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Alimohammadi M, Mirzabozorg H, Farahmand F, Kim S, Baril C, Ploeg HL. Statistical distribution of micro and macro pores in acrylic bone cement- effect of amount of antibiotic content. J Mech Behav Biomed Mater 2024; 150:106297. [PMID: 38100980 DOI: 10.1016/j.jmbbm.2023.106297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/02/2023] [Accepted: 12/02/2023] [Indexed: 12/17/2023]
Abstract
Aseptic loosening due to mechanical failure of bone cement is considered to be a leading cause of revision of joint replacement systems. Detailed quantified information on the number, size and distribution pattern of pores can help to obtain a deeper understanding of the bone cement's fatigue behavior. The objective of this study was to provide statistical descriptions for the pore distribution characteristics of laboratory bone cement specimens with different amounts of antibiotic contents. For four groups of bone cement (Palacos) specimens, containing 0.3, 0.6, 1.2 and 2.4 wt/wt% of telavancin antibiotic, seven samples per group were micro computed tomography scanned (38.97 μm voxel size). The images were first preprocessed in Mimics and then analyzed in Dragonfly, with the level of threshold being set such that single-pixel pores become visible. The normalized pore volume data of the specimens were then used to extract the logarithmic histograms of the pore densities for antibiotic groups, as well as their three-parameter Weibull probability density functions. Statistical comparison of the pore distribution data of the antibiotic groups using the Mann-Whitney non-parametric test revealed a significantly larger porosity (p < 0.05) in groups with larger added antibiotic contents (2.4 and 0.6 wt/wt% vs 0.3 wt/wt%). Further analysis revealed that this effect was associated with the significantly larger frequency of micropores of 0.1-0.5 mm diameter (p < 0.05) in groups with larger antibiotic content (2.4 wt/wt% vs and 0.6 and 0.3 wt/wt%), implying that the elution of the added antibiotic produces micropores in this diameter range mainly. Based on this observation and the fatigue test results in the literature, it was suggested that micropore clusters have a detrimental effect on the mechanical properties of bone cement and play a major role in initiating fatigue cracks in highly antibiotic added specimens.
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Affiliation(s)
- Mahsa Alimohammadi
- Civil Engineering Department, KN Toosi University of Technology, Tehran, Iran; Department of Mechanical and Materials Engineering, Queen's University, Kingston, ON, Canada
| | - Hassan Mirzabozorg
- Civil Engineering Department, KN Toosi University of Technology, Tehran, Iran
| | - Farzam Farahmand
- Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran
| | - Sunjung Kim
- Department of Orthopaedic Surgery, University of Illinois Chicago, Chicago, IL, USA
| | - Caroline Baril
- Department of Mechanical and Materials Engineering, Queen's University, Kingston, ON, Canada
| | - Heidi-Lynn Ploeg
- Department of Mechanical and Materials Engineering, Queen's University, Kingston, ON, Canada.
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Humez M, Fröschen FS, Wirtz DC, Kühn KD. [The third-generation modern cementing technique in hip and knee arthroplasty]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023; 52:968-980. [PMID: 37828239 DOI: 10.1007/s00132-023-04446-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/01/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Implant loosening is the most common reason for revision surgery. OBJECTIVES Contribution of modern cementing technique to the long-term stability of an implant. METHODS Evaluation of the available evidence on modern cementing technique. RESULTS Modern cementing technique in hip arthroplasty is considered established and leads to better cementing results. In knee arthroplasty, there are also specific recommendations, including intensive cleaning of the bone bed, mixing of bone cement under vacuum and application of bone cement to the implant and the bone. CONCLUSIONS The use of modern cementing technique in hip and knee arthroplasty facilitates cementing, increases safety, and minimizes the risk of mechanical loosening.
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Affiliation(s)
- Martina Humez
- Heraeus Medical GmbH, Philipp-Reis-Str. 8/13, 61273, Wehrheim, Deutschland.
| | | | | | - Klaus-Dieter Kühn
- Heraeus Medical GmbH, Philipp-Reis-Str. 8/13, 61273, Wehrheim, Deutschland
- Department of Orthopaedics and Trauma, Medizinische Universität Graz, Graz, Österreich
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Chaurasiya SP, Ghosh R. A new mathematical model of compressive stress-strain behaviour of low viscosity and high viscosity bone cement with different strain rates. Med Eng Phys 2023; 117:104001. [PMID: 37331754 DOI: 10.1016/j.medengphy.2023.104001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/23/2023] [Accepted: 05/27/2023] [Indexed: 06/20/2023]
Abstract
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.
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Affiliation(s)
- Sonalal Prasad Chaurasiya
- Biomechanics Research Laboratory, School of Mechanical and Materials Engineering, Indian Institute of Technology Mandi, Kamand, Mandi, 175075, Himachal Pradesh, India
| | - Rajesh Ghosh
- Biomechanics Research Laboratory, School of Mechanical and Materials Engineering, Indian Institute of Technology Mandi, Kamand, Mandi, 175075, Himachal Pradesh, India.
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Szabelski J, Karpiński R, Krakowski P, Jojczuk M, Jonak J, Nogalski A. Analysis of the Effect of Component Ratio Imbalances on Selected Mechanical Properties of Seasoned, Medium Viscosity Bone Cements. MATERIALS (BASEL, SWITZERLAND) 2022; 15:5577. [PMID: 36013714 PMCID: PMC9416016 DOI: 10.3390/ma15165577] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/05/2022] [Accepted: 08/11/2022] [Indexed: 06/15/2023]
Abstract
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.
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Affiliation(s)
- Jakub Szabelski
- Department of Computerization and Production Robotization, Faculty of Mechanical Engineering, Lublin University of Technology, Nadbystrzycka 36, 20-618 Lublin, Poland
| | - Robert Karpiński
- Department of Machine Design and Mechatronics, Faculty of Mechanical Engineering, Lublin University of Technology, Nadbystrzycka 36, 20-618 Lublin, Poland
| | - Przemysław Krakowski
- Chair and Department of Trauma Surgery and Emergency Medicine, Medical University of Lublin, Staszica 11, 20-081 Lublin, Poland
- Orthopaedic Department, Łęczna Hospital, Krasnystawska 52, 21-010 Leczna, Poland
| | - Mariusz Jojczuk
- Chair and Department of Trauma Surgery and Emergency Medicine, Medical University of Lublin, Staszica 11, 20-081 Lublin, Poland
| | - Józef Jonak
- Department of Machine Design and Mechatronics, Faculty of Mechanical Engineering, Lublin University of Technology, Nadbystrzycka 36, 20-618 Lublin, Poland
| | - Adam Nogalski
- Chair and Department of Trauma Surgery and Emergency Medicine, Medical University of Lublin, Staszica 11, 20-081 Lublin, Poland
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Two-year fixation and ten-year clinical outcomes of total knee arthroplasty inserted with normal-curing bone cement and slow-curing bone cement: A randomized controlled trial in 54 patients. Knee 2021; 33:110-124. [PMID: 34619515 DOI: 10.1016/j.knee.2021.08.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 05/12/2021] [Accepted: 08/25/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The normal-curing Refobacin® Bone Cement R (RR) and slow-curing Refobacin® Plus Bone Cement (RP) were introduced after discontinuation of the historically most used bone cement, Refobacin®-Palacos® R, in 2005. The aim of this study was to compare total knee arthroplasty component fixation with the two bone cements. METHODS 54 patients with primary knee osteoarthritis were randomized to either RR (N = 27) or RP (N = 27) bone cement and followed for two years with radiostereometric analysis of tibial and femoral component migration and dual-energy x-ray absorptiometry measured periprosthetic bone mineral density (BMD). Further, patients were followed up at ten years with clinical outcome scores (OKS and KOOS). RESULTS At two-years follow-up, tibial total translation was 0.31 mm (95% CI: 0.19 - 0.42) for the RP group and 0.56 mm (95% CI: 0.45 - 0.67) (p < 0.01) for the RR group. There was continuous tibial component migration from one to two years follow-up (MTPM > 0.2 mm) in 13/27 patients from the RR and in 12/26 patients from the RP group. There was no difference between groups in BMD baseline values or changes during follow-up, as well as no correlation between change in BMD and tibial component migration. At ten-years follow-up, the improvement in the clinical outcome scores was similar between groups. There were no prosthesis related complications during the 10-year follow-up. CONCLUSION At two years, tibial total translation was lower in the RP compared with the RR cement group, but BMD changes were similar. At ten years, no components were revised and clinical outcome scores were similar between groups.
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Phull SS, Yazdi AR, Ghert M, Towler MR. Bone cement as a local chemotherapeutic drug delivery carrier in orthopedic oncology: A review. J Bone Oncol 2021; 26:100345. [PMID: 33552885 PMCID: PMC7856326 DOI: 10.1016/j.jbo.2020.100345] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/08/2020] [Accepted: 12/11/2020] [Indexed: 01/05/2023] Open
Abstract
Metastatic bone lesions are common among patients with advanced cancers. While chemotherapy and radiotherapy may be prescribed immediately after diagnosis, the majority of severe metastatic bone lesions are treated by reconstructive surgery, which, in some cases, is followed by postoperative radiotherapy or chemotherapy. However, despite recent advancements in orthopedic surgery, patients undergoing reconstruction still have the risk of developing severe complications such as tumor recurrence and reconstruction failure. This has led to the introduction and evaluation of poly (methyl methacrylate) and inorganic bone cements as local carriers for chemotherapeutic drugs (usually, antineoplastic drugs (ANPDs)). The present work is a critical review of the literature on the potential use of these cements in orthopedic oncology. While several studies have demonstrated the benefits of providing high local drug concentrations while minimizing systemic side effects, only six studies have been conducted to assess the local toxic effect of these drug-loaded cements and they all reported negative effects on healthy bone structure. These findings do not close the door on chemotherapeutic bone cements; rather, they should assist in materials selection when designing future materials for the treatment of metastatic bone disease.
