Abstract
Poly(methyl methacrylate) (PMMA) is used to manage bone loss in revision total knee arthroplasty (rTKA). However, the application of PMMA has been associated with complications such as volumetric shrinkage, necrosis, wear debris, and loosening. Glass polyalkenoate cements (GPCs) have potential bone cementation applications. Unlike PMMA, GPC does not undergo volumetric shrinkage, adheres chemically to bone, and does not undergo an exothermic setting reaction. In this study, two different compositions of GPCs (GPCA and GPCB), based on the patented glass system SiO2-CaO-SrO-P2O5-Ta2O5, were investigated. Working and setting times, pH, ion release, compressive strength, and cytotoxicity of each composition were assessed, and based on the results of these tests, three sets of samples from GPCA were implanted into the distal femur and proximal tibia of three sheep (alongside PMMA as control). Clinical CT scans and micro-CT images obtained at 0, 6, and 12 weeks revealed the varied radiological responses of sheep bone to GPCA. One GPCA sample (implanted in the sheep for 12 weeks) was characterized with no bone resorption. Furthermore, a continuous bone–cement interface was observed in the CT images of this sample. The other implanted GPCA showed a thin radiolucent border at six weeks, indicating some bone resorption occurred. The third sample showed extensive bone resorption at both six and 12 weeks. Possible speculative factors that might be involved in the varied response can be: excessive Zn2+ ion release, low pH, mixing variability, and difficulty in inserting the samples into different parts of the sheep bone.
Highlights
Revision total knee arthroplasty rates have dramatically increased worldwide in recent years
Assay no showed in pre-osteoblast cell numbers for GPCA after 24 h, while a reduction of cells was seen for GPCB
The release of ions (e.g., Ta2+, Ca2+, Sr2+, P5+ ) from the GPCA in the first day was greater than GPCB
Summary
Revision total knee arthroplasty (rTKA) rates have dramatically increased worldwide in recent years. The total annual number of rTKA surgeries is forecast to rapidly increase by 182% in 2014 to 2030 in the United States (U.S.) [1]. In Canada, more than 75,000 rTKA surgeries were performed between 2018 and 2019, reflecting a 22.5% increase compared to five years earlier [2]. While rTKA surgeries comprise a relatively small percentage of all joint replacements (and approximately 7% of all knee replacements [2]), revision surgeries are more complex than primary surgical procedures, resulting in higher inpatient costs (nearly double that of the primary total knee arthroplasty (TKA)), decreased function of the knee, and longer patient recovery time [2]. The following table reviews each treatment option currently available in rTKA
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