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Trivedi Z, Wychowaniec JK, Gehweiler D, Sprecher CM, Boger A, Gueorguiev B, D’Este M, Ricken T, Röhrle O. Rheological Analysis and Evaluation of Measurement Techniques for Curing Poly(Methyl Methacrylate) Bone Cement in Vertebroplasty. ACS Biomater Sci Eng 2024; 10:4575-4586. [PMID: 38839046 PMCID: PMC11235098 DOI: 10.1021/acsbiomaterials.4c00417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 04/08/2024] [Accepted: 04/09/2024] [Indexed: 06/07/2024]
Abstract
Vertebroplasty is a minimally invasive surgical procedure used to treat vertebral fractures, which conventionally involves injecting poly(methyl methacrylate) (PMMA) bone cement into the fractured vertebra. A common risk associated with vertebroplasty is cement leaking out of the vertebra during the injection, which may occur due to a lack of understanding of the complex flow behavior. Therefore, experiments to quantify the cement's flow properties are necessary for understanding and proper handling of the bone cement. In this study, we aimed to characterize the behavior of PMMA bone cement in its curing stages to obtain parameters that govern the flow behavior during injection. We used rotational and oscillatory rheometry for our measurements, as well as a custom-made injector setup that replicated a typical vertebroplasty setting. Our results showed that the complex viscoelastic behavior of bone cement is significantly affected by deformations and temperature. We found that the results from rotational tests, often used for characterizing the bone cement, are susceptible to measurement artifacts caused by wall slip and "ridge"-like formations in the test sample. We also found the Cox-Merz rule to be conditionally valid, which affects the use of oscillatory tests to obtain the shear-thinning characteristics of bone cement. Our findings identify important differences in the measured flow behavior of PMMA bone cement when assessed by different rheological methods, an understanding that is crucial for its risk-free usage in downstream medical applications.
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Affiliation(s)
- Zubin Trivedi
- Institute
for Modelling and Simulation of Biomechanical Systems, University of Stuttgart, Pfaffenwaldring 5a, 70569 Stuttgart, Germany
- Institute
of Structural Mechanics and Dynamics in Aerospace Engineering, University of Stuttgart, Pfaffenwaldring 27, 70569 Stuttgart, Germany
| | | | - Dominic Gehweiler
- AO
Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland
| | | | - Andreas Boger
- Ansbach
University of Applied Sciences, Residenzstraße 8, 91522 Ansbach, Germany
| | - Boyko Gueorguiev
- AO
Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland
| | - Matteo D’Este
- AO
Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland
| | - Tim Ricken
- Institute
of Structural Mechanics and Dynamics in Aerospace Engineering, University of Stuttgart, Pfaffenwaldring 27, 70569 Stuttgart, Germany
| | - Oliver Röhrle
- Institute
for Modelling and Simulation of Biomechanical Systems, University of Stuttgart, Pfaffenwaldring 5a, 70569 Stuttgart, Germany
- Stuttgart
Center for Simulation Science (SC SimTech), Pfaffenwaldring 5a, 70569 Stuttgart, Germany
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Park SS, Lim H, Lee BT. In vivo evaluation of hyaluronic acid-polyethylene glycol amended PMMA bone cement for orthopaedic application. JOURNAL OF BIOMATERIALS SCIENCE. POLYMER EDITION 2024:1-16. [PMID: 38815001 DOI: 10.1080/09205063.2024.2359789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 05/21/2024] [Indexed: 06/01/2024]
Abstract
The utilization of polymethyl methacrylate (PMMA) bone cement is employed for the purpose of stabilizing fractured vertebral bodies. The existence of a mechanical imbalance in hard polymethylmethacrylate (PMMA) bone cement has the potential to increase the likelihood of a fracture occurring in the neighbouring vertebral body. In order to reduce potential difficulties, the primary goal of this study is to investigate the potential benefits of increasing PMMA bone cement's bioactivity and lowering its elastic modulus. The incorporation of a 10% volume fraction of hyaluronic acid (HyA) and polyethylene glycol (PEG) into the bone cement led to an improvement in the bioactivity and decreasing of elastic modulus of polymethylmethacrylate (PMMA). The integration of HyPE gel phase presents several advantages over pure PMMA bone cement, including enhanced setting parameters, improved degradability, and increased biocompatibility. The gel phase is additionally accountable for a reduction in the elastic modulus of polymethylmethacrylate (PMMA) bone cement. In addition, the existence of a porous structure that arises from the degradation of the HyPE gel phase delivers a significant amount of room, thereby enhancing the process of bone regeneration when implanted in the femur of rabbits. The utilization of HyPE in PMMA has been shown through comprehensive µ-CT analysis to enhance bone formation, thereby promoting osteointegration at the implantation site. Furthermore, the histological analysis demonstrated the existence of osteogenic activity in the PMMA polyethylene glycol supplemented with 10% HyA and 10% PEG after a 2-month period subsequent to implantation.
