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Perez‐Prieto D, Koetter K, Fontanellas‐Fes A, Martínez‐Cruz O, the RACat working group. Total knee arthroplasty revision risks depending on the bone cement used-Data from 50,545 knee replacements of the Catalan Arthroplasty Registry. J Exp Orthop 2025; 12:e70271. [PMID: 40421410 PMCID: PMC12104820 DOI: 10.1002/jeo2.70271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2025] [Revised: 02/20/2025] [Accepted: 02/22/2025] [Indexed: 05/28/2025] Open
Abstract
Purpose Clinical data on individual bone cement brands and viscosities in cemented total knee arthroplasty (TKA) is scarce. The Catalan arthroplasty registry (RACat) documents usage of cement brands including viscosities and the inclusion of antibiotics. The objective was to compare the clinical performance of the widely used bone cement brand PALACOS® to other blinded bone cement brands in TKA using data from the RACat. Methods Patient data on 50,545 primary TKA between 2007 and 2017 in the RACat were analysed retrospectively. Implant survival of PALACOS bone cement was compared to other blinded bone cement brand groups using the all-cause revision risk as primary study endpoint. Results Comparing implant survival, it was found that (1) PALACOS® (with or without gentamicin) was associated with a significantly lower revision risk compared to other cement brands (with or without antibiotics) (p = 0.001): RR PALACOS 2.03% versus RR other brands 3.88%, and RR PALACOS+G 1.84% versus RR other antibiotic-loaded bone cements (ALBC) 3.85%; (2) ALBC (all brands) did not reduce the risk of revisions (p = n.s) compared to plain bone cements (PBC); and (3) the medium viscosity PALACOS MV+G showed the lowest reoperation risk versus other ALBC (all viscosities): RR 1.12% versus RR 3.85%. Competing-risk regression models confirmed reduction in revision risk for all PALACOS compared with other brands (p = 0.001) and for PALACOS+G compared with other ALBC (p < 0.001) but showed no difference when comparing all ALBC with all PBC (p = 0.403). Comparing PALACOS MV+G with all other ALBC showed reduction of revision risk (p < 0.001) and no difference when comparing PALACOS medium viscosity (MV) with all other PBC (p = 0.108). Conclusions Type of cement brand, viscosity and the addition of antibiotics have an impact on revision risk of TKA. Medium viscosity cement with gentamicin (PALACOS MV+G), for which no clinical data were previously available, was associated with the lowest revision risk in TKA. Level of Evidence Level III, retrospective comparative study.
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Affiliation(s)
- Daniel Perez‐Prieto
- Ortophedic Surgery, Hospital del MarUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Katharina Koetter
- Department of Health Economics & Outcome ResearchHeraeus Medical GmbHWehrheimGermany
| | | | - Olga Martínez‐Cruz
- Departament de SalutData Analytics Program for Research and Innovation in Health (PADRIS) Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS)BarcelonaSpain
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Monfort-Mira M, Balaguer-Castro M, Jornet-Gibert M, Cito S, De la Flor-López S, Torner P. Mechanical Integrity Assessment of Polymethylmethacrylate Bone Cement Incorporating Local Anesthetics: Implications for Joint Arthroplasty. J Arthroplasty 2025:S0883-5403(25)00029-4. [PMID: 39848451 DOI: 10.1016/j.arth.2025.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 01/11/2025] [Accepted: 01/14/2025] [Indexed: 01/25/2025] Open
Abstract
BACKGROUND Effective management of postsurgical pain following arthroplasty remains a challenge, lacking a definitive gold standard. As most knee and hip arthroplasties are cemented or hybrid, we used the property of bone cement as a drug carrier and added powdered local anesthetics (lidocaine hydrochloride and bupivacaine hydrochloride) to the polymethylmethacrylate (PMMA) as analgesics. However, the addition of drugs to bone cement may compromise its mechanical properties, necessitating a thorough analysis. Our objective was to assess the impact of added local anesthetics on the mechanical properties of PMMA bone cement. METHODS Mechanical properties, including compressive strength, bending modulus, and bending strength, were evaluated following the procedure set by the International Organization for Standardization 5833-2002 and the American Society for Testing and Materials F451-1 standards. There were three of the following study groups compared: PMMA, PMMA with lidocaine hydrochloride, and PMMA with bupivacaine hydrochloride. RESULTS Significant differences were observed between groups in compressive and bending strength, but not in bending modulus. Despite these differences, the mean compressive strength and bending modulus of all groups and the mean bending strength of the lidocaine group surpassed the minimum values set by the International Organization for Standardization 5833-2002 and American Society for Testing and Materials F 451-08 standards for acrylic bone cement. However, the bupivacaine group fell short of the minimum bending strength value. CONCLUSIONS The addition of powdered local anesthetics to PMMA affects its mechanical properties, specifically compressive and bending strength, without compromising the bending modulus. While differences were noted, all groups surpassed the minimum standards for compressive strength and bending modulus. However, the bupivacaine group did not meet the minimum bending strength requirement. This highlights the importance of considering mechanical properties when incorporating drugs into bone cement for implant fixation.
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Affiliation(s)
- Montserrat Monfort-Mira
- Department of Orthopaedic Surgery and Traumatology, Hospital Clínic Barcelona, Barcelona, Spain
| | - Mariano Balaguer-Castro
- Department of Orthopaedic Surgery and Traumatology, Hospital Clínic Barcelona, Barcelona, Spain
| | - Montsant Jornet-Gibert
- Department of Orthopaedic Surgery and Traumatology, Hospital Clínic Barcelona, Barcelona, Spain
| | - Salvatore Cito
- Department of Mechanical Engineering, Universitat Rovira i Virgili, Tarragona, Spain
| | | | - Pere Torner
- Department of Orthopaedic Surgery and Traumatology, Hospital Clínic Barcelona, Barcelona, Spain
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Oe K, Iida H, Saito T. The 'Japanese paradox' of total hip arthroplasty: where are we going? Expert Rev Med Devices 2025; 22:31-48. [PMID: 39748157 DOI: 10.1080/17434440.2024.2448741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2024] [Accepted: 12/16/2024] [Indexed: 01/04/2025]
Abstract
INTRODUCTION There is a worldwide trend toward 'revisiting' cemented total hip arthroplasty (THA). In Japan, however, cemented THAs accounts for 11%, and the percentage of cemented hemiarthroplasty is estimated to be less than 10%. This review was designed to reconsider the option of cemented THA and to encourage policy changes in Japan to support the best possible care for patients. AREA COVERED In this article, we reviewed the history of THA and the current situations of the world, based on past reports and nationwide registries. Merits and demerits of cemented THA were evaluated from various perspectives. EXPERT OPINION Cemented THA had great advantages, including establishment of the acetabular cup, diversity of the femoral stem, antibiotic-loaded acrylic cement, revision, low incidence of periprosthetic fracture, and hemiarthroplasty. In patients older than 75 years of age, cemented THA resulted in the lowest risk of revision. Guidelines for femoral neck fracture recommended the use of cemented hemiarthroplasty in many countries because of low incidence of periprosthetic fracture. Numerous contradictions regarding implant price and cost of operations have also been noted in Japan. For the patients, we need to rethink what is truth and what is fiction.
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Affiliation(s)
- Kenichi Oe
- Department of Orthopaedic Surgery, Kansai Medical University, Hirakata, Osaka, Japan
| | - Hirokazu Iida
- Department of Orthopaedic Surgery, Kansai Medical University, Hirakata, Osaka, Japan
| | - Takanori Saito
- Department of Orthopaedic Surgery, Kansai Medical University, Hirakata, Osaka, Japan
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Xiao SW, Zhou SF, Pan SX, Li GD, Li Q, Li AH. Precooling storage of bone cement in percutaneous vertebroplasty for osteoporotic vertebral compression fracture. BMC Musculoskelet Disord 2024; 25:1032. [PMID: 39702166 DOI: 10.1186/s12891-024-08162-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 12/06/2024] [Indexed: 12/21/2024] Open
Abstract
PURPOSE This study aimed to investigate the effect of precooling storage of bone cement in percutaneous vertebroplasty(PVP) for the patients with osteoporotic vertebral compression fracture (OVCF). METHODS A total of 207 OVCF patients who underwent PVP were included in this study. Two different storage methods for the bone cement were randomly utilized: an operating room (NT group, 23 °C) and a refrigerator (PC group, 4 °C). Clinical outcomes were evaluated using the visual analog scale (VAS) and Oswestry Disability Index (ODI) scores. In addition, radiographic evaluations were performed using anterior vertebral height and Cobb angle. RESULTS The time of cement infusion was 10.8 ± 2.1 min in the PC group, which was significantly longer compared to the NT group (6.9 ± 1.8 min)(P < 0.0001). However, the postoperative VAS score was lower in the PC group than the NT group (P < 0.0001). Moreover, compared to the NT group, the cement distribution score and rate of cement touching both upper and lower vertebral endplates were higher in the PC group (P < 0.0001 and = 0.037, respectively). Additionally, the anterior vertebral height was higher in the PC group compared to the NT group at both the 2-day postoperative assessment and the final follow-up (P = 0.046 and 0.026, respectively). Lastly, the rates of cement leakage and re-compression were lower in the PC group (P = 0.016 and 0.034, respectively) compared with the NT group. CONCLUSION Precooling storage of bone cement may prolong manipulation time in percutaneous vertebroplasty, optimize pain relief for patients, and mitigate the risk of bone cement leakage and re-compression. TRIAL REGISTRATION Trial registration number: ChiCTR2400092330. Retrospective registration date: 14/11/2024 ( www.chictr.org.cn ).
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Affiliation(s)
- Shan-Wen Xiao
- Department of Spine and Orthopedic Surgery, Wuzhou Red Cross hospital, #3-1, Xin Xing Road 1, Wuzhou, 543000, China.
| | - Su-Fang Zhou
- Medical care department for personnel, Wuzhou workers' hospital, Gaodi Road South. No.1, Three lane, Wuzhou, 543000, China
| | - Shi-Xin Pan
- Department of Spine and Orthopedic Surgery, Wuzhou Red Cross hospital, #3-1, Xin Xing Road 1, Wuzhou, 543000, China
| | - Guo-Dong Li
- Department of Spine and Orthopedic Surgery, Wuzhou Red Cross hospital, #3-1, Xin Xing Road 1, Wuzhou, 543000, China
| | - Quan Li
- Department of Spine and Orthopedic Surgery, Wuzhou Red Cross hospital, #3-1, Xin Xing Road 1, Wuzhou, 543000, China
| | - Ai-Hui Li
- Department of Spine and Orthopedic Surgery, Wuzhou Red Cross hospital, #3-1, Xin Xing Road 1, Wuzhou, 543000, China
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Fraval A, Zhou Y, Parvizi J. Antibiotic-loaded cement in total joint arthroplasty: a comprehensive review. Arch Orthop Trauma Surg 2024; 144:5165-5175. [PMID: 38687383 DOI: 10.1007/s00402-024-05328-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 04/14/2024] [Indexed: 05/02/2024]
Abstract
This review evaluates the decision-making framework for using antibiotic-loaded cement (ALC) in the management of prosthetic joint infection (PJI). Drawing on available literature, we offer orthopaedic surgeons a guided discussion on several critical considerations. First, we explore the impact of antibiotic-loading on the mechanical properties of polymethylmethacrylate (PMMA) cement, assessing both strength and durability. We then explore the optimal antibiotic dosage to load into cement, aiming to achieve effective local concentrations for infection control without compromising mechanical stability. Furthermore, we explore how cement and antibiotic properties affect the overall antibiotic elution characteristics of ALC. Finally, we discuss risks of systemic toxicity, particularly acute kidney injury, when using ALC. The principal goal in this review is to provide a balanced approach based on best available evidence that optimises antibiotic elution from ALC whilst minimising potential harms associated with its use.
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Affiliation(s)
- Andrew Fraval
- Department of Orthopaedic Surgery, St. Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia.
