Influence of several biodegradable components added to pure and nanosilver-doped PMMA bone cements on its biological and mechanical properties

Dual functional profluorescent nitroxides for the detection of reactive oxygen species and inhibition of collagen degradation during reassembly

High content of reactive oxygen species (ROS) in the human body leads to oxidative stress and serious health problems, such as cancer and cardiovascular or bone diseases. It is also one of the agents that cause collagen damage. Herein, detection of ROS, scavenging of formed carbon-centered radicals and inhibition of collagen fragmentation were performed in a single operation using newly synthesized profluorescent nitroxide PN1via a switch-on approach. Reassembly of acid soluble collagen (ASC) in the presence of hydroxyl and hydroperoxyl radicals, representatives of ROS, was monitored to study the efficiency of the PN1 probe. Self-assembly curves of collagen fibril solution were in accordance with differential scanning calorimetry (DSC) and scanning electron microscopy (SEM) observations, and indicated that PN1 efficiently inhibited the collagen chain scission. In order to prevent the leakage of the probe in materials, a PN2 monomer was successfully incorporated with MMA to form a profluorescent copolymer probe. Furthermore, PN1 and PN2-MMA copolymer probes offered high sensitivity of detection of ROS in the presence of collagen fibrils with detection limits of 1.1 and 2.7 μM, respectively. The mechanism of ROS detection and inhibition of collagen degradation by profluorescent nitroxides was proposed.

Incorporation of black phosphorus nanosheets into poly(propylene fumarate) biodegradable bone cement to enhance bioactivity and osteogenesis

BACKGROUND

Injectable bone cement is commonly used in clinical orthopaedics to fill bone defects, treat vertebral compression fractures, and fix joint prostheses during joint replacement surgery. Poly(propylene fumarate) (PPF) has been proposed as a biodegradable and injectable alternative to polymethylmethacrylate (PMMA) bone cement. Recently, there has been considerable interest in two-dimensional (2D) black phosphorus nanomaterials (BPNSs) in the biomedical field due to their excellent photothermal and osteogenic properties. In this study, we investigated the biological and physicochemical qualities of BPNSs mixed with PPF bone cement created through thermal cross-linking.

METHODS

PPF was prepared through a two-step process, and BPNSs were prepared via a liquid phase stripping method. BP/PPF was subsequently prepared through thermal cross-linking, and its characteristics were thoroughly analysed. The mechanical properties, cytocompatibility, osteogenic performance, degradation performance, photothermal performance, and in vivo toxicity of BP/PPF were evaluated.

RESULTS

BP/PPF exhibited low cytotoxicity levels and mechanical properties similar to that of bone, whereas the inclusion of BPNSs promoted preosteoblast adherence, proliferation, and differentiation on the surface of the bone cement. Furthermore, 200 BP/PPF demonstrated superior cytocompatibility and osteogenic effects, leading to the degradation of PPF bone cement and enabling it to possess photothermal properties. When exposed to an 808-nm laser, the temperature of the bone cement increased to 45-55 °C. Furthermore, haematoxylin and eosin-stained sections from the in vivo toxicity test did not display any anomalous tissue changes.

CONCLUSION

BP/PPF exhibited mechanical properties similar to that of bone: outstanding photothermal properties, cytocompatibility, and osteoinductivity. BP/PPF serves as an effective degradable bone cement and holds great potential in the field of bone regeneration.

Dual-Setting Bone Cement Based On Magnesium Phosphate Modified with Glycol Methacrylate Designed for Biomedical Applications

