Abstract
PurposeThe aim was to determine effects of diluent monomer and monocalcium phosphate monohydrate (MCPM) on polymerization kinetics and volumetric stability, apatite precipitation, strontium release and fatigue of novel dual-paste composites for vertebroplasty.Materials and methodsPolypropylene (PPGDMA) or triethylene (TEGDMA) glycol dimethacrylates (25 wt%) diluents were combined with urethane dimethacrylate (70 wt%) and hydroxyethyl methacrylate (5 wt%). 70 wt% filler containing glass particles, glass fibers (20 wt%) and polylysine (5 wt%) was added. Benzoyl peroxide and MCPM (10 or 20 wt%) or N-tolyglycine glycidyl methacrylate and tristrontium phosphate (15 wt%) were included to give initiator or activator pastes. Commercial PMMA (Simplex) and bone composite (Cortoss) were used for comparison. ATR-FTIR was used to determine thermal activated polymerization kinetics of initiator pastes at 50–80°C. Paste stability, following storage at 4–37°C, was assessed visually or through mixed paste polymerization kinetics at 25°C. Polymerization shrinkage and heat generation were calculated from final monomer conversions. Subsequent expansion and surface apatite precipitation in simulated body fluid (SBF) were assessed gravimetrically and via SEM. Strontium release into water was assessed using ICP-MS. Biaxial flexural strength (BFS) and fatigue properties were determined at 37°C after 4 weeks in SBF.ResultsPolymerization profiles all exhibited an inhibition time before polymerization as predicted by free radical polymerization mechanisms. Initiator paste inhibition times and maximum reaction rates were described well by Arrhenius plots. Plot extrapolation, however, underestimated lower temperature paste stability. Replacement of TEGDMA by PPGDMA, enhanced paste stability, final monomer conversion, water-sorption induced expansion and strontium release but reduced polymerization shrinkage and heat generation. Increasing MCPM level enhanced volume expansion, surface apatite precipitation and strontium release. Although the experimental composite flexural strengths were lower compared to those of commercially available Simplex, the extrapolated low load fatigue lives of all materials were comparable.ConclusionsIncreased inhibition times at high temperature give longer predicted shelf-life whilst stability of mixed paste inhibition times is important for consistent clinical application. Increased volumetric stability, strontium release and apatite formation should encourage bone integration. Replacing TEGDMA by PPGDMA and increasing MCPM could therefore increase suitability of the above novel bone composites for vertebroplasty. Long fatigue lives of the composites may also ensure long-term durability of the materials.
Highlights
Osteoporotic fracture of the spine causes severe pain, height loss, limited mobility, kyphosis, and reduced pulmonary function [1]
The views expressed are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research (NIHR) or the Department of Health
Polymethyl methacrylate (PMMA) cement is the most commonly used bone cement for VP and KP. Limitations of this cement include poor controlled setting and viscosity that may increase the risk of cement leakage [7]
Summary
Osteoporotic fracture of the spine (osteoporotic vertebral fracture; OVF) causes severe pain, height loss, limited mobility, kyphosis, and reduced pulmonary function [1]. Surgical managements that relieve severe pain rapidly such as vertebroplasty (VP) and balloon kyphoplasty (KP) are indicated. These procedures involve injection of a bone cement to stabilize fractures. Polymethyl methacrylate (PMMA) cement is the most commonly used bone cement for VP and KP Limitations of this cement include poor controlled setting and viscosity that may increase the risk of cement leakage [7]. Further concerns are high polymerization shrinkage, heat generation, and risk of toxic unreacted monomers release [8]. These shortcomings may cause gap formation and local inflammation leading to fibrous encapsulation [9] reducing the integrity of the bone-cement interface. Conventional PMMA cements lack the ability to promote bone formation
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