Current polymethyl methacrylate (PMMA) bone cements face significant trade-offs between radiopacity, mechanical strength, and biocompatibility when incorporating conventional additives like barium sulfate. This study introduces bismuth chalcogenides (Bi2X3, X = O, S, Se) as advanced multifunctional radiopacifiers for PMMA bone cement, identifying Bi2S3 as a breakthrough candidate. At 20 wt% loading, Bi2S3-PMMA achieves a compressive strength of 82.4 ± 3.1 MPa-exceeding the clinical threshold (70 MPa)-while matching the radiopacity of commercial 30% BaSO4-PMMA. The composite exhibits exceptional biocompatibility, maintaining >95% cell viability and reducing Bi3+ ion leaching to 0.424 ppm, significantly lower than levels observed with Bi2O3 (9.495 ppm) and Bi2Se3 (0.607 ppm). Notably, Bi2S3-PMMA significantly enhances osteogenesis, inducing a 2.3-fold increase in alkaline phosphatase activity in bone marrow mesenchymal stem cells compared to unmodified PMMA. Radiographic analyses confirm superior visibility across clinical X-ray energies (80.9-140.9 kV), and three-point bending tests reveal a 25% increase in fracture toughness (work of fracture, WOF = 1.8 kJ m-2) over BaSO4-PMMA. These results establish Bi2S3-PMMA as a next-generation bone cement that resolves the longstanding compromise between mechanical integrity, imaging capability, and bioactivity. Owing to its balanced performance, this material holds transformative potential for vertebroplasty, spinal surgeries, and load-bearing orthopedic applications.

Repairing partial ossicular discontinuity in cadaveric human temporal bones (TB) with bone cement will restore stapes velocity to baseline. Clinically, we expect improvement in high-frequency (HF, ≥4kHz) hearing loss after surgical repair of partial ossicular discontinuity. Partial ossicular discontinuity in cadaveric TBs reduces stapes velocity at HFs. Clinically, this manifests as a HF conductive hearing loss (HFCHL). The effects of joint reestablishment on HF hearing has not been widely studied. Six, unfixed, previously frozen human TBs from donors without known ear disease were used to study the mechanical effects of partial ossicular discontinuity before and after repair. Dual laser Doppler vibrometers measured sound-induced stapes and umbo velocity. Results were correlated with preoperative and postoperative audiometric thresholds from 2 patients who underwent endoscopic bone-cement repair of surgically confirmed partial ossicular discontinuity. Partial joint discontinuity decreased stapes velocity by 20dB from 2 to 14kHz, and increased umbo velocity by 5 to 8dB below 1kHz. Repair with bone cement restored umbo and stapes velocity to baseline across frequencies. Clinically, 2 patients presented with HFCHL with air-bone gaps (ABG) ≥60dB for patient 1 and ≥25dB for patient 2, and hypercompliant middle ears on tympanometry. Postoperatively the 4kHz ABG closed by ≥40dB for patient 1 and completely closed for patient 2. Air conduction thresholds improved between 6 and 8kHz, and tympanometry normalized. Bone cement repair of partial ossicular discontinuity restores middle ear HF sound transmission in temporal bones and improves HF air conduction hearing thresholds in patients, suggesting some HF hearing losses are conductive and are surgically correctable.

Calcium sulfate cement (CSC) is limited in clinical applications due to its low mechanical strength, rapid degradation, and insufficient bioactivity. Here, we developed a novel composite bone cement by integrating acrylamide-grafted chitosan (CS-AM) with calcium glycerophosphate (CaGP) and incorporating magnesium polyphosphate (MPP) and polyvinyl alcohol (PVA) to enhance structural and functional properties. The composite was systematically evaluated using experimental characterization and Materials Studio molecular simulations to elucidate intermolecular interactions. Molecular simulations revealed strong interactions between CS-AM and CaGP, as well as between MPP and PVA, forming a dense hydrogen-bond network. Electrostatic potential and electron density analyses confirmed stable interfacial bonding and structural integrity. The test results of compressive strength, injectability and degradation profile demonstrated the combination of the components. Notably, the HCMP composite greatly enhanced osteogenic differentiation, with quantitative PCR showing substantial upregulation of Runx2, BMP2, OCN, OPN, and COL1 enhanced by 4.11-, 2.77-, 4.34-, 2.60-, and 3.57-fold, respectively, relative to controls. Hydroxytyrosol (HT) was further introduced to confer antibacterial activity. Collectively, these findings indicate that the engineered composite exhibits superior mechanical and biological performance and that molecular-level insights provide a rational foundation for the design of high-performance bone repair materials.

