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Relationship between fracture toughness and impact strength of acrylic bone cement.

This work involved determining the fracture toughness, KIc (in MPa(square root)m) (using rectangular compact tension specimens) and impact strength, IS (in kJ/m2) (Charpy type specimens) of Surgical Simplex P and three variants of Palacos R acrylic bone cements. The best fit to these results yielded a power relationship KIc = 0.795(IS)0.59. The usefulness of this relationship is detailed, especially for the purpose of performing quality control checks on bone cements.

Biocompatible Materials↗

Effect of porosity and environment on the mechanical behavior of acrylic bone cement modified with acrylonitrile-butadiene-styrene particles: part II. Fatigue crack propagation.

The aim of this study was to investigate the effect of adding an elastomeric second phase, acrylonitrile-butadiene-styrene, on the fatigue crack propagation behavior of poly(methyl methacrylate) bone cement. Moreover, the influence of porosity and environmental conditions was studied. When comparing the plain cement to the modified cement, a decrease in the crack propagation rate was observed at between 1 and 2 orders of magnitude. The storage in a physiological environment (saline solution at 37 degrees C) also caused a decrease in the crack propagation rate of about 2 orders of magnitude for the plain and modified cement prepared in air or under a vacuum. Porosity did not have any noticeable effect on the fatigue crack propagation behavior of the cement.

Acrylic Resins↗

[Vacuum mixing systems for bone cement completion - comparison of different systems].

INTRODUCTION: The use of vacuum mixing systems when mixing bone cement reduces its porosity and hereby significantly improves the features of the material. The currently available mixing systems are compared with regard to handling, mechanical properties and economical aspects. METHODS: In 8 vacuum mixing systems the handling, pump performance, system tightness, the used air volume, the filter efficiency, the remaining amounts in the mixing system and the porosity of the cements are shown in comparison. RESULTS: All vacuum mixing systems reduce the porosity of the cement in comparison to hand mixed cements significantly if used correctly. The individual examinations, though, show enormous differences, which can be of significance to the user in the individual choice of system and, depending on the individual circumstances, can influence the quality of the mixed cement. CONCLUSION: The results enable the user to choose and handle a vacuum mixing system which is optimally suitable for the individual circumstances in respect to the characteristics examined.

Arthroplasty, Replacement↗

Fume levels during bone cement mixing.

This article compares some of the various products available for mixing and preparing bone cement. It should be noted that the tests were not independent as the author is employed by one of the product manufacturers. It should also be noted that the tests were carried out under laboratory conditions and therefore do not include practices carried out by scrubbed staff that could affect the results.

Air Pollution, Indoor↗

Long-term follow-up study of bioactive bone cement in canine total hip arthroplasty.

We report a long-term study of bioactive bone cement (BABC) in a canine total hip arthroplasty (THA) at follow-up of 8 years. Previous studies have shown excellent biomechanical and histological results at follow-up of 6, 12, and 24 months. In the present study, THA was performed in a beagle dog using BABC consisting of an apatite- and wollastonite-containing glass ceramic (AW-GC) powder and SiO2 powder as the filler and a bisphenol-a-glycidyl methacrylate (Bis-GMA) based resin as the organic matrix. Histological examination showed direct bonding between BABC and bone without any intervening soft tissue layer at the BABC-bone interface. A reactive layer, through which BABC bonded to the bone, was observed thicker at 8 years than it was at 24 weeks. No adverse effects of BABC were observed. BABC maintained the high bioactivity and direct bonding to bone in a canine THA at follow-up of 8 years.

Animals↗

An ultrasonic pulse-echo technique for monitoring the setting of CaSO4-based bone cement.

We present a new ultrasonic technique for monitoring the entire setting process of injectable bone cement. The problem with existing standards is their subjectivity. Because of this the results are not comparable between different research groups. A strong advantage with the proposed technique is that it is non-invasive and non-destructive, since no manipulation of the cement sample is needed once the measurement has started. Furthermore, the results are reproducible with small variations. The testing was performed on calcium sulfate cement using an ultrasonic pulse-echo approach. The results show that the acoustic properties of the cement are strongly correlated with the setting time, the density, and the adiabatic bulk modulus. The measured initial and final setting times agree well with the Gillmore needles standard. An important difference compared to the standards, is that the technique presented here allows the user to follow the entire setting process on-line.

Acoustics↗

Effect of gentamicin on shear and interface strengths of bone cement.

Antibiotic impregnated cement offers a potential method for salvage of infected total joint replacements. The addition of gentamicin in concentrations of .5, 1.0, and 2.0 per 40 significantly affects the shear strength of Palacos acrylic bone cement. The clinical significance of this strnegth drop is not clear. Large grained antibiotic additives have deleterious effect on shear strength. Measurements were made to determine the effect of gentamicin concentration on the bone-cement interface strength but no trend could be determined. The interface strength was much less than the strength of Palacos alone and suggested that bone strength is the limiting factor.

Acrylic Resins↗

[Emission of air pollutants in removal of bone cement with ultrasound instruments in revision endoprosthetics].