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Yushy Zhou
- Department of Orthopaedic Surgery, St. Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia
| | - Javad Parvizi
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
- International Joint Center, Acibadem University Hospital, Istanbul, Turkey
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Xu TG, Shi J, Qi H, Chen S, Li B, Zhang F, He JH. Radiopaque and Biocompatible PMMA Bone Cement Triggered by Nano Tantalum Carbide and Its Osteogenic Performance. ACS Biomater Sci Eng 2024; 10:5624-5631. [PMID: 39107258 DOI: 10.1021/acsbiomaterials.4c00552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2024]
Abstract
Poly(methyl methacrylate) (PMMA) bone cements have been widely used in orthopedics; thanks to their excellent mechanical properties, biocompatibility, and chemical stability. Barium sulfate and zirconia are usually added into PMMA bone cement to enhance the X-ray radiopacity, while the mechanical strength, radiopacity, and biocompatibility are not well improved. In this study, an insoluble and corrosion-resistant ceramic, tantalum carbide (TaC), was added into the PMMA bone cement as radiopacifies, significantly improving the mechanical, radiopaque, biocompatibility, and osteogenic performance of bone cement. The TaC-PMMA bone cement with varied TaC contents exhibits compressive strength over 100 MPa, higher than that of the commercial 30% BaSO4-PMMA bone cement. Intriguingly, when the TaC content reaches 20%, the radiopacity is equivalent to the commercial bone cement with 30% of BaSO4 in PMMA. The cytotoxicity and osteogenic performance indicate that the incorporation of TaC not only enhances the osteogenic properties of PMMA but also does not reduce cell viability. This study suggests that TaC could be a superior and multifunctional radio-pacifier for PMMA bone cement, offering a promising avenue for improving patient outcomes in orthopedic applications.
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Affiliation(s)
- Tong-Guang Xu
- Department of Orthopedics, The People's Hospital of Suzhou New District, Suzhou, Jiangsu 215129, China
| | - Jiaxu Shi
- Medical 3D Printing Center, Orthopedic Institute, Department of Orthopedic Surgery, The First Affiliated Hospital, School of Biology and Basic Medical Sciences, Suzhou Medical College, Soochow University, Suzhou, Jiangsu 215000, China
| | - Hang Qi
- College of Chemistry, Chemical Engineering and Materials Science, Soochow University, Suzhou, Jiangsu 215123, China
| | - Song Chen
- Medical 3D Printing Center, Orthopedic Institute, Department of Orthopedic Surgery, The First Affiliated Hospital, School of Biology and Basic Medical Sciences, Suzhou Medical College, Soochow University, Suzhou, Jiangsu 215000, China
| | - Bin Li
- Medical 3D Printing Center, Orthopedic Institute, Department of Orthopedic Surgery, The First Affiliated Hospital, School of Biology and Basic Medical Sciences, Suzhou Medical College, Soochow University, Suzhou, Jiangsu 215000, China
| | - Feng Zhang
- Analysis and Testing Center, Soochow University, Suzhou, Jiangsu 215123, China
| | - Jing-Hui He
- College of Chemistry, Chemical Engineering and Materials Science, Soochow University, Suzhou, Jiangsu 215123, China
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Egger V, Dammerer D, Degenhart G, Pallua JD, Schmölz W, Thaler M, Kühn KD, Nogler M, Putzer D. Does the Addition of Low-Dose Antibiotics Compromise the Mechanical Properties of Polymethylmethacrylate (PMMA)? Polymers (Basel) 2024; 16:2378. [PMID: 39204597 PMCID: PMC11359730 DOI: 10.3390/polym16162378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 08/13/2024] [Accepted: 08/14/2024] [Indexed: 09/04/2024] Open
Abstract
The increasing numbers of total joint replacements and related implant-associated infections demand solutions, which can provide a high-dose local delivery of antibiotics. Antibiotic-loaded bone cement (ALBC) is an accepted treatment method for infected joint arthroplasties. The mechanical properties of low-dose gentamicin-loaded bone cement (BC) in medium- and high-viscosity versions were compared to unloaded BC using a vacuum mixing system. As an additional control group, manual mixed unloaded BC was used. In a uniaxial compression test, ultimate compressive strength, compressive yield strength, and compression modulus of elasticity, as well as ultimate and yield strain, were determined according to ISO 5833-2022 guidelines. All groups exceeded the minimum compressive strength (70 MPa) specified in the ISO 5833 guidelines. Both ALBC groups showed a similar ultimate compressive and yield strength to the unloaded BC. The results showed that vacuum mixing increased the compression strength of BC. ALBC showed similar compressive strength to their non-antibiotic counterparts when vacuum mixing was performed. Added low-dose gentamicin acted as a plasticizer on bone cement. From a biomechanical point of view, the usage of gentamicin-based ALBC formulations is viable.
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Affiliation(s)
- Valentina Egger
- Department of Orthopaedic and Traumatology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (V.E.); (J.D.P.); (M.N.)
| | - Dietmar Dammerer
- Department for Orthopaedics and Traumatology, University Hospital Krems, 3500 Krems an der Donau, Austria;
- Department for Orthopedics and Traumatology, Karl Landsteiner University of Health Sciences, 3500 Krems an der Donau, Austria
| | - Gerald Degenhart
- Department for Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - Johannes D. Pallua
- Department of Orthopaedic and Traumatology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (V.E.); (J.D.P.); (M.N.)
| | - Werner Schmölz
- Department of Orthopaedic and Traumatology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (V.E.); (J.D.P.); (M.N.)
| | - Martin Thaler
- Helios Klinikum, Arthroplasty Center Munich West, 81241 Munich, Germany;
- Center of Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University of Greifswald, 17489 Greifswald, Germany
| | - Klaus-Dieter Kühn
- Department for Orthopaedics and Traumatology, Medical University Graz, 8036 Graz, Austria;
| | - Michael Nogler
- Department of Orthopaedic and Traumatology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (V.E.); (J.D.P.); (M.N.)
| | - David Putzer
- Department of Orthopaedic and Traumatology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (V.E.); (J.D.P.); (M.N.)
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Kittinger C, Stadler J, Kühn KD. Evaluation of Gentamicin Release of PMMA Cements Using Different Methods: HPLC, Elution and Inhibition Zone Testing. Antibiotics (Basel) 2024; 13:754. [PMID: 39200054 PMCID: PMC11350647 DOI: 10.3390/antibiotics13080754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 07/26/2024] [Accepted: 08/07/2024] [Indexed: 09/01/2024] Open
Abstract
(1) Background: There is an ongoing discussion on the elution efficacy of antibiotic-impregnated cements. Our experiments were intended to clarify if there are differences in the antibiotic elution of HPLC compared with inhibition zone testing using eluates or PMMA discs. (2) Materials and Methods: Two cement brands with different concentrations of the active ingredient were tested in antimicrobial Kirby-Bauer (disc diffusion) assays. Cement platelets were directly applied on the agar plates and their zone of inhibition was measured. In parallel, the platelets were incubated in phosphate buffered saline (PBS) and at distinct points of time transferred into new buffer. At these time points, 50 µL of the bone cement eluates was used for zone of inhibition testing. Standard gentamicin sulfate solutions served as a control in the same test setup. To verify the microbiological investigations, the antibiotic content of the eluates was also measured via high-performance liquid chromatography (HPLC). (3) Results: The experiments with cement eluates showed better differentiable results than the direct application of the cement discs. The results were also comparable to investigations with HPLC and gentamicin sulfate standard solutions. (4) Conclusions: The results of elution rates are influenced by the test system and the period of observation chosen. The microbial test systems reflect the results of HPLC to the same degree and give evidence of the efficacy of the antibiotics. The HPLC tests on eluates were more suitable in representing differences in release characteristics.
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Affiliation(s)
- Clemens Kittinger
- D&R Insitute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Neue Stiftingtalstraße 6/III 1, 8036 Graz, Austria;
| | - Johannes Stadler
- Department of Orthopaedics and Trauma, Medical University of Graz, 8036 Graz, Austria;
| | - Klaus Dieter Kühn
- Department of Orthopaedics and Trauma, Medical University of Graz, 8036 Graz, Austria;
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Patel R, Mcconaghie G, Webb J, Laing G, Roach R, Banerjee R. An overview of bone cement: Perioperative considerations, complications, outcomes and future implications. J Perioper Pract 2024; 34:106-111. [PMID: 37243329 DOI: 10.1177/17504589231169861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Polymethyl methacrylate is commonly known as bone cement and is widely used for implant fixation in various orthopaedic arthroplasty and trauma surgery. The first bone cement use in orthopaedics is widely accredited to the famous English surgeon, John Charnley, who in 1958, used it for total hip arthroplasty. Since then, there have been many developments in cementing techniques in arthroplasty surgery. This overview aims to cover the perioperative considerations of bone cement, including cementing techniques, current outcomes and complications such as bone cement implantation syndrome. The overview will additionally consider future developments involving bone cement in orthopaedic arthroplasty.
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Affiliation(s)
- Ravi Patel
- Department of Trauma and Orthopaedics, The Princess Royal Hospital, The Shrewsbury and Telford Hospital NHS Trust, Telford, UK
- Department of Trauma and Orthopaedics, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK
| | - Greg Mcconaghie
- Department of Trauma and Orthopaedics, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK
| | - Jeremy Webb
- Department of Trauma and Orthopaedics, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK
| | - Georgina Laing
- Department of Trauma and Orthopaedics, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK
| | - Richard Roach
- Department of Trauma and Orthopaedics, The Princess Royal Hospital, The Shrewsbury and Telford Hospital NHS Trust, Telford, UK
- Department of Trauma and Orthopaedics, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK
| | - Robin Banerjee
- Department of Trauma and Orthopaedics, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK
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Bhogal SS, D’Auria JL, Gehrmann SV, Baratz ME, Kaufmann RA. Polymethyl Methacrylate for Elbow Arthroplasty: Is There Another Way? JOURNAL OF HAND SURGERY GLOBAL ONLINE 2024; 6:233-235. [PMID: 38903837 PMCID: PMC11185885 DOI: 10.1016/j.jhsg.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 11/29/2023] [Indexed: 06/22/2024] Open
Abstract
Polymethyl methacrylate remains the only US Food and Drug Administration-approved method of total elbow arthroplasty fixation and exhibits high aseptic loosening rates that result in challenging revision surgeries and potential morbidity secondary to bone-cement implantation syndrome. In this policy paper, the authors aim to explore the historical background of polymethyl methacrylate and the complications that arise in association with its use. We will review arthroplasty trends in the elbow and lower extremities and the challenges with the US Food and Drug Administration-approval process.
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Affiliation(s)
- Sumail S. Bhogal
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Jennifer L. D’Auria
- Hand and Upper Extremity Division, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Piittsburgh, PA
| | - Sebastian V. Gehrmann
- Department of Orthopedic and Trauma Surgery, Katholisches Karl-Leisner Klinikum, Kleve, Germany
| | - Mark E. Baratz
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Robert A. Kaufmann
- Hand and Upper Extremity Division, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Piittsburgh, PA
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Patel R, Mcconaghie G, Webb J, Laing G, Philpott M, Roach R, Wagner W, Rhee SJ, Banerjee R. Five historical innovations that have shaped modern orthopaedic surgery. J Perioper Pract 2024; 34:84-92. [PMID: 37596805 DOI: 10.1177/17504589231179302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
Abstract
Throughout history, many innovations have contributed to the development of modern orthopaedic surgery, improving patient outcomes and expanding the range of treatment options available to patients. This article explores five key historical innovations that have shaped modern orthopaedic surgery: X-ray imaging, bone cement, the Thomas splint, the Pneumatic tourniquet and robotic-assisted surgery. We will review the development, impact and significance of each innovation, highlighting their contributions to the field of orthopaedic surgery and their ongoing relevance in contemporary and perioperative practice.