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Affiliation(s)
- Sunjeev S. Phull
- Department of Biomedical Engineering, Ryerson University, Toronto M5B 2K3, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto M5B 1W8, Ontario, Canada
| | - Alireza Rahimnejad Yazdi
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto M5B 1W8, Ontario, Canada
- Department of Mechanical Engineering, Ryerson University, Toronto M5B 2K3, Ontario, Canada
| | - Michelle Ghert
- Department of Surgery, McMaster University, Hamilton L8V 5C2, Ontario, Canada
| | - Mark R. Towler
- Department of Biomedical Engineering, Ryerson University, Toronto M5B 2K3, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto M5B 1W8, Ontario, Canada
- Department of Mechanical Engineering, Ryerson University, Toronto M5B 2K3, Ontario, Canada
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Affiliation(s)
- René A Monzón
- Adult Reconstruction, Department of Orthopaedics, University of California-Davis Medical Center, Sacramento, California
| | - John G Coury
- Department of Orthopaedic Surgery, Doctors Medical Center, Valley Consortium for Medical Education, Modesto, California
| | - Gregory D Disse
- Adult Reconstruction, Department of Orthopaedics, University of California-Davis Medical Center, Sacramento, California
| | - Zachary C Lum
- Adult Reconstruction, Department of Orthopaedics, University of California-Davis Medical Center, Sacramento, California
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Soleymani Eil Bakhtiari S, Bakhsheshi-Rad HR, Karbasi S, Tavakoli M, Razzaghi M, Ismail AF, RamaKrishna S, Berto F. Polymethyl Methacrylate-Based Bone Cements Containing Carbon Nanotubes and Graphene Oxide: An Overview of Physical, Mechanical, and Biological Properties. Polymers (Basel) 2020; 12:polym12071469. [PMID: 32629907 PMCID: PMC7407371 DOI: 10.3390/polym12071469] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/19/2020] [Accepted: 06/23/2020] [Indexed: 02/07/2023] Open
Abstract
Every year, millions of people in the world get bone diseases and need orthopedic surgery as one of the most important treatments. Owing to their superior properties, such as acceptable biocompatibility and providing great primary bone fixation with the implant, polymethyl methacrylate (PMMA)-based bone cements (BCs) are among the essential materials as fixation implants in different orthopedic and trauma surgeries. On the other hand, these BCs have some disadvantages, including Lack of bone formation and bioactivity, and low mechanical properties, which can lead to bone cement (BC) failure. Hence, plenty of studies have been concentrating on eliminating BC failures by using different kinds of ceramics and polymers for reinforcement and also by producing composite materials. This review article aims to evaluate mechanical properties, self-setting characteristics, biocompatibility, and bioactivity of the PMMA-based BCs composites containing carbon nanotubes (CNTs), graphene oxide (GO), and carbon-based compounds. In the present study, we compared the effects of CNTs and GO as reinforcement agents in the PMMA-based BCs. Upcoming study on the PMMA-based BCs should concentrate on trialing combinations of these carbon-based reinforcing agents as this might improve beneficial characteristics.
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Affiliation(s)
- Sanaz Soleymani Eil Bakhtiari
- Advanced Materials Research Center, Department of Materials Engineering, Najafabad Branch, Islamic Azad University, Najafabad, Iran; (S.S.E.B.); (M.R.)
| | - Hamid Reza Bakhsheshi-Rad
- Advanced Materials Research Center, Department of Materials Engineering, Najafabad Branch, Islamic Azad University, Najafabad, Iran; (S.S.E.B.); (M.R.)
- Correspondence: or (H.R.B.-R.); (F.B.)
| | - Saeed Karbasi
- Biomaterials and Tissue Engineering Department, School of Advanced Technologes in Medicine, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran;
| | - Mohamadreza Tavakoli
- Department of Materials Engineering, Isfahan University of Technology, Isfahan 84156-83111, Iran;
| | - Mahmood Razzaghi
- Advanced Materials Research Center, Department of Materials Engineering, Najafabad Branch, Islamic Azad University, Najafabad, Iran; (S.S.E.B.); (M.R.)
| | - Ahmad Fauzi Ismail
- Advanced Membrane Technology Research Center (AMTEC), Universiti Teknologi Malaysia, Skudai, Johor Bahru, Johor 81310, Malaysia;
| | - Seeram RamaKrishna
- Department of Mechanical Engineering, National University of Singapore, 9 Engineering Drive 1, Singapore 117576, Singapore;
| | - Filippo Berto
- Department of Mechanical and Industrial Engineering, Norwegian University of Science and Technology, 7491 Trondheim, Norway
- Correspondence: or (H.R.B.-R.); (F.B.)
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9
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Gandomkarzadeh M, Moghimi HR, Mahboubi A. Evaluation of the Effect of Ciprofloxacin and Vancomycin on Mechanical Properties of PMMA Cement; a Preliminary Study on Molecular Weight. Sci Rep 2020; 10:3981. [PMID: 32132614 PMCID: PMC7055350 DOI: 10.1038/s41598-020-60970-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 02/18/2020] [Indexed: 11/09/2022] Open
Abstract
Antibiotic-loaded bone cement (ALBC) is commonly used in joint replacement therapy for prevention and treatment of bone infection and mechanical properties of the cement is still an important issue. The effects of ciprofloxacin and vancomycin was investigated on mechanical characterization of PMMA bone cement. Different properties of cement containing (0, 2.5, 5 and 10% W/W) antibiotics, including compressive and bending properties, microstructural, porosity and density were evaluated. Both antibiotics significantly reduced the density values and mechanical properties (compressive and flexural strength and modulus) in all groups in comparison to control over first two weeks (p < 0.05). This reduction was due to increased porosity upon antibiotic addition (3.05 and 3.67% for ciprofloxacin and vancomycin, respectively) in comparison to control (2.08%) (p < 0.001) and exposure to aqueous medium. Vancomycin as antibiotic with higher molecular weight (MW = 1485) had significant effect on compressive strength reduction of the cement at high amount compared to ciprofloxacin (MW = 367) (P < 0.01), there was no difference between two antibiotics at lower concentrations (P > 0.05). The effect of antibiotic loading is both molecular weight and drug content dependent. The time is also an important parameter and the second week is the probably optimum time to study mechanical behavior of ALBC.
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Affiliation(s)
- Marzieh Gandomkarzadeh
- Department of Pharmaceutics and Nanotechnology, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Moghimi
- Department of Pharmaceutics and Nanotechnology, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arash Mahboubi
- Department of Pharmaceutics and Nanotechnology, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran. .,Food Safety Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Li T, Fu L, Wang J, Shi Z. High dose of vancomycin plus gentamicin incorporated acrylic bone cement decreased the elution of vancomycin. Infect Drug Resist 2019; 12:2191-2199. [PMID: 31410038 PMCID: PMC6645360 DOI: 10.2147/idr.s203740] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 07/03/2019] [Indexed: 12/23/2022] Open
Abstract
Purpose Low doses of vancomycin and gentamicin were commonly incorporated into acrylic bone cement (antibiotic-impregnated bone cement, AIBC) during revision arthroplasty. Previous studies showed that only a very small amount of antibiotics could be eluted from AIBC. Given the fact that a high dose of antibiotic would elute high concentration of antibiotic, this study investigated the influence of a high dose of dual-antibiotic loading on the properties of cement. Methods A total of 8 groups of AIBC containing either gentamicin or vancomycin or both with different amounts of antibiotics (1 g, 2 g and 4 g) were tested on material properties, elution profiles, antibacterial activity and cytological toxicity. Results A high dose of gentamicin and vancomycin AIBC (with 2 g gentamicin and 2 g vancomycin loaded) regiment showed acceptable compressive strength of 74.25±0.72 MPa. No cytotoxicity or antibacterial activity reduction was observed in any group tested in this study. The elution profiles indicated that incorporating 2 g vancomycin resulted in 4.77% (1049.57±3.74 μg) released after 28 days. However, after 2 g gentamicin was added, the vancomycin released was significantly reduced to 2.42% (532.24±1.77 μg) (p<0.001), approximately 50% reduction. No significant influence of vancomycin on gentamicin was observed. Conclusion These findings suggest that the addition of 2 g vancomycin and 2 g gentamicin into acrylic bone cement was preferred while considering this dual-antibiotic AIBC regiment with acceptably material properties and effective antibacterial activity. However, special attention should be drawn to the reduction of vancomycin elution when incorporated with gentamicin.
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Affiliation(s)
- Tao Li
- Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Lilan Fu
- Nanfang PET Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Jian Wang
- Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Zhanjun Shi
- Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
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11
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Slane J, Gietman B, Squire M. Antibiotic elution from acrylic bone cement loaded with high doses of tobramycin and vancomycin. J Orthop Res 2018; 36:1078-1085. [PMID: 28876459 DOI: 10.1002/jor.23722] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 08/29/2017] [Indexed: 02/04/2023]
Abstract
Two-stage revision treatment of prosthetic joint infection (PJI) frequently employs the use of a temporary bone cement spacer loaded with multiple antibiotic types. Tobramycin and vancomycin are commonly used antibiotics in cement spacers, however, there is no consensus on the relative concentrations and combinations that should be used. Therefore, the purpose of this study was to investigate the influence of dual antibiotic loading on the total antibiotic elution and compressive mechanical properties of acrylic bone cement. Varying concentrations of tobramycin (0-3 g) and vancomycin (0-3 g) were added either alone or in combination to acrylic cement (Palacos R), resulting in 12 experimental groups. Samples were submerged in 37°C saline for 28 d and sampled at specific time points. The collected eluent was analyzed to determine the cumulative antibiotic release. In addition, the cement's compressive mechanical properties and porosity were characterized. Interestingly, the cement with the highest concentration of antibiotics did not possess the best elution properties. Cement samples containing both 3 g of tobramycin and 2 g vancomycin demonstrated the highest cumulative antibiotic release after 28 d, which was coupled with a significant decrease in the mechanical properties and an increased porosity. The collected data also suggests that tobramycin elutes more effectively than vancomycin from cement. In conclusion, this study demonstrates that high antibiotic loading in cement does not necessarily lead to enhanced antibiotic elution. Clinically this information may be used to optimize cement spacer antibiotic loading so that both duration and amount of antibiotics eluted are optimized. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1078-1085, 2018.
