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PubMedDate not supplied

Acute local tissue effects of polymerizing acrylic bone cement. An intravital microscopic study in the hamster's check pouch on the chemically induced microvascular changes.

The chemical effect of polymerizing CMW and Simplex-P bone cements was recorded by intravital microscopy in the hamster's cheek pouch. Thermal effects and pressure on the tissue were eliminated. Where a direct cement-tissue contact was present, severe, apparently irreversible, microcirculatory disturbances were recorded. Both cements caused equally extensive microvascular damage. Intact epithelium and connective tissue appeared to protect the underlying vascular bed from the effect of the monomer. No differences in tissue reaction were recorded when the cement past was applied after normal and prolonged kneading.

Animals↗
PubMed1988

Release of gentamicin from acrylic bone cement. Elution and diffusion studies.

It has been generally assumed that release of antibiotic from methylmethacrylate occurs either from the surface, through pores in the matrix of the cement, or by diffusion through the matrix. In vitro and in vivo studies of the release of antibiotic from cement have produced variable and inconsistent results. In our laboratory, preliminary observations suggested that antibiotic is released from methylmethacrylate by flow through an interconnecting series of voids and cracks in the cement, rather than through diffusion after having been homogeneously distributed throughout the cement. Therefore, experiments were performed to answer the fundamental question of whether the matrix of methylmethacrylate bone cement is permeable to gentamicin. In vivo elution studies were performed on injection-molded rods of methylmethacrylate that had been loaded with two different amounts of gentamicin. The first group of rods contained 0.5 gram of gentamicin for each packet and the second, 1.5 grams for each packet. The rods were embedded subcutaneously in the subcostal region of sheep for three months. Bioassay of sections of the rods, using the tube-diffusion technique of Mitchison and Spicer, showed that the more highly loaded cement had released a significantly greater proportion of gentamicin. This occurred because the more highly loaded cement contained a greater number of defects that contained gentamicin (filled voids and interconnecting cracks). In vitro diffusion studies were also performed, using 0.8-millimeter-thick disks of methylmethacrylate that did not contain antibiotic. Test solutions of either gentamicin or methylene blue were placed in the inner compartments of diffusion chambers. The outer compartments contained tissue-culture medium 199, which was sampled monthly and assayed for gentamicin or methylene blue.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2003

Elimination of barium sulphate from acrylic bone cements. Use of two iodine-containing monomers.

The aim of this work is to present a new approach to joint arthroplasty failure related to bone cement mantle. As barium sulphate is considered one of the main causes of mechanical weakness in the cement, we substituted this inorganic radiopacifier of the solid component for radiopaque monomers in the liquid component. We obtained two different cements, one containing 5 vol% 2-[2',3',5'-triiodobenzoyl] ethyl methacrylate (TIBMA) and the other containing 3,5-diiodine salicylic methacrylate (DISMA). In both cases, the mechanical properties of these new cements were better than those of the barium sulphate-containing cement. The radiopacity obtained was comparable to that of the aforementioned cement and all the samples showed good biocompatibility.

Barium Sulfate↗
PubMed1992

Effect of lithotriptor treatment on the fracture toughness of acrylic bone cement.

Extracorporeal shock wave lithotripsy (ESWL) has now been established as an efficacious non-invasive modality for the management of renal calculi and has shown promise for management of other types of stone, as well. Following on from these successes, ESWL has recently been proposed for use in the preliminary stages of revision of cemented total hip joint replacements as a means of breaking up the cement mantle. It is useful, therefore, to examine the effect of shock waves on pertinent mechanical properties of the cement. This study utilizes the chevron-notch short-rod specimen and a commercially available test system to obtain the values of one such property, namely fracture toughness, of Palacos Radiopaque bone cement before and after treatment with shock waves delivered from a lithotriptor. The fracture toughness drops by about 14% following the shock wave treatment, thus confirming the possibility that ESWL can be used, as indicated earlier, in revision arthroplasty.

Acrylic Resins↗
PubMed1992

Segmental metacarpal replacement with bone cement and a silicone joint prosthesis: a case report.

The replacement of the distal half of the third metacarpal and the metacarpophalangeal joint with bone cement and a silicone implant is reported. Eight years after surgery, x-ray and clinical examination revealed no evidence of instability or material failure. The active and passive range of motion in the reconstructed metacarpophalangeal joint was 35 degrees, and the hand was free of pain.

Bone Cements↗
PubMed2002

Applications of a new carbonated calcium phosphate bone cement: early experience in pediatric and adult craniofacial reconstruction.