Magnesium phosphate cement (MPC) is a suitable alternative for the currently used calcium phosphates, owing to beneficial properties like favorable resorption rate, fast hardening, and higher compressive strength. However, due to insufficient mechanical properties and high brittleness, further improvement is still expected. In this paper, we reported the preparation of a novel type of dual-setting cement based on MPC with poly(2-hydroxyethyl methacrylate) (pHEMA). The aim of our study was to evaluate the effect of HEMA addition, especially its concentration and premix time, on the selected properties of the composite. Several beneficial effects were found: better formability, shortened setting time, and improvement of mechanical strengths. The developed cements were hardening in ∼16-21 min, consisted of well-crystallized phases and polymerized HEMA, had porosity between ∼2-11%, degraded slowly by ∼0.1-4%/18 days, their wettability was ∼20-30°, they showed compressive and bending strength between ∼45-73 and 13-20 MPa, respectively, and, finally, their Young's Modulus was close to ∼2.5-3.0 GPa. The results showed that the optimal cement composition is MPC+15%HEMA and 4 min of polymer premixing time. Overall, our research suggested that this developed cement may be used in various biomedical applications.

Study on the poly(methyl methacrylate-acrylic acid)/calcium phosphate cement composite bound by chelation with enhanced water absorption and biomechanical properties

Polymethylmethacrylate (PMMA) bone cement has been widely used as a critical material for fixing prostheses and filling bone defects. The shrinkage of PMMA bone cement was addressed by the additives, however, the uneven integral water absorption and expansion performance as well as the deteriorated mechanical properties of the modified bone cement after immersion in phosphate buffered saline (PBS) and simulation body fluid (SBF) affected the long-term stability after implantation. Calcium phosphate cement (CPC) is a biomaterial with promising applications in orthopedics, whose hydration reaction provides an important driving force for the transfer of water. Besides, the mechanical properties of CPC can be enhanced with the curing process. In this study, CPC was utilized to modify the poly(methyl methacrylate-acrylic acid) [P(MMA-AA)] bone cement. The results demonstrated the successful construction of interconnected CPC water delivery networks in the P(MMA-AA)/CPC composite, the water absorption ratio and expansion ratio of the composite were up to 131.18 ± 9.14% and 168.19 ± 5.44%, respectively. Meanwhile, the transformation of CPC water delivery networks into rigid mechanical support networks as well as the chelation interaction between organic-inorganic enhanced the mechanical properties of the composite after immersion, the compressive strength after immersion reached 62.97 ± 0.97 MPa, which was 27.65% higher than that before immersion. The degradation ratio of the composite was up to 13.76 ± 0.23% after 9 days of immersion, which was 16.4% higher than that of CPC. Furthermore, composites exhibited superior biocompatibility as the release of Ca2+. Therefore, P(MMA-AA)/CPC composite serves as a promising medical filling material for clinical use.

Composite Bone Cements with Enhanced Drug Elution

Antibiotic-loaded bone cement (ALBC) has become an indispensable material in orthopedic surgery in recent decades, owing to the possibility of drugs delivery to the surgical site. It is applied for both infection prophylaxis (e.g., in primary joint arthroplasty) and infection treatment (e.g., in periprosthetic infection). However, the introduction of antibiotic to the polymer matrix diminishes the mechanical strength of the latter. Moreover, the majority of the loaded antibiotic remains embedded in polymer and does not participate in drug elution. Incorporation of the various additives to ALBC can help to overcome these issues. In this paper, four different natural micro/nanoscale materials (halloysite, nanocrystalline cellulose, micro- and nanofibrillated cellulose) were tested as additives to commercial Simplex P bone cement preloaded with vancomycin. The influence of all four materials on the polymerization process was comprehensively studied, including the investigation of the maximum temperature of polymerization, setting time, and monomer leaching. The introduction of the natural additives led to a considerable enhancement of drug elution and microhardness in the composite bone cements compared to ALBC. The best combination of the polymerization rate, monomer leaching, antibiotic release, and microhardness was observed for the sample containing nanofibrillated cellulose (NFC).

