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PubMed2004

Early corrective osteotomy for a malunited Colles' fracture using volar approach and calcium phosphate bone cement: a case report.

We report a case of malunion of the distal radius after a Colles' fracture treated with osteotomy using a volar approach combined with calcium phosphate bone cement grafting of the dorsal defect via a drill hole from the volar cortex 6 weeks after the injury. One year and 4 months after surgery range of motion and grip strength were improved and x-rays of the wrist showed complete union of the distal radius with progressive absorption of the calcium phosphate bone cement.

Adult↗
PubMedDate not supplied

Effect of sterilization method on properties of Palacos R acrylic bone cement.

The focus of this work was a delineation of the effect of the method of sterilization (gamma-irradiation versus exposure to ethylene oxide (EtO) gas) of the powder constituents of Palacos R bone cement on the molecular weight, quasi-static tensile and compressive properties and fatigue performance of the fully polymerized material. It was found that the quasi-static properties are not noticeably affected. However, when the powder constituents were gamma-sterilized, both the molecular weight and the fatigue performance of the cement are significantly lower compared to when the constituents are EtO-sterilized. Explanations are offered for these findings, and recommendations are submitted regarding the preferred method of sterilization of bone cement and reporting of studies in which different formulations of cement are compared.

Bone Cements↗
PubMed1985

A model of tension and compression cracks with cohesive zone at a bone-cement interface.

This paper gives an insight about compression and tension cracks as encountered at a bone-cement interface. Within the context of continuum theory of fracture, an analytical solution is presented for the problem of a bimaterial interface edge crack under uniaxial tension or compression, assuming no tangential slip along the crack faces since cement pedicles penetrate into the cancellous bone several millimeters. Also essential to the solution are cohesive zone effects that account for a strengthening mechanism over the crack faces. The solution provides a methodological framework for quantifying the influence of the cohesive zone on the magnitude of the stress singularity. Mode I crack tip stress intensity factors are calculated at different stages of the loading and unloading phases under uniaxial tension or compression. Finally, an inelastic mechanism is presented that gives theoretical support to explain the formation of interfacial compression cracks, a phenomenon that was not previously appreciated and that arises from the rigid cement being forced into the more compliant cancellous bone.

Biomechanical Phenomena↗
PubMed1978

Spinal fixation using acrylic bone cement: mechanical property measurements.

Following dorsal laminectomies (L2-L3), the resultant spinal instabilities were stabilized by placing four Steinmann pins and embedding them in acrylic bone cement. The cement was molded about the instability and incorporated the pins and articular process. Mechanical testing was performed to evaluate the strength of the resultant union between the two vertebrae. Three types of samples, in vivo, in vitro and normal were tested using a specially built apparatus. The results showed average maximum loads of 150, 180 and 180 Newtons respectively which represent 29, 42 and 37 MPa in calculated shear stresses. The results indicate that the use of bone cement with pins can stabilize the injured vertebral discs easily iwth the maximum load or shear strength equivalent to that of normal vertebral discs.

Animals↗
PubMed1995

Microstructural investigation of bone-cement interface.

We evaluated the microstructural characteristics of newly formed bone tissue at the interface with cement. The bone-cement interfaces of the femoral components of nine hip prostheses retrieved after loosening were investigated by means of X-ray diffraction on microareas and microhardness. The bone far from the interface of two stable prostheses was used as a control. The newly formed bone adjacent to cement in the loosened prostheses showed a maturity degree lower than that of bone adjacent to cement in stable prostheses. The lattice parameters of bone apatite did not show significant variations as compared to the reference values. Bone trabeculae at the interface with loosened prostheses often showed an osteoid lining characterized by a strongly demineralized lamellar and haversian structure. Radioopaque cement particles are sometimes found in the trabecular bone tissue around the prosthesis.

Apatites↗
PubMed1994

Effect of methylene blue on the fracture toughness of acrylic bone cement.

It has been advocated that the use of contrast acrylic bone cement (namely, a cement in which a suitable additive is included) for the fixation of a cemented arthroplasty will facilitate its revision (should this be necessary). It is useful, therefore, to determine the extent to which each of the relevant mechanical properties of the cement is affected by the presence of such an additive. It is shown, in the present work, that the addition of one contrast agent (an aqueous methylene blue solution) to a cement has no statistically significant effect on its mode-I plane-strain fracture toughness. This strengthens the case for the use of contrast cement for the aforementioned application.

