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Prevention of fibrous layer formation between bone and adhesive bone cement: in vivo evaluation of bone impregnation with 4-META/MMA-TBB cement.

We have studied a new adhesive bone cement, that consists of 4-methacryloyloxyethyl trimellitate anhydride (4-META) and methylmethacrylate (MMA) as monomers, tri-n-butyl borane (TBB) as the initiator, and polymethylmethacrylate powder (4-META/MMA-TBB cement). This cement has shown remarkable adhesive properties to bone in vitro. In this study, we assessed the interface in vivo periodically. The femora of rabbits were fenestrated and filled with either the 4-META/MMA-TBB cement or a conventional polymethylmethacrylate cement. The animals were killed after 1, 4, 12, and 24 weeks to analyze the interface by optical microscopy and transmission electron microscopy. Optical microscopic examinations showed that the cured 4-META/MMA-TBB adhesive cement bonded to bone directly for 24 weeks, whereas a fibrous tissue layer was observed between the bone and cured conventional cement at 12 weeks after the operation. The transmission electron microscopy views of 4-META/MMA-TBB cement bonded to bone demonstrated a unique "hybridized bone" with the cement in the subsurface of the substrate in every case. The formation of the hybridized bone indicates the bonding mechanism of the adhesive cement to bone, which prevents the fibrosis intervention between bone and cement. These results suggest that the biomechanical and adhesive properties of 4-META/MMA-TBB cement make it a useful bone-bonding agent in orthopedic surgery.

Animals↗

Stress transfer at the femoral bone/bone cement interface as a function of the cement thickness.

When a cement canal prosthesis is used as the femoral component in total hip replacement (THR), the penetration depth of the bone cement can be varied according to the cement implantation pressure. Using experimental data which give a relation between the pressure applied to the cement at implantation and the resulting shape of the cement layer, a three-dimensional finite element study was performed to calculate the stress distribution at the bone/bone cement interface. The calculations show that the interface stresses increase with increasing depth of penetration by the cement layer. The explanation of this effect is that as the bone cement penetrates further into the cancellous bone, the cancellous bone is stiffened and can no longer act as a soft interposition between cortical bone and bone cement. From these results and from the clinical requirement that as little bone as possible be destroyed in any kind of allo-arthroplasty, we conclude that the penetration depth of bone cement into cancellous bone in THR should be minimized to the depth necessary in order to achieve sufficient initial stability of the implant. The results show that a cement-canal prosthesis meets these requirements if a cement implantation pressure of 1.0 bar is used.

Bone Cements↗

Tensile strength of the cement-bone interface depends on the amount of bone interdigitated with PMMA cement.

An experimental investigation was performed to (1) determine the general mechanical behavior and in particular, the post-yield behavior of the cement-bone interface under tensile loading, (2) determine where interface failure occurs, and (3) determine if the mechanical properties of the interface could be related to the density of bone at the interface and/or the amount of cement-bone interdigitation. Seventy-one cement-bone test specimens were machined from human proximal femurs that had been broached and cemented using contemporary cementing techniques. The amount of cement-bone interdigitation was documented and the quantitative computed tomography equivalent mineral density (QCT density) of the bone with cement was measured. Specimens were loaded to failure in tension under displacement control and exhibited linear elastic behavior with some reduction in stiffness until the peak tensile stress was reached (1.28 +/- 0.79 MPa). A substantial amount of strain softening (negative tangent stiffness) with an exponential-type decay was found after the peak stress and continued until there was complete debonding of the specimens (at 0.93 +/- 0.44 mm displacement). Interfacial failure most often occurred at the extent of cement penetration into the bone (56% of specimens) or with small spicules of cement left in the bone (38% of specimens). The results showed that the post-yield tensile behavior contributes substantially to the energy required to cause failure of the cement-bone interface, but the post-yield behavior was not well correlated with the amount of interdigitation or density of bone. Linear regression analysis revealed a moderate (r2 = 0.499, p < 0.0001) positive relationship between the tensile strength of the cement-bone interface and the quantity of bone interdigitated with the cement.

Adult↗

Effect of geometrical cement size on in vitro and in vivo indomethacin release from self-setting apatite cement.

