The effect of cross-linking agents on acrylic bone cements containing radiopacifiers

Long-Term Prevention of Arthroplasty Infections via Incorporation of Activated AgNbO3 Nanoparticles in PMMA Bone Cement

We investigated the possibility of loading PMMA bone cement with antimicrobial nanostructured AgNbO3 particles to counter biofilm formation at the cement-tissue interface. We found that a formulation containing (1-4)% AgNbO3 showed high antibacterial activity against Gram-positive Staphylococcus aureus and Gram-negative Pseudomonas aeruginosa while not showing any toxicity against THP1 human cell lines. In addition, loading the particles did not impact the mechanical properties of the cement. The results thus obtained illustrate the potential of the approach to replace the current technique of mixing cement with conventional antibiotics, which is associated with shortcomings such as efficacy loss from antibiotic depletion.

Combining Chromatographic, Rheological, and Mechanical Analysis to Study the Manufacturing Potential of Acrylic Blends into Polyacrylic Casts

Polyacrylics have been considered for a broad range of material applications, including coatings, dental applications, and adhesives. In this experimental study, the casting potential of a group of (co)monomers belonging to the acrylic family has been explored to enable a more sustainable use of these polymer materials in the medical and veterinary science field. The individual contributions of each comonomer have been analyzed, the reaction conversion has been studied via gas chromatography (GC), the rheological behavior has been characterized via stress-controlled measurements, and the final mechanical properties have been obtained from tensile, flexure, and impact tests. The GC results allow assessing the pot life and thus the working window of the casting process. For the rheological measurements, which start from low-viscous mixtures, a novel protocol has been introduced to obtain accurate absolute data. The rheological data reflect the time dependencies of the GC data but facilitate a more direct link with the macroscopic material data. Specifically, the steep increase in the viscosity with increasing reaction time for the methyl methacrylate (MMA)/ethylene glycol dimethyl methacrylate (EGDMA) case (2% crosslinker) allows maximizing several mechanical properties: the tensile/flexure modulus, the tensile/flexure stress at break, and the impact strength. This opens the pathway to more dedicated chemistry design for corrosion casting and polyacrylic material design in general.

A bone substitute composed of polymethyl-methacrylate bone cement and Bio-Gene allogeneic bone promotes osteoblast viability, adhesion and differentiation

BACKGROUND

Increasing reports on new cement formulations that address the shortcomings of PMMA bone cements and various active components have been introduced to improve the biological activity of PMMA cement.

OBJECTIVE

Evaluating the biological properties of PMMA cements reinforced with Bio-Gene allogeneic bone.

METHODS

The MC3T3-E1 mouse osteoblast-like cells were utilized to determine the effects of Bio-Gene + PMMA on osteoblast viability, adhesion and differentiation.

RESULTS

The combination of allogeneic bone and PMMA increased the number of adherent live cells compared to both control group and PMMA or Bio-Gene group. Scanning electron microscopy observed that the number of cells adhered to Bio-Gene + PMMA was larger than Bio-Gene and PMMA group. Compared with the control and PMMA or Bio-Gene group, the level of ALP and the number of calcium nodules after osteoinduction was remarkably enhanced in Bio-Gene + PMMA group. Additionally, the combination of Bio-Gene and PMMA induced the protein expression of osteocalcin, osterix and collagen I.

CONCLUSION

The composition of PMMA and allogeneic bone could provide a more beneficial microenvironment for osteoblast proliferation, adhesion and differentiation. PMMA bone cement reinforced with Bio-Gene allogeneic bone may act as a novel bone substitute to improve the biological activity of PMMA cement.