Acrylates↗
PubMed1988

Bone cement and the liver. A dose-related effect?

The serum liver enzyme levels of 40 consecutive patients before and after cemented hip replacement were compared with a control group having operation without use of cement. Serum gammaglutamyl transferase (SGGT) was abnormally raised, for more than four days, in 12 of the 40 patients (32%) in whom bone cement was used, compared with one of the 36 control patients. The changes in SGGT levels after operation correlated with the weight of cement used (r = 0.66, p less than 0.001), but there was return to normal levels in all patients. A temporary dose-related effect of bone cement on liver function is demonstrated.

Alanine Transaminase↗
PubMed1976

Mechanical properties of bone cements containing large doses of antibiotic powders.

The addition of up to 10 g gentamicin sulfate antibiotic powder to 60 g units of Simplex-P acrylic bone cement caused gradual, proportional decreases in the bulk muchanical properties of compressive and diametral tensile strengths. Water leaching of the antibiotic from the cement did not significnatly decrease these strenghts. Scanning electron microscopy (SEM) and energy-dispersive x-ray spectroscopy (EDS) showed the antibiotic to reside in the acrylic matrix as discrete particles not usually associated with internal porosity. The surface-sensitive flexural strength of a proprietary bone cement was lowered immediately by small quantities of antibiotic powder, and continued to decrease as doses of up to 10 g/unit were admixed. Water leaching caused channeling as the antibiotic was removed from the surface, but it did not create further changes in flexural strength.

Bone Cements↗
PubMed1988

The correlation between the roentgenographic appearance and operative findings at the bone-cement junction of the socket in Charnley low friction arthroplasties.

In a series of 200 Charnley low friction arthroplasties revised for various reasons, the preoperative anteroposterior roentgenograms were categorized in terms of demarcation at the bone-cement interface of the socket and compared with the operative findings of movement at the bone-cement junction. All sockets showing no demarcation were found to be fixed soundly. Seven percent of the sockets showing demarcation of the outer one-third only were loose, and when two-thirds of the sockets were demarcated, 71% were loose. Ninety-four percent of the sockets with complete demarcation and all sockets that had migrated were found to be loose at revision. There is a definite correlation between roentgenographic demarcation and socket loosening. The more extensive the demarcation, the more likely it is that the socket is loose. Radiographic demarcation of the cemented socket is a prognostic sign for eventual failure.

Adult↗
PubMed2005

In vitro evaluation of antibiotic release from and bacteria growth inhibition by antibiotic-loaded acrylic bone cement spacers.

The antibiotic release from and the bacteria growth inhibition by antibiotic-loaded acrylic bone cement hip spacers were studied. The cement used was Palacos R, and it was loaded with either one antibiotic powder (gentamicin, vancomycin, teicoplanin, or synercid) [monoantibiotic case] or two antibiotic powders (gentamicin + vancomycin or gentamicin + teicoplanin) [biantibiotic case] and then tested against Staphylococcus epidermidis, Staphylococcus aureus, Enterococcus faecalis, and methicillin-resistant Staphylococcus aureus (MRSA). Antibiotic elution and bacteria growth were measured every 24 h simultaneously by fluorescence polarization immunoassay and photometrically, respectively. The gentamicin + vancomycin combination achieved the longest growth inhibition on S. epidermidis and MRSA (mean of 20 and 14 days, respectively). Gentamicin + teicoplanin-loaded spacers were capable of inhibiting growth on E. faecalis and S. aureus for the longest period (11 and 16 days, respectively). The highest concentrations of gentamicin and vancomycin could be assayed during the first 4 days. Teicoplanin concentrations could be detected only during the first 72 h, synercid was not detected at all, possibly because of the limitation of the detection technique used. A greater percentage of the gentamicin was released than of the vancomycin. The aminoglycosid-glycopeptid combination showed a synergistic effect on the release of gentamicin, but not on vancomycin or teicoplanin. Biantibiotic-impregnated hip spacers proved to be superior to monoantibiotic ones. Because of important differences between the conditions used for the present tests and the in vivo environment, any recommendation with regard to the use of monoantibiotic- and biantibiotic-loaded acrylic bone cement spacers must await the results of further investigations.

