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PubMed2004

Bone inductive properties of rhBMP-2 loaded porous calcium phosphate cement implants in cranial defects in rabbits.

In this study, the osteoinductive properties of porous calcium phosphate (Ca-P) cement loaded with bone morphogenetic protein 2 (rhBMP-2) were evaluated and compared with rhBMP-2 loaded absorbable collagen sponge (ACS). Discs with a diameter of 8mm were loaded with a buffer solution with or without 10 microg rhBMP-2 and inserted in 8mm full thickness cranial defects in rabbits for 2 and 10 weeks of implantation. Histological analysis revealed excellent osteoconductive properties of the Ca-P material. It maintained its shape and stability during the implantation time better than the ACS but showed no degradation like the ACS. Quantification of the Ca-P cement implants showed that bone formation was increased significantly by administration of rhBMP-2 (10 weeks pore fill: 53.0+/-5.4%), and also reached a reasonable amount without rhBMP-2 (43.1+/-10.4%). Remarkably, callus-like bone formation outside the implant was observed frequently in the 2 weeks rhBMP-2 loaded Ca-P cement implants, suggesting a correlation with the presence of growth factor in the surrounding tissue. However, an additional in vitro assay revealed an accumulative release of no more than 9.7+/-0.9% after 4 weeks. We conclude that: (1). Porous Ca-P cement is an appropriate candidate scaffold material for bone engineering. (2). Bone formation can be enhanced by lyophilization of rhBMP-2 on the cement. (3). Degradation of porous Ca-P cement is species-, implantation site- and implant dimension-specific.

Animals↗
PubMed2004

Calcium sulphate-based cements containing cephalexin.

Cephalexin containing gypsum and apatite/gypsum cements have been synthesised. The presence of cephalexin into the cements does not alter neither the physico-chemical behaviour of the cements nor produce structural changes on them. These cements behave as drug delivery systems when soaked in simulated body fluid. The release of the drug is different depending on the composition. For gypsum cements, the cephalexin is quickly released, helped by a dissolution process of the matrix, whereas the drug release is more controlled by the hydroxyapatite presence in hydroxyapatite/gypsum samples. Apatite containing cements do not only show a different drug release process, also the paste viscosity is lower and a faster formation "in vitro" of an apatite-type layer on their surface is observed.

Anti-Bacterial Agents↗
PubMed2004

Effect of added gelatin on the properties of calcium phosphate cement.

This study investigates the effect of gelatin on the setting time, compressive strength, phase evolution and microstructure of calcium phosphate cement. The composite cement powder (about 18 wt% gelatin, and 82 wt% alpha-tricalcium phosphate) was prepared from the solid compound obtained by casting a gelatin aqueous solution containing alpha-tricalcium phosphate. 5 wt% of CaHPO(4) x 2H(2)O were added to the powder before mixing with the liquid phase. Two cement formulations were prepared using two different liquid/powder ratios, and their properties compared with those of control samples, prepared without gelatin. The final setting time increases from 10 min to more than 45 min when the L/P ratio increases from 0.3 to 0.4 ml/g. The presence of gelatin accelerates the setting reaction, and improves the mechanical properties of the cements. The compressive strength increases with the setting reaction up to 10.7-14.0 MPa for the gelatin cements, whereas the control samples exhibit much lower values. The improved mechanical properties of the composite cements with respect to the controls can be related to their reduced total porosity and more compact microstructure.

Biocompatible Materials↗
PubMed2005

Modulation of porosity in apatitic cements by the use of alpha-tricalcium phosphate-calcium sulphate dihydrate mixtures.

Calcium phosphate bone cements are injectable biomaterials that are being used in dental and orthopaedic applications through minimally invasive surgery techniques. Nowadays, apatitic bone cements based on alpha-tricalcium phosphate (alpha-TCP) are of special interest due to their self-setting behaviour when mixed with an aqueous liquid phase. In this study, a new method to improve osteointegration of alpha-TCP-based cements is presented. This method consists in the modification of the cement's powder phase with different amounts of calcium sulphate dihydrate (CSD). The resulting hardening properties of the new biphasic cements are a combination between the progressive hardening due to the main alpha-TCP reactant and the progressive dissolution of the CSD phase, which render a porous material. It was observed that the maximum compressive strength of Biocement-H (45 MPa) decreased as the amount of CSD increased in the cement powder mixture ( approximately 30 MPa for 25 wt% of CSD). It was also observed that after complete dissolution of the CSD phase a porous apatitic structure appears with a mechanical compressive strength suitable for cancellous bone applications (10 MPa).

