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Bökeler U, Bühler A, Eschbach D, Ilies C, Liener U, Knauf T. The Influence of a Modified 3rd Generation Cementation Technique and Vaccum Mixing of Bone Cement on the Bone Cement Implantation Syndrome (BCIS) in Geriatric Patients with Cemented Hemiarthroplasty for Femoral Neck Fractures. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1587. [PMID: 36363544 PMCID: PMC9696240 DOI: 10.3390/medicina58111587] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/01/2022] [Accepted: 11/01/2022] [Indexed: 10/14/2023]
Abstract
Background and Objectives: Cemented hemi arthroplasty is a common and effective procedure performed to treat femoral neck fractures in elderly patients. The bone cement implantation syndrome (BCIS) is a severe and potentially fatal complication which can be associated with the implantation of a hip prosthesis. The aim of this study was to investigate the influence of a modified cementing technique on the incidence of BCIS. Material and Methods: The clinical data of patients which were treated with a cemented hip arthroplasty after the introduction of the modified 3rd generation cementing technique were compared with a matched group of patients who were treated with a 2nd generation cementing technique. The anesthesia charts for all patients were reviewed for the relevant parameters before, during and after cementation. Each patient was classified as having no BCIS (grade 0) or BCIS grade 1,2, or 3 depending on the severity of hypotension, hypoxia loss of consciousness. Results: A total of 92 patients with complete data sets could be included in the study. The mean age was 83 years. 43 patients (Group A) were treated with a 2nd and 49 patients (Group B) with a 3rd generation cementing technique. The incidence of BCIS grade 1,2, and 3 was significantly higher (p = 0,036) in group A (n = 25; 58%) compared to group B (n = 17; 35%). Early mortality was higher in group A (n = 4) compared to group B (n = 0). Conclusions: BCIS is a potentially severe complication with a significant impact on early mortality following cemented hemiarthroplasty of the hip for the treatment of proximal femur fracture. Using a modified 3rd generation cementing technique, it is possible to significantly reduce the incidence of BCIS and its associated mortality.
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Affiliation(s)
- Ulf Bökeler
- Department for Orthopaedics and Trauma Surgery, Marienhospital Stuttgart Böheimstrasse 37, 70199 Stuttgart, Germany
| | - Alissa Bühler
- Department for Orthopaedics and Trauma Surgery, Marienhospital Stuttgart Böheimstrasse 37, 70199 Stuttgart, Germany
| | - Daphne Eschbach
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, 35039 Marburg, Germany
| | - Christoph Ilies
- Department for Anesthesia and Intensive Care, Marienhospital Stuttgart, 70199 Stuttgart, Germany
| | - Ulrich Liener
- Department for Orthopaedics and Trauma Surgery, Marienhospital Stuttgart Böheimstrasse 37, 70199 Stuttgart, Germany
| | - Tom Knauf
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg, 35039 Marburg, Germany
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Role of Implantable Drug Delivery Devices with Dual Platform Capabilities in the Prevention and Treatment of Bacterial Osteomyelitis. Bioengineering (Basel) 2022; 9:bioengineering9020065. [PMID: 35200418 PMCID: PMC8869141 DOI: 10.3390/bioengineering9020065] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/01/2022] [Accepted: 02/03/2022] [Indexed: 11/26/2022] Open
Abstract
As medicine advances and physicians are able to provide patients with innovative solutions, including placement of temporary or permanent medical devices that drastically improve quality of life of the patient, there is the persistent, recurring problem of chronic bacterial infection, including osteomyelitis. Osteomyelitis can manifest as a result of traumatic or contaminated wounds or implant-associated infections. This bacterial infection can persist as a result of inadequate treatment regimens or the presence of biofilm on implanted medical devices. One strategy to mitigate these concerns is the use of implantable medical devices that simultaneously act as local drug delivery devices (DDDs). This classification of device has the potential to prevent or aid in clearing chronic bacterial infection by delivering effective doses of antibiotics to the area of interest and can be engineered to simultaneously aid in tissue regeneration. This review will provide a background on bacterial infection and current therapies as well as current and prospective implantable DDDs, with a particular emphasis on local DDDs to combat bacterial osteomyelitis.
