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PubMed1988

A rat model of resorption of bone at the cement-bone interface in the presence of polyethylene wear particles.

Resorption of bone and the formation of a membrane at the interface between acrylic cement and bone were induced by particles of high-density polyethylene that were similar in size to those that are present in the tissues surrounding a human joint prosthesis. A non-weight-bearing plug of methylmethacrylate was inserted through the knee joint into the distal part of the femur of the rat. The plug rapidly became surrounded by a shell of bone. After repeated injections of particles of high-density polyethylene into the knee joint, resorption of bone occurred at this stable interface. No resorption of bone occurred after the opposite knee was injected with a control preparation that did not contain particles. The resorption of bone that occurred around the plug after the injection of particles of polyethylene took place in the absence of mechanical causes for loosening and in the absence of infection.

Animals↗
PubMed2003

[Bone cements based on polymethylmethacrylate].

Bone cements based on polymethylmethacrylate (PMMA) remain an important material for anchorage of artificial joints. Polymers based on PMMA originally developed for dental surgery have been successfully used in bone surgery for more than 40 years. At first sight the cold-curing PMMA bone cement seems to be a rather simple material consisting of a powder and a liquid. But in fact it is a complex material fulfilling various functions at its application site after the implantation. Its properties vary according to the composition of its basic elements. They already play a decisive role for the working behavior during mixing of both components. The differences in the working behavior considerably affect the cementing technique and the accurate application in vivo. These influence the mechanical performance of the cured cement mantle and the long-term results of the implantation. Standardized test methods are used to characterize bone cements,whereas the clinical relevance of the test methods has to be evaluated critically.Additionally,PMMA bone cements act as a drug delivery system as a local carrier of antibiotics. This paper gives a review of the composition and properties of PMMA bone cements and their influence on practical application.

Anti-Bacterial Agents↗
PubMed2000

Use of alpha-tricalcium phosphate (TCP) as powders and as an aqueous dispersion to modify processing, microstructure, and mechanical properties of polymethylmethacrylate (PMMA) bone cements and to produce bone-substitute compounds.

Addition of tricalcium phosphate (alpha-TCP) powders as an aqueous dispersion to a polymethylmethacrylate (PMMA) bone cement is shown to produce a class of composites that due to their microstructure and mechanical properties may be suitable for application as bone substitutes. The PMMA forms a solid cellular matrix with open cells about 100 micrometer in size and incorporating TCP clusters. The TCP aggregates inside the cells form a porous network, with average mesopore diameters of about 0.1 micrometer, that is accessible from the outer surface. If TCP is added to PMMA in the form of dried powders, the composites are not applicable as bone substitutes. The dynamic elastic modulus (DEM) and compressive and tensile strengths were measured and discussed for both classes of composites. The mechanical properties of the bone-substitute composites, although lower than the other class of composites, are still competitive with those properties of a porous ceramic matrix of hydroxyapatite and with those of natural bones.

Bone Cements↗
PubMed1999

Bone-bonding ability of bioactive bone cement under mechanical stress.

Bioactive bone cement (BABC) is able to bond to bone through a Ca-P rich layer. It was evaluated so far in a rat tibial model, where no mechanical stresses are supposed to take place. The objective is to investigate the behavior of BABC in the environment of posterolateral spinal fixation model, in which the bone cement interface is exposed to continuous mechanical stress. Japanese white rabbits were used. Fixation of L5-L6 segment was done by wiring the spinous and transverse processes of L5 and L6 vertebrae. Then BABC was applied over the transverse processes and the intertransverse process membrane on both sides. Polymethylmethacrylate (PMMA) bone cement was used similarly in the control group. Animals were sacrificed after 1 day, 4, 8, and 16 weeks postoperatively. Bone cement interface was examined using Giemsa surface staining and SEM, and affinity index was measured. Biomechanical testing was done nondestructively in right and left torsion. BABC bonded to bone directly with no intervening soft tissue at 4, 8, and 16 weeks, while soft tissue was consistently seen between PMMA bone cement and bone. BABC-spine constructs were stiffer than PMMA-spine constructs at all time intervals. BABC bonded directly to bone under mechanical stress and afforded stiffer fixation than PMMA bone cement.