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Affiliation(s)
- Seong-Su Park
- Department of Regenerative Medicine, College of Medicine, Soonchunhyang University, Cheonan, South Korea
| | - Hansung Lim
- Department of Regenerative Medicine, College of Medicine, Soonchunhyang University, Cheonan, South Korea
| | - Byong-Taek Lee
- Department of Regenerative Medicine, College of Medicine, Soonchunhyang University, Cheonan, South Korea
- Institute of Tissue Regeneration, College of Medicine, Soonchunhyang University, Cheonan, South Korea
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Bai J, Ge G, Wang Q, Li W, Zheng K, Xu Y, Yang H, Pan G, Geng D. Engineering Stem Cell Recruitment and Osteoinduction via Bioadhesive Molecular Mimics to Improve Osteoporotic Bone-Implant Integration. Research (Wash D C) 2022; 2022:9823784. [PMID: 36157511 PMCID: PMC9484833 DOI: 10.34133/2022/9823784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 08/22/2022] [Indexed: 11/14/2022] Open
Abstract
For patients with osteoporosis, the therapeutic outcomes of osteoimplants are substantially affected by the impaired proliferation, migration, and osteogenic differentiation abilities of bone marrow mesenchymal stem cells (BMSCs). To improve bone-implant integration in osteoporotic condition, here we reported a one-step biomimetic surface strategy to introduce BMSC recruiting and osteoinductive abilities onto metallic osteoimplants. In our design, the bioadhesive molecular peptide mimic inspired by mussel foot proteins (Mfps) was used as molecular bridging for surface functionalization. Specifically, a BMSC-targeting peptide sequence (E7) and an osteogenic growth peptide (Y5) were grafted onto the titanium implant surfaces through a mussel adhesion mechanism. We found that a rational E7/Y5 feeding ratio could lead to an optimal dual functionalization capable of not only significantly improving the biocompatibility of the implant but also enabling it to recruit endogenous BMSCs for colonization, proliferation, and osteogenic differentiation. Mechanistically, the E7-assisted in situ recruitment of endogenous BMSCs as well as the enhanced interfacial osteogenesis and osteointegration was associated with activation of the C-X-C chemokine receptor type 4 (CXCR4) receptor on the cell surface and promotion of stromal cell-derived factor (SDF-1α) autocrine secretion. We anticipated that rational dual-functional surfaces through bioadhesive molecular mimics will provide a simple, effective, nonimmunogenic, and safe means to improve the clinical outcomes of intraosseous implants, especially under osteoporotic conditions.
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Affiliation(s)
- Jiaxiang Bai
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, Jiangsu 215006, China
- Institute for Advanced Materials, School of Materials Science and Engineering, Jiangsu University, 301 Xuefu Road, Zhenjiang, Jiangsu 212013, China
| | - Gaoran Ge
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, Jiangsu 215006, China
| | - Qing Wang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, Jiangsu 215006, China
| | - Wenming Li
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, Jiangsu 215006, China
| | - Kai Zheng
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, Jiangsu 215006, China
| | - Yaozeng Xu
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, Jiangsu 215006, China
| | - Huilin Yang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, Jiangsu 215006, China
| | - Guoqing Pan
- Institute for Advanced Materials, School of Materials Science and Engineering, Jiangsu University, 301 Xuefu Road, Zhenjiang, Jiangsu 212013, China
| | - Dechun Geng
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, Jiangsu 215006, China
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Akgül T, Korkmaz M, Pehlivanoglu T, Bayram S, Özdemir MA, Karalar Ş. Biomechanical Comparison of Pull-out Strength of Different Cementation and Pedicle Screw Placement Techniques in a Calf Spine Model. Indian J Orthop 2020; 54:134-140. [PMID: 32952921 PMCID: PMC7474045 DOI: 10.1007/s43465-020-00199-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 07/11/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND We hypothesized that an entire pedicle screw tract cement augmentation has greater strength than traditional techniques. METHOD Twenty-four fresh frozen calf lumbar spines were randomized into three study groups, each having eight vertebrae: (1) screw cemented after vertebroplasty; (2) fenestrated cemented screw; and (3) cementation of the entire pedicle screw tract. For the right side screws, two pedicle screws were inserted in each vertebra with the standard position in the sagittal plane, whereas the left side screws were placed at a 30° angle craniocaudal plane. From the recorded force-displacement curves, the maximum peak load (failure load) of each screw was determined. The mode of failure was screw stripping at all levels tested. RESULTS The pull-out strength for standard screw replacement at the sagittal plane was 1843.3 N, 1707.45 N, and 5365.1 N consecutively. The failure load value in the standard position in the sagittal plane in the cementation of the entire pedicle screw tract group was significantly higher than that in the fenestrated cemented screw group and screw cemented after vertebroplasty (p < 0.001 and p < 0.001, respectively). The standard pedicle screw position in the sagittal plane showed a significant pull-out strength than the others (p < 0.001). CONCLUSION The pull-out strength of the cementation of the entire pedicle screw tract was 2.5 times higher than the others. The pull-out strength of the pedicle screws in malposition obtained the same strength to the standard positions after the augmentation procedure in our study.
