Polymethylmethacrylate-based bone cement modified with hydroxyapatite

Calcium Orthophosphate (CaPO4) Containing Composites for Biomedical Applications: Formulations, Properties, and Applications

The goal of this review is to present a wide range of hybrid formulations and composites containing calcium orthophosphates (abbreviated as CaPO4) that are suitable for use in biomedical applications and currently on the market. The bioactive, biocompatible, and osteoconductive properties of various CaPO4-based formulations make them valuable in the rapidly developing field of biomedical research, both in vitro and in vivo. Due to the brittleness of CaPO4, it is essential to combine the desired osteologic properties of ceramic CaPO4 with those of other compounds to create novel, multifunctional bone graft biomaterials. Consequently, this analysis offers a thorough overview of the hybrid formulations and CaPO4-based composites that are currently known. To do this, a comprehensive search of the literature on the subject was carried out in all significant databases to extract pertinent papers. There have been many formulations found with different material compositions, production methods, structural and bioactive features, and in vitro and in vivo properties. When these formulations contain additional biofunctional ingredients, such as drugs, proteins, enzymes, or antibacterial agents, they offer improved biomedical applications. Moreover, a lot of these formulations allow cell loading and promote the development of smart formulations based on CaPO4. This evaluation also discusses basic problems and scientific difficulties that call for more investigation and advancements. It also indicates perspectives for the future.

Bioactive hybrid membrane-based cellulose acetate/bioactive glass/hydroxyapatite/carbon nanotubes nanocomposite for dental applications

The present work aimed to fabricate a set of hybrid bioactive membrane in the form of bio-nanocomposite films for dental applications using the casting dissolution procedures. The formulation of the targeted materials was consisting of cellulose acetate/bioactive glass/hydroxyapatite/carbon nanotubes with a general abbreviation CA-HAP-BG-SWCNTs. The nanocomposites were characterized using XRD, FTIR, SEM-EDX and Raman spectroscopy. XRD, FTIR and SEM characters confirm the nanocomposites formation with good compatibility. The fabricated materials had a semi crystalline structure. The mechanical and thermal properties, as well as contact angle and bioactivity of the fabricated nanocomposites were investigated. The SEM images for showed beehive-like architectures with a thicker frame for the second material. All fabricated materials showed good thermal behaviors. Furthermore, the agar diffusion antimicrobial study showed that the prepared nanocomposites do not exhibit an antibacterial activity against five pathogenic bacterial strains. Additionally, cytotoxicity of a dental nanocomposite filling agent was evaluated. Vero normal cells were incubated with test materials for 72h at 37 °C and 5% CO₂. Cell viability was detected using a SRB assay. All nanocomposites were mildly to non-cytotoxic to Vero cells at high concentration in contrast to the inhibitory effect of doxorubicin which was added at 10-fold lower concertation than the nanocomposites. Hence, the proposed nanocomposite is promising candidates for dental applications.

Fabrication and characterization of a bioactive polymethylmethacrylate-based porous cement loaded with strontium/calcium apatite nanoparticles

Polymethylmethacrylate (PMMA)-based cements are used for bone reparation due to their biocompatibility, suitable mechanical properties, and mouldability. However, these materials suffer from high exothermic polymerization and poor bioactivity, which can cause the formation of fibrous tissue around the implant and aseptic loosening. Herein, we tackled these problems by adding Sr²⁺ -substituted hydroxyapatite nanoparticles (NPs) and a porogenic compound to the formulations, thus creating a microenvironment suitable for the proliferation of osteoblasts. The NPs resembled the structure of the bone's apatite and enabled the controlled release of Sr²⁺ . Trends in the X-ray patterns and infrared spectra confirmed that Sr²⁺ replaced Ca²⁺ in the whole composition range of the NPs. The inclusion of an effervescent additive reduced the polymerization temperature and lead to the formation of highly porous cement exhibiting mechanical properties comparable to the trabecular bone. The formation of an opened and interconnected matrix allowed osteoblasts to penetrate the cement structure. Most importantly, the gas formation confined the NPs at the surface of the pores, guaranteeing the controlled delivery of Sr²⁺ within a concentration sufficient to maintain osteoblast viability. Additionally, the cement was able to form apatite when immersed into simulated body fluids, further increasing its bioactivity. Therefore, we offer a formulation of PMMA cement with improved in vitro performance supported by enhanced bioactivity, increased osteoblast viability and deposition of mineralized matrix assigned to the loading with Sr²⁺ -substituted hydroxyapatite NPs and the creation of an interconnected porous structure. Altogether, our results hold promise for enhanced bone reparation guided by PMMA cements.

