Acrylic bone cements: clinical developments and current status: Scandinavia

Effect of barium-coated halloysite nanotube addition on the cytocompatibility, mechanical and contrast properties of poly(methyl methacrylate) cement

Halloysite nanotubes (HNTs) were investigated as a platform for tunable nanoparticle composition and enhanced opacity in poly(methyl methacrylate) (PMMA) bone cement. Halloysite has been widely used to increase the mechanical properties of various polymer matrices, in stark contrast to other fillers such as barium sulfate that provide opacity but also decrease mechanical strength. The present work describes a dry deposition method for successively fabricating barium sulfate nanoparticles onto the exterior surface of HNTs. A sintering process was used to coat the HNTs in barium sulfate. Barium sulfate-coated HNTs were then added to PMMA bone cement and the samples were tested for mechanical strength and tailored opacity correlated with the fabrication ratio and the amount of barium sulfate-coated HNTs added. The potential cytotoxic effect of barium-coated HNTs in PMMA cement was also tested on osteosarcoma cells. Barium-coated HNTs were found to be completely cytocompatible, and cell proliferation was not inhibited after exposure to the barium-coated HNTs embedded in PMMA cement. We demonstrate a simple method for the creation of barium-coated nanoparticles that imparted improved contrast and material properties to native PMMA. An easy and efficient method for coating clay nanotubes offers the potential for enhanced imaging by radiologists or orthopedic surgeons.

The mechanical effect of the existing cement mantle on the in-cement femoral revision

BACKGROUND

Cement-in-cement revision hip arthroplasty is an increasingly popular technique to replace a loose femoral stem which retains much of the original cement mantle. However, some concern exists regarding the retention of the existing fatigued and aged cement in such cement-in-cement revisions. This study investigates whether leaving an existing fatigued and aged cement mantle degrades the mechanical performance of a cement-in-cement revision construct.

METHODS

Primary cement mantles were formed by cementing a polished stem into sections of tubular steel. If in the test group, the mantle underwent conditioning in saline to simulate ageing and was subject to a fatigue of 1 million cycles. If in the control group no such conditioning or fatigue was carried out. The cement-in-cement procedure was then undertaken. Both groups underwent a fatigue of 1 million cycles subsequent to the revision procedure.

FINDINGS

Application of a Mann-Whitney test on the recorded subsidence (means: 0.51, 0.46, n=10+10, P=0.496) and inducible displacement (means: 0.38, 0.36, P=0.96) revealed that there was no statistical difference between the groups.

INTERPRETATION

This study represents further biomechanical investigation of the mechanical behaviour of cement-in-cement revision constructs. Results suggest that pre-revision fatigue and ageing of the cement may not be deleterious to the mechanical performance of the revision construct. Thus, this study provides biomechanical evidence to back-up recent successes with this useful revision technique.