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Hasandoost L, Alhalawani A, Rodriguez O, Rahimnejad Yazdi A, Zalzal P, Schemitsch EH, Waldman SD, Papini M, Towler MR. Calcium sulfate-containing glass polyalkenoate cement for revision total knee arthroplasty fixation. J Biomed Mater Res B Appl Biomater 2020; 108:3356-3369. [PMID: 32548909 DOI: 10.1002/jbm.b.34671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 04/18/2020] [Accepted: 06/03/2020] [Indexed: 11/06/2022]
Abstract
Poly(methyl methacrylate) (PMMA) bone cement is used as a minor void filler in revision total knee arthroplasty (rTKA). The application of PMMA is indicated only for peripheral bone defects with less than 5 mm depth and that cover less than 50% of the bone surface. Treating bone defects with PMMA results in complications as a result of volumetric shrinkage, bone necrosis, and aseptic loosening. These concerns have driven the development of alternative bone cements. We report here on novel modified glass polyalkenoate cements (mGPCs) containing 1, 5 and 15 wt% calcium sulfate (CaSO4 ) and how the modified cements' properties compare to those of PMMA used in rTKA. CaSO4 is incorporated into the mGPC to improve both osteoconductivity and bioresorbability. The results confirm that the incorporation of CaSO4 into mGPCs decreases the setting time and increases release of therapeutic ions such as Ca2+ and Zn2+ over 30 days of maturation in deionized (DI) water. Moreover, the compressive strength for 5 and 15 wt% CaSO4 addition increased to over 30 MPa after 30 day maturation. Although the overall initial compressive strength of the mGPC (~ 30 MPa) is less than PMMA (~ 95 MPa), the compressive strength of mGPC is closer to that of cancellous bone (~ 1.2-7.8 MPa). CaSO4 addition did not affect biaxial flexural strength. Fourier transform infrared analysis indicated no cross-linking between CaSO4 and the GPC after 30 days. in vivo tests are required to determine the effects the modified GPCs as alternative on PMMA in rTKA.
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Affiliation(s)
- Leyla Hasandoost
- Faculty of Engineering and Architectural Science, Biomedical Engineering Program, Ryerson University, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Adel Alhalawani
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Mechanical & Industrial Engineering, Ryerson University, Toronto, Ontario, Canada
| | - Omar Rodriguez
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Mechanical & Industrial Engineering, Ryerson University, Toronto, Ontario, Canada
| | - Alireza Rahimnejad Yazdi
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Mechanical & Industrial Engineering, Ryerson University, Toronto, Ontario, Canada
| | - Paul Zalzal
- Faculty of Health Sciences, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.,Oakville Trafalgar Memorial Hospital, Oakville, Ontario, Canada
| | - Emil H Schemitsch
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Surgery, University of Western Ontario, London, Ontario, Canada
| | - Stephen D Waldman
- Faculty of Engineering and Architectural Science, Biomedical Engineering Program, Ryerson University, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Chemical Engineering, Ryerson University, Toronto, Ontario, Canada
| | - Marcello Papini
- Faculty of Engineering and Architectural Science, Biomedical Engineering Program, Ryerson University, Toronto, Ontario, Canada.,Department of Mechanical & Industrial Engineering, Ryerson University, Toronto, Ontario, Canada
| | - Mark R Towler
- Faculty of Engineering and Architectural Science, Biomedical Engineering Program, Ryerson University, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Mechanical & Industrial Engineering, Ryerson University, Toronto, Ontario, Canada
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Leschinger T, Engel K, Brüggemann GP, Dederer V, Neiss WF, Scheyerer MJ, Müller LP, Wegmann K. Glass -polyalkenoate cement: An alternative material for kyphoplasty in osteoporotic vertebral compression fractures - An ex vivo study. J Mech Behav Biomed Mater 2018; 83:46-51. [PMID: 29677554 DOI: 10.1016/j.jmbbm.2018.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 02/27/2018] [Accepted: 03/05/2018] [Indexed: 12/27/2022]
Abstract
Adjacent vertebral body fracture is described as a risk after vertebroplasty and kyphoplasty. It may be true that this phenomenon is caused precisely because of the frequently used polymethylmethacrylate cement (PMMA), which shows a higher level of stiffness than bone material and may ultimately lead to shifting stress levels within the entire spine. The goal of the present study was to evaluate and compare the pressure distribution in the endplate of human vertebrae after kyphoplasty with PMMA and aluminum-free glass-polyalkenoate cement (gpc). For the present study, 8 fresh frozen human cadaveric vertebral bodies from the thoracolumbar junction were used. All vertebrae were augmented transpedicularly on one side with gpc and on the other side with PMMA. A loading of 600 N, 800 N and 1000 N was applied. In the data processing an individual region of interest (roi) was generated for each vertebra. The following parameters were determined for each roi: maximum force [N], maximum pressure [kPa], mean pressure [kPa], roi area [cm2]. We found significantly higher mean pressure values in the areas of the vertebrae augmented with PMMA, compared to the ones after augmentation with gpc (p = 0.012) when applying 1000 N. In the groups with lower forces there were no statistical relevant differences. The pressure distribution shows an advantage for gpc. A material, which does not create load concentration onto the cranial and caudal vertebral surface, could have major advantages concerning the risk of adjacent vertebral fractures. Thus the results of the 1000 N loading protocol suggest gpc being a possible alternative to ordinary PMMA cement, regarding its influence on stiffness in kyphoplasty. These and other general aspects like incorporation should be addressed and elaborated more detailed in further studies.
