Commercial Acrylic Bone Cement Research Articles

Effect of barium sulfate surface treatments on the mechanical properties of acrylic bone cements

Although current commercial acrylic bone cements have been used successfully in total joint replacement surgery for over five decades, some further improvement are being investigated to cope with cement failure, one approach is surface modification of BaSO4 particles to improve its interfacial adhesion with the polymeric matrix in acrylic bone cements formulations. In this article, BaSO4 particles were modified by different surface treatments. The first of them involved the use of 3-(trimethoxysilyl)propyl methacrylate as a coupling agent; in the second, the radiopaque particles were exposed to oxygen plasma at power levels of 15 and 70 W, followed by MPS coupling agent and the last one consisted in exposing the radiopaque particles to methyl methacrylate (MMA) plasma. Mechanical properties of the bone cements prepared with modified BaSO4 particles were improved due to its higher dispersion degree in polymeric matrix.

Autonomic healing of acrylic bone cement.

Self-healing in orthopedic bone cement is demonstrated with a novel thermoplastic solvent-bonding approach. Low toxicity solvent-filled microcapsules, embedded in a commercial acrylic bone cement matrix, enable recovery of up to 80% of the virgin fracture toughness of the cement at room and body temperature conditions without external stimuli or human intervention.

Thermophysical properties and material modelling of acrylic bone cements used in vertebroplasty

The stabilization of osteoporotic vertebrae with acrylic bone cement, called vertebroplasty, is a common procedure in modern surgery. However, the thermomechanical-chemically coupled material behaviour of curing bone cements makes the application even for experienced surgeons difficult and can lead to potential complications like heat necrosis, leaking bone cement, embolisms and postoperative load shifting. In order to reduce these potential complications, to minimize the risks and to better understand the occurring effects, the thermophysical properties of a commercial acrylic bone cement were investigated in detail using differential scanning calorimetry, volumetric dilatometry and temperature controlled rheometry. More specifically, the reaction kinetics, the specific heat, the thermal conductivity, the thermal expansion, the chemical shrinkage as well as the mechanical behaviour was studied during the reaction process of the bone cement. Furthermore, the explored material behaviour is described by a customized material model that takes into account all observed effects. With the aid of this model the inhomogeneous chemical, thermal and mechanical states that appear during the application and curing of acrylic bone cements, can be studied by finite element treatment.

High resolution X-ray imaging of bone-implant interface by large area flat-panel detector

The aim of the research was to investigate the cemented bone-implant interface behavior (cement layer degradation and bone-cement interface debonding) with emphasis on imaging techniques suitable to detect the early defects in the cement layer. To simulate in vivo conditions a human pelvic bone was implanted with polyurethane acetabular cup using commercial acrylic bone cement. The implanted cup was then loaded in a custom hip simulator to initiate fatigue crack propagation in the bone cement. The pelvic bone was then repetitively scanned in a micro-tomography device. Reconstructed tomography images showed failure processes that occurred in the cement layer during the first 250,000 cycles.A failure in cemented acetabular implant — debonding, crumbling and smeared cracks — has been found to be at the bone-cement interface. Use of micro-focus source and high resolution flat panel detector of large physical dimensions allowed to reconstruct the micro-structural models suitable for investigation of migration, micro-motions and consecutive loosening of the implant. The large area flat panel detector with physical dimensions 120 × 120mm with 50μm pixel size provided a superior image quality compared to clinical CT systems with 300−150μm pixel size.

The Properties of Polymethyl Methacrylate (PMMA) Bone Cement Filled with Titania and Hydroxyapatite Fillers

Commercial acrylic bone cement was modified by incorporating different filler loadings of bioactive hydroxyapatite and titania nanopowders. The effects of nanofiller loading on the mechanical and thermal properties were evaluated. The peak temperature during the polymerization of bone cement was observed to decrease with increasing filler loading. In addition, the flexural strength decreased and morphological studies of the fracture surfaces revealed an increase in porosity with the increase in filler loading. Silanation was conducted on the optimum filler loading, and the influence of silanation on the mechanical properties of bone cement was assessed.