Mechanical Properties and Wear Susceptibility Determined by Nanoindentation Technique of Ti13Nb13Zr Titanium Alloy after "Direct Laser Writing"

Laser treatment has often been applied to rebuild the surface layer of titanium and its alloys destined for long-term implants. Such treatment has always been associated with forming melted and re-solidified thin surface layers. The process parameters of such laser treatment can be different, including the patterning of a surface by so-called direct writing. In this research, pulse laser treatment was performed on the Ti13Nb13Zr alloy surface, with the distance between adjacent laser paths ranging between 20 and 50 µm. The obtained periodic structures were tested to examine the effects of the scan distance on the microstructure using SEM, the roughness and chemical and phase composition using EDS and XRD, and the mechanical properties using the nanoindentation technique. After direct laser writing, the thickness of the melted layers was between 547 and 123 µm, and the surface roughness varied between 1.74 and 0.69 µm. An increase in hardness was observed after laser treatment. The highest hardness, 5.44 GPa, was obtained for the sample modified with a laser beam spacing of 50 µm. The value of the distance has been shown to be important for several properties and related to a complex microstructure of the thin surface layer close to and far from the laser path.

A new mathematical model of compressive stress-strain behaviour of low viscosity and high viscosity bone cement with different strain rates

A new mathematical model of compressive stress-strain behaviour of low viscosity (LV) and high viscosity (HV) bone cement has been proposed to capture large uniaxial deformation under constant applied strain rate by incorporating three-term power law. The modeling capacity of the proposed model has been validated using uniaxial compressive test under eight different low strain rates ranging from 1.39 × 10^-4 s^-1 to 3.53 × 10^-2 s^-1 for low viscosity and high viscosity bone cement. The well agreement between the model and experimental response suggests that the proposed model can successfully predict rate dependent deformation behavior for Poly(methyl methacrylate) (PMMA) bone cement. Additionally, the proposed model was compared with the generalized Maxwell viscoelastic model and found to be in good agreement. The comparison of compressive responses over low strain rates for LV and HV bone cement reveals their rate-dependent compressive yield stress behaviour along with a higher value of compressive yield stress of LV bone cement compared to HV bone cement. For example, at the strain rate of 1.39 × 10^-4 s^-1 the mean value of compressive yield stress of LV bone cement was found to be 64.46 MPa, whereas for HV bone cement it was 54.00 MPa. Moreover, the modeling of experimental compressive yield stress with the Ree-Eyring molecular theory suggests that the variation of yield stress of PMMA bone cement can be predicted using two processes Ree-Eyring theory. The proposed constitutive model might be useful to characterize large deformation behaviour with high accuracy for PMMA bone cement. Finally, both variants of PMMA bone cement also exhibit ductile-like compressive behaviour below the strain rate of 2.1 × 10^-2 s^-1, whereas above this threshold strain rate, brittle-like compressive failure behavior is observed.

Enhancing Stability of High-Concentration β-Tricalcium Phosphate Suspension for Biomedical Application

We propose a novel process to efficiently prepare highly dispersed and stable Tricalcium Phosphate (β-TCP) suspensions. TCP is coupled with a polymer to enhance its brittleness to be used as an artificial hard tissue. A high solid fraction of β-TCP is mixed with the polymer in order to improve the mechanical strength of the prepared material. The high solid fractions led to fast particle aggregation due to Van der Waals forces, and sediments appeared quickly in the suspension. As a result, we used a dispersant, dispex AA4040 (A40), to boost the surface potential and steric hindrance of particles to make a stable suspension. However, the particle size of β-TCP is too large to form a suspension, as the gravity effect is much more dominant than Brownian motion. Hence, β-TCP was subjected to wet ball milling to break the aggregated particles, and particle size was reduced to ~300 nm. Further, to decrease sedimentation velocity, cellulose nanocrystals (CNCs) are added as a thickening agent to increase the overall viscosity of suspension. Besides the viscosity enhancement, CNCs were also wrapped with A40 micelles and increase the stability of the suspension. These CNC/A40 micelles further facilitated stable suspension of β-TCP particles with an average hydration radius of 244.5 nm. Finally, β-TCP bone cement was formulated with the suspension, and the related cytotoxicity was estimated to demonstrate its applicability for hard tissue applications.