Influence of Antibiotic-Loaded Acrylic Bone Cement Composition on Drug Release Behavior and Mechanism

Periprosthetic joint infection (PJI) is a devastating complication after total joint replacement with considerable morbidity and large economic burdens. Antibiotic-Loaded Bone Cement (ALBC) has been developed as a valuable tool for local administration and is becoming one of the most effective methods for the prevention and treatment of orthopedic infections. Controlling antibiotic release from ALBC is critical to achieve effective infection control, however, the antibiotic elution rates are generally low, and the mechanisms are poorly understood. Thus, the present study aims to investigate the effects of the basic acrylic bone cement components, including liquid/powder (monomer-to-polymer) ratios, radiopacifier, initiator, and doses of antibiotics on the porosity, antibiotic elution rates and mechanical properties of polymethylmethacrylate (PMMA) based ALBC. The obtained results from the in vitro studies suggested that a reduction in the liquid/powder ratio and an increase in the radiopacifier ratio and gentamicin doses led to increased porosity and release of antibiotic, while the initiator ratio exerted no effect on elution rates. In conclusion, we hope that by varying the composition of ALBC, we could considerably enhance the antibiotic elution rates by increasing porosity, while maintaining an adequate mechanical strength of the bone cements. This finding might provide insights into controlling antibiotic release from ALBC to achieve effective infection control after total joint replacement surgery.

[Biomechanical study of polymethyl methacrylate bone cement and allogeneic bone for strengthening sheep vertebrae]

Objective

To investigate the feasibility and mechanical properties of polymethyl methacrylate (PMMA) bone cement and allogeneic bone mixture to strengthen sheep vertebrae with osteoporotic compression fracture.

Methods

A total of 75 lumbar vertebrae (L ₁-L ₅) of adult goats was harvested to prepare the osteoporotic vertebral body model by decalcification. The volume of vertebral body and the weight and bone density before and after decalcification were measured. And the failure strength, failure displacement, and stiffness were tested by using a mechanical tester. Then the vertebral compression fracture models were prepared and divided into 3 groups ( n=25). The vertebral bodies were injected with allogeneic bone in group A, PMMA bone cement in group B, and mixture of allogeneic bone and PMMA bone cement in a ratio of 1∶1 in group C. After CT observation of the implant distribution in the vertebral body, the failure strength, failure displacement, and stiffness of the vertebral body were measured again.

Results

There was no significant difference in weight, bone density, and volume of vertebral bodies before decalcification between groups ( P>0.05). After decalcification, there was no significant difference in bone density, decreasing rate, and weight between groups ( P>0.05). There were significant differences in vertebral body weight and bone mineral density between pre- and post-decalcification in 3 groups ( P<0.05). CT showed that the implants in each group were evenly distributed in the vertebral body with no leakage. Before fracture, the differences in vertebral body failure strength, failure displacement, and stiffness between groups were not significant ( P>0.05). After augmentation, the failure displacement of group A was significantly greater than that of groups B and C, and the failure strength and stiffness were less than those of groups B and C, the failure displacement of group C was greater than that of group B, and the failure strength and stiffness were less than those of group B, the differences between groups were significant ( P<0.05). Except for the failure strength of group A ( P>0.05), the differences in the failure strength, failure displacement, and stiffness before fracture and after augmentation in the other groups were significant ( P<0.05).

Conclusion

The mixture of allogeneic bone and PMMA bone cement in a ratio of 1∶1 can improve the strength of the vertebral body of sheep osteoporotic compression fractures and restore the initial stiffness of the vertebral body. It has good mechanical properties and can be used as one of the filling materials in percutaneous vertebroplasty.

Iodinated poly(p-dioxanone) as a facile platform for X-ray imaging of resorbable implantable medical devices

Currently, implantable fibrous medical devices still suffer from invisibility under current clinical imaging techniques. To address this problem, 2, 3, 5-triiodobenzoic acid (TIBA) was recruited as a contrast agent, and then a set of iodinated poly(p-dioxanone) (PPDO) fibers was fabricated via melt-spinning hybrid blends of PPDO with TIBA (PPDO/TIBA). The impact of TIBA content on the rheological behavior of blends was evaluated firstly. The physical, chemical, and thermal properties of PPDO/TIBA fibers were investigated accordingly by SEM, FTIR, DSC, and TGA. Moreover, the radiopaque property of PPDO/TIBA hybrid fibers as a potential radio-opacifying platform for medical devices was verified in vitro and in vivo. Finally, the accumulated release results of the hybrid fibers during in vitro degradation indicate the continual X-ray visibility of the hybrid fibers maintains for 22 days. This intriguing iodinated platform may pave the way for constructing fibrous materials with in-situ X-ray tracking property.