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Affiliation(s)
- Turgut Akgül
- Department of Orthopedics and Traumatology, Faculty of Medicine, Istanbul University, Çapa Fatih, Istanbul, 34093 Turkey
| | - Murat Korkmaz
- Department of Orthopedics and Traumatology, Faculty of Medicine, KOÇ University, Istanbul, Turkey
| | - Tuna Pehlivanoglu
- Department of Orthopedics and Traumatology, Emsey Hospital, Istanbul, Turkey
| | - Serkan Bayram
- Department of Orthopedics and Traumatology, Faculty of Medicine, Istanbul University, Çapa Fatih, Istanbul, 34093 Turkey
| | - Mustafa Abdullah Özdemir
- Department of Orthopedics and Traumatology, Faculty of Medicine, Istanbul University, Çapa Fatih, Istanbul, 34093 Turkey
| | - Şahin Karalar
- Department of Orthopedics and Traumatology, Faculty of Medicine, Istanbul University, Çapa Fatih, Istanbul, 34093 Turkey
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Bastidas-Coral AP, Bakker AD, Kleverlaan CJ, Hogervorst JMA, Klein-Nulend J, Forouzanfar T. Polymethyl methacrylate does not adversely affect the osteogenic potential of human adipose stem cells or primary osteoblasts. J Biomed Mater Res B Appl Biomater 2019; 108:1536-1545. [PMID: 31648414 PMCID: PMC7187190 DOI: 10.1002/jbm.b.34501] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 08/11/2019] [Accepted: 09/22/2019] [Indexed: 12/23/2022]
Abstract
Custom-made polymethyl methacrylate (PMMA) bone cement is used to treat cranial bone defects but whether it is cytotoxic is still unsure. Possible PMMA-induced adverse effects in vivo affect mesenchymal stem cells and osteoblasts at the implant site. We aimed to investigate whether PMMA affects osteogenic and osteoclast activation potential of human mesenchymal stem cells and/or osteoblasts. Immediately after polymerization, PMMA was added to cultured human adipose stem cells (hASCs) or human osteoblasts (hOBs). Medium lactate dehydrogenase was measured (day 1), metabolic activity, proliferation, osteogenic and osteoclast-activation marker expression (day 1 and 7), and mineralization (day 14). PMMA did not affect lactate dehydrogenase, KI67 gene expression, or metabolic activity in hASCs and hOBs. PMMA transiently decreased DNA content in hOBs only. PMMA increased COL1 gene expression in hASCs, but decreased RUNX2 in hOBs. PMMA did not affect osteocalcin or alkaline phosphatase (ALP) expression, ALP activity, or mineralization. Only in hOBs, PMMA decreased RANKL/OPG ratio. In conclusion, PMMA is not cytotoxic and does not adversely affect the osteogenic potential of hASCs or hOBs. Moreover, PMMA does not enhance production of osteoclast factors by hASCs and hOBs in vitro. Therefore, PMMA bone cement seems highly suitable to treat patients with cranial bone defects.
