Abstract
BackgroundPolymethylmethacrylate bone cement cannot provide an adhesive chemical bonding to form a stable cement-bone interface. Bioactive bone cements show bone bonding ability, but their clinical application is limited because bone resorption is observed after implantation. Porous polymethylmethacrylate can be achieved with the addition of carboxymethylcellulose, alginate and gelatin microparticles to promote bone ingrowth, but the mechanical properties are too low to be used in orthopedic applications. Bone ingrowth into cement could decrease the possibility of bone resorption and promote the formation of a stable interface. However, scarce literature is reported on bioactive bone cements that allow bone ingrowth. In this paper, we reported a porous surface modified bioactive bone cement with desired mechanical properties, which could allow for bone ingrowth.Materials and MethodsThe porous surface modified bioactive bone cement was evaluated to determine its handling characteristics, mechanical properties and behavior in a simulated body fluid. The in vitro cellular responses of the samples were also investigated in terms of cell attachment, proliferation, and osteoblastic differentiation. Furthermore, bone ingrowth was examined in a rabbit femoral condyle defect model by using micro-CT imaging and histological analysis. The strength of the implant–bone interface was also investigated by push-out tests.ResultsThe modified bone cement with a low content of bioactive fillers resulted in proper handling characteristics and adequate mechanical properties, but slightly affected its bioactivity. Moreover, the degree of attachment, proliferation and osteogenic differentiation of preosteoblast cells was also increased. The results of the push-out test revealed that higher interfacial bonding strength was achieved with the modified bone cement because of the formation of the apatite layer and the osseointegration after implantation in the bony defect.ConclusionsOur findings suggested a new bioactive bone cement for prosthetic fixation in total joint replacement.
Highlights
Tight fixation between polymethylmethacrylate (PMMA) bone cement and bone is of great importance for a successful outcome of total joint replacement
Our findings suggested a new bioactive bone cement for prosthetic fixation in total joint replacement
Lye KW et al proposed a porous PMMA cement incorporated with b-TCP particles, but the addition of b-TCP did not convey any advantage in terms of increase in bone formation and ingrowth due to the way the b-TCP particles were included into the PMMA matrix [18]
Summary
Tight fixation between polymethylmethacrylate (PMMA) bone cement and bone is of great importance for a successful outcome of total joint replacement. Bone resorption is observed after implantation in the bioactive bone cement group, which will gradually compromise fixation This is because weakness of the calcium phosphorous layer formed on the surface of the bioactive bone cement results in particles of wear debris and stimulates bone resorption [13]. Another strategy is to provide porosity in PMMA bone cement with the addition of carboxymethylcellulose (CMC) [14], alginate [15] and gelatin microparticles (GMPs) [16]. Porous polymethylmethacrylate can be achieved with the addition of carboxymethylcellulose, alginate and gelatin microparticles to promote bone ingrowth, but the mechanical properties are too low to be used in orthopedic applications. We reported a porous surface modified bioactive bone cement with desired mechanical properties, which could allow for bone ingrowth
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