Hydroxyapatite Microspheres as an Additive to Enhance Radiopacity, Biocompatibility, and Osteoconductivity of Poly(methyl methacrylate) Bone Cement

Bone Cement in Adult Hip and Knee Reconstruction: A Review of Commercially Available Options and Clinical Outcomes

Polymethyl-methacrylate (PMMA) bone cement is used extensively in hip and knee arthroplasty. A thorough understanding of the basic chemistry underlying PMMA is important for orthopaedic surgeons because this underscores the specific way bone cement is used during surgery. Recently, clinical research has shed light on the various types of PMMA regarding the viscosity of the mixture and the effect of cement additives. These variations in composition may alter the clinical efficacy of implanted bone cement in hip and knee arthroplasty. Understanding these key differences will allow the surgeon to tailor the PMMA composition as needed to maximize outcomes of hip and knee arthroplasty. This review will summarize the preclinical feature of PMMA, evaluate current and past commercially available bone cement options, analyze preclinical results and clinical outcomes of various bone cement types, and highlight future areas of research.

PMMA bone cement with L-arginine/nano fish bone nanocomplex for apatite formation

Bone cement is one of the materials used in orthopaedics that serves various functions, such as binding bone implants, replacing damaged bones and filling spaces within bones. Various materials have been used to synthesize bone cement, and one promising material for further research is fish bone waste-based bone cement. This study investigates the potential of fish bone waste-based bone cement by incorporating nano fish bone (NFB) and L-arginine (L-Arg) protein into polymethyl methacrylate (PMMA) to examine apatite growth. NFB derived from the Salmo salar fish positively influences osteoblast cell proliferation and differentiation, while L-Arg enhances biocompatibility and antibiotic properties. The NFB/L-Arg combination holds promise in accelerating new bone formation and cell growth, both of which are crucial for fracture healing and bone remodelling. Tensile strength tests reveal the superior performance of BC-PMMA-1-NFB/L-Arg (36.11 MPa) compared with commercial PMMA (32 MPa). Immersion tests with simulated body fluid (SBF) solution for 7 days reveal accelerated apatite layer formation, emphasizing the potential benefits of NFB/L-Arg in bone cement applications.

Advancements in poly(methyl Methacrylate) bone cement for enhanced osteoconductivity and mechanical properties in vertebroplasty: A comprehensive review

The evolution of polymethyl methacrylate (PMMA) based bone cement (BC) from plexiglass to a biomaterial has revolutionized the joint and vertebral arthroplasties field. This widely used grouting material possesses exceptional properties for medical applications, including excellent biocompatibility, impressive mechanical strength, and favorable handling characteristics. PMMA-based BC is preferred in challenging conditions such as osteoporotic vertebral compression fractures, scoliosis, vertebral hemangiomas, spinal metastases, and myelomas, where it is crucial in withstanding stress. This review aims to comprehensively analyze the available reports and guide further research toward enhanced formulations of vertebral BC, focusing on its osteoconductive and mechanical properties. Furthermore, the review emphasizes the significant impact of BC's mechanical properties and osteoconductivity on the success and longevity of vertebroplasty procedures.

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

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

Development of a bioactive and radiopaque bismuth doped baghdadite ceramic for bone tissue engineering

