An in vitro assessment of the antibacterial properties and cytotoxicity of nanoparticulate silver bone cement

Infections with multiresistant bacteria have become a serious problem in joint arthroplasty. This study reports about in vitro antibacterial activity against multiresistant bacteria and in vitro cytotoxicity of polymethylmetacrylate bone cement loaded with metallic silver particles with a size of 5-50 nm called NanoSilver. In vitro antibacterial activity against S. epidermidis, methicillin-resistant S. epidermidis (MRSE), and methicillin-resistant S. aureus (MRSA) was studied by microplate proliferation tests. Quantitative elution testing and qualitative ongrowth of human osteoblasts was done to study in vitro cytotoxicity. Only NanoSilver cement showed high-antibacterial activity against all strains, including MRSE and MRSA. Gentamicin cement was not effective against MRSA and MRSE due to the high-level gentamicin resistance of the tested strains. Plain cement did not inhibit proliferation of any strains. There was no significant difference regarding in vitro cytotoxicity between NanoSilver and the non-toxic control. Cytotoxicity of cement loaded with silver salts made this kind of silver unsuitable for all day clinical use in the past. This new form of silver called NanoSilver was free of in vitro cytotoxicity and showed high effectiveness against multiresistant bacteria. If the results can be confirmed in vivo NanoSilver may have a high interest in joint arthroplasty.

Antibacterial and mechanical properties of bone cement impregnated with chitosan nanoparticles

Although total joint replacement has become commonplace in recent years, bacterial infection remains a significant complication following this procedure. One approach to reduce the incidence of joint replacement infection is to add antimicrobial agents to the bone cement used to fix the implant. In this in vitro study, we investigated the use of chitosan nanoparticles (CS NP) and quaternary ammonium chitosan derivative nanoparticles (QCS NP) as bactericidal agents in poly(methyl methacrylate) (PMMA) bone cement with and without gentamicin. The antibacterial activity was tested against Staphylococcus aureus (S. aureus) and Staphylococcus epidermidis (S. epidermidis). A 10(3)-fold reduction in the number of viable bacterial cells upon contact with the surface was achievable using QCS NP at a nanoparticle/bone cement weight ratio of 15%. The inhibition of S. aureus and S. epidermidis growth on the surface of the CS NP and QCS NP-loaded bone cements was clearly shown using the LIVE/DEAD Baclight bacterial viability kits and fluorescence microscopy. The CS NP and QCS NP also provided a significant additional bactericidal effect to gentamicin-loaded bone cement. The antibacterial effectiveness remained high even after the modified bone cements had been immersed for 3 weeks in an aqueous medium. No cytotoxic effect of the CS NP- and QCS NP-loaded cements was shown in a mouse fibroblast MTT cytotoxicity assay. Mechanical tests indicated that the addition of the CS and QCS in nanoparticulate form allowed the retention of a significant degree of the bone cement's strength. These results indicate a new promising strategy for combating joint implant infection.

Toxicology and biocompatibility of bioglasses

Evidence for the lack of toxicity of various bioglass formulations has been deduced from studies carried out, both in vivo and in vitro, in several different centers. Recent studies of the authors, described here, include testing of solid bioglass implants in the soft tissues of rats and rabbits for time periods of up to eight weeks. Two new techniques are described for the toxicological testing of particulate biomaterials. These tests, which involve rat peritoneal macrophages in culture and a mouse pulmonary biomaterial embolus model, indicate the biocompatibility of bioglass powders. Thus, the surface activity so critical in bone adhesion is without toxic effect in non-osseous tissues in contact with solid bioglass implants. Should wear occur and produce particulate bioglass, the material should be eliminated without consequence.

Histological and compositional evaluations of three types of calcium phosphate cements when implanted in subcutaneous tissue immediately after mixing