Animals↗
PubMed1976

[Release of antibiotics from bone cement and penetration to infected cortical bone (author's transl)].

Addition of antibiotics to bone cement is used more and more in orthopedics and traumatology. Indications are discussed: 1. infection prophylaxis in replacement arthroplasty, 2. therapy and recidive prophylaxis in infected arthroplasty, 3. therapy of chronic osteomyelitis. Our own experiments show release of antibiotics from bone cement Palacos and penetration into cortical bone after experimental osteomyelitis. Carbenicillin and Cephalotin show high level of concentration for 2 weeks, after 3 weeks there is no concentration evident. Lincomycin and Gentamycin in the first days show high tissue levels, after decrease and increase again after second week. Gentamycin was examined during 10 months showing high levels after this time.

Animals↗
PubMed2004

Fracture toughness of steel-fiber-reinforced bone cement.

Fractures in the bone-cement mantle (polymethyl methacrylate) have been linked to the failure of cemented total joint prostheses. The heat generated by the curing bone cement has also been implicated in the necrosis of surrounding bone tissue, leading to loosening of the implants. The addition of reinforcements may improve the fracture properties of bone cement and decrease the peak temperatures during curing. This study investigates the changes in the fracture properties and the temperatures generated in the ASTM F451 tests by the addition of 316L stainless steel fibers to bone cement. The influence of filler volume fraction (5-15% by volume) and aspect ratios (19, 46, 57) on the fracture toughness of the acrylic bone cement was assessed. Increasing the volume fraction of the steel fibers resulted in significant increases in the fracture toughness of the steel-fiber-reinforced composite. Fracture-toughness increases of up to 2.63 times the control values were obtained with the use of steel-fiber reinforcements. No clear trend in the fracture toughness was discerned for increasing aspect ratios of the reinforcements. There is a decrease in the peak temperatures reached during the curing of the steel-fiber-reinforced bone cement, though the decrease is too small to be clinically relevant. Large increases in the fatigue life of acrylic bone cement were also obtained by the addition of steel fibers. These results indicate that the use of steel fibers may enhance the durability of cemented joint prostheses.

Biocompatible Materials↗
PubMed2006

Antimicrobial properties of erythromycin and colistin impregnated bone cement. An in vitro analysis.

Deep surgical site infection is a devastating consequence of total joint arthroplasty. The use of antibiotic impregnated bone cement is a well-accepted adjunct for treatment of established infection and prevention of deep orthopaedic infection. It allows local delivery of the antibiotic at the cement-bone interface and sustained release of antibiotic provides adequate antibiotic coverage after the wound closure. Preclinical testing, randomised and clinical trials indicate that the use of antibiotic-impregnated bone cement is a potentially effective strategy in reducing the risk of deep surgical site infection following total joint arthroplasty. The purpose of this study was to assess antibacterial activity of erythromycin and colistin impregnated bone cement against strains of organisms' representative of orthopaedic infections including Gram-positive and Gram-negative aerobic organisms: Staphylococcus aureus, coagulase-negative Staphylococci, Enterococcus sp., Proteus sp., Klebsiella sp., Pseudomonas sp., and Escherichia coli. Pre-blended Simplex P bone cement with the addition of erythromycin and colistin (Howemedica Inc) was mixed thoroughly with 20ml liquid under sterile conditions to produce uniform cylindrical discs with a diameter of 14mm and thickness of 2mm. 24-48 hour agar cultures of Staphylococcus aureus, coagulase-negative Staphylococci, Enterococcus sp.,Proteus sp., Klebsiella sp.,Pseudomonas sp., and Escherichia coli were used for the agar diffusion tests. The agar plates were streaked for confluent growth followed by application of erythromycin and colistin impregnated bone cement disc to each agar plate. The plates were incubated at 30 degrees C and examined at 24, 48, 72 hours, and four and five days after the preparation of the impregnated cement. The susceptibility of Staphylococcus aureus to the control discs was most clearly demonstrated showing a distinct zone of inhibition. The zone observed around coagulase-negative Staphylococci, Klebsiella sp., Pseudomonas sp., and Escherichia coli were also significant. However, there was no zone of inhibition or signs of antibacterial activity at the cemented surface were detected around discs with Enterococcus sp. and Proteus sp. The results showed that Simplex P bone cement with the addition of erythromycin and colistin was effective against most of the broad spectrum organisms encountered during total joint arthroplasty. The activity of Simplex P bone cement impregnated with erythromycin and colistin is mainly during the first 72 hours.