Ameliorating the Mechanical Parameters, Thermal Stability, and Wettability of Acrylic Polymer by Cement Filling for High-Efficiency Waterproofing

Acrylic polymer/cement nanocomposites in dark and light colors have been developed for coating floors and swimming pools. This work aims to emphasize the effect of cement filling on the mechanical parameters, thermal stability, and wettability of acrylic polymer. The preparation was carried out using the casting method from acrylic polymer coating solution, which was added to cement nanoparticles (65 nm) with weight concentrations of (0, 1, 2, 4, and 8 wt%) to achieve high-quality specifications and good adhesion. Maximum impact strength and Hardness shore A were observed at cement ratios of 2 wt% and 4 wt%, respectively. Changing the filling ratio has a significant effect on the strain of the nanocomposites. The contact angle was increased as the concentration of additives and cement increased, indicating that the synthesized coating is not hydrophilic and does not allow water permeability through it. The results show that the acrylic polymer/cement with a cement ratio of 8 wt% is the best nanocomposite for high-efficiency waterproofing.

Analysis of the Effect of Component Ratio Imbalances on Selected Mechanical Properties of Seasoned, Medium Viscosity Bone Cements

The paper presents the results of experimental strength tests of specimens made of two commercially available bone cements subjected to compression, that is a typical variant of load of this material during use in the human body, after it has been used for implantation of prostheses or supplementation of bone defects. One of the factors analysed in detail was the duration of cement seasoning in Ringer's solution that simulates the aggressive environment of the human body and material degradation caused by it. The study also focused on the parameters of quantitative deviation from the recommended proportions of liquid (MMA monomer, accelerator and stabiliser) and powder (PMMA prepolymer and initiator) components, i.e., unintentional inaccuracy of component proportioning at the stage of cement mass preparation. Statistical analysis has shown the influence of these factors on the decrease in compressive strength of the cements studied, which may be of significant importance in operational practice.

Evaluation of the Effect of Selected Physiological Fluid Contaminants on the Mechanical Properties of Selected Medium-Viscosity PMMA Bone Cements

Revision surgeries several years after the implantation of the prosthesis are unfavorable from the patient’s point of view as they expose him to additional discomfort, to risk of complications and are expensive. One of the factors responsible for the aseptic loosening of the prosthesis is the gradual degradation of the cement material as a result of working under considerable loads, in an aggressive environment of the human body. Contaminants present in the surgical field may significantly affect the durability of the bone cement and, consequently, of the entire bone-cement-prosthesis system. The paper presents the results of an analysis of selected mechanical properties of two medium-viscosity bone cements DePuy CMW3 Gentamicin and Heraeus Palamed, for the samples contaminated with saline and blood in the range of 1–10%. The results obtained for compressive strength and modulus of elasticity were subjected to statistical analysis, which estimated the nature of changes in these parameters depending on the amount and type of contamination and their statistical significance.

Influence of Different Nanometals Implemented in PMMA Bone Cement on Biological and Mechanical Properties

Cemented arthroplasty is a common process to fix prostheses when a patient becomes older and his/her bone quality deteriorates. The applied cements are biocompatible, can transfer loads, and dampen vibrations, but do not provide antibacterial protection. The present work is aimed at the development of cement with antibacterial effectivity achieved with the implementation of nanoparticles of different metals. The powders of Ag, Cu with particles size in a range of 10–30 nm (Cu10) and 70–100 nm (Cu70), AgCu, and Ni were added to PMMA cement. Their influence on compression strength, wettability, and antibacterial properties of cement was assessed. The surface topography of samples was examined with biological and scanning electron microscopy. The mechanical properties were determined by compression tests. A contact angle was observed with a goniometer. The biological tests included an assessment of cytotoxicity (XTT test on human cells Saos-2 line) and bacteria viability exposure (6 months). The cements with Ag and Cu nanopowders were free of bacteria. For AgCu and Ni nanoparticles, the bacterial solution became denser over time and, after 6 months, the bacteria clustered into conglomerates, creating a biofilm. All metal powders in their native form in direct contact reduce the number of eukaryotic cells. Cell viability is the least limited by Ag and Cu particles of smaller size. All samples demonstrated hydrophobic nature in the wettability test. The mechanical strength was not significantly affected by the additions of metal powders. The nanometal particles incorporated in PMMA-based bone cement can introduce long-term resistance against bacteria, not resulting in any serious deterioration of compression strength.