To evaluate the soft tissue response of calcium phosphate cement (CPC), consisting of an equimolar mixture of tetracalcium phosphate (TTCP) and dicalcium phosphate anhydrous (DCPA) under conditions close to those encountered in actual surgical procedures, we implanted three types of CPC [conventional CPC (c-CPC), fast-setting CPC (FSCPC), and antiwashout type FSCPC (aw-FSCPC; formerly called nondecay type FSCPC or nd-FSCPC)] subcutaneously in the abdomens of rats immediately (1 min) after mixing. At 1 week after surgery, histological examination and compositional analysis were performed using light microscopy and powder X-ray diffraction (XRD), respectively. The implanted c-CPC was crumbled completely, whereas FSCPC and aw-FSCPC retained their shape. Large vesicles containing copious inflammatory effusion were subcutaneously formed around the c-CPC. Histologically, many foreign-body giant cells were collected around the c-CPC, and moderate inflammatory cell infiltration was observed at 1 week after surgery. In contrast, the FSCPC and aw-FSCPC were covered with a thin layer of granulation tissue that included few giant cells and presented slight inflammatory cell infiltration, and no effusion was observed. The XRD analysis of the c-CPC revealed the presence of some unreacted DCPA even 1 week after implantation, whereas almost no DCPA was found in the FSCPC or aw-FSCPC. In conclusion, it was found that CPC does not always show excellent tissue response. When c-CPC is implanted subcutaneously in rats immediately after mixing, it fails to set and causes a severe inflammatory response. Therefore, the type of CPC should be chosen according to the clinical particulars. CPC should be used in a manner that assures its setting reaction. We recommend the use of FSCPC and aw-FSCPC for surgical applications, such as orthopedics, plastic and reconstructive surgery, and oral and maxillofacial surgery, where the cement might otherwise crumble due to the pressure before setting.

Toxic effects of methylmethacrylate monomer on leukocytes and endothelial cells in vitro

The influence of methylmethacrylate monomer (MMA) on the cellular integrity of monocytes, granulocytes and endothelial cells in vitro was investigated. Clinically relevant blood concentrations of MMA (i.e., 5-10 micrograms/mL) were clearly cytotoxic to all cell types studied, as evidenced by the release of lactic dehydrogenase (LD) and 51Cr, and increased uptake of trypan blue (vital staining). Scanning electron microscopic examination of cells treated with 10 micrograms/mL MMA showed marked signs of cytotoxicity after 1 min incubation, and after 30 min the majority of the cells were totally disintegrated. These findings may have clinical bearing on intraoperative cardiorespiratory dysfunction and deep vein thrombosis in MMA-fixed joint replacement surgery.

Experimental studies on a new bioactive bone cement: hydroxyapatite composite resin

We developed hydroxyapatite composite resin (CAP) as a new type of bioactive bone cement. CAP is composed of 80% w/w hydroxyapatite granules (mean particle size: 2 microns) and bis-phenol-A glycidyl methacrylate-based resin. The setting time is 5 min and the peak curing temperature during polymerization is 46 degrees C. In this study, the mechanical strength of CAP and the biological behaviour of the CAP-bone interface were examined. The compressive strength of CAP was 260 MPa and this was about three times greater than that of commercial polymethylmethacrylate (PMMA) bone cement. The tensile strength and fracture toughness of CAP also exceeded those of PMMA cement. CAP was implanted into the femoral condyles of rabbits. Two weeks later, new bone formation was already seen on the surface of the CAP implants. At 8 wk, bone was growing directly onto the surface of the CAP implants and no intervening fibrous tissue could be observed at the CAP-bone interface. These results show that CAP is a promising material which possesses superior mechanical strength and the biological property of achieving direct contact with bone.

Cardiovascular effects of methylmethacrylate cement

Experiments were carried out on dogs in an attempt to identify the mechanisms underlying the systemic hypotension associated with the application of acrylic cement substances to raw bone surfaces, as in reconstructive hip surgery. Intravenous injection of the liquid component of such cements (monomeric methylmethacrylate) into six dogs produced a significant fall in blood pressure together with an increase in heart rate and cardiac output. This seemed to be due to peripheral vasodilatation caused directly by the monomer and not through the release of histamine. Absorption of free monomer from the mixed cement into the systemic circulation at operation is likely to have the same effect. Precautionary measures can be taken and groups of patients who are especially at risk can be identified, thus reducing the hazards of total hip replacement.