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Affiliation(s)
- Ravi Patel
- Department of Trauma and Orthopaedics, The Princess Royal Hospital, The Shrewsbury and Telford Trust, Telford, UK
- Department of Trauma and Orthopaedics, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK
| | - Greg Mcconaghie
- Department of Trauma and Orthopaedics, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK
| | - Jeremy Webb
- Department of Trauma and Orthopaedics, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK
| | - Georgina Laing
- Department of Trauma and Orthopaedics, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK
| | - Matthew Philpott
- Department of Trauma and Orthopaedics, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK
| | - Richard Roach
- Department of Trauma and Orthopaedics, The Princess Royal Hospital, The Shrewsbury and Telford Trust, Telford, UK
| | - Wilhelm Wagner
- Department of Trauma and Orthopaedics, The Princess Royal Hospital, The Shrewsbury and Telford Trust, Telford, UK
| | - Shin-Jae Rhee
- Department of Trauma and Orthopaedics, The Princess Royal Hospital, The Shrewsbury and Telford Trust, Telford, UK
| | - Robin Banerjee
- Department of Trauma and Orthopaedics, The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK
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Qayoom I, Prasad A, Srivastava E, Fazili KM, Nussler AK, Kumar A. Organic-inorganic composite of polypropylene fumarate and nanohydroxyapatite as carrier of antibiotics for the treatment of bone infections. BIOMATERIALS ADVANCES 2024; 157:213714. [PMID: 38096647 DOI: 10.1016/j.bioadv.2023.213714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 10/27/2023] [Accepted: 11/26/2023] [Indexed: 02/02/2024]
Abstract
Current treatment approaches in clinics to treat the infectious lesions have partial success thus demanding the need for development of advanced treatment modalities. In this study we fabricated an organic-inorganic composite of polypropylene fumarate (PPF) and nanohydroxyapatite (nHAP) by photo-crosslinking as a carrier of two clinically used antibiotics, ciprofloxacin (CIP) and rifampicin (RFP) for the treatment of bone infections. Carboxy terminal-PPF was first synthesized by cis-trans isomerization of maleic anhydride which was then photo-crosslinked using diethylfumarate (DEF) as crosslinker and bis-acylphosphine oxide (BAPO) as photo-initiator under UV lights (P). A composite of PPF and nHAP was fabricated by incorporating 40 % of nHAP in the polymeric matrix of PPF (PH) which was then characterized for different physicochemical parameters. CIP was added along with nHAP to fabricated CIPloaded composite scaffolds (PHC) which was then coated with RFP to synthesize RFP coated CIP-loaded scaffolds (PHCR). It was observed that there was a temporal separation in the in vitro release of two antibiotics after coating PHC with RFP with 80.48 ± 0.40 % release of CIP from PHC and 62.43 ± 0.21 % release of CIP from PHCR for a period of 60 days. Moreover, in vitro protein adsorption was also found to be maximum in PHCR (154.95 ± 0.07 μg/mL) as observed in PHC (75.42 ± 0.06 μg/mL), PH (24.47 ± 0.08 μg/mL) and P alone (4.47 ± 0.02 μg/mL). The scaffolds were also evaluated using in vivo infection model to assess their capacity in reducing the bacterial burden at the infection site. The outcome of this study suggests that RFP coated CIP-loaded PPF composite scaffolds could reduce bacterial burden and simultaneously augment bone healing during infection related fractures.
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Affiliation(s)
- Irfan Qayoom
- Department of Biological Sciences and Bioengineering, Indian Institute of Technology Kanpur, Kanpur 208016, UP, India
| | - Abhay Prasad
- Department of Biological Sciences and Bioengineering, Indian Institute of Technology Kanpur, Kanpur 208016, UP, India
| | - Ekta Srivastava
- Department of Biological Sciences and Bioengineering, Indian Institute of Technology Kanpur, Kanpur 208016, UP, India
| | - Khalid Majid Fazili
- Department of Biotechnology, University of Kashmir, Srinagar 190006, Jammu and Kashmir, India
| | - Andreas K Nussler
- Siegfried Weller Research Institute at the BG Trauma Center Tübingen, Department of Trauma and Reconstructive Surgery, University of Tübingen, Tübingen 72076, Germany
| | - Ashok Kumar
- Department of Biological Sciences and Bioengineering, Indian Institute of Technology Kanpur, Kanpur 208016, UP, India; Centre for Environmental Science and Engineering, Indian Institute of Technology Kanpur, Kanpur 208016, UP, India; Center for Nanosciences, Indian Institute of Technology Kanpur, Kanpur 208016, UP, India; The Mehta Family Centre for Engineering in Medicine, Indian Institute of Technology Kanpur, Kanpur 208016, UP, India; Centre of Excellence for Orthopedics and Prosthetics, Gangwal School of Medical Sciences and Technology, Indian Institute of Technology Kanpur, Kanpur 208016, UP, India.
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13
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Paul C, Steinhauser E, Kühn KD. [Processing properties and viscosities of PMMA bone cements]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023; 52:957-967. [PMID: 37902859 PMCID: PMC10691994 DOI: 10.1007/s00132-023-04450-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 11/01/2023]
Abstract
Processing properties of PMMA bone cements can be divided into four phases: 1. mixing, 2. waiting, 3. processing and 4. curing. Each of these phases is subject to several external influencing factors, such as temperature and humidity, which must be considered during application. Instructions for use provided by the manufacturers of PMMA bone cements and mixing and application systems contain important information on correct application. The processing properties of PMMA bone cements and possible factors influencing the curing process are of great importance for safe procedures in the operating room. Knowledge of the viscosity and consistency of the PMMA bone cement from the dough phase to complete curing facilitates preparation and application, which in the long term significantly improves the requirements placed on PMMA cements regarding the function and service life of the implant.
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Affiliation(s)
| | - Erwin Steinhauser
- Fakultät für angewandte Naturwissenschaften und Mechatronik, Hochschule München, München, Deutschland
| | - Klaus-Dieter Kühn
- Heraeus Medical GmbH, Wehrheim, Deutschland
- Universitätsklinik für Orthopädie und Traumatologie, Medizinische Universität Graz, Graz, Österreich
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14
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Chao B, Jiao J, Yang L, Wang Y, Yu T, Liu H, Zhang H, Li M, Wang W, Cui X, Du S, Wang Z, Wu M. Comprehensive evaluation and advanced modification of polymethylmethacrylate cement in bone tumor treatment. J Mater Chem B 2023; 11:9369-9385. [PMID: 37712890 DOI: 10.1039/d3tb01494k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
Bone tumors are invasive diseases with a tendency toward recurrence, disability, and high mortality rates due to their grievous complications. As a commercial polymeric biomaterial, polymethylmethacrylate (PMMA) cement possesses remarkable mechanical properties, injectability, and plasticity and is, therefore, frequently applied in bone tissue engineering. Numerous positive effects in bone tumor treatment have been demonstrated, including biomechanical stabilization, analgesic effects, and tumor recurrence prevention. However, to our knowledge, a comprehensive evaluation of the application of the PMMA cement in bone tumor treatment has not yet been reported. This review comprehensively evaluates the efficiency and complications of the PMMA cement in bone tumor treatment, for the first time, and introduces advanced modification strategies, providing an objective and reliable reference for the application of the PMMA cement in treating bone tumors. We have also summarized the current research on modifications to enhance the anti-tumor efficacy of the PMMA cement, such as drug carriers and magnetic hyperthermia.
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Affiliation(s)
- Bo Chao
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Jianhang Jiao
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Lili Yang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Yang Wang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Tong Yu
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - He Liu
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Han Zhang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Mufeng Li
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Wenjie Wang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Xiangran Cui
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Shangyu Du
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Zhonghan Wang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
| | - Minfei Wu
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun 130041, P. R. China.
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15
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Thompson Z, Hothi H, Brillantes J, Khoshbin A, Atrey A. A Geometric Analysis of Polyethylene Liners Exposed to Acrylic-based Bone Cement. Arthroplast Today 2023; 23:101184. [PMID: 37745962 PMCID: PMC10517260 DOI: 10.1016/j.artd.2023.101184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 05/29/2023] [Accepted: 07/03/2023] [Indexed: 09/26/2023] Open
Abstract
Background Acrylic-based bone cement (polymethyl methacrylate [PMMA]) is a material commonly used in orthopaedic surgeries; however, during PMMA polymerization, a highly exothermic reaction occurs. The heat released in polymerization can damage nearby materials including poorly heat-resistant cross-linked polyethylene (XLPE). Both PMMA and XLPE are used in total hip arthroplasty and could interact during femoral stem fixation. We sought to determine if the exothermic polymerization of PMMA could alter the surface characteristics of XLPE acetabular liners. Methods Six XLPE liners were assigned to one of 4 experimental categories with varying volumes of PMMA applied in a manner that mimicked how the 2 materials would come into contact intraoperatively. Measurements were taken both pre- and post-intervention using a coordinate measuring machine for geometric and gravimetric analysis. Light microscopy was conducted postintervention to examine the surface for damage. Results Coordinate measuring machine measurements showed minimal gross deformation in all 6 liners, but there were isolated surface deposits in 4 of 6 liners. The average maximal surface deviations, when compared to the control, for liners exposed to 1 cc of cement, 2 cc of cement, or 1 cc of cement with a femoral head implant attached were 26.6 μm, 77.2 μm, and 26.4 μm, respectively. All but one liner showed an increase in volume following intervention when compared to the control. Subtle scratches were identified using light microscopy on all 6 liners. Conclusions XLPE shows areas of isolated surface deformation in a dose-dependent manner but with minimal gross deformation after interacting with highly exothermic PMMA.
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Affiliation(s)
| | - Harry Hothi
- The Royal National Orthopaedic Hospital, Stanmore, UK
| | - Jacqueline Brillantes
- University of Toronto, Toronto, Canada
- St. Michael’s Hospital, University of Toronto, Toronto, Canada
| | - Amir Khoshbin
- University of Toronto, Toronto, Canada
- St. Michael’s Hospital, University of Toronto, Toronto, Canada
| | - Amit Atrey
- University of Toronto, Toronto, Canada
- St. Michael’s Hospital, University of Toronto, Toronto, Canada
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16
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Noworyta M, Topa-Skwarczyńska M, Jamróz P, Oksiuta D, Tyszka-Czochara M, Trembecka-Wójciga K, Ortyl J. Influence of the Type of Nanofillers on the Properties of Composites Used in Dentistry and 3D Printing. Int J Mol Sci 2023; 24:10549. [PMID: 37445729 DOI: 10.3390/ijms241310549] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/09/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
Photopolymerization is a growing field with an extensive range of applications and is environmentally friendly owing to its energy-efficient nature. Such light-assisted curing methods were initially used to cure the coatings. However, it has become common to use photopolymerization to produce 3D objects, such as bridges or dental crowns, as well as to cure dental fillings. In this study, polymer nanocomposites containing inorganic nanofillers (such as zinc nano-oxide and zinc nano-oxide doped with two wt.% aluminum, titanium nano-oxide, kaolin nanoclay, zirconium nano-oxide, aluminum nano-oxide, and silicon nano-oxide) were fabricated and studied using Real Time FT-IR to investigate the effects of these nanoadditives on the final conversion rates of the obtained nanocomposites. The effects of the fillers on the viscosity of the produced nanocomposites were also investigated, and 3D prints of the selected nanocomposites were presented.
