Synthesis and characterization of a new vertebroplasty cement based on gold-containing PMMA microspheres

Design and fabrication of high-performance injectable self-setting trimagnesium phosphate

Magnesium phosphate bone cement has become a widely used orthopedic implant due to the advantages of fast-setting and high early strength. However, developing magnesium phosphate cement possessing applicable injectability, high strength, and biocompatibility simultaneously remains a significant challenge. Herein, we propose a strategy to develop high-performance bone cement and establish a trimagnesium phosphate cement (TMPC) system. The TMPC exhibits high early strength, low curing temperature, neutral pH, and excellent injectability, overcoming the critical limitations of recently studied magnesium phosphate cement. By monitoring the hydration pH value and electroconductivity, we demonstrate that the magnesium-to-phosphate ratio could manipulate the components of hydration products and their transformation by adjusting the pH of the system, which will influence the hydration speed. Further, the ratio could regulate the hydration network and the properties of TMPC. Moreover, in vitro studies show that TMPC has outstanding biocompatibility and bone-filling capacity. The facile preparation properties and these advantages of TMPC render it a potential clinical alternative to polymethylmethacrylate and calcium phosphate bone cement. This study will contribute to the rational design of high-performance bone cement.

New Research Progress of Modified Bone Cement Applied to Vertebroplasty

Percutaneous vertebroplasty and percutaneous kyphoplasty are effective methods to treat acute osteoporotic vertebral compression fractures that can quickly provide patients with pain relief, prevent further height loss of the vertebral body, and help correct kyphosis. Many clinical studies have investigated the characteristics of bone cement. Bone cement is a biomaterial injected into the vertebral body that must have good biocompatibility and biosafety. The optimization of the characteristics of bone cement has become of great interest. Bone cement can be mainly divided into 3 types: polymethyl methacrylate, calcium phosphate cement, and calcium sulfate cement. Each type of cement has its own advantages and disadvantages. In the past 10 years, the performance of bone cement has been greatly improved via different methods. The aim of our review is to provide an overview of the current progress in the types of modified bone cement and summarize the key clinical findings.

Novel Bone Void Filling Cement Compositions Based on Shell Nacre and Siloxane Methacrylate Resin: Development and Characterization

Shell nacre from Pinctada species has been extensively researched for managing bone defects. However, there is a gap in the research regarding using shell nacre powder as a cement with improved biological and physicochemical properties. To address this, bone void filling cement was formulated by incorporating shell nacre powder and an organically modified ceramic resin (ormocer). The shell nacre powder was specifically processed from the shells of Pinctada fucata and analysed using thermogravimetric analysis (TGA), X-ray diffraction spectroscopy, Fourier transform infrared (FTIR), and Raman spectroscopy, confirming the presence of organic constituents and inorganic aragonite. Trace element analysis confirmed the eligibility of shell nacre powder for biomedical applications. Next, the ormocer SNLSM2 was synthesized through a modified sol-gel method. FTIR, Raman, TGA, and transmission electron microscopy studies revealed the presence of a ladder-structured siloxane backbone and methacrylate side chain. To develop chemical curable composite shell nacre cement (SNC), different amounts of shell nacre (24%, 48%, and 72%) were added to the SNLSM2 resin, and the impact on the physicochemical properties of the cement was studied. Among the compositions, SNC 72 exhibited significantly lower linear polymerization shrinkage (0.4%) and higher compressive (>100 MPa) and flexural strength (>35 MPa). SNC 72 was radiopaque, and the exotherm generated during the cement curing was minimal. Cytotoxicity studies with L929 cells revealed the non-cytotoxic nature of the cement. Overall, the findings of this study prove that the shell nacre cement is a promising candidate for managing bone voids.