Thermal analysis of bone cement polymerisation at the cement-bone interface

The two major problems that have been reported with the use of polymethylmethacrylate (PMMA) cement are thermal necrosis of surrounding bone due to the high heat generation during polymerisation and chemical necrosis due to unreacted monomer release. Computer models have been used to study the temperature and monomer distribution after cementation. In most of these models, however, polymerisation is modelled as temperature independent and cancellous bone is modelled as a continuum. Such models thus cannot account for the expected important role of the trabecular bone micro-structure. The aim of this study is to investigate the distribution of temperature and monomer leftover at the cancellous bone-cement interface during polymerisation for a realistic trabecular bone-cement micro-structure and realistic temperature-dependent polymerisation kinetics behaviour. A 3-D computer model of a piece of bovine cancellous bone that underwent pressurization with bone-cement was generated using a micro-computed tomography scanner. This geometry was used as the basis for a finite element model and a temperature-dependent problem for bone cement polymerisation kinetics was solved to simulate the bone cement polymerisation process in the vicinity of the interface. The transient temperature field throughout the interface was calculated, along with the polymerisation fraction distribution in the cement domain. The calculations revealed that the tips of the bone trabeculae that are embedded in the cement attain temperatures much higher than the average temperature of the bone volume. A small fraction of the bone (10%) is exposed to temperatures exceeding 70 degrees C, but the exposure time to these high temperatures is limited to 50s. In the region near the bone, the cement polymerisation fraction (about 84%) is less than that in the centre (where it is reaching values of over 96%). An important finding of this study thus is the fact that the bone tissue that is subjected to the highest temperatures is also subjected to high leftover monomer concentration. Furthermore the maximum bone temperature is reached relatively early, when monomer content in the neighbouring cement is still quite high.

In vitro biodegradation of three brushite calcium phosphate cements by a macrophage cell-line

Depending upon local conditions, brushite (CaHPO4 x 2 H2O) cements may be largely resorbed or (following hydrolysis to hydroxyapatite) remain stable in vivo. To determine which factors influence cement resorption, previous studies have investigated the solution-driven degradation of brushite cements in vitro in the absence of any cells. However, the mechanism of cell-mediated biodegradation of the brushite cement is still unknown. The aim of the current study was to observe the cell-mediated biodegradation of brushite cement formulations in vitro. The cements were aged in the presence of a murine cell line (RAW264.7), which had the potential to form osteoclasts in the presence of the receptor for nuclear factor kappa B ligand (RANKL) in vitro, independently of macrophage colony stimulating factor (M-CSF). The cytotoxicity of the cements on RAW264.7 cells and the calcium and phosphate released from materials to the culture media were analysed. Scanning electron microscopy (SEM) and focused ion beam (FIB) microscopy were used to characterise the ultrastructure of the cells. The results showed that the RAW264.7 cell line formed multinucleated TRAP positive osteoclast-like cells, capable of ruffled border formation and lacunar resorption on the brushite calcium phosphate cement in vitro. In the osteoclast-like cell cultures, ultrastructural analysis by SEM revealed phenotypic characteristics of osteoclasts including formation of a sealing zone and ruffled border. Penetration of the surface of the cement, was demonstrated using FIB, and this showed the potential demineralising effect of the cells on the cements. This study has set up a useful model to investigate the cell-mediated cement degradation in vitro.

Tissue response to fast-setting calcium phosphate cement in bone

Fast-setting calcium phosphate cement (FSCPC) is a promising new bioactive cement with a significantly short setting time (approximately 5-6 min) compared to conventional calcium phosphate cement (c-CPC) (30-60 min) at physiologic temperatures. As a result of its ability to set quickly, it is applicable in surgical procedures where fast setting is required. In this study, FSCPC was implanted in rat tibiae to evaluate tissue response and biocompatibility. FSCPC was converted to hydroxyapatite (HAP) in bone faster than c-CPC in the first 6 h. By 24 h, significant amounts of both FSCPC and c-CPC had been converted to HAP. The conversion of FSCPC into HAP further proceeded gradually, reaching 100% within 8 weeks. Infrared spectroscopic analysis disclosed the deposition of B-type carbonate apatite, which is a biological apatite contained in human dentin or bone, on the surface of the FSCPC. Histologically, FSCPC showed a tissue response similar to that of c-CPC. A slight inflammatory reaction was observed in the soft tissue apposed to both cements in the early period, and new bone was formed along the surface of the FSCPC at the adjacent bone. However, no resorption of either cement by osteoclasts or macrophages was observed within 8 weeks. We conclude that FSCPC is superior to c-CPC in clinical applications in oral and maxillofacial, orthopedic, plastic, and reconstructive surgery, since it shows a faster setting time and higher mechanical strength in the early period that are required in these surgical procedures, as well as osteoconductivity and excellent biocompatibility similar to that of c-CPC.

