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PubMed2002

In vitro analysis of antifungal impregnated polymethylmethacrylate bone cement.

Fungal infection is a rare but devastating complication of total joint arthroplasty. Many patients require removal of the components and resection arthroplasty for cure; however, revision arthroplasty with medicated polymethylmethacrylate bone cement may be used to salvage the joint. Some studies have documented the efficacy of mixing antibiotics with polymethylmethacrylate, but the efficacy of antifungal drugs when mixed with polymethylmethacrylate is unknown. An in vitro agar diffusion method was used in the current study to investigate this potential, and several clinically important conclusions resulted: (1) after incorporation into bone cement, fluconazole and amphotericin B remained active whereas 5-flucytosine did not, (2) inhibitory activity improved with greater drug concentrations, and (3) more drug eluted from Palacos R than Simplex P cement.

Amphotericin B↗
PubMed1998

[Successful treatment by PCPS of cardiac arrest related to the use of bone cement in cementedendoprosthesis of the femoral head: a case report].

A 65-year-old female with pulmonary tuberculosis and systemic sarcoidosis developed sudden cardiac arrest after the use of bone cement in cementedendoprosthesis of the femoral head. Cardiac arrest was difficult to manage with ordinary CPR and PCPS was immediately instituted. After resuscitation, the patient suffered from intraabdominal hemorrhage due to hepatic injury caused by CPR. On the 1st post-operative day the patient required surgical treatment to stop bleeding and was then weaned from PCPS. The patient required ventilatory support over next 7 days, but survived without neurological sequelae. When anesthetizing an elderly patient with preexisting cardiopulmonary disease for cementedendoprosthesis, PCPS should be considered in case of cardiac arrest due to the use of bone cement.

Aged↗
PubMedDate not supplied

Ceramic bearing surfaces in total artificial joints: resistance to third body wear damage from bone cement particles.

Studies of explanted Charnley hip prostheses have shown damage or scratching of the polished stainless steel femoral heads. This surface damage is probably due to third body wear by bone cement particles. Damaged femoral heads will produce increased wear rates of ultra high molecular weight polyethylene (UHMWPE) acetabular cups. Sliding wear tests carried out in the laboratory have shown that alumina ceramic counterfaces are more resistant to third body damage from bone cement particles than stainless steel counterfaces. The use of the ceramic femoral heads in artificial hip joints will help to preserve the smooth surface finish on the femoral bearing surface, which is necessary to ensure low wear rates of the UHMWPE cup throughout the lifetime of the prosthesis.

Biocompatible Materials↗
PubMed2004

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

Deep infection is a devastating complication following total joint arthroplasty. Preclinical testing; randomized; clinical trials; national joint replacement data; and our experience indicate that the use of antibiotic-impregnated bone cement is a potentially effective strategy in reducing the risk of deep infection following both primary and revision total joint arthroplasty. Allergic reactions, bacterial resistance, and cost represent barriers to the widespread use of antibiotic bone cement.

Anti-Bacterial Agents↗
PubMed1984

Bone injury caused by curing bone cement. A vital microscopic study in the rabbit tibia.

The tissue trauma caused by leakage of monomer from curing bone cement was studied in rabbit bone. With a chamber method it was possible to study by intravital microscopy the tissue response in the same animal from the time of cement application to as long as 350 days afterward. The immediate monomer effects were mainly vascular: blood flow disturbances, blood flow standstill, and intravascular hemolysis. The most striking finding was that the extent of vascular disturbance was related to the type of tissue afflicted: In fatty marrow the effects were widespread, and in bone or fibrous tissue they were very limited. This is interpreted to reflect the affinity of the monomer to lipid-rich tissues. Follow-up observations showed marked resorption of marrow fat cells during the first weeks after injury, whereas very little bone was resorbed.

Animals↗
PubMed1997

Optimization of benzoyl peroxide concentration in an experimental bone cement based on poly(methyl methacrylate).

The effect of the concentration of benzoyl peroxide in poly(methyl methacrylate) bone cement formulations on their setting characteristics, particularly peak temperature and setting time, were studied. An optimization of the concentration of benzoyl peroxide was made with respect to curing parameters and compared with the residual monomer content. The mechanical properties of the different formulations were also determined and the results indicated that a composition of 1.5% wt/wt and 0.82% wt/wt of benzoyl peroxide and N,N-dimethyl-p-toluidine concentrations, respectively, gave the highest yield strength. Studies on the preparation of bone cement formulations containing different amounts of barium sulphate were also performed to assess the effect on the polymerization process and mechanical properties of the cements.