Enhancing mechanical properties of an injectable two-solution acrylic bone cement using a difunctional crosslinker

Two-solution bone cements modified with ethylene glycol-dimethacrylate (EG-DMA) as a crosslinker have been developed as an attempt to further improve the mechanical properties of acrylic bone cement. The result of this study shows that EG-DMA can increase the mechanical properties and fractional monomer conversion while preserving the thermal characteristics. The strength and bending modulus increase with EG-DMA concentrations at 5-10 vol % EG-DMA. Substituting the EG-DMA content past 10 vol % decreases the bending properties due to the effects of reduced monomer concentrations. Strengthened EG-DMA samples demonstrated an increase in ductility with noticeably different fracture surface morphologies than the control samples, indicated by microtroughs and ridge formation caused by excessive plastic strain. This work provides insight into the effect of substituting a crosslinker for MMA monomer in an injectable two-solution system and lays out the ideal concentrations of EG-DMA for superior mechanical or fractional monomer conversion properties. © 2018 Wiley Periodicals, Inc. J. Biomed. Mater. Res. Part B, 2018. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 783-790, 2019.

Mechanical and thermal behaviour of an acrylic bone cement modified with a triblock copolymer

The basic formulation of an acrylic bone cement has been modified by the addition of a block copolymer, Nanostrength(®) (NS), in order to augment the mechanical properties and particularly the fracture toughness of the bone cement. Two grades of NS at different levels of loading, between 1 and 10 wt.%, have been used. Mechanical tests were conducted to study the behaviour of the modified cements; specific tests measured the bend, compression and fracture toughness properties. The failure mode of the fracture test specimens was analysed using scanning electron microscopy (SEM). The effect of NS addition on the thermal properties was also determined, and the polymerisation reaction using differential scanning calorimetry. It was observed that the addition of NS produced an improvement in the fracture toughness and ductility of the cement, which could have a positive contribution by reducing the premature fracture of the cement mantle. The residual monomer content was reduced when the NS was added. However this also produced an increase in the maximum temperature and the heat delivered during the polymerisation of the cement.

Synthesis and biocompatibility of a biodegradable and functionalizable thermo-sensitive hydrogel

Injectable thermal gels are a useful tool for drug delivery and tissue engineering. However, most thermal gels do not solidify rapidly at body temperature (37°C). We addressed this by synthesizing a thermo-sensitive, rapidly biodegrading hydrogel. Our hydrogel, poly(ethylene glycol)-co-poly(propanol serinate hexamethylene urethane) (EPSHU), is an ABA block copolymer comprising A, methoxy poly ethylene glycol group and B, poly (propanol L-serinate hexamethylene urethane). EPSHU was characterized by gel permeation chromatography for molecular weight and ¹H NMR and Fourier transformed infrared for structure. Rheological studies measured the phase transition temperature. In vitro degradation in cholesterol esterase and in Dulbecco's phosphate buffered saline (DPBS) was tracked using the average molecular weight measured by gel permeation chromatography. LIVE/DEAD and resazurin reduction assays performed on NIH 3T3 fibroblasts exposed to EPSHU extracts demonstrated no cytotoxicity. Subcutaneous implantation into BALB/cJ mice indicated good biocompatibility in vivo. The biodegradability and biocompatibility of EPSHU together make it a promising candidate for drug delivery applications that demand carrier gel degradation within months.

Novel injectable biomaterials for bone augmentation based on isosorbide dimethacrylic monomers

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

Direct and interactive effects of three variables on properties of PMMA bone cement for vertebral body augmentation

PMMA bone cements are widely used for vertebral body augmentation procedures vertebroplasty and balloon kyphoplasty. Although there are studies in the literature on the direct effects of relevant variables on the properties of these cements, there are none on the interactive effects. In the present work, such a study was performed on both types of effects, with the variables being the concentration of initiator (benzoyl peroxide), the concentration of crosslinker (ethylene glycol dimethacrylate), and the liquid-to-powder ratio used in preparing the cement; and the properties being the compressive strength, the compressive modulus, the doughing time, the setting time, and the maximum polymerization temperature. Two additional properties obtained from the viscosity-versus-time curves, namely the time at the onset of curing, and the critical curing rate were also studied. Significant interactive effects between the amount of crosslinker and the amount of radical initiator were found to affect the doughing time and the critical curing rate. These effects were explained in terms of the reaction kinetics. It was concluded that interactive effects may exist and should be taken into account when designing bone cement formulations.