Anti-Bacterial Agents↗
PubMed2004

Effect of rapidly resorbable calcium phosphates and a calcium phosphate bone cement on the expression of bone-related genes and proteins in vitro.

The use of biodegradable bone substitutes is advantageous for alveolar ridge augmentation because it avoids second-site surgery for autograft harvesting. This study examines the effect of novel, rapidly resorbable calcium phosphates and a calcium phosphate bone cement on the expression of bone-related genes and proteins by human bone-derived cells (HBDCs) and compares this behavior to that of tricalciumphosphate (TCP). Test materials were alpha-TCP, two materials with a crystalline phase Ca(2)KNa(PO(4))(2) and with a small amorphous portion containing either magnesium potassium phosphate (material denominated GB14) or silica phosphate (material denominated GB9), and a calcium phosphate bone cement (material denominated Biocement D). HBDCs were grown on the substrata for 3, 7, 14, and 21 days, counted, and probed for various mRNAs and proteins (type I collagen, osteocalcin, osteopontin, osteonectin, alkaline phosphatase, and bone sialoprotein). All substrates supported continuous cellular growth for 21 days. In the presence of GB14 and Biocement D specimens cell proliferation was reduced and cell differentiation increased. At day 21, the greatest number of cells was found on GB9 expressing significantly higher levels of bone-related proteins than cells grown on all other surfaces. Because all novel materials facilitated the expression of the osteoblastic phenotype at least as much as TCP and the polystyrene control, these biomaterials can be regarded as excellent candidate bone substitute materials. GB9 induced the highest proliferation and cellular differentiation after 21 days of incubation, suggesting that this material may possess a higher potency for enhancing osteogenesis than TCP.

Adolescent↗
PubMed2006

[A study on alpha-tricalcium phosphate bone cement carbon fiber-reinforced].

In order to improve the mechanical properties of alpha-tricalcium phosphate (alpha-TCP), we prepared surface-modified carbon fibers (CF) reinforced alpha-TCP composite bone cement. Bone cement was soaked in Ringer's body solution to test its capacity of fast formation of hydroxyapatite crystals and self-solidification. Scan electronic microscope (SEM) observation and compressive strength measurement were taken to analyze the mechanical properties and the micro- morphological structure of CF reinforced alpha-TCP bone cement. The results showed that the bone cement was transferred into hydroxyapatite plates after being soaked in Ringer's simulated body fluid for 5 days. Suitable amount of carbon fibers could well spread in and bond with the matrix of the bone cement. The mechanical properties of the bone cement have been improved by CF reinforcing; the compressive strength reaches 46.7 MPa when the amount of carbon fibers is 0.5% in weight percent, which is 22% higher than that of the non-reinforced alpha-TCP bone cement.

Bone Cements↗
PubMed1992

Adhesive bone cement containing hydroxyapatite particle as bone compatible filler.

