Use Of Acrylic Bone Cement Research Articles

Dr. John H. Charnley: An Architect and Pioneer of the Modern Era of Hip Replacement Surgery.

Dr. John H. Charnley (1924-1982) revolutionized orthopedic surgery with his groundbreaking innovations in hip replacement with exceptional skill and a holistic thought process, which has had an impact to this day in the world of arthroplasty. His innovations have improved the lives of numerous patients who had painful and discomforting arthritis and have been instrumental in providing painless mobile joints to these patients. This article reviews Charnley's contributions to the development of low-friction arthroplasty using ultra-high-molecular-weight polyethylene and the use of acrylic bone cement for improved implant fixation. These advancements dealt with the critical issues of friction, wear, and implant stability, significantly enhancing patient outcomes and implant longevity. Charnley's work led to the global standardization of hip replacement procedures, influencing orthopedic practices globally and setting benchmarks for modern implant designs. His principles continue to inform ongoing research and advancements in hip replacement technology. This review also discusses the challenges and criticisms faced by Charnley's innovations, reflecting on their evolution and impact on contemporary orthopedic surgery. A surgeon blessed with a noble heart who would help his patients who were in trouble by going out of the way and was determined for a better tomorrow, self-driven by his compassion and ambition for treating his patients. Charnley's legacy remains pivotal in shaping the field and improving the quality of life for patients undergoing hip replacement surgery.

Acrylic bone cement with Tutopatch for frontal sinus obliteration.

To evaluate the use of acrylic bone cement with a Tutopatch collagen implant for frontal sinus obliteration after mucocele excision using a subjective assessment of patient satisfaction. Patients with a recurrent frontal sinus mucocele with posterior table erosion, for whom an endoscopic approach was not feasible, and who underwent osteoplastic frontal sinus obliteration, were included. The post-operative outcomes were evaluated using a non-standardised questionnaire, comparing pre- and post-operative scores. All patients expressed post-operative satisfaction. Except for hyposmia, significant improvements were observed in all symptom scores. No major complications were observed during the post-operative course. Acrylic bone cement with Tutopatch can be effectively used in frontal sinus reconstruction in cases where an endoscopic approach is not feasible.

Classifications in Brief: The Dorr Classification of Femoral Bone.

Classifications in Brief: The Dorr Classification of Femoral Bone.

The role of microconstituents on the fatigue failure of bone cement

Implant fixation via the use of acrylic bone cement is now a well-established practice in orthopaedics. Excellent long-term clinical results are evidenced in national joint registers based on over 5 decades of clinical experience. Increased life expectancies, patient BMI, together with the need to remain active in later life, are expected to put greater demands on the materials used in load bearing joint arthroplasty. Failure of bone cement and its interfaces with the implant and bone often leads to loosening, requiring revision surgery. This is a particularly invasive procedure, with lower long-term success rates compared to the primary procedure. To reduce the incidence of bone cement failure, it is necessary to understand the origins of failure in vivo. In the past, bulk failure of bone cement has been attributed to damage accumulation originating at pores. Advances in imaging technology now mean that we are able to observe cement microconstituents readily and identify crack-initiating defects more precisely as we attempt to understand origins of failure. The role of radiopacifier particles within the bone cement has not been examined extensively to date, and the present study demonstrates that this microconstituent could be in crack formation due in part to its ability to agglomerate and not bond with the surrounding matrix. To verify this hypothesis, explanted bone cement and laboratory tested bone cement are compared and correlations in failure mechanisms are discussed.