Study of the radical polymerization mechanism and its application in the preparation of high-performance PMMA by reactive extrusion

In this study, the mechanism of radical polymerization was further explored by pre-dissolving different polymers and studying the kinetics of the bulk polymerization of methyl methacrylate (MMA) under shear-free conditions. Based on the analysis of the conversion and absolute molecular weight, it was found that, contrary to the shearing effect, the inert polymer with viscosity was the key factor to preventing the mutual termination of radical active species and reducing the termination rate constant k _t. Therefore, pre-dissolving the polymer could increase the polymerization rate and molecular weight of the system simultaneously, making the polymerization system enter the automatic acceleration zone faster and greatly reducing the generation of small molecular weight polymers, leading to a narrower molecular weight distribution. When the system entered the auto-acceleration zone, k _t decreased rapidly and greatly and entered the second steady-state polymerization stage. Then, with the increase in the polymerization conversion, the molecular weight gradually increased, while the polymerization rate gradually decreased. In shear-free bulk polymerization systems, k _t can be minimized and radical lifetimes maximized, but the polymerization system is at best a long-lived polymerization rather than a living polymerization. On this basis, by using MMA to pre-dissolve ultrahigh molecular weight PMMA and core-shell particles (CSR), the mechanical properties and heat resistance of the PMMA with pre-dissolved polymer obtained by reactive extrusion polymerization were better than for pure PMMA obtained under the same conditions. Compared with pure PMMA, the flexural strength and impact strength of PMMA with pre-dissolved CSR were up to 166.2% and 230.5%. With the same quality of CSR, the same two mechanical properties of the samples obtained by the blending method were just improved by 29.0% and 20.4%. This was closely related to the distribution of CSR in the pre-dissolved PMMA-CSR matrix with a distribution of spherical single particles 200-300 nm in diameter, which enabled PMMA-CSR to exhibit a high degree of transparency. This one-step process for realizing PMMA polymerization and high performance shows extremely high industrial application prospects.

PMMA/ABS/CoCl2 Composites for Pharmaceutical Applications: Thermal, Antimicrobial, Antibiofilm, and Antioxidant Studies

In this study, PMMA/ABS/CoCl₂ ternary composite films were fabricated by the solution casting technique. The different weight ratios of cobalt chloride (≤10 wt) were incorporated into the PMMA/ABS blend (80:20). The chemical structure and thermal properties of the synthesized composites were assessed by FT-IR, TGA, and XRD. The biological properties of ternary composites, such as in vitro antibacterial activity and antioxidant capacity, were investigated. The enhanced thermal stability and promising antibacterial, selective antibiofilm, and potential antioxidant properties of PMMA/ABS/cobalt chloride composites demonstrated that they can be used for high-quality plastics and in many pharmaceutical applications.

A Novel Calcium Phosphate-Based Nanocomposite for Augmentation of Cortical Bone Trajectory Screw Fixation

Purpose

To evaluate the effect of cement augmentation of cortical bone trajectory (CBT) screws using a novel calcium phosphate–based nanocomposite (CPN).

Material and Methods

CBT screws were placed into cadaveric lumbar vertebrae. Depending on the material used for augmentation, they were divided into the following three groups: CPN, polymethylmethacrylate (PMMA), and control. Radiological imaging was used to evaluate the cement dispersion. Biomechanical tests were conducted to measure the stability of CBT screws. A rat cranial defect model was used to evaluate biodegradation and osseointegration of the CPN.

Results

After cement augmentation, the CPN tended to disperse into the distal part of the screws, whereas PMMA remained limited to the proximal part of the screws (P < 0.05). As for cement morphology, the CPN tended to form a concentrated mass, whereas PMMA arranged itself as a scattered cement cloud, but the difference was not significant (P > 0.05). The axial pullout test showed that the average maximal pullout force (Fmax) of CPN-augmented CBT screws was similar to that of the PMMA group (CPN, 1639.56 ± 358.21 N vs PMMA, 1778.45 ± 399.83 N; P = 0.745) and was significantly greater than that of the control group (1019.01 ± 371.98 N; P < 0.05). The average torque value in the CPN group was higher than that in the control group (CPN, 1.51 ± 0.78 N∙m vs control, 0.97 ± 0.58 N∙m) and lower than that in the PMMA group (1.93 ± 0.81 N∙m), but there were no statistically significant differences (P > 0.05). The CPN could be biodegraded and gradually replaced by newly formed bone tissue after 12 weeks in a rat cranial defect model.

Conclusion

The biocompatible CPN could be a valuable augmentation material to enhance CBT screw stability.