Journal Article↗
PubMed2005

In vitro and in vivo biological responses to a novel radiopacifying agent for bone cement.

Iodixanol (IDX) and iohexol (IHX) have been investigated as possible radiopacification agents for polymethylmethacrylate (PMMA) bone cement, to replace the currently used barium sulphate and zirconia. IDX and IHX are both water-soluble iodine-based contrast media and for the last 20 years have been used extensively in clinical diagnostic procedures such as contrast media enhanced computed tomography, angiography and urography. One of the major reasons to remove the current radiopacifying agents is their well-documented cytotoxicity and their potential to increase bone resorption. Using in vitro bone resorption assays, the effect of PMMA particles plus IDX or IHX to induce osteoclast formation and lacunar resorption on dentine slices has been investigated. These responses have been compared with the in vitro response to PMMA particles containing the conventional radiopacifying agents, that is, barium sulphate and zirconia. In parallel, the in vivo reaction, in terms of new bone formation, to particles of these materials has been tested using a bone harvest chamber in rabbit tibiae. In vitro cell culture showed that PMMA containing IHX resulted in significantly less bone resorption than PMMA containing the conventional opacifiers. In vivo testing, however, showed no significant differences between the amounts of new bone formed around cement samples containing the two iodine-based opacifying agents in particulate form, although both led to fewer inflammatory cells than particles of PMMA containing zirconia. Our results suggest that a non-ionic radiopacifier could be considered as an alternative to the conventional radiopacifying agents used in biomaterials in orthopaedic surgery.

Animals↗
PubMed2000

Relative influence of composition and viscosity of acrylic bone cement on its apparent fracture toughness.

The composition and viscosity of an acrylic bone cement have both been identified in the literature as being parameters that affect the mechanical properties of the material and, by extension, the in vivo longevity of cemented arthroplasties. The objective of the present study was to determine the relative influence of these parameters on a key cement mechanical property; namely, its fracture toughness. Two sets of cements were selected purposefully to allow the study objective to be achieved. Thus, one set comprised two cements with very similar compositions but very different viscosities (Cemex RX, a medium-viscosity brand, and Cemex Isoplastic, a high-viscosity brand) while the other set comprised two cements with similar viscosities but with many differences in composition (Cemex Isoplastic and CMW 1). Values of the fracture toughness (as determined using chevron-notched short rod specimens) [K(ISR)] obtained for Cemex RX and Cemex Isoplastic were 1.83 +/- 0.12 and 1.85 +/- 0.12 MPa square root(m), respectively, with the difference not being statistically significant. The K(ISR) values obtained for Cemex Isoplastic and CMW 1 were 1.85 +/- 0.12 and 1.64 +/- 0.18 MPa square root(m), respectively, with the difference being statistically significant. Thus, the influence of cement composition on its K(ISR) is more marked relative to the influence of cement viscosity. Explanations of this finding are offered, together with comments on the implications of the results for the in vivo longevity of cemented arthroplasties.

Acrylic Resins↗
PubMed2006

Alloplastic bone cements in otologic surgery: long-term follow-up and lessons learned.

OBJECTIVE: Otolaryngologists are often confronted with structural defects in the tegmen, scutum, or external auditory canal (EAC). Carbonated calcium phosphate (CCP) bone cements offer an alternative way of managing these defects. STUDY DESIGN AND SETTING: Retrospective review in an academic otology practice. The technical feasibility of these techniques described as well as the wound healing and structural integrity results. RESULTS: CCP bone cement was used to reconstruct defects of the tegmen or EAC in 22 patients. The material was used to repair the EAC in 19 of these patients, including complete EAC reconstruction in 4 patients, and tegmen defects only in 3 cases. CONCLUSION: The surgical technique is not technically difficult and the alloplastic material is hard within minutes of application. Twenty patients have been followed for over 1 year with an average follow-up period of 3.8 years. Failure, defined as infection or explantation, occurred in 4 patients followed over 3 years. There was a difference in outcomes for pediatric cases. EBM RATING: C-4.

