Acrylic bone cement: in vitro and in vivo property-structure relationship--a selective review

Does vacuum mixing affect diameter shrinkage of a PMMA cement mantle during in vitro cemented acetabulum implantation?

Radiolucent lines on immediate postoperative cemented acetabular component radiographs between the PMMA bone cement mantle and bone are an indicator of an increased risk of early loosening. The cause of these lines has yet to be identified. Thermal and chemical necrosis, fluid interposition and cement shrinkage have all been suggested in the literature. The aim of the study reported here was to take an engineering approach - eliminating confounding variables present during surgery - to quantify the size of the interstice created by cement shrinkage when a 50 mm diameter flanged acetabular cup is implanted in a model acetabulum with a 52 mm hemispherical bore under controlled conditions using vacuum and non-vacuum mixed cement. Irrespective of the mixing method used, a significant interstice was created between the bone cement and the mock acetabulum. When the cement was mixed under vacuum the interstice created between the mock acetabulum and the cement mantle was 0.60 mm ± 0.09 mm; when the cement was mixed under non-vacuum conditions the interstice created was 0.39 mm ± 0.15 mm. Possible explanations for radiolucent lines are discussed.

Analysis of rheological properties of bone cements

The rheological properties of three commercially available bone cements, CMW 1, Palacos R and Cemex ISOPLASTIC, were investigated. Testing was undertaken at both 25 and 37 degrees C using an oscillating parallel plate rheometer. Results showed that the three high viscosity cements exhibited distinct differences in curing rate, with CMW 1 curing in 8.7 min, Palacos R and Cemex ISOPLASTIC in 13 min at 25 degrees C. Furthermore it was found that these curing rates were strongly temperature dependent, with curing rates being halved at 37 degrees C. By monitoring the change of viscosity with time over the entire curing process, the results showed that these cements had differing viscosity profiles and hence exhibit very different handling characteristics. However, all the cements reached the same maximum viscosity of 75 x 10(3) Pa s. Also, the change in elastic/viscous moduli and tan delta with time, show the cements changing from a viscous material to an elastic solid with a clear peak in the viscous modulus during the latter stages of curing. These results give valuable information about the changes in rheological properties for each commercial bone cement, especially during the final curing process.

Noninvasive in vivo EPR monitoring of the methyl methacrylate polymerization during the bone cement formation

The curing of poly(methyl methacrylate) (PMMA) bone cement is done by a free radical polymerization. As the amount of free radicals present is a marker of the amount of unpolymerized chains present in the polymer, it is assumed that this could be related to the mechanical properties such as strength or density. In this study, the direct observation of the free radicals produced during the PMMA bone cement formation was obtained for the first time in vivo using low-frequency EPR spectrometers (1.2 GHz). Low frequency permits measurements in live animals due to the increased microwave penetration. The amount of polymerization radicals was carried out noninvasively over days on the same animals. The decay rates obtained in vitro and in vivo were compared: the decay rates were significantly lower when the curing process occurred in vivo compared to the situation in vitro. As the kinetics are rather different in vitro and in vivo, this emphasizes the value of the present method that permits the noninvasive monitoring of the curing process directly in vivo.

Application of extracorporeal shock wave lithotripter (ECSWL) in orthopedics. I. Foundations and overview

In this paper we have reviewed the feasibility of using a shock wave lithotripter to loosen the interface between the bone and acrylic bone cement for revision arthroplasty. We have reviewed the physics of shock wave and its applications in medicine, especially its interaction with tissues. The calculations show that the energy is greatly reduced at the interface both in the soft tissue-bone interface and cement-bone interface. On the other hand, a tensile and compressive pressure can be operated at the cement-bone interface that can cause the interface to break if the pressure exceeds the tensile strength of the cement-bone interface. Subsequent papers will deal with in vitro and in vivo application of the shock wave in the treatment of the cement from the intramedullary canal.

Orthopedic prosthesis fixation

The fixation of orthopedic implants has been one of the most difficult and challenging problems. The fixation can be achieved via: (a) direct mechanical fixation using screws, pins, wires, etc.; (b) passive or interference mechanical fixation where the implants are allowed to move or merely positioned onto the tissue surfaces; (c) bone cement fixation which is actually a grouting material; (d) biological fixation by allowing tissues to grow into the interstices of pores or textured surfaces of implants; (e) direct chemical bonding between implant and tissues; or (f) any combination of the above techniques. This article is concerned with various fixation techniques including the potential use of electrical, pulsed electromagnetic field, chemical stimulation using calcium phosphates for the enhancement of tissue ingrowth, direct bonding with bone by glass-ceramics and resorbable particle impregnated bone cement to take advantages of both the immediate fixation offered by the bone cement and long term fixation due to tissue ingrowth.