PMMA Bone Cements Modified with Silane-Treated and PMMA-Grafted Hydroxyapatite Nanocrystals: Preparation and Characterization

In this study, vinyltrimethoxysilane-treated hydroxyapatite (vHAP) and PMMA-grafted HAP (gHAP) were successfully prepared from original HAP (oHAP). Three kinds of HAP (oHAP, vHAP and g HAP) were used as additives for the preparation of three groups of HAP-modified PMMA bone cements (oHAP-BC, vHAP-BC and gHAP-BC). The setting, bending and compression properties of the bone cements were conducted according to ISO 5833:2002. The obtained results showed that the maximum temperature while curing the HAP-modified bone cements (HAP-BCs) decreased from 64.9 to 60.8 °C and the setting time increased from 8.1 to 14.0 min, respectively, with increasing HAP loading from 0 to 15 wt.%. The vHAP-BC and gHAP-BC groups exhibited higher mechanical properties than the required values in ISO 5833. Electron microscopy images showed that the vHAP and gHAP nanoparticles were dispersed better in the polymerized PMMA matrix than the oHAP nanoparticles. FTIR analysis indicated the polar interaction between the PO₄ groups of the HAP nanoparticles and the ester groups of the polymerized PMMA matrix. Thermal gravimetric analysis indicated that mixtures of ZrO₂/HAPs were not able to significantly improve the thermal stability of the HAP-BCs. DSC diagrams showed that the incorporation of gHAP to PMMA bone cement with loadings lower than 10 wt.% can increase T_g by about 2.4 °C.

Cytocompatibility of Polymethyl Methacrylate Honeycomb-like Pattern on Perfluorinated Polymer

In this study, we present a simple approach for developing a biocompatible polymer scaffold with a honeycomb-like micropattern. We aimed to combine a plasma treatment of fluorinated ethylene propylene (FEP) substrate with an improved phase separation technique. The plasma exposure served for modification of the polymer surface properties, such as roughness, surface chemistry, and wettability. The treated FEP substrate was applied for the growth of a honeycomb-like pattern from a solution of polymethyl methacrylate (PMMA). The properties of the pattern were strongly dependent on the conditions of plasma exposure of the FEP substrate. The physico-chemical properties of the prepared pattern, such as changes in wettability, aging, morphology, and surface chemistry, were determined. Further, we have examined the cellular response of human osteoblasts (U-2 OS) on the modified substrates. The micropattern prepared with a selected combination of surface activation and amount of PMMA for honeycomb construction showed a positive effect on U-2 OS cell adhesion and proliferation. Samples with higher PMMA content (3 and 4 g) formed more periodic hexagonal structures on the surface compared to its lower amount (1 and 2 g), which led to a significant increase in the pattern cytocompatibility compared to pristine or plasma-treated FEP.

Investigation on the Influences of Hygrothermal Aging on the Indentation Size Effects and Micro-Indentation Measurements of PMMA. Part I: Experimental Results

The polymethyl methacrylate (PMMA) subjected to hygrothermal aging was applied to nanoindentation tests under different indentation strain rates. The influences of hygrothermal aging on the indentation behaviors of PMMA are discussed. Results show that the indentation elastic modulus and hardness decrease with increasing aging time. Furthermore, the indentation size effects (ISE) can be observed in aged PMMA specimens as they are sensitive to aging time as well as to the indentation strain rate. The quantitative analysis of ISE is proposed on the basis of shear transformation-mediated plasticity and was presented in our companion paper.

Mineralized collagen-modified PMMA cement enhances bone integration and reduces fibrous encapsulation in the treatment of lumbar degenerative disc disease

As a minimally invasive surgery, percutaneous cement discoplasty (PCD) is now contemplated to treat lumbar disc degeneration disease in elder population. Here, we investigated whether the osteogenic mineralized collagen (MC) modified polymethylmethacrylate (PMMA) cement could be a suitable material in PCD surgery. Injectability, hydrophilicity and mechanical properties of the MC-modified PMMA (PMMA-MC) was characterized. The introduction of MC did not change the application and setting time of PMMA and was easy to be handled in minimally invasive operation. Hydrophilicity of PMMA-MC was greatly improved and its elastic modulus was tailored to complement mechanical performance of bone under dynamic stress. Then, PCD surgery in a goat model with induced disc degeneration was performed with implantation of PMMA-MC or PMMA. Three months after implantation, micro-computed tomography analysis revealed a 36.4% higher circumferential contact index between PMMA-MC and bone, as compared to PMMA alone. Histological staining confirmed that the surface of PMMA-MC was in direct contact with new bone, while the PMMA was covered by fibrous tissue. The observed gathering of macrophages around the implant was suspected to be the cause of fibrous encapsulation. Therefore, the interactions of PMMA and PMMA-MC with macrophages were investigated in vitro. We discovered that the addition of MC could hinder the proliferation and fusion of the macrophages. Moreover, expressions of fibroblast-stimulating growth factors, insulin-like growth factor, basic fibroblast growth factor and tumor necrosis factor-β were significantly down-regulated in the macrophages cocultured with PMMA-MC. Together, the promoted osteointegration and reduced fibrous tissue formation observed with PMMA-MC material makes it a promising candidate for PCD surgery.

