyl methacrylate (PEMA-nBMA) bone cements have been established. From gravimetric measurements, the kinetics of successive absorption and desorption cycles, equilibrium uptake, diffusion coefficients and solubility data have been determined. In general, the water uptake could be modelled by the classical laws of diffusion. The introduction of the HA reduced the water uptake of the bone cement, with a further decrease if the HA filler was surface treated with a silane coupling agent. However, the system comprising the silicated silanated HA-filled cement produced a large uptake of water, with relatively low diffusion coefficients, which is attributed to the presence of soluble sites in the matrix.

Absorption↗
PubMed2003

[A pilot study of repair of periodontal bone defects with carbonated phosphate bone cement modified with synthesized peptides in dogs].

OBJECTIVE: To explore the possibility of repairing periodontal defects with carbonated calcium phosphate bone cement (CCPBC) modified with synthesized peptides. METHODS: Periodontal bone defects in 4 dogs were surgically created and then restored directly with hydroxyapatite (HA), Perioglass, CCPBC and CCPBC modified with peptides. The results were compared at different levels. RESULTS: Bone replacement materials were lost in HA and Perioglass groups. In the HA group defects were restored with connective tissue. Perioglass group had only a little new bone around materials by alveolar bone. CCPBC could firmly stay in bone defects to maintain the space of bone defects even without membrane use. CCPBC modified with peptides was superior to HA, Perioglass, and CCPBC, surrounded by a great deal of new bone. CONCLUSION: Under limitation of this study, CCPBC modified with peptides has some osteoinuctive activity and may have good prospect for the clinical application in periodontal defect repair.

Alveolar Bone Loss↗
PubMed2006

Comparison of sampling and analytical methods used during the preparation of methyl methacrylate bone cements.

Surgeons, surgical nurses, and other operating room staff are exposed to airborne concentrations of methyl methacrylate during the preparation of orthopedic bone cement. Three sampling and analysis methods have been used to measurement methyl methacrylate in this work environment: (1) direct-reading photoacoustic infrared spectrometry, (2) solid sorbent and gas chromatography with flame ionization detection, and (3) colorimetric detector tubes. Previous studies have measured operating room exposures and judged the efficacy of cement mixing wth little, if any, regard for method sensitivity, detection limits, precision, or accuracy. The present investigation was designed to allow concurrent monitoring of methyl methacrylate levels from the same air volume using each of the three methods. Three popular orthopedic bone cement products were mixed during a number of repeat preparations (n = 36). Airborne concentrations were monitored concurrently during each preparation. Attention was given to the proper treatment of detection limits, and the results are reported both as raw data and descriptive statistics. A one-way ANOVA using a Tukey-Kramer HSD comparison was performed on method-specific results indicating that the photoacoustic infrared spectrometry and solid sorbent, gas chromatography with flame ionization detection are in good agreement, but the colorimetric detector tube method reports significantly different airborne concentrations. It is concluded that previous assessments using the photoacoustic infrared spectrometry and solid sorbent, gas chromatography with flame ionization detection may be relied on, but the detector tube method underreports actual exposures. Accordingly, the results of past exposure assessments and mixing method efficacy studies using colorimetric detector tubes may not be reliable.

Air Pollutants, Occupational↗
PubMedDate not supplied

[Adjuvant therapy (phenol, bone cement) in giant cell tumors].

69 patients were treated with giant-cell tumors in the Orthopaedic Department of the Semmelweis Medical School in Budapest between 1975-1989. The recurrence rate was 15 cases in 36 patients who were treated with curettage and spongiosa plasty only. In 11 cases the curettage was combined with adjuvants (phenol and/or filling with bone cement). This way the recurrence rate could be decreased to 1 case out of 11. The use of phenol and bone cement proved to be useful adjuvants to the surgical curettage at the giant-cell tumors and without complications.

Adult↗
PubMed2004

Addition of fusidic acid impregnated bone cement to systemic teicoplanin therapy in the treatment of rat osteomyelitis.

