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Methylmethacrylate metabolism in man. The hydrolysis of methylmethacrylate to methacrylic acid during total hip replacement.

Methylmethacrylate, the monomeric component of the polymethylmethacrylate cement used in orthopedic surgery, has been shown to undergo hydrolysis to methacrylic acid during hip replacement operations. Circulating levels of methacrylic acid were comparable with those of methylmethacrylate. Concentrations of both methylmethacrylate and methacrylic acid normally lay in the range 0--15 micrograms/cc. No correlation could be discerned between changes in the concentrations of methylmethacrylate and methacrylic acid, and changes in blood pressure.

Acetabulum

The effect of methylmethacrylate on chemotaxis of polymorphonuclear leukocytes.

The effect of methylmethacrylate on chemotaxis of polymorphonuclear leukocytes was evaluated by an in vitro method that involved migration of human leukocytes under agarose. Chemotactic factors produced during growth of Staphylococcus epidermidis, Staphylococcus aureus, and Escherichia coli remained chemotactically active in the presence of a methylmethacrylate concentration of 1.25 per cent, which was the highest tested. The methylmethacrylate also did not alter the activity of the chemotactic factor produced by zymosan activation of normal human serum. However, when methylmethacrylate was added to normal human serum prior to zymosan activation, a methylmethacrylate concentration of 0.312 per cent significantly depressed the subsequent zymosan-induced chemotactic activity and concentrations above 0.312 per cent abolished it. When methylmethacrylate was added to the polymorphonuclear leukocyte suspensions, there was significant depression of the migration of cells at a concentration of 0.312 per cent, and at concentrations of 0.625 and 1.25 per cent no leukocyte migration occurred.

Cell Migration Inhibition

Methylmethacrylate is a mutagen for Salmonella typhimurium.

The long-term effects of exposure to monomeric methylmethacrylate have yet to be established. We have measured the toxicity and mutagenicity of methylmethacrylate for Salmonella typhimurium. At levels of thirty-four millimolar, methylmethacrylate exhibited 28 per cent of the mutagenic activity of an equimolar dose of dimethylnitrosamine. Methylmethacrylate alone exhibited toxicity to the bacteria, but when the methylmethacrylate was incubated with a rat-liver enzyme metabolizing system, mutagenesis was induced. These findings suggest that an intermediate metabolite of methylmethacrylate is mutagenic to Salmonella typhimurium.

Adhesives

The effect of methylmethacrylate on fracture healing.

Fractures were created in the femur of dogs by dividing the midshaft with an airdriven saw. Immobilization was achieved with a four-hole compression plate. No methylmethacrylate supplementation was used in the control groups. In the three experimental groups methylmethacrylate was added to the internal fixation by placing it on the endosteal, periosteal, and both surfaces of the bone. Healing of the fractures uniformly failed to occur when methylmethacrylate was apposed to both periosteal and endosteal regions. Histologic, fluorescent, and autoradiographic studies indicated that the bone surface in contact with methylmethacrylate was necrotic and did not incorporate tetracycline or Ca-45. New bone occurred only on the surface which was not in contact with methylmethacrylate.

Animals

Effects of monomeric methylmethacrylate on ocular tissues.

Toxic effects of high doses of monomeric methylmethacrylate were demonstrated in rabbit eyes. These effects were not related to surgical manipulation. Monomeric methylmethacrylate caused limbal hyperemia, corneal edema, corneal neovascularization, iris engorgement, anterior chamber inflammation, iris atrophy, and cataract. The doses of monomeric methylmethacrylate needed to produce these lesions were much higher than the amount of monomer available for leaching out of implanted intraocular lenses.

Animals

The effect of methylmethacrylate on the bacterial inhibiting properties of normal human serum.

In vitro evaluation of the effect of known concentrations of methylmethacrylate on the bacterial inhibiting properties of normal human serum has been carried out. In low concentrations, methylmethacrylate was found to abolish almost completely the growth inhibition of Staphylococcus epidermidis by normal human serum. Normal human serum did not have an effect on growth of Staphylococcus aureus. It did inhibit growth of Escherichia coli, but there was no reversal of this effect by methylmethacrylate.