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Kulkarni GS, Kulkarni S, Babhulkar S. Cement beads and cement spacers: indications, techniques, and clinical results. OTA Int 2021; 4:e118(1-6). [PMID: 37609476 PMCID: PMC10441671 DOI: 10.1097/oi9.0000000000000118] [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: 09/28/2020] [Accepted: 12/22/2020] [Indexed: 08/24/2023]
Abstract
Objectives To report our experience on the use of antibiotic coated nails (ACN) and cement beads for the management of bone infections. Materials and methods Infected nonunion (INU) cases were classified as: Type I (mild infection with no gap), Type II (moderate with good alignment, severe infection, gap <3 cm, no deformity), Type III (severe infection with gap ≥3 cm, deformity and limb shortening). Treatment involved either the insertion of ACN and cast (Type I), insertion of ACN, beads and external fixator (Type II), or Ilizarov methodology (Type III). A subset of 28 open fractures were admitted with severe contamination or delayed presentation with established infection and treated with debridement, ACN insertion, and antibiotic beads placed in soft tissue dead space areas. Results Results of 133 cases were classified excellent, good, and poor. Type I INU reported 40 excellent and 22 good results. Type II INU reported 28 (39%) excellent, 30 (43%) good, and 13 (18%) poor results. Poor results were due to uncontrolled infection and knee stiffness. Three patients required knee fusion and 1 required amputation. Fracture union was reported in 68 cases. Four of the 28 Gustilo grade III open fractures treated with ACN developed infected nonunion and had poor function caused by stiff knees. Conclusions An antibiotic impregnated cement nail (ACN) fills the dead space and elutes high concentrations of antibiotics providing some mechanical stability. We recommend the adjunct use of an ACN for the management of INU cases and for use in select cases of Gustilo grade III open fractures.
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Affiliation(s)
| | - Sunil Kulkarni
- GSKs Fracture and Orthopedic Hospital, PG Institute of Swasthiyog Pratishthan, Miraj
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Tuncer K, Gür B, Şenol O, Aydın MR, Gündoğdu Ö. New bone cements with Pluronic®F127 for prophylaxis and treatment of periprosthetic joint infections. J Mech Behav Biomed Mater 2021; 119:104496. [PMID: 33812290 DOI: 10.1016/j.jmbbm.2021.104496] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 03/21/2021] [Accepted: 03/23/2021] [Indexed: 11/16/2022]
Abstract
In line with the increase in orthopedic prosthetic surgeries, there has been a significant rise in periprosthetic joint infections (PJI) due to Methicillin-Resistant Staphylococcus Aureus (MRSA) bacteria. In case of infection, antibiotic-added spacers are temporarily placed into the periprosthetic region. With the release of antibiotics usually failing to work in fighting off infection, recent studies have centered around developing more effective approaches. New polymethylmethacrylate (PMMA) cement mixtures were prepared for this study with Pluronic®F127, bicarbonate, and citric acid addition. Optimal solutions were searched by monitoring vancomycin release on consecutive days with HPLC in in-vitro. The strengths of the samples were measured via four-point bending tests. Compared to conventional PMMA, strength values were observed to have improved by about 20% with 1.0 g of Pluronic®F127. According to HPLC studies, the highest increase for the area under the curve value was obtained for Pluronic®F127 doped mixture with a value of about 20%. It is understood from SEM and BET studies that addition of Pluronic®F127 helps increase porosity. The present study concludes that the optimum concentration of Pluronic®F127 could improve the strength and drug-releasing capacity of the spacer by increasing its porosity.
