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PubMed1999

Reconstruction of bone using calcium phosphate bone cements: a critical review.

The calcium phosphate cements (CPCs) are rapidly emerging as a new technology in craniofacial surgery and will soon impact many areas of orthopedic and maxillofacial reconstructive surgery as well. These materials are, in many ways, substantially different from the previously marketed dense, crystalline, hydroxyapatite (HA) ceramic materials of the 1980s. The CPCs are blends of amorphous and crystalline calcium phosphate compounds and set to produce HA. These materials 1) have x-ray diffraction spectra similar to the mineral phase of bone, 2) set endothermically at body temperature, 3) are capable of being injected into fractures or bone defects, 4) have compressive strengths equal to or greater than bone, 5) form chemical bonds to the host bone, and 6) may exhibit osteoconductive properties. This review provides an overall commentary on the different types of CPCs, emphasizing those materials currently on the market or soon to emerge in the marketplace.

Animals↗
PubMed1991

Removal torque for bone-cement and titanium screws implanted in rabbits.

Screw-shaped implants of commercially pure titanium and polymerized methyl methacrylate were inserted into the rabbit tibia. The animals were divided into two groups, and the implants were unscrewed after 5 weeks and 9 months, respectively. After both intervals, removal torque was greatest for the titanium implants. This difference was probably due to lower biocompatibility for the plastic material.

Animals↗
PubMed2005

A new, reliable, and simple-to-use method for the analysis of a population of values of a random variable using the Weibull probability distribution: application to acrylic bone cement fatigue results.

In cases where the Weibull probability distribution is being investigated as a possible fit to experimentally obtained results of a random variable (V), there is, currently, no accurate and reliable but simple-to-use method available for simultaneously (a) establishing if the fit is of the two- or three-parameter variant of the distribution, and/or (b) estimating the minimum value of the variable (V(0)), in cases where the three-parameter variant is shown to be applicable. In the present work, the details of such a method -- which uses a simple nonlinear regression analysis -- are presented, together with results of its use when applied to 4 sets of number-of-cycles-to-fracture results from fatigue tests, performed in our laboratory, using specimens fabricated from 3 different acrylic bone cement formulations. The key result of the method is that the two- or three-parameter variant of the probability distribution is applicable if the estimate of V(0) obtained is less than or greater than zero, respectively.

Algorithms↗
PubMed2002

Bone cement extracts modulate the osteoprotegerin/osteoprotegerin-ligand expression in MG63 osteoblast-like cells.

The osteoprotegerin-ligand (OPG-L) has been identified as the essential factor required for osteoclastogenesis, and its effects are prevented by the osteoprotegerin (OPG). The OPG-L/OPG balance plays a crucial role in coordinating the sequence of osteoclast and osteoblast differentiation during the bone remodeling. The aim of the study was to investigate if polymethylmethacrylate-based cements are able to modulate the expression of OPG-L/OPG in MG63 cells, which are known to have high levels of OPG and inducible expression of OPG-L. Four radio-opaque cements. namely Sulfix-60, CMW1, CMW2 and CMW3, were polymerized for either 1 h or 7 d. MG63 were incubated for 24 h with culture medium only, cement extracts and 2 microg/ml of human recombinant IL-1beta as positive control. An RT-PCR was performed to detect the OPG and OPG-L expression, and the house-keeping gene, GAPDH, was used as a reference for the semi-quantitative analysis. An increase in the OPG-L band density was observed for all cements, and consequently, the OPG-L/OPG ratio also increased. The ability of bone cements to induce the expression of OPG-L could be a co-factor in the development of osteolysis at the bone-cement interface.

Bone Cements↗
PubMed1994

Abrasive wear of ceramic, metal, and UHMWPE bearing surfaces from third-body bone, PMMA bone cement, and titanium debris.

The debris generated by the progressive wear of total joint replacement (TJR) devices is considered a primary cause of osteolysis, bone resorption, and premature failure of artificial hips and knees. The vast majority of this debris originates from the UHMWPE articulating surfaces caused by tribological interaction with the opposing metal or ceramic surface and hard particulates contained in the sinovial fluid. Entrapment of third body debris, such as cortical bone, PMMA cement, and titanium debris, between the articulating surfaces can cause abrasion of both the hard bearing surface and the UHMWPE. The propensity for abrasive wear is dependent on the relationship between the hardness of the third-body debris and the hardness of the bearing surfaces. To gain a better understanding of this relationship and its effect on wear, the abrasive wear behavior of several metal and ceramic bearing surfaces was characterized in terms of the hardness of both the third-body debris and the metal or ceramic substrate. The effects of abrasion and increased surface roughness of the metal or ceramic surfaces on wear of the UHMWPE was also determined. In addition, the amount of UHMWPE wear was quantified in terms of the amount (particles/ml) of titanium fretting-type debris contained in solution. The results of this investigation showed the resistance to abrasive wear of the metal and ceramic bearing surfaces to increase with increasing surface hardness. Bone debris, PMMA cement, and titanium debris produced visible abrasion of all metal surfaces including nitrogen ion implanted Ti-6Al-4V. The ceramic bearing surfaces showed no evidence of abrasion and produced the least amount of UHMWPE wear. The wear of UHMWPE sliding against Co-Cr-Mo was found to increase with increasing levels of 1.48 microns titanium debris added to the wear test solution. The rate of UHMWPE wear increased rapidly for concentrations of titanium debris in the test solution exceeding about 10(5) particles/ml. These test results suggest that third-body particles, both large and small, are capable of causing increased abrasive wear of UHMWPE, and that abrasion of the hard bearing surfaces will occur if the hardness of the third-body debris exceeds the hardness of the metal or ceramic bearing surface.

