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Shrinkage stresses in bone cement.

Shrinkage of bone cement is reported primarily as a consequence of polymerisation, however thermal shrinkage also occurs as a result of its exothermic reaction. It is proposed that the latter effect is important, since it occurs late in the curing cycle at a time when the cement has attained its mechanical properties as a solid, and that residual stresses result. Observations from experiments and literature reports suggest that residual stresses may be sufficient to initiate cracks at the interface between hip replacement stems and cement.A theoretical model has been developed to calculate interference stresses, using thick-walled cylinder theory, on the basis of thermal and total shrinkages. Thermal shrinkage values were calculated using the coefficient of linear thermal expansion of bone cement, while total shrinkages were measured. Moduli of elasticity values were measured for acrylic bone cements ranging from 2.1 to 2.7GPa, as were Poisson's ratio values ranging from 0.38 to 0.46. Theoretical calculation of stresses in a cement mantle, based on assumptions of thermal shrinkage alone, predicted circumferential stresses of 8.4-25.2MPa for cement curing temperatures in the range 60-140 degrees C. It is concluded that cracks observed around hip prosthesis stems in laboratory specimens of bone cement are due to shrinkage and that residual stresses are sufficient to cause crack initiation prior to functional loading.

Bone Cements↗

In vitro adhesion and biocompatability of osteoblast-like cells to poly(methylmethacrylate) and poly(ethylmethacrylate) bone cements.

A bone cement, poly(ethylmethacrylate)/n-butylmethacrylate (PEMA/nBMA) has been developed with lower exotherm and monomer leaching compared to the traditional poly(methylmethacrylate)/methylmethacrylate (PMMA/MMA) cement. This study compares the in vitro biological response to the cements using primary human osteoblast-like cells (HOB). Cell attachment was qualified by immunolocalization of vinculin and actin cytoskeleton, showing more organization on PEMA/nBMA compared to PMMA/MMA. Proliferation was assessed using tritiated thymidine incorporation, and phenotype expression determined by measuring alkaline phosphatase (ALP) activity. An increase in proliferation and ALP activity was observed on PEMA/nBMA compared to PMMA/MMA. The results confirm the biocompatability of PEMA/nBMA, and an enhanced cell attachment and expression of differentiated cell phenotype.

Journal Article↗

Experimental fixation of bone cement and composite resins to bone.

The aim of this study was to ascertain whether the use of liquid acrylic resin or NeoCryl XK-53 acrylic emulsion or etching of the bone surface with phosphoric acid or the application of both these methods would improve the bonding of CMW bone cement or Concise and Silar composite resin to bone. The test materials were applied to fresh cortical bovine bone. Their bonding capacity was measured by the Instron Universal Testing Machine. The surfaces of the test materials and the bone surfaces were examined by means of optic microscope or scanning electron microscope. The bonding strength of the bone cement and composite resins as such were found to be of the same magnitude. A three- to five-fold improvement was obtained with liquid acrylic intermediary material. Acid etching impaired the bonding.

Acrylic Resins↗

Does sodium fluoride in bone cement affect implant fixation. Part II: evaluation of the effect of sodium fluoride additions to acrylic bone cement and the fixation of titanium implants in ovariectomized rabbits.

Bone integration of threaded implants made of cured polymethylmethacrylate containing sodium fluoride or commercially pure (c.p.) titanium were studied in normal and estrogen deficient New Zealand white rabbits. Nine had been ovariectomized through laparoscopy and nine served as controls. Four weeks after the ovariectomy two threaded implants made of cured bone cement with or without sodium fluoride addition were inserted in each tibia. One threaded commercially pure titanium implant was inserted in each patello-femoral joint flush to the cartilage. Six weeks after implant insertion measurement of the peak removal torque necessary to loosen the implants and light microscopical histomorphometrical investigations of tissue integration were performed. In the ovariectomized rabbits addition of sodium fluoride to the cement resulted in increased area of bone in the threads (p=0.04), but no corresponding effect could be noted in the controls. The removal torque was lower in the ovariectomized rabbits compared to the non-ovariectomized when comparing implant with sodium fluoride addition (p=0.02). The bone tissue response and the removal torque of the titanium implants were not influenced by ovariectomy in these rabbits.

Journal Article↗

Decreased blood perfusion in canine tibial diaphysis after filling with acrylic bone cement compared with inert bone wax.