Anti-Bacterial Agents↗
PubMed2001

Temperature and ageing condition effects on the characterization of acrylic bone cement.

This study investigates the effect of the environmental temperature and ageing condition on the characterization of acrylic bone cement. The tests were performed according to ISO 5833. The testing parameters were allowed to vary within the limits defined by the standard, in order to assess their effect on the results of the test. In certain cases the tests were also performed under conditions which the standard does not provide for but which are likely to occur clinically. This investigation showed that the cement behaviour may also change in the temperature range specified in the standard. Therefore, it is deemed appropriate to correlate the curing parameters of the bone cement to the environmental temperature, performing the test at different temperatures. In this way the effect of temperature on the duration of the phases in the cement curing could be assessed. The resultant graphical representation of the effect of temperature on the duration of the phases in cement curing has direct clinical relevance. Furthermore, this study showed that the ageing conditions of the mechanically tested specimens affected the results. Hence, it is deemed advisable to modify the ageing conditions of the specimens, fixing them closer to the in vivo conditions.

Arthroplasty, Replacement↗
PubMed2006

Biocompatibility of glass-ionomer bone cements.

Glass-ionomer cements (GIC) have been extensively used in dentistry for over 30 years. Due to their excellent biocompatibility in dental applications GIC have been formulated for medical applications. The past decade has seen some impressive advances in the development of medical GICs, however these advances have been matched by serious critical problems. This review examines the properties of GICs, which can influence their behaviour in a biological environment. The progress made and the problems encountered in the development of these bone cements will also be addressed. The review will conclude with the research currently being employed to optimise the biocompatibility of these important biomaterials. There is little doubt that GICs compare favourably with alternative bone cements for specific applications, based on in vitro and in vivo studies. There is however, a degree of risk inherent in the use of any medical device or biomaterial. GICs must therefore be used carefully and in accordance with the instructions that are based on a significant body of research data.

Aluminum↗
PubMed1998

[Heat of polymerization of bone cement can induce cardiac arrest].

Total hip arthroplasty is associated with cardiopulmonary complications including cardiac arrest. We present one of four cases of cardiac arrest, two of the cases were fatal. The pathogenesis suggested to explain these complications is venous air embolism, generated by the methylmethacrylate bone cement polymerization causing thermal blood damage. To prevent this happening cortical bone allotransplantation around the prosthesis and bone cement with a low temperature of polymerization may be used.

Aged↗
PubMedDate not supplied

[Biocompatibility of a new ionomer bone cement in endoprosthetics. In vitro testing using a mixed bone cell culture].

Periosteal derived bovine osteoblasts and osteoclasts migrated in culture onto an ionomeric cement, currently evaluated as a cement for orthopaedic implants. Cell cultures were maintained for 4 weeks and used to study the in-vitro behaviour of cells on the material surface. Osteoblasts and osteoclasts colonized the substrate in monolayers and exhibited their phenotypic morphology. Differentiation into both cell lines were demonstrated by immunostaining. Staining for aluminium in cells growing on the bone cement showed an uptake and storage of aluminium in the cells. EDAX-microanalysis revealed high concentrations of Al and Si in the periosteal tissue. Despite uptake of Al in the cells, signs of toxicity were not apparent in the cell culture system.

Aluminum↗
PubMed2003

Effect of bone porosity on the mechanical integrity of the bone-cement interface.