Apatites↗
PubMed2005

Development of high-viscosity, two-paste bioactive bone cements.

Self-curing two-paste bone cements have been developed using methacrylate monomers with a view to formulate cements with low polymerization exotherm, low shrinkage, better mechanical properties, and improved adhesion to bone and implant surfaces. The monomers include bis-phenol A glycidyl dimethacrylate (bis-GMA), urethane dimethacrylate (UDMA) and triethylene glycol dimethacrylate (TEGDMA) as a viscosity modifier. Two-paste systems were formulated containing 60% by weight of a bioactive ceramic, hydroxyapatite. A methacroyloxy silane (A174) was used as a coupling agent due to its higher water stability in comparison to other aminosilanes to silanate the hydroxyapatite particles prior to composite formulation. A comparison of the FT-infrared spectrum of hydroxyapatite and silanated hydroxyapatite showed the presence of the carbonyl groups ( approximately 1720 cm(-1)), -C=C-( approximately 1630 cm(-1)) and Si-O- (1300-1250 cm(-1)) which indicated the availability of silane groups on the filler surface. Two methods of mixing were effected to form the bone cement: firstly by mixing in an open bowl and secondly by extruding the two pastes by an auto-mixing tip using a gun to dispense the pastes. Both types of cements yielded low polymerization exotherms with good mechanical properties; however, the lower viscosity of UDMA allowed better extrusion and handling properties. A biologically active apatite layer formed on the bone cement surface within a short period after its immersion in simulated body fluid, demonstrating in vitro bioactivity of the composite. This preliminary data thus suggests that UDMA is a viable alternative to bis-GMA as a polymerizable matrix in the formation of bone cements.

Biomimetic Materials↗
PubMed2005

Anterior spinal column augmentation with injectable bone cements.

A vertebral fracture, whether originating from osteoporosis or trauma, can be the cause of pain, disability, deformation and neurological deficit. The treatment of vertebral compression fractures has, for many years until the advent of vertebroplasty, consisted of bedrest and analgesics. Vertebroplasty is a percutaneous technique during which bone cement is injected in a vertebral body to provide immediate pain relief by stabilization. Inflatable bone tamps can, prior to the injection of cement, be used to create a void in the vertebral body, in which case the technique is known as balloon vertebroplasty (or kyphoplasty). The chance of extracorporal cement leakage is smaller for balloon vertebroplasty than for vertebroplasty. Some authors also claim to have gained some correction in vertebral body height or angulation. Both interventions can be used for several indications, including osteoporotic compression fractures and osteolytic lesions of the vertebral body such as myeloma, hemangioma or metastasis, and also for traumatic burst fractures in combination with pedicle screw instrumentation. Polymethyl methacrylate cement is the bone void filler that is used most frequently, although the application of calcium phosphate cements has been studied widely in vitro, in vivo and also in small-scale clinical series. The clinical results of (balloon-) vertebroplasty are favorable with 85-95% of all patients experiencing immediate and long-lasting relief of pain. Serious complications are relatively rare but include neurological deficit and pulmonary embolism. In this paper, both vertebroplasty and balloon vertebroplasty and their respective indications, techniques and results are described in relation with the application and limitations of permanent and resorbable injectable bone cements.

Absorbable Implants↗
PubMed2006

Mechanical evaluation of implanted calcium phosphate cement incorporated with PLGA microparticles.

In this study, the mechanical properties of an implanted calcium phosphate (CaP) cement incorporated with 20wt% poly (dl-lactic-co-glycolic acid) (PLGA) microparticles were investigated in a rat cranial defect. After 2, 4 and 8 weeks of implantation, implants were evaluated mechanically (push-out test) and morphologically (Scanning Electron Microscopy (SEM) and histology). The results of the push-out test showed that after 2 weeks the shear strength of the implants was 0.44+/-0.44MPa (average+/-sd), which increased to 1.34+/-1.05MPa at 4 weeks and finally resulted in 2.60+/-2.78MPa at 8 weeks. SEM examination showed a fracture plane at the bone-cement interface at 2 weeks, while the 4- and 8-week specimens created a fracture plane into the CaP/PLGA composites, indicating an increased strength of the bone-cement interface. Histological evaluation revealed that the two weeks implantation period resulted in minimal bone ingrowth, while at 4 weeks of implantation the peripheral PLGA microparticles were degraded and replaced by deposition of newly formed bone. Finally, after 8 weeks of implantation the degradation of the PLGA microparticles was almost completed, which was observed by the bone ingrowth throughout the CaP/PLGA composites. On basis of our results, we conclude that the shear strength of the bone-cement interface increased over time due to bone ingrowth into the CaP/PLGA composites. Although the bone-cement contact could be optimized with an injectable CaP cement to enhance bone ingrowth, still the mechanical properties of the composites after 8 weeks of implantation are insufficient for load-bearing purposes.