Biocompatible Materials↗
PubMed1999

[Resection of nerve of wrist combining replacement of lunate with bone cement prosthesis in treatment of Kienbock's disease].

OBJECTIVE: There are various methods used to treat the Kienbock's disease with various outcomes. This study investigated the effect of combining acrylic lunate prosthesis replacement with resection of articular branches to wrist from anterior and dorsal interosseous nerve. METHODS: From January 1992 to January 1997, six cases were included. All of the patients were in stage III according to Lichtman's classification. Besides replacement of the acrylic lunate prosthesis, segment of the pure sensory branches from anterior and posterior interosseous nerves were resected. RESULTS: Follow-up for 10 to 54 months (an average of 32 months) the pain was relieved in all patients except one. The range of movement of wrists were as followings: The extension of the wrist was 20 to 35 degrees (an average of 26 degrees) and flexion was 20 to 35 degrees (an average of 32 degrees). There was no improvement in radial and ulnar deviation. CONCLUSION: Lunate prosthesis replacement combined with resection of articular branches to wrist resulted in a painless wrist and was a satisfactory method.

Adolescent↗
PubMed2006

Injectable calcium phosphate bone cement provides favorable space and a scaffold for periodontal regeneration in dogs.

BACKGROUND: An earlier study showed that an injectable calcium phosphate cement (CPC) served as a stable scaffold for bone formation and promoted histocompatible healing of periodontal tissue in dogs. In this study, we evaluated the influence of CPC on regeneration of periodontal defects with experimental periodontitis in dogs. METHODS: Experimental periodontitis was induced by placing stainless-steel mesh on the mesial side of maxillary canines in six adult, healthy beagle dogs. Subsequently, intrabony defects were resized so as to be standard, and CPC was injected in the experimental bone defects. Non-grafted defects on the contralateral side served as controls. Twelve weeks after surgery, the animals were sacrificed and histologic specimens were prepared. Periodontal tissue healing was evaluated histologically and histometrically. RESULTS: Healing of periodontal tissues, in terms of bone and cementum formation, was consistently observed in the CPC-applied sites. CPC was partly replaced by new bone. New cementum and periodontal ligament-like tissue were observed between CPC and the root surface. New bone (P <0.05), new cementum (P <0.01), and new connective tissue attachment and adhesion (P <0.05) were significantly enhanced in the experimental sites. CONCLUSION: Calcium phosphate cement provides stable wound healing and enhanced periodontal regeneration in periodontal defects in dogs with experimental periodontitis.

Animals↗
PubMed2002

The effect of augmentation with resorbable or conventional bone cement on the holding strength for femoral neck fracture devices.

OBJECTIVES: To compare maximum extraction torque and pull-out load for femoral neck fracture implants inserted with standard technique or after augmentation with polymethylmethacrylate (PMMA) or calcium phosphate cement (Norian SRS). DESIGN: Biomechanical study using synthetic bone. INTERVENTION: Implants were inserted in foam blocks with three different densities for simulation of normal bone or slight or severe osteoporosis. Tested implants included three screws (AO, Olmed, Hansson), one screw with both threads and a barb (Hybrid), and one pin with a hook (LIH hook-pin). Implants were inserted by standard technique and after augmentation with PMMA or Norian SRS. MAIN OUTCOME MEASUREMENT: The effect of (a) density of the synthetic bone (low, medium, high), (b) augmentation (none, PMMA, SRS), and (c) type of implant (AO, Olmed, Hansson, Hybrid, LIH) on the maximum extraction torque and pull-out load was determined using a material testing machine. Analysis of variance with Fisher's PLSD post hoc test was used to determine statistical differences. RESULTS: PMMA significantly increased maximum torque and pull-out load for all implants and block densities when compared without cement (p < 0.0001), whereas enhancement with SRS was far less pronounced and most obvious in low density blocks. For screws normally inserted without predrilling (Olmed and Hansson) the use of SRS in high density blocks caused a significant reduction in maximum torque (p < 0.0001) and pull-out load (p < 0.0001). SRS-augmented specimens failed through the cement at the periphery of the threads, whereas PMMA-augmented specimens failed between the cement and the synthetic bone. CONCLUSION: This study suggests that augmentation with PMMA around femoral neck fracture implants will increase the holding power significantly when compared with standard insertion technique as well as augmentation with calcium phosphate cement. Augmentation with calcium phosphate cement like SRS will increase the holding characteristics mainly in low density bone, whereas in high density bone it might even reduce the maximum torque because of the need for predrilling when using the cement for augmentation.

Biomechanical Phenomena↗
PubMed1996

Reinforcement of bone cement around the femoral prosthesis tip by pre-coated wire coil: a human cadaver bone study.

In order to alleviate fixation-related problems of cemented total hip arthroplasty (THA), a wire coil was incorporated within the cement mantle at the distal end of femoral prosthesis in a sectioned human cadaver specimen. Mechanical push-out test results showed that the wire reinforcement reduces the hoop strain by 50% at the exterior surface of the bone. The reinforced specimen also showed less axial stem displacement. The use of wire coil within the cement mantle could reduce hoop strain and axial stem displacement in the femoral prosthesis of total hip joint implants.

Bone Cements↗