The relationship between in vitro and in vivo indomethacin (IMC) release from a self-setting bioactive apatite cement and cement size were investigated. Differently sized apatite cements (total weight, 500 mg); either 64 of the small size (2 mm diameter x 2 mm thickness), sixteen of the medium size (4 mm x 2 mm) or one of the large size (15 mm x 2 mm) were obtained from cement bulk powder containing tetracalcium phosphate, dicalcium phosphate dihydrate and hydroxyapatite. In vitro IMC release from the 1, 2 and 5% drug-loaded apatite cement systems in simulated body fluid (SBF) (pH 7.25) at 37 degrees C increased with increasing concentrations of IMC and with decreasing geometrical size of the cement. The plots of in vitro IMC release per unit area against the square root of time increased with increasing IMC concentrations, but not with decreasing geometrical size of the cement. After subcutaneous (s.c.) implantation of differently sized 1% IMC-loaded cements in male Wistar rats, the plasma IMC concentration and the area under the curve increased with decreasing cement diameter. The in vivo IMC release profiles of the cement were deconvoluted from the plasma IMC profiles after s.c. administration of IMC solution. The plots of in vivo IMC release per unit area against the square root of time suggested that the initial release from all 1% drug-loaded cements was very rapid, slowed after one day, but continued for over two weeks. The relationship between the in vitro release in SBF and the in vivo release in rats of IMC-loaded cements was linear.

Animals↗

Cement penetration and stiffness of the cement-bone composite in the proximal tibia in a porcine model.

PURPOSE: To assess the stiffness of the cement bone composite and the depth and uniformity of cement penetration into the surface of the tibial component during total knee reconstruction in a porcine model. METHODS: The effectiveness of 3 protocols were compared: 2 commonly used cementing techniques-finger-packing of cement on the cut surface followed by impaction, and coating of the undersurface of the prosthesis with cement followed by impaction-and a new method using a tibial cement-pressurising device. Cement penetration was measured by computed tomography; stiffness was determined by hydraulic penetration testing. RESULTS: Cement penetration at a depth of 1 mm was significantly greater following coating the undersurface of the prosthesis than following finger-packing (p=0.008). There was no significant difference at deeper levels or between the tibial-pressurising device group and either of the 2 other groups at any level (p>0.3 in all cases). Differences in surface stiffness by tibial plateau region were found in tibiae that had been cemented using finger-packing and in those that had had their undersurface coated, but not in tibiae that had been cemented using the tibial-pressurising device. CONCLUSION: The tibial cement-pressurising device eliminated regional differences in stiffness seen with other cementing methods. Elimination of these differences by using this device should reduce micromotion and the incidence of aseptic loosening of tibial base plates in total knee arthroplasty.

Analysis of Variance↗

Bond strength of brackets cemented with light-cured glass-ionomer cements to contaminated enamel.

PURPOSE: To examine the effect of contamination on the bond strength of orthodontic brackets cemented with either a commercial (Fuji Ortho LC) or an experimental light-cured glass-ionomer cement to enamel, and the effect of etching times on the bond strength. MATERIALS & METHODS: Simulated metal brackets were applied with the cements to bond polished and etched (37% phosphoric acid) bovine enamel with and without contamination by water, human saliva, and blood. After 1-day water immersion, the shear bond strengths were measured. The fractured surfaces were examined using SEM. Additional tests were conducted on: (1) the Knoop hardness of the contaminated cements, (2) the HEMA composition of the cements, (3) the viscosity of the cements, and (4) the intensity of transmitted visible light through the contaminants. The results were compared by ANOVA and Duncan's tests at P=0.05. RESULTS: Water and saliva reduced the bond strength to polished and etched enamel, except for the bond strength of Fuji Ortho LC to polished enamel. The blood contamination produced poor bond strengths to polished and etched enamel. The experimental cement showed higher bond strengths to polished enamel with water and saliva contamination than Fuji Ortho LC. The bond strength of the experimental cement to etched enamel with and without contamination were comparable to those of Fuji Ortho LC. SEM micrographs revealed that the specimens exhibiting high bond strengths to polished and etched enamel mainly had cement-enamel interface failure and cement-metal mesh interface failure, respectively. Fuji Ortho LC had higher HEMA concentration than the experimental cement. The highest viscosity was measured with blood, followed by saliva and water. Blood contamination, showing the highest attenuation of the light intensity, reduced Knoop hardness of the experimental cement and Fuji Ortho LC.

Acid Etching, Dental↗

Acetabular cement compactor. An experimental study of pressurization of cement in the acetabulum in total hip arthroplasty.

To improve cement fixation of acetabular components for total hip arthroplasty, a new instrument, the acetabular cement compactor, was devised. Measurements in human cadaveric acetabula show that the cement intrusion pressure is significantly and substantially increased by the acetabular cement compactor. The depth of cement intrusion is greatly improved when the compactor is used, as compared with finger packing. The impression casts of the acetabular cement are superior when the cement is inserted using the acetabular cement compactor. Occlusion of the orifice of the keying holes permits generation of high pressure in the cement within them. This can be achieved by using the keying-hole seal. Pressurization of the acetabular cement used in the dough stage by the acetabular cement compactor substantively improves acetabular cement fixation.

Acetabulum↗

The effect of cement type and mixing on the bi-axial fracture strength of cemented aluminous core porcelain discs.