Surface degradation-enabled osseointegrative, angiogenic and antiinfective properties of magnesium-modified acrylic bone cement

Objective

This work focuses on tackling the inadequate bone/implant interface strength of acrylic bone cements, which is a formidable problem diminishing their clinical performance, especially in percutaneous kyphoplasty surgery.

Methods

A new strategy of incorporating magnesium particles into clinically used poly(methylmethacrylate) (PMMA) bone cement to prepare a surface-degradable bone cement (SdBC) is proposed and validated both in vitro and in vivo.

Results

This surface degradation characteristic enables osseointegrative, angiogenic and antiinfective properties. SdBC showed fast surface degradation and formed porous surfaces as designed, while the desirable high compressive strengths (≥70 MPa) of the cement were preserved. Besides, the SdBC with proper Mg content promoted osteoblast adhesion, spreading, proliferation and endothelial cell angiogenesis capacity compared with PMMA. Also, SdBC demonstrated clear inhibitory effect on Staphylococcus aureus and Escherichia coli. In vivo evaluation on SdBC by the rat femur defect model showed that the bone/implant interface strength was significantly enhanced in SdBC (push-out force of 11.8 ± 1.5 N for SdBC vs 7.0 ± 2.3N for PMMA), suggesting significantly improved osseointegration and bone growth induced by the surface degradation of the cement. The injectability, setting times and compressive strengths of SdBC with proper content of Mg particles (2.8 wt% and 5.4 wt%) were comparable with those of the clinical acrylic bone cement, while the heat release during polymerization was reduced (maximum temperature 78 ± 1 °C for PMMA vs 73.3 ± 1.5 °C for SdBC).

Conclusions

This work validates a new concept of designing bioactive bone/implant interface in PMMA bone cement. And this surface-degradable bone cement possesses great potential for minimally invasive orthopaedic surgeries such as percutaneous kyphoplasty.

The translational potential of this article

This work reports PMMA/Mg surface-degradable acrylic bone cements that possess enhanced osseointegrative, angiogenic and antiinfective properties that are lacking in the clinically used acrylic bone cements. This new kind of bone cements could improve the treatment outcome of many orthopaedic surgeries such as percutaneous kyphoplasty and arthroplasty.

Injectable TEMPO-oxidized nanofibrillated cellulose/biphasic calcium phosphate hydrogel for bone regeneration

Nanofibrillated cellulose, obtained from rice straw agricultural wastes was used as a substrate for the preparation of a new injectable and mineralized hydrogel for bone regeneration. Tetramethyl pyridine oxyl (TEMPO) oxidized nanofibrillated cellulose, was mineralized through the incorporation of a prepared and characterized biphasic calcium phosphate at a fixed ratio of 50 wt%. The TEMPO-oxidized rice straw nanofibrillated cellulose was characterized using transmission electron microscopy, Fourier transform infrared, and carboxylic content determination. The injectability and viscosity of the prepared hydrogel were evaluated using universal testing machine and rheometer testing, respectively. Cytotoxicity and alkaline phosphatase level tests on osteoblast like-cells for in vitro assessment of the biocompatibility were investigated. Results revealed that the isolated rice straw nanofibrillated cellulose is a nanocomposite of the cellulose nanofibers and silica nanoparticles. Rheological properties of the tested materials are suitable for use as injectable material and of nontoxic effect on osteoblast-like cells, as revealed by the positive alkaline phosphate assay. However, nanofibrillated cellulose/ biphasic calcium phosphate hydrogel showed higher cytotoxicity and lower bioactivity test results when compared to that of nanofibrillated cellulose.