BACKGROUND: Osteopenia is one factor that may influence the decision about the type of implant fixation to use in total hip arthroplasty. However, clinical studies generally do not associate the outcome of an arthroplasty with the degree of osteopenia. The mechanical integrity of the cement fixation of an implant may be affected by the relative degree of osteopenia, which could account for some of the variable long-term results after total hip arthroplasty performed with cement. The purpose of this study was to determine the effects of bone porosity, trabecular orientation, cement pressure, and cement penetration depth on fracture toughness at the bone-cement interface. METHODS: Trabecular bone from the proximal part of bovine femora was used with a single brand of commercial acrylic bone cement to form compact-tension interface specimens representing a range of bone porosities, orientations, and cement pressures within a clinically achievable range. All specimens were loaded to failure with use of a servohydraulic testing machine, and fracture toughness at the interface was calculated. After testing, images of a representative sample of specimens were made with use of computed tomography to measure the penetration depth of the cement into the bone. RESULTS: Significant correlations were found between fracture toughness and bone porosity, trabecular orientation, and cement pressure, with bone porosity having the strongest effect (p < 0.000015). Examination of the computed tomographic images also showed a significant correlation between fracture toughness and maximum cement penetration depth (p < 0.033), as well as significant partial correlations between maximum and mean penetration depth and bone porosity (p < 0.0037 and p < 0.0028). CONCLUSION: The fracture resistance of the bone-cement interface is greatly improved when the ability of the cement to flow into the intertrabecular spaces is enhanced.

Animals↗
PubMed1999

A novel high-viscosity, two-solution acrylic bone cement: effect of chemical composition on properties.

Solutions of poly(methyl methacrylate) (PMMA) powder predissolved in methyl methacrylate (MMA) have been developed as an alternative to current powder/liquid bone cements. They utilize the same addition polymerization chemistry as commercial cements, but in mixing and delivering via a closed system, porosity is eliminated and the dependence of material properties on the surgical technique is decreased. Twelve different sets of compositions were prepared, with two solutions of constant polymer-to-monomer ratio (80 g of PMMA/100 mL of MMA) and all combinations of four benzoyl peroxide (BPO) initiator levels added to the first solution and three N, N-dimethyl-p-toluidine (DMPT) activator levels added to the second. These compositions were tested, along with Simplex-P bone cement, for effects of BPO and DMPT concentrations on polymerization exotherm, setting time, flexural strength, modulus, and maximum strain. The results show that each of these dependent variables was affected significantly by the individual concentrations of BPO and DMPT and their interactions. The flexural strength, modulus, and polymerization exotherm reached their maximums at about a 1:1 molar ratio of BPO to DMPT. Most compositions had exotherms, setting times, and maximum strains within the range of commercial cements and flexural strengths and moduli up to 54 and 43% higher than Simplex-P, respectively.

Benzoyl Peroxide↗
PubMed1983

Adherence and growth of bacteria on bone cement in vitro and in chronologically infected artificial joints.

Low grade infections following total hip replacements manifest themselves late after surgery. These infections seem to be sterile; there are major problems in identifying the causative organism by cultivation. SEM investigation of small samples of the bone cement, the task of which is to anchor the prosthesis in the bone, is a suitable method for identifying the bacterial origin of these infections. During conventional histological preparation polymethacrylates are dissolved. Freeze-drying techniques, however, allow the preparation of bone cement samples for the SEM. The growth of staphylococci on cement particles shows that these resins can no longer be considered biologically inert. The surface is attacked by the bacteria.

Bone Cements↗
PubMed2006

Treatment of enchondroma of the hand with injectable calcium phosphate bone cement.

PURPOSE: To report the results of treatment of enchondroma of the hand managed by curettage and calcium phosphate bone cement (CPC) grafting. METHODS: Ten patients with digital enchondroma were reviewed. There were 6 proximal phalanges, 2 middle phalanges, and 2 metacarpal bones. The average patient age at surgery was 31 years. The average follow-up period was 41 months. We reviewed the final function and radiographic appearance of the surgically treated digits. We defined the term bony incorporation of CPC as a seamless change of radiographic appearance and no gap between cancellous bone and CPC. RESULTS: At final evaluation the bony incorporation was uneventful in all patients. Radiographs showed apparent partial absorption of CPC in only 2 patients. All digits had full range of motion after surgery. One digit fixed with multiple pins to treat a pathologic fracture simultaneously resulted in malunion and needed additional surgeries to correct digital overlap. No other complications were encountered. CONCLUSIONS: Patients with enchondroma of the hand are good candidates for treatment with CPC. In the case of pathologic fracture before surgery, however, surgery may be delayed until fracture healing because early corrective osteotomy with CPC might be difficult in a patient with malunion TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.

Adolescent↗