Acrylic bone cement containing hydroxyapatite (HA) as a filler was developed using 4-methacryloyloxyethyl trimellitate anhydride (4-META) to promote adhesion both to bone and HA. The mechanical strengths of the cement did not decrease significantly with increasing HA in the cement by 4-META. However, strengths decreased with increasing HA content in the absence of 4-META. Scanning electron micrographic examination of fractured surfaces of the cement clearly showed that the HA particles adhered to the matrix resin when 4-META was added. Thus, it was important to maintain the original mechanical strengths for 4-META. The HA particles along the surface increased with increased HA content in the cement. The cement adhered to bone with a tensile bond strength was higher than 10 MPa.

Acrylic Resins↗
PubMed1998

Pre-yield and post-yield shear behavior of the cement-bone interface.

Aseptic loosening of cemented total hip replacements is thought to involve mechanical failure of the cement-bone interface. However, the mechanical response of the interface, particularly the post-yield behavior, is not well understood. The purpose of this study was to determine the constitutive behavior of the cement-bone interface for loading in shear using a combination of experimental and finite element methods. A total of 55 cement-bone specimens (5 x 10 x 15-20 mm) from the proximal femur of human cadavers were loaded to failure under displacement control with use of a custom shear test jig. Finite element models of the test specimens were made and included provision for a two-parameter nonlinear interface model at the cement-bone interface. The experimental tests revealed a complicated load versus displacement response with an initial linear region and a reduction in slope until the ultimate strength (2.25+/-1.49 MPa) was reached, followed by an exponential decrease in load with increasing displacement until the entire interface debonded. Failure most often occurred at the cement-bone interface, where the cement penetrated into the bone with bone remaining in the cement in 30 specimens and with bone remaining in the cement and cement spicules remaining in the bone in 22 specimens. The adjacent bulk bone and cement did not appear to be permanently deformed. Finite element models of the test specimens revealed that failure initiated at the base of the test specimen before the peak load had been reached. The two interface parameters, interface strength (2.71+/-1.90 MPa) and interface-softening exponent (4.96+/-3.47 1/mm), could be determined directly from the experimental data and provided a good fit with the experimental structural response for a wide range of interface strengths. These results show that the cement-bone interface does not fail abruptly when the shear strength is reached but absorbs a substantial amount of energy with post-yield strain-softening behavior.

Adult↗
PubMed1998

Effect of cement modulus on the shear properties of the bone-cement interface.

Shear tests of the bone-cement interface were performed in vitro using two types of bone cement, standard poly(methyl methacrylate) (PMMA) and a reduced-modulus formulation with poly(butyl methacrylate) beads in a methyl methacrylate matrix (PBMMA). Tests of shear properties were also calculated on cancellous bone and on each cement alone. The tests were done using the Iosipescu shear test method which generates a pure shear force in a zero-moment section of the specimen. With this method, shear properties can be determined at specified locations throughout the specimen. Tests were performed across the entire interface region, specifically in the middle of the region of cement bone interdigitation and at both the bone and cement ends of that region. Ultimate shear strengths and shear moduli were calculated. The shear modulus of the PBMMA is less than 3% that of PMMA. The strength and modulus of cancellous bone had a direct relation to the apparent density of the bone, as did the strength and modulus of the bone-composite interface and the composite region. Strength and modulus were dictated by the bone at the bone-composite interface, and by the cement at the cement composite interface. Through the composite region, the stiffer of the two materials in the composite determined the shear properties. Reduced-modulus bone cement substantially decreases the interfacial shear stresses at the bone-cement interface which should decrease the rate of resorptive bone remodelling at this interface.

Animals↗
PubMed1992

[An experimental study of the process of bony ingrowth into inorganic bone-particle impregnated bone cement].

A composite of inorganic bone particles formed with bone cement in certain proportion was implanted in the proximal femora of 15 New Zealand rabbits. The animals were sacrificed in batches at different intervals after implantation and specimens were sectioned for scanning electron microscopic (SEM) observation and push-out test. SEM showed that the bone particles in the composite were in contact with each other and forming bony pathways. The gaps between inorganic bone particle bone cement and cortical bone were filled at first with collagen fibrils which were interwoven to form collagen fiber bundles and then mineralized to assume woven bone. The bone particles became smaller in size and were enveloped, absorbed and replaced by new bone structure gradually reaching the depth of bone cement along the pathways formed by bone particles. The shear strength of the cement-bone interface was increased subsequently.