Hydroxyapatite Microspheres as an Additive to Enhance Radiopacity, Biocompatibility, and Osteoconductivity of Poly(methyl methacrylate) Bone Cement

This study demonstrates the utility of hydroxyapatite (HA) microspheres as an additive to enhance the radiopaque properties, biocompatibility, and osteoconductivity of poly(methyl methacrylate) (PMMA)-based bone cements. HA microspheres were synthesized using spray drying. They had well-defined spherical shapes, thus allowing for the production of PMMA/HA composites with a very high HA content (20 vol % and 40 vol %). The uniform distribution of these HA microspheres in the PMMA matrix resulted in a remarkable increase in compressive modulus (p < 0.05), while preserving a reasonably high compressive strength. The PMMA/HA bone cements showed much higher radiopacity than PMMA containing BaSO₄ as the additive. This was attributed to the high HA content up to 40 vol %. In addition, the biocompatibility and osteoconductivity of PMMA/HA bone cements were significantly enhanced compared to those of PMMA bone cements containing BaSO₄, which were assessed using in vitro tests and in vivo animal experiments.

Photocurable bioactive bone cement based on hydroxyethyl methacrylate-poly(acrylic/maleic) acid resin and mesoporous sol gel-derived bioactive glass

This paper reports on strong and bioactive bone cement based on ternary bioactive SiO2-CaO-P2O5 glass particles and a photocurable resin comprising hydroxyethyl methacrylate (HEMA) and poly(acrylic/maleic) acid. The as-cured composite represented a compressive strength of about 95 MPa but it weakened during soaking in simulated body fluid, SBF, qua its compressive strength reached to about 20 MPa after immersing for 30 days. Biodegradability of the composite was confirmed by reducing its initial weight (~32%) as well as decreasing the molecular weight of early cured resin during the soaking procedure. The composite exhibited in vitro calcium phosphate precipitation in the form of nanosized carbonated hydroxyapatite, which indicates its bone bonding ability. Proliferation of calvarium-derived newborn rat osteoblasts seeded on top of the composite was observed during incubation at 37 °C, meanwhile, an adequate cell supporting ability was found. Consequently, it seems that the produced composite is an appropriate alternative for bone defect injuries, because of its good cell responses, high compressive strength and ongoing biodegradability, though more in vivo experiments are essential to confirm this assumption.

Osteoblast biocompatibility of premineralized, hexamethylene-1,6-diaminocarboxysulfonate crosslinked chitosan fibers

Biopolymer-ceramic composites are thought to be particularly promising materials for bone tissue engineering as they more closely mimic natural bone. Here, we demonstrate the fabrication by electrospinning of fibrous chitosan-hydroxyapatite composite scaffolds with low (1 wt %) and high (10 wt %) mineral contents. Scanning electron microscopy (FESEM), energy dispersive spectroscopy (EDS) and unidirectional tensile testing were performed to determine fiber surface morphology, elemental composition, and tensile Young's modulus (E) and ultimate tensile strength (σUTS ), respectively. EDS scans of the scaffolds indicated that the fibers, crosslinked with either hexamethylene-1,6-diaminocarboxysulfonate (HDACS) or genipin, have a crystalline hydroxyapatite mineral content at 10 wt % additive. Moreover, FESEM micrographs showed that all electrospun fibers have diameters (122-249 nm), which fall within the range of those of fibrous collagen found in the extracellular matrix of bone. Young's modulus and ultimate tensile strength of the various crosslinked composite compositions were in the range of 116-329 MPa and 2-15 MPa, respectively. Osteocytes seeded onto the mineralized fibers were able to demonstrate good biocompatibility enhancing the potential use for this material in future bone tissue engineering applications.

Calcium Orthophosphate-Containing Biocomposites and Hybrid Biomaterials for Biomedical Applications

The state-of-the-art on calcium orthophosphate (CaPO4)-containing biocomposites and hybrid biomaterials suitable for biomedical applications is presented. Since these types of biomaterials offer many significant and exciting possibilities for hard tissue regeneration, this subject belongs to a rapidly expanding area of biomedical research. Through the successful combinations of the desired properties of matrix materials with those of fillers (in such systems, CaPO4 might play either role), innovative bone graft biomaterials can be designed. Various types of CaPO4-based biocomposites and hybrid biomaterials those are either already in use or being investigated for biomedical applications are extensively discussed. Many different formulations in terms of the material constituents, fabrication technologies, structural and bioactive properties, as well as both in vitro and in vivo characteristics have been already proposed. Among the others, the nano-structurally controlled biocomposites, those containing nanodimensional compounds, biomimetically fabricated formulations with collagen, chitin and/or gelatin, as well as various functionally graded structures seem to be the most promising candidates for clinical applications. The specific advantages of using CaPO4-based biocomposites and hybrid biomaterials in the selected applications are highlighted. As the way from a laboratory to a hospital is a long one and the prospective biomedical candidates have to meet many different necessities, the critical issues and scientific challenges that require further research and development are also examined.