Static shear strength between polished stem and seven commercial acrylic bone cements

The stem-cement interface is one of the most significant sites in cemented total hip replacement and has long been implicated in failure of the whole joint system. However, shear strength at this interface has rarely been compared across a range of commercially available bone cements. The present study seeks to address this issue by carrying out a comparative study. The results indicated that the static shear strength was more dependent on cement type than cement viscosity and volume. However, both cement type and viscosity were contributory factors on porosity and micropore size in the cement surface. There was no significant difference between Simplex P and Simplex P with Tobramycin. Although the bone cements were all hand mixed in this study, the static shear strength was significantly larger than the values recorded by other researchers, and the porosity and micropore size showed much lower values. Bone cement transfer films were detected on the stem surface, typically about 4-10 mum thick. They were considered to be an important factor contributing to high friction at the stem-cement interface after initial debonding.

Effect of bone porosity on the mechanical integrity of the bone-cement interface.

Osteopenia is one factor that may influence the decision about the type of implant fixation to use in total hip arthroplasty. However, clinical studies generally do not associate the outcome of an arthroplasty with the degree of osteopenia. The mechanical integrity of the cement fixation of an implant may be affected by the relative degree of osteopenia, which could account for some of the variable long-term results after total hip arthroplasty performed with cement. The purpose of this study was to determine the effects of bone porosity, trabecular orientation, cement pressure, and cement penetration depth on fracture toughness at the bone-cement interface. Trabecular bone from the proximal part of bovine femora was used with a single brand of commercial acrylic bone cement to form compact-tension interface specimens representing a range of bone porosities, orientations, and cement pressures within a clinically achievable range. All specimens were loaded to failure with use of a servohydraulic testing machine, and fracture toughness at the interface was calculated. After testing, images of a representative sample of specimens were made with use of computed tomography to measure the penetration depth of the cement into the bone. Significant correlations were found between fracture toughness and bone porosity, trabecular orientation, and cement pressure, with bone porosity having the strongest effect (p < 0.000015). Examination of the computed tomographic images also showed a significant correlation between fracture toughness and maximum cement penetration depth (p < 0.033), as well as significant partial correlations between maximum and mean penetration depth and bone porosity (p < 0.0037 and p < 0.0028). The fracture resistance of the bone-cement interface is greatly improved when the ability of the cement to flow into the intertrabecular spaces is enhanced.

Creep behavior of bone cement: a method for time extrapolation using time-temperature equivalence.

The clinical lifetime of poly(methyl methacrylate) (PMMA) bone cement is considerably longer than the time over which it is convenient to perform creep testing. Consequently, it is desirable to be able to predict the long term creep behavior of bone cement from the results of short term testing. A simple method is described for prediction of long term creep using the principle of time-temperature equivalence in polymers. The use of the method is illustrated using a commercial acrylic bone cement. A creep strain of approximately 0.6% is predicted after 400 days under a constant flexural stress of 2 MPa. The temperature range and stress levels over which it is appropriate to perform testing are described. Finally, the effects of physical aging on the accuracy of the method are discussed and creep data from aged cement are reported.

Curing characteristics of acrylic bone cement.

Commercial acrylic bone cements are supplied as two components, a polymer powder and a liquid monomer. Mixing of the two components is followed by a progressive polymerization of the liquid monomer to yield a solid mass, a high level of heat being generated during this exothermic reaction. The exposure of bone to high temperatures has led to incidences of bone necrosis and tissue damage, ultimately resulting in failure of the prosthetic fixation. The aim of this study was to determine the thermal properties of two acrylic bone cements as they progress through their polymerization cycles. It was also felt that there was a need to quantify the variations in the curing characteristics as a function of preparing bone cement by different techniques, hand mixing and vacuum mixing. A number of parameters were calculated using the data gathered from the investigation: peak temperature, cure temperature, cure time, and the cumulative thermal necrosis damage index. The results show the temperature profile recorded during polymerization was lowest when the cement was prepared using the Howmedica Mix-Kit I system: 36 degrees C for Palacos R and 41 degrees C for CMW3 respectively. When the acrylic cements were prepared in any vacuum mixing system there was evidence of an increase in the cure temperature. The main factor that contributed to this rise in temperature was an imbalance in the polymer powder : liquid monomer ratio, there was a high incidence of unmixed powder visible in the mixing barrel of some contemporary vacuum mixing devices. Observing the thermal characteristics of the polymethyl methacrylate (PMMA) bone cements assessed, it was found that particular formulations of bone cements are suited to certain mixing methodologies. It is vital that a full investigation is conducted on a cement mixing/delivery system prior to its introduction into the orthopaedic market.