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Affiliation(s)
- Kutsi Tuncer
- Department of Orthopedics and Traumatology, Faculty of Medicine, Ataturk University, 25240, Erzurum, Turkey; Anesthesiology, Clinical Research Office, Atatürk University, 25240, Erzurum, Turkey
| | - Bahri Gür
- Department of Biochemistry, Faculty of Sciences and Arts, Iğdır University, 76000, Iğdır, Turkey.
| | - Onur Şenol
- Department of Analytical Chemistry, Faculty of Pharmacy, Atatürk University, 25240, Erzurum, Turkey
| | - Muhammet Raci Aydın
- Department of Mechanical Engineering, Faculty of Engineering, Iğdır University, 76000, Iğdır, Turkey.
| | - Ömer Gündoğdu
- Department of Mechanical Engineering, Faculty of Engineering, Iğdır University, 76000, Iğdır, Turkey; Department of Mechanical Engineering, Faculty of Engineering, Atatürk University, 25240, Erzurum, Turkey
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Effect of Physiological Saline Solution Contamination on Selected Mechanical Properties of Seasoned Acrylic Bone Cements of Medium and High Viscosity. MATERIALS 2020; 14:ma14010110. [PMID: 33383870 PMCID: PMC7796448 DOI: 10.3390/ma14010110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 12/18/2020] [Accepted: 12/21/2020] [Indexed: 12/29/2022]
Abstract
Bone cements play a key role in present-day surgery, including the implantation of hip and knee joint endoprostheses. The correct and durable bonding of the prosthesis to the bone is affected by both the static strength characteristics determined in accordance with ISO 5833:2002 and the resistance to long-term exposure to an aggressive environment of the human body and the impurities that may be introduced into the cement during implementation. The study attempts to demonstrate statistically significant degradation of cement as a result of the seasoning of cement samples in Ringer’s solution with simultaneous contamination of the material with saline solution, which is usually present in the surgical field (e.g., during the fixing of endoprostheses). The results of statistical analysis showed the nature of changes in compressive strength and microhardness due to seasoning time and degree of contamination.
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Barszczewska-Rybarek I, Chladek G. Studies on the Curing Efficiency and Mechanical Properties of Bis-GMA and TEGDMA Nanocomposites Containing Silver Nanoparticles. Int J Mol Sci 2018; 19:ijms19123937. [PMID: 30544584 PMCID: PMC6320904 DOI: 10.3390/ijms19123937] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 11/26/2018] [Accepted: 12/05/2018] [Indexed: 11/16/2022] Open
Abstract
Bioactive dimethacrylate composites filled with silver nanoparticles (AgNP) might be used in medical applications, such as dental restorations and bone cements. The composition of bisphenol A glycerolate dimethacrylate (Bis-GMA) and triethylene glycol dimethacrylate (TEGDMA) mixed in a 60/40 wt% ratio was filled from 25 to 5000 ppm of AgNP. An exponential increase in resin viscosity was observed with an increase in AgNP concentration. Curing was performed by way of photopolymerization, room temperature polymerization, and thermal polymerization. The results showed that the polymerization mode determines the degree of conversion (DC), which governs the ultimate mechanical properties of nanocomposites. Thermal polymerization resulted in a higher DC than photo- and room temperature polymerizations. The DC always decreased as AgNP content increased. Flexural strength, flexural modulus, hardness, and impact strength initially increased, as AgNP concentration increased, and then decreased at higher AgNP loadings. This turning point usually occurred when the DC dropped below 65% and moved toward higher AgNP concentrations, according to the following order of polymerization methods: photopolymerization < room temperature polymerization < thermal polymerization. Water sorption (WS) was also determined. Nanocomposites revealed an average decrease of 16% in WS with respect to the neat polymer. AgNP concentration did not significantly affect WS.
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Affiliation(s)
- Izabela Barszczewska-Rybarek
- Department of Physical Chemistry and Technology of Polymers, Silesian University of Technology, 44-100 Gliwice, Poland.
| | - Grzegorz Chladek
- Institute of Engineering Materials and Biomaterials, Silesian University of Technology, 44-100 Gliwice, Poland.