Bacteria

The effect of methylmethacrylate on bacterial phagocytosis and killing by human polymorphonuclear leukocytes.

The phagocytic and bactericidal activities of human polymorphonuclear leukocytes in the presence of methylmethacrylate were determined by in vitro techniques. It was found that methylmethacrylate in concentrations as low as 0.156 per cent significantly decreased the ability of leukocytes to phagocytose and kill strains of Staphylococcus epidermidis, Staphylococcus aureus, and Escherichia coli. The evidence indicates that methylmethacrylate impairs the killing more than the phagocytosis by the leukocytes.

Blood Bactericidal Activity

The effect of methylmethacrylate on complement activity.

The effect of methylmethacrylate on the activity of the complement sequence has been investigated in vitro by standard hemolysis techniques. It was demonstrated that concentrations of methylmethacrylate monomer as low as .25% inhibit the reactions of the complement sequence by 50%. Methylmethacrylate concentrations of 2.5 to 5.0% abolished all complement activity. This effect is on the late-acting components of the complement sequence which are important for chemotaxis of polymorphonuclear leukocytes, immune adherence of bacteria to polymorphonuclear leukocytes, phagocytosos of bacteria by polymorphonuclear leukocytes, and bacteriolysis.

Bacteria

Tobramycin-impregnated methylmethacrylate for mandible reconstruction.

Reconstruction of the mandible to restore continuity following resection is described in four cases using a tobramycin-impregnated methylmethacrylate implant fabricated at the time of surgery. Methylmethacrylate has excellent biocompatibility and strength and has been used in surgery for over 20 years. The technique uses readily available materials and is similar in concept to reconstruction with a metal plate. Potential advantages are: (1) the presence of a potent antibiotic within the implant that is released over a period of months to minimize postoperative infection and (2) the capability of the material to accurately fit any defect, either when used alone or in combination with a plate or rod. Three of the four patients whom we present are doing well; one implant became exposed following postoperative radiotherapy and had to be removed.

Adolescent

Arterial occlusion secondary to methylmethacrylate use.

We are reporting a new complication of the use of methylmethacrylate, namely occlusion of the iliac artery with embolization. We believe that the occlusion is related to trauma to the intima by the heat of polymerization created by methylmethacrylate, with resultant thrombosis. In view of the initial failure of embolectomy alone, we suggest direct attack on the involved artery with prosthetic replacement, and management of the distal embolus by embolectomy with Fogarty catheters.

Embolism

Cardiovascular effects of total hip placement in man. With observations on the effects of methylmethacrylate on the isolated rabbit heart.

The cardiovascular effects of total hip placement were evaluated in 10 surgical patients, aged 55 to 82, while receiving fluroxene-N2O-O2 anesthesia. The anesthetic regimen caused mild cardiovascular depression. The placement of the acrylic cement into the acetabulum and femoral shaft also induced mild cardiovascular depression, but these changes were not significant at p less than 0.05. In one 67-yr-old woman, there were significant reductions of cardiac output and stroke volume 2 min after the insertion of acrylic into the femoral shaft, despite careful replacement of intravascular loss and careful anesthetic management. Methylmethacrylate (1 X 10(-6) to 1 X 10(-4), v/v) was administered to 24 isolated perfused rabbits hearts. These concentrations of methylmetacrylate are of the same order as measurable blood levels in surgical patients. There was a dose-dependent depression of left ventricular dP/dt correlated with a depression of the spontaneous heart rate. When the bradycardia was prevented by electrically pacing the hearts or the administration of atropine, the depressed dP/dt rose to control levels. Reduction in myocardial temperature and heart rate by means of reduction in perfusate temperature of the isolated hearts reduced the myocardial depressant effect of methylmethacrylate.

Aged

Some physical and mechanical factors affecting the simple shear strength of methylmethacrylate.