Macrophage exposure to polymethyl methacrylate leads to mediator release and injury

To understand further the role of macrophages in the loosening of cemented arthroplasty, several in vitro effects of polymethyl methacrylate (PMMA) particle exposure in these cells were studied. The kinetics of arachidonic acid and derived inflammatory mediator release was characterized following macrophage exposure to either PMMA or control polystyrene particles. Temporal release of radiolabeled products by [14C]arachidonate-labeled cells was determined by sequential scintillation counting. Significant dose-dependent release of arachidonic acid mediators by macrophages was observed within half an hour of exposure to either PMMA or styrene particles. Unexposed control cells incubated in media alone did not release detectable amounts of radiolabeled products. The leakage of intracellular lactate dehydrogenase (LDH), a marker of cell injury, was detected spectrophotometrically 4 h following exposure to PMMA but not styrene. PMMA-induced LDH release was dose dependent. In contrast, polystyrene exposure failed to increase LDH release above unexposed control cells. These in vitro studies reveal that macrophages rapidly released arachidonic acid and derived inflammatory mediators in response to both PMMA and styrene particles. However, cells exposed to PMMA are lethally damaged, as reflected by the subsequent leakage of their intracellular LDH. We propose that a similar sequence of events may occur when macrophages encounter PMMA particles at the bone-cement interface. This is characteristic of a foreign body granulomatous response.

Review of the biological response to a novel bone cement containing poly(ethyl methacrylate) and n-butyl methacrylate

This review describes work published independently elsewhere in which the biological reactions to poly(ethyl methacrylate) n-butyl methacrylate (PEMBMA) have been studied. This material has been compared throughout with conventional poly(methyl methacrylate) (PMMA). Butyl methacrylate monomer used in PEMBMA was slightly less toxic than methyl methacrylate monomer used in PMMA when injected intraperitoneally in mice. No differences in cardiorespiratory effects were found between n-butyl and methyl monomer infused intravenously into anaesthetized rabbits. The tissue reaction to the beaded polymers of poly(methyl methacrylate) and poly(ethyl methacrylate) implanted subcutaneously was identical. The surface appearance of the two materials differed significantly when viewed by scanning electron microscopy, showing a series of elevations resembling tightly packed spheres in the case of PMMA, but a smooth surface with only occasional smooth elevations in the case of PEMBMA. Intramuscular implantation showed more fibrous tissue and tissue damage in relation to PMMA cured in situ compared with PEMBMA and there was more bone necrosis and a thicker fibrous tissue layer adjacent to PMMA than PEMBMA when cured intraosseously.

Self-setting properties and in vitro bioactivity of calcium sulfate hemihydrate-tricalcium silicate composite bone cements

Self-setting biomaterials are widely used for tissue repair and regeneration. Calcium sulfate hemihydrate has been used for many years as a self-setting biomaterial due to its good setting properties. However, too fast a degradation rate and lack of bioactivity have limited its application in orthopaedic field. Herein, tricalcium silicate was introduced into calcium sulfate hemihydrate (CaSO(4).1/2H(2)O) to form a calcium sulfate hemihydrate-based composite, and its behavior as a cement was studied in comparison with pure calcium sulfate hemihydrate. The results indicated that the workability and setting time of the composite pastes are higher than those of pure CaSO(4).1/2H(2)O, and the composite pastes showed much better short- and long-term mechanical properties than those of pure CaSO(4).1/2H(2)O. Moreover, the biphasic specimens showed significantly improved bioactivity and degradability compared with those of pure CaSO(4).1/2H(2)O, indicating that the composite cements might have a significant clinical advantage over the traditional CaSO(4).1/2H(2)O cement.

Effects of polymerization heat and monomers from acrylic cement on canine bone

We investigated the effects of polymerization heat and toxicity of polymethylmetacrylate bone cement in the canine tibial diaphysis. Heat was studied by filling the tibias with either bone cement or bone wax contained in a monomer tight membrane pouch. Toxicity was studied by filling both tibias with cement, with the control side contained in the membrane pouch. Bone blood perfusion was measured by microsphere technic, and bone remodeling by 99mTc-methylene diphosphonate uptake and by histologic technique. In bone exposed to the combination of polymerization heat and monomer, both perfusion and remodeling were impaired. We did not find any effects of polymerization heat alone. We conclude that hot toxic chemicals from bone cement during polymerization may inhibit bone blood perfusion and remodeling, whereas heat alone seems to be of minor importance for the regenerative processes in cemented diaphyseal bone.