Taken for Granted: An Analysis of Sternal Closure Techniques.

Comparing PKP outcomes in very severe osteoporotic vertebral compression fractures across distinct spinal segments: upper/middle thoracic versus thoracolumbar.

Evaluation of calcium phosphate bone cement in augmenting screw hole defects in the ulna: A biomechanical study.

Spine surgeries are one of the most widely performed operations in orthopaedic surgery and neurosurgery. However, one of the most common complications of spine surgeries is surgical site infection (SSI), which is associated with various postoperative morbidities. The use of antibiotics-impregnated bone cement (AIBC) is common in orthopaedic surgeries. Therefore, we aim to provide a comprehensive review of AIBC use in spine surgeries.Data were gathered from PubMed, Europe PMC, and ScienceDirect using keywords associated with AIBC and spine surgeries. We included all publications associated with AIBC and spine surgeries. Studies without full papers, non-English publications, review articles, and animal or cadaveric studies were excluded. The quality of each included studies were assessed using the Newcastle Ottawa Scale and the Joanna Briggs Institute Critical Appraisal for case reports, case series, and quasi-experimental studies.Fifteen studies of 322 patients using AIBC in spine surgery were included. Ten of 15 studies reported 100% infection-free events with AIBC administration with or without given systemic antibiotics. Two studies did not report 100% infection-free events due to methicillin-resistant Staphylococcus aureus (MRSA) infections and technical causes. Three studies reported the use of AIBC without disclosing outcomes. Various types of bacteria ranging from methicillin-sensitive Staphylococcus aureus to MRSA have been discovered, with polymethylmethacrylate and vancomycin being the most frequently used AIBCs.AIBC can be used to prevent postoperative infections due to its high effectiveness, easy administration, and no side effects. Further studies are needed to determine the most appropriate antibiotics, dose, and type of cement.

Short-term clinical observation of the impact of bone cement leakage during percutaneous vertebroplasty on patient pain

Polymethylmethacrylate (PMMA) bone cement is widely used in orthopedics, accounting for approximately 80% of knee joint replacements in the United States. While prosthesis designs and materials have evolved to improve performance and durability, PMMA cement has undergone minimal compositional changes. Carbon-based nanomaterials, particularly graphene oxide (GO), have attracted interest for their ability to enhance the mechanical and thermal properties of orthopedic cements. This study evaluated the effects of incorporating different GO concentrations into PMMA bone cement on its mechanical properties, cytocompatibility, and antibacterial activity. PMMA was modified with GO at 0.1, 0.25, and 0.5 weight percent (wt%) for mechanical and antibacterial tests, and at 1.0 wt% for cytocompatibility. Mechanical performance was assessed via four-point bending tests. Cytocompatibility was evaluated using mouse embryonic fibroblasts (NIH/3T3), and antibacterial activity was tested against Staphylococcus aureus using a modified direct contact assay. GO incorporation significantly increased Young’s modulus (0.1% and 0.25%, p = 0.009) and improved tensile strength (p = 0.0015) and flexural strength (p = 0.025) at 0.1%. Cytocompatibility remained comparable to the control (p = 0.873). Antibacterial activity was concentration dependent, with 0.25% and 0.5% GO maintaining significant bacterial inhibition up to 48 h, whereas 0.1% showed no sustained effect. Overall, 0.25 wt% GO provided the most suitable balance between mechanical integrity and antibacterial performance, indicating that PMMA–GO bone cements with this composition can combine enhanced mechanical properties with relevant antibacterial activity without compromising biocompatibility, and are therefore promising candidates for orthopedic applications.