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Affiliation(s)
- Joshua Slane
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin.,Institute for Orthopaedic Research and Training, KU Leuven/University Hospitals Leuven, Weligerveld 1, 3212 Lubbeek, Pellenberg, Belgium
| | - Bradley Gietman
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin
| | - Matthew Squire
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin
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12
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Palagummi SV, Landis FA, Chiang MYM. Real-time synchronous measurement of curing characteristics and polymerization stress in bone cements with a cantilever-beam based instrument. THE REVIEW OF SCIENTIFIC INSTRUMENTS 2018; 89:035102. [PMID: 29604748 PMCID: PMC5834317 DOI: 10.1063/1.5025476] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 02/07/2018] [Indexed: 06/08/2023]
Abstract
An instrumentation capable of simultaneously determining degree of conversion (DC), polymerization stress (PS), and polymerization exotherm (PE) in real time was introduced to self-curing bone cements. This comprises the combination of an in situ high-speed near-infrared spectrometer, a cantilever-beam instrument with compliance-variable feature, and a microprobe thermocouple. Two polymethylmethacrylate-based commercial bone cements, containing essentially the same raw materials but differ in their viscosity for orthopedic applications, were used to demonstrate the applicability of the instrumentation. The results show that for both the cements studied the final DC was marginally different, the final PS was different at the low compliance, the peak of the PE was similar, and their polymerization rates were significantly different. Systematic variation of instrumental compliance for testing reveals differences in the characteristics of PS profiles of both the cements. This emphasizes the importance of instrumental compliance in obtaining an accurate understanding of PS evaluation. Finally, the key advantage for the simultaneous measurements is that these polymerization properties can be correlated directly, thus providing higher measurement confidence and enables a more in-depth understanding of the network formation process.
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Affiliation(s)
- Sri Vikram Palagummi
- Biosystems and Biomaterials Division, National Institute of Standards and Technology, Gaithersburg, Maryland 20899, USA
| | - Forrest A Landis
- Penn State University-York Campus, York, Pennsylvania 17403, USA
| | - Martin Y M Chiang
- Biosystems and Biomaterials Division, National Institute of Standards and Technology, Gaithersburg, Maryland 20899, USA
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13
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Al Thaher Y, Perni S, Prokopovich P. Nano-carrier based drug delivery systems for sustained antimicrobial agent release from orthopaedic cementous material. Adv Colloid Interface Sci 2017; 249:234-247. [PMID: 28477865 DOI: 10.1016/j.cis.2017.04.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 04/25/2017] [Accepted: 04/26/2017] [Indexed: 12/22/2022]
Abstract
Total joint replacement (TJR), such as hip and knee replacement, is a popular procedure worldwide. Prosthetic joint infections (PJI) after this procedure have been widely reported, where treatment of such infections is complex with high cost and prolonged hospital stay. In cemented arthroplasties, the use of antibiotic loaded bone cement (ALBC) is a standard practice for the prophylaxis and treatment of PJI. Recently, the development of bacterial resistance by pathogenic microorganisms against most commonly used antibiotics increased the interest in alternative approaches for antimicrobial delivery systems such as nanotechnology. This review summarizes the efforts made to improve the antimicrobial properties of PMMA bone cements using nanotechnology based antibiotic and non-antibiotic delivery systems to overcome drawbacks of ALBC in the prophylaxis and treatment of PJIs after hip and knee replacement.
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Affiliation(s)
- Yazan Al Thaher
- School of Pharmacy and Pharmaceutical Science, Cardiff University, Cardiff, UK
| | - Stefano Perni
- School of Pharmacy and Pharmaceutical Science, Cardiff University, Cardiff, UK
| | - Polina Prokopovich
- School of Pharmacy and Pharmaceutical Science, Cardiff University, Cardiff, UK.
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Low Rates of Aseptic Tibial Loosening in Obese Patients With Use of High-Viscosity Cement and Standard Tibial Tray: 2-Year Minimum Follow-Up. J Arthroplasty 2017; 32:S183-S186. [PMID: 28511945 DOI: 10.1016/j.arth.2017.04.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 03/27/2017] [Accepted: 04/10/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Total knee arthroplasty is overall a very successful surgery, but complications do occur. These complications include aseptic loosening of the tibial component, and obese patients are among the highest risk group. High-viscosity cement (HVC) has been implicated as a possible cause for aseptic loosening of the tibial component. The purpose of this study was to evaluate the incidence of aseptic loosening of the tibial component in obese patients with the use of HVC and standard tibial tray. METHODS We identified 1366 obese patients (1851 knees) with a body mass index >35 kg/m2 and 2-year minimum follow-up who underwent primary total knee arthroplasty using HVC and a symmetrical, grit-blasted, cobalt-chrome tibial component with 40-mm stem. Preoperative and postoperative range of motion, Knee Society (KS) scores, complications, and reoperations were evaluated. Specifically, we assessed the rate of tibial aseptic loosening. RESULTS At a mean 5.4 years follow-up, only 1 in 1851 knees had aseptic loosening of the tibial component for an incidence of 0.054%. There was a mean increase of 3.3 degrees of knee range of motion. KS pain level decreased by 38.6 points (50 point scale). KS clinical scores improved by 52.2, Knee Society functional scores improved by 19.5, University of California, Los Angeles, activity score improved by 0.9, and Oxford Knee Score by 15.7. All these improvements were statistically significant with P < .001. CONCLUSION Standard tibial components and HVC can be used in most patients, including the high-risk obese group, with low rates of tibial aseptic loosening.
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Paz E, Forriol F, del Real J, Dunne N. Graphene oxide versus graphene for optimisation of PMMA bone cement for orthopaedic applications. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2017; 77:1003-1011. [DOI: 10.1016/j.msec.2017.03.269] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 03/28/2017] [Indexed: 01/26/2023]
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Failure at the Tibial Cement-Implant Interface With the Use of High-Viscosity Cement in Total Knee Arthroplasty. J Arthroplasty 2016; 31:2579-2582. [PMID: 27155996 DOI: 10.1016/j.arth.2016.03.063] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 03/11/2016] [Accepted: 03/29/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Recent literature has shown debonding of the tibial implant-cement interface as a potential cause for implant loosening. The purpose of this case series is to report this phenomenon in a historically well-performing implant when used with high-viscosity cement (HVC). METHODS Thirteen primary cemented Biomet Vanguard total knee arthroplasties were referred to 1 of 2 institutions with complaints of persistent pain after their index procedure. A radiographic and infectious work-up was completed for each patient. All 13 patients underwent a revision of the index surgery with intraoperative diagnosis of tibial component debonding at the implant-cement interface. HVC (Cobalt, DJO Surgical, Vista, CA and Depuy HVC; Depuy Inc, Warsaw, IN) was used in all index cases. RESULTS The average time to revision surgery for the 13 patients was 2.7 ± 1.9 years from the index surgery. Laboratory infectious markers were within normal in most cases, and all intra-articular aspirations showed no bacterial, fungal, or anaerobic growth. Eleven of 13 patients showed no radiographic evidence of loosening; however, all cases demonstrated tibial component debonding intraoperatively. CONCLUSION Given our institution's experience and previously reported data demonstrating excellent survivorship with this total knee arthroplasty prosthesis, we propose that the early failures seen in this case series may be associated with the use of HVC cement. In the setting of a negative infectious work-up and no radiographic evidence to suggest loosening, the surgeon should consider debonding of the tibial component as a potential cause for persistent pain if HVC cement was used with this prosthetic design.
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Gergely RCR, Toohey KS, Jones ME, Small SR, Berend ME. Towards the optimization of the preparation procedures of PMMA bone cement. J Orthop Res 2016; 34:915-23. [PMID: 26573962 DOI: 10.1002/jor.23100] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 11/03/2015] [Indexed: 02/04/2023]
Abstract
The mechanical properties and thermal history of polymethyl-methacrylate bone cement vary significantly with the preparation procedure used. Because the polymerization reaction is exothermic, many researchers have attempted to minimize thermal osteonecrosis due to heat generation by altering procedures in the preparation of the cement. In most previous studies, only one or two aspects of the preparation procedure were controlled, and there has been little research that comprehensively examines the effects of preparation on the cure kinetics and resulting properties of bone cement. In this study, cement viscosity, cement layer thickness, initial cement temperature, initial metal component temperature, and mixing method were varied to assess the effects on the cement. Maximum temperature, polymerization time, necrosis index, bending strength, and porosity were chosen to evaluate the different preparation procedures, where an optimal procedure would minimize necrosis, reduce cement cure time, and maximize bending strength. Design of Experiments (DOE) was used to examine the main effects and interactions of preparation techniques. Among the most prominent results, it was found that the cure kinetics and the related quantities are primarily controlled by the initial metal component temperature and that the bending strength is most dependent on the mixing method. For the two formulations studied, the optimum preparation procedures should keep cement and metal components at room temperature prior to mixing with a vacuum mixing system. Reducing cement mantle thickness may also be advantageous, as it reduces the maximum temperature and the risk of tissue damage. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:915-923, 2016.
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Affiliation(s)
- Ryan C R Gergely
- Rose-Hulman Institute of Technology, 5500 Wabash Avenue, Terre Haute, Indiana, 47803
| | - Kathleen S Toohey
- Rose-Hulman Institute of Technology, 5500 Wabash Avenue, Terre Haute, Indiana, 47803
| | - Mary E Jones
- Rose-Hulman Institute of Technology, 5500 Wabash Avenue, Terre Haute, Indiana, 47803
| | - Scott R Small
- JRSI Foundation, Inc., 1199 Hadley Road, Mooresville, Indiana, 46158
| | - Michael E Berend
- JRSI Foundation, Inc., 1199 Hadley Road, Mooresville, Indiana, 46158
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Hazelwood KJ, O'Rourke M, Stamos VP, McMillan RD, Beigler D, Robb WJ. Case series report: Early cement-implant interface fixation failure in total knee replacement. Knee 2015; 22:424-8. [PMID: 25795544 DOI: 10.1016/j.knee.2015.02.016] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 02/23/2015] [Accepted: 02/24/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Early failure in cemented total knee replacement (TKR) due to aseptic loosening is uncommon. A small number of early failures requiring revision were observed at one hospital due to observed cement-implant fixation failure. The purpose of this case series is to report and identify possible causes for these early failures. METHODS Between May 2005 and December 2010, 3048 primary TKRs were performed over a five-year period of time by six surgeons. Two total knee systems were used during this period of time. Nine early failures were observed in eight patients. High viscosity cement (HVC) was used in all these cases. RESULTS Aseptic loosening of the tibial component was observed in all nine early total knee failures. The high viscosity bone cement was noted to be non-adherent to the tibial trays at the time of revision surgery. HVC was used in all these cases. CONCLUSIONS Properties of HVC may contribute to make it more susceptible to early failure in a small number of TKRs. HVC in total hip replacement (THR) has been associated with cement micro-fractures, cement debris generation and early implant failure. The mechanical properties of HVC may similarly contribute to early failure at the cement-implant interface in a small percentage TKRs.