An investigation of the effect of kneading time on the simple shear strength of cold-cured plain methylmethacrylate bone cement and on the effect of anchor-hole configuration on the load-carrying capabilities of the cement anchor-hole configuration demonstrates that at a strain-rate of 10-3 rad/second, the mean simple shear strength of the cement was 251.65 (plus or minus 3%) for both 30-second and 2-minute kneading times. Increasing the loading rate to 10-1 rad/second increased the simple shear strength of 326.20 kg/cm-2 (plus or minus 2%). The geometric configuration did not significantly affect the maximum shear load-carrying capabilities of the methylmethacrylate.

Acetabulum

Methylmethacrylate as an adjunct in the internal fixation of intertrochanteric fractures of the femur.

Twenty-eight unstable four-part intertrochanteric fractures in 27 elderly patients with severely osteoporotic femurs were treated by means of internal fixation (commonly the 130 or 95 A.O. blade plate) in combination with methylmethacrylate. Of the 28, ten patients with eleven fractures were recalled and reexamined; 12 had died; five were lost to followup (1 1/2-8 1/2 years) at the time of this review but sufficient documentation existed for their inclusion. There were no deep wound infections. We did not encounter any hypotension during surgery or as a result of the methylmethacrylate. One patient developed a pulmonary embolus 5 days postoperation and responded well to anticoagulant therapy. There were three failures; one femoral shaft fracture at the plate end, one nonunion, both requiring total hip replacemens, and the third failure was due to malreduction of fracture and was later revised. Where bone fragments were in contact, union occurred rapidly and the presence of cement did not interfere with bone union in any way. The patients were pain free and began full weight bearing the day after surgery.

Aged

Qualitative alterations of cytochrome P-450 in mouse liver microsomes after administration of acrylamide and methylmethacrylate.

Cytochrome P-450 in mouse liver microsomes was characterized by SDS-polyacrylamide gel electrophoresis after intraperitoneal injection of 80 mg phenobarbital, 4.5 and 45 mg acrylamide and 60 and 600 mg methylmethacrylate per kg body weight each day for four days. Four different forms of cytochrome P-450 with molecular weights of 47,000, 50,000, 54,000 and 56,000 were identified by staining for peroxidase activity and protein. The amount of cytochrome P-450 with a molecular weight of 47,000 (MLvMcP-450(47) decreased in the phenobarbital group and in both acrylamide groups. After methylmethacrylate treatment, this form increased at the low dose but was totally repressed at the high dose. The cytochrome P-450 form with a molecular weight of 50,000 (MLvMcP-450(50) was significantly increased only in the phenobarbital group. An increase in the total amount of cytochrome P-450 was only observed following treatment with phenobarbital.

Acrylamides

Methylmethacrylate as an adjunct in the internal fixation of pathologic fractures.

The authors evaluated methylmethacrylate as an adjunct to internal fixation of 47 pathologic fractures of long bones (10 of the humerus and 37 of the femur) in 43 patients with metastatic disease. In their experience this method proved to be vastly superior to other methods of internal fixation. All patients were relieved of pain and, if able to walk, could do so almost immediately after fixation of the fracture. In the others comfort was enhanced and nursing greatly facilitated. The surgical technique of internal fixation is described in detail. Correct selection of the metal implant, meticulous attention to the biomechanical considerations and restoration of bone continuity by means of methylmethacrylate are most important if a gratifying result is to be obtained.

Adult

Methylmethacrylate: A study of teratogenicity and fetal toxocity of the vapor in the mouse.

To determine possible deleterious effects of methylmethacrylate vapor on mouse gestation, pregnant mice were exposed to average vapor concentrations of 1330 parts per million for two hours twice daily during Day 6 through Day 15 of pregnancy. A slight increase in the average weight of the fetuses of the exposed mothers were demonstrated but no other evidence of fetal toxicity or teratologic effects was found. During three total hip replacements, the concentration of methylmethacrylate in operating-room air never rose above 280 parts per million.

Abnormalities, Drug-Induced