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Abstract
BACKGROUND Although many factors are known to influence the polymerization time of bone cement, it remains unclear which bone cement shape predicts the precise polymerization time. The purpose of this study was to investigate whether different cement shapes influenced polymerization time and to identify the relationship between cement shape and ambient operating theater temperature, relative humidity, and equilibration time. METHODS Samples were gathered prospectively from 237 patients undergoing primary total knee arthroplasty. The cement components were made into 2 different shapes: lump and pan. The time at which no macroscopic indentation of both cement models was possible was recorded as the polymerization time. RESULTS There was no significant difference between hand mixing (lump shape: 789.3 ± 128.4 seconds, P = .591; pan shape: 899.3 ± 152.2 seconds, P = .584) and vacuum mixing (lump shape: 780.2 ± 131.1 seconds, P = .591; pan shape: 909.9 ± 143.3 seconds, P = .584) in terms of polymerization time. Conversely, the polymerization time was significantly shorter for Antibiotic Simplex (lump shape: 757.4 ± 114.9 seconds, P = .001; pan shape: 879.5 ± 125.0 seconds, P < .001) when compared with Palacos R+G (lump shape: 829.0 ± 139.3 seconds, P = .001; pan shape: 942.9 ± 172.0 seconds, P < .001). Polymerization time was also significantly longer (P < .001) for the pan shape model (904 ± 148.0 seconds) when compared with the lump shape model (785.2 ± 129.4 seconds). In addition, the polymerization time decreased with increasing temperature (lump shape: R = 0.334, P < .001; pan shape: R = 0.375, P < .001), humidity (lump shape: R = 0.091, P < .001; pan shape: R = 0.106, P < .001), and equilibration time (lump shape: R = 0.073, P < .001; pan shape: R = 0.044, P < .001). CONCLUSIONS The polymerization time was equally affected by temperature, relative humidity, and equilibration time regardless of bone cement shape. Furthermore, the pan shape model better reflected the cement polymerization time between implant and bone compared with the lump shape model. The current findings suggest that, clinically, constant pressure with the knee in <45° of flexion needs to be applied until remaining pan shaped cement is completely polymerized.
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Anagnostakos K, Fink B. Antibiotic-loaded cement spacers – lessons learned from the past 20 years. Expert Rev Med Devices 2018; 15:231-245. [DOI: 10.1080/17434440.2018.1435270] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
| | - Bernd Fink
- Klinik für Endoprothetik, Allgemeine und Rheumaorthopädie, Orthopädische Klinik Markgröningen, Markgröningen, Germany
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Custom-Made Antibiotic Cement Nails in Orthopaedic Trauma: Review of Outcomes, New Approaches, and Perspectives. BIOMED RESEARCH INTERNATIONAL 2015; 2015:387186. [PMID: 26509153 PMCID: PMC4609780 DOI: 10.1155/2015/387186] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 05/18/2015] [Accepted: 05/20/2015] [Indexed: 01/26/2023]
Abstract
Since the first description in 2002 by Paley and Herzenberg, antibiotic bone cement nails (ACNs) have become an effective tool in the orthopaedic trauma surgeons' hands. They simultaneously elute high amounts of antibiotics into medullary canal dead space and provide limited stability to the debrided long bone. In this paper, we perform a systematic review of current evidence on ACNs in orthopaedic trauma and provide an up-to-date review of the indications, operative technique, failure mechanisms, complications, outcomes, and outlooks for the ACNs use in long bone infection.
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Martínez-Moreno J, Mura C, Merino V, Nácher A, Climente M, Merino-Sanjuán M. Study of the Influence of Bone Cement Type and Mixing Method on the Bioactivity and the Elution Kinetics of Ciprofloxacin. J Arthroplasty 2015; 30:1243-9. [PMID: 25743107 DOI: 10.1016/j.arth.2015.02.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 01/20/2015] [Accepted: 02/11/2015] [Indexed: 02/01/2023] Open
Abstract
The objectives of this study were to examine ciprofloxacin release from three trademarks of bone cements (Simplex®, Lima® and Palacos®) and its bioactivity using as variables, the mixing method, the chemical form of the antibiotic and the antibiotic combination. The antibiotic amount released in base form represents 35% of antibiotic amount released when hydrochloride form is incorporated. Moreover, the combination (vancomycin and ciprofloxacin) shows a stronger release (132%) than hydrochloride ciprofloxacin alone. Three cements show equal drug release profile (P > 0.05). A bioactivity simulation exercise showed that until 72 hours post-surgery, ciprofloxacin concentrations in the implant would be higher than 0.1 μg/mL in 100% of the patients. After drain removal, it is expected that bioactivity would increase since drug clearance from implant would decrease.