Baghdadite (Ca₃ZrSi₂O₉, BAG), is a Zr-doped calcium silicate that has outstanding bioactivity both in vitro and in vivo. Bioceramic scaffolds should be sufficiently radiopaque to be distinguishable in vivo from surrounding bone structures. To enhance the radiopacity of BAG, this study investigated the effect of incorporating bismuth ions into its crystalline structure (Bi_xCa_3-xZrSi₂O₉, x = 0, 0.1, 0.2, 0.5; BAG, Bi0.1-BAG, Bi0.2-BAG, Bi0.5-BAG, respectively). Monophasic baghdadite was retained after bismuth ion incorporation up to x = 0.2 at calcination temperatures of 1350 °C. When pressed and sintered, energy dispersive x-ray spectroscopy showed that BAG and Bi0.1-BAG retained crystalline homogeneity, but Bi0.2-BAG formed zirconium-rich crystalline regions. BAG, Bi0.1-BAG and Bi0.2-BAG exhibited non-degradation after 56 days of immersion in culture medium. Bi0.1-BAG exhibited the lowest change in culture medium pH (+0.0), compared to BAG (+0.7) and Bi0.2-BAG (+0.2) after 56 days of culture media immersion. Bi0.1-BAG exhibited similar strength and modulus to BAG (σ: 200-290 MPa; E: 4-5 GPa), and significantly higher compressive strength and modulus versus Bi0.2-BAG (σ: 150-200 MPa; E: 3.5-4 GPa) across 56 days of aqueous immersion. In vitro studies using primary human bone derived cells (HOBs) demonstrated a significant increase in HOBs proliferation when cultured on Bi0.1-BAG for seven days compared to BAG and Bi0.2-BAG. Importantly, Bi0.1-BAG showed increased radiopacity by ~33%, when compared to BAG, and by ~115% when compared to biphasic calcium phosphate. The properties of Bi0.1-BAG show promise for its use as a bioactive ceramic with sufficient radiopacity for treatment of bone defects.

Cytotoxicity and cell response of preosteoblast in calcium sulfate-augmented PMMA bone cement

Poly(methyl methacrylate) (PMMA) has been widely used in orthopedic applications, but bone ingrowth and toxic monomer release are drawback of this material. Particle reinforcement with osteoconductive substitute, such as calcium sulfate (CaSO₄), is one of the solutions used to modify PMMA bone cement. The current study investigated the mechanical, chemical and biological properties of CaSO₄-augmented bone cement. Mechanical strength was measured by a material testing machine. The concentration of methyl methacrylate (MMA) monomer from the various formulations of PMMA mixed with CaSO₄was measured by ultra-performance liquid chromatography (UPLC). CCK-8 assay and ALP assay were performed to evaluate cytotoxicity of released MMA monomer and cell differentiation. The attachment of cells to CaSO₄-augmented bone cement discs was observed by confocal and scanning electron microscopy, and surface topography was also evaluated by atomic force microscopy. The results revealed that increased CaSO₄weight ratios led to compromised mechanical strength and increased MMA monomer release. Cell density and cell differentiation on CaSO₄-augmented bone cement discs were decreased at CaSO₄weight ratios above 10%. In addition, the presence of micropores on the surface and surface roughness were both increased for PMMA composite discs containing higher levels of CaSO₄. These results demonstrated that fewer MC3T3-E1 cells on the surface of CaSO₄-PMMA composites was correlated to increased MMA monomer release, micropore number and surface roughness. In summary, the augmentation of a higher proportion of CaSO₄(>10 wt. %) to PMMA did not promote the biological properties of traditional PMMA bone cement.

Novel Hydroxyapatite Beads for the Adsorption of Radionuclides from Decommissioned Nuclear Power Plant Sites

Although a powdered form of hydroxyapatite (p-HdA) has been studied for the adsorption of heavy metals that contaminate the restoration sites of decommissioned nuclear power plants, most of the studies are limited in the laboratory due to the head loss and post-separation in practical applications. Herein, we fabricated a porous bead form of HdA (b-HdA) as a novel adsorbent for removing radionuclides from aqueous environments via a facile synthesis by mixing the p-HdA precursor and polyvinyl butyral (PVB) as a binder and added a sintering process for the final production of a porous structure. The spherical b-HdA with an approximate diameter of 2.0 mm was successfully fabricated. The effectiveness of the b-HdA at removing Co(II) was investigated via the adsorption equilibrium at various experimental temperatures. The b-HdA exhibited the adsorption capacity for Co(II) ions with a maximum of 7.73 and 11.35 mg/g at 293 K and 313 K, respectively. The experimental kinetic data were well described using a pseudo-second-order kinetic model, and the adsorption mechanisms of Co(II) onto the b-HdA were revealed to be a chemisorption process with intraparticle diffusion being the rate-limiting step. In addition, the competitive adsorption onto the b-HdA with the order of U(VI) > Co(II) > Ni(II) > Sr(II) > Cs(I) was also observed in the multi-radionuclides system. Considering the advantages of the size, applicability to the continuous-flow column, and the easy separation from treated water, the b-HdA can be an excellent absorbent with high potential for practical applications for removing radionuclides.