Assessment of injectable and cohesive nanohydroxyapatite composites for biological functions

Pressing need for utilization of injectables/fillers in various forms of orthopaedic treatments/surgeries commands an equal demand for better graft material. Injectable bone graft material based on biomimetically synthesized nanohydroxyapatite was developed and subjected to ball milling for different times; three materials thus produced were evaluated for their biological properties. The three composites tested were found to have some difference in proliferation and differentiation on mesenchymal stem cells in cultures. In vivo studies were performed by implanting the graft materials with or without cells in the bone drill hole injury created in the femur of Wistar rats. Our studies show that the composites lead to well-healed injury site with normal histology without inflammation or fibrous tissue formation and bone deformity. This material needs to be tested on large animals for further ascertaining its applicability in clinical use.

Improved osteoblast response to UV-irradiated PMMA/TiO2 nanocomposites with controllable wettability

Osteoblast response was evaluated with polymethylmethacrylate (PMMA)/titanium dioxide (TiO2) nanocomposite thin films that exhibit the controllable wettability with ultraviolet (UV) treatment. In this study, three samples of PMMA/TiO2 were fabricated with three different compositional volume ratios (i.e., 25/75, 50/50, and 75/25) followed by UV treatment for 0, 4, and 8 h. All samples showed the increased hydrophilicity after UV irradiation. The films fabricated with the greater amount of TiO2 and treated with the longer UV irradiation time increased the hydrophilicity more. The partial elimination of PMMA on the surface after UV irradiation created a durable hydrophilic surface by (1) exposing higher amount of TiO2 on the surface, (2) increasing the hydroxyl groups on the TiO2 surface, and (3) producing a mesoporous structure that helps to hold the water molecules on the surface longer. The partial elimination of PMMA on the surface was confirmed by Fourier transform infrared spectroscopy. Surface profiler and atomic force microscopy demonstrated the increased surface roughness after UV irradiation. Both scanning electron microscopy and energy-dispersive X-ray spectroscopy demonstrated that particles containing calcium and phosphate elements appeared on the 8 h UV-treated surface of PMMA/TiO2 25/75 samples after 4 days soaking in Dulbecco's Modified Eagle Medium. UV treatment showed the osteoblast adhesion improved on all the surfaces. While all UV-treated hydrophilic samples demonstrated the improvement of osteoblast cell adhesion, the PMMA/TiO2 25/75 sample after 8 h UV irradiation (n = 5, P value = 0.000) represented the best cellular response as compared to other samples. UV-treated PMMA/TiO2 nanocomposite thin films with controllable surface properties represent a high potential for the biomaterials used in both orthopedic and dental applications.

Study of the viability and adhesion of osteoblast cells to bone cements mixed with hydroxyapatite at different concentrations to use in vertebral augmentation techniques

OBJECTIVE

The purpose of this study is to compare the biocompatibility and the effect in osteoblasts of polymethyl methacrylate alone, and mixed with hydroxyapatite in different concentrations of 5, 10, 15 and 20%, without exceeding 20%, as it can alter mechanical properties of the composite.

MATERIAL AND METHODS

Experimental study comparing osteoblast response to Polymethyl methacrylate alone and with hydroxyapatite in different concentrations.

RESULTS

Composites at 15 and 20% obtained better osteoblast response, with higher osteoblastic activity markers, and lower apoptosis markers. Electron microscopy images show improved adhesion of osteoblasts.

Novel injectable biomaterials for bone augmentation based on isosorbide dimethacrylic monomers

Drawbacks with the commonly used PMMA-based bone cements, such as an excessive elastic modulus and potentially toxic residual monomer content, motivate the development of alternative cements. In this work an attempt to prepare an injectable biomaterial based on isosorbide-alicyclic diol derived from renewable resources was presented. Two novel dimethacrylic monomers ISDGMA - 2,5-bis(2-hydroxy-3-methacryloyloxypropoxy)-1,4:3,6-dianhydro-sorbitol and ISETDMA - dimethacrylate of ethoxylated isosorbide were synthesized and used to prepare a series of low-viscosity compositions comprising bioactive nano-sized hydroxyapatite in the form of a two-paste system. Formulations exhibited a non-Newtonian shear-thinning behavior, setting times between 2.6 min and 5.3 min at 37°C and maximum curing temperatures of 65°C. Due to the hydrophilic nature of ISDGMA, cured compositions could absorb up to 13.6% water and as a result the Young's modulus decreased from 1,429 MPa down to 470 MPa. Both, poly(ISDGMA) and poly(ISETDMA) were subjected to a MTT study on mice fibroblasts (BALB/3T3) and gave relative cell viabilities above 70% of control. A selected model bone cement was additionally investigated using human osteosarcoma cells (SaOS-2) in an MTS test, which exhibited concentration-dependent cell viability. The preliminary results, presented in this work reveal the potential of two novel dimethacrylic monomers in the preparation of an injectable biomaterial for bone augmentation, which could overcome some of the drawbacks typical for conventional acrylic bone cement.

