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At least 919 records · Page 51Linked to original sources
PubMed1996

Acrylic bone-cement. Influence of mixer design and unmixed powder.

The effects of hand mixing with two different mechanical mixing systems (fixed versus rotating central axis) on unmixed powder content, macroporosity, density, and bending strength of acrylic bone-cement are compared. The effects of voids and unmixed powder on cement bending strength are also evaluated. In acrylic cement, both unmixed powder monomer and voids 1 mm and larger can be easily visualized and analyzed on radiographs of 3-mm-thick samples. Image analysis allowed demonstration of a significant increase in unmixed powder content (P < .0001), in cement prepared using a vacuum mixing system with a fixed central axis compared with both the rotating axis system and hand mixing. The rotating-axis system produced cement of higher density compared with hand mixing only (P = .004). There was a significant correlation between the number of voids measured per square centimeter and cement bending strength (P < .0001), as well as an independent and significant correlation between unmixed powder content and cement bending strength (P < .0001). Mechanical mixing using a fixed central axis produced significantly weaker cement compared with both hand mixing (P < .015) and the rotating-central-axis system (P < .0001). A 15% drop in strength between the two mechanical mixing systems was observed. It is therefore concluded that the use of different rotating systems in mechanical mixers can influence void and unmixed powder content and, consequently, the mechanical properties of acrylic cement, and that unmixed powder is an independent factor affecting the bending strength of the cement.

Acrylates↗
PubMed1989

Fatigue of acrylic bone cement--effect of frequency and environment.

This study was conducted to investigate some fundamental fatigue testing variables as they apply to the response characteristics of acrylic bone cement. Cyclic loading under load control was conducted at frequencies of 1, 2, 5, 10, and 20 Hz in air at room temperature. At a tensile stress range of 0.3-20.0 MPa the fatigue life increased linearly with logarithmic frequency. The effect of conditioning and testing in saline at both room temperature and 37 degrees C at similar stress levels and a frequency of 10 Hz were also examined. When compared to dry testing at room temperature, testing in saline at 37 degrees C resulted in a reduction in fatigue life while testing in saline at room temperature produced an increase in fatigue life. Of a number of statistical distributions considered, the Weibull was found to be the most appropriate in documenting the findings of this investigation. A companion fractographic investigation of the failure surfaces demonstrated distinct regions of crack growth and fast fracture.

Acrylates↗
PubMed1997

Influence of temperature and vacuum mixing on bone cement properties.

To analyze the influence of varying viscosity and mixing temperature (22 degrees C and 6 degrees C) on macro- and microporosity, density, and compressive strength in vacuum mixed bone cement, high, medium, and low viscosity cement were mixed in 2 vacuum mixing systems and compared with bowl mixing at atmospheric pressure. At 22 degrees C, vacuum mixing significantly reduced void volume to less than approximately 3 per mill. The reduction was most pronounced in low viscosity cement. Microporosity also was reduced in all cements by vacuum mixing and to highest degree in low viscosity cement. At 6 degrees C the reduction of micropores was more pronounced in high viscosity cement. In medium and especially low viscosity cement, the prechilling gave an increased number of micropores. Cement density also was significantly reduced in low viscosity cement at 6 degrees C. Vacuum mixing significantly increased compressive strength by approximately 15% in all cement types (30 days). The temperature did not significantly influence compressive strength, but low viscosity cement generally was stronger when mixed at 22 degrees C. It is concluded that vacuum mixing improves cement quality. However, the temperature influences the final result; in particular, low viscosity cement should not be mixed after prechilling to 6 degrees C.

Biophysical Phenomena↗
PubMed1980

The role of metal and bone cement fixation in the management of malignant lesions of the vertebral column.

Fifteen patients with malignant spinal metastases underwent fixation of the spine using metallic implants and bone cement. The operation provided considerable relief of pain in all 15 cases and a significant improvement in mobility in 12 cases. These results compared favourably with 77 patients with fatal metastatic cancer of the spine who were treated without spinal surgery. The technique seems to be best indicated for use in patients with breast and thyroid cancer with a relatively prolonged terminal course.

Adult↗
PubMed1997

Application of tertiary amines with reduced toxicity to the curing process of acrylic bone cements.

4-Dimethylaminobenzyl alcohol (DMOH) and 4-dimethylaminobenzyl methacrylate (DMMO) were used as the activators in the benzoyl peroxide initiated redox polymerization for the preparation of acrylic bone cement based on poly(methylmethacrylate) beads of different particle size. The residual monomer content of the cured cements was about 2 wt %, independent of the redox system used in the polymerization, indicating that the activating effect of the tertiary aromatic amines DMOH or DMMO was sufficient to reach a polymerization conversion similar to that obtained with the benzoyl peroxide (BPO) N,N-dimethyl-4-toluidine (DMT) system. The BPO/DMOH and BPO/DMMO redox systems provided exotherms of decreasing peak temperature and increasing setting time, and the cured materials presented higher average molecular weight and similar glass transition temperatures in comparison with those obtained when DMT was used as the activator. In addition, these activators are three times less toxic than the classical DMT.