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Affiliation(s)
- Kyle J Hazelwood
- Luke Air Force Base, 56th Medical Group, Orthopaedic Surgery, Luke AFB, AZ, United States.
| | - Michael O'Rourke
- Department of Orthopaedic Surgery, Northshore University Healthsystem, Evanston, IL, United States
| | - Van P Stamos
- Department of Orthopaedic Surgery, Northshore University Healthsystem, Evanston, IL, United States
| | - Robert D McMillan
- Department of Orthopaedic Surgery, Northshore University Healthsystem, Evanston, IL, United States
| | - David Beigler
- Department of Orthopaedic Surgery, Northshore University Healthsystem, Evanston, IL, United States
| | - William J Robb
- Department of Orthopaedic Surgery, Northshore University Healthsystem, Evanston, IL, United States
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Yamaga Y, Kanatani M, Nomura S. Usefulness of a rotation–revolution mixer for mixing powder–liquid reline material. J Prosthodont Res 2015; 59:71-8. [DOI: 10.1016/j.jpor.2014.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 11/07/2014] [Accepted: 11/11/2014] [Indexed: 10/24/2022]
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20
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Clements J, Walker G, Pentlavalli S, Dunne N. Optimisation of a two-liquid component pre-filled acrylic bone cement system: a design of experiments approach to optimise cement final properties. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2014; 25:2287-2296. [PMID: 25005558 DOI: 10.1007/s10856-014-5260-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 06/16/2014] [Indexed: 06/03/2023]
Abstract
The initial composition of acrylic bone cement along with the mixing and delivery technique used can influence its final properties and therefore its clinical success in vivo. The polymerisation of acrylic bone cement is complex with a number of processes happening simultaneously. Acrylic bone cement mixing and delivery systems have undergone several design changes in their advancement, although the cement constituents themselves have remained unchanged since they were first used. This study was conducted to determine the factors that had the greatest effect on the final properties of acrylic bone cement using a pre-filled bone cement mixing and delivery system. A design of experiments (DoE) approach was used to determine the impact of the factors associated with this mixing and delivery method on the final properties of the cement produced. The DoE illustrated that all factors present within this study had a significant impact on the final properties of the cement. An optimum cement composition was hypothesised and tested. This optimum recipe produced cement with final mechanical and thermal properties within the clinical guidelines and stated by ISO 5833 (International Standard Organisation (ISO), International standard 5833: implants for surgery-acrylic resin cements, 2002), however the low setting times observed would not be clinically viable and could result in complications during the surgical technique. As a result further development would be required to improve the setting time of the cement in order for it to be deemed suitable for use in total joint replacement surgery.
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Affiliation(s)
- James Clements
- School of Mechanical and Aerospace Engineering, Queen's University Belfast, Stranmillis Road, Belfast, BT9 5AH, UK
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21
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Slane JA, Vivanco JF, Rose WE, Squire MW, Ploeg HL. The influence of low concentrations of a water soluble poragen on the material properties, antibiotic release, and biofilm inhibition of an acrylic bone cement. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2014; 42:168-76. [PMID: 25063107 DOI: 10.1016/j.msec.2014.05.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 03/26/2014] [Accepted: 05/06/2014] [Indexed: 12/21/2022]
Abstract
Soluble particulate fillers can be incorporated into antibiotic-loaded acrylic bone cement in an effort to enhance antibiotic elution. Xylitol is a material that shows potential for use as a filler due to its high solubility and potential to inhibit biofilm formation. The objective of this work, therefore, was to investigate the usage of low concentrations of xylitol in a gentamicin-loaded cement. Five different cements were prepared with various xylitol loadings (0, 1, 2.5, 5 or 10 g) per cement unit, and the resulting impact on the mechanical properties, cumulative antibiotic release, biofilm inhibition, and thermal characteristics were quantified. Xylitol significantly increased cement porosity and a sustained increase in gentamicin elution was observed in all samples containing xylitol with a maximum cumulative release of 41.3%. Xylitol had no significant inhibitory effect on biofilm formation. All measured mechanical properties tended to decrease with increasing xylitol concentration; however, these effects were not always significant. Polymerization characteristics were consistent among all groups with no significant differences found. The results from this study indicate that xylitol-modified bone cement may not be appropriate for implant fixation but could be used in instances where sustained, increased antibiotic elution is warranted, such as in cement spacers or beads.
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Affiliation(s)
- Josh A Slane
- Materials Science Program, University of Wisconsin-Madison, Madison, WI, USA; Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI, USA.
| | - Juan F Vivanco
- Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI, USA; Facultad de Ingeniería y Ciencias, Universidad Adolfo Ibañez, Viña del Mar, Chile
| | - Warren E Rose
- Pharmacy Practice Division, School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
| | - Matthew W Squire
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA
| | - Heidi-Lynn Ploeg
- Materials Science Program, University of Wisconsin-Madison, Madison, WI, USA; Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, WI, USA
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Tarsuslugil SM, O'Hara RM, Dunne NJ, Buchanan FJ, Orr JF, Barton DC, Wilcox RK. Experimental and computational approach investigating burst fracture augmentation using PMMA and calcium phosphate cements. Ann Biomed Eng 2014; 42:751-62. [PMID: 24395013 PMCID: PMC3949010 DOI: 10.1007/s10439-013-0959-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 12/06/2013] [Indexed: 11/28/2022]
Abstract
The aim of the study was to use a computational and experimental approach to evaluate, compare and predict the ability of calcium phosphate (CaP) and poly (methyl methacrylate) (PMMA) augmentation cements to restore mechanical stability to traumatically fractured vertebrae, following a vertebroplasty procedure. Traumatic fractures (n = 17) were generated in a series of porcine vertebrae using a drop-weight method. The fractured vertebrae were imaged using μCT and tested under axial compression. Twelve of the fractured vertebrae were randomly selected to undergo a vertebroplasty procedure using either a PMMA (n = 6) or a CaP cement variation (n = 6). The specimens were imaged using μCT and re-tested. Finite element models of the fractured and augmented vertebrae were generated from the μCT data and used to compare the effect of fracture void fill with augmented specimen stiffness. Significant increases (p < 0.05) in failure load were found for both of the augmented specimen groups compared to the fractured group. The experimental and computational results indicated that neither the CaP cement nor PMMA cement could completely restore the vertebral mechanical behavior to the intact level. The effectiveness of the procedure appeared to be more influenced by the volume of fracture filled rather than by the mechanical properties of the cement itself.
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Affiliation(s)
- Sami M Tarsuslugil
- School of Mechanical Engineering, University of Leeds, Leeds, LS2 9JT, UK,
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23
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Karimzadeh A, Ayatollahi MR. Mechanical Properties of Biomaterials Determined by Nano-Indentation and Nano-Scratch Tests. SOLID MECHANICS AND ITS APPLICATIONS 2014. [DOI: 10.1007/978-94-007-6919-9_10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
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Zhang H, Blunt L, Jiang X, Brown L, Barrans S. The Significance of the Micropores at the Stem–Cement Interface in Total Hip Replacement. JOURNAL OF BIOMATERIALS SCIENCE-POLYMER EDITION 2012; 22:845-56. [DOI: 10.1163/092050610x540495] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- H. Zhang
- a State Key Laboratory of Tribology, School of Mechanical Engineering, Tsinghua University, Beijing 100084, P. R. China; Centre for Precision Technologies, School of Computing and Engineering, University of Huddersfield, Huddersfield HD1 3DH, UK.
| | - L. Blunt
- b Centre for Precision Technologies, School of Computing and Engineering, University of Huddersfield, Huddersfield HD1 3DH, UK
| | - X. Jiang
- c Centre for Precision Technologies, School of Computing and Engineering, University of Huddersfield, Huddersfield HD1 3DH, UK
| | - L. Brown
- d Centre for Precision Technologies, School of Computing and Engineering, University of Huddersfield, Huddersfield HD1 3DH, UK
| | - S. Barrans
- e Centre for Precision Technologies, School of Computing and Engineering, University of Huddersfield, Huddersfield HD1 3DH, UK
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25
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Guedes RM, Gomes M, Simões JA. DMTA analysis for long-term mechanical behaviour prediction of PMMA-based bone cements. JOURNAL OF BIOMATERIALS SCIENCE-POLYMER EDITION 2012. [DOI: 10.1163/156856206778530678] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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26
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Completo A, Coutinho M, Schiller M, Ramos A, Relvas C, Simões JA. A Device to Control Implant and Bone-Cement Temperatures in Cemented Arthroplasty. J Med Device 2012. [DOI: 10.1115/1.4005783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
At present, most of the orthopaedic implants used in articular reconstruction are fixed to host bone using acrylic bone-cement. Bone-cement polymerization leads to an exothermic reaction with heat release and consequent temperature rise. The increase of temperature in the bone beyond the tolerated limits can develop osteocyte thermal necrosis and ultimately lead to bone resorption at the cement-bone interface, with subsequent loosening of the implant. Another issue that plays an important role in implant loosening is debonding of the cement from the implant initiated by crack formation at the interfacial voids. It is well established that low porosity enables better fatigue cement properties. Moderate preheating of the implant is expected to reverse the direction of polymerization, and has the ability to reduce interfacial void formation and improve interfacial shear strength. To increase the implant temperature at the initial cementing phase in order to reduce interfacial void formation, and subsequently, cool the implant in the latter cement polymerization phase to prevent the possibility of bone thermal necrosis, a new automated electronic device was designed to be use in cemented joint replacements. The developed device was specifically designed for the knee arthroplasty, namely for tibial-tray cementing. The device controls the heat flux direction between the tibial-tray and the atmosphere through the “Peltier effect,” using Peltier tablets. The device is placed on the tibial-tray during the cementing phase and starts to heat it in a first phase, promoting the polymerization that initiates at the warmer cement-implant interface. In a second phase, the heat flux in the Peltier tablets is inverted to extract the heat generated during cement polymerization. The device efficiency was evaluated by cementing several tibial-trays in bovine fresh bone and measuring the tray and cement temperatures. The temperature results in the implant and in the cement showed that the device increases and maintains the implant temperature above room temperature at the initial cementing phase, while in the subsequent phase it cools the tibial-tray and cement. Significant differences were found for peak cement temperatures between the tests performed with and without the device. The device showed its capacity to promote the beginning of cement polymerization at the implant interface contributing towards improving interfacial shear strength and in reducing the peak cement temperature in the subsequent polymerization process, thus contributing to the prevention of the bone thermal necrosis effect.