Properties and osteoblast cytocompatibility of self-curing acrylic cements modified by glass fillers

Materials filled with a silicate glass (MSi) and a borate glass (MB) were developed and compared in terms of their in vitro behavior. The effect of filler composition and concentration (0, 30, 40 and 50 wt%) on the curing parameters, residual monomer, water uptake, weight loss, bioactivity, mechanical properties (bending and compression) and osteoblast cytocompatibility was evaluated. The addition of bioactive glass filler significantly improved the cements curing parameters and the mechanical properties. The most relevant results were obtained for the lower filler concentration (30 t%) a maximum flexural strength of 40.4 Pa for MB3 and a maximum compressive strength of 95.7 MPa for MSi3. In vitro bioactivity in acellular media was enhanced by the higher glass contents in the cements. Regarding the biological assessment, the incorporation of the silicate glass significantly improved osteoblast cytocompatibility, whereas the presence of the borate glass resulted in a poor cell response. Nevertheless it was shown that the surviving cells on the MB surface were in a more differentiated stage compared to those growing over non-filled poly(methyl methacrylate). Results suggest that the developed formulations offer a high range of properties that might be interesting for their use as self-curing cements.

Bulk properties and bioactivity assessment of porous polymethylmethacrylate cement loaded with calcium phosphates under simulated physiological conditions

Polymethylmethacrylate (PMMA) cements are widely used in spinal surgery. Nevertheless, these types of cements present some documented drawbacks. Therefore, efforts have been made to improve the properties and biological performance of solid PMMA. A porous structure would seem to be advantageous for anchoring purposes. This work studied the bulk physicochemical, mechanical and interconnectivity properties of porous PMMA cements loaded with various amounts of calcium phosphate (CaP). As a measure of bioactivity, changes of PMMA cements under simulated physiological conditions were studied in a calcium phosphate solution for 0, 3, 7, 14, 21 and 28 days. Scanning electron microscopy (SEM), X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), micro-computed tomography (μ-CT) and mechanical compression tests were performed to characterize the morphology, crystallographic and chemical composition, interconnectivity and mechanical properties, respectively. SEM allowed observing the result of loading CaP into the porous PMMA, which was corroborated by XRD, FTIR and μ-CT. No interference of the CaP with the PMMA was detected. μ-CT described similar interconnectivity and pore distribution for all CaP percentages. Mechanical properties were not significantly altered by the CaP percentages or the immersion time. Hence, porous PMMA was effectively loaded with CaP, which provided the material with properties for potential osteoconductivity.

Enhanced osteoblast responses to poly(methyl methacrylate)/hydroxyapatite electrospun nanocomposites for bone tissue engineering

Hydroxyapatite (HA)-containing polymers have been proposed for improving the biological properties of bone cements. Poly(methyl methacrylate) (PMMA) has long been used to secure orthopedic implants to skeletal bones. The aim of this study was to determine whether the incorporation of HA nanoparticles into the PMMA nanofibrous scaffolds enhances the biological functions of osteoblasts. The number of osteoblasts adhered and proliferated on the PMMA/HA nanofibrous scaffolds was significantly larger than that on the PMMA alone. The cytoskeletal organization and alkaline phosphatase (ALP) activity of the osteoblasts on the PMMA/HA nanofibrous scaffolds were clearly higher than that on the PMMA control. The amount of calcium ions released from 20 wt% HA-containing PMMA nanofibrous scaffolds (PMMA/HA20) was much higher than that released from 10 wt% HA-containing PMMA nanofibrous scaffolds (PMMA/HA10) (HA, 10 wt%). These findings suggested that osteoblast differentiation was accelerated by the incorporation of HA into the PMMA nanofibrous scaffolds. Therefore, the incorporation of HA into the PMMA nanofibrous scaffolds could be a useful method. This can be used for providing PMMA scaffolds with enhanced osteogenic properties.

Starch and its Derived Products: Biotechnological and Biomedical Applications

Starches are one of the most abundant renewable natural resources available to us, however their potential as a biomass feedstock for the production of a vast range of commercially viable chemicals/components for application in many areas of industrial, food and biomedical sciences is currently under-exploited. This review begins by presenting an overview of starch sources, composition and structure, and physicochemical characteristics. Specific topics discussed include amylose and amylopectin structure, their location in the amorphous and crystalline regions of starch granules, granule morphology, gelatinisation and pasting characteristics. The remainder of the review then focuses upon the biotechnological production of starch hydrolysis products, such as maltodextrins, glucose and fructose syrups, and cyclodextrins, and the chemical modification of starch, namely, oxidation, stabilisation (esterification and etherification), and cross-linking. Finally some specific examples of the development of starch-derived biomaterials for application in areas such as orthopaedics, bone cements, tissue engineering, and hydrogels are presented.

