PMMA-Based Bone Cements and the Problem of Joint Arthroplasty Infections: Status and New Perspectives.

Bistolfi Bistolfi,Ferracini Ferracini,Miola Miola,Vernè Vernè,Albanese Albanese

doi:10.3390/ma12234002

Bistolfi Bistolfi, Ferracini Ferracini + Show 3 more

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https://doi.org/10.3390/ma12234002

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Abstract

Polymethyl methacrylate (PMMA)-based bone cement is a biomaterial that has been used over the last 50 years to stabilize hip and knee implants or as a bone filler. Although PMMA-based bone cement is widely used and allows a fast-primary fixation to the bone, it does not guarantee a mechanically and biologically stable interface with bone, and most of all it is prone to bacteria adhesion and infection development. In the 1970s, antibiotic-loaded bone cements were introduced to reduce the infection rate in arthroplasty; however, the efficiency of antibiotic-containing bone cement is still a debated issue. For these reasons, in recent years, the scientific community has investigated new approaches to impart antibacterial properties to PMMA bone cement. The aim of this review is to summarize the current status regarding antibiotic-loaded PMMA-based bone cements, fill the gap regarding the lack of data on antibacterial bone cement, and explore the progress of antibacterial bone cement formulations, focusing attention on the new perspectives. In particular, this review highlights the innovative study of composite bone cements containing inorganic antibacterial and bioactive phases, which are a fascinating alternative that can impart both osteointegration and antibacterial properties to PMMA-based bone cement.

Highlights

Bone cement, or Polymethyl methacrylate (PMMA), is a polymer belonging to the category of acrylic resins, obtained from the mixture at room temperature of a monomer and a polymer in the presence of an initiator, an activator, and a stabilizer [1]
The aim of this review is to summarize the current status regarding antibiotic-loaded PMMA-based bone cements, fill the gap regarding the lack of data on antibacterial bone cement, and explore the progress of antibacterial bone cement formulations, focusing attention on the new perspectives
The aim of this review is to provide a comprehensive overview of the different approaches to impart antibacterial properties to PMMA-based bone cement, starting from antibiotic-loaded bone adopted to impart antibacterial properties to PMMA-based bone cement, starting from antibioticcement to innovative formulations, ongoingthe issues in this area

Summary

Introduction

PMMA (polymethyl methacrylate), is a polymer belonging to the category of acrylic resins, obtained from the mixture at room temperature of a monomer (methyl methacrylate, MMA) and a polymer (pre-polymerized polymethyl methacrylate particles) in the presence of an initiator, an activator, and a stabilizer [1]. PMMA-based bone cements are widely used in orthopedics, with two different functions: (1) to fix the joint arthroplasties to the bone (2), and to act as a temporary spacer for two-stage revision of septic, infected joint arthroplasties. They are inert materials that are unable to stimulate anchoring to bone tissue and are prone to bacterial contamination. The use of ALBCs is connected to the issue of antibiotic resistance [2,6] For this reason, the research community started to investigate alternative strategies to develop antibiotic-free bone cements with antibacterial properties

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