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Affiliation(s)
- Javier Martínez-Moreno
- Departamento de Farmacia y Tecnología Farmacéutica, Facultad de Farmacia, Valencia, Spain; Instituto de Reconocimiento Molecular y Desarrollo Tecnológico, Centro Mixto Universidad Politécnica de Valencia-Universidad de Valencia, Spain; Servicio de Farmacia, Hospital Universitario Doctor Peset de Valencia, Spain
| | - Carla Mura
- Departamento de Farmacia y Tecnología Farmacéutica, Facultad de Farmacia, Valencia, Spain; Instituto de Reconocimiento Molecular y Desarrollo Tecnológico, Centro Mixto Universidad Politécnica de Valencia-Universidad de Valencia, Spain
| | - Virginia Merino
- Departamento de Farmacia y Tecnología Farmacéutica, Facultad de Farmacia, Valencia, Spain; Instituto de Reconocimiento Molecular y Desarrollo Tecnológico, Centro Mixto Universidad Politécnica de Valencia-Universidad de Valencia, Spain
| | - Amparo Nácher
- Departamento de Farmacia y Tecnología Farmacéutica, Facultad de Farmacia, Valencia, Spain; Instituto de Reconocimiento Molecular y Desarrollo Tecnológico, Centro Mixto Universidad Politécnica de Valencia-Universidad de Valencia, Spain
| | - Mónica Climente
- Departamento de Farmacia y Tecnología Farmacéutica, Facultad de Farmacia, Valencia, Spain; Servicio de Farmacia, Hospital Universitario Doctor Peset de Valencia, Spain
| | - Matilde Merino-Sanjuán
- Departamento de Farmacia y Tecnología Farmacéutica, Facultad de Farmacia, Valencia, Spain; Instituto de Reconocimiento Molecular y Desarrollo Tecnológico, Centro Mixto Universidad Politécnica de Valencia-Universidad de Valencia, Spain
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Is the Stryker Revolution mixing system fit for purpose? Reliability and a micro-CT assessment of cement porosity. Hip Int 2012; 22:90-5. [PMID: 22344479 DOI: 10.5301/hip.2012.9043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2012] [Indexed: 02/04/2023]
Abstract
The Stryker Revolution(TM) is a new mixing system that employs a high vacuum and a motorised mixing spatula in an effort to reduce cement porosity. We have compared Revolution(TM) with Depuy Cemvac(®), in terms of system reliability and cement porosity. Standardised Simplex P(®) and SmartSet(®) HV cement samples were produced using both mixing systems and analysed using a micro-CT scanner. The overall porosity, number and volume of voids were measured. Void analysis was subdivided into macro-pores (>0.5 mm3) and micro-pores (0.0005-0.5 mm3). Both systems were easy to use and no breakages were encountered. There was no significant difference in overall porosity between Revolution(TM) and Cemvac(®). Revolution(TM) produced over a five-fold decrease in average macro-pore size with medium viscosity cement (p=0.02), but produced a greater number of micro-pores (p<0.01). SmartSet(®) HV specimens had a higher porosity compared to Simplex P(®). This study demonstrated that the Revolution(TM) system was reliable and reduced porosity at least as effectively as the established Cemvac(®) system. The Revolution(TM) produced a greater number of smaller pores and further testing is required to establish if this results in a significant mechanical benefit.