BackgroundIntravertebral cleft (IVC) is a linear intravertebral imaging characteristic in fractured vertebrae filled with liquid or gas, once considered specific to Kummell’s disease but now also observed in acute traumatic fractures, and its risk factors and relationship with bone cement leakage after percutaneous vertebroplasty (PVP)/percutaneous kyphoplasty (PKP) remain to be explored. The study aims to identify IVC risk factors in acute vertebral fractures (AVFs) patients and assess its link to bone cement leakage post-PVP/PKP.MethodsA total of 1,612 patients diagnosed with AVF at two medical centres were retrospectively included. The diagnostic criterion for IVC was the presence of linear intravertebral lesions filled with liquid or gas in computed tomography (CT) and magnetic resonance imaging (MRI). A total of 126 patients (127 vertebrae) were diagnosed with intravertebral fissures and included in the IVC group, while 125 age- and sex-matched patients (134 vertebrae) without IVC were included in the control group. Clinical and imaging characteristics, including demography, osteoporosis severity, and vertebral fracture line involvement, were compared between the two groups. In patients who underwent PKP or PVP within three months, the incidence and types of bone cement leakage were analysed.ResultsThe compression severity and vertebral fracture line involvement of the inferior endplate, posterior wall, and basivertebral foramen significantly differed between the IVC and control groups (P<0.05). Vertebral fracture line involvement of the basivertebral foramen was a risk factor for IVC [95% confidence interval (CI): 2.297 (1.303–4.048), P=0.004]. An interaction effect between vertebral fracture line involvement of the basivertebral foramen and the posterior wall was observed (P<0.05). Within 3 months, 64 vertebrae underwent PKP or PVP in the IVC group, and 15 cases (23.438%) exhibited leakage. Sixty-one vertebrae in the control group underwent PKP or PVP, with 6 cases (10.000%) exhibiting leakage. There was a significant difference between the two groups (P=0.042). C-type leakage was the most common type in the IVC group, accounting for 86.7% (13/15) of all cases.ConclusionsA basivertebral foramen fracture is an IVC risk factor for AVF. AVF with IVC significantly increases bone cement leakage risk after PVP/PKP.

Injectable carbon nanotube-reinforced calcium phosphate bone cements with high-strength and improved osteogenesis for bone regeneration.

Orthopedic osteosarcomas and metastatic lesions can be difficult to treat with systemically delivered chemotherapy agents alone. Following removal of the primary tumor, implantation of cement to fill the lesion is often done to stabilize weight-bearing bones. One of the commonly used treatments to address osteosarcoma is systemic delivery of doxorubicin. Therefore, research on the incorporation and release of efficacious doxorubicin for local delivery from cement is important. Poly(methyl methacrylate) (PMMA)-based bone cements are the gold standard in orthopedics but have inherent disadvantages. Efforts to overcome some of these deficiencies led to the development of a novel silorane-based biomaterial (SBB). This work evaluated the ability of both PMMA and SBB to incorporate and release efficacious doxorubicin. PMMA-released doxorubicin showed reduced chemotherapeutic efficacy in vitro. The mechanical properties of PMMA were reduced from controls upon doxorubicin incorporation, likely stemming from doxorubicin inhibition of PMMA radical polymerization. SBB properties were not affected by doxorubicin incorporation and SBB eluted doxorubicin was fully efficacious in vitro compared to doxorubicin controls. These results indicate a likely inhibitory interaction between PMMA and doxorubicin, which affects both the strength of PMMA and the efficacy of doxorubicin. Further, this work illustrates SBB as a potential biomaterial alternative for traditional acrylics for medical biomaterial applications where load-bearing strength alongside drug delivery are key factors.

Percutaneous vertebral augmentation (PVA) represents a mainstream minimally invasive surgical procedure for the treatment of osteoporotic vertebral compression fractures (OVCF). However, postoperative complications often arise from bone cement leakage (CL). This study aimed to conduct a comprehensive meta-analysis to identify risk factors for CL and established a risk appraisal model based on the findings. We systematically reviewed seven major databases up to September 2024 to identify studies examining CL following PVA treatment in OVCF. Meta-analysis was performed using RevMan 5.4 software. The results were used to establish a risk appraisal model for CL. The meta-analysis identified several factors, including Cobb angle, Bone mineral density, Cement viscosity, Cement volume injected, Stage of bone cement injection, Cortical defect, Fracture severity, Intravertebral vacuum cleft, Basivertebral foramen sign and Number of vertebral fractures. The risk appraisal model constructed type Logit(P) = - 0.621 + 0.412X Cobb angle + 0.842X BMD + 0.842X Cement viscosity + 0.495X Cement volume injected + 0.432X Stage of bone cement injection + 0.775X Cortical defect + 0.438X Fracture severity + 0.358X IVC + 1.015X Basivertebral foramen sign + 0.742X Number of vertebral fractures. The receiver operating characteristic curve (ROC) curve showed an area under curve (AUC) of 0.831, and the Hosmer-Lemeshow test showed χ2 = 5.933, which is a good predictor of CL. The risk appraisal model was validated to have a moderately effective predictive value and can serve as a valuable tool for clinicians to assess leakage risk and improve patient management strategies during surgical interventions.