Acrylates↗
PubMed1994

Mechanical properties of vacuum-mixed acrylic bone cement.

The thrust of the present work was the experimental determination of the uniaxial static compressive and fully reversed tension-compression fatigue properties of CMW 3 acrylic bone cement whose constituents were mixed in a proprietary chamber while simultaneously subjected to a vacuum. Selected indices of performance in this material are: mean static compressive strength, 81.4 MPa; mean compressive modulus of elasticity, 1.95 GPa; endurance limit, 8.1 MPa; and characteristic fatigue life (using a three-parameter Weibull fit to the fatigue test data obtained at a stress of +/- 10 MPa), 238,712 cycles. The difficulties in comparing results obtained using different cement formulations, preparation conditions, and test conditions are detailed. With this in mind, it is suggested that the present results are within the range of values reported by previous workers for other formulations mixed using a variety of methods. The clinical significance of the present results is discussed.

Acrylates↗
PubMed1996

New aspects of the effect of size and size distribution on the setting parameters and mechanical properties of acrylic bone cements.

The effect of the size and the size distribution of poly(methyl methacrylate) (PMMA) beads on the classical kinetic parameters, peak temperature and setting time, for acrylic bone cement formulations prepared with PMMA particles in the range 10-60 microns of average diameter and a relatively wide size distribution is analysed. In addition, the combined effects of the concentration of the free radical initiator benzoyl peroxide and the activator N, N-dimethyl-4-toluidine for the different particle sizes are studied and compared with those commercially available formulations like CMW or Rostal. The results obtained indicated that the use of PMMA particles with average diameter of 50-60 microns, and a relatively wide size distribution (10-140 microns diameter), significantly changes the curing parameters (peak temperature and setting time) of the cement formulations in comparison with the classical behaviour of the commercial systems of CMW and Rostal, without any noticeable loss in the mechanical properties, such as tensile strength, elastic moduli, and compressive strength and plastic strain.

Benzoyl Peroxide↗
PubMed1979

Fracture processes in acrylic bone cement containing barium sulphate dispersions.

This paper describes the effects of dispersions of barium sulphate (BaSO4) particles on crack nucleation and growth in a commercially available surgical acrylic bone cement. A simple model is presented which is based on the nucleation and growth of voids around each BaSO4 particle. The model assumes that the local stress at a particle depends on the strain applied to the material, whereas the overall stress on the system depends on the volume fraction of particles. The effects of saline solution and blood serum on crack propagation are described.

Barium Sulfate↗
PubMed2004

[Use of the injectable bone cement Norian SRS for tibial plateau fractures. Results of a prospective 30-month follow-up study].

Reduction of the depressed joint surface in tibial plateau fractures often leaves large cancellous bone defects. These metaphyseal voids are typically filled with autogenous bone grafts that can cause a significant donor site morbidity. The use of injectable bone cement offers the opportunity to support the reduced joint surface without bone grafting. The aim of this study was to evaluate the clinical and radiological outcome as well as the period of partial weight bearing after the use of Norian SRS in tibial plateau fractures. Twenty-one patients with a mean age of 48 years were included in this prospective trial. According to the AO/OTA Classification, there were seven fractures of type B2, ten B3, one C1, one C2, and two fractures of type C3. The period of partial weight bearing was 3.7 weeks. In 18 patients the follow-up was more than 24 months. After a mean follow-up of 30 months, the Lysholm score was 87.9 at mean. The radiological part of the Rasmussen score was excellent and good in eight cases each and fair in four cases. Soft tissue reactions due to the cement were not observed. On all radiographs taken 36 months after the operation the cement bloc was still visible. The results show that Norian SRS can be used to fill metaphyseal bone defects in tibial plateau fractures. Clinical and radiological results are comparable to those of fractures treated with autologous bone graft. The high compression strength allows early full weight bearing without the risk of secondary loss of reduction.

Adult↗
PubMed1996

Methotrexate eluted from bone cement: effect on giant cell tumor of bone in vitro.