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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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Proschek D, Kafchitsas K, Kurth AA, Mattyasovszky SG, Betz S, Ludwig HR, Mack MG. The quality of applied bone cement depends on the chemical composition of the application system. Eur Surg Res 2011; 47:189-95. [PMID: 21986340 DOI: 10.1159/000330450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 06/15/2011] [Indexed: 11/19/2022]
Abstract
UNLABELLED The exothermal reaction of polymethylmethacrylate leads to an extensive interaction between bone cement and the synthetic material of the application system. This chemical reaction changes the structure of the cement and might generate air inclusions. METHODS AND MATERIALS Two application systems for bone cement made of polycarbonate (PC) and polypropylene (PP) were evaluated. The application systems were mounted in a testing unit. The testing device injects a defined amount of bone cement with a certain pressure. After the injection procedure a microscopic examination was carried out. RESULTS There were no differences in the size and the design of the used syringes. Forty procedures were carried out. The time frame for application of the cement was 5 min in the PC group and 9 min in the PP group. There was a remarkable interaction between the plastics and the cement with the appearance of numerous air inclusions in the PC group. Barely any interaction was found in the PP group. CONCLUSION Application systems made of PP enable a prolonged application time and a reduced number of air inclusions. Further research, especially on a molecular level as well as material tests on the quality of the applied bone cement, should be carried out.
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Affiliation(s)
- D Proschek
- Center for Musculoskeletal Surgery, Department of Orthopedic Surgery, University Medical Center, Mainz, Germany. proschek @ arcor.de
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Abstract
PURPOSE Prosthesis color production and stability as a result of pore entrapment during mixing has not been investigated for maxillofacial silicone prostheses. The purpose of this study was to investigate pore numbers and percentages of a maxillofacial silicone elastomer mixed by two different techniques, using X-ray microfocus computerized tomography (Micro-CT), and to investigate the effect of porosity on color reproducibility and stability after two different aging conditions. MATERIALS AND METHODS Sixty-four disk-shaped specimens were prepared (8-mm diameter, 3-mm thick) by mixing TechSil S25 silicone elastomer (Technovent, Leeds, UK) following two techniques: manual mixing (n = 32) and mechanical mixing under vacuum (n = 32). Half the specimens in each group were intrinsically pigmented, and the other half remained unpigmented. Pore numbers, volumes, and percentages were calculated using the Micro-CT, and then specimens of each subgroup were stored in simulated sebum for 6 months (n = 8), and exposed to accelerated daylight aging for 360 hours (n = 8). Color change (ΔE) was measured at the start and end of conditioning. Pore numbers and percentages were analyzed using one-way Analysis of Variance (ANOVA) and Dunnett's-T3 post-hoc tests (p < 0.05). Independent t-test was used to detect differences (p < 0.05) in ΔE between manually and mechanically mixed specimens, in both unpigmented and pigmented states and to detect differences (p < 0.05) in ΔE before and after conditioning within each mixing method. RESULTS Mechanical mixing under vacuum reduced the number and percentage of pores in comparison to manual mixing, within pigmented and unpigmented silicone specimens (p < 0.05). Perceptible ΔE between manual and mechanical mixing techniques were 5.93 and 5.18 for both unpigmented and pigmented specimens, respectively. Under sebum storage, manually mixed unpigmented specimens showed lower ΔE (p < 0.05) than those that were mechanically mixed; however, pigmented silicone specimens showed the same ΔE (p > 0.05). After light aging, mixing method had no effect on ΔE of unpigmented specimens (p > 0.05). Furthermore, mechanically mixed pigmented specimens showed lower ΔE (p < 0.05). CONCLUSIONS Within silicone elastomers (whether pigmented or unpigmented), mechanical mixing under vacuum reduced pore numbers and percentages in comparison to manual mixing. For selected skin shade, pores affected the resultant color of prosthesis (color reproducibility). Additionally, silicone pores affected silicone color stability upon service. CLINICAL SIGNIFICANCE In fabricating maxillofacial prostheses, mechanically mixing silicone under vacuum produces pore-free prostheses, tending to enhance their color production and stability.
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Affiliation(s)
- Muhanad M Hatamleh
- Department of Allied Dental Science, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan.