Preparation and evaluation of osteogenic nano-MgO/PMMA bone cement for bone healing in a rat critical size calvarial defect

The clinical outcomes of polymethylmethacrylate (PMMA) bone cement used to fill gaps or marrow cavities of bones and bone defects are limited due to poor handling properties, mismatched mechanical properties with natural bone and lack of osteogenesis for bone healing. In this study, a series of PMMA bone cements containing active nano-MgO particles (nano-MgO/PMMA) were prepared. The handling and mechanical properties were systemically evaluated according to an International Standardization Organization standard (ISO 5833:2002). The biocompatibility and osteogenic activity of nano-MgO/PMMA were also analysed in vitro. The osteogenic effects of nano-MgO/PMMA were assessed in a rat calvarial critical bone defect model. The addition of less than 15 wt% nano-MgO to PMMA improved the handling properties of PMMA. Compared with PMMA, the compression modulus and strength of 20MP (20 wt% nano-MgO to PMMA) decreased to 0.725 ± 0.023 GPa and 25.38 ± 2.82 MPa, respectively. In vitro studies with MC3T3-E1 showed that nano-MgO/PMMA had better biocompatibility than the PMMA group after 7 days of culture. The nano-MgO/PMMA groups showed more calcium nodules and higher osteogenic gene expression levels than PMMA after 12 days of osteogenic induction of the rat BMSCs. The in vivo studies analysed by micro-CT and histomorphology results proved that nano-MgO/PMMA could significantly enhance new bone formation. The mean new bone mineral density in the nano-MgO/PMMA group was 50% greater than that in the PMMA group. In addition, biomechanical tests showed that nano-MgO/PMMA was superior to PMMA in bone-bonding strength after 12 weeks implantation. Therefore, the nano-MgO/PMMA bone cement has good potential in joint fixation and bone defect filling applications.

Environmentally Friendly Marine Antifouling Coating Based on a Synergistic Strategy

The development of environmentally friendly and long-term marine antifouling coating remains a huge challenge in the maritime industry. For this purpose, we developed a novel and efficient antifouling coating based on a synergistic strategy, incorporating contact inhibition, fouling repelling, and antifouling properties. Results demonstrated that the coating could efficiently resist the adhesion of protein, bacteria, and Navicula diatoms. More importantly, marine field tests showed the coating could efficiently inhibit biofouling for at least 8 months. This approach paves a new way for the development of environmentally friendly and long-term antifouling coating.

Strontium ranelate simultaneously improves the radiopacity and osteogenesis of calcium phosphate cement

In a minimally invasive surgery of osteoporotic fractures, high radiopacity is necessary to monitor the delivery and positioning of injectable cements and good osteogenesis is indispensable. In this work, strontium ranelate (SrR), an agent for treating osteoporosis, is firstly used as a radiopaque agent for calcium phosphate cement (CPC). The addition of SrR does not affect the hydration products of CPC, but prolonged the setting time and decreased the compressive strength. The injectability of the cement was higher than 85% when SrR content is more than 10 wt%. The radiopacity of CPC is significantly improved by SrR and higher than cortical bone when the content of SrR is more than 5 wt%. The concentration of Sr ions released from CPC is increased by the increasing content of SrR, which is among 17-1329 μM. Moreover, CPCs with SrR significantly promote the osteogenic differentiation of mouse bone marrow mesenchymal stem cells and inhibit the osteoclastogenic differentiation of RAW264.7 cells. Based on its good radiopacity and osteogenesis, suppressed osteoclastogenesis and appropriate physicochemical properties, the radiopaque CPC with more than 10 wt% SrR is prospective to be a promising biomaterial for osteoporotic fracture repairing in minimal invasive surgery.

Synthesis and Characterization of an Injectable and Hydrophilous Expandable Bone Cement Based on Poly(methyl methacrylate)