Drug delivery systems: 3A. Role of polymers in drug delivery

At present, polymers represent a class of ubiquitous materials. They are being used for a multitude of purposes and the almost inexhaustible varieties of molecular architecture that macromolecular materials can possess provides the possibility for a myriad of applications. Because of the increased interest being shown in the macromolecules by the pharmaceutical industry for the fabrication of drug delivery systems, numerous polymers have been synthesized and successfully used in drug delivery devices. The necessary conditions for developing the concept of pharmaceutically applicable polymers depend upon delineating a detailed knowledge of the relationship between the structure and properties of polymer networks. A number of polymers have been studied systematically from this point of view and there is every indication that the systems described have the potential to become clinically valuable and therefore marketable drug delivery systems. The potential of these promising polymers is still far from being exhausted and there is a strong possibility that many important developments will be forthcoming in this field in the future. In the current review article, polymers for controlled release have been divided into four major categories: diffusion-controlled systems; chemically controlled systems; solvent-activated systems; and magnetically controlled systems. Polymers as drug carriers also have been divided into various subgroups: soluble, biodegradable, mucoadhesive and other polymeric systems. The latter group includes polymers containing pendant bioactive substituents, matrix systems, heparin-releasing polymers, ionic polymers, oligomers and miscellaneous. At an introductory and fundamental level, an overview of these polymers and the materials science for the design of drug delivery systems will be discussed.

Influence of mixing technique on some properties of PMMA bone cement

PMMA bone cements (Refobacin-Palacos R, Sulfix 6, AKZ, and CMW bone cement, types I and II), from six different clinics, were investigated in three stages. In the first stage, studies of density, hardness, flexural strength, and compressive strength were made, as well as molecular weight measurements and microscopic investigations. These studies reflected the current state of techniques of application used in operating theaters. They revealed wide variations in the properties of the materials studied. Secondly, a comprehensive study of the process-technology in the laboratory was performed. The following variables were investigated or discussed: mixing vessel, order of the individual components, mixing time, rate of mixing, pressure application on the mixed bone cement, kneading, cement thickness, pouring into the syringe, contact force during polymerization, and preparation quantity. The third stage involved the development and clinical testing of an improved mixing technique. Using this improved mixing technique, all three selected clinics achieved far better results with reduced variability. A comparison between a centrifuging technique after mixing and our improved, but conventional, mixing technique, displays advantages for the latter. The question regarding a correlation between cement specimens of high porosity and early implant loosening could not be answered on the basis of the 43 PMMA bone cement explants investigated (implanted 6 months to 15 years). In some cases, the studies revealed that the bone cement manufacturers should be required to revise and quantify existing instructions for use. The users, on the other hand, should give more consideration to the mixing technique and its consequences.

Molecular and mechanical property changes during aging of bone cement in vitro and in vivo

The changes in mechanical properties and free radical concentration of curing Simplex P Radiopaque Bone Cement in vivo and in vitro conditions were studied. Samples were prepared so that each in vivo sample that cured and aged in the canine femoral intramedullary cavities had an in vitro counterpart that was cured and aged in a constant-temperature saline bath at 37 degrees C. An electron paramagnetic resonance (EPR) spectrometer was used to measure the growth and decay (curing) of polymerization radicals. The results of EPR measurements showed that the curing (disappearance of free radicals) of in vivo samples takes a much longer time (more than 4 weeks) than in vitro curing (less than 2 weeks). The mechanical tests indicate that, whether aged in vivo or in vitro, the strength increased rapidly for the first 1-2 weeks and then slight increases were seen for up to 6 months.

Bioadhesive polymers as platforms for oral controlled drug delivery II: synthesis and evaluation of some swelling, water-insoluble bioadhesive polymers

A series of cross-linked, swellable polymers was sythesized from monomers such as acrylic acid, methacrylic acid, and others with various cross-linking agents to produce a range of polymers differing in charge densities and hydrophobicity. The densities, rate, and extent of hydration of the polymers were determined. An increase in the number of hydrophobic groups in the polymer structure reduced hydration whereas the density of the polymer was unaffected. A sensitive in vitro method for measuring adhesion of polymer to tissue from the rabbit stomach was developed. Polymers of acrylic acid loosely cross-linked (0.3%, w/w) with three different agents, divinyl glycol, 2,5-dimethyl-1,5-hexadiene, and divinylbenzene, showed the same degree of bioadhesion while poly(methacrylic acid-divinylbenzene) showed reduced bioadhesion. The small percent of cross-linking agent, irrespective of physicochemical properties, did not contribute substantially to bioadhesion, whereas the starting monomer had a large effect. The effect of pH on the bioadhesion of poly(acrylic acid-divinyl glycol) was studied at constant temperature, ionic strength, and osmolality. The polymer showed maximum adhesion at pH 5 and 6 and a minimum at pH 7. Gastrointestinal transit studies of cross-linked polymers in rats were studied. Poly(acrylic acid-divinyl glycol) and poly(methacrylic acid-divinylbenzene) were shown to have substantially longer GI transit times than the control, Amberlite 200 resin beads. The delay in transit time was due to bioadhesion of the polymer to the mucin-epithelial cell surface which was clearly observable on animal autopsy. The acrylic acid polymer showed a longer GI transit time than the methacrylic acid polymer, and this in vivo GI transit result is consistent with in vitro bioadhesion test results.