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Affiliation(s)
- Małgorzata Noworyta
- Faculty of Chemical Engineering and Technology, Cracow University of Technology, Warszawska 24, 31-155 Cracow, Poland
| | - Monika Topa-Skwarczyńska
- Faculty of Chemical Engineering and Technology, Cracow University of Technology, Warszawska 24, 31-155 Cracow, Poland
| | - Paweł Jamróz
- Faculty of Chemical Engineering and Technology, Cracow University of Technology, Warszawska 24, 31-155 Cracow, Poland
| | - Dawid Oksiuta
- Faculty of Mechanical Engineering, Cracow University of Technology, Jana Pawła II 37, 31-864 Cracow, Poland
| | | | - Klaudia Trembecka-Wójciga
- Institute of Metallurgy and Materials Science, Polish Academy of Sciences, Reymonta 25, 30-059 Cracow, Poland
| | - Joanna Ortyl
- Faculty of Chemical Engineering and Technology, Cracow University of Technology, Warszawska 24, 31-155 Cracow, Poland
- Photo4Chem Ltd., Lea 114, 30-133 Cracow, Poland
- Photo HiTech Ltd., Bobrzyńskiego 14, 30-348 Cracow, Poland
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17
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Main K, Khan MA, Nuutinen JP, Young AM, Liaqat S, Muhammad N. Evaluation of modified dental composites as an alternative to Poly(methyl methacrylate) bone cement. Polym Bull (Berl) 2023. [DOI: 10.1007/s00289-023-04677-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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18
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Campeiro Junior LD, Rahal SC, Souza MA, Osowski A, Silva Júnior JIS. Induced membrane technique using bone cement with or without cefazolin in chicken segmental radius defect. Front Vet Sci 2023; 10:1027951. [PMID: 36960145 PMCID: PMC10027929 DOI: 10.3389/fvets.2023.1027951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 01/18/2023] [Indexed: 03/09/2023] Open
Abstract
The utilization of antibiotic-loaded cement spacer in the induced membrane development has been a debate topic in human medicine. To the best of the author's knowledge, these combinations have not yet been evaluated in birds. Therefore, this study assessed induced membrane formation using radiography and histology, in a segmental defect of a chicken radius, with or without the addition of cefazolin. Thirty 18-month-old healthy chickens were divided into two equal groups: G1-bone defect filled with bone cement; G2-bone defect filled with cefazolin powder-loaded bone cement. Radiographic examinations of the left forearm were taken immediately after surgery and at 7, 15, and 21 postoperative days. For the collection of the induced membranes, five chickens in each group were euthanized at 7, 15, and 21 days after surgery. Radiographically, the bone cement was identified as a radiopaque structure occupying the bone defect in both groups. Mild new bone formation in at least one of the fractured extremities of the bone defect was seen only 21 days after surgery in most chickens. Histologically, there was no difference in the mean thickness of the induced membrane between groups at all time points. Multifocal multinucleated cells differed between groups at 7 (G1 > G2) and 21 (G2 > G1) days after surgery. Mononuclear inflammatory infiltrate differed between groups only on day 21 (G1 > G2). Fibrous tissue proliferation did not differ between groups at all evaluation times. Blood vessel density differed only at 21 days postoperatively (G2 < G1). Multifocal areas of cartilage differed between groups at all time points (G1 > G2). In conclusion, cefazolin mixed with bone cement did not affect thickness of the induced membrane, but did result in a negative effect on some histological aspects, such as fewer vessels, less multifocal areas of cartilage, and persistence of inflammation.
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Affiliation(s)
- Luiz D. Campeiro Junior
- Department of Veterinary Surgery and Animal Reproduction, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, Brazil
| | - Sheila Canevese Rahal
- Department of Veterinary Surgery and Animal Reproduction, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, Brazil
- *Correspondence: Sheila Canevese Rahal
| | - Marcos A. Souza
- Department of Veterinary Pathology, Mato Grosso School of Veterinary Medicine, Cuiabá, Brazil
| | - Alini Osowski
- Department of Veterinary Surgery and Animal Reproduction, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, Brazil
| | - José I. S. Silva Júnior
- Department of Veterinary Surgery and Animal Reproduction, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, Brazil
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19
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Satalich JR, Lombardo DJ, Newman S, Golladay GJ, Patel NK. Cementation in total hip arthroplasty: history, principles, and technique. EFORT Open Rev 2022; 7:747-757. [PMID: 36475555 PMCID: PMC9780613 DOI: 10.1530/eor-22-0002] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Total hip arthroplasty (THA) is a remarkably successful operation that has grown rapidly its utilization. Early modern THA constructs as developed by Sir John Charnley featured cemented femoral stems and acetabular components. The technique of cementing components for THA has evolved over time. Modern acetabular preparation requires exposure of the subchondral bone with appropriate cement penetration into the trabecular bone, whereas femoral preparation requires cleaning of the canal, cement restrictor placement, retrograde filling, and pressurization of the cement. When used appropriately, these techniques result in excellent long-term survivorship of implants and are also widely considered to be the ideal method of fixation for hip fractures. The purpose of this article to review the history, properties, techniques, and outcomes of bone cement utilization in THA.
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Affiliation(s)
- James R Satalich
- VCU Health Department of Orthopaedic Surgery, Richmond, Virginia, USA,Correspondence should be addressed to James R Satalich;
| | - Daniel J Lombardo
- VCU Health Department of Orthopaedic Surgery, Richmond, Virginia, USA
| | - Simon Newman
- Nuffield Orthopaedic Center, University of Oxford, Oxford, UK
| | | | - Nirav K Patel
- VCU Health Department of Orthopaedic Surgery, Richmond, Virginia, USA
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20
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Qayoom I, Srivastava E, Kumar A. Anti-infective composite cryogel scaffold treats osteomyelitis and augments bone healing in rat femoral condyle. BIOMATERIALS ADVANCES 2022; 142:213133. [PMID: 36215747 DOI: 10.1016/j.bioadv.2022.213133] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/14/2022] [Accepted: 09/24/2022] [Indexed: 06/16/2023]
Abstract
Bone and joint infections pose a serious challenge in the orthopedic medical condition which presents a major health care problem and economic burden to the patients. The current treatment strategies adopted have a very limited successful outcome in majority of the cases and need serious reconsiderations in terms of management, diagnosis and effective treatment approach. Herein, we have developed a composite cryogel scaffold from nanohydroxyapatite and collagen mimicking natural bone composition for the local delivery of antibiotic to treat osteomyelitis. The biomimetic and biodegradable antibiotic-loaded composite scaffold was found to be biocompatible with potent osteogenic capacity and anti-infective characteristics under in vitro conditions. Moreover, the anti-infective potency of the antibiotic-loaded composite cryogel was also evaluated in rat osteomyelitis model to cure the infection and promote bone healing. It was observed that anti-infective collagen-nanohydroxyapatite composite cryogel when loaded with bone morphogenetic protein-2 (BMP-2) and zoledronic acid (ZA) could completely eradicate the infection in rat femoral condyle and simultaneously, accelerate bone healing at the dead space created during surgical procedures. The approach developed in this study is the development of biomimetic and bioactive composite carrier of antibiotics for the treatment of bone infection. The findings of this study insinuate that this antibiotic-loaded composite cryogel scaffold could potentially be used as an anti-infective biomaterial for the treatment of bone infections which will simultaneosuly promote bone healing at the dead space created during surgical procedures.
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Affiliation(s)
- Irfan Qayoom
- Department of Biological Sciences and Bioengineering, Indian Institute of Technology Kanpur, Kanpur 208016, India
| | - Ekta Srivastava
- Department of Biological Sciences and Bioengineering, Indian Institute of Technology Kanpur, Kanpur 208016, India
| | - Ashok Kumar
- Department of Biological Sciences and Bioengineering, Indian Institute of Technology Kanpur, Kanpur 208016, India; Centre for Environmental Science and Engineering, Indian Institute of Technology Kanpur, Kanpur 208016, India; Center for Nanosciences, Indian Institute of Technology Kanpur, Kanpur 208016, India; The Mehta Family Centre for Engineering in Medicine, Indian Institute of Technology Kanpur, Kanpur 208016, India; Centre of Excellence, School of Medical Research and Technology, IndianInstitute of Technology Kanpur, Kanpur-208016, UP, India.
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21
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Berberich C, Josse J, Ruiz PS. Patients at a high risk of PJI: Can we reduce the incidence of infection using dual antibiotic-loaded bone cement? ARTHROPLASTY 2022; 4:41. [PMID: 36068617 PMCID: PMC9450350 DOI: 10.1186/s42836-022-00142-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/26/2022] [Indexed: 11/10/2022] Open
Abstract
AbstractProsthetic joint infection (PJI) is one of the most devastating complications of orthopedic surgery. However, not all patients are equally at the risk of severe infection. The incidences of PJI vary with the host and surgery-related risk factors. It is now generally accepted that some important medical comorbidities may predispose the patients to a high risk of PJI. Time-consuming and invasive surgical procedures, such as revision arthroplasties, are also associated with a high incidence of PJI, presumably due to the increased risk of surgical site contamination. Effective infection-preventing strategies should begin with identifying and optimizing the patients at a high risk of infection prior to surgery. Optimizing the operating room environment and antibiotic prophylaxis are also essential strategies that help minimize the overall incidence of infection in orthopedic surgery. The ideal antibiotic prophylaxis is still under debate, and discussions have emerged about whether variations or adjustments to the standard protocol are justified in patients at a high risk of infection. This also includes evaluating the possible benefits and risks of using high-dose dual antibiotic-loaded bone cement instead of low-dose single antibiotic-loaded bone cement in arthroplasty. This review summarizes the evidence showing that the combination of two local antibiotics in bone cement exerts a strong and longer-lasting antimicrobial effect against PJI-associated pathogens. This conclusion is consistent with the preliminary clinical studies showing a low incidence of PJI in high-risk patients undergoing cemented hemiarthroplasty, cemented revision, and primary arthroplasty if dual ALBC is used. These results may encourage clinicians to consolidate this hypothesis in a wider clinical range.
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22
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Schulze M, Fobker M, Puetzler J, Hillebrand J, Niemann S, Schulte E, Kurzynski J, Gosheger G, Hasselmann J. Mechanical and microbiological testing concept for activatable anti-infective biopolymer implant coatings. BIOMATERIALS ADVANCES 2022; 138:212917. [PMID: 35913227 DOI: 10.1016/j.bioadv.2022.212917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/29/2022] [Accepted: 05/20/2022] [Indexed: 06/15/2023]
Abstract
An anti-infective bilayer implant coating with selectively activatable properties was developed to prevent biofilm formation and to support the treatment of periprosthetic infection as a local adjunct to current treatment concepts. In a first step, Ti6Al4V discs were coated with a permanent layer of Poly(l-lactide) (PLLA) including silver ions. The PLLA could be optionally released by the application of extracorporeal shock waves. In a second step, a resorbable layer of triglyceride (TAG) with incorporated antibiotics was applied. The second layer is designed for resorption within weeks. Prior to approval and clinical application, a comprehensive evaluation process to determine mechanical/physical and microbiological properties is obligate. To date, none of the existing test standards covers both drug-releasing and activatable coatings for orthopedic implants. Therefore, a comprehensive test concept was developed to characterize the new coating in a pilot series. The coatings were homogeneously applied on the Ti6Al4V substrate, resulting in an adhesion strength sufficient for non-articulating surfaces for PLLA. Proof of the extracorporeal shockwave activation of PLLA was demonstrated both mechanically and microbiologically, with a simultaneous increase of biocompatibility compared to standard electroplated silver coating. Wettability was significantly reduced for both layers in comparison to the Ti6Al4V substrate. Thus, potentially inhibiting biofilm formation. Furthermore, the TAG coating promoted cell proliferation and bacterial eradication. In conclusion, the testing concept is applicable for similar biopolymer coating systems. Furthermore, the extracorporeal activation could represent a completely new supportive approach for the treatment of periprosthetic joint infections.
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Affiliation(s)
- Martin Schulze
- Clinic for General Orthopedics and Tumororthopedics, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany.
| | - Manfred Fobker
- Central Laboratory, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Jan Puetzler
- Clinic for General Orthopedics and Tumororthopedics, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Jule Hillebrand
- Clinic for General Orthopedics and Tumororthopedics, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Silke Niemann
- Institute of Medical Microbiology, University Hospital Muenster, Domagkstraße 10, 48149 Muenster, Germany
| | - Erhard Schulte
- Central Laboratory, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Jochen Kurzynski
- Materials Engineering Laboratory, Department of Mechanical Engineering, University of Applied Sciences Muenster, Stegerwaldstraße 39, 48565 Steinfurt, Germany
| | - Georg Gosheger
- Clinic for General Orthopedics and Tumororthopedics, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Julian Hasselmann
- Clinic for General Orthopedics and Tumororthopedics, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany; Materials Engineering Laboratory, Department of Mechanical Engineering, University of Applied Sciences Muenster, Stegerwaldstraße 39, 48565 Steinfurt, Germany
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Katzir M, Rustagi T, Hatef J, Mendel E. Cost Analysis With Use of Expandable Cage or Cement in Single level Thoracic Vertebrectomy in Metastasis. Global Spine J 2022; 12:858-865. [PMID: 33307822 PMCID: PMC9344502 DOI: 10.1177/2192568220975375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective case series. OBJECTIVE Patient with metastatic cancer frequently require spinal operations for neural decompression and stabilization, most commonly thoracic vertebrectomy with reconstruction. Objective of the study was to assess economic aspects associated with use of cement versus expandable cage in patients with single level thoracic metastatic disease. We also looked at the differences in the clinical, radiological, complications and survival differences to assess non-inferiority of PMMA over cages. METHODS The electronic medical records of patients undergoing single level thoracic vertebrectomy and reconstruction were reviewed. Two groups were made: PMMA and EC. Totals surgical cost, implant costs was analyzed. We also looked at the clinical/ radiological outcome, complication and survival analysis. RESULTS 96 patients were identified including 70 one-level resections. For 1-level surgeries, Implant costs for use of cement-$75 compared to $9000 for cages. Overall surgical cost was significantly less for PMMA compared to use of EC. No difference was seen in clinical outcome or complication was seen. We noticed significantly better kyphosis correction in the PMMA group. CONCLUSIONS Polymethylmethacrylate cement offers significant cost advantage for reconstruction after thoracic vertebrectomy. It also allows for better kyphosis correction and comparable clinical outcomes and non-inferior to cages.