The effectiveness of methotrexate eluted from polymethylmethacrylate on cell lines established from giant cell tumor of bone was investigated in vitro to determine the possible efficacy of this treatment. Elation of methotrexate from polymethylmethacrylate beads and boluses was shown in vitro to be dose dependent and limited by the size of the bolus. Cytocidal activity of methotrexate elated from polymethylmethacrylate beads prepared without monomer and of boluses of polymethylmethacrylate with the same dose of methotrexate prepared with monomer against 2 human giant cell tumor cell lines was statistically significant at 24 hours in culture. Statistical significance occurred at 24 hours in culture. Activity was maintained in vitro after 17 days. These experiments showed that eluted methotrexate remained effective against tumor cells after exposure to thermal changes during polymerization of polymethylmethacrylate. While extensive curettage of giant cell tumor of bone followed by filling in the defect with polymethylmethacrylate has become a common treatment, a local adjuvant is necessary to reduce further risk of local recurrence. A potential alternative to cryosurgery or instillation of phenol is the use of methotrexate impregnated polymethylmethacrylate to treat residual microscopic disease after curettage. This method may provide locally effective chemotherapy without the risks of systemic toxicities.

Antimetabolites, Antineoplastic↗
PubMedDate not supplied

[Elimination of antibiotics from Palacos bone cement (personal experience from a bacteriological viewpoint after 10-year application in joint replacement surgery].

Long-term studies were set up to investigate the release of various antibiotics from bone cement. In some cases release was evidenced for a few days, in others for many months or years. All alloarthroplastic operations are threatened by infection. We therefore advocate the prophylactic use of antibiotics in any case of major corrective joint replacement surgery, and our method has been valuable in many patients. Deep infection from resistant bacteria and mixed infection require a combination of two or more appropriate antibiotics. The antibiotic effect evidenced in vitro cannot simply be transferred to the mechanism of elution of antibiotics out of cement. Examples are given. Bacteriological studies and clinical investigations are a prelude to prophylactic treatment with single antibiotics and in combination. A great number of able bacteriologists and clinicians is required in attempts to tackle this vast and difficult therapeutical problem.

Anti-Bacterial Agents↗
PubMed1992

Mixing does not improve mechanical properties of all bone cements. Manual and centrifugation-vacuum mixing compared for 10 cement brands.

Contemporary mixing methods--centrifugation, vacuum mixing with or without precompression--were compared with manual mixing by testing strength characteristics in accordance with a proposed revision of the international standard for bone cements as applied to 10 cement brands. Simplex brands and low-viscosity cements were the strongest, and were not improved by any of the vacuum-mixing procedures. Centrifuging was found unsuitable for low-viscosity cements. Without attaining the strength of the former, the cements best suited for auxiliary mixing methods were CMW-1 and Palacos brands, which improved 6-11 percent by either of the methods. The Sterivac system was generally found unacceptable, because about 20 percent of a cement package was retained in the mixing gear, and the application of precompression had no additional effect on compressive and bending strengths.

Acrylic Resins↗
PubMed1988

The use of acrylic bone cement for cervical fusion in patients with rheumatoid arthritis.

We report on 14 patients with instability of the cervical spine secondary to rheumatoid arthritis treated by fusion using a combination of traditional bone grafting techniques and methylmethacrylate bone cement. Successful fusion was achieved in all cases with few complications. The high infection rate reported by other authors was avoided by reducing the bulk of the cement mass and the use of antibiotic impregnated cement. We recommend this method of fusion to all orthopaedic surgeons involved in the treatment of patients with rheumatoid arthritis.

Adult↗
PubMed1985

The clearance of gentamicin from antibiotic-loaded bone cement.

The concentrations of Gentamicin in the serum, drainage fluid and urine were determined by radioimmunoassay in 40 patients after total hip replacement and 10 after knee replacement. Palacos R bone cement with added Gentamicin had been used to fix the prostheses in all cases. Two types of response were observed; in Group I the Gentamicin levels rose very rapidly, whereas in Group II a more gradual increase was seen. In all cases the level of Gentamicin had fallen to a negligible amount by the fifth day after operation.

Bone Cements↗
PubMed2004

An in vitro assessment of the antibacterial properties and cytotoxicity of nanoparticulate silver bone cement.

Infections with multiresistant bacteria have become a serious problem in joint arthroplasty. This study reports about in vitro antibacterial activity against multiresistant bacteria and in vitro cytotoxicity of polymethylmetacrylate bone cement loaded with metallic silver particles with a size of 5-50 nm called NanoSilver. In vitro antibacterial activity against S. epidermidis, methicillin-resistant S. epidermidis (MRSE), and methicillin-resistant S. aureus (MRSA) was studied by microplate proliferation tests. Quantitative elution testing and qualitative ongrowth of human osteoblasts was done to study in vitro cytotoxicity. Only NanoSilver cement showed high-antibacterial activity against all strains, including MRSE and MRSA. Gentamicin cement was not effective against MRSA and MRSE due to the high-level gentamicin resistance of the tested strains. Plain cement did not inhibit proliferation of any strains. There was no significant difference regarding in vitro cytotoxicity between NanoSilver and the non-toxic control. Cytotoxicity of cement loaded with silver salts made this kind of silver unsuitable for all day clinical use in the past. This new form of silver called NanoSilver was free of in vitro cytotoxicity and showed high effectiveness against multiresistant bacteria. If the results can be confirmed in vivo NanoSilver may have a high interest in joint arthroplasty.