Gentamicin sulphate release from a modified commercial acrylic surgical radiopaque bone cement. I. Influence of the gentamicin concentration on the release process mechanism.

The purpose of the present work was the study of the gentamicin sulphate (GS) release from a commercial acrylic bone cement CMW-1 with the aims of establishing the influence of the slabs preparation as well as the release mechanism and kinetics. The effect of the amount of GS on the release kinetic parameters has been also investigated. In vitro release studies were performed in a buffered saline solution at pH 7.4 and 37 degrees C. The GS concentration was determined using an indirect spectrophotometric method with an o-phthaldialdehyde as a derivatizing reagent. A commercial and three modified samples were tested. The free and fractured surfaces of the GS cement slabs before and after the release studies were observed by means of scanning electron microscopy (SEM). For low GS concentration loading the release was very incomplete because most of the GS beads were encapsulated by the hydrophobic PMMA matrix. A higher amount of antibiotic was released from cement that has a higher amount incorporated. A model and therefore a mechanism of release based on this model have been proposed. It has allowed us to explain the changes in dissolution kinetics of an acrylic matrix type controlled release system up to 12% GS loading. The cumulative amount of GS released M(t)/M(i), was fitted as a function of time. For lower amounts of GS, the regression analysis (R(2)>0.99) revealed that the release is most adequately represented by M(t)/M(i)=b+kt(n), where b represents a burst effect. The goodness of fit decreases as the amount of GS increases. The influence of some other type of release mechanism for higher amounts of GS must be taken into account and a second model for the release, M(t)/M(i)=b+k x [1-exp(-kt)], is proposed.

Thermal characteristics of curing acrylic bone cement

Commercial acrylic bone cements are supplied as two components, a polymer powder and a liquid monomer. Mixing of the two components is followed by a progressive polymerisation of the liquid monomer to yield a solid mass, a high level of heat being generated during this exothermic reaction. The exposure of bone to high temperatures has led to incidences of bone necrosis and tissue damage, ultimately resulting in failure of the prosthetic fixation. The aim of this study was to determine the thermal properties of various acrylic bone cements as they progress through their polymerisation cycles. It was also felt that there was a need to quantify variations in the curing characteristics as a function of preparing bone cement by different techniques, hand mixing and vacuum mixing. A number of parameters were calculated using the data gathered from the investigation; peak temperature, cure temperature, cure time, and the cumulative thermal necrosis damage index. Observing the thermal characteristics of the polymethyl methacrylate bone cements assessed, it was found that particular formulations of bone cements are suited to certain m xing methodologies. It is vital that a full investigation is conducted on a cement mixing/delivery system prior to its introduction into the orthopaedic market.

Influence of filler content on static properties of glass-reinforced bone cement.

A commercial acrylic bone cement was modified by the incorporation of different weight fractions of glass spheres. The influence of the filler proportion on the mechanical behavior was assessed. Composite cements were prepared by replacing part of the powder phase of the cement by an equivalent weight of glass particles, which resulted in an increase in the liquid-to-powder (L/P) ratio of the polymeric matrix. Dynamic mechanical analysis revealed an increase in residual monomer content with increasing filler proportion as a consequence of the increase in L/P. Flexural, compressive, and fracture properties of the cement with varying amounts of glass particles were measured. It was found that up to 50 wt% glass particles could be added with significant increases in flexural modulus and fracture toughness. The mechanical behavior was explained in terms of both the reinforcing effect of the filler and the plasticizing effect of the monomer. Glass-filled bone cements displayed superior workability compared with the standard cement, which was attributed to a decrease in the viscosity of the initial mix and the surface characteristics of the glass particles. The observed increase in fracture toughness could be rationalized through the application of proposed mechanisms for toughening of particle-reinforced polymers.