Biocomposites and hybrid biomaterials based on calcium orthophosphates

The state-of-the-art of biocomposites and hybrid biomaterials based on calcium orthophosphates that are suitable for biomedical applications is presented in this review. Since these types of biomaterials offer many significant and exciting possibilities for hard tissue regeneration, this subject belongs to a rapidly expanding area of biomedical research. Through successful combinations of the desired properties of matrix materials with those of fillers (in such systems, calcium orthophosphates might play either role), innovative bone graft biomaterials can be designed. Various types of biocomposites and hybrid biomaterials based on calcium orthophosphates, either those already in use or being investigated for biomedical applications, are extensively discussed. Many different formulations, in terms of the material constituents, fabrication technologies, structural and bioactive properties as well as both in vitro and in vivo characteristics, have already been proposed. Among the others, the nanostructurally controlled biocomposites, those containing nanodimensional compounds, biomimetically fabricated formulations with collagen, chitin and/or gelatin as well as various functionally graded structures seem to be the most promising candidates for clinical applications. The specific advantages of using biocomposites and hybrid biomaterials based on calcium orthophosphates in the selected applications are highlighted. As the way from the laboratory to the hospital is a long one, and the prospective biomedical candidates have to meet many different necessities, this review also examines the critical issues and scientific challenges that require further research and development.

Mechanical performance and in vivo tests of an acrylic bone cement filled with bioactive sepia officinalis cuttlebone

To promote osteointegration, bioactive cuttlebone particles containing collagen were used to fill an acrylic cement, varying filler concentration (0-50 wt%). Cuttlebone was characterized by X-ray diffraction, plasma atomic emission and FT-IR. Mechanical properties of the filled cement were determined following ASTM procedures, included stress-strain, compression, bending, and fracture toughness tests. For in vivo tests, three groups of seven adult healthy rabbits were prepared to make an implant in the parietal bone of each one. For such groups (I-III), the amount of filler in the cement was 0, 10 and 30 wt%, respectively. Mechanical results for the composites complied with norm requirements. However, as mechanical performance for composite with 50 wt% of filler decreased significantly, for the in vivo tests, such composite was excluded. In vivo tests showed that three implants of group I were loosely attached to the parietal bone, whereas all the implants made with cement containing cuttlebone particles (groups II and III) were firmly attached to the parietal bone, indicating osteointegration. These results clearly show the potential of this type of bioactive filler to be used for medical applications.

How do porosity-inducing techniques affect antibiotic elution from bone cement? An in vitro comparison between hydrogen peroxide and a mechanical mixer

Background

Increasing the porosity of an antibiotic-loaded cement spacer increases the antibiotic elution, but the correlation between porosity and antibiotic elution is not well documented. The purposes of this study was to attempt new porosity-increasing methods and to investigate the correlation between antibiotic elution and both total and surface porosity.

Materials and methods

Five types of antibiotic-loaded bone cement (ALBC) using 2 g cefazolin and 40 g cement were prepared. Other than manual mixing, hydrogen peroxide was used as a foaming agent and a mixing drill piece was used as a mechanical device to try to induce porosity when mixing the cement. Elution of antibiotic into phosphate-buffered saline was measured from 1 h to 1 week. Surface porosity was calculated from density values which were measured with a density kit and an electronic balance, while total porosity was quantified using micro-computed tomography.

Results

When a mixing drill piece was used to induce porosity, we observed a significant increasin antibiotic elution compared to a manually mixed ALBC. On the other hand, hydrogen peroxide reduced the elution significantly. Mild correlation between the total amount of cluted in 1 week antibiotic elution and total porosity was observed.

Conclusions

In terms of improving elution, the mixing drill piece seemed to be efficient. A relationship between surface porosity and elution efficacy was not observed.