OBJECTIVES: Luting agents in current use include zinc phosphate, zinc polycarboxylate, conventional glass-ionomer, resin-modified glass-ionomer and resin composite cements. Dental cements may be used in practice with a wide range of mixing ratios. Accordingly, the impact of cement type and mixing on the strength of alumina reinforcing porcelain was investigated. METHODS: Standard Vitadur-N core porcelain disc specimens were coated with different cement types of varying mixing ratios to produce a luting thickness. Sets of 25 coated specimens were stored at 37+/-1 degrees C for 24h prior to testing. Mean fracture strengths, standard deviations and associated Weibull Moduli (m) were determined using bi-axial fracture (ball-on-ring). RESULTS: The strength data for porcelain discs coated with different cement types manipulated at the consistency indicated for luting all-ceramic crowns showed little variation in magnitude and consistency. The plots of survival probability against strength for specimens coated with acid-base cements appear to develop a slight asymmetry at the lower values of strength. This effect was more pronounced for acid-base cements prepared at mixing ratios below that recommended for luting purposes. SIGNIFICANCE: The corrosive acidic environment of acid-base cements may have extended pre-existing flaws in the porcelain discs producing the asymmetry in the survival distributions. Resin composite cements appear to enhance the strength of the porcelain disc specimens possibly by healing the surface imperfections. This may increase their scope of application over acid-base cements to include the luting of all-ceramic restorations.

Aluminum Oxide↗

Influence of mixing method on the cement temperature-mixing time history and doughing time of three acrylic cements for vertebroplasty.

Acrylic cements are increasingly being used to augment osteoporotic vertebrae in a procedure called vertebroplasty. Two significant factors that may complicate the use of acrylic cements are: (a) short handling time, which may result in insufficient filling of the vertebra; and (b) exothermic setting (curing) behavior, which may result in thermal damage of the surrounding tissue. It has been previously reported that mixing the cement components under oscillation, as compared to manual mixing, increases the handling time. More specifically, it seems that oscillatory mixing slows down the cement polymerization process and, consequently, widens the time window during which cement is injectable. However, the effect of oscillatory mixing on the exothermic setting behavior of cement undergoing polymerization has not been examined. In this study, the exothermic setting behavior of three commercially available acrylic cements--Antibiotic Simplex, DP-Pour&trade, and Vertebroplastic--were examined for both manual and oscillatory mixing methods. For each combination of cement and mixing method, the parameters that were measured were the exothermic setting curve (and hence the cement setting temperature and setting time) and the cement doughing time. It was found that oscillatory mixing had no significant effect on any of these parameters. Based on the results of this study, it can be concluded that, for the tested cements, the setting process is a reaction-controlled process rather than a diffusion-controlled one. Clinically, this implies that oscillatory mixing may be used to increase the working period for acrylic cements without increasing the risk of thermal damage to surrounding tissue.

Bone Substitutes↗

Effect of eugenol and non-eugenol containing temporary cement on permanent cement retention and microhardness of cured composite resin.

This present study had three aims: 1) to evaluate the bond strengths of carboxylate and resin cements in cementing cast Co-Cr crowns to pretreatment of composite resin cores with eugenol and non-eugenol containing temporary cements, 2) to determine the microhardness of composite resin treated with temporary cement, 3) to view the surface differences of composite resin with SEM. The composite cores were divided into three experimental groups for the following pretreatments: Group 1, No treatment was provided, Group 2, The external walls of the composite cores were covered with eugenol-containing temporary cement, Group 3, The external walls of the composite cores were covered with non-eugenol containing temporary cement. Analysis of variance results showed that there was a significant difference between all three groups. Temporary cement with eugenol was significantly reduced the bond strength of full crown casting with resin cement compared with non-eugenol. The resin specimens treated with the eugenol-containing temporary cement showed the lowest microhardness values, the non-eugenol-containing temporary cement was not significantly different from those of the control groups.

Analysis of Variance↗

A three-dimensional non-linear finite element study of the effect of cement-prosthesis debonding in cemented femoral total hip components.

A three-dimensional non-linear finite element analysis of a cemented femoral component in which the component was partially debonded from the cement mantle was used to assess the effects of debonding on stresses in the cement. Three cases of partial cement-metal debonding were modelled with debonding of the proximal portion of the implant down to a horizontal plane which was 35, 62.5, or 82.5 mm below the prosthesis collar. Each situation was studied under loads simulating both gait and stairclimbing. Also, complete debonding between the implant and the surrounding cement mantle was modeled for loads simulating gait. Under stair climbing loads with partial cement-mental debonding, hoop stresses of 13-18 MPa were observed in the cement at the cement-metal interface at the proximal postero-medial corner of the implant. Similarly, in stair climbing, the maximum principal stresses in the cement were also adjacent to the proximal postero-medial region of the implant. These stresses were compressive and increased from 15 MPa with fully bonded interfaces to 48 MPa with debonding down to 82.5 mm below the prosthesis collar. Under gait loads, complete debonding caused high compressive stresses up to 34.9 MPa in the cement distal to the prosthesis tip. Thus, cement failure subsequent to prosthesis debonding is likely in the proximal region in a partially debonded implant due to stair climbing loads and is likely below the prosthesis tip in a fully debonded implant due to gait loading.