Electrospun polyamide-6/chitosan nanofibers reinforced nano-hydroxyapatite/polyamide-6 composite bilayered membranes for guided bone regeneration

Periodontal defect poses a significant challenge in orthopedics. Guided Bone Regeneration (GBR) membrane is considered as one of the most successful methods applied to reconstruct alveolar bone and then to achieve periodontal defect repair/regeneration. In this paper, a novel polyamide-6/chitosan@nano-hydroxyapatite/polyamide-6 (PA6/CS@n-HA/PA6) bilayered tissue guided membranes by combining a solvent casting and an electrospinning technique was designed. The developed PA6/CS@n-HA/PA6 composites were characterized by a series of tests. The results show that n-HA/PA6 and electrospun PA6/CS layers are tightly bound by molecular interaction and chemical bonding, which enhances the bonding strength between two distinct layers. The porosity and adsorption average pore diameter of the PA6/CS@n-HA/PA6 membranes are 36.90 % and 22.61 nm, respectively. The tensile strength and elastic modulus of PA6/CS@n-HA/PA6 composites are 1.41 ± 0.18 MPa and 7.15 ± 1.09 MPa, respectively. In vitro cell culture studies demonstrate that PA6/CS@n-HA/PA6 bilayered scaffolds have biological safety, good bioactivity, biocompatibility and osteoconductivity.

Micro- and Nanoparticulate Hydroxyapatite Powders as Fillers in Polyacrylate Bone Cement-A Comparative Study

Acrylate polymer-based bone cements constitute the most popular bonding agents used in regenerative surgery. Due to their inferior biocompatibility, however, these materials are often enriched with ceramic additives including hydroxyapatite (HAp). The aim of this paper was to perform a comparative study of the acrylate cements filled with different content (3–21%) of nano- and microscale hydroxyapatite. The work concerns a comparison of times and temperatures of the cross-linking reaction, as well as morphology, glass transition temperature, and principal mechanical properties of the resulting composites. Before being used as a filler, both HAp forms were subjected to an in-depth characterization of their morphology, specific surface area, pore size distribution, and wettability as well as chemical composition and structure. For that purpose, such analytical techniques as scanning electron microscopy, Fourier-transform infrared spectroscopy, X-ray diffraction, tensiometry, Brunauer–Emmett–Teller surface area analysis, differential scanning calorimetry, Shore D hardness test, and Charpy impact test were used. The results indicated a drop of cross-linking temperature and an extension of setting time with the addition of µHAp. The µHAp-filled acrylate composites were characterized by a globular surface morphology, higher glass transition temperature, and lower hardness and impact strength compared to nHAp-filled materials. This relationship was evident at higher nHAp concentrations.

Effect of Physiological Fluids Contamination on Selected Mechanical Properties of Acrylate Bone Cement