Adolescent↗
PubMed2004

The in vitro elution of gentamicin sulfate from a commercially available gentamicin-loaded acrylic bone cement, VersaBond AB.

The present study was designed to yield results that would be used to contribute to the ongoing debate about the mechanism of the in vitro elution of an antibiotic from an antibiotic-loaded acrylic bone cement. To this end, the elution rates (R) of gentamicin sulfate (expressed as a weight percentage of the initial mass of the antibiotic in the specimen, normalized with respect to the duration of the test) from statically loaded (STATIC) and dynamically loaded (+/-10 MPa; 2 Hz; until fracture; DYNAMIC) specimens fabricated from a commercially available acrylic bone cement (VersaBond AB), in phosphate-buffered saline solution at 37 degrees C, were obtained with the use of a spectrophotometric method. There was evidence of microcracking in the fracture surfaces of DYNAMIC specimens, but no such evidence in the case of STATIC specimens. The surface area of the DYNAMIC specimens, during the tensile phase of the cyclical loading, was estimated to be about 3% larger than for the STATIC specimens (1742 mm(2) versus 1696 mm(2)). The bulk porosities P of the specimens in both sets were also determined and found to not be statistically different, with P for the STATIC and DYNAMIC specimens being 8.55 +/- 0.10 and 8.88 +/- 0.18%, respectively. At the end of the test period, R was found to be 0.36 +/- 0.20 and 1.28 +/- 0.14 wt %/day for the STATIC and DYNAMIC specimens, respectively. It is suggested that the present results provide support for the postulate that the elution mechanism of gentamicin in this cement is a surface phenomenon.

Bone Cements↗
PubMed2003

Copolymerization of photocrosslinkable anhydride monomers for use as a biodegradable bone cement.

A multifunctional anhydride monomer, methacrylated sebacic anhydride (MSA), was synthesized and copolymerized with methacrylic anhydride via photoinitiated polymerization to form highly crosslinked, degradable networks. This material system was investigated as a potential degradable bone cement. Several aspects were examined, including curing characteristics, degradation rates and mechanical properties. These copolymer networks reached high double-bond conversions on clinically acceptable time scales (<5 min). Furthermore, these divinyl monomer copolymerizations exhibit features of classical crosslinking polymerizations, including autoacceleration, autodeceleration and limited double-bond conversion. Additionally, the networks degrade via a surface erosion mechanism by which the degradation rate can be controlled through varying the degree of oligomerization of the multifunctional monomer backbone, varying the copolymer precursor composition and changing the monomer backbone chemistry. Finally, the copolymer was found to have improved mechanical properties over homopolymerized MSA. Compressive strengths as high as 78 +/- 5 MPa were attained with a 70/30 wt% MSA/methacrylic anhydride copolymer, which are comparable to measured (91 +/- 7 MPa) and literature (approx. 100 MPa) values for conventional poly(methyl methacrylate) bone cement.

Biocompatible Materials↗
PubMed1998

[Use of bone cements with added methotrexate for stabilization of pathologic fractures and filling of long bone defects in cases of neoplasm metastasis].

Preliminary results of surgical treatment in 24 patients with pathologic fractures or metastatic long bone defects impending fracture are presented. Fourteen females and 10 males aged 36-72 years with femoral (18 cases), tibial (4 cases) or humeral (2 cases) involvement were followed-up for 6-48 months. In 12 patients the pain ceased or decreased, 3 patients occasionally required non narcotic analgesics, in 9 cases the pain continued. All patients with lower extremity involvement were able to ambulate with an aid of walking sticks, 2 patients with humeral fracture resumed activities of daily living. Nine patients with multiple metastases to the lungs and spine died on average 15 months after surgery. The longest survival rate was found in patients with kidney cancer-19 months, ovary cancer-17 months and breast cancer 15 months. No postoperative complications were found. In 2 patients fracture fixation lost their stability after 8 and 10 weeks due to excessive weight bearing.

Activities of Daily Living↗
PubMed2002

New acrylic bone cements conjugated to vitamin E: curing parameters, properties, and biocompatibility.