Bone cements and their potential use in a mandibular endoprosthesis

Bone cement was first used in the 1950s. Since then many modifications have been made and alternatives developed to the original polymethylmethacrylate (PMMA) cement. In view of the use of bone cement in a novel mandibular endoprosthetic system, we performed a review of the current literature on this material. Different cements are described and their potential use in a mandibular endoprosthetic system discussed. The PMMA-based cements are currently the most suitable choice. Plain PMMA has the longest track record and is the default choice for the initial development phase of this system. If there is a significant risk of infection, then an antibiotic-loaded PMMA cement can be selected. However, modified PMMA cements, composite resin cements, osteoinductive calcium phosphate compounds, and cementless fixation are options that offer advantages over PMMA cements, and further research should be conducted to study their suitability.

Impact of polymer-bound iodine on fibronectin adsorption and osteoblast cell morphology in radiopaque medical polymers: tyrosine-derived polycarbonate blends as a model system

Imaging of polymer implants during surgical implantations is challenging in that most materials lack sufficient X-ray contrast. Synthetic derivatization with iodine serves to increase the scattering contrast but results in distinct physicochemical properties in the material which influence subsequent protein adsorption and cell morphology behavior. Herein we report the impact of increasing iodine inclusion on the cell morphology (cell area and shape) of MC3T3-E1 osteoblasts on a series of homopolymers and discrete blend thin films of poly(desaminotyrosyl tyrosine ethyl ester carbonate), poly(DTE carbonate), and an iodinated analogue poly(I(2)-DTE carbonate). Cell morphology is correlated to film chemical composition via measuring fibronectin (FN) adhesion protein adsorption profile on these films. FN exhibits up to 2-fold greater adsorption affinity for poly(I(2)-DTE carbonate) than (poly(DTE carbonate)). A correlation was established between cell area, roundness, and the measured FN adsorption profile on the blend films up to 75% by mass poly(I(2)-DTE carbonate). Data suggest that incorporation of iodine within the polymer backbone has a distinct impact on the way FN proteins adsorb to the surface and within the studied blend systems; the effect is composition dependent.

Crack initiation processes in acrylic bone cement

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.

Alternative acrylic bone cement formulations for cemented arthroplasties: present status, key issues, and future prospects

All the commercially available plain acrylic bone cement brands that are used in cemented arthroplasties are based on poly (methyl methacrylate) and, with a few exceptions, have the same constituents. It is well known that these brands are beset with many drawbacks, such as high maximum exotherm temperature, lack of bioactivity, and volumetric shrinkage upon curing. Furthermore, concerns have been raised about a number of the constituents, such as toxicity of the activator (N,N,dimethyl-p-toluidine) and possible involvement of the radiopacifier (BaSO(4) or ZrO(2) particles) in third-body wear. Thus, over the years, many research efforts have been expended to address these drawbacks, culminating in a large number of alternative formulations, which may be grouped into 16 categories. Although there are a number of reviews of the large literature that now exists on these formulations, each covers only some of the categories and none contains a detailed discussion of the germane issues. The objective of the present work, therefore, was to present a comprehensive and critical review of the whole field. In addition to succinct descriptions of the cements in each category, there are explicative summaries of literature reports, a detailed discussion of several key issues surrounding the potential for use of these cements in cemented arthroplasties, and a presentation of numerous ideas for future studies.

X-ray imaging optimization of 3D tissue engineering scaffolds via combinatorial fabrication methods