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Pre-Packed Vacuum Bone Cement Mixing Systems. A Further Step in Reducing Methylmethacrylate Exposure in Surgery. ACTA ACUST UNITED AC 2010; 54:955-61. [DOI: 10.1093/annhyg/meq045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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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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Baleani M, Bialoblocka-Juszczyk E, Engels GE, Viceconti M. The effect of vacuum mixing and pre-heating the femoral component on the mechanical properties of the cement mantle. ACTA ACUST UNITED AC 2010; 92:454-60. [PMID: 20190321 DOI: 10.1302/0301-620x.92b3.22579] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
We investigated the effect of pre-heating a femoral component on the porosity and strength of bone cement, with or without vacuum mixing used for total hip replacement. Cement mantles were moulded in a manner simulating clinical practice for cemented hip replacement. During polymerisation, the temperature was monitored. Specimens of cement extracted from the mantles underwent bending or fatigue tests, and were examined for porosity. Pre-heating the stem alone significantly increased the mean temperature values measured within the mantle (+14.2 degrees C) (p < 0.001) and reduced the mean curing time (-1.5 min) (p < 0.001). The addition of vacuum mixing modulated the mean rise in the temperature of polymerisation to 11 degrees C and reduced the mean duration of the process by one minute and 50 seconds (p = 0.01 and p < 0.001, respectively). In all cases, the maximum temperature values measured in the mould simulating the femur were < 50 degrees C. The mixing technique and pre-heating the stem slightly increased the static mechanical strength of bone cement. However, the fatigue life of the cement was improved by both vacuum mixing and pre-heating the stem, but was most marked (+ 280 degrees C) when these methods were combined. Pre-heating the stem appears to be an effective way of improving the quality of the cement mantle, which might enhance the long-term performance of bone cement, especially when combined with vacuum mixing.
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Affiliation(s)
- M Baleani
- Laboratorio di Tecnologia Medica, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136, Bologna, Italy.
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Randelli P, Evola FR, Cabitza P, Polli L, Denti M, Vaienti L. Prophylactic use of antibiotic-loaded bone cement in primary total knee replacement. Knee Surg Sports Traumatol Arthrosc 2010; 18:181-6. [PMID: 19795106 DOI: 10.1007/s00167-009-0921-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2008] [Accepted: 09/03/2009] [Indexed: 02/07/2023]
Abstract
Despite significant advances in intraoperative antimicrobial procedures, deep infection remains the most devastating complication following total joint arthroplasty. Clinical studies' results and safety profile of antibiotic-loaded bone cement are discussed in this review. Antibiotic bone cement prophylaxis is a safe and effective strategy in reducing the risk of deep infection following primary total joint arthroplasty.
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Affiliation(s)
- Pietro Randelli
- Dipartimento di Scienze Medico-Chirurgiche, Università degli Studi di Milano, Policlinico San Donato IRCCS, Via Morandi 30, San Donato Milanese, 20097, Milan, Italy.
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Anagnostakos K, Kelm J. Enhancement of antibiotic elution from acrylic bone cement. J Biomed Mater Res B Appl Biomater 2009; 90:467-75. [PMID: 19145626 DOI: 10.1002/jbm.b.31281] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Antibiotic-loaded acrylic bone cement is a well-established tool in the prophylaxis and treatment of orthopedic infections. Numerous studies about its pharmacokinetic properties have demonstrated that only a small part of the incorporated antibiotic amounts can be released, mostly over the first 8-10 weeks. Therefore, in the past 10 years, several attempts have been made for enhancement of the drug elution from bone cement. This article reviews this experience and pays special attention on biantibiotic combinations, additives other than antimicrobial agents, as well as the effect of ultrasound on the antibiotic elution characteristics.
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Affiliation(s)
- Konstantinos Anagnostakos
- Klinik für Orthopädie und Orthopädische Chirurgie, Universität des Saarlandes, Homburg/Saar, Germany. )
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Munro NA, Nicol M, Selvaraj S, Hussain SM, Finlayson DF. Femoral cement pressurization in hip arthroplasty: a comparison of 3 systems. J Arthroplasty 2007; 22:893-901. [PMID: 17826282 DOI: 10.1016/j.arth.2006.09.014] [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] [Received: 07/23/2005] [Revised: 05/23/2006] [Accepted: 09/05/2006] [Indexed: 02/01/2023] Open
Abstract
Cement pressurization is critical to achieving optimal results in cemented arthroplasty of the hip. An in vitro experiment using plastic femoral models (10 per group) was undertaken to measure the pressures developed by 3 cementing systems: the Howmedica Mark 1 (Stryker Howmedica, Limerick, Ireland) and DePuy Cemvac retrograde cementation systems (DePuy CMW, Blackpool, UK), and a novel antegrade system consisting of a 60-mL catheter-tipped syringe and a Miller proximal femoral seal (Zimmer Ltd, Swindon, UK). The mean pressure was higher for the syringe system (161.45 +/- 28.9 kPa) than the Mark 1 (103.51 +/- 22.0 kPa) or Cemvac (92.65 +/- 30.7 kPa) systems (P = .0001). In addition, fewer cement mantle defects were seen with the syringe system (1, interquartile range [IQR] 1-2) than the Mark 1 (3, IQR 2-4) or Cemvac (3, IQR 1-3) systems (P = .0256).