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Affiliation(s)
- Tim Leschinger
- Center for Orthopedic and Trauma Surgery, University Medical Center, Cologne, Germany; Cologne Center for Musculoskeletal Biomechanics, Medical Faculty, University of Cologne, Cologne, Germany.
| | - Karsten Engel
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany
| | - Gert Peter Brüggemann
- Cologne Center for Musculoskeletal Biomechanics, Medical Faculty, University of Cologne, Cologne, Germany; Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany
| | - Viktoria Dederer
- Center for Orthopedic and Trauma Surgery, University Medical Center, Cologne, Germany; Cologne Center for Musculoskeletal Biomechanics, Medical Faculty, University of Cologne, Cologne, Germany
| | | | - Max Joseph Scheyerer
- Center for Orthopedic and Trauma Surgery, University Medical Center, Cologne, Germany; Cologne Center for Musculoskeletal Biomechanics, Medical Faculty, University of Cologne, Cologne, Germany
| | - Lars Peter Müller
- Center for Orthopedic and Trauma Surgery, University Medical Center, Cologne, Germany; Cologne Center for Musculoskeletal Biomechanics, Medical Faculty, University of Cologne, Cologne, Germany
| | - Kilian Wegmann
- Center for Orthopedic and Trauma Surgery, University Medical Center, Cologne, Germany; Cologne Center for Musculoskeletal Biomechanics, Medical Faculty, University of Cologne, Cologne, Germany
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Cimatti B, Santos MAD, Brassesco MS, Okano LT, Barboza WM, Nogueira-Barbosa MH, Engel EE. Safety, osseointegration, and bone ingrowth analysis of PMMA-based porous cement on animal metaphyseal bone defect model. J Biomed Mater Res B Appl Biomater 2017; 106:649-658. [PMID: 28276202 DOI: 10.1002/jbm.b.33870] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 01/17/2017] [Accepted: 02/13/2017] [Indexed: 12/28/2022]
Abstract
Bone defects created after curettage of benign bone tumors are customarily filled with solid poly(methyl methacrylate) (PMMA) or other bone substitutes. In this study, we depicted a porous PMMA-based cement (produced by mixing sodium bicarbonate and citric acid) and evaluated the prospect of its clinic application. Cement samples were characterized by high-performance liquid chromatography (HPLC) coupled to mass spectrometry and its cytotoxicity evaluated in fibroblast cultures. Implantation in rabbits allowed the histologic analysis of bone, kidneys, and liver for toxicity and coagulation tests, and MRI images for hemostasis evaluation. Osseointegration was analyzed through radiography, microtomography (micro-CT), SEM, and histology of sheep specimens. Rabbit specimens were analyzed 1, 4, and 7 days after implantation of porous or solid bone cement in 6.0 mm femoral defects. Sheep specimens were analyzed 3 and 6 months after implantation or not of porous or solid cement in 15.0 mm subchondral tibial defects. The production process did not release any detectable toxic substance but slightly reduced fibroblast proliferation in vitro. Until 7 days after surgery, no local or systemic alterations could be detected in histology, or hematoma formation in histology or MRI. Sheep implants showed 6 mm linear ingrowth from the bone-cement interface and 20% bone ingrowth considering the whole defect area. Radiography, micro-CT, SEM, and histology confirmed these findings. We conclude that our porous PMMA-based cement is an attractive alternative treatment for bone defect filling that combines osseointegration and early weight bearing. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 649-658, 2018.
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Affiliation(s)
- Bruno Cimatti
- Department of Biomechanics, Medicine and Rehabilitation of the Locomotor System, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Mariana Avelino Dos Santos
- Department of Biomechanics, Medicine and Rehabilitation of the Locomotor System, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Maria Sol Brassesco
- Department of Biology, Faculty of Philosophy, Sciences and Letters at Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Laura Tiemi Okano
- Department of Chemistry, Faculty of Philosophy, Sciences and Letters at Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Wendell Monteiro Barboza
- Department of Biomechanics, Medicine and Rehabilitation of the Locomotor System, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | - Edgard Eduard Engel
- Department of Biomechanics, Medicine and Rehabilitation of the Locomotor System, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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