We compared the efficacy of the combination of fusidic acid impregnated bone cement and systemic teicoplanin to systemic teicoplanin alone in implant-related osteomyelitis model in the rats. Foreign bodies were implanted into the medullary channels of 30 rat tibias after intramedullary inoculation of methicillin-resistant Staphylococcus aureus. Following proof of induction of osteomyelitis in the rats on the 21st day, a bone cement rod including 1/40 ratio of fusidic acid was inserted into the medullary channel of the tibias in the study group. Teicoplanin was administered i.m. at 20 mg/kg/day for 14 days to both the study and control groups. At the end of the treatment, the tibias were examined macroscopically, microbiologically and histopathologically. The elimination rate with the teicoplanin+fusidic acid combination was 81.8%, while with teicoplanin alone was 55.6% (p=0.33). Although the difference between the two groups was not statistically significant, the combination treatment had a positive effect in eliminating the microorganism.

Animals↗
PubMed2000

The use of water-jetting technology in prostheses revision surgery-first results of parameter studies on bone and bone cement.

Water-jet cutting techniques have been used in industrial applications for many different materials. Recently these techniques have been developed into a revolutionary cutting tool for soft tissues in visceral surgery. The present study investigates the usage of this cutting technology for the revision surgery of endoprostheses. In the first part of the study, samples of bovine bone and acrylic bone cement (PMMA) were cut using an industrial jet cutting device with pure water. Below 400 bar, only PMMA was cut; above 400 bar, bone was also cut, but only pressures above 800 bar resulted in clinically useful rates of material removal (cut depth 2. 4 mm at 10 mm/min traverse speed). In the second part of the study, the effect of adding biocompatible abrasives to the water in order to reduce the required pressure was investigated, resulting in a significantly higher removal of material. At 600 bar, PMMA was cut 5. 2 mm deep with plain water and 15.2 mm deep with added abrasives. The quality of the cuts was increased by the abrasive. Though there was no clear selectivity between bone and PMMA any more, the rate of material removal at similar pressures was significantly higher for PMMA than for bone (600 bar: 1.6 mm cut depth for bone samples, 15.2 mm for PMMA). The measured cut depths with either method were not influenced by a change of the cutting direction with respect to the main direction of the osteons in the bone. However, a reduction of the jet surface angle (90 degrees to 23 degrees ) resulted for bone in a significantly lower cut depth at 600 bar (plain water: 0.62 mm vs. 0.06 mm; abrasive: 1.61 mm vs. 0.60 mm). The laboratory experiments indicate that abrasive water jets may be suitable for cutting biomaterials like bone and bone cement.

Analysis of Variance↗
PubMed1978

[Histomorphology of the bone-cement contact. Experimental phenomenology of the osseous reconstruction processes. I].

In animal experiments the femurs of 25 rabbits were filled with bone cement. In cross sections of the diaphysis even after only one week, small gaps were found filled by lamellar formation of new bone. Osteoblast layers directly on the cement surface were also observed. After 4 to 6 weeks there was a circularly closed contact of inner lamellae and after 9 months a secondary medullary cavity was formed. At this time there was formed a trabcular contact with the implant, interrupted by medullary spaces full of cells. Sometimes woven-bone formations were found in the bone-cement interface.

Animals↗
PubMed1989

Lack of sister-chromatid exchange induction by polymethyl methacrylate bone cement in human lymphocytes cultured in vitro.

Human lymphocytes cultured in vitro were used to assess the ability of polymethyl methacrylate (PMMA), currently used in orthopedic surgery as bone cement, to induce sister-chromatid exchanges (SCE). Under the conditions used in this study, PMMA bone cement did not produce any significant increase in SCEs in phytohemagglutinin-stimulated human lymphocytes. However, a significant decline (p less than 0.05) in the proliferation rate index was observed, which might be an indicator of the cytotoxic effect of PMMA.

Adult↗