Residual monomer content in bone cements based on poly(methyl methacrylate)

Acrylic bone cements are widely used in orthopaedics, and it is generally accepted that due to the vitrification phenomenon the monomer does not reach complete conversion after the cure of the resin. The degree of polymerization attainable in a commercial acrylic bone cement based on poly(methylmethacrylate) (PMMA) has been investigated by differential scanning calorimetry (DSC) using isothermal and dynamic modes. Because DSC tends to be less sensitive at high conversions, especially if there exists a permanent residue, gas chromatography (GC) was also used. The residual monomer has also been determined in samples cured under adiabatic conditions. The autocatalytic model developed by Kamal is used to analyse the curing kinetics. The final kinetic model is satisfactorily applied to dynamic and isothermal curing reactions. © 2000 Society of Chemical Industry

Polymethylmethacrylate-based bone cement modified with hydroxyapatite

A commercial acrylic bone cement was modified by the incorporation of different weight fractions of polycrystalline hydroxyapatite (HA), and the modified formulation was investigated. The influence of the filler proportion on the flow characteristics and the mechanical behavior of the resultant composite was evaluated. The residual monomer present in the cured materials was measured by gas chromatography. The comparison of the residual monomer present in the cements with and without reinforcement demonstrated that the degree of polymerization was not affected by the addition of HA. Porosity morphology was analyzed by optical and scanning electron microscopy. Image examination revealed that the porosity and the pore size of the hardened cement increased with an increasing amount of particulate filler. Flexural, compressive, and fracture properties of the cement with varying amounts of HA reinforcement were measured. It was found that up to 15 wt% HA could be added for increases in flexural modulus and fracture toughness. HA acts as a rigid filler that enhances fracture resistance and flexural modulus. Our results show that the workability of the modified formulation limited the incorporation of the ceramic filler to a maximum value of 15 wt%. © 1999 John Wiley & Sons, Inc. J Biomed Mater Res (Appl Biomater) 48: 150–158, 1999

Polymethylmethacrylate-based bone cement modified with hydroxyapatite.

A commercial acrylic bone cement was modified by the incorporation of different weight fractions of polycrystalline hydroxyapatite (HA), and the modified formulation was investigated. The influence of the filler proportion on the flow characteristics and the mechanical behavior of the resultant composite was evaluated. The residual monomer present in the cured materials was measured by gas chromatography. The comparison of the residual monomer present in the cements with and without reinforcement demonstrated that the degree of polymerization was not affected by the addition of HA. Porosity morphology was analyzed by optical and scanning electron microscopy. Image examination revealed that the porosity and the pore size of the hardened cement increased with an increasing amount of particulate filler. Flexural, compressive, and fracture properties of the cement with varying amounts of HA reinforcement were measured. It was found that up to 15 wt% HA could be added for increases in flexural modulus and fracture toughness. HA acts as a rigid filler that enhances fracture resistance and flexural modulus. Our results show that the workability of the modified formulation limited the incorporation of the ceramic filler to a maximum value of 15 wt%.

Effect of residual monomer content on some properties of a poly(methyl methacrylate)-based bone cement

Through this article, the degree of polymerization attainable in a commercial acrylic bone cement based on poly(methyl methacrylate) (PMMA) was investigated by differential scanning calorimetry (DSC) and gas chromatography (GC). The results obtained revealed a marked dependence between the maximum monomer conversion and the cure temperature. Specimens for the mechanical evaluation of the cement were subjected to two different cure conditions: one set of samples was allowed to cure at room temperature and an additional set was also postcured at 140°C for 2 h. The latter thermal treatment permitted one to discard the presence of the unreacted monomer in the hardened material. The effect of the unreacted monomer on the mechanical behavior was evaluated by measuring the flexural modulus (E), the compressive yield stress (σy), and the fracture toughness (KIC). Samples prepared at room temperature for mechanical evaluation contained residual monomer which acts as a plasticizer of the matrix, increasing KIC and decreasing E and σy. The cure temperature and mold di-mensions influence the amount of the residual monomer in the hardened material. Thus, differences in the values of the mechanical properties measured for the same commercial formulation may be attributed to a different mold dimension used in the test. © 1998 John Wiley & Sons, Inc. J Appl Polym Sci 69: 1367–1383, 1998