Use of acrylic bone cement for reconstruction of cranial bone defects

Use of acrylic bone cement for reconstruction of cranial bone defects

Total Hip Replacement and the Law of Diminishing Returns

Total hip replacement was introduced primarily to relieve pain and restore function in patients crippled with arthritis of the hip. Secondary objectives included optimized durability of implant fixation and the bearing surfaces, as well as a combination of optimized mobility and stability of the articular couple. Early attempts at replacement of the hip joint were condemned as a result of poor materials and poor design. Charnley1 made three major contributions to the evolution of contemporary hip replacement: the concept of low-friction torque arthroplasty, the introduction of high-density polyethylene, and the use of acrylic bone cement to secure implant fixation to bone. In studies of total hip arthroplasty with use of the first-generation Charnley stem, Berry et al.2 and Callaghan et al.3 reported a twenty-five-year survival rate of 81% and 77%, respectively, with revision of any component as the end point. Similar results have been reported by other authors4-6. Initially, the indications for total hip replacement were largely limited to the elderly and infirm, or to patients who had other locomotor limitations (e.g., rheumatoid arthritis with polyarticular involvement). Today, indications for total hip replacement are often influenced by quality-of-life issues, and patients seek “high-performance hips” to deliver their aspirations and expectations. Components must therefore provide durable fixation despite high activity levels, and the bearing surfaces need to be resilient and exhibit low wear to provide a durable articulation. The wear debris should excite a limited biological response or none at all. Surgical practice is changing to accommodate the philosophy of the preservation of bone and soft tissue and to deliver the accelerated rehabilitation regimes expected by the patient. Computer-aided surgery may assist with component orientation, particularly when exposure is reduced by soft-tissue-sparing minimally invasive surgery. Fig. 1: Graph from the Swedish Hip Register showing the improved …

The use of acrylic bone cement for suture anchoring.

Healing of tendon or ligament sutured to bone depends among other parameters on the mechanical stability of the suture fixation in or to the bone. The authors propose a method of anchoring suture material using bone cement as a substitute for conventional suture anchors. Conditions for secure fixation of suture material in bone cement were assessed and the technique of anchoring suture material with acrylic cement in bone was developed. Mechanical testing and microcomputed tomography of the suture-cement-bone compound were done. It was found that the suture always should be knotted before embedding it at least 2 mm deep in the bone cement. The holes drilled into the bone in which the sutures are secured with cement should be at least 3.5 mm in diameter and 10 mm deep; in cortical bone a tapped thread is required. Sutures can be secured safely using cement anchors which provide higher pull-out strength of a factor two to five than conventional metallic suture anchors of comparable size. They also adapt to anatomic situations where conventional anchors cannot be used and are more favorable in osteoporotic bone. Cement anchoring of sutures seems to be a cost-effective and valuable alternative when there is poor bone quality or extraordinarily high mechanical load.

Thermal effects of acrylic cementation at bone tumour sites

The use of acrylic bone cement as an adjunct to surgical excision of giant cell tumour of bone appears to reduce the incidence of tumour recurrence. Possible mechanisms for this apparent tumour inhibition include cytotoxic effects from the methylmethacrylate monomer and tissue hyperthermia from the heat of polymerization of the cement. This work presents a method for the prediction of temperature fields and resulting tissue necrosis arising from the implantation of polymethylmethacrylate (PMMA) at the site of a curretted giant cell tumour of bone. This is accomplished using a two-dimensional model based on geometry obtained from digitized MRI images of the distal femur. A general-coordinate, non-orthogonal grid generation technique is used and solutions are obtained with an alternating-direction implicit (ADI) finite-difference scheme. The nodal temperature histories are then used to evaluate the effect of variable defect size on the zone of thermally induced cell necrosis. The results suggest the depth of the necrotic region is quite sensitive to the size of the implant. In at least some cases, the heating effect is sufficient to cause significant necrosis of tumorigenic cells. Implanting a large mass of acrylic may risk overkill, damaging substantial amounts of healthy tissue.

Component motion in bipolar cemented hemiarthroplasty.