Acrylic bone cement formulations with antioxidant character were prepared by incorporation of a methacrylic monomer derived from vitamin E (MVE). Increasing concentrations of this monomer provided decreasing peak temperature values, ranging from 62 to 36 degrees C, and increasing setting time with values between 17 and 25 min. Mechanical properties were evaluated by compression and tension tests. Compressive strength of the new formulations were superior to 70 MPa in all cases. The cement containing 25 wt % MVE, however, showed a significant decrease in tensile properties. Biocompatibility of the new formulations was studied in vitro. The analysis of the effect of leachables from cements into the media showed continued cell proliferation and cell viability with a significant increase for the cement containing 15 wt % MVE. This formulation also showed a significant increase in cellular proliferation over a period of 7 days as indicated by the Alamar Blue test. The cells were able to differentiate and express phenotypical markers in presence of all materials. A significant increase in alkaline phosphatase activity was observed on the cements prepared in presence of 15-25 wt % MVE compared with PMMA. Morphological assessment showed that the human osteoblast (HOB) cells were able to adhere, retain their morphology, and proliferate on all the cements.

Acrylates↗
PubMed1984

Flow characteristics of acrylic bone cements.

Flow properties of Simplex, Zimmer Regular, Zimmer LVC, and Sulfix bone cements were measured as functions of time between two and five minutes after mixing. The mass flowrates measured for Zimmer Regular and Simplex were quite similar in the temperature range of 20.0 degrees -23.3 degrees. At 18.3 degrees Simplex had approximately double the flowrate of Zimmer Regular two minutes after mixing. The flowrate for LVC was approximately four times that measured for Zimmer Regular at 20.0 degrees. Sulfix displayed the greatest sensitivity of flowrate with temperature; at 18.3 degrees its flow characteristics were similar to those of LVC, and at 23.3 degrees it behaved more like Simplex and Zimmer Regular. All cements demonstrated substantial relative increases in flowrates with only slight increases in pressure; Sulfix was the most pressure sensitive. Set times for Zimmer, LVC, and Sulfix were virtually identical, ranging from a mean of 11 minutes (at 18.3 degrees) to 7.5 minutes (at 23.3 degrees). Simplex had considerably longer set times, averaging 15.8 minutes (at 18.3 degrees) and 9.4 minutes (at 23.3 degrees). Although Simplex demonstrated the greatest sensitivity of set time with temperature (almost double that measured for the other 3 cements), it did not show the greatest sensitivity of flowrate with temperature.

Bone Cements↗
PubMed1973

Cardiovascular effects of acrylic bone cement in rabbits and cats.

The cardiovascular responses to forcing acrylic bone cement, Plasticine, or soft paraffin wax into the medullary cavity of the femur have been studied in rabbits and cats. An acute fall in blood pressure, occurring within a few seconds of insertion, was demonstrated with each substance. In a few of the animals the blood pressure response had a second more protracted component and it is suggested that more than one mechanism is involved. The cardiovascular effects that have been observed in man when acrylic cement is used in prosthetic hip surgery also may be due to more than one mechanism.

Acrylic Resins↗
PubMed1984

Long-term compressive creep deformation and damage in acrylic bone cements.

Compressive creep tests were performed on five commercially available acrylic bone cements under conditions simulating in vivo usage. Measured creep strains are quite large, generally exceeding elastic strains. Large variations in creep response were noted among the various cements, with a carbon-reinforced cement by far the most resistant to creep. The empirical model epsilon = a exp(b sigma)tn was found to predict creep strains within about 10% of the measured values. Microscopic examination of some specimens after testing revealed significant cracking, resulting from long-term loading, that could be a contributing cause of time-dependent failure.

Bone Cements↗
PubMed2003

Palmar plating with calcium phosphate bone cement for unstable Colles' fractures.

A prospective study was done in 20 patients with unstable Colles' fractures with metaphyseal bone defects and who were treated with palmar plating combined with injectable calcium phosphate bone cement. The patients were three men and 17 women with a mean age of 69 years (range, 65-86 years) at the time of the injury. The followup after the operation ranged from 6 to 24 months (mean, 12 months). Union was gained in all the patients. The records of radiographic parameters, including the palmar tilting angle, radial inclination, radial length, and ulnar variance had been maintained since the surgery. According to the rating scale of Gartland and Werley, 16 patients had excellent results and four had good results. There were no neurovascular and tendon injuries as complications.

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