A 12 month in vivo study on the response of bone to a hydroxyapatite–polymethylmethacrylate cranioplasty composite

We investigated the osteoconductivity and biocompatibility in vivo of a new hydroxyapatite-polymethylmethacrylate (HA-PMMA) composite developed for use as an implant material for cranioplasty, which is expected to have the good osteoconductivity of HA together with the strength and ease of handling of PMMA. The HA-PMMA composites were implanted in eight full-grown beagles and then 6, 12, 24 weeks and 1 year after implantation, the animals were sacrificed and the implanted materials removed along with the surrounding tissues. Extirpated specimens were studied using an optical microscope and micro-computed tomography (micro-CT). Fibrous connective tissue was prominent in the interface of the composite at 6 weeks. New bone formation was seen around the implant, 12 and 24 weeks after operation. At 1 year, new bone filled in the interface of the HA-PMMA composite and adhered to the surrounding autogenous bone. Mixing HA and PMMA did not interfere with the osteoconductivity of the HA component. In micro-CT findings, the new bone growing on the HA-PMMA composite could be seen attaching preferentially to HA particles exposed at the composite surface, rather than the PMMA. This study demonstrated that this HA-PMMA composite is a good candidate for cranial bone implants due to its good osteoconductivity and biocompatibility.

Synthesis and characterisation of core–shell structures for orthopaedic surgery

This paperwork deals with the obtaining and characterisation of new acrylic cements for bone surgery. The final mixture of cement contains derivatives of methacryloyloxyethyl phosphate, methacrylic acid or 2-acrylamido-2-methyl-1-propane sulphonic acid. The idea of using these monomers is sustained by their ability to form ionic bonds with barium, which is responsible for X-ray reflection and by the biocompatibility of these structures. The strategy consists in the obtaining of core-shell structures through heterogeneous polymerisation, which are used for final cement's manufacture. The orthopaedic cements were characterised by SEM, EDX, compression resistance and cytotoxicity assays.

Wollastonite-Poly(Ethylmethacrylate-Co-Vinylpyrrolydone) Nanostructured Materials: Mechanical Properties and Biocompatibility

Synthetic pseudowollastonite (psW) and a nanostructured copolymer made of a biostable component, Poly(ethylmethacrylate) (PEMA) and a bioresorbable component, vinylpyrrolidone (VP) are used in this work for the preparation of a new family of bone substitutes that allow osseointegration and mechanical stability. Composites are prepared by bulk polymerization of the desired composition in 15 mm diameter cylindrical plastic moulds. Polymerization was induced thermally at 50°C using 1wt% azobis(isobutyronitrile) (AIBN) as free-radical initiator. The moulds were filled to a height of 100 mm and 1 mm height discs were cut with a diamond saw. Specimens with a ceramic/polymer ratio 58/42, 33/67,17/83 and 0/100 were obtained. Compression stress in the range 39-59 MPa and elastic modulus between 2.64 and 4.14 GPa are obtained where the greater values correspond to the specimens prepared with a 60% ceramic load. Degradation in SBF produces a porous nanostructure in the polymeric component indicating microdomains of different solubility and the formation of an apatite-like layer on the surface of the wollastonite component. All the compositions assayed present a biocompatibility at least of the level or even superior than the Thermanox® control used.

Poly(2-hydroxyethyl methacrylate) biomimetic coating to improve osseointegration of a PMMA/HA/glass composite implant: in vivo mechanical and histomorphometric assessments

Bone implants must simultaneously satisfy many requirements, even though the surface properties remain a crucial aspect in osseointegration success. Since a single material with a uniform structure cannot satisfy all of these requirements, composite materials specifically designed for orthopedic or dental implant application should be envisaged. Two poly(methylmethacrylate)/hydroxyapatite composites reinforced by E-glass fibres, uncoated (PMMA/HA/Glass) and poly(2-hydroxyethyl methacrylate) (PMMA/HA/Glass+pHEMA) coated by the biomimetic method, were mechanically (push-out test) and histomorphometrically (Affinity Index, AI) investigated in an in vivo rabbit model. Cylindrical implants (diameter 2 mm x 5 mm length) were inserted into rabbit femoral cortical (mid-diaphysis) and cancellous (distal epiphysis) bone, under general anesthesia. The highest values of push-out force and ultimate shear strength were observed for the PMMA/HA/Glass at 12 weeks, which significantly (p < 0.001) differed from those of PMMA/HA/Glass+pHEMA at the same experimental time and from those of PMMA/HA/Glass at 4 weeks. At both experimental times, significantly (p < 0.0005) lower values of AI were observed in the PMMA/HA/Glass+pHEMA versus PMMA/HA/Glass (distal femoral epiphysis: 4 weeks = 33%; 12 weeks = 19%; femoral diaphysis: 4 weeks = 15%; 12 weeks = 11%). The good mechanical and histomorphometric results obtained with PMMA/HA/Glass should be followed by further evaluation of bone remodeling processes and mechanical strength around loaded PMMA/HA/Glass implants at longer experimental times. Finally, the biomimetic method applied to pHEMA needs to be further investigated in order to improve the positive effect of SBF on pHEMA and to enhance the coating adhesion.