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Affiliation(s)
- A. Completo
- Department of Mechanical Engineering, University of Aveiro, 3810-193 Aveiro, Portugal
| | - M. Coutinho
- Department of Mechanical Engineering, University of Aveiro, 3810-193 Aveiro, Portugal
| | - M. Schiller
- Department of Mechanical Engineering, University of Aveiro, 3810-193 Aveiro, Portugal
| | - A. Ramos
- Department of Mechanical Engineering, University of Aveiro, 3810-193 Aveiro, Portugal
| | - C. Relvas
- Department of Mechanical Engineering, University of Aveiro, 3810-193 Aveiro, Portugal
| | - J. A. Simões
- Department of Mechanical Engineering, University of Aveiro, 3810-193 Aveiro, Portugal
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Kim S, Greenleaf R, Miller MC, Satish L, Kathju S, Ehrlich G, Post JC, Sotereanos NG, Stoodley P. Mechanical effects, antimicrobial efficacy and cytotoxicity of usnic acid as a biofilm prophylaxis in PMMA. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2011; 22:2773-2780. [PMID: 21938390 DOI: 10.1007/s10856-011-4445-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2010] [Accepted: 09/05/2011] [Indexed: 05/31/2023]
Abstract
Experiments were performed to test the null hypothesis that the addition of a natural occurring antibiotic would not alter mechanical properties of polymethylmethacrylate (PMMA). Compression and four-point bending tests were used to assess mechanical properties of zirconium dioxide bearing bone cement (Type Zr) and barium sulfate bearing bone cement (Type Ba), mixed with the antibiotic usnic acid ("usnic"), used to create a surface resistant to biofilm formation. Addition of usnic had a statistically significant effect on the material properties. Compressive and bending strengths decreased as usnic was added and Type Zr was stronger than Type Ba although material properties remained above recommended minima. With implications of liver toxicity with large doses of usnic taken as a dietary supplement, cytotoxicity tests using bone cement coupons were performed and showed very little or no toxicity in primary cultures of rabbit skin derived fibroblasts. A simple test of usnic's efficacy as a biofilm prophylaxis in PMMA was also conducted. Bone cement coupons with usnic were tested for their effectiveness against methicillin resistant Staphylococcus aureus. Diminished biofilm formation on usnic-containing coupons indicated that usnic can be an effective anti-microbial agent.
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Rudol G, Wilcox R, Jin Z, Tsiridis E. The effect of surface finish and interstitial fluid on the cement-in-cement interface in revision surgery of the hip. ACTA ACUST UNITED AC 2011; 93:188-93. [DOI: 10.1302/0301-620x.93b2.24759] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The mechanical performance of the cement-in-cement interface in revision surgery has not been fully investigated. The quantitative effect posed by interstitial fluids and roughening of the primary mantle remains unclear. We have analysed the strength of the bilaminar cement-bone interface after exposure of the surface of the primary mantle to roughening and fluid interference. The end surfaces of cylindrical blocks of cement were machined smooth (Ra = 200 nm) or rough (Ra = 5 μm) and exposed to either different volumes of water and carboxymethylcellulose (a bone-marrow equivalent) or left dry. Secondary blocks were cast against the modelled surface. Monoblocks of cement were used as a control group. The porosity of the samples was investigated using micro-CT. Samples were exposed to a single shearing force to failure. The mean failure load of the monoblock control was 5.63 kN (95% confidence interval (CI) 5.17 to 6.08) with an estimated shear strength of 36 MPa. When small volumes of any fluid or large volumes were used, the respective values fell between 4.66 kN and 4.84 kN with no significant difference irrespective of roughening (p > 0.05). Large volumes of carboxymethylcellulose significantly weakened the interface. Roughening in this group significantly increased the strength with failure loads of 2.80 kN (95% CI 2.37 to 3.21) compared with 0.86 kN (95% CI 0.43 to 1.27) in the smooth variant. Roughening of the primary mantle may not therefore be as crucial as has been previously thought in clinically relevant circumstances.
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Affiliation(s)
- G. Rudol
- Department of Trauma and Orthopaedics, Leeds General Infirmary, Clarendon A, Great George Street, Leeds LS1 3EX, UK
| | - R. Wilcox
- Institute of Medical and Biological Engineering, School of Mechanical Engineering University of Leeds, Leeds LS2 9JT, UK
| | - Z. Jin
- Institute of Medical and Biological Engineering, School of Mechanical Engineering University of Leeds, Leeds LS2 9JT, UK
| | - E. Tsiridis
- University of Thessaloniki, University Campus GR 54124, Thessaloniki, Greece
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Abstract
Acrylic bone cements are in extensive use in joint replacement surgery. They are weight bearing and load transferring in the bone-cement-prosthesis complex and therefore, inter alia, their mechanical properties are deemed to be crucial for the overall outcome. In spite of adequate preclinical test results according to the current specifications (ISO, ASTM), cements with inferior clinical results have appeared on the market. The aim of this study was to investigate whether it is possible to predict the long term clinical performance of acrylic bone cement on the basis of mechanical in vitro testing. We performed in vitro quasistatic testing of cement after aging in different media and at different temperatures for up to 5 years. Dynamic creep testing and testing of retrieved cement were also performed. Testing under dry conditions, as required in current standards, always gave higher values for mechanical properties than did storage and testing under more physiological conditions. We could demonstrate a continuous increase in mechanical properties when testing in air, while testing in water resulted in a slight decrease in mechanical properties after 1 week and then levelled out. Palacos bone cement showed a higher creep than CMW3G and the retrieved Boneloc specimens showed a higher creep than retrieved Palacos. The strength of a bone cement develops more slowly than the apparent high initial setting rate indicates and there are changes in mechanical properties over a period of five years. The effect of water absorption is important for the physical properties but the mechanical changes caused by physical aging are still present after immersion in water. The established standards are in need of more clinically relevant test methods and their associated requirements need better definition. We recommend that testing of bone cements should be performed after extended aging under simulated physiological conditions. Simple quasistatic and dynamic creep tests seem unable to predict clinical performance of acrylic bone cements when the products under test are chemically very similar. However, such testing might be clinically relevant if the cements exhibit substantial differences.
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Affiliation(s)
- Markus Nottrott
- Centre for Bone- and Soft tissue Tumours, Department of Orthopaedic Surgery, Haukeland University Hospital, NO-5021 Bergen, Norway.
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Bishop NE, Schoenwald M, Schultz P, Püschel K, Morlock MM. The condition of the cement mantle in femoral hip prosthesis implantations--a post mortem retrieval study. Hip Int 2009; 19:87-95. [PMID: 19462363 DOI: 10.1177/112070000901900202] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Despite numerous studies demonstrating the characteristics of the optimal cement mantle in joint replacement, the clinical state of the cement mantle is rarely assessed. A random sample of 214 cemented implanted femoral hip components was retrieved post mortem from Hamburg, Germany, and sectioned to investigate the quality of the cement mantle. The most common observation made in at least one measured region per retrieval was debonding (82% of stems), followed by a thin cement mantle (74%), stem-bone contact (48%), soft tissue at the stem interface (44%), no cement-bone interdigitation (30%), a gap at the stem interface (28%), voids in the cement (22%) and cracks and blood in the cement mantle (<10%). 21% of stems demonstrated complete debonding of the interface. However, distributions of all other defects were local, with less than 10% of stems demonstrating any imperfection in more than 21% of the regions assessed. No progressive damage was observed with implantation duration. The results suggest that current implantation technique may be adequate for proper implant function over the service life in the older patient population. However, for younger and more active patients, perfection of the cementation technique is crucial, particularly in modern implant systems such as resurfacing. The frequency of almost all defects could be further reduced by careful implantation technique, providing the increased service life necessary for the ever younger, more physically demanding, patient population.
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Affiliation(s)
- Nicholas E Bishop
- Biomechanics Section, TUHH Hamburg University of Technology, Hamburg, Germany.
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Coultrup OJ, Browne M, Hunt C, Taylor M. Accounting for inclusions and voids allows the prediction of tensile fatigue life of bone cement. J Biomech Eng 2009; 131:051007. [PMID: 19388777 DOI: 10.1115/1.3049518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Previous attempts by researchers to predict the fatigue behavior of bone cement have been capable of predicting the location of final failure in complex geometries but incapable of predicting cement fatigue life to the right order of magnitude of loading cycles. This has been attributed to a failure to model the internal defects present in bone cement and their associated stress singularities. In this study, dog-bone-shaped specimens of bone cement were micro-computed-tomography (microCT) scanned to generate computational finite element (FE) models before uniaxial tensile fatigue testing. Acoustic emission (AE) monitoring was used to locate damage events in real time during tensile fatigue tests and to facilitate a comparison with the damage predicted in FE simulations of the same tests. By tracking both acoustic emissions and predicted damage back to microCT scans, barium sulfate (BaSO(4)) agglomerates were found not to be significant in determining fatigue life (p=0.0604) of specimens. Both the experimental and numerical studies showed that diffuse damage occurred throughout the gauge length. A good linear correlation (R(2)=0.70, p=0.0252) was found between the experimental and the predicted tensile fatigue life. Although the FE models were not always able to predict the correct failure location, damage was predicted in simulations at areas identified as experiencing damage using AE monitoring.