Absorbable Implants↗
PubMed2004

The apparent increase of the Young's modulus in thin cement layers.

OBJECTIVES: The bond of adhesive luting cements to the tooth tissues and restorative materials is expected to hinder their transverse contraction for the layer thickness applied in dental restorations. It was hypothesized that the hindering of the transverse deformation will influence the relation between stress and strain (the stiffness) in the direction perpendicular to the substrate surface. The aim of this study was to investigate the relation between cement layers with different ratio between bonded and free surface (C-factor) and the stiffness of these layers, i.e. an apparent increase of the Young's modulus of the dental luting cement. METHODS: A commercial luting cement RelyX ARC (3M, St Paul, MN, USA) was used in this study. The 'real" Young's modulus and the Poisson ratio were determined and these values were used in models with layers with different C-factors (0.5, 1.0, 2.0, 3.0, 4.0, 5.0 and 6.0) in a three-dimensional Finite Element Analysis program (FEMAP, E.S.P., Maryland Height, MO, USA). The apparent Young's modulus was measured for layers with thicknesses of 0.5 mm (C = 6.0) and 6.0 mm (C = 0.5) and compared with the results of the Finite Element Analysis (FEA) analysis. RESULTS: The apparent Young's modulus in the 0.5 mm layer was 20% higher than the apparent Young's modulus in the 6.0 mm layer. This result was confirmed by the results of the F.E. analysis. For very thin layers the stiffness will be 25% higher than the Young's modulus. SIGNIFICANCE: The hindering of the transverse contraction has to be taken into account studying the mechanical properties of dental luting cements because it influences the behavior of these luting cements in thin layers.

Bisphenol A-Glycidyl Methacrylate↗
PubMed2004

Stress distributions in adhesively cemented ceramic and resin-composite Class II inlay restorations: a 3D-FEA study.

OBJECTIVES: The purpose of this study was to investigate the effect of differences in the resin-cement elastic modulus on stress-transmission to ceramic or resin-based composite inlay-restored Class II MOD cavities during vertical occlusal loading. METHODS: Three finite-element (FE) models of Class II MOD cavity restorations in an upper premolar were produced. Model A represented a glass-ceramic inlay in combination with an adhesive and a high Young's modulus resin-cement. Model B represented the same glass-ceramic inlay in combination with the same adhesive and a low Young's modulus resin-cement. Model C represented a heat-cured resin-composite inlay in combination with the same adhesive and the same low Young's modulus resin cement. Occlusal vertical loading of 400 N was simulated on the FE models of the restored teeth. Ansys FE software was used to compute the local von Mises stresses for each of the models and to compare the observed maximum intensities and distributions. Experimental validation of the FE models was conducted. RESULTS: Complex biomechanical behavior of the restored teeth became apparent, arising from the effects of the axial and lateral components of the constant occlusal vertical loading. In the ceramic-inlay models, the greatest von Mises stress was observed on the lateral walls, vestibular and lingual, of the cavity. Indirect resin-composite inlays performed better in terms of stress dissipation. Glass-ceramic inlays transferred stresses to the dental walls and, depending on its rigidity, to the resin-cement and the adhesive layers. For high cement layer modulus values, the ceramic restorations were not able to redistribute the stresses properly into the cavity. However, stress-redistribution did occur with the resin-composite inlays. SIGNIFICANCE: Application of low modulus luting and restorative materials do partially absorb deformations under loading and limit the stress intensity, transmitted to the remaining tooth structures.

Bicuspid↗
PubMed2005

Bond strength of resin cements to H2O2-treated titanium plates.