Additives Imparting Antimicrobial Properties to Acrylic Bone Cements

PMMA bone cements are mainly used to fix implanted prostheses and are introduced as a fluid mixture, which hardens over time. The problem of infected prosthesis could be solved due to the development of some new antibacterial bone cements. In this paper, we show the results obtained to develop four different modified PMMA bone cements by using antimicrobial additives, such as gentamicin, peppermint oil incorporated in hydroxyapatite, and silver nanoparticles incorporated in a ceramic glass matrix (2 and 4%). The structure and morphology of the modified bone cements were investigated by SEM and EDS. We perform experimental measurements on wettability, hydration degree, and degradation degree after immersion in simulated body fluid. The cytotoxicity was evaluated by MTT assay using the human MG-63 cell line. Antimicrobial properties were checked against standard strains Staphylococcus aureus, Pseudomonas aeruginosa, and Candida albicans. The addition of antimicrobial agents did not significantly affect the hydration and degradation degree. In terms of biocompatibility assessed by the MTT test, all experimental PMMA bone cements are biocompatible. The performance of bone cements with peppermint essential oil and silver nanoparticles against these two pathogens suggests that these antibacterial additives look promising to be used in clinical practice against bacterial infection.

Optimization of Mechanical and Setting Properties in Acrylic Bone Cements Added with Graphene Oxide

The extended use of acrylic bone cements (ABC) in orthopedics presents some disadvantages related to the generation of high temperatures during methyl methacrylate polymerization, thermal tissue necrosis, and low mechanical properties. Both weaknesses cause an increase in costs for the health system and a decrease in the patient’s quality of life due to the prosthesis’s loosening. Materials such as graphene oxide (GO) have a reinforcing effect on ABC’s mechanical and setting properties. This article shows for the first time the interactions present between the factors sonication time and GO percentage in the liquid phase, together with the percentage of benzoyl peroxide (BPO) in the solid phase, on the mechanical and setting properties established for cements in the ISO 5833-02 standard. Optimization of the factors using a completely randomized experimental design with a factorial structure resulted in selecting nine combinations that presented an increase in compression, flexion, and the setting time and decreased the maximum temperature reached during the polymerization. All of these characteristics are desirable for improving the clinical performance of cement. Those containing 0.3 wt.% of GO were highlighted from the selected formulations because all the possible combinations of the studied factors generate desirable properties for the ABC.

Nanosilver-loaded PMMA bone cement doped with different bioactive glasses - evaluation of cytocompatibility, antibacterial activity, and mechanical properties

Nanosilver-loaded PMMA bone cement (BC-AgNp) is a novel cement developed as a replacement for conventional cements. Despite its favorable properties and antibacterial activity, BC-AgNp still lacks biodegradability and bioactivity. Hence, we investigated doping with bioactive glasses (BGs) to create a new bioactive BC characterized by time-varying porosity and gradual release of AgNp. The BC Cemex was used as the base material and modified simultaneously with the AgNp and BGs: melted 45S5 and 13-93B3 glasses with various particle sizes and sol-gel derived SiO₂/CaO microparticles. The effect of BG addition was examined by microscopic analysis, an assessment of setting parameters, wettability, FTIR and UV-VIS spectroscopy, mechanical testing, and hemo- and cytocompatibility and antibacterial efficiency studies. The results show that it is possible to incorporate various BGs into BC-AgNp, which leads to different properties depending on the type and size of BGs. The smaller particles of melted BGs showed higher porosity and better antibacterial properties with the moderate deterioration of mechanical properties. The sol-gel derived BGs, however, displayed a tendency for agglomeration and random distribution in BC-AgNp. The BGs with greater solubility more efficiently improve the antibacterial properties of BC-AgNp. Besides, the unreacted MMA monomer release could negatively influence the cellular response. Despite that, cements doped with different BGs are suitable for medical applications.