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Affiliation(s)
- Oliver J Coultrup
- Bioengineering Research Group, School of Engineering Sciences, University of Southampton, Southampton SO17 1BJ, UK
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Sinnett-Jones PE, Browne M, Moffat AJ, Jeffers JRT, Saffari N, Buffière JY, Sinclair I. Crack initiation processes in acrylic bone cement. J Biomed Mater Res A 2009; 89:1088-97. [PMID: 18481811 DOI: 10.1002/jbm.a.32037] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
A major constraint in improving the understanding of the micromechanics of the fatigue failure process and, hence, in optimizing bone cement performance is found in the uncertainties associated with monitoring the evolution of the internal defects that are believed to dominate in vivo failure. The present study aimed to synthesize high resolution imaging with complementary damage monitoring/detection techniques. As a result, evidence of the chronology of failure has been obtained. The earliest stages of crack initiation have been captured and it is proposed that, in the presence of a pore, crack initiation may occur away from the pore due to the combined influence of pore morphology and the presence of defects within regions of stress concentration. Furthermore, experimental evidence shows that large agglomerations of BaSO(4) are subject to microcracking during fatigue, although in the majority of cases, these are not the primary cause of failure. It is proposed that cracks may then remain contained within the agglomerations because of the clamping effect of the matrix during volumetric shrinkage upon curing.
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Affiliation(s)
- P E Sinnett-Jones
- Bioengineering Sciences Research Group, School of Engineering Sciences, Southampton University, Southampton SO17 1BJ, United Kingdom
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Mavrogordato M, Taylor M, Taylor A, Browne M. Acoustic emission monitoring and 3D visualization of polymerization-induced damage of acrylic polymer materials. J Biomed Mater Res B Appl Biomater 2008; 90:223-8. [DOI: 10.1002/jbm.b.31276] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Nottrott M, Mølster AO, Moldestad IO, Walsh WR, Gjerdet NR. Performance of bone cements: are current preclinical specifications adequate? Acta Orthop 2008; 79:826-31. [PMID: 19085502 DOI: 10.1080/17453670810016920] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Current specifications (standards) for preclinical testing of bone cements (ISO 5833: 2002, ASTM F451-99a) require simple mechanical testing after ageing for 24 h under dry conditions at 23 degrees C. Some bone cements have fulfilled the requirements in the specifications, and yet had inferior clinical results. Clinically, bone cements are subjected to complex loading patterns in a moist or wet environment at 37 degrees C. Thus, both the validity and the robustness of current standard testing protocols can be questioned. METHODS We examined the influence of temperature and storage medium on the properties of bone cement. We also compared the results of storage and testing under standard conditions of 23 degrees C in dry air, with the results obtained at 37 degrees C in water or plasma. RESULTS The dry specimens showed an increase in strength and elastic modulus with time, while the values of the wet ones decreased. There was no difference between specimens stored in water or in plasma. Ultimate compressive strength of dry specimens after 24 h was 1.16 times higher than that of the ones stored wet, increasing to 1.34 times after 1 month, and 1.46 times after 6 months (p<0.001 for all comparisons). INTERPRETATION Testing under dry conditions-as required in current standards-always gave higher values for mechanical properties than did storage and testing under more physiological conditions. The sensitivity of test values to different environments implies that testing conditions for bone cements should be scrutinized in order to develop more relevant testing protocols that reflect the in vivo environment more closely.
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Affiliation(s)
- Markus Nottrott
- Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway.
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Nuño N, Madrala A, Plamondon D. Measurement of transient and residual stresses during polymerization of bone cement for cemented hip implants. J Biomech 2008; 41:2605-11. [PMID: 18692188 DOI: 10.1016/j.jbiomech.2008.06.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2008] [Revised: 05/24/2008] [Accepted: 06/19/2008] [Indexed: 10/21/2022]
Abstract
The initial fixation of a cemented hip implant relies on the strength of the interface between the stem, bone cement and adjacent bone. Bone cement is used as grouting material to fix the prosthesis to the bone. The curing process of bone cement is an exothermic reaction where bone cement undergoes volumetric changes that will generate transient stresses resulting in residual stresses once polymerization is completed. However, the precise magnitude of these stresses is still not well documented in the literature. The objective of this study is to develop an experiment for the direct measurement of the transient and residual radial stresses at the stem-cement interface generated during cement polymerization. The idealized femoral-cemented implant consists of a stem placed inside a hollow cylindrical bone filled with bone cement. A sub-miniature load cell is inserted inside the stem to make a direct measurement of the radial compressive forces at the stem-cement interface, which are then converted to radial stresses. A thermocouple measures the temperature evolution during the polymerization process. The results show the evolution of stress generation corresponding to volumetric changes in the cement. The effect of initial temperature of the stem and bone as well as the cement-bone interface condition (adhesion or no adhesion) on residual radial stresses is investigated. A maximum peak temperature of 70 degrees C corresponds to a peak in transient stress during cement curing. Maximum radial residual stresses of 0.6 MPa in compression are measured for the preheated stem.
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Affiliation(s)
- N Nuño
- Ecole de technologie supérieure, Laboratoire de recherche en imagerie et orthopédie, Département de génie de la production automatisée, Université du Québec, 1100 rue Notre-Dame Ouest, Montréal, Québec, Canada H3C 1K3.
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Dunne NJ, Hill J, McAfee P, Kirkpatrick R, Patrick S, Tunney M. Incorporation of large amounts of gentamicin sulphate into acrylic bone cement: Effect on handling and mechanical properties, antibiotic release, and biofilm formation. Proc Inst Mech Eng H 2008; 222:355-65. [DOI: 10.1243/09544119jeim355] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Bacterial infection remains a significant complication following total joint replacement. If infection is suspected when revision surgery is being performed, a large dose of antibiotic, usually gentamicin sulphate, is often blended with the acrylic bone cement powder in an attempt to reduce the risk of recurrent infection. In this in-vitro study the effect of small and large doses of gentamicin sulphate on the handling and mechanical properties of the cement, gentamicin release from the cement, and in-vitro biofilm formation by clinical Staphylococcus spp. isolates on the cement was determined. An increase in gentamicin loading of 1, 2, 3, or 4 g, in a cement powder mass of 40 g, resulted in a significant decrease in the compressive and four-point bending strength, but a significant increase in the amount of gentamicin released over a 72 h period. When overt infection was modelled, using Staphylococcus spp. clinical isolates at an inoculum of 1×107 colony-forming units/ml, an increase in the amount of gentamicin (1, 2, 3, or 4 g) added to 40 g of poly(methyl methacrylate) cement resulted in an initial decrease in bacterial colonization but this beneficial effect was no longer apparent by 72 h, with the bacterial strains forming biofilms on the cements despite the release of high levels of gentamicin. The findings suggest that orthopaedic surgeons should carefully consider the clinical consequences of blending large doses (1 g or more per 40 g of poly(methyl methacrylate)) of gentamicin into Palacos® R bone cement for use in revision surgery as the increased gentamicin loading does not prevent bacterial biofilm formation and the effect on the mechanical properties could be important to the longevity of the prosthetic joint.
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Affiliation(s)
- N J Dunne
- School of Mechanical and Aerospace Engineering, Queen's University Belfast, Belfast, UK
| | - J Hill
- School of Mechanical and Aerospace Engineering, Queen's University Belfast, Belfast, UK
| | - P McAfee
- School of Mechanical and Aerospace Engineering, Queen's University Belfast, Belfast, UK
| | - R Kirkpatrick
- School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - S Patrick
- School of Medicine and Dentistry, Queen's University Belfast, Belfast, UK
| | - M Tunney
- School of Pharmacy, Queen's University Belfast, Belfast, UK
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37
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Dunne NJ, Xu Y, Makem J, Orr I. Ultrasonic characterization of the mechanical properties and polymerization reaction of acrylic-based bone cements. Proc Inst Mech Eng H 2007; 221:251-61. [PMID: 17539581 DOI: 10.1243/09544119jeim168] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In this investigation the pulse-echo technique was validated as a method that could be used to monitor the complete polymerization of acrylic bone cement in a surgical theatre. Currently, orthopaedic surgeons have no objective method to quantify the state of cure of bone cement as it progresses through its polymerization cycle. Clear benefits of the pulse-echo technique are that it is easy to use, non-invasive, and non-destructive. Furthermore, the test results were found to be highly reproducible with minor deviations. Three proprietary cements were used to confirm the validity of the technique; CMW Endurance, Palacos R and Simplex P. The results showed that the acoustic properties of bone cement clearly demonstrated a relationship with the different stages of polymerization, and in particular with the transitions between the waiting, dough, and setting phases. Additionally, the cure time of the poly(methyl methacrylate) cements consistently correlated with the attainment of 75 per cent of the average maximum velocity of sound value. The measured cure times concurred with the ISO and ASTM standards. Moreover, measurements of the final sound velocity and broadband ultrasonic attenuation correlated strongly with the density and mechanical properties of the cured bone cement samples.
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Affiliation(s)
- N J Dunne
- Medical Polymers Research Institute, Queens University of Belfast, Belfast, UK.
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38
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Shafranska O, Kokott A, Sülthaus D, Ziegler G. Effect of surface modification of polymer beads on the mechanical properties of acrylic bone cement. JOURNAL OF BIOMATERIALS SCIENCE. POLYMER EDITION 2007; 18:439-51. [PMID: 17540118 DOI: 10.1163/156856207780425040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The effect of surface modification of polymer filler on the static mechanical properties of acrylic bone cement was studied. The surface of polymer beads was modified with carboxylic and amino groups by photochemical reaction with azide compounds. Monomer modifiers (maleic anhydride, methacrylic acid and p-aminostyrene) are attached to the functionalized surface of polymer beads. Functional allyl groups, which are capable of the graft polymerisation reaction, are attached to the surface via photochemical reaction with N-(2-nitro-4-azidophenyl)-N-(-propen) amine. This approach to bone cement provides the additional covalent bonds between the polymer beads and the inter-bead matrix. The static mechanical properties of bone cements containing modified polymer beads were investigated and compared with the static mechanical properties of unmodified cements. The absolute values of compressive strength for the modified and unmodified cements were found to be similar. An increase in flexural strength for the modified cements (dry and after water storage) was observed. The structure of the surface functional groups affects the methyl methacrylate grafting resulting in a higher value of flexural strength for the maleic anhydride- and p-aminostyrene-modified cements. The scanning electron microscopy examination of the fracture surface of the cement samples showed an improvement of the adhesion between the beads and the matrix after modification.