OBJECTIVE: This study investigated the effects of H(2)O(2)-treatment of titanium surfaces on cement shear bond strengths, and characterized H(2)O(2)-treated titanium surfaces. METHODS: Using 34.5% hydrogen peroxide solution, cp Ti plates (10 mm x 10 mm x 1 mm) were treated by (1) an immersion method, and (2) halogen irradiation while immersed in H(2)O(2) for varying times. A cylindrical block (6 mm diameter, 4 mm height) of four different cements was bonded onto H(2)O(2)-treated surfaces. The cement bond strengths were evaluated under shear mode. Treated surfaces were also characterized for color change, wettability, AC impedance, and transmission electron diffraction of stripped oxide film. RESULTS: The cement shear bond strength of cp Ti treated with H(2)O(2) and halogen for 160 s was the highest and was approximately 14 times higher than the un-treated control cp Ti plates. Bond strengths are correlated linearly to wettability. The more surface wetted with the cement material, the higher the resultant shear bond strength value. SIGNIFICANCE: These results suggest that a combined treatment of hydrogen peroxide and halogen light irradiation provides an effective surface condition with appropriate oxide film thickness to enhance the cement bond strength.

Color↗
PubMed2005

Novel amino acid modified zinc polycarboxylates for improved dental cements.

OBJECTIVE: The objective of this study was to develop a novel amino acid modified zinc/calcium polycarboxylate cement system, formulate the cements, and evaluate their mechanical strengths. MATERIALS AND METHODS: Acrylate and methacrylate derivatives of four amino acids were synthesized and characterized using FT-IR and 1HNMR spectroscopy. The derivatives were formulated with polymer having pendent methacrylate group, water, and synthesized novel filler. Compressive (CS) as well as flexural strengths (FS) and viscosities of the resin liquids were used as tools to evaluate the formulations and formed cements. The specimens for CS and FS tests were conditioned in distilled water at 37 degrees C for 24 h and 7 d, respectively, prior to testing. RESULTS: The measured CS and FS of the cements was in the decreasing order of methacryloyl beta-alanine > acryloyl glutamic acid = acryloyl beta-alanine > methacryloyl glutamic acid > 2-hydroxyethyl methacrylate. Methacryloyl beta-alanine was selected for further formulations due to its relatively low solution viscosity and high CS as well as FS. Effects of polymer content, P/L ratio, tartaric acid and initiator concentration were significant. During aging, the cement showed a constant increase in CS for up to 1 month and then kept constant for up to 3 months. CONCLUSIONS: This study developed a novel amino acid modified zinc/calcium polycarboxylate cement system. This system was 85% higher in CS, 98% higher in DTS and 183% higher in FS, compared to Durelon.

Amino Acids↗
PubMed2004

A fatigue damage model for the cement-bone interface.

Loss of fixation at the cement-bone interface can contribute to clinical loosening of cemented total hip replacements. In this study, the fatigue damage response was determined for cement-bone constructs subjected to shear fatigue loading. A typical three-phase fatigue response was observed with substantial early damage, followed by a long constant damage rate region and a final abrupt increase in damage to fracture. All of the damage resulted from creep (permanent) deformation during fatigue loading and there was no loss in cyclic stiffness. Using a Von Mises equivalent stress/strain concept, a general damage model was developed to describe the fatigue creep response of the cement-bone interface under either shear or tensile fatigue loading. Time to failure was highly correlated (r2=0.971) with equivalent creep strain rate and moderately related (r2=0.428) with equivalent initial strain for the two loading regimes. The equivalent creep strain at failure (0.052+/-0.018) was found to be independent of the applied equivalent stress. A combination of the creep damage model (to describe the damage process) with a constant final equivalent strain (as a failure criteria) could be used to assess the cement-bone failure response of cemented implant systems.

Bone Cements↗
PubMed2004

Stress analysis of cemented glenoid prostheses in total shoulder arthroplasty.