Body Weight↗

Thermal analysis of bone cement polymerisation at the cement-bone interface.

The two major problems that have been reported with the use of polymethylmethacrylate (PMMA) cement are thermal necrosis of surrounding bone due to the high heat generation during polymerisation and chemical necrosis due to unreacted monomer release. Computer models have been used to study the temperature and monomer distribution after cementation. In most of these models, however, polymerisation is modelled as temperature independent and cancellous bone is modelled as a continuum. Such models thus cannot account for the expected important role of the trabecular bone micro-structure. The aim of this study is to investigate the distribution of temperature and monomer leftover at the cancellous bone-cement interface during polymerisation for a realistic trabecular bone-cement micro-structure and realistic temperature-dependent polymerisation kinetics behaviour. A 3-D computer model of a piece of bovine cancellous bone that underwent pressurization with bone-cement was generated using a micro-computed tomography scanner. This geometry was used as the basis for a finite element model and a temperature-dependent problem for bone cement polymerisation kinetics was solved to simulate the bone cement polymerisation process in the vicinity of the interface. The transient temperature field throughout the interface was calculated, along with the polymerisation fraction distribution in the cement domain. The calculations revealed that the tips of the bone trabeculae that are embedded in the cement attain temperatures much higher than the average temperature of the bone volume. A small fraction of the bone (10%) is exposed to temperatures exceeding 70 degrees C, but the exposure time to these high temperatures is limited to 50s. In the region near the bone, the cement polymerisation fraction (about 84%) is less than that in the centre (where it is reaching values of over 96%). An important finding of this study thus is the fact that the bone tissue that is subjected to the highest temperatures is also subjected to high leftover monomer concentration. Furthermore the maximum bone temperature is reached relatively early, when monomer content in the neighbouring cement is still quite high.

Animals↗

Material changes in osteoporotic human cancellous bone following infiltration with acrylic bone cement for a vertebral cement augmentation.

Bone cement infiltration can be effective at mechanically augmenting osteoporotic vertebrae. While most published literature describes the gain in mechanical strength of augmented vertebrae, we report the first measurements of viscoelastic material changes of cancellous bone due to cement infiltration. We infiltrated cancellous core specimen harvested from osteoporotic cadaveric spines with acrylic bone cement. Bone specimen before and after cement infiltration were subjected to identical quasi-static and relaxation loading in confined and free compression. Testing data were fitted to a linear viscoelastic model of compressible material and the model parameters for cement, native cancellous bone, and cancellous bone infiltrated (composite) with cement were identified. The fitting demonstrated that the linear viscoelastic model presented in this paper accurately describes the mechanical behaviour of cement and bone, before and after infiltration. Although the composite specimen did not completely adopt the properties of bulk bone cement, the stiffening of cancellous bone due to cement infiltration is considerable. The composite was, for example, 8.5 times stiffer than native bone. The local stiffening of cancellous bone in patients may alter the load transfer of the augmented motion segment and may be the cause of subsequent fractures in the vertebrae adjacent to the ones infiltrated with cement. The material model and parameters in this paper, together with an adequate finite-element model, can be helpful to investigate the load shift, the mechanism for subsequent fractures, and filling patterns for ideal cement infiltration.

Bone Density↗

Chromium content in human skin after in vitro application of ordinary cement and ferrous-sulphate-reduced cement.

The amount of chromium found in human skin after in vitro application of cement suspensions on full-thickness human skin in diffusion cells was investigated. Cement suspensions made from ordinary Portland cement or Portland cement with the chromate reduced with added ferrous sulphate were used. The cement suspensions were either applied on the skin surface under occlusion for 48 h or applied repeatedly every 24 h for 96 h. No statistically significant difference in chromium content of skin layers between skin exposed to ordinary Portland cement, skin exposed to cement with added ferrous sulphate and unexposed skin was observed, despite a more permeable skin barrier at the alkaline pH of the cement suspensions, i.e., pH 12.5. Increased chromium levels in epidermis and dermis were seen when ordinary Portland cement was applied as a suspension with added sodium sulphate (20%) on the skin surface for 96 h. The content of water-soluble chromium in ordinary Portland cement may vary due to the alkali sulphate content of the cement.

Cementation↗

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↗