This study analyses the degradation rate of selected mechanical properties of bone cement contaminated with human blood and saline solution. During the polymerisation stage, the PMMA cement specimens were supplemented with the selected physiological fluids in a range of concentrations from 0% to 10%. The samples were then subjected to the standardised compression tests, as per ISO 5833: 2002, and hardness tests. The obtained results were analysed statistically to display the difference in the degradation of the material relative to the degree of contamination. Subsequently, numerical modelling was employed to determine the mathematical relationship between the degree of contamination and the material strength degradation rate. The introduction of various concentrations of contaminants into the cement mass resulted in a statistically significant change in their compressive strength. It was shown that the addition of more than 4% of saline and more than 6% of blood (by weight) causes that the specimens exhibit lower strength than the minimum critical value of 70 MPa, specified in the abovementioned International Standard. It was further revealed that the cement hardness characteristics degraded accordingly. The mathematical models showed a very good fit with the results from the experiments: The coefficient of determination R2 was 0.987 in the case of the linear hardness model for blood and 0.983 for salt solution; secondly, the values of R2 for the third-degree polynomial model of compressive strength were 0.88 for blood and 0.92 for salt. From the results, it can be seen that there is a quantitative/qualitative relationship between the contamination rate and the drop in the tested mechanical characteristics. Therefore, great effort must be taken to minimise the contact of the bone cement with physiological fluids, which naturally occur in the operative field, particularly when the material cures, in order to prevent the cement material strength declining below the minimum threshold specified in the ISO standard.

Enhanced osteogenic proliferation and differentiation of human adipose-derived stem cells on a porous n-HA/PGS-M composite scaffold

This study explored the applicability, cellular efficacy, and osteogenic activities of porous nano-hydroxyapatite/Poly (glycerol sebacate)-grafted maleic anhydride (n-HA/PGS-g-M) composite scaffolds. Nuclear magnetic resonance (NMR) analyses indicated that approximately 43% of the hydroxide radicals in PGS were displaced by maleic anhydride. Resonance bands at 1036 cm^-1 occurred in scaffolds containing nHA powders, and peak areas increased when n-HA weight increased in PGS-M-n-HA-0.4, PGS-M-n-HA-0.5, and PGS-M-n-HA-0.6 scaffolds. The n-HA/PGS-g-M composite scaffolds exhibited porous microstructure with average pore size of 150-300 µm in scanning electron microscopy (SEM) analysis. Differential scanning calorimetry (DSC) identified the glass transition temperature (Tg) as -25-30 °C, indicative of quality resilience. The modulus of compressibility increased when n-HA content increased. Interestingly, viability of human adipose-derived stem cells (hADSCs) in vitro and expression of the osteogenic related genes RUNX2, OCN, and COL1A1 was enhanced in the n-HA/PGS-g-M composite scaffolds compared to those factors observed in PGS-g-M scaffolds. Finally, simulated body fluid (SBF) tests indicated more apatite deposits on the surface of n-HA/PGS-g-M scaffolds compared to PGS-g-M scaffolds. Overall, porous n-HA/PGS-g-M composite scaffolds possessed acceptable biocompatibility and mechanical properties, and they stimulated hADSC cell proliferation and differentiation. Given these qualities, the composite scaffolds have potential applications in bone tissue engineering.

Enhanced Osseointegration Ability of Poly(lactic acid) via Tantalum Sputtering-Based Plasma Immersion Ion Implantation

Poly(lactic acid) (PLA) is the most utilized biodegradable polymer in orthopedic implant applications because of its ability to replace regenerated bone tissue via continuous degradation over time. However, the poor osteoblast affinity for PLA results in a high risk of early implant failure, and this issue remains one of the most difficult challenges with this technology. In this study, we demonstrate the use of a new technique in which plasma immersion ion implantation (PIII) is combined with a conventional DC magnetron sputtering. This technique, referred to as sputtering-based PIII (S-PIII), makes it possible to produce a tantalum (Ta)-implanted PLA surface within 30 s without any tangible degradation or deformation of the PLA substrate. Compared to a Ta-coated PLA surface, the Ta-implanted PLA showed twice the surface roughness and substantially enhanced adhesion stability in dry and wet conditions. The strong hydrophobic surface properties and biologically relatively inert chemical structure of PLA were ameliorated by Ta S-PIII treatment, which produced a moderate hydrophilic surface and enhanced cell-material interactions. Furthermore, in an in vivo evaluation in a rabbit distal femur implantation model, Ta-implanted PLA demonstrated significantly enhanced osseointegration and osteogenesis compared with bare PLA. These results indicate that the Ta-implanted PLA has great potential for orthopedic implant applications.