Glenoid component loosening is the most-frequently encountered problem in the total shoulder arthroplasty. The purpose of the study was to investigate whether failure of the glenoid component is caused by stresses generated within the cement mantle, implant materials and at the various interfaces during humeral abduction, using 3-D FE analyses of implanted glenoid structures. FE models, one total polyethylene and the other, metal backed polyethylene, were developed using CT-scan data and submodelling technique, which was based on an overall solution of a natural scapula model acted upon by all the muscles, ligaments and joint reaction forces. Material interfaces were assumed to be fully bonded. Based on the FE stress analysis, the following observations were made. (1) The submodelling technique, which required a large-size submodel and the use of prescribed displacements at cut-boundaries located far away from the glenoid, was crucial for evaluations on glenoid component. (2) Total polyethylene results in lower-peak stresses (tensile: 10 MPa, Von-Mises: 8.31 MPa) in the cement as compared to a metal-backed design (tensile: 11.5 MPa, Von-Mises: 9.81 MPa). The maximum principal (tensile) stresses generated in the cement mantle for both the designs were below its failure strength, but might evoke crack initiation. (3) The cement-bone interface adjacent to the tip of the keel seemed very likely to fail for both the designs. In case of metal-backed design, this interface adjacent to the tip of the keel appears even more likely to fail. (4) High metal-cement interface stresses for a moderate load might indicate failure at higher load. (5) It appears that both the designs were vulnerable to failure in some ways or the other. A part of the subchondral bone along the longitudinal axis of the glenoid cavity should be preserved to strengthen the glenoid structure and to reduce the use of cement.

Arthroplasty, Replacement↗
PubMed2006

Cement mantle fatigue failure in total hip replacement: experimental and computational testing.

One possible loosening mechanism of the femoral component in total hip replacement is fatigue cracking of the cement mantle. A computational method capable of simulating this process may therefore be a useful tool in the preclinical evaluation of prospective implants. In this study, we investigated the ability of a computational method to predict fatigue cracking in experimental models of the implanted femur construct. Experimental specimens were fabricated such that cement mantle visualisation was possible throughout the test. Two different implant surface finishes were considered: grit blasted and polished. Loading was applied to represent level gait for two million cycles. Computational (finite element) models were generated to the same geometry as the experimental specimens, with residual stress and porosity simulated in the cement mantle. Cement fatigue and creep were modelled over a simulated two million cycles. For the polished stem surface finish, the predicted fracture locations in the finite element models closely matched those on the experimental specimens, and the recorded stem displacements were also comparable. For the grit blasted stem surface finish, no cement mantle fractures were predicted by the computational method, which was again in agreement with the experimental results. It was concluded that the computational method was capable of predicting cement mantle fracture and subsequent stem displacement for the structure considered.

Arthroplasty, Replacement, Hip↗
PubMed2005

Assessment of the suitability of a new brushite calcium phosphate cement for cranioplasty - an experimental study in sheep.

INTRODUCTION: Aim of this experimental study was to assess the suitability of a new brushite calcium phosphate cement (chronOS Inject) for cranioplasty and to compare the results with a commercially available apatite calcium phosphate bone cement (Biobon). MATERIAL AND METHODS: A bilateral full-size craniotomy defect (23 mm in diameter) was created in the parietal bones of 18 adult Swiss Alpine sheep and filled with either chronOS Inject or Biobon. The observation intervals were 2, 4 and 6 months. Macroscopical, radiological, histological and histomorphometrical evaluations were performed. RESULTS: New bone formation was moderate and did not differ significantly between the biomaterials. Cement resorption occurred centripetally in the chronOS Inject group and proceeded significantly faster than the degradation process of Biobon. However, implantation of chronOS Inject was associated with a significantly higher rate of fibrous tissue formation. Cement resorption was mediated by macrophages in the chronOS Inject group, while osteoclasts were the predominant cell type involved in degradation of Biobon. Osteoblasts were found adjacent to residual cement in both groups. CONCLUSION: chronOS Inject demonstrated osteoconductive properties, good biocompatibility and superior bioresorbability but none of the cements proved suitable for filling large cranial bony defects due to the high rate of fibrous tissue formation and insufficient bony regeneration.

Analysis of Variance↗
PubMed2004

Adhesive permeability affects coupling of resin cements that utilise self-etching primers to dentine.