Hydroxyapatite cements have recently been employed as bone substitutes in craniofacial reconstruction. They are easily applied, nonresorbable, available in unlimited quantity, and eliminate donor-site morbidity. Norian CRS (craniofacial repair system) is a new carbonated calcium phosphate paste that is unique in that it more closely resembles bone than do traditional hydroxyapatite pastes. Norian is a low-order crystalline apatite soluble at a low pH, facilitating its resorption and replacement by host bone. The cement was first used for craniofacial surgery in North America at the Children's Hospital of Philadelphia. This report presents the authors' experience with this bone substitute in both pediatric and adult craniofacial reconstruction. Sixteen adult and pediatric patients underwent craniofacial reconstruction involving the use of carbonated calcium phosphate paste for correction of defects that required from 5 to 110 g of carbonated calcium phosphate paste (mean, 28.5 g). The patients were all followed for a minimum of 14 months. Minor complications included one case of infection and two cases involving cement microfragmentation. In the authors' experience, carbonated calcium phosphate paste has proved to be an excellent alloplastic material for osseous augmentation and reconstruction in the craniofacial skeleton. Few problems were encountered using this material; no significant morbidity was encountered. Although this material seems to be promising as a bone substitute, further follow-up will be necessary to evaluate its potential role in craniofacial surgery.

Adolescent↗
PubMed2001

No effect of methacrylate-based bone cement CMW 1 on the plasmatic phase of coagulation, red blood cells and endothelial cells in vitro.

The compatibility of a methacrylate-based bone cement (CMW 1, DePuy International Ltd, England) used for the fixation of joint prostheses was evaluated on plasma, an erythrocyte suspension and cultured human endothelial cells. The extract of the cement was tested, following 1 hour and 7 days of curing. After the contact in vitro of the extract with plasma, activated partial thromboplastin time, antithrombin III, thrombin-antithrombin complexes and fibrin degradation products were assayed. Hemolytic activity was tested by adding the cement extracts to a suspension of erythrocytes. After 4 hours of incubation at 37 degrees C, the hemoglobin concentration was determined on the supernatants by the colorimetric method. The effect of the cement on tissue factor and thrombomodulin production was evaluated on human umbilical vein endothelial cell cultures. Tissue factor was determined in cell lysates by enzyme immunoassay, following 4 hours' incubation of cultures with the cement extract. Thrombomodulin was assayed in cell lysates by enzyme immuno assay, after 24 hours' incubation with the cement extract. The response to all trans-retinoic acid (ATRA) was tested. The cement caused no significant modifications of the coagulation tests, had no hemolytic activity, did not determine tissue factor production and did not modify thrombomodulin, compared to the negative control. The response to stimulation with ATRA was similar to that of the negative control. We conclude that the cement extract does not affect the plasmatic phase of coagulation, has no effect on erythrocytes, does not induce the expression of procoagulant activity by endothelial cells and does not impair their antithrombotic property, within the limits of the tests performed.

Blood Coagulation↗
PubMed2001

Effect of CMW 1 bone cement on transforming growth factor-beta 1 expression by endothelial cells.

The present study examined the effects of in vitro challenge with an acrylic bone cement CMW 1 on the expression of transforming growth factor-beta 1 (TGF-beta 1) in human umbilical vein endothelial cells (HUVEC). The extracts in cell culture medium of the cements were tested, after 1 h and 7-day curing. Some cultures were also stimulated with interleukin-1 beta (IL-1 beta) or all-trans retinoic acid (ATRA). The expression of mRNA was evaluated by RT-PCR with specific primers. The release of TGF-beta 1 into the conditioned medium was evaluated by enzyme immunoassay. TGF-beta 1 mRNA was constitutively expressed by endothelial cells in the culture medium after 24 h. The incubation with the extracts of CMW 1, cured both for 1 h and 7 days, induced changes neither in mRNA expression, nor in the release of TGF-beta 1 into the conditioned medium, compared to the unstimulated cells. Even stimulation with ATRA, alone or added to the extracts at both curing times, affected neither mRNA expression nor TGF-beta 1 release, compared to the cells incubated with the cement alone or with the unstimulated cultures. The mRNA expression and the release were not changed by the stimulation with IL-1beta alone or added to the extract cured for 1 h. A significant decrease compared to the unstimulated cells was observed after the addition of IL-1 beta to the extract cured for 7 days. It was concluded that CMW 1 extract did not significantly modify TGF-beta 1 expression after 1-h curing, or after 7-day curing. Incubation with CMW 1 added with ATRA did not produce any changes in TGF-beta 1 synthesis. Incubation with cement extract after 7-day curing added with IL-beta 1 produced a significant reduction in TGF-beta 1 release.

Bone Cements↗
PubMed1989

Reinforcement of bone cement using metal meshes.

Following on from previous work reported in this journal, a practical system has been developed for in situ fibre reinforcement of bone cement in the hip joint prosthesis. A fibre preform is inserted during the operation, surrounding the metal stem of the prosthesis, forming a composite with the cement. Tests performed on full-scale models of the joint show improvements in fatigue life by more than an order of magnitude when a preform of metal fibres is used; this significantly delays the onset of cement cracking and stem loosening. Initial results reported previously suggest that other fibre materials such as carbon may give even greater improvements. Clinical trials have begun, using a form of the metal mesh.

Bone Cements↗
PubMed1994

Treatment of the infected total knee arthroplasty with insertion of another prosthesis. The effect of antibiotic-impregnated bone cement.