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Dall GF, Simpson PMS, Mackenzie SP, Breusch SJ. Inter- and intra-batch variability in the handling characteristics and viscosity of commonly used antibiotic-loaded bone cements. Acta Orthop 2007; 78:412-20. [PMID: 17611857 DOI: 10.1080/17453670710014004] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Several factors can affect the viscosity of a cement and therefore its handling characteristics. We performed an in vitro study to ascertain whether anecdotal observations of differences in handling between batches of the same brand of cement actually existed. METHODS 3 batches of Simplex P Tobramycin (SPT), Refobacin Bone Cement (RBC), SmartSet GHV (SSG) and Palacos R+G (PRG) were tested. 6 replicates of each batch were vacuum-mixed and their viscosity in relation to time was measured under laboratory conditions using a rheometer. We examined the handling characteristics of 6 replicates of each batch after they were hand-mixed under theater conditions. RESULTS Inter- and intra-batch variability was seen in the viscosity of all brands of cement tested. Interbatch calculations were influenced by high intra-batch variability in viscosity. The viscosity of RBC cement was similar to that of SSG, but different to that of PRG (p = 0.01 at 5 N and p = 0.009 at 40 N). INTERPRETATION Our results suggest that in clinical practice, extrinsic factors such as preparation conditions and methods probably play a more important role than the intrinsic variability of cements. However, variability in handling and viscosity will exist in all brands of cement prepared under theater conditions and the surgeon must be aware of why they may act differently.
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Affiliation(s)
- Graham F Dall
- Department of Orthopaedics, New Royal Infirmary, University of Edinburgh, Edinburgh, Scotland
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Dalén T, Nilsson KG. VersaBond bone cement prospective randomized study of the clinical properties of a new bone cement in total knee replacement. Knee 2005; 12:311-7. [PMID: 16026700 DOI: 10.1016/j.knee.2004.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2004] [Revised: 11/04/2004] [Accepted: 11/04/2004] [Indexed: 02/02/2023]
Abstract
VersaBond is a newly developed bone cement. To investigate its clinical performance, VersaBond was compared to Palacos R in a prospective randomized study in total knee replacement. Fifty-nine patients (61 knees) undergoing total knee replacement were randomized to either VersaBond or Palacos R bone cement and followed for 24 months using radiostereometric analysis (RSA). Up to 2 years there were no significant differences in clinical performance between the two cements. The mean/median values for implant migration were very similar for the two bone cements, as were the dispersion, and distribution of outliers. Also the proportion "stable" and "continuously migrating" implants was similar between the two cements. The result of this study indicates that VersaBond bone cement will perform at least equally as well as Palacos R in total knee replacement as regards as aseptic loosening.
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Affiliation(s)
- Tore Dalén
- Implant Research Unit, Department of Orthopaedics, Umeå University Hospital, Umeå S-901 85, Sweden.
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Lidgren L, Robertson O. Acrylic bone cements: clinical developments and current status: Scandinavia. Orthop Clin North Am 2005; 36:55-61, vi. [PMID: 15542123 DOI: 10.1016/j.ocl.2004.06.008] [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: 02/02/2023]
Abstract
This article focuses on bone cement, the cementing technique used, and their influence on aseptic loosening and infection of acrylic and joint implants--Scandinavian view.
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Affiliation(s)
- Lars Lidgren
- Department of Orthopedics, Lund University Hospital, SE-221 85, Lund, Sweden.
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