Sixteen dogs had one tibia filled with acrylic PMMA bone cement and the opposite, control tibia filled with inert bone wax. After 1, 4, and 12 weeks, the blood perfusion in diaphyses was measured with Sc-46 labeled microspheres. The blood flow rates increased from 1 to 4 weeks and dropped to about the 1-week level after 12 weeks on both sides, with the acrylic side lower than the control side. On both sides, Disulphine Blue staining of the bones showed severe endosteal avascularity after 1 and 4 weeks and massive periosteal apposition after 4 and 12 weeks. The initial increase in blood flow is considered due to periosteal apposition, and the differences in blood flow rates are attributed to avascularity caused by the polymerization heat and toxicity of the acrylic cement.

Animals↗

Ultrastructure of the bone-cement and the bone-metal interface.

A review is given of the methods used to demonstrate the bone-implant interface by transmission electron microscopy (TEM). Neither method is yet refined enough to permit demonstration without artifacts of the contact between implant, cells, and organic and inorganic matrix. Published studies on certain metallic implants and bone cement demonstrate a direct contact between bone matrix and implant, without a continuous interposed layer of cells. The 1000 nm closest to the implant surface show a variable structure, the interpretation of which is unknown. The degree of mineralization within this distance of the implant has not yet been adequately studied. Without completely reliable analytic methods and comparable implantation protocols, the gradation of implant biocompatibility, based on the TEM appearance of the interface, should be performed with great caution.

Animals↗

Platelet activation after in vitro contact with seven acrylic bone cements.

Seven acrylic bone cements were evaluated: Cemex Rx (Tecres S.p.a., Italy), Cemex Isoplastic (Tecres S.p.a., Italy), Zimmer Low Viscosity Cement (L.V.C., Zimmer, IN, USA), Zimmer bone cement - dough type (Zimmer, IN, USA), CMW (DePuy International Ltd., UK), Cerim LT (Cremascoli S.r.l., Italy), and Palacos (Merck, Wehreim, Germany). The cements after polymerization were put in contact in vitro with platelet-rich plasma. Plasma in contact only with siliconated glass was used as the negative control. After contact, platelet number, beta-thromboglobulin (beta-TG), and transforming growth factor-beta1 (TGF-beta1) were determined. The Wilcoxon signed rank test showed Palacos R and L.V.C. induced a significant decrease of platelet number compared with the negative control. All cements determined a significant increase in beta-TG. CMW 3, Palacos, L.V.C., and Zimmer dough type determined a significant increase in TGF-beta1 compared with the negative control.

Biocompatible Materials↗

Porosity reduction in bone cement at the cement-stem interface.

The fatigue failure of bone cement, leading to loosening of the stem, is likely to be one mode of failure of cemented total hip replacements. There is strong evidence that cracks in the cement are initiated at voids which act as stress risers, particularly at the cement-stem interface. The preferential formation of voids at this site results from shrinkage during polymerisation and the initiation of this process at the warmer cement-bone interface, which causes bone cement to shrink away from the stem. A reversal of the direction of polymerisation would shrink the cement on to the stem and reduce or eliminate the formation of voids at this interface. We have investigated this by implanting hip prostheses, at room temperature or preheated to 44 degrees C, into human cadaver femora kept at 37 degrees C. Two types of bone cement were either hand-mixed or vacuum-mixed before implantation. We found that the area of porosity at the cement-stem interface was dramatically reduced by preheating the stem and that the preheating temperature of 44 degrees C determined by computer analysis of transient heat transfer was the minimum required to induce initial polymerisation at the cement-stem interface. Temperature measurements taken during these experiments in vitro showed that preheating of the stem caused a negligible increase in the temperature of the bone. Reduction of porosity at the cement-stem interface could significantly increase the life of hip arthroplasties.

Bone Cements↗

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↗

The effect of different cement insertion techniques on the bone-cement interface.

Since the introduction of cemented total hip arthroplasty, the method of cement usage has evolved through several generations. These changes may have been responsible for an improvement in femoral component longevity. The nature of the bone-cement interface in first-generation cementing techniques has been described, but the bone-cement interface in more recent cementing techniques has not. This article describes the bone-cement interface after 2 different cementing techniques in a canine total hip arthroplasty model.

Animals↗

Comparison of diametral shrinkage of centrifuged and uncentrifuged Simplex P bone cement.