This paper presents the results of a retrospective cohort observational study aimed at analyzing the prognostic significance of microbiological factors in determining the clinical efficacy of osteoplasty for bone tissue defects using polymethyl methacrylate (PMMA) bone cement in patients with gunshot fractures of long tubular bones. Clinical outcomes of osteoplasty with PMMA bone cement were analyzed in 39 wounded patients with gunshot fractures of long tubular bones. The mean age of the patients was 38.77±9.31 years. Clinical outcomes were assessed using the modified 100-point Neer–Grantham–Shelton scale, a validated scoring system widely applied for assessing the functional recovery after bone reconstruction. Overall, the clinical parameters of 30 patients in whom infectious agents were identified based on bacteriological testing were analyzed. Statistical analysis was performed using IBM SPSS Statistics 27.0.1. Differences were considered statistically significant at p≤0.05. The mean clinical score corresponded to a good result – 74.51±14.24 points. Excellent results were achieved in 11 (28.20 %) patients, good in 14 (35.90 %), satisfactory in 9 (23.08 %), and poor in 5 (12.82 %). Analysis of the wound microbiocenosis revealed that in most cases – 22 (73.33 %) Gram-negative microflora predominated, while Gram-positive organisms were isolated in 8 (26.67 %) samples. Among the Gram-negative bacteria isolated from combat wounds, non-fermenting rods predominated and were identified in 14 (46.67 %) samples, whereas microorganisms of the Enterobacteriaceae family were isolated in 8 (26.67 %) cases. Within the Gram-positive microbiota of gunshot wounds, cocci of the Staphylococcus genus were found in 5 (16.67 %) cases, and Gram-positive rods of the Bacillus genus were identified in 3 (10.00 %) samples. Bacteria belonging to the ESKAPE group were detected in 19 (48.72 %) cases. Significantly poorer clinical outcomes of PMMA bone cement application were observed in patients with gunshot injuries contaminated by Gram-negative microflora (τ=–0.48, p=0.0002), Enterobacteriaceae (τ=–0.28, p=0.03), Klebsiella spp. (τ=–0.28, p=0.03), and ESKAPE pathogens (τ=–0.44, p=0.0006). In contrast, significantly better clinical outcomes were achieved in patients with gunshot wounds colonized by Gram-positive flora (τ=+0.48, p=0.0002), Staphylococcus spp. (τ=+0.32, p=0.01), and Bacillus spp. (τ=+0.31, p=0.02). Analysis of the prognostic value of the examined factors demonstrated higher odds of achieving excellent outcomes with PMMA bone cement use in patients whose wounds contained Gram-positive microorganisms (OR=7.50, CI (1.15-48.97), p=0.02). Conversely, the presence of ESKAPE pathogens in wound samples was associated with increased odds of only satisfactory outcomes (OR=2.79, CI (1.35-13.35), p=0.003). The obtained data emphasize the necessity of a comprehensive approach to managing patients with gunshot fractures and bone tissue defects, which should include not only the use of bone substitutes but also mandatory bacteriological diagnostics and targeted antibiotic therapy considering the specific microbial pathogens, highlighting the importance of integrating microbiological monitoring into surgical protocols for improved outcomes.