The use of ultrasonic instruments to remove PMMA bone cement during revision hip arthroplasty results in the production of fumes. These emissions were analysed under standardized laboratory conditions, when it was found that the MMA concentration measured was only 1/10th of the MAC value. In terms of occupational safety, the MMA fumes emitted may therefore be considered non-hazardous for the medical personnel.

Air Pollutants, Occupational↗

Biological levels of aluminium after use of aluminium-containing bone cement in post-otoneurosurgery.

Use aluminium-containing biomaterials in otoneurosurgery for reconstitution of bone in contact with cerebrospinal fluid (CSF) also led to cases of encephalopathy and death. We report aluminium (Al) concentrations in the biological fluids of six French patients following use of Al-containing bone cement in otoneurosurgery. In five patients, the mean plasma Al levels (microgram/L) were: 1.20 +/- 0.05 (case 2), 9.20 +/- 0.10 (case 3), 1.00 +/- 0.05 (case 4), 2.80 +/- 0.05 (case 5) and 2.00 +/- 0.05 (case 6). In case 1, Al concentrations were 176 micrograms/L in the postauricular CSF accumulation, 34 micrograms/L in the pontocerebellar angle and 4 and 6 micrograms/L in the lumbar shunt. As a precautionary measure, in the first three cases the biomaterial was removed soon after the intervention, and no increase in plasma or CSF Al was observed. In the other cases, absence of neurobiological symptoms and normal concentrations of Al in plasma led neurosurgeons not to extract this biomaterial. Al assay thus may be considered to be a complementary and at times a decision-generating factor. Care is needed at all stages from sampling through analysis because Al is ubiquitous and factually high results may be clinically misleading. Herein, such considerations are discussed in conjunction with the neurotoxicity of this metal in man. In addition, the authors call for in-depth preliminary trials of these biomaterials in animals prior to introduction on the market.

Adult↗

Centrifugation as a method of improving tensile and fatigue properties of acrylic bone cement.

In this study centrifugation dramatically reduced the porosity and substantially increased the mechanical properties of bone cement. Monotonic tensile tests to failure of centrifuged specimens of cement demonstrated an increase of 24 per cent in the mean ultimate tensile strength compared with the control value. Mean ultimate tensile strain was improved by 54 per cent. In fully reversed tension-compression fatigue-testing, centrifugation resulted in a mean increase in fatigue life of 136 per cent. These strong advantages in mechanical properties were obtained without any detrimental changes. There was no change in elastic modulus, setting time, or peak temperature. Handling properties were improved. There was no increase in systemic toxicity as demonstrated in dogs by assessment of arterial blood-pressure response and peak levels of monomer in the serum during simulated total hip arthroplasty. We also present a practical system of cement centrifugation and delivery that is suitable for use in the operating room.

Acrylic Resins↗

Effect of fabrication pressure on the fatigue performance of Cemex XL acrylic bone cement.

During a cemented arthroplasty, the prepared polymerizing dough of acrylic bone cement is subjected to pressurization in a number of ways; first, during delivery into the freshly prepared bone bed, second, during packing in that bed (either digitally or with the aid of a mechanical device), and, third, during the insertion of the prosthesis. Only a few studies have reported on the influence of the level of pressurization experienced during these events (which, depending on the cementing technique used, has been put at between 8 and 273 kPa) on various properties of the cement. That was the focus of the present study, in which the fully reversed tension-compression (+/-15 MPa; 5 Hz) fatigue lives (expressed as number of cycles to fracture, N(f)) of rectangular cross-sectioned "dog-bone" specimens (Type V, per ASTM D 638) fabricated from Cemex XL cement, at pressure applied continuously to the cement dough during curing in the specimen mold, p=75,150, and 300 kPa, were determined. The N(f) results were analyzed using the linearized transformation of the three-parameter Weibull relationship to obtain estimates of the Weibull mean, N(WM), which was taken to be the index of fatigue performance of the specimen set. Over the range of p studied, N(WM) increased as p increased (for example, from 329,118 cycles when p was 75 kPa to 388,496 cycles when p was 300 kPa); however, the increase was not significant over any pair of p increment steps (Mann-Whitney U-test; alpha<0.05).

Compressive Strength↗

Calcium phosphate bone cement for treatment of distal radius fractures: a preliminary report.

Distal radius fractures in osteoporotic patients are often complicated with a residual deformity and a subsequent stiff and painful wrist. The aim of this study was to evaluate the usefulness of calcium phosphate bone cement (CPC95) in the treatment of these fractures. Seven Colles type fractures in seven patients (all female; average age, 58 years) were treated. After a closed reduction, the fractures were fixed either by percutaneous pinning or by external skeletal fixation. The CPC95 was then injected into the cancellous bone defect through a small dorsal incision. The functional and radiological results were evaluated for up to 1 year. All patients were graded as good or excellent within 3 months, and all were graded as excellent at the final follow-up. The average duration of immobilization was 3.5 weeks. The overall shortening of the radius was 2.3 mm. In one patient, CPC95 extruded into the extensor tendon sheath and was surgically removed. Injection of CPC95 is a promising augmentation of osteosynthesis for distal radius fractures, although a prospective control study is mandatory to prove the usefulness of this material. The equipment and surgical technique should be refined to avoid the extrusion of CPC95.

Biocompatible Materials↗