Mechanical and Fracture Behaviour Evaluation of Commercial Acrylic Bone Cements

The deformation and fracture behaviour of some commercial acrylic bone cements have been investigated. Cements were characterized by gel permeation chromatography, dynamic mechanical analysis and scanning electron microscopy. The influence of liquid to powder ratio, curing temperature, strain rate and non-reacted monomer was analysed for one radiolucent cement. Results showed that the β transition activation process influences both deformation and fracture behaviour. Fracture surface stress whiteness revealed the presence of crazes as the main plastic deformation mechanism. Non-reacted monomer acted as a plasticizer leading to materials with lower yield strength, σy, that induces crack tip blunting and improves toughness. It appears that the presence of radiopacifier fillers also improves fracture toughness by promoting interactions between the crack and the second phase dispersion. © 1997 SCI.

Enhanced strength in cemented stem fixation using adhesive acrylic cement as a metal coating material.

One cause of aseptic loosening of cemented total hip arthroplasty is mechanical weakness at the interface between the metal stem and the cured bone cement. Adhesive acrylic bone cement containing 4-methacryloyloxyethyl trimellitate anhydride (4-META) was applied as a metal coating material to increase the strength of the cemented fixation. The 4-META cement has 2-3 times greater tensile bond strength to metals than does commercial acrylic bone cement. The shear strength of the coated metals fixed with bone cement was approximately 4 times greater in SUS-304 and 3 times greater in titanium (Ti) alloy than those of uncoated metals, and this strength did not decrease after 1 week's immersion in saline. The coating process using the 4-META cement can be performed at normal room temperature, so that metal stems for bone cement fixation could be coated during the course of an operation resulting in potentially improved results of total hip arthroplasty.

The effects of implanted ionomeric and acrylic bone cements on peripheral nerve function

The effects of two experimental ionomeric and one commercial acrylic bone cement and set ionomeric microimplant bone substitute (lonogran®) on peripheral nerve conduction, 1 and 3 weeks after implantation, have been compared. In 44 experiments the rat saphenous nerve was exposed midway between the ankle and thigh and bone cement placed into a pocket created in the connective tissue adjacent to the nerve. In terminal experiments, 1 and 3 weeks later, stimulating electrodes were placed on the saphenous nerve at the ankle, and the amplitude and conduction velocity of the compound action potential (CAP) evoked was recorded through another pair of electrodes positioned on the nerve proximal to the implant, in the thigh. One week after placing an ionomeric bone cement (HVA or V-4), no neural activity could be recorded. Three weeks, after HVA implantation apparently normal CAPs were recorded indicating a recovery from a temporary nerve conduction block, but 3 weeks after V-4 implantation only small CAPs were recorded and these could be attributed to axonal regeneration. After implantation of acrylic bone cement, small CAPs were recorded after 1 week, and within 3 weeks nerve conduction appeared to have completely recovered. Three weeks after placing set ionomeric microimplant particles the amplitude and conduction velocity of the CAP was similar to the controls.

Selection of acrylic bone cements for use in joint replacement

Commercial acrylic bone cements have been compared in terms of their mechanical, thermal and rheological properties. Significant differences have been found between the tensile strengths, shear strengths and peak polymerization temperatures of the cements tested. Large differences have been found between the viscosities of different formulations and the duration of their working periods during polymerization. Optimum cement selection is found to depend critically upon ambient conditions within the operating theatre considered in combination with the characteristics of the cements themselves. It is proposed that, at present, the only differences between commercial bone cements of relevance to successful joint replacement lie in the area of rheological properties during polymerization.