Preparation, physical–chemical characterisation and cytocompatibility of calcium carbonate cements

The feasibility of calcium carbonate cements involving the recrystallisation of metastable calcium carbonate varieties has been demonstrated. Calcium carbonate cement compositions presented in this paper can be prepared straightforwardly by simply mixing water (liquid phase) with two calcium carbonate phases (solid phase) which can be easily obtained by precipitation. An original cement composition was obtained by mixing amorphous calcium carbonate and vaterite with an aqueous medium. The cement set and hardened within 2h at 37 degrees C in an atmosphere saturated with water and the final composition of the cement consisted mostly of aragonite. The hardened cement was microporous and showed poor mechanical properties. Cytotoxicity tests revealed excellent cytocompatibility of calcium carbonate cement compositions. Calcium carbonates with a higher solubility than the apatite formed for most of the marketed calcium phosphate cements might be of interest to increase biomedical cement resorption rates and to favour its replacement by bone tissue.

Novel bioactive composite bone cements based on the beta-tricalcium phosphate-monocalcium phosphate monohydrate composite cement system

Bioactive composite bone cements were obtained by incorporation of tricalcium silicate (Ca3SiO5, C3S) into a brushite bone cement composed of beta-tricalcium phosphate [beta-Ca3(PO4)2, beta-TCP] and monocalcium phosphate monohydrate [Ca(H2PO4)2.H2O, MCPM], and the properties of the new cements were studied and compared with pure brushite cement. The results indicated that the injectability, setting time and short- and long-term mechanical strength of the material are higher than those of pure brushite cement, and the compressive strength of the TCP/MCPM/C3S composite paste increased with increasing aging time. Moreover, the TCP/MCPM/C3S specimens showed significantly improved in vitro bioactivity in simulated body fluid and similar degradability in phosphate-buffered saline as compared with brushite cement. Additionally, the reacted TCP/MCPM/C3S paste possesses the ability to stimulate osteoblast proliferation and promote osteoblastic differentiation of the bone marrow stromal cells. The results indicated that the TCP/MCPM/C3S cements may be used as a bioactive material for bone regeneration, and might have significant clinical advantage over the traditional beta-TCP/MCPM brushite cement.

Application of tertiary amines with reduced toxicity to the curing process of acrylic bone cements

4-Dimethylaminobenzyl alcohol (DMOH) and 4-dimethylaminobenzyl methacrylate (DMMO) were used as the activators in the benzoyl peroxide initiated redox polymerization for the preparation of acrylic bone cement based on poly(methylmethacrylate) beads of different particle size. The residual monomer content of the cured cements was about 2 wt %, independent of the redox system used in the polymerization, indicating that the activating effect of the tertiary aromatic amines DMOH or DMMO was sufficient to reach a polymerization conversion similar to that obtained with the benzoyl peroxide (BPO) N,N-dimethyl-4-toluidine (DMT) system. The BPO/DMOH and BPO/DMMO redox systems provided exotherms of decreasing peak temperature and increasing setting time, and the cured materials presented higher average molecular weight and similar glass transition temperatures in comparison with those obtained when DMT was used as the activator. In addition, these activators are three times less toxic than the classical DMT.

Osteoblast cell death on methacrylate polymers involves apoptosis

The success of an implant depends on the implant-tissue interface. There are many causes of implant failure, one of which is tissue necrosis. The aim of this in vitro study was to determine whether cell death of primary human osteoblasts (implant site specific cells) occurred by apoptosis (a form of programmed cell death) on two methacrylate polymers. Cells were cultured on poly(ethyl methacrylate)/tetrahydrofurfuryl methacrylate and poly(methyl methacrylate in the form of 13-mm discs, in conditioned medium containing leachable monomer and in the presence of various concentrations of monomer itself in the culture medium. It was found that monomer and leached monomer caused apoptosis of human osteoblast cells in this system. Tetrahydrofurfuryl methacrylate monomer was found to be more toxic than currently used monomer methylmethacrylate. Preincubation of polymers in serum containing medium was found to increase the biocompatibility of the polymers. High levels of apoptosis occurred on polymer used directly after polymerization. Apoptosis levels were decreased after polymer was incubated at 60 degrees C overnight or for 3 days. Apoptosis therefore may occur in cells at the implant site in vivo.