A total of 17 patients with a cemented bipolar Hastings hemiarthroplasty were examined clinically and radiologically between 1 and 3 years after being treated for a displaced femoral neck fracture. Only a minor part of the motion in the Hastings prostheses took place between the metal femoral head and the polyethylene liner (intraprosthetic). In seven cases, no "true" intraprosthetic motion weightbearing was observed (including five cases with intraprosthetic motion caused by impingement). The relative amount of intraprosthetic motion did not decrease with weightbearing. The functional result was not correlated to the relative amount of intraprosthetic motion with weightbearing. In conclusion, the short-term success of the bipolar prostheses is probably not accomplished by a reduction in extraprosthetic motion caused by the biarticular design but by other factors, including the optimal indications for hemiarthroplasty (high age, low activity level), the consistent use of acrylic bone cement, and the shock-absorbing effect of the polyethylene liner.

The use of acrylic bone cement for cervical fusion in patients with rheumatoid arthritis.

We report on 14 patients with instability of the cervical spine secondary to rheumatoid arthritis treated by fusion using a combination of traditional bone grafting techniques and methylmethacrylate bone cement. Successful fusion was achieved in all cases with few complications. The high infection rate reported by other authors was avoided by reducing the bulk of the cement mass and the use of antibiotic impregnated cement. We recommend this method of fusion to all orthopaedic surgeons involved in the treatment of patients with rheumatoid arthritis.

Use of tricalcium phosphate or electrical stimulation to enhance the bone-porous implant interface.

Implant stabilization by biologic ingrowth into a porous surface offers a durable method of prosthetic fixation. These systems, however, lack the immediate stability offered by the use of acrylic bone cement. The interface strength of porous coated Co--Cr--Mo in a canine model does not approach that of acrylic bone cement until two weeks postoperatively. It is expected that this would be a minimum time period in clinical applications. Both chemical and electrical means have been advocated as methods to affect tissue ingrowth. A study using a canine model was undertaken to determine tissue ingrowth rates utilizing examples of these two methods: (1) impregnation of the porous structures with tricalcium phosphate powder (TCP); or (2) the application of an electrical stimulator to the implant with the implant itself serving as the cathode. Ten implants were coated with TCP, two each at weekly intervals from 1 to 5 weeks. Plain porous rods were likewise implanted, serving as the controls. While histology did reveal a slightly more dense bony structure, the interface bond strength was not affected by TCP. Electrical stimulation of the implant was similarly investigated with an additional time period of 10 weeks. Compared to the controls, the electrically stimulated implants reveal no statistically demonstratable difference in interface strength. Histologic specimens indicate larger areas of calcification than are observed in the controls.

Structural Weakening of Layered Acrylic Bone Cement

Occasionally during arthroplasty procedures, additional cement is required to supplement an initial polymerizing mass. In vitro studies demonstrate that this practice significantly weakens the integrity of the added cement, as determined in mechanical shear. This is accompanied by a marked increase in cement porosity, with the voids acting as sites of stress concentration. This caveat has important consequences in clinical use of acrylic bone cement.

Porous acrylic cement.

The use of acrylic bone cement has a number of shortcomings, viz., high curing temperatures that can cause thermal necrosis, release of toxic monomer, and a less than perfect cement-to-bone bond. However, by modifying the cement composition through the addition of a soluble, nontoxic filler such as sucrose or tricalcium phosphate which does not impair the workability of the material during surgery, a significant improvement in the performance of the cement can be achieved. Because the filler replaces part of the acrylic components, less heat is generated during curing while the filler itself acts as a heat sink. Also, less monomer, proportional to the amount replaced by the filler, diffuses from the implant site. Upon elution of the filler, a porous cement will be obtained provided that a critical minimum percentage loading is exceeded so that the filler crystals will make physical contact with each other. The value of this percentage depends on both crystal modification and size. In the 125-175 micron sucrose crystal size range, the critical minimum percentage lies in the range of 20-28 wt% loading. Above 30%, the interconnecting pore size increases sharply to a value which allows good tissue ingrowth into the pores. The introduction of filler and pores causes a drop in strength, but the diametral tensile strength of modified cement containing up to 40% pores and sucrose lies between .7 and 1.5 kg/mm2, respectively, which is still in the same range as that of bone.

Case report: cardiac arrest following use of acrylic bone cement.

Case report: cardiac arrest following use of acrylic bone cement.