Poly(methyl methacrylate) (PMMA), the most common bone cement, has been used as a graft substitute in orthopedic surgeries such as vertebroplasty. However, an undesirable minor crack in the bone-cement interface provoked by shrinkage during polymerization and high elastic modulus of conventional PMMA bone cement dramatically increases the risk of vertebral body refracture postsurgery. Thus, herein, a hydrophilous expandable bone cement was synthesized based on a PMMA commercial cement (Mendec Spine Resin), acrylic acid (AA), and styrene (St). The two synthesized cements (PMMA-PAA, PMMA-PAA-PSt) showed excellent volumetric swelling in vitro and cohesive bone-cement contact in rabbit femur cavity defect. The elastic modulus and compressive strength of the new cements were lower than PMMA. Furthermore, the in vitro analysis indicated that the new cements had lower cytotoxicity than PMMA, including superior proliferation and lower apoptotic rates of Sprague-Dawly rat-derived osteoblasts. Western blotting for protein expression and RT-PCR analysis of osteogenesis-specific genes were conducted on SD rat-derived osteoblasts from both PMMA and new cements films; the results showed that new cements enhanced the expression of osteogenesis-specific genes. Scanning electron microscopy demonstrated improved morphology and attachment of osteoblast on new cement discs compared to the PMMA discs. Additionally, the histological morphologies of the bone-cement interface from the rabbit medial femoral condyle cavity defect model revealed direct and cohesive contact with the bone in the new cement groups in contrast to a minor crack in the PMMA cement group. The sign of a new bone growing into the cement has been found in the new cements after 12 weeks, thereby indicating the osteogenic capacity in vivo. In conclusion, the synthesized hydrophilous expandable bone cements based on PMMA and poly(acrylic acid) (PAA) are promising candidates for vertebroplasty.

Evolution of Surface Nanopores in Pressurised Gyrospun Polymeric Microfibers

The selection of a solvent or solvent system and the ensuing polymer–solvent interactions are crucial factors affecting the preparation of fibers with multiple morphologies. A range of poly(methylmethacrylate) fibers were prepared by pressurised gyration using acetone, chloroform, N,N-dimethylformamide (DMF), ethyl acetate and dichloromethane as solvents. It was found that microscale fibers with surface nanopores were formed when using chloroform, ethyl acetate and dichloromethane and poreless fibers were formed when using acetone and DMF as the solvent. These observations are explained on the basis of the physical properties of the solvents and mechanisms of pore formation. The formation of porous fibers is caused by many solvent properties such as volatility, solubility parameters, vapour pressure and surface tension. Cross-sectional images show that the nanopores are only on the surface of the fibers and they were not inter-connected. Further, the results show that fibers with desired nanopores (40–400 nm) can be prepared by carefully selecting the solvent and applied pressure in the gyration process.

Antibacterial Adhesion of Poly(methyl methacrylate) Modified by Borneol Acrylate

Poly(methyl methacrylate) (PMMA) is a widely used biomaterial. But there is still a challenge facing its unwanted bacterial adhesion because the subsequent biofilm formation usually leads to failure of related implants. Herein, we present a borneol-modified PMMA based on a facile and effective stereochemical strategy, generating antibacterial copolymer named as P(MMA-co-BA). It was synthesized by free radical polymerization and studied with different ratio between methyl methacrylate (MMA) and borneol acrylate (BA) monomers. NMR, GPC, and EA, etc., were used to confirm their chemical features. Their films were challenged with Escherichia coli (Gram-negative) and Bacillus subtilis (Gram-positive), showing a BA content dependent antibacterial performance. The minimum effective dose should be 10%. Then in vivo subcutaneous implantations in mice demonstrated their biocompatibilities through routine histotomy and HE staining. Therefore, P(MMA-co-BA)s not only exhibited their unique antibacterial character but also suggested a potential for the safe usage of borneol-modified PMMA frame and devices for further implantation.

A Review of PMMA Bone Cement and Intra-Cardiac Embolism

Percutaneous vertebroplasty procedure is of major importance, given the significantly increasing aging population and the higher number of orthopedic procedures related to vertebral compression fractures. Vertebroplasty is a complex technique involving the injection of polymethylmethacrylate (PMMA) into the compressed vertebral body for mechanical stabilization of the fracture. Our understanding and ability to modify these mechanisms through alterations in cement material is rapidly evolving. However, the rate of cardiac complications secondary to PMMA injection and subsequent cement leakage has increased with time. The following review considers the main effects of PMMA bone cement on the heart, and the extent of influence of the materials on cardiac embolism. Clinically, cement leakage results in life-threatening cardiac injury. The convolution of this outcome through an appropriate balance of complex material properties is highlighted via clinical case reports.