To investigate the correlation between postoperative bone cement distribution patterns and the incidence of cage subsidence in elderly osteoporotic patients undergoing oblique lateral interbody fusion combined with anterolateral fixation and stress endplate augmentation (OLIF-AF-SEA). This retrospective study analyzed 86 osteoporotic patients aged ≥ 60 years who underwent single-level L4-5 OLIF-AF-SEA with a minimum postoperative follow-up of 24 months. Postoperative X-rays were used to classify bone cement distribution patterns, including coronal plane distribution (three-zone method), endplate contact (binary classification), and presence of intervertebral leakage. Cage subsidence was defined as a reduction in disc height of ≥ 2mm. Statistical analyses included chi-square tests and univariate binary logistic regression. Among the 86 patients, 16 (18.6%) experienced cage subsidence. Subsidence was significantly associated with unilateral or paramedian cement distribution in the coronal plane, lack of endplate contact, and the presence of intervertebral leakage (all p < 0.001). Logistic regression analysis identified non-bilateral distribution (L4: B = - 4.313; L5: B = - 5.273), absence of endplate contact (B = - 4.234), and intervertebral leakage (B = 3.446) as significant predictors of subsidence. No significant differences were found between the subsidence and non-subsidence groups in terms of age, sex, BMI, or bone quality parameters. Postoperative bone cement distribution patterns may influence cage stability following OLIF-AF-SEA. Bilateral distribution, contact with both superior and inferior endplates, and absence of intervertebral leakage are closely associated with reduced risk of subsidence. These findings highlight the importance of standardized cement injection strategies and provide a theoretical foundation for improving surgical outcomes in elderly osteoporotic patients undergoing OLIF-AF-SEA.

Introduction: Giant cell tumor of bone typically arises from the epiphysis of long bones; involvement of the distal tibia is a relative rarity, especially in adolescents. While this tumor is benign, GCTB may behave quite aggressively with recurrence or even pulmonary metastasis. The case below describes the natural history of a distal tibial GCTB that was complicated by recurrence and lung metastasis, detailing the use of multiple modalities of management. Case presentation: A 17-year-old female patient presented with an eight-month history of progressive swelling and pain in the left ankle. Imaging showed an expansile lytic lesion in the distal tibia; biopsy confirmed GCTB. She then underwent wide excision with reconstruction using a fibular graft and talofibular arthrodesis. Two years later, during surveillance imaging, pulmonary nodules consistent with metastasis were shown; she was thus treated with monthly intravenous zoledronic acid, 4 mg for six months. In 2019, a local recurrence was detected and treated with curettage and augmentation with bone cement. On follow-up in 2021, the patient had no pain, was fully ambulatory, and was without further recurrence or metastatic progression. Discussion: Distal tibial GCTB has a high tendency for recurrence despite adequate resection due to the poor soft-tissue cover surrounding it. Though pulmonary metastasis is rare, the case indicates the importance of long-term thoracic surveillance. Zoledronic acid in this case contributed to the radiological stabilization of metastatic lesions and thus appears as a possible adjunct in recurrent or metastatic GCTB. Conclusion: This case illustrates the indolent course of the distal tibial GCTB and represents an example of tailored multi-modality treatment with extended follow-up. Zoledronic acid may offer effective disease stabilization to a highly selected patient population at high risk. Keywords: Giant cell tumor, progression, recurrence, distal tibia, fibular graft, arthrodesis

Staphylococcus aureus small-colony variants (SCVs) are unique phenotypic forms that significantly contribute to the development of chronic, recurrent, and treatment-refractory infections. These variants arise from metabolic defects, most commonly in the menadione, hemin, or thymidine biosynthetic pathways, leading to slow growth, atypical colony morphology, and altered virulence expression. The ability of these bacteria to persist intracellularly, form robust biofilms, and resist multiple antibiotics poses a significant clinical challenge. SCVs have been implicated in osteomyelitis, prosthetic joint infections, bloodstream infections, and cystic fibrosis airway disease, where they are often overlooked because of their atypical features and slow growth in diagnostic cultures. Therapeutically, conventional agents such as vancomycin and β-lactams exhibit limited efficacy against intracellular or biofilm-associated SCVs. In contrast, fluoroquinolones and rifampin achieve intracellular penetration but carry the risk of inducing resistance and selecting for SCVs. Recent experimental strategies, including ATP synthase inhibitors such as tomatidine and resveratrol, nanoparticle-based drug delivery, antibiotic-loaded bone cement, and pH modulation through alkalinization, have demonstrated promising activity, although clinical validation remains limited. Adjunctive measures such as surgical debridement and phage therapy provide additional options but are limited by feasibility and safety concerns. Taken together, SCVs represent an important survival strategy for S. aureus that complicates both diagnosis and treatment. Combination antimicrobial regimens that exploit diverse mechanisms of action remain the cornerstone of current management, while novel therapeutic approaches hold future potential. Continued research into the biology of SCVs and translational studies are essential to develop effective, clinically applicable interventions for these persistent infections.