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Affiliation(s)
- Miki Katzir
- Department of Neurological Surgery, Ohio State University Wexner Medical
Center, The James Cancer Hospital & Solove Research Institute,
Columbus, OH, USA
| | - Tarush Rustagi
- Department of Neurological Surgery, Ohio State University Wexner Medical
Center, The James Cancer Hospital & Solove Research Institute,
Columbus, OH, USA,Department of Spine Surgery, Indian
Spinal Injuries Centre, New Delhi, India,Tarush Rustagi, MD, Department of
Neurological Surgery, Ohio State University Wexner Medical Center, 410 W 10th
Ave, Columbus, OH 110070, USA.
| | - Jeffrey Hatef
- Department of Neurological Surgery, Ohio State University Wexner Medical
Center, The James Cancer Hospital & Solove Research Institute,
Columbus, OH, USA
| | - Ehud Mendel
- Department of Neurological Surgery, Ohio State University Wexner Medical
Center, The James Cancer Hospital & Solove Research Institute,
Columbus, OH, USA
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Xin W, Gao Y, Yue B. Recent Advances in Multifunctional Hydrogels for the Treatment of Osteomyelitis. Front Bioeng Biotechnol 2022; 10:865250. [PMID: 35547176 PMCID: PMC9081433 DOI: 10.3389/fbioe.2022.865250] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 04/04/2022] [Indexed: 11/13/2022] Open
Abstract
Osteomyelitis (OM), a devastating disease caused by microbial infection of bones, remains a major challenge for orthopedic surgeons. Conventional approaches for prevention and treatment of OM are unsatisfactory. Various alternative strategies have been proposed, among which, hydrogel-based strategies have demonstrated potential due to their unique properties, including loadable, implantable, injectable, printable, degradable, and responsive to stimuli. Several protocols, including different hydrogel designs, selection of antimicrobial agent, co-administration of bone morphogenetic protein 2 (BMP 2), and nanoparticles, have been shown to improve the biological properties, including antimicrobial effects, osteo-induction, and controlled drug delivery. In this review, we describe the current and future directions for designing hydrogels and their applications to improve the biological response to OM in vivo.
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Acrylic bone cement with Tutopatch for frontal sinus obliteration. The Journal of Laryngology & Otology 2022; 136:329-332. [DOI: 10.1017/s002221512200041x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjectiveTo 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.MethodsPatients 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.ResultsAll 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.ConclusionAcrylic bone cement with Tutopatch can be effectively used in frontal sinus reconstruction in cases where an endoscopic approach is not feasible.
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Reinforced cementoplasty for pelvic tumour lesions and pelvic traumatic fractures: preliminary experience. Eur Radiol 2022; 32:6187-6195. [PMID: 35362749 DOI: 10.1007/s00330-022-08742-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 03/06/2022] [Accepted: 03/09/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Pelvic bone pathological lesions and traumatic fractures are a considerable source of pain and disability. In this study, we sought to evaluate the effectiveness of reinforced cementoplasty (RC) in painful and unstable lesions involving the pelvic bone in terms of pain relief and functional recovery. METHODS All patients with neoplastic lesion or pelvic fracture for whom a pelvic bone RC was carried out between November 2013 and October 2017 were included in our study. All patients who failed the medical management, patients unsuitable for surgery, and patients with unstable osteolytic lesions were eligible to RC. Clinical outcome was evaluated with a 1-month and 6-month post-procedure follow-up. The primary endpoint was local pain relief measured by the visual analogue scale (VAS). RESULTS Twenty-two patients (18 females, 4 males; mean age of 65.4 ± 13.3 years [range 38-80]) presenting with painful and unstable pelvic lesions were treated by RC during the study period. Among the 22 patients, 8 patients presented with unstable pelvic fractures (3 patients with iliac crest fracture, 3 with sacral fractures, and the remaining 2 with peri-acetabular fractures). No procedure-related complications were recorded. All patients had significant pain relief and functional improvement at 1 month. One patient (4.5%) had suffered a secondary fracture due to local tumour progression. CONCLUSIONS Reinforced cementoplasty is an original minimally invasive technique that may help in providing pain relief and effective bone stability for neoplastic and traumatic lesions involving the pelvic bone. KEY POINTS • Reinforced cementoplasty is feasible in both traumatic fractures and tumoural bone lesions of the pelvis. • Reinforced cementoplasty for pelvic bone lesions provides pain relief and functional recovery. • Recurrence of pelvic bone fracture was observed in 4.5% of the cases in our series.
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Crego-Vita D, Aedo-Martín D, Garcia-Cañas R, Espigares-Correa A, Sánchez-Pérez C, Berberich CE. Periprosthetic joint infections in femoral neck fracture patients treated with hemiarthroplasty – should we use antibiotic-loaded bone cement? World J Orthop 2022; 13:150-159. [PMID: 35317403 PMCID: PMC8891664 DOI: 10.5312/wjo.v13.i2.150] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/16/2021] [Accepted: 01/20/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hemiarthroplasty is the most common treatment in elderly patients with displaced intra-capsular femoral neck fracture (FNF). Prosthetic joint infection (PJI) is one of the most feared and frequent complications post-surgery because of the frail health status of these patients and the need for fast track surgery. Therefore, priorities should lie in effective preventive strategies to mitigate this burden.
AIM To determine how much the implementation of the routine use of antibiotic-loaded bone cement (ALBC) as a relatively easy-to-apply amendment to the surgical practice reduces the infection rate in our hemiarthroplasty cohort.
METHODS We retrospectively assessed all demographic, health status and treatment-related data of our FNF patients undergoing cemented hemiarthroplasty in the period from 2011 to 2017; 241 patients were further analyzed after exclusion of patients with cancer-related sequelae and those who died before the end of the 1-year observation period. The PJI rate as diagnosed on basis of the Musculoskeletal Infection Society (MSIS) criteria 2011 was determined for each included patient and compared in function of the bone cement used for hip stem fixation. Patients were split into a group receiving a plain bone cement in the period from January 2011 to June 2013 (non-ALBC group) and into a group receiving an ALBC in the period July 2013 to December 2017 (ALBC group). Data analysis was performed with statistical software. We further calculated the cost-efficacy of the implementation of routine use of ALBC in the second group balancing the in-hospital infection related treatment costs with the extra costs of use of ALBC.
RESULTS In total 241 FNF patients who received cemented hemiarthroplasty in the period from January 2011 to January 2017 were eligible for inclusion in this retrospective study. There were 8 PJI cases identified in the ALBC group among n = 94 patients, whereas 28 PJI cases were observed in the non-ALBC group among n = 147 patients. The statistical analysis showed an infection risk reduction of 55.3% (in particular due to the avoidance of chronic delayed infections) in the ALBC group (95%CI: 6.2%-78.7%; P = 0.0025). The cost-evaluation analysis demonstrated a considerable cost saving of 3.500 € per patient, related to the implementation of routine use of ALBC in this group.
CONCLUSION Use of ALBC is a potent infection preventive factor in FNF patients receiving cemented hemiarthroplasties. It was further found to be highly cost-effective.
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Affiliation(s)
- Diana Crego-Vita
- Department of Orthopaedic and Trauma Surgery, Hospital Central de la Defensa Gómez Ulla, Madrid 28047, Spain
| | - Daniel Aedo-Martín
- Department of Orthopaedic and Trauma Surgery, Hospital Universitario del Henares, Universidad Francisco de Vitoria, Coslada 28822, Madrid, Spain
| | - Rafael Garcia-Cañas
- Department of Orthopaedic and Trauma Surgery, Hospital Central de la Defensa Gómez Ulla, Madrid 28047, Spain
| | - Andrea Espigares-Correa
- Department of Orthopeadic and Trauma Surgery, Hospital Central de la Defensa Gómez Ulla, Madrid 28047, Spain
| | - Coral Sánchez-Pérez
- Department of Orthopeadic and Trauma Surgery, General University Hospital Gregorio Maranon, Madrid 28007, Spain
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Feng F, Chen M, Wang X, Zhang H, Nie H, Tang H. Translation of a spinal bone cement product from bench to bedside. Bioact Mater 2021; 10:345-354. [PMID: 34901551 PMCID: PMC8636668 DOI: 10.1016/j.bioactmat.2021.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/01/2021] [Accepted: 08/09/2021] [Indexed: 01/18/2023] Open
Abstract
Spinal acrylic bone cements (ABCs) are used clinically for percutaneous vertebroplasty (PVP) and kyphoplasty (PKP) to treat osteoporotic vertebral compression fractures. Product translation of spinal ABC products followed the design control processes including design verification and validation. The bench to bedside translation of the first Chinese spinal ABC product (Alliment®, namely Alliment Cement) approved by National Medical Products Administration of China was investigated and another commercial product served as the control (Osteopal®V, namely Osteopal V Cement). Results of non-clinical bench performance verification tests of compression, bending and monomer release showed that the newly marketed Alliment Cement is similar to the Osteopal V Cement with properties of both meeting the criteria specified by standards. The Alliment Cement demonstrated good biocompatibility during the 26 weeks’ bone implantation test. Porcine cadaver validation tests further revealed that the Alliment Cement satisfied the needs for both PVP and PKP procedures. A post-approval, retrospective clinical investigation further demonstrated the safety and efficacy of the Alliment Cement, with a significant reduction of pain and the improved stability of the fractured vertebral bodies. A successful translation of biomaterial medical products needs close collaborations among academia, industry, healthcare professionals and regulatory agencies.
Bench-to-bedside research of the first Chinese spinal acrylic bone cement product. •Pre- & clinical investigations demonstrate the product's safety and efficacy. •Translation of biomaterial medical products follows regulated processes.
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Affiliation(s)
- Fei Feng
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, No. 95, Yong An Rd, Xi Cheng District, Beijing, 100050, China
| | - Mengmeng Chen
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, No. 95, Yong An Rd, Xi Cheng District, Beijing, 100050, China
| | - Xuan Wang
- Beijing Bonsci Technology Co Ltd, No.100, 6th Kechuang Street, Beijing Economic and Technological Development Area, Beijing, 100176, China
| | - Hongwei Zhang
- Beijing Bonsci Technology Co Ltd, No.100, 6th Kechuang Street, Beijing Economic and Technological Development Area, Beijing, 100176, China
| | - Hongtao Nie
- Beijing Bonsci Technology Co Ltd, No.100, 6th Kechuang Street, Beijing Economic and Technological Development Area, Beijing, 100176, China
| | - Hai Tang
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, No. 95, Yong An Rd, Xi Cheng District, Beijing, 100050, China
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Current opinions on the mechanism, classification, imaging diagnosis and treatment of post-traumatic osteomyelitis. Chin J Traumatol 2021; 24:320-327. [PMID: 34429227 PMCID: PMC8606609 DOI: 10.1016/j.cjtee.2021.07.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 06/28/2021] [Accepted: 07/06/2021] [Indexed: 02/04/2023] Open
Abstract
Post-traumatic osteomyelitis (PTO) is a worldwide problem in the field of orthopaedic trauma. So far, there is no ideal treatment or consensus-based gold standard for its management. This paper reviews the representative literature focusing on PTO, mainly from the following four aspects: (1) the pathophysiological mechanism of PTO and the interaction mechanism between bacteria and the body, including fracture stress, different components of internal fixation devices, immune response, occurrence and development mechanisms of inflammation in PTO, as well as the occurrence and development mechanisms of PTO in skeletal system; (2) clinical classification, mainly the etiological classification, histological classification, anatomical classification and the newly proposed new classifications (a brief analysis of their scope and limitations); (3) imaging diagnosis, including non-invasive examination and invasive examination (this paper discusses their advantages and disadvantages respectively, and briefly compares the sensitivity and effectiveness of the current examinations); and (4) strategies, including antibiotic administration, surgical choices and other treatment programs. Based on the above-mentioned four aspects, we try to put forward some noteworthy sections, in order to make the existing opinions more specific.