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Affiliation(s)
- Angela P Bastidas-Coral
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Astrid D Bakker
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Cornelis J Kleverlaan
- Department of Dental Materials Science, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Jolanda M A Hogervorst
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Jenneke Klein-Nulend
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Tymour Forouzanfar
- Department of Oral and Maxillofacial Surgery/Oral Pathology, Amsterdam University Medical Centers (Amsterdam UMC)-location VUmc/Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam Movement Sciences, Amsterdam, The Netherlands
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Robo C, Hulsart-Billström G, Nilsson M, Persson C. In vivo response to a low-modulus PMMA bone cement in an ovine model. Acta Biomater 2018; 72:362-370. [PMID: 29559365 DOI: 10.1016/j.actbio.2018.03.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 03/03/2018] [Accepted: 03/06/2018] [Indexed: 02/08/2023]
Abstract
Poly(methyl methacrylate) (PMMA) is the most commonly used material for the treatment of osteoporosis-induced vertebral compression fractures. However, its high stiffness may introduce an increased risk of adjacent vertebral fractures post-surgery. One alternative in overcoming this concern is the use of additives. This presents its own challenge in maintaining an adequate biocompatibility when modifying the base cement. The aim of this study was to evaluate the in vivo biocompatibility of linoleic acid (LA)-modified acrylic bone cement using a large animal model for the first time, in order to further advance towards clinical use. A worst-case approach was used, choosing a slow-setting base cement. The in vitro monomer release from the cements was also assessed. Additional material characterization, including mechanical tests, are summarized in Appendix A. Unmodified and LA-modified cements were injected into a total of 56 bone defects created in the femur and humerus of sheep. Histopathologic and histomorphometric analysis indicated that LA-modified cement showed a harmless tissue response similar to that of the unmodified cement. Adjacent bone remodeling was observed microscopically 4 weeks after implantation, suggesting a normal healing process of the bone tissues surrounding the implant. LA-modified cement exhibited lower mechanical properties, with a reduction in the elastic modulus of up to 65%. The handling properties were slightly modified without negatively affecting the injectability of the base cement. LA-modified bone cement showed good biocompatibility as well as bone compliant mechanical properties and may therefore be a promising material for the treatment of osteoporotic vertebral fractures. STATEMENT OF SIGNIFICANCE The benefits of using linoleic acid to reduce the stiffness of poly(methyl methacrylate) bone cement has been demonstrated previously, with the in vitro and in vivo response of the modified cement in small animals reported as comparable to the base cement. However, biocompatibility evaluation of modified cement in large animal models for future clinical use has yet to be performed. In this study, modified and unmodified cements were injected into bone defects created in sheep. We showed that the inflammatory response of the modified cement was similar to the base cement, allowing remodelling of the bone surrounding the implant. This demonstrates the potential of low-modulus PMMA cement in the field of bone augmentation.
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Sa Y, Yang F, Wang Y, Wolke JGC, Jansen JA. Modifications of Poly(Methyl Methacrylate) Cement for Application in Orthopedic Surgery. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1078:119-134. [DOI: 10.1007/978-981-13-0950-2_7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Aghyarian S, Bentley E, Hoang TN, Gindri IM, Kosmopoulos V, Kim HKW, C. Rodrigues D. In Vitro and In Vivo Characterization of Premixed PMMA-CaP Composite Bone Cements. ACS Biomater Sci Eng 2017; 3:2267-2277. [DOI: 10.1021/acsbiomaterials.7b00276] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Shant Aghyarian
- Biomaterials
for Osseointegration and Novel Engineering Laboratory (BONE Lab),
Department of Bioengineering, University of Texas at Dallas, Richardson, Texas 75080, United States
| | - Elizabeth Bentley
- Biomaterials
for Osseointegration and Novel Engineering Laboratory (BONE Lab),
Department of Bioengineering, University of Texas at Dallas, Richardson, Texas 75080, United States
| | - Thao N. Hoang
- Biomaterials
for Osseointegration and Novel Engineering Laboratory (BONE Lab),
Department of Bioengineering, University of Texas at Dallas, Richardson, Texas 75080, United States
| | - Izabelle M. Gindri
- Biomaterials
for Osseointegration and Novel Engineering Laboratory (BONE Lab),
Department of Bioengineering, University of Texas at Dallas, Richardson, Texas 75080, United States
| | - Victor Kosmopoulos
- Department
of Orthopaedic Surgery, University of North Texas Health Science Center (UNTHSC), Fort Worth, Texas 76107, United States
- Department
of Materials Science and Engineering, University of North Texas, Denton, Texas 76203, United States
| | - Harry K. W. Kim
- Center
for Excellence in Hip Disorders, Texas Scottish Rite Hospital for Children, 2222 Welborn Street, Dallas, Texas 75219, United States
- Department
of Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, Texas 75390, United States
| | - Danieli C. Rodrigues
- Biomaterials
for Osseointegration and Novel Engineering Laboratory (BONE Lab),
Department of Bioengineering, University of Texas at Dallas, Richardson, Texas 75080, United States
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