Bioactive bone cement as a principal fixture for spinal burst fracture: an in vitro biomechanical and morphologic study

STUDY DESIGN

An in vitro biomechanical and radiographic study to evaluate the properties of a newly developed bioactive bone cement for stabilization of the fractured spine, suitable for minimally invasive application.

OBJECTIVES

To determine the mechanical stability of the fractured spine after injection of the newly developed bioactive bone cement under quasi-static and cyclic loading regimens.

SUMMARY OF BACKGROUND DATA

Bone cement injection has been reported as a potentially useful, minimally invasive technique for treating vertebral body fracture or stabilizing osteoporosis. However, potential problems associated with the use of polymethylmethacrylate (PMMA) have prompted the search for alternative solutions. The use of bioactive bone cement as a potential replacement for PMMA has been reported.

METHODS

Biomechanical and radiographic analyses were used to test the mechanical stability of the fractured spine. The cement used was formed from hydroxyapatite powder containing strontium and bisphenol A diglycidylether dimethacrylate (D-GMA) resin. Twenty-six fresh porcine spine specimens (T10-L1) were divided into three groups: pilot, intact, and cemented. Spinal stiffness and failure strength were recorded in the intact group with the specimens flexed at 10 degrees. Uniform injuries were created in all specimens of the cemented group, and compressive loading was applied with 10 degrees of flexion until a fracture occurred. The bone cement was injected into the fractured spine, and stiffness was evaluated after 1 hour. Failure strength was also recorded after 3000 and 20,000 fatigue load cycles. Morphology of the specimens was observed and evaluated.

RESULTS

Results from a cell biocompatibility test indicated that the new bioactive bone cement was favorable for cell growth. Spinal stiffness significantly decreased after fracture (47.5% of intact condition). Instant stiffness of the spine recovered to 107.8% of the intact condition after bone cement injection. After 3000 and 20,000 cycles of fatigue loading, stiffness of the cemented spine was found to be 93.5% and 94.4% of intact stiffness, respectively (P < 0.05). Average failure strength of the spine was 5056 N (after 3000 cycles) and 5301 N (after 20,000 cycles) after bone cement injection and fatigue loading. Radiographs and cross-sectional observations indicated a good cement-bone bonding and fracture fill.

CONCLUSIONS

A new bioactive bone cement without cytotoxic effect has been developed. Results show that minimally invasive techniques to apply this cement to porcine spines results in augmentation of mild burst fractures such that the original stiffness and strength of the vertebra are recovered. This new cement therefore shows potential as an augmentation to traditional instrumentation in the surgical management of vertebral fractures. The potential for further clinical applications is currently under investigation.

Cardiovascular changes after pulmonary embolism from injecting calcium phosphate cement

Concerns have been raised that the use of calcium phosphate (CaP) cements for the augmentation of fractured, osteoporotic bones may aggravate cardiovascular deterioration in the event of pulmonary cement embolism by stimulating coagulation. The aim of the present study was therefore to investigate the cardiovascular changes after pulmonary embolism of CaP cement using an animal model. In 14 sheep, 2.0 mL CaP or polymethylmethacrylate cement were injected intravenously. Cardiovascular parameters and antithrombin levels were monitored until 60 min postinjection. Postmortem, lungs were subjected to CT scanning, and 3D reconstruction of the cement was performed. Intravenous injection of CaP cement resulted in a more severe increase in pulmonary arterial pressure and decrease in arterial blood pressure. Disintegration of the CaP cement seemed to be the reason for the more severe reaction. There was no evidence of thromboembolism. Disintegration of CaP cement in circulating blood does not only compromise the mechanical properties, but also represents a risk of cardiovascular complications. Reliable cohesion of CaP cements in an aqueous environment is essential for clinical applications such as osteoporotic bone augmentation.

Tissue reaction to methyl methacrylate monomer. A comparative study in the rabbit's ear on the toxicity of methyl methacrylate monomer of varying composition

The aim of the present investigation was to evaluate if a bone cement monomer with a high concentration of accelerator (N,N-dimethyl-p-toluidine) is more toxic than a methyl methacrylate monomer, free from accelerator. 1) No difference in the acute local toxicity between CMW, Simplex-P and pure methyl methacrylate monomer was seen. 2) By gas chromatography. N,N-dimethyl-p-toluidine was shown to be water soluble to a small extent. Any bone cement monomer in current use can be fully dissolved in saline to a concentration of about 1 per cent.