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Influence of Tranexamic Acid on Elution Characteristics and Compressive Strength of Antibiotic-Loaded PMMA-Bone Cement with Gentamicin. MATERIALS 2021; 14:ma14195639. [PMID: 34640035 PMCID: PMC8510380 DOI: 10.3390/ma14195639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 01/27/2023]
Abstract
PURPOSE The topical application of tranexamic acid (TXA) into the joint space during total joint arthroplasty (TJA) with no increase of complications, has been widely reported. We investigated the influence of TXA on antibiotic release, activity of the released antibiotic against a clinical isolate of S. aureus, and compressive strength of a widely used commercially prepared gentamicin-loaded cement brand (PALACOS R + G). METHOD 12 bone cement cylinders (diameter and height = 6 and 12 mm, respectively) were molded. After curing in air for at least 1 h, six of the cylinders were completely immersed in 5 mL of fetal calf serum (FCS) and the other six were completely immersed in a solution consisting of 4.9 mL of FCS and 0.1 mL (10 mg) of TXA. Gentamicin elution tests were performed over 7 d. Four hundred µL of the gentamicin eluate were taken every 24 h for the first 7 d without renewing the immersion fluid. The gentamicin concentration was determined in a clinical analyzer using a homogeny enzyme immuno-assay. The antimicrobial activity of the eluate, obtained after day 7, was tested. An agar diffusion test regime was used with Staphylococcus aureus. Bacteria were grown in a LB medium and plated on LB agar plates to get a bacterial lawn. Fifty µL of each eluate were pipetted on 12-mm diameter filter discs, which were placed in the middle of the agar gel. After 24 h of cultivation at 37 °C, the zone of inhibition (ZOI) for each specimen was measured. The compressive strength of the cements was determined per ISO 5833. RESULTS At each time point in the gentamicin release test, the difference in gentamicin concentration, obtained from specimens immersed in the FCS solution only and those immersed in the FCS + TXA solution was not significant (p = 0.055-0.522). The same trend was seen in each of the following parameters, after 7 d of immersion: (1) Cumulative gentamicin concentration (p < 0.297); (2) gentamicin activity against S. aureus (strongly visible); (3) ZOI size (mostly > 20 mm) (p = 0.631); and (4) compressive strength (p = 0.262). CONCLUSIONS For the PALACOS R + G specimens, the addition of TXA to FCS does not produce significant decreases in gentamicin concentration, in the activity of the gentamicin eluate against a clinical isolate of S. aureus, the zone of inhibition of S. aureus, and in the compressive strength of the cement, after 7 d of immersion in the test solution.
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Amerstorfer F, Schober M, Valentin T, Klim S, Leithner A, Fischerauer S, Glehr M. Risk of reinfection after two- or multiple-stage knee revision surgery using superficial vancomycin coating and conventional spacers. J Orthop Res 2021; 39:1700-1709. [PMID: 33118642 PMCID: PMC8451795 DOI: 10.1002/jor.24892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 10/06/2020] [Accepted: 10/21/2020] [Indexed: 02/04/2023]
Abstract
This study investigates the effect of superficial vancomycin coating (SVC) in two- or more-stage exchange procedures of prosthetic knee joint infections. We hypothesized that spacer treatment with SVC result in lower reinfection rates than conventional spacers after prosthetic reimplantation. Our secondary aim was to determine the demographic and treatment factors associated with reinfection rates. This retrospective cohort study compromised 96 cases with prosthetic knee infections. Twenty-four cases were treated with a temporary SVC spacer and 72 cases with conventional spacers. Prosthetic reinfection occurred after a median observation period of 1.7 ± 4.0 years in 24 cases (25%). The prevalence of having a reinfection was not significantly different between the two treatment groups (13% [3 cases] in the SVC group vs. 29% [21 cases] in the conventional spacer group [p = .104]). In seven cases (7.3%), two in the SVC group (8.3%) and five (6.9%) in the conventional spacer group (p ≥ .999), histological, respectively microbiological evaluations from the intraoperative specimens revealed persistent infection at the second stage. Nevertheless, in all seven cases no significant higher risk of periprosthetic reinfection was observed during follow-up (p = .750). Our secondary investigation of cofactors revealed that spacers additionally stabilized by nails were significantly associated with a 3.9-fold higher hazard ratio of sustaining a reinfection of revision prosthesis (p = .005).
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Affiliation(s)
| | - Martina Schober
- Department of Orthopedics and TraumaHospital St. Josef BraunauBraunau am InnAustria
| | - Thomas Valentin
- Section of Infectious Diseases and Tropical Medicine, Department of Internal MedicineMedical University of GrazGrazAustria
| | - Sebastian Klim
- Department of Orthopedics and TraumaMedical University of GrazGrazAustria
| | - Andreas Leithner
- Department of Orthopedics and TraumaMedical University of GrazGrazAustria
| | - Stefan Fischerauer
- Department of Orthopedics and TraumaMedical University of GrazGrazAustria
| | - Mathias Glehr
- Department of Orthopedics and TraumaMedical University of GrazGrazAustria
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Optimization of Mechanical and Setting Properties in Acrylic Bone Cements Added with Graphene Oxide. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11115185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The extended use of acrylic bone cements (ABC) in orthopedics presents some disadvantages related to the generation of high temperatures during methyl methacrylate polymerization, thermal tissue necrosis, and low mechanical properties. Both weaknesses cause an increase in costs for the health system and a decrease in the patient’s quality of life due to the prosthesis’s loosening. Materials such as graphene oxide (GO) have a reinforcing effect on ABC’s mechanical and setting properties. This article shows for the first time the interactions present between the factors sonication time and GO percentage in the liquid phase, together with the percentage of benzoyl peroxide (BPO) in the solid phase, on the mechanical and setting properties established for cements in the ISO 5833-02 standard. Optimization of the factors using a completely randomized experimental design with a factorial structure resulted in selecting nine combinations that presented an increase in compression, flexion, and the setting time and decreased the maximum temperature reached during the polymerization. All of these characteristics are desirable for improving the clinical performance of cement. Those containing 0.3 wt.% of GO were highlighted from the selected formulations because all the possible combinations of the studied factors generate desirable properties for the ABC.
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Healing of Artificially Created Gap Non-union Using Autologous Cultured Osteoblasts Impregnated Over Three-Dimensional Biodegradable Scaffold: An Experimental Study (Rabbit). Indian J Orthop 2021; 55:460-465. [PMID: 34306561 PMCID: PMC8275701 DOI: 10.1007/s43465-020-00288-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 10/07/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND The large bone defect often require bone transplant or its substitutes to restore bone integrity which have some limitations. The study was conducted to analyze role of autologous osteoblast that are amplified in vivo and impregnated in a synthesized three-dimensional gelatin hydroxyapatite scaffold for treating artificially created critical size defect in rabbit's iliac crest. METHODS In this research, 4-month-old ten healthy white male rabbits of average weight 2-3 kg were chosen. Osteoblasts cells were isolated from the rabbit iliac crest and were taken in transfer medium to the laboratory and cultured for 2-3 weeks. These osteoblast cells were seed on 3-dimensional scaffold and culture the construct for 2 weeks. The cultured autologous osteoblasts over the scaffold were transplanted into the defect by reopening the iliac crest of the same rabbit from which is cells were extracted. Serial radiograph of pelvis was done to see progressive signs of union. RESULTS Out of ten rabbits chosen for study two rabbits were passed during study. Gross and radiological examination of rabbits was done at 0, 4, 8 and 12 weeks. Features of union was seen in six rabbits on follow-up. There is no signs of union or minimal new bone formation around the implant material were seen in two case. CONCLUSION The study demonstrated using autologous cultured osteoblasts impregnated over three-dimensional biodegradable scaffold for large bone defect is a good option. The importance of three-dimensional biodegradable scaffold is that it provide scaffolding for sufficient interval for new bone formation.
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Cámara-Torres M, Duarte S, Sinha R, Egizabal A, Álvarez N, Bastianini M, Sisani M, Scopece P, Scatto M, Bonetto A, Marcomini A, Sanchez A, Patelli A, Mota C, Moroni L. 3D additive manufactured composite scaffolds with antibiotic-loaded lamellar fillers for bone infection prevention and tissue regeneration. Bioact Mater 2021; 6:1073-1082. [PMID: 33102947 PMCID: PMC7569267 DOI: 10.1016/j.bioactmat.2020.09.031] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/07/2020] [Accepted: 09/23/2020] [Indexed: 12/11/2022] Open
Abstract
Bone infections following open bone fracture or implant surgery remain a challenge in the orthopedics field. In order to avoid high doses of systemic drug administration, optimized local antibiotic release from scaffolds is required. 3D additive manufactured (AM) scaffolds made with biodegradable polymers are ideal to support bone healing in non-union scenarios and can be given antimicrobial properties by the incorporation of antibiotics. In this study, ciprofloxacin and gentamicin intercalated in the interlamellar spaces of magnesium aluminum layered double hydroxides (MgAl) and α-zirconium phosphates (ZrP), respectively, are dispersed within a thermoplastic polymer by melt compounding and subsequently processed via high temperature melt extrusion AM (~190 °C) into 3D scaffolds. The inorganic fillers enable a sustained antibiotics release through the polymer matrix, controlled by antibiotics counterions exchange or pH conditions. Importantly, both antibiotics retain their functionality after the manufacturing process at high temperatures, as verified by their activity against both Gram + and Gram - bacterial strains. Moreover, scaffolds loaded with filler-antibiotic do not impair human mesenchymal stromal cells osteogenic differentiation, allowing matrix mineralization and the expression of relevant osteogenic markers. Overall, these results suggest the possibility of fabricating dual functionality 3D scaffolds via high temperature melt extrusion for bone regeneration and infection prevention.
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Affiliation(s)
- María Cámara-Torres
- Maastricht University, MERLN Institute for Technology-Inspired Regenerative Medicine, Complex Tissue Regeneration Department, Universiteitssingel 40, 6229, ER, Maastricht, the Netherlands
| | - Stacy Duarte
- Maastricht University, MERLN Institute for Technology-Inspired Regenerative Medicine, Complex Tissue Regeneration Department, Universiteitssingel 40, 6229, ER, Maastricht, the Netherlands
| | - Ravi Sinha
- Maastricht University, MERLN Institute for Technology-Inspired Regenerative Medicine, Complex Tissue Regeneration Department, Universiteitssingel 40, 6229, ER, Maastricht, the Netherlands
| | - Ainhoa Egizabal
- TECNALIA, Basque Research and Technology Alliance (BRTA), Mikeletegi Pasealekua 2, 20009, Donostia-San Sebastian, Spain
| | - Noelia Álvarez
- TECNALIA, Basque Research and Technology Alliance (BRTA), Mikeletegi Pasealekua 2, 20009, Donostia-San Sebastian, Spain
| | - Maria Bastianini
- Prolabin & Tefarm S.r.l., Via Dell'Acciaio, 9 06134, Perugia, Italy
| | - Michele Sisani
- Prolabin & Tefarm S.r.l., Via Dell'Acciaio, 9 06134, Perugia, Italy
| | - Paolo Scopece
- Nadir S.r.l., Via Torino, 155/b, 30172, Venice, Italy
| | - Marco Scatto
- Nadir S.r.l., Via Torino, 155/b, 30172, Venice, Italy
| | - Alessandro Bonetto
- Department of Environmental Sciences, Informatics and Statistics, Ca’ Foscari University of Venice, Dorsoduro 3246, 30172, Venice, Italy
| | - Antonio Marcomini
- Department of Environmental Sciences, Informatics and Statistics, Ca’ Foscari University of Venice, Dorsoduro 3246, 30172, Venice, Italy
| | - Alberto Sanchez
- TECNALIA, Basque Research and Technology Alliance (BRTA), Mikeletegi Pasealekua 2, 20009, Donostia-San Sebastian, Spain
| | - Alessandro Patelli
- Department of Physics and Astronomy, Padova University, Via Marzolo, 8, 35131, Padova, Italy
| | - Carlos Mota
- Maastricht University, MERLN Institute for Technology-Inspired Regenerative Medicine, Complex Tissue Regeneration Department, Universiteitssingel 40, 6229, ER, Maastricht, the Netherlands
| | - Lorenzo Moroni
- Maastricht University, MERLN Institute for Technology-Inspired Regenerative Medicine, Complex Tissue Regeneration Department, Universiteitssingel 40, 6229, ER, Maastricht, the Netherlands
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Berberich CE, Josse J, Laurent F, Ferry T. Dual antibiotic loaded bone cement in patients at high infection risks in arthroplasty: Rationale of use for prophylaxis and scientific evidence. World J Orthop 2021; 12:119-128. [PMID: 33816139 PMCID: PMC7995342 DOI: 10.5312/wjo.v12.i3.119] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/20/2021] [Accepted: 03/08/2021] [Indexed: 02/06/2023] Open
Abstract
In view of the demographic changes and projected increase of arthroplasty procedures worldwide, the number of prosthetic joint infection cases will naturally grow. Therefore, in order to counteract this trend more rigid rules and a stricter implementation of effective preventive strategies is of highest importance. In the absence of a “miracle weapon” priorities should lie in evidence-based measures including preoperative optimization of patients at higher infection risks, the fulfilment of strict hygiene rules in the operating theatre and an effective antibiotic prophylaxis regimen. Instead of a “one size fits all” philosophy, it has been proposed to adjust the antibiotic prophylaxis protocol to major infection risks taking into account important patient- and procedure-related risk factors. A stronger focus on the local application mode via use of high dose dual antibiotic-loaded bone cement in such risk situations may have its advantages and is easy to apply in the theatre. The more potent antimicrobial growth inhibition in vitro and the strong reduction of the prosthetic joint infection rate in risk for infection patients with aid of dual antibiotic-loaded bone cement in clinical studies align with this hypothesis.