We have developed a combinatorial method for determining optimum tissue scaffold composition for several X-ray imaging techniques. X-ray radiography and X-ray microcomputed tomography enable non-invasive imaging of implants in vivo and in vitro. However, highly porous polymeric scaffolds do not always possess sufficient X-ray contrast and are therefore difficult to image with X-ray-based techniques. Incorporation of high radiocontrast atoms, such as iodine, into the polymer structure improves X-ray radiopacity but also affects physicochemical properties and material performance. Thus, we have developed a combinatorial library approach to efficiently determine the minimum amount of contrast agent necessary for X-ray-based imaging. The combinatorial approach is demonstrated in a polymer blend scaffold system where X-ray imaging of poly(desaminotyrosyl-tyrosine ethyl ester carbonate) (pDTEc) scaffolds is improved through a controlled composition variation with an iodinated-pDTEc analog (pI(2)DTEc). The results show that pDTEc scaffolds must include at least 9%, 16%, 38% or 46% pI(2)DTEc (by mass) to enable effective imaging by microradiography, dental radiography, dental radiography through 0.75cm of muscle tissue or microcomputed tomography, respectively. Only two scaffold libraries were required to determine these minimum pI(2)DTEc percentages required for X-ray imaging, which demonstrates the efficiency of this new combinatorial approach for optimizing scaffold formulations.

The chemistry of acrylic bone cements and implications for clinical use in image-guided therapy

Advances in image-guided therapy for vertebral fractures and other bone-related disorders have made acrylic bone cement an integral part of the interventional armamentarium. Unfortunately, information on the properties and chemistry of these compounds is mostly published in the biomaterial sciences literature, a source with which the interventional community is generally unfamiliar. This review focuses on the chemistry of bone cement polymerization and the properties of components in polymethylmethacrylate (PMMA)-based polymers, the most commonly used bone cements in interventional procedures such as percutaneous vertebroplasty. The effects of altering the concentration of components such as methylmethacrylate monomers, PMMA beads, benzoyl peroxide activator, N,N-dimethyl-p-toluidine (DMPT) initiator, and radiopacifiers on the setting time, polymerization temperature, and compressive strength of the cement are also considered. This information will allow interventional radiologists to manipulate bone cement characteristics for specific applications and maximize the clinical potential of image-guided interventions.

Fatigue testing and performance of acrylic bone-cement materials: state-of-the-art review

Over the past three decades or so, a very large volume of literature has been generated on the impact of an assortment of variables on the fatigue lifetimes of a large number of acrylic bone-cement formulations. In the present article, this literature is examined critically to reveal areas of agreement, areas of disagreement, as well as a welter of underexplored and unexplored topics. For example, there is unanimity of support for the notion that an increase in the molecular weight of the powder constituents or the fully cured cement leads to an increase in the cement's fatigue life, whereas there is disagreement as to whether vacuum mixing the cement constituents leads to an increase in the fatigue life of the fully cured cement (relative to the hand-mixed counterpart). Among the underexplored topics is systematic study of the effect of test frequency on the fatigue results, whereas determination of the optimal concentration of the antibiotic in an antibiotic-loaded cement is an example of the unexplored topics. It is pointed out that resolving the controversies, addressing the underexplored topics, and filling the lacunae will allow comprehensive evaluations of acrylic bone-cement materials to be made. This enhanced body of knowledge will prove invaluable in the continued use of acrylic bone cement as the anchoring agent in cemented arthroplasties.

Injectable acrylic bone cements for vertebroplasty with improved properties

Currently commercially available acrylic bone cements lack adequate radiopacity and viscosity when they are used in percutaneous vertebroplasty (PVP). In this work improved formulations of radiopaque and injectable poly(methyl methacrylate) bone cements were prepared with different amounts (10-50 wt.%) of BaTiO3 or SrTiO3 particles as the radiopaque agent. Two sets of cements were prepared by using untreated or silanated radiopaque particles, respectively. The influence of the content and nature of the radiopaque agent as well as its silanation with 3-(trimethoxysilyl) propyl methacrylate (gamma-MPS), on the curing parameters, residual monomer content, radiopacity, mechanical properties, and injectability of the resulting materials, was examined. Doughing and setting times, maximum temperature, and compressive strength of all formulations fulfilled the requirements of standard specifications, with values of peak temperature in the range 57-72 degrees C and those of compressive strength between 114 and 135 MPa. Formulations containing at least 20 wt.% BaTiO3 or SrTiO3 had radiopacities equal to or greater than that corresponding to 2 mm of Al as required for surgical plastics. Injectability of any of the formulations provided 75-80 wt.% of the total mass manually injected through a conventional biopsy needle 4 min after mixing. Silanation of the BaTiO3 or SrTiO3 particles led to formulations with improved mechanical properties and injectability compared to those obtained with the untreated fillers.