Borate mineral loading into acrylic bone cements to gain cost-effectivity, enhanced antibacterial resistivity, and better cellular integration properties

Polymethyl methacrylate (PMMA), called as bone cement, has been used in implant surgery, initially in dental practices, then in arthroplasty surgery for decades. Bone cement is a highly preferred chemical in the field of orthopedics due to its bone-like hardness and mechanical strength. Meanwhile, antibiotic-loaded cements are used in joints and similar surgeries are generally due to the risk of infection. In this study, we aimed to demonstrate the effects of borate mineral loading into bone cement on enhancing the antibacterial resistivity and cell integration as well as retaining mechanical properties. Moreover, the incorporation of minerals into bone cements makes them much more cost-friendly biomaterials for surgical operations. Herein, antibacterial properties were evaluated by using vancomycin- and gentamycin-susceptible strains of Enterococcus faecalis and Staphylococcus aureus whereas cell viability tests were performed by osteoblast cell lines. Three sets of the bone cements, plain, calcium borate-, and sodium borate-loaded, were prepared through commercial procedures and subjected to mechanical, antibacterial and cell viability tests. Percentage deformation determined by compression tests under 0.100 MPa pressure was determined in the range of 12.58%-10.67% in respect to the amount of sodium borate mineral loaded whereas that was determined in the range of 12.54%-9.87% in respect to the amount of calcium borate mineral loaded. Micro-CT results also supported good mineral integration and structural features of the composite bone cements. Furthermore, mineral incorporation enhanced the cell viability, in other words, cellular integrity, up to 101.28% for sodium borate-loaded (NB75, 7.5 g mineral) and 72.04% for calcium borate-loaded (CB75, 7.5 g mineral) bone cement according to the negative control group, fresh culture medium. As a conclusion, both of these minerals could be classified as promising alternatives for developing bone cements with better antibacterial resistivity and cellular integration properties.

The Role of Chitosan and Graphene Oxide in Bioactive and Antibacterial Properties of Acrylic Bone Cements

Acrylic bone cements (ABC) are widely used in orthopedics for joint fixation, antibiotic release, and bone defect filling, among others. However, most commercially available ABCs exhibit a lack of bioactivity and are susceptible to infection after implantation. These disadvantages generate long-term loosening of the prosthesis, high morbidity, and prolonged and expensive treatments. Due to the great importance of acrylic bone cements in orthopedics, the scientific community has advanced several efforts to develop bioactive ABCs with antibacterial activity through several strategies, including the use of biodegradable materials such as chitosan (CS) and nanostructures such as graphene oxide (GO), with promising results. This paper reviews several studies reporting advantages in bioactivity and antibacterial properties after incorporating CS and GO in bone cements. Detailed information on the possible mechanisms by which these fillers confer bioactive and antibacterial properties to cements, resulting in formulations with great potential for use in orthopedics, are also a focus in the manuscript. To the best of our knowledge, this is the first systematic review that presents the improvement in biological properties with CS and GO addition in cements that we believe will contribute to the biomedical field.

Use of Deep Learning Networks and Statistical Modeling to Predict Changes in Mechanical Parameters of Contaminated Bone Cements

The purpose of the study was to test the usefulness of deep learning artificial neural networks and statistical modeling in predicting the strength of bone cements with defects. The defects are related to the introduction of admixtures, such as blood or saline, as contaminants into the cement at the preparation stage. Due to the wide range of applications of deep learning, among others in speech recognition, bioinformation processing, and medication design, the extent was checked to which it is possible to obtain information related to the prediction of the compressive strength of bone cements. Development and improvement of deep learning network (DLN) algorithms and statistical modeling in the analysis of changes in the mechanical parameters of the tested materials will enable determining an acceptable margin of error during surgery or cement preparation in relation to the expected strength of the material used to fill bone cavities. The use of the abovementioned computer methods may, therefore, play a significant role in the initial qualitative assessment of the effects of procedures and, thus, mitigation of errors resulting in failure to maintain the required mechanical parameters and patient dissatisfaction.