Reducing the porosity of bone cement substantially strengthens the cement in fatigue. However, concern has been raised that reducing the porosity of the cement would increase the shrinkage of the cement and thus compromise the cement-bone interface. We measured diametral shrinkage of cement mantles prepared with and without centrifugation of the cement. Four cement preparations (centrifuged and uncentrifuged mixed with monomer at either room temperature or 0 degrees C) were used to form cement mantles of four different thicknesses (2, 4, 6, and 8 mm) around a stainless steel rod. We conclude that porosity reduction dramatically increases the fatigue strength of bone cement without substantially changing the diametral dimensions of the polymerized cement when studied in the shape and volume of a cement mantle that would be used for total hip replacement.

Biocompatible Materials↗

Comparison and optimization of three centrifugation systems for reducing porosity of Simplex P bone cement.

Simplex P bone cement was spun for 30, 60, and 120 seconds in three different centrifugation systems (I.E.C. HN-S II, I.E.C. clinical, and Johnson & Johnson) to determine whether differences among the three systems also produce differences in the improvement of the fatigue strength of the cement. The fatigue properties of the cement after centrifugation were also assessed when it was mixed with monomer that had been chilled to 0 degrees C. There were important and statistically significant differences in the fatigue life of Simplex P spun for the same duration in the different centrifuges. Simplex P prepared as recommended by the manufacturer had an average fatigue life of 15,143 cycles in the test system used. Optimum centrifugation among the techniques studied increased the fatigue life nearly fivefold, to the range of 71,000 cycles. Taking into account both the fatigue strength and the viscosity of the cement, the optimum centrifugation system for improving the fatigue life of Simplex P bone cement is the Miller cartridge containing two packs of cement spun in the IEC-HN-S II centrifuge. The authors recommend 30 seconds of centrifugation if the monomer is not chilled prior to mixing and 60 seconds if the monomer is chilled.

Bone Cements↗

Flow characteristics of curing polymethyl methacrylate bone cement.

During polymerization, polymethyl methacrylate bone cements have complex viscoelastic characteristics. Within a short working time they transform from dough-like consistencies to solid cements. Therefore, the time at which a cement is introduced to cancellous bone surfaces and subjected to pressure is important, to achieve optimum flow and mechanical interdigitation. Achieving adequate mechanical interlock increases the area for load transfer and reduces localized bone-cement interface stresses. The aim of this study was to measure the flow characteristics for commercial bone cements as a function of time and calculate the apparent viscosities for the curing bone cements. The capillary extrusion method was used to measure the rate of flow of the curing cement, by means of a melt flow index apparatus, which was manufactured in-house. The tests were conducted using nozzles of different lengths and under two loads. This enabled the power index value, n, and the pressure at the die entry, P0, to be calculated for each material with respect to time. Once the flow characteristics were determined, a series of formulae were used to calculate the shear rates, gamma, the shear stresses, tau, and the apparent viscosities, eta a, of the curing bone cements. The results indicated that acrylic bone cements are non-Newtonian, pseudoplastic materials, since the power index values are less than 1.0 during the curing stage. The consistency indices, K, were calculated from the shear stress versus shear rate data. The apparent viscosities of the cements were found to increase with respect to increases in time. Clinically, it was considered desirable to inject and pressurize the cement into the medullary canal while its viscosity is relatively low in order to obtain maximum interdigitation into cancellous bone, provided adequate containment and a means of pressurization can be achieved. The pseudoplastic character of bone cements is responsible for their reduction in viscosity with increased shear rate, a property that may be exploited to enhance penetration with appropriate delivery.

Biocompatible Materials↗

An in vitro study of the effect of environment and storage time on the fracture properties of bone cement.

Changes either within the bone cement or at the cement-bone interface are known to contribute to loosening and hence failure of many cemented joint replacements. This study examines the in vitro changes in the fracture properties of bone cement as a result of storage, at both 21 and 37 degrees C, in air, water, Ringer's solution and lipid over a period of 2 years. Specimens stored in the fluid media were found to behave in a more ductile manner than those stored in air. Samples stored at 37 degrees C behaved in a more brittle manner than those stored at 21 degrees C. Although the work of fracture values measured for the samples stored in the water-based media increased during the first 18 months, this was followed by a decrease in the subsequent 6 months.

Bone Cements↗