OBJECTIVES: To examine the effects of an experimental bonding technique that reduces the permeability of the adhesive layer on the coupling of resin cements to dentine. METHODS: Extracted human third molars had their mid to deep dentin surface exposed flat by transversally sectioning the crowns. Resin composite overlays were constructed and cemented to the surfaces using either Panavia F (Kuraray) or Bistite II DC (Tokuyama) resin cements mediated by their respective one-step or two-step self-etch adhesives. Experimental groups were prepared in the same way, except that the additional layer of a low-viscosity bonding resin (LVBR, Scotchbond Multi-Purpose Plus, 3M ESPE) was placed on the bonded dentine surface before luting the overlays with the respective resin cements. The bonded assemblies were stored for 24 h in water at 37 degrees C and subsequently prepared for microtensile bond strength testing. Beams of approximately 0.8 mm(2) were tested in tension at 0.5 mm/min in a universal tester. Fractured surfaces were examined under scanning electron microscopy (SEM). Additional specimens were prepared and examined with TEM using a silver nitrate-staining technique. RESULTS: Two-way ANOVA showed significant interactions between materials and bonding protocols (p<0.05). When bonded according to manufacturer's directions, Panavia F produced bond strengths that were significantly lower than Bistite II DC (p<0.05). The placement of an additional layer of a LVBR improved significantly the bond strengths of Panavia F (p<0.05), but not of Bistite II DC (p>0.05). SEM observation of the fractured surfaces in Panavia F showed rosette-like features that were exclusive for specimens bonded according to manufacturer's directions. Such features corresponded well with the ultrastructure of the interfaces that showed more nanoleakage associated with the more permeable adhesive interface. The application of the additional layer of the LVBR reduced the amount of silver impregnation for both adhesives suggesting that reduced permeability of the adhesives resulted in improved coupling of the resin cements to dentin. CONCLUSIONS: Placement of an intermediate layer of a LVBR between the bonded dentine surface and the resin cements resulted in improved coupling of Panavia F to dentine.

Acid Etching, Dental↗
PubMed2004

The role of timing of tourniquet release and cementing on perioperative blood loss in total knee replacement.

The purpose of our study is to estimate the effect of tourniquet release and cementing in perioperative blood loss associated with total knee arthroplasty. Eighty patients were randomly allocated into two equal groups concerning the timing of tourniquet release. Group A: patients with tourniquet release and haemostasis before wound closure and group B: patients with tourniquet release after skin closure and compressive bandaging. These groups were further subdivided in two subgroups (+ and -) depending on cementing or not of the tibial tray only. The total blood loss averaged 961 ml in group A and 692 ml in group B, while it was estimated 763 ml in the cemented group and 890 ml in the non-cemented group. The total blood loss within subgroups was Group A+ 904 ml, Group A- 1017 ml, Group B+ 622 ml and Group B- 762 ml. The mean number of blood units transfused per patient was 4.7 in Group A and 4.0 in Group B, while the mean operating time was 79 min and 66 min, respectively. Complications such as deep vein thrombosis, haematomata and minor wound complications occurred in patients of Group A and Group B, 0 and 2, 0 and 2, 8 and 11, respectively. Intraoperative tourniquet release seems to be related with significantly greater blood loss (P<0.001) and demands in blood transfusion P<0.05 as well as a longer operating time (P<0.001). Cementing of total knee replacements has a better haemostatic role compared to non-cemented prosthesis (P<0.05). Even though complications were more in postoperative tourniquet release group, no statistically significant difference was found between group A and B. Postoperative tourniquet release seems to offer better conditions of haemostasis probably due to the better controlled fibrolytic activity.

Aged↗
PubMed2006

Femoroplasty--augmentation of the proximal femur with a composite bone cement--feasibility, biomechanical properties and osteosynthesis potential.

BACKGROUND: Analogous to vertebroplasty, cement-augmentation of the proximal femur ("femoroplasty") could reinforce osteoporotic bones. This study was to evaluate (i) the feasibility of femoroplasty with a composite cement (Cortoss), (ii) its influence on femoral strength by mechanical testing and (iii) the feasibility of stable osteosynthesis of the augmented fractured bones. METHODS: Nine human cadaveric femora were augmented with a composite bone cement, the surface heat generation monitored, and then tested biomechanically against their native contralateral control to determine fracture strength. Subsequently, thirteen reinforced and fractured femora were osteosynthetized by different implants and tested against their osteosynthetisized, non-augmented contralateral control. FINDINGS: Cement could be injected easily, with a moderate temperature rise. A positive correlation between BMD and fracture load and a significant increase in fracture load (+43%) of the augmented femora compared to their native controls (6324 N and 4430 N, respectively) as well as a significant increase in energy-to-failure (+187%, 86 N m and 30 N m, respectively) was found. Osteosynthesis was possible in cement-augmented femora. Osteosynthetisized femora showed equivalent strength to the intact controls. INTERPRETATION: Augmentation of the proximal femur with composite bone cement could be of use in prophylaxis of fractures in osteoporotic femurs. Osteosynthesis of the fractured augmented bones is a challenging procedure but has a good chance to restore strength.

Biomechanical Phenomena↗