Comment on "effect of low-temperature modulation of bone cement viscosity on the efficacy of cement dispersion and clinical outcomes after percutaneous kyphoplasty: a retrospective cohort study".

Background:This study aimed to investigate the incidence of perioperative myocardial infarction/injury (PMI) and mortality and to identify associated risk factors, in patients undergoing surgical treatment for proximal femur fractures (PFFs).Methods:We performed a post hoc analysis of a prospective cohort study and included consecutive patients undergoing surgery for PFFs (femoral neck, intertrochanteric, or subtrochanteric fractures) at a tertiary center between 2014 and 2018. All patients underwent systematic PMI screening using serial high-sensitivity cardiac troponin T measurements. The primary outcomes were incidence of PMI and all-cause mortality at 1 year. Univariable logistic regression identified risk factors for PMI and mortality.Results:Among 348 patients, 23% developed PMI. PMI incidence did not differ significantly between arthroplasty and osteosynthesis groups (22.0% vs. 24.0%, p = 0.7). A history of myocardial infarction and hypertension was associated with increased PMI risk. One-year mortality was 17.8% overall and higher in patients with PMI compared with those without (27.5% vs. 14.9%, p = 0.013). Significant risk factors for 1-year mortality included low body mass index, history of atrial fibrillation, low preoperative hemoglobin, and higher anesthesiologists class. No associations were found between PMI or mortality and fracture type, implant type, use of bone cement, or anesthesia type.Conclusions:PMI is common after surgical treatment of PFFs and is associated with increased mortality. Systematic screening improves detection, enabling optimization of perioperative management. We recommend routine PMI screening in high-risk patients undergoing PFF surgery to reduce adverse outcomes.Level of Evidence:Level II. See Instructions for Authors for a complete description of levels of evidence.

This study aims to improve the radiopacity of absorbable bone cements through the addition of gadolinium nanoparticles (GdNP). We also aim to determine whether photon-counting CT (PCCT) provides superior contrast-to-noise ratio (CNR) between GdNP-loaded bone cement and vertebral bone when compared with energy-integrating CT (EID-CT), and to evaluate the accuracy of PCCT material decomposition for quantifying gadolinium concentration in solution and the GdNP-loaded cements. GdNPs were synthesized using a one-pot thermal decomposition method and characterized using transmission electron microscopy and dynamic light scattering. Hydroxyapatite-based bone cement was loaded with varying mass fractions of GdNPs (0% to 10% w/w), and the CNR between the GdNP-loaded cement and vertebral bone was evaluated using preclinical micro-EID-CT and micro-PCCT scanners. Gadolinium material decomposition images were used to measure the amount of gadolinium present in each of the cements. In addition, gadolinium standards (0 to 20mg/mL) were imaged with a preclinical micro-PCCT, and the concentration of gadolinium in the vials was estimated using gadolinium material decomposition images. The synthesized GdNPs had a mean diameter of 15.42±1.82nm. Signal intensity increased with increasing mass fractions of GdNPs for both EID-CT and PCCT. In EID-CT images, cements with ≥4% GdNP loading had higher CNRs relative to bone than the cement with no GdNP loading (P<0.05). The CNR between the 8% and 10% GdNP-loaded bone cement significantly differed from than the bone cement with no GdNP loading for all PCCT energy bins (P<0.05). The 42-51keV energy bin yielded the largest CNRs overall when compared with the CNRs of other energy bins. Overall, the CNRs obtained from PCCT images were larger than the EID-CT CNRs. The concentration of gadolinium in the cements measured using the PCCT material decomposition images was correlated with the mass fractions of GdNP (r=0.9753). Estimated gadolinium concentrations were highly correlated with the nominal concentration of the gadolinium standards (r=0.999) and the PCCT was able to accurately quantify gadolinium concentrations with a root mean square error of 1.60mg/mL. The use of GdNPs led to a higher cement-vertebra CNR for both EID-CT and PCCT. Overall, PCCT demonstrated higher CNRs than EID-CT. Material decomposition successfully quantified the concentration of gadolinium in vials and allowed for improved visual differentiation of the GdNP-loaded bone cement from the calcium-based vertebral bodies. Thus, the incorporation of radiopaque GdNPs and imaging with PCCT improved visualization of the bone cement. These methods could be used to improve monitoring of implanted bone cements. In addition, PCCT material decomposition enabled accurate quantification of gadolinium in solution.