Fixation of the craniofacial skeleton with butyl-2-cyanoacrylate and its effects on histotoxicity and healing

Butyl-2-cyanoacrylate is an easily applied, biocompatible, bioresorbable polymer glue that provides an alternative to conventional rigid fixation techniques. Our aim was to determine if cyanoacrylate fixation of the bone flap in a rabbit craniotomy model provides the healing and strength afforded by plate and screw fixation. We also investigated the inflammatory responses of adjacent tissues including the scalp, cranium, and brain. A unilateral parietal bone flap was elevated in 33 adult New Zealand rabbits. The bone was fixed in position with cyanoacrylate (n = 13), fixed with a microplate and screws (n = 14), or was replaced without fixation (sham-control, n = 6). Normal scar formation and no residual polymer were found in scalp specimens. Neuropathologic analysis identified the presence of residual polymer on the surface of 2 of the 13 rabbit brains. Histopathologic analysis of the bone flap-to-skull interface revealed no difference in the degree but rather in the quality of inflammation and healing between the plate and screw and polymer fixation groups. Microdensitometric analysis of the bone gap revealed nearly equivalent bone density in the cyanoacrylate and plated groups, tending to less density in the sham group (p = 0.11 and 0.09, respectively). An additional study focusing on neurotoxicity was performed in 20 adult rabbits with 3-week and 11-week recovery periods and similarly found the absence of a marked inflammatory response to the polymer. In conclusion, bone healing and soft-tissue inflammation were comparable between cyanoacrylate and plate and screw fixation groups. Although butyl-2-cyanoacrylate glue fixation may provide a reasonable alternative to hardware fixation, further investigations are necessary to identify its ideal utilization.

Cytotoxic effect of bone cements in HL-60 cells: distinction between apoptosis and necrosis

Ten PMMA-based bone cements used in prosthetic surgery have been studied with respect to the induction of programmed cell death (i.e., apoptosis) in HL-60 cells, which are remarkably sensitive to various apoptotic stimuli. Annexin V binding and propidium iodide (PI) exclusion were the methods for detection of early apoptotic changes, while PI entry was considered as a marker of necrosis. Hoechst 33342 staining was used to detect DNA fragmentation and Alamar blue was applied to measure oxide-reduction activity of cells. The production of reactive oxygen species (ROS) related to cell damage was verified using dichlorofluorescein-diacetate (DCFH-DA) oxidation to DCF. Under our experimental conditions, the cements tested, for the most part, were not toxic to leukemic cells at 4 and 24 h. After 24 h, three cements were able to induce cell death, with two eliciting both apoptosis and necrosis, and one cement acting mainly via apoptosis. Both processes of cell death are likely to be mediated by the production of oxygen-free radicals. These findings provide potential leads for investigation into the molecular mechanisms of cell death, which are responsible for tissue damage by cements and intolerance of cemented prostheses.

Acrylic bone cement induces the production of free radicals by cultured human fibroblasts

Arthroplasty with poly(methyl methacrylate) (PMMA) bone cement induces late loosening phenomena that compromise the prosthetic stability. As free radicals are inflammatory mediators and cytotoxic, it seemed useful to investigate whether PMMA induces the liberation of free radicals and/or cytotoxicity. The effect of PMMA interaction on cultured human fibroblasts was accessed by the cell viability test (MTT), and by the measurement of lipoperoxides in the incubation medium. The incubation with the medium exposed to PMMA induced a significant reduction in the viability and a significant increase in lipoperoxide liberation (vs control). These data suggest that PMMA is cytotoxic. This effect seems to be mediated by lipoperoxide and possibly by other free radicals, and may explain the peri-implant loosening phenomena that compromise the prosthetic stability.

Biocompatibility of particulate polymethylmethacrylate bone cements: a comparative study in vitro and in vivo

The biocompatibility of particles of four different commercial polymethylmethacrylate (PMMA) bone cements was evaluated by exposing human synovial fibroblasts and mouse peritoneal macrophages to particles of cement. Cell integrity and inflammatory potential were assessed using enzyme release and microscopical examination. Results suggested the occurrence of cell damage in both cell types and macrophage studies indicated inflammatory potential. The response in vivo was investigated by intra-articular injection of the particles into mouse knee joints. Clinical and histological evaluation was performed over 2-52 wk. Particles of all four cements were well tolerated in the joints.