Animals↗
PubMed1993

Improved cortical histology after cementation with a new MMA-DMA-IBMA bone cement: an animal study.

The histological response of bone to inert bone wax, conventional polymethylmethacrylate (PMMA), and a new formulation of bone cement, methylmethacrylate/n-decylmethacrylate/isobornylmethacrylate (MMA/DMA/IBMA) was investigated in canine tibial diaphysis. The new formulation of cement is characterized by a reduced exothermic temperature at curing and reduced leakage of chemicals to the adjacent bone. In comparison with bone wax, the MMA/DMA/IBMA bone cement did not differ significantly with respect to periosteal apposition and bone remodeling, although a tendency to inhibit the biological response was encountered. The MMA/DMA/IBMA was clearly superior to PMMA bone cement in respect to both bone necrosis and repair, as well as bone remodeling.

Animals↗
PubMed1993

[Effects of inadequate cementing techniques on mechanical loading of bone cement].

Good, painfree and durable function of an endoprosthesis is highly dependent on its anchorage in the bony bed. Apart from the problem of mechanical loading of the prosthesis and the change in the strains in the cortical bone, stresses on the bone cement as a force-transmitting element, are of considerable importance. Inadequate cementing technique and resulting faulty cementing is a common cause of loosening of the endoprosthesis. The present article investigates the influence of inadequate cementing technique on the stress and strain conditions of bone cement, in particular at the distal end of the prosthesis.

Biomechanical Phenomena↗
PubMed1975

Characterization of bone cements.

Properties of acrylic bone cements during and after curing were determined for three brands of bone cement. Curing time and consistency were chosen for the characterization of the handling and working behavior of these materials. The performance of bone cements after curing may be related amongst other things to the following properties: water resorption, solubility/disintegration, flexural modulus of elasticity, yield stress, proportional limit, flexural strength and impact strength. Methods to determine these handling and material properties are described. The influence of radiopacifying and antibiotic additives on these properties is evaluated as well as the influence of porosity on flexural strength and impact strength. The results indicate that considerable differences in the handling properties occur. The material properties of the three brands tested do not show marked differences. Radiopacifying and antibiotic additives appear to have a negative effect on material properties; the effect of porosity as it develops during curing under simulated clinical conditions is more pronounced.

Acrylates↗
PubMed1995

Reinforcement of bone cement around prostheses by pre-coated wire coil: a finite element model study.

The longevity of cemented total joint replacements, namely total hip arthroplasty (THA), depends on the integrity of the cement per se and interfaces of the metallic stem-cement and bone-cement, and stress/stress transmission and its distribution. A simple coil made of stainless steel wire was placed around a tapered stem in a simulated cement mantle to counteract the radial- and hoop-stresses created by the stem loading. Two-dimensional axisymmetric finite element analysis was performed to elucidate the level of the stress and its distribution with and without the wire coil. The results suggest that the peak stresses distributed throughout the cement may be reduced by more than one half, via the incorporation of a wire coil, confirming the mechanical test results, which showed an average fracture load of 3.70 +/- 1.13 kN for pure bone cement control and 9.02 +/- 1.54 kN for the wire coil reinforced specimens. These results indicate that the reinforcement of the cement mantle with a wire coil in the distal end of the hip stem prosthesis could reduce the hoop-stresses, which may results in reduced stresses in the bone and cement interface. Consequently, loosening of the interfaces of the bone-cement and cement-stem could be reduced due to the enhanced fatigue life of the bone cement mantle with favorable stress distribution at the distal tip of the stem.

Biomechanical Phenomena↗