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Affiliation(s)
- Olena Shafranska
- Friedrich-Baur Research Institute for Biomaterials, University of Bayreuth, Ludwig-Thoma Str. 36c, 95447 Bayreuth, Germany.
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39
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Nottrott M, Mølster AO, Gjerdet NR. Time dependent mechanical properties of bone cement. Anin vitro study over one year. J Biomed Mater Res B Appl Biomater 2007; 83:416-21. [PMID: 17415769 DOI: 10.1002/jbm.b.30811] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Changes in mechanical properties of bone cements over time are of clinical importance, but not well documented. Specifications for testing do not address the time factor. This study recorded changes in compressive properties and microstructure of one bone cement stored under simulated physiological conditions (water at 37 degrees C) from 20 min up to 1 year and in dry air at 37 degrees C for comparison. Compressive strength increased within the first week (p < 0.001), decreased at 1 month (p < 0.001), and remained at that level at 1 year. Elastic modulus showed a similar development. Maximum strain values, indicating plastic deformability, increased continuously over 1 year. Microscopy revealed microcracks between the pre-polymer beads and the matrix in specimens tested after 20 min, whereas there were less cracks in 1 year specimens. Increase in strength during the first week is due to polymerization and formation of interpenetrating molecular networks. The subsequent decrease could be due to the plasticizing effect of water uptake, as supported by higher values for dry specimens. It can be speculated that microcracks which could be initiated while reducing an arthroplasty at 15 min, acting as initiators for fatigue fractures in the cement mantle, contribute to cement failure. It is recommended that testing of bone cements should be performed after extended ageing at simulated physiological conditions, for the present cement at least 5 weeks. Results obtained at less than one week could be influenced by ongoing polymerization, as well as microcracks and lower coherence between the prepolymer beads and the matrix.
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Affiliation(s)
- Markus Nottrott
- Department of Orthopaedic Surgery, Haukeland University Hospital, 5021 Bergen, Norway.
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40
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Hsieh PH, Tai CL, Chang YH, Lee MS, Shih HN, Shih CH. Precooling of the femoral canal enhances shear strength at the cement-prosthesis interface and reduces the polymerization temperature. J Orthop Res 2006; 24:1809-14. [PMID: 16865715 DOI: 10.1002/jor.20242] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Preheating of the femoral stem in total hip arthroplasty improves the cement-prosthesis bond by decreasing the interfacial porosity. The main concern, however, is the potential thermal osteonecrosis because of an increased polymerization temperature. In this study, the effects of femoral canal precooling on the characteristics of the cement-stem interface were evaluated in an experimental model for three test conditions: precooling of the femoral canal, preheating of the stem (44 degrees C), and a control in which stems were inserted at room temperature without thermal manipulation of the implant, cement, or bone. Compared to the control group, precooling of the femoral canal and preheating of the stem had similar effects on the cement-stem interface, with greater interfacial shear strength and a reduced porosity. Femoral canal precooling also produced a lower temperature at the cement-bone interface. No difference was found in the ultimate compressive strength of bone cement for the three preparation conditions. Based on this laboratory model, precooling of the femoral canal could improve shear strength and porosity at the stem-cement interface, minimize thermal injury, and maintain the mechanical strength of the cement.
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Affiliation(s)
- Pang-Hsin Hsieh
- Department of Orthopedics, Chang Gung Memorial Hospital, Kweishan, Taoyuan, Taiwan.
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41
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Lewis G, Xu J, Dunne N, Daly C, Orr J. Critical comparison of two methods for the determination of nanomechanical properties of a material: Application to synthetic and natural biomaterials. J Biomed Mater Res B Appl Biomater 2006; 78:312-7. [PMID: 16470815 DOI: 10.1002/jbm.b.30489] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Two methods used for determining the elastic modulus (E) and hardness (H) of a material--the original version of the well-known Oliver-Pharr Method, OOPM, and a variant of it called the Modified Slopes Method, MSM--were critically compared. The nanoindentation test results, of indenter load-versus-indenter displacement, were recorded for six series of specimens, three of commercially-available acrylic bone cements (Palacos R and Cemex XL) and three of bones (human, bovine, and mouse). In the first series, the specimens were prepared from Palacos R cement mantles retrieved from cemented total hip joint replacements after 11 months, 11 years, and 21 years in vivo. In the second and third series, the specimens were fabricated from hand- and vacuum-mixed dough of Cemex XL cement, respectively. In the fourth, fifth, and sixth series, the specimens were prepared from fresh frozen cortical bone of human tibia, plexiform bone from fresh bovine tibia, and femora from inbred mice, respectively. It was found that, for a given material, the values of E or H computed using OOPM and MSM are not significantly different. However, the recommendation is that MSM is preferable because it is straightforward-only the nanoindentation measurements and values of constants that depend on the geometry of the indenter used are needed. In contrast, when the OOPM is used, there is a critical input (the indenter tip area function), whose computation is problematic. The article also includes a succinct discussion of factors that affect the values of material properties computed from nanoindentation measurements, such as the loading rate and the surface roughness of the test specimen.
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Affiliation(s)
- Gladius Lewis
- Department of Mechanical Engineering, The University of Memphis, Tennessee 38152-3180, USA.
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42
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Cox BD, Wilcox RK, Levesley MC, Hall RM. Assessment of a three-dimensional measurement technique for the porosity evaluation of PMMA bone cement. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2006; 17:553-7. [PMID: 16691354 DOI: 10.1007/s10856-006-8939-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2005] [Accepted: 08/10/2005] [Indexed: 05/09/2023]
Abstract
In vitro testing of bone cement has historically resulted in the belief that porosity should be minimised to help reduce the risk of prosthesis failure through aseptic loosening. Traditional porosity measurement techniques rely on the analysis of a two dimensional representation of a three dimensional structure. However, with an increasing interest in the number, size and distribution of pores in bone cement, the reliability of a two dimensional approach is questionable. The purpose of this study was to investigate the use of micro computed tomography (micro-CT) for the three dimensional measurement of bone cement porosity by comparison with two traditional techniques. Eighteen bone cement specimens were analysed for porosity using each technique. Levels of agreement between techniques were evaluated, and technique precision was assessed in terms of repeatability and sensitivity to changes in threshold. Micro-CT data was used to illustrate the effectiveness of predicting the porosity of a whole structure from a sample region; an approach often used with traditional techniques. In summary, poor agreement was found between all techniques. However, micro-CT was found to be significantly more repeatable and less sensitive to changes in threshold. The results demonstrated that porosity cannot be reliably determined using traditional techniques and that a large proportion of a specimen is required to provide an accurate porosity measurement.
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Affiliation(s)
- Benjamin D Cox
- School of Mechanical Engineering, University of Leeds, Leeds LS2 9JT, UK
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43
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Dunne NJ, Leonard D, Daly C, Buchanan FJ, Orr JF. Validation of the small-punch test as a technique for characterizing the mechanical properties of acrylic bone cement. Proc Inst Mech Eng H 2006; 220:11-21. [PMID: 16459442 DOI: 10.1243/095441105x68980] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This paper examines the validity of using the small-punch test technique as a means of quantifying the mechanical properties of acrylic bone cement under different test conditions. The elastic moduli calculated using the small-punch test method were compared with data measured using the international standard for acrylic bone resin, ISO 5833. Conclusions from the study indicate that the small-punch test is a reproducible miniature specimen test method that can be used to characterize the mechanical properties of retrieved acrylic bone cement as used in total joint replacement surgery. Moreover, the test conditions were found to influence the elastic modulus of acrylic bone cement. The test temperature had a greater effect on the elastic behaviour of the bone cement than the test medium.
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Affiliation(s)
- N J Dunne
- School of Mechanical and Manufacturing Engineering, Queen's University of Belfast, Belfast, Northern Ireland.
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44
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Sinnett-Jones PE, Browne M, Ludwig W, Buffière JY, Sinclair I. Microtomography assessment of failure in acrylic bone cement. Biomaterials 2005; 26:6460-6. [PMID: 15967499 DOI: 10.1016/j.biomaterials.2005.04.064] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2005] [Accepted: 04/20/2005] [Indexed: 10/25/2022]
Abstract
Micromechanical studies of fatigue and fracture processes in acrylic bone cement have been limited to surface examination techniques and indirect signal analysis. Observations may then be mechanically unrepresentative and/or affected by the presence of the free surface. To overcome such limiting factors the present study has utilised synchrotron X-ray microtomography for the observation of internal defects and failure processes that occurred within a commercial bone cement during loading. The high resolution and the edge detection capability (via phase contrast imaging) have enabled clear microstructural imaging of both strongly and weakly absorbing features, with an effective isotropic voxel size of 0.7 microm. Detailed assessment of fatigue damage processes in in vitro fatigue test specimens is also achieved. Present observations confirm a link with macroscopic failure and the presence of larger voids, at which crack initiation may be linked to the mechanical stress concentration set up by adjacent beads at pore surfaces. This study does not particularly support the suggested propensity for failure to occur via the inter-bead matrix; however crack deflections at matrix/bead interfaces and the incidence of crack arrest within beads do imply locally increased resistance to failure and potential improvements in global crack growth resistance via crack tip shielding.
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Affiliation(s)
- P E Sinnett-Jones
- Bioengineering Sciences Research Group, School of Engineering Sciences, Southampton University, Highfield, Southampton SO17 1BJ, UK.