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Affiliation(s)
| | - Jérôme Josse
- Institut des Sciences Pharmaceutiques et Biologiques de Lyon (ISPB), International Center for Research in Infectiology, Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon 69008, France
- Interregional Reference Center for the Management of Complex Osteo-Articular Infections, Hospices Civils de Lyon, Lyon 69008, France
| | - Frédéric Laurent
- Institut des Sciences Pharmaceutiques et Biologiques de Lyon (ISPB), International Center for Research in Infectiology, Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon 69008, France
- Interregional Reference Center for the Management of Complex Osteo-Articular Infections, Hospices Civils de Lyon, Lyon 69008, France
- Bacteriology Laboratory, Institute of Infectious Agents, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon 69008, France
| | - Tristan Ferry
- Institut des Sciences Pharmaceutiques et Biologiques de Lyon (ISPB), International Center for Research in Infectiology, Inserm U1111, CNRS UMR5308, ENS de Lyon, UCBL1, Lyon 69008, France
- Interregional Reference Center for the Management of Complex Osteo-Articular Infections, Hospices Civils de Lyon, Lyon 69008, France
- Infectious and Tropical Diseases Department, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon 69008, France
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Sun H, Ma X, Li Z, Liu J, Wang W, Qi X. Release characteristics of enoxaparin sodium-loaded polymethylmethacrylate bone cement. J Orthop Surg Res 2021; 16:108. [PMID: 33541384 PMCID: PMC7860616 DOI: 10.1186/s13018-021-02223-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/11/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND This study aimed to prepare the polymethylmethacrylate (PMMA) bone cement release system with different concentrations of enoxaparin sodium (ES) and to investigate the release characteristics of ES after loading into the PMMA bone cement. METHODS In the experimental group, 40 g Palacos®R PMMA bone cement was loaded with various amount of ES 4000, 8000, 12,000, 16,000, 20,000, and 24,000 AXaIU, respectively. The control group was not loaded with ES. Scanning electron microscopy (SEM) was used to observe the surface microstructure of the bone cement in the two groups. In the experiment group, the mold was extracted continuously with pH7.4 Tris-HCL buffer for 10 days. The extract solution was collected every day and the anti-FXa potency was measured. The experiment design and statistical analysis were conducted using a quantitative response parallel line method. RESULTS Under the SEM, it was observed that ES was filled in the pores of PMMA bone cement polymer structure and released from the pores after extraction. There was a burst effect of the release. The release amount of ES on the first day was 0.415, 0.858, 1.110, 1.564, 1.952, and 2.513, respectively, from the six groups with various ES loading amount of 4000, 8000, 12,000, 16,000, 20,000, and 24,000 AXaIU, all reaching the peak of release on the first day. The release decreased rapidly on the next day and entered the plateau phase on the fourth day. CONCLUSION The prepared ES-PMMA bone cement has high application potential in orthopedic surgery. ES-PMMA bone cement shows good drug release characteristics. The released enoxaparin sodium has a local anti-coagulant effect within 24 h after application, but it will not be released for a long time, which is complementary to postoperative anti-coagulation therapy.
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Affiliation(s)
- Hui Sun
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xinzhe Ma
- Department of Orthopaedic Surgery, Shijiazhuang Third Hospital, Shijiazhuang, China
| | - Zhiyong Li
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jianning Liu
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wei Wang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiangbei Qi
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China.
- Tiemenguan District of the Third Hospital of Hebei Medical University, Tiemenguan City, China.
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Kaiser D, Zimmerli N, Hartmann R, Bachmann E, Kühn KD, Meyer DC. Systematic Biomechanical Analysis of Prerequisites for Reliable Intraoperative Bonding of Polymethylmethacrylate Bone Cement in Preexisting Cement in Revision Arthroplasty. Orthopedics 2021; 44:e55-e60. [PMID: 33089336 DOI: 10.3928/01477447-20201007-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 10/24/2019] [Indexed: 02/03/2023]
Abstract
Removal of a stable cement mantle may be invasive and time consuming and may result in unnecessary damage to bone and surrounding soft tissue. The goal of this study was to investigate the feasibility of the use of polymethylmethacrylate cement on preexisting cement as well as to explore the prerequisites for practical clinical use under standardized laboratory conditions. The strength of the cement-cement interface was evaluated with a 4-point bending to failure test, according to International Organization for Standardization 5833, as well as standardized shear strength, according to American Society for Testing and Materials D732. Various intraoperative cleaning agents were tested to remove simulated contamination with bone marrow. Contamination of the cement-cement interface with bone marrow decreases bending strength, modulus, and shear strength. Removal of the bone marrow with a degreasing agent significantly increases bending strength as well as bending modulus and can increase shear strength up to 9% compared with use of a nondegreasing agent. The cement-cement interface may reach up to 85% of bending strength, 92% of bending modulus, and comparable shear strength compared with a uniform cement block. Meticulous removal of fatty contaminant is important. Use of a degreasing agent further increases the stability of the cement-cement interface. With these precautions, it is safe to assume that the combined molecular and mechanical interlock is sufficient for most clinical applications and will not represent the weakest link in prosthetic revision. [Orthopedics. 2021;44(1):e55-e60.].
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Systems for local, sustained release of zoledronic acid as a potential treatment for metastatic bone disease. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2021; 118:111395. [DOI: 10.1016/j.msec.2020.111395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 07/22/2020] [Accepted: 08/17/2020] [Indexed: 01/31/2023]
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Soleymani Eil Bakhtiari S, Bakhsheshi‐Rad HR, Karbasi S, Tavakoli M, Hassanzadeh Tabrizi SA, Ismail AF, Seifalian A, RamaKrishna S, Berto F. Poly(methyl methacrylate) bone cement, its rise, growth, downfall and future. POLYM INT 2020. [DOI: 10.1002/pi.6136] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Sanaz Soleymani Eil Bakhtiari
- Advanced Materials Research Center, Department of Materials Engineering Najafabad Branch, Islamic Azad University Najafabad Iran
| | - Hamid Reza Bakhsheshi‐Rad
- Advanced Materials Research Center, Department of Materials Engineering Najafabad Branch, Islamic Azad University Najafabad Iran
| | - Saeed Karbasi
- Biomaterials and Tissue Engineering Department, School of Advanced Technologies in Medicine Isfahan University of Medical Sciences Isfahan 81746‐73461 Iran
| | - Mohamadreza Tavakoli
- Department of Materials Engineering Isfahan University of Technology Isfahan 84156‐83111 Iran
| | - Sayed Ali Hassanzadeh Tabrizi
- Advanced Materials Research Center, Department of Materials Engineering Najafabad Branch, Islamic Azad University Najafabad Iran
| | - Ahmad Fauzi Ismail
- Advanced Membrane Technology Research Center (AMTEC) Universiti Teknologi Malaysia Skudai, Johor Bahru Johor 81310 Malaysia
| | - Alexander Seifalian
- Nanotechnology and Regenerative Medicine Commercialisation Centre (NanoRegMed Ltd) London Biosciences Innovation Centre 2 Royal College Street London NW1 0NH U.K
| | - Seeram RamaKrishna
- Department of Mechanical Engineering National University of Singapore 9 Engineering Drive 1 Singapore 117576 Singapore
| | - Filippo Berto
- Department of Mechanical and Industrial Engineering Norwegian University of Science and Technology 7491 Trondheim Norway
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Effect of barium sulfate surface treatments on the mechanical properties of acrylic bone cements. Polym Bull (Berl) 2020. [DOI: 10.1007/s00289-020-03407-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Strain shielding for cemented hip implants. Clin Biomech (Bristol, Avon) 2020; 77:105027. [PMID: 32447179 DOI: 10.1016/j.clinbiomech.2020.105027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 04/27/2020] [Accepted: 04/29/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Long-term survival of hip implants is of increasing relevance due to the rising life expectancy. The biomechanical effect of strain shielding as a result of implant insertion may lead to bone resorption, thus increasing risk for implant loosening and periprosthetic fractures. Patient-specific quantification of strain shielding could assist orthopedic surgeons in choosing the biomechanically most appropriate prosthesis. METHODS Validated quantitative CT-based finite element models of five femurs in intact and implanted states were considered to propose a systematic algorithm for strain shielding quantification. Three different strain measures were investigated and the most appropriate measure for strain shielding quantification is recommended. It is used to demonstrate a practical femur-specific implant selection among three common designs. FINDINGS Strain shielding measures demonstrated similar trends in all Gruen zones except zone 1, where the volumetric strain measure differed from von-Mises and maximum principal strains. The volumetric strain measure is in better agreement with clinical bone resorption records. It is also consistent with the biological mechanism of bone remodeling so it is recommended for strain shielding quantification. Applying the strain shielding algorithm on three different implants for a specific femur suggests that the collared design is preferable. Such quantitative biomechanical input is valuable for practical patient specific implant selection. INTERPRETATION Volumetric strain should be considered for strain shielding examination. The presented methodology may potentially enable patient-specific pre-operative strain shielding evaluation so to minimize strain shielding. It should be further used in a longitudinal study so to correlate between strain shielding predictions and clinical bone resorption.
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Ramot Y, Nedvetzki S, Rosenfeld S, Rousselle SD, Nyska A, Emanuel N. D-PLEX 100 in an Abdominal Surgery Incision Model in Miniature Swine: Safety Study. Toxicol Pathol 2020; 48:677-685. [PMID: 32525456 DOI: 10.1177/0192623320928902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Surgical site infections (SSIs) are a common surgical-related complication. To avoid these complications, a new biodegradable polymer-lipid encapsulation matrix that provides controlled release of doxycycline (doxycycline/polymer-lipid encapsulation matrix [D-PLEX]) has been developed. The aim of this comprehensive study was to evaluate the potential safety of D-PLEX100 in abdominal surgical site. D-PLEX100 was administered into incisions of abdominal surgical site in Yucatan miniature swine, which were followed for up to 6 months and compared to sham-control swine. The D-PLEX100 mass did not migrate from the incisional site, and there was no evidence for systemic toxicity or other safety concerns. Surgical incision sites, including the peritoneal surface, were fully healed at 6 months in all animals. Most of the D-PLEX100 mass was absorbed during the first 3 months, and by 6 months, D-PLEX100 was fully absorbed. Toxicokinetic evaluation revealed that doxycycline concentrations were evident at 30 minutes and persisted to 8 days (71 mg/kg) or at least 15 days (284 mg/kg) and were no longer present in plasma by day 29. This study supports the safety of D-PLEX100 and its favorable degradability profile. A clinical study is being performed to assess the safety and the efficacy of D-PLEX100 to prevent human abdominal SSIs.