Animals↗
PubMed1999

Effectiveness of bone cement containing tobramycin. An in vitro susceptibility study of 99 organisms found in infected joint arthroplasty.

We used 99 strains of organisms representative of orthopaedic infections to examine the effectiveness of a bone cement containing tobramycin, employing a modified in vitro Kirby-Bauer susceptibility model. The spectrum was broad, including Gram-positive and Gram-negative aerobic organisms, anaerobes and mycobacteria. Simplex P with added tobramycin was effective against most of the strains, including those which are resistant to typical systemic levels of tobramycin. Although direct correlation between in vitro and in vivo results is difficult, the study showed that tobramycin is stable to the exothermic polymerisation of the cement, and that it is released from the surface of the cement at concentrations high enough to inhibit the growth of most organisms which may be encountered after joint arthroplasty.

Anti-Bacterial Agents↗
PubMed2002

The in vitro elution characteristics of vancomycin combined with imipenem-cilastatin in acrylic bone-cements: a pharmacokinetic study.

The aim of this in vitro study was to compare the elution characteristics of vancomycin alone and in combination with imipenem-cilastatin from 3 acrylic bone-cements (CMW1 [DePuy International, Blackpool, UK], Palacos R [Schering-Plough, Wehrheim, Germany], and Simplex P [Howmedica International, London, UK]). Six groups of 3 antibiotic-loaded cement disks were prepared, incorporating 2 g of vancomycin (3 groups) and 2 g of vancomycin plus 2 g of imipenem-cilastatin (3 groups). The disks were placed in saline baths for 5 weeks, with the baths being sampled periodically and the elution rates calculated. The total amount of vancomycin released by the cements treated with vancomycin alone was 7.98 mg for CMW1, 7.74 mg for Palacos R, and 6.76 mg for Simplex P; with the addition of imipenem-cilastatin, the total amount of vancomycin released by the 3 cements increased by 30.58%, 50.52%, and 50.15%. CMW1 had better elution characteristics than the other cements when treated with vancomycin alone; the elution of Palacos R and Simplex P was better than that of CMW1 when vancomycin was combined with imipenem-cilastatin.

Acrylic Resins↗
PubMed1996

In vitro measurement of strain in the bone cement surrounding the femoral component of total hip replacements during simulated gait and stair-climbing.

The strains in the cement mantle surrounding the cemented femoral component of a total hip replacement were measured in vitro, using strain gauges embedded within the cement mantle adjacent to the femoral component in femurs from cadavers under physiologic loads simulating both single-limb stance and stair-climbing. Cement strains in the most proximal portion of the cement mantle were measured with and without full contact of the collar of the femoral stem on the cortex of the medial portion of the femoral neck during both loading conditions. To our knowledge, these are the first studies to contrast by direct measurement the strain profile in the cement mantle of a cemented femoral component under simulated stair-climbing with that occurring under simulated single-limb stance. They extend the findings from finite element analyses and from clinical specimens retrieved at autopsy in identifying those regions of the cement mantle most likely to fail. At two specific foci, the magnitude of the strain in the cement mantle approaches values that could lead to early fatigue failure of the cement. The two regions in which the strains were highest (greater than 1,000 microstrain) were the most proximal portions of the cement mantle and near the tip of the femoral component. Although these two regions are recognized areas of high strain and also common sites of cement debonding and cement mantle failure, the strain-gauge studies showed that the magnitude of cement strains in the proximal portion of the cement mantle were highest during stair-climbing; in contrast, high strains at the tip region occurred in both gait and stair-climbing. Contact between the collar and the medial portion of the femoral neck reduced the strain in the proximal portion of the cement mantle not only in single-limb stance but in stair-climbing as well. The level of strain recorded in these studies for a simulated person weighing 115 pounds (52 kg) could lead to cement fracture during extended in vivo service life of a cemented femoral component, from either single-limb stance or stair-climbing. This risk would be increased if a void or defect existed in the cement mantle at these sites. Moreover, the increase in strain in the cement mantle was linear with increases in body weight between 100 and 200 pounds (45 and 91 kg) of spinal load, indicating that strains in a heavy patient could readily exceed the fatigue limit of the cement, particularly if a stress riser such as a pore in the cement or a sharp corner of the prosthesis were present. These data reemphasize the need to continue efforts to develop methods to strengthen bone cement and to reduce those factors that increase the strain in the cement mantle of cemented femoral components of total hip arthroplasty, particularly proximally and near the tip.

Adult↗