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45
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Shim JB, Warner SJ, Hasenwinkel JM, Gilbert JL. Analysis of the shelf life of a two-solution bone cement. Biomaterials 2005; 26:4181-7. [PMID: 15664645 DOI: 10.1016/j.biomaterials.2004.10.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2004] [Accepted: 10/19/2004] [Indexed: 10/26/2022]
Abstract
Two-solution bone cement consists of methyl methacrylate monomer and poly(methyl methacrylate) polymer dissolved together to yield a viscous solution. Two solutions are used such that the initiator, benzoyl peroxide (BPO), is placed in one solution and the activator, N,N, dimethyl-para-toluidine, is placed in the other. This approach to bone cement provides for a simplified use during surgery and eliminates some of the sources of porosity formation. However, the BPO-containing solution cement will spontaneously polymerize over time and will limit the useful shelf life of this component of the system. The activator-containing component is much more stable and is not as susceptible to spontaneous polymerization. In making two-solution cements, it is envisioned that antibiotics may be incorporated and that the polymer may be sterilized using gamma(gamma)-irradiation. Therefore, this study investigated the shelf life of the initiator-containing solution bone cement and studied the effects of initiator concentration, gamma-irradiation, gentamicin addition, and the role of storage temperature. Isothermal differential scanning calorimetry (Iso-DSC) techniques were used to monitor the polymerization of BPO-containing solutions. It was found that the shelf life was highly temperature dependent and followed an Arrhenius expression where refrigeration storage (4 degrees C) yielded approximately a 12-month storage time, while 70 degrees C storage results in setting in about 5-7 min. gamma-irradiation and gentamicin addition did not significantly affect the shelf life. Initiator concentration affected storage time with higher levels resulting in shorter shelf life.
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Affiliation(s)
- J B Shim
- Department of Bioengineering and Neuroscience, Syracuse University, Syracuse, NY 13244-5290, USA.
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Zenios M, Nokes L, Galasko CSB. Effect of a bisphosphonate, disodium pamidronate, on the quasi-static flexural properties of Palacos R acrylic bone cement. J Biomed Mater Res B Appl Biomater 2005; 71:322-6. [PMID: 15384075 DOI: 10.1002/jbm.b.30101] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Aseptic loosening is a major complication of joint replacements and is thought to be associated with a heavy macrophage infiltrate in response to wear particles. Bisphosphonates are compounds known to inhibit osteoclastic activity and are used to reduce osteolysis in Paget's disease, osteoporosis, and metastatic bone disease. Oral bisphosphonates have also been used to decrease osteolysis and therefore prevent aseptic loosening of joint replacements. It has been suggested that bisphosphonates mixed in bone cement can reduce bone resorption in joint replacement surgery. This would be an excellent therapeutic option to prevent or control osteolysis. The present aim was to study the mechanical properties of a commercially available acrylic bone cement, Palacos R, mixed with the bisphosphonate pamidronate. The liquid monomer of Palacos R was mixed with liquid pamidronate. Two groups of bone-cement strips were produced, one with added pamidronate and one without. The flexural properties of the cement strips were examined. A significant reduction in both the bending modulus and bending strength of the specimens with added pamidronate was found. In conclusion, the use of liquid pamidronate mixed with the acrylic bone cement Palacos R in order to reduce osteolysis is not recommended because of its effect on the mechanical properties of Palacos R.
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47
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Jeffers JRT, Browne M, Roques A, Taylor M. On the Importance of Considering Porosity When Simulating the Fatigue of Bone Cement. J Biomech Eng 2005; 127:563-70. [PMID: 16121525 DOI: 10.1115/1.1934182] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Fatigue cracking in the cement mantle of total hip replacement has been identified as a possible cause of implant loosening. Retrieval studies and in vitro tests have found porosity in the cement may facilitate fatigue cracking of the mantle. The fatigue process has been simulated computationally using a finite element/continuum damage mechanics (FE/CDM) method and used as a preclinical testing tool, but has not considered the effects of porosity. In this study, experimental tensile and four-point bend fatigue tests were performed. The tensile fatigue S-N data were used to drive the computational simulation (FE/CDM) of fatigue in finite element models of the tensile and four-point bend specimens. Porosity was simulated in the finite element models according to the theory of elasticity and using Monte Carlo methods. The computational fatigue simulations generated variability in the fatigue life at any given stress level, due to each model having a unique porosity distribution. The fracture site also varied between specimens. Experimental validation was achieved for four-point bend loading, but only when porosity was included. This demonstrates that the computational simulation of fatigue, driven by uniaxial S-N data can be used to simulate nonuniaxial loadcases. Further simulations of bone cement fatigue should include porosity to better represent the realities of experimental models.
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Affiliation(s)
- Jonathan R T Jeffers
- Bioengineering Sciences Research Group, School of Engineering Sciences, University of Southampton, Southampton S017 1BJ, United Kingdom
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48
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Abstract
Histomorphologic analyses of artificial joint components implanted into bone need special technology for processing and for documentation; published histological work systematically done therefore is rare. The histopathology, three-dimensionally analyzed in a complete sequence of sections is, however, the only precise answer in terms of biocompatibility and bone response. A complete analysis allows a type-related predictable prognosis of an implantation that is at least comparable to a finite element analysis with respect to load transfer to host bone. The histopathologic collection of the ZOW Munich is comprised of more than 5000 nondemineralized bone and joint specimens and more than 500 artificial joint components implanted in the human skeleton for up to 25 years. Fifty-nine implant-bone specimens without signs of loosening already have been processed and analyzed systematically. According to the strain-adapted bone remodelling, different types of anchorage clearly were differentiated and their morphologic substrate could be worked out. Based on that, the cemented standard anchorage could be distinguished histologically from the cemented press-fit procedure, and the noncemented press-fit from the porous ingrowths pattern. In terms of the topography of the bony integration, the proximal and distal press-fit and ingrowth pattern were analyzed; beside that, the cemented and noncemented epiphyseal resurfacings could be defined histologically. In all histologic specimens the remodelling appeared as a result of stress-related strain, reflecting stiffness of the implant and the resistance of bone to deformation. It clearly was worked out that all success of cemented components is based on preserved cancellous bone honeycombs stiffened by bone cement, representing an adaptation of bone in terms of stiffness to the stiff implants.
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Kim SB, Kim YJ, Yoon TL, Park SA, Cho IH, Kim EJ, Kim IA, Shin JW. The characteristics of a hydroxyapatite–chitosan–PMMA bone cement. Biomaterials 2004; 25:5715-23. [PMID: 15147817 DOI: 10.1016/j.biomaterials.2004.01.022] [Citation(s) in RCA: 172] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2003] [Accepted: 01/17/2004] [Indexed: 10/26/2022]
Abstract
In this study, we propose a new bioactive bone cement (BBC), composed of natural bone powder (hydroxyapatite; HA), chitosan powder, and the currently available polymethylmethacrylate (PMMA) bone cement, for use in orthopedic surgeries such as vertebroplasty or as bone filler. Three types of BBCs (BBC I, BBC II, and BBC III) were prepared with different composition ratios. In vitro tests and animal studies were performed with the new BBCs, and with a currently available commercial PMMA bone cement. Surface morphology, chemical composition, changes in pH over time, exothermic temperatures, intrusion, and cellular responses were investigated in vitro. Scanning electron microscopy (SEM) and radiological and histological examinations were performed in animal studies. The results showed that the major components of the BBCs were C, O, Ca, P, Cl, Si, S, Ba, and Mg. The pH values of the BBCs decreased after 1 day, but eventually recovered to 7.2-7.4. The water absorbency, weight loss, and porosity of the BBCs were higher than those of pure PMMA, but the compressive Young's modulus and the ultimate compressive strength (UCS) of the BBCs were lower than those of pure PMMA. The exothermic temperatures of the BBCs were considerably lower than that of pure PMMA. BBC II and III required longer times to solidify than did pure PMMA. Intrusion tests showed that the BBCs were more intrusive than was pure PMMA. Cell proliferation tests demonstrated that BBC II was preferable to pure PMMA for cell attachment and proliferation. No cytotoxic characteristics were found associated with any of the BBCs. In animal tests, BBC II was more biocompatible and osteoconductible than was pure PMMA. The results of in vitro and animal studies indicated that the proposed BBCs have potential clinical application as replacements for the pure PMMA bone cements currently in use.
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Affiliation(s)
- Seok Bong Kim
- Department of Biomedical Engineering, Inje University, 607 Eu-Bang Dong, Gimhae, Gyeongnam 621-749, South Korea
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Abstract
BACKGROUND Debonding of the cement from metal implants has been implicated in the loosening of cemented total hip prostheses. Strengthening of the stem-cement interface has been suggested as a way to prevent loosening of the component. Previously, it was reported that preheating the stem to 44 degrees C reduced the porosity of the cement at the stem-cement interface. The purpose of this study was to determine the effect of stem preheating on the characteristics of the stem-cement interface. METHODS The effects of stem preheating, at temperatures of 37 degrees C, 44 degrees C, and 50 degrees C, on the stem-cement interface were studied in a test model and a preparation that closely simulated the clinical situation. Static interface strength was determined initially and after the stems had been kept in isotonic saline solution at 37 degrees C for two weeks. Fatigue lifetimes were measured, and the nature and extent of porosity at the interface were quantified. RESULTS Stem preheating had significant effects on the stem-cement interface. Stems preheated to 37 degrees C had greater interface shear strength than stems at room temperature both initially (53% greater strength) and after simulated aging (155% greater strength). Fatigue lifetimes were also improved, and there was a >99% decrease in interface porosity. The setting time of the cement decreased 12%, and the maximum temperature at the cement-bone interface increased 6 degrees C. Similar effects were found after preheating to 44 degrees C and 50 degrees C. CONCLUSIONS Stem preheating had significant effects on the stem-cement interface, with significant improvements in the shear strength and cement porosity of the interface. Also, polymerization temperatures at the cement-bone interface increased. The possible biological effects of these increased interface temperatures at the cement-bone interface require further study.
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Affiliation(s)
- Kazuho Iesaka
- Department of Orthopaedic Surgery, Musculoskeletal Research Center, New York University-Hospital for Joint Diseases, New York, NY 10003, USA.
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