Eighty-six patients with 89 infected total knee arthroplasties were treated with insertion of another prosthesis. Treatment was not according to an established protocol for parameters, such as delay between removal of the infected prosthesis and insertion of the new prosthesis, duration of antibiotics, use of antibiotic-impregnated cement spacers or beads, and use of antibiotic-impregnated cement for prosthetic fixation at revision surgery. Final followup averaged 52 months (range, 6-126 months). Complications occurred in 30 (33.7%) knees, with recurrent deep infection developing in 10 (11.24%) knees. Patient age, medical diagnosis, type of microorganism, duration of parenteral antibiotics, delay between the resection and revision surgery, and use of antibiotic-impregnated cement spacers or beads were not correlated with the cure rate of infection. Use of antibiotic-impregnated bone cement for prosthesis fixation at revision surgery was the only variable that correlated with the cure rate of deep infection. Seven (28%) of the 25 knees without antibiotic-impregnated cement for prosthesis fixation developed recurrent infection compared with 3 (4.7%) of 64 knees with antibiotic-impregnated cement for prosthesis fixation. This difference was statistically significant (p = 0.0025, log-rank test).

Adult↗
PubMed1976

Monomer leakage from polymerizing acrylic bone cement. An in vitro study on the influence of speed and duration of mixing, cement volume and surface area.

An in vitro study was dthesigned to measure the effects of variable cement volumes and modified mixing techniques on the monomer leakage after simulated implantation. The cement volume as such was found to be an irrelevant parameter for calculations of the monomer loss from bone cement. The leakage was directly related to the surface area of the cement. Variations in the thickness of the cement mantle from 1 to 5 mm did not affect the leakage. Late cement insertion should reduce the total monomer leakage into the tissues. It is doubtful whether an increased stirring speed during mixing reduces the monomer leakage after implantation.

Bone Cements↗
PubMed2000

Low-friction arthroplasty with Boneloc bone-cement: outcome at 2 to 4 years.

We report the clinical and radiologic outcome of 109 Chamley low-friction arthroplasties implanted with Boneloc bone-cement (Biomet, Bridgend, South Wales, UK) into 104 patients. The mean follow-up was 30 months (range, 2-48 months). There were 72 women (mean age, 71 years) and 32 men (mean age, 72). Cartridge-packed cement was used in 37 cases and vacuum-packed cement in 72 cases. Survivorship analysis based on revision for aseptic loosening showed 79% survival at 4 years. Seventeen (15.5%) hips have been revised for aseptic loosening to date, in which all stems and 4 cups were loose. Extensive femoral osteolysis was always present and resulted in 4 cases of femoral cortical perforation at revision. Survivorship analysis based on revision and radiologic failure showed only 55% survival over the same period. When radiologic loosenings were included as failures, the vacuum-packed cement performed significantly worse than the cartridge-packed cement it replaced. These poor results were consistent with the withdrawal of Boneloc from clinical use in 1995, and we recommend indefinite follow-up for surviving prostheses.

Aged↗
PubMed1992

The effect of irrigating solutions on the strength of the cement-bone interface.

Irrigating solutions are commonly used in the preparation of bony surfaces before total joint replacement components are cemented. Using an experimental cemented arthroplasty model, metal pseudo-prostheses were cemented to a cadaveric bone surface prepared with a specific irrigating solution. A tension load was then applied to the prosthesis until failure occurred at the cement-bone interface. A quantitative analysis of the effect of three commonly used irrigating solutions on the strength of the cement-bone interface is presented. Sixty trials were performed with normal saline, povidone iodine and hydrogen peroxide. Irrigation with hydrogen peroxide afforded statistically superior cement fixation in this arthroplasty model when compared with either normal saline or povidone iodine (P less than 0.01 Chi-squared test).

Animals↗
PubMed1987

Vacuum mixing of acrylic bone cement.

A partial-vacuum (500-550 mmHg), slow-speed (2 Hz) system for optimal blending of the liquid and powder components of Simplex-P acrylic bone cement was developed to eliminate five different sources of porosity observed with x-ray during the course of cement preparation and specimen fabrication. The vacuum mixing system produces set specimens of less than 1% porosity that have significant improvements over specimens prepared with conventional mixing in the mechanical properties of tensile and compressive strength and uniaxial tensile fatigue life. Hence, a much stronger cement can be available in surgery without any change in original chemical composition.

Bone Cements↗
PubMed1976

Mechanical strength of acrylic bone cements impregnated with antibiotics.

Admixing of several antibiotic powders which were insoluble in methyl methacrylate did not decrease the compressive and diametral tensile strengths of two acrylic bone cements when tested after setting for 1 day and after leaching 40 days in water at 37 degrees C. When antibiotics were added as water solutions, the included water resulted in a significant decrease in these bulk mechanical properties. Storage in water for 40 days caused surface irregularities only on specimens of the set antibiotic admixtures. Approximately 0.5% of the admixed dosage of these water-soluble antibiotics could be leached from the set cements. The observed surface channels, presumably left by the loss of antibiotic, suggest further study of surface-sensitive mechanical properties may be needed. The bulk mechanical strengths presented here are conclusive only for the particular combinations of antibiotics and cements investigated, and should not be generalized at this time to any or all antibiotic admixtures or other mechanical properties.

Anti-Bacterial Agents↗