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Affiliation(s)
- Yuval Ramot
- Hadassah Medical Center, Hebrew University of Jerusalem, the Faculty of Medicine, Jerusalem, Israel
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Soykut B, Erdem O, Yalçın CÖ, Üstündağ A, Duydu Y, Akay C, Pişkin B. Occupational exposure of dental technicians to methyl methacrylate: Genotoxicity assessment. MUTATION RESEARCH-GENETIC TOXICOLOGY AND ENVIRONMENTAL MUTAGENESIS 2020; 852:503159. [DOI: 10.1016/j.mrgentox.2020.503159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 02/12/2020] [Accepted: 02/13/2020] [Indexed: 01/20/2023]
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Qu W, Wei C, Yu L, Deng Y, Fu P, Kang Z, Zhu S. Three-Stage Masquelet Technique and One-Stage Reconstruction to Treat Foot and Ankle Tuberculosis. Foot Ankle Int 2020; 41:331-341. [PMID: 31801382 PMCID: PMC7065448 DOI: 10.1177/1071100719890854] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this article was to report the feasibility and effectiveness of 3-stage Masquelet technique and 1-stage operation for different stages of foot and ankle tuberculosis (TB). METHODS Ten consecutive patients with foot and ankle TB were retrospectively analyzed between January 2014 and December 2018. Five patients were treated with the 3-stage Masquelet technique, including thorough debridement with vacuum sealing drainage, implantation of antibiotic cement spacer, and subsequent reconstruction. Five patients were treated with a 1-stage reconstruction. The American Orthopaedic Foot & Ankle Society (AOFAS) and visual analog scale (VAS) pain scores were recorded at the last follow-up. The follow-up was 30.3 ± 17.8 months. RESULTS No reactivation of TB was observed in any patients. For the 3-stage operation group, 1 patient developed a distal tibia fracture. The duration of anti-TB therapy was 12.0 ± 0.8 months. The AOFAS score increased from 39.5 ± 9.9 preoperatively to 75.3 ± 7.0 postoperatively (P < .05). The VAS pain score decreased from 6.3 ± 1.9 to 1.5 ± 1.3 (P < .05). For the 1-stage operation, 1 patient had wound necrosis. The duration of anti-TB therapy was 13.8 ± 1.1 months. The AOFAS score increased from 51.8 ± 15.0 to 81.8 ± 6.3 (P < .05). The VAS pain score decreased from 5.4 ± 1.1 to 1.0 ± 0.7 (P < .05). CONCLUSION Three-stage operation was effective for foot and ankle TB with stage IV, sinus tracts or other infections, and 1-stage reconstruction was effective for early-stage TBs. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Wenqiang Qu
- Department of Orthopaedic Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Chi Wei
- Department of Orthopaedic Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Li Yu
- Department of Orthopaedic Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Yu Deng
- Department of Orthopaedic Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Panfeng Fu
- Department of Orthopaedic Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Zhe Kang
- Department of Orthopaedic Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Shaobo Zhu
- Department of Orthopaedic Trauma and Microsurgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
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Rare Episode of Cement Leakage During Vesselplasty in a Case of Vertebral Compression Fracture. World Neurosurg 2020; 137:416-420. [PMID: 32084615 DOI: 10.1016/j.wneu.2020.02.071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 02/11/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Osteoporosis has become an important issue owing to the increasing elderly population. It is the most common cause of vertebral compression fracture. Conservative treatment is often ineffective, whereas surgical treatment has a vital role in compression fracture. Vesselplasty is a new surgical alternative to traditional vertebroplasty and kyphoplasty. It uses a polyethylene terephthalate balloon that functions as both a vertebral body expander and a bone cement container. We present a rare but catastrophic case of cement leakage during vesselplasty resulting in devastating neurologic compromise. This case highlights the need for awareness of vesselplasty safety and the importance of using a low-temperature bone cement. CASE DESCRIPTION A 77-year-old woman presented with debilitating back pain owing to acute T6 compression fracture as detected by magnetic resonance imaging. Under biplanar fluoroscopy, vesselplasty using a polyethylene terephthalate balloon container was performed at the T6 vertebrae. During cement injection, balloon rupture and cement leakage occurred compromising the spinal canal. Emergent laminectomy and cement removal were performed. Paraplegia developed postoperatively. CONCLUSIONS Though vesselplasty is claimed to be safe, cement leakage related to balloon rupture occurred in our case. Furthermore, thermal effects were difficult to observe during polymethyl methacrylate polymerization. Heat not only might cause irreversible complications but also might make the balloon rupture more easily.
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Pacheco-Salazar O, Wakayama S, Can-Herrera L, Dzul-Cervantes M, Ríos-Soberanis C, Cervantes-Uc J. Damage Evolution and Fracture Events Sequence Analysis of Core-Shell Nanoparticle Modified Bone Cements by Acoustic Emission Technique. Polymers (Basel) 2020; 12:polym12010208. [PMID: 31952108 PMCID: PMC7023568 DOI: 10.3390/polym12010208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/07/2020] [Accepted: 01/11/2020] [Indexed: 11/17/2022] Open
Abstract
In this research, damage in bone cements that were prepared with core-shell nanoparticles was monitored during four-point bending tests through an analysis of acoustic emission (AE) signals. The core-shell structure consisted of poly(butyl acrylate) (PBA) as rubbery core and methyl methacrylate/styrene copolymer (P(MMA-co-St)) as a glassy shell. Furthermore, different core-shell ratios 20/80, 30/70, 40/60, and 50/50 were prepared and incorporated into the solid phase of the bone cement formulation at 5, 10, and 15 wt %, respectively. The incorporation of a rubbery phase into the bone cement formulation decreased the bending strength and bending modulus. The AE technique revealed that the nanoparticles play an important role on the fracture mechanism of the bone cement, since a higher amount of AE signals (higher amplitude and energy) were obtained from bone cements that were prepared with the nanoparticles in comparison with those without nanoparticles (the reference bone cement). The SEM examination of the fracture surfaces revealed that all of the bone cement formulations exhibited stress whitening, which arises from the development of crazes before the crack propagation. Finally, the use of the AE technique and the fracture surface analysis by SEM enabled insight into the fracture mechanisms that are presented during four-point bending test of the bone cement containing nanoparticles.
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Affiliation(s)
- O.F. Pacheco-Salazar
- Instituto Tecnológico Superior de Calkiní en el Estado de Campeche, Avenida Ah Canul, s/n por Carretera Federal, C.P. 24900, Calkiní, Campeche, Mexico;
- Correspondence: ; Tel.: +52-999-1444-091
| | - Shuichi Wakayama
- Department of Mechanical Engineering, Tokyo Metropolitan University, 1-1 Minami-Osawa, Hachioji-shi, Tokyo 192-0397, Japan;
| | - L.A. Can-Herrera
- Departamento de Física Aplicada, CINVESTAV-IPN, Unidad Mérida, Carretera Antigua a Progreso km 6, Cordemex, C.P. 97310, Mérida, Yucatán, Mexico;
| | - M.A.A. Dzul-Cervantes
- Instituto Tecnológico Superior de Calkiní en el Estado de Campeche, Avenida Ah Canul, s/n por Carretera Federal, C.P. 24900, Calkiní, Campeche, Mexico;
| | - C.R. Ríos-Soberanis
- Unidad de Materiales, Centro de Investigación Científica de Yucatán, A.C., Calle 43 No. 130 x 32 y 34, Chuburná de Hidalgo, C.P. 97205, Mérida, Yucatán, Mexico; (C.R.R.-S.); (J.M.C.-U.)
| | - J.M. Cervantes-Uc
- Unidad de Materiales, Centro de Investigación Científica de Yucatán, A.C., Calle 43 No. 130 x 32 y 34, Chuburná de Hidalgo, C.P. 97205, Mérida, Yucatán, Mexico; (C.R.R.-S.); (J.M.C.-U.)
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Vancomycin and its crystalline degradation products released from bone grafts and different types of bone cement. Folia Microbiol (Praha) 2019; 65:475-482. [PMID: 31654320 DOI: 10.1007/s12223-019-00752-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 09/20/2019] [Indexed: 10/25/2022]
Abstract
Vancomycin is often used in orthopedic surgery as a local prophylaxis of bacterial infection. The aim of this work was to compare the release of vancomycin and its biologically inactive crystalline degradation products (CDP-1) during in vitro experiments from different types of local antibiotic delivery systems (bone grafts and bone cements). The concentrations of vancomycin and its crystalline degradation products were determined by high-performance liquid chromatography. Each experiment was performed in a phosphate buffer solution over 21 days. Morselized bone grafts, synthetic bone cements Palacos and Copal, and synthetic bone grafts were tested as local carriers of vancomycin. The highest concentration approximately 670 mg/L of vancomycin was released from synthetic bone grafts Actifuse. Even after 21 days, the concentration of vancomycin was still above the minimum inhibitory concentration (MIC). The maximum concentration of vancomycin released in two experiments with human bone grafts exceeded 600 mg/L during the first day and was still above MIC level 21 days later when the experiment was concluded. By comparing the synthetic bone cements Palacos and Copal, Copal had the average maximum concentration of only 32.4 mg/L and Palacos 35.7 mg/L. The concentration of vancomycin fell below the MIC for vancomycin-resistant Staphylococcus aureus (VRSA) on the seventh day with Palacos and the ninth day with Copal. This study showed the insufficient concentration of released vancomycin from synthetic bone cements at the end of the experiment. For improvement of local prophylaxis, it would be beneficial to increase the amount of vancomycin in bone cements.
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Li T, Fu L, Wang J, Shi Z. High dose of vancomycin plus gentamicin incorporated acrylic bone cement decreased the elution of vancomycin. Infect Drug Resist 2019; 12:2191-2199. [PMID: 31410038 PMCID: PMC6645360 DOI: 10.2147/idr.s203740] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 07/03/2019] [Indexed: 12/23/2022] Open
Abstract
Purpose Low doses of vancomycin and gentamicin were commonly incorporated into acrylic bone cement (antibiotic-impregnated bone cement, AIBC) during revision arthroplasty. Previous studies showed that only a very small amount of antibiotics could be eluted from AIBC. Given the fact that a high dose of antibiotic would elute high concentration of antibiotic, this study investigated the influence of a high dose of dual-antibiotic loading on the properties of cement. Methods A total of 8 groups of AIBC containing either gentamicin or vancomycin or both with different amounts of antibiotics (1 g, 2 g and 4 g) were tested on material properties, elution profiles, antibacterial activity and cytological toxicity. Results A high dose of gentamicin and vancomycin AIBC (with 2 g gentamicin and 2 g vancomycin loaded) regiment showed acceptable compressive strength of 74.25±0.72 MPa. No cytotoxicity or antibacterial activity reduction was observed in any group tested in this study. The elution profiles indicated that incorporating 2 g vancomycin resulted in 4.77% (1049.57±3.74 μg) released after 28 days. However, after 2 g gentamicin was added, the vancomycin released was significantly reduced to 2.42% (532.24±1.77 μg) (p<0.001), approximately 50% reduction. No significant influence of vancomycin on gentamicin was observed. Conclusion These findings suggest that the addition of 2 g vancomycin and 2 g gentamicin into acrylic bone cement was preferred while considering this dual-antibiotic AIBC regiment with acceptably material properties and effective antibacterial activity. However, special attention should be drawn to the reduction of vancomycin elution when incorporated with gentamicin.
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Affiliation(s)
- Tao Li
- Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Lilan Fu
- Nanfang PET Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Jian Wang
- Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Zhanjun Shi
- Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
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Valencia Zapata ME, Mina Hernandez JH, Grande Tovar CD, Valencia Llano CH, Diaz Escobar JA, Vázquez-Lasa B, San Román J, Rojo L. Novel Bioactive and Antibacterial Acrylic Bone Cement Nanocomposites Modified with Graphene Oxide and Chitosan. Int J Mol Sci 2019; 20:ijms20122938. [PMID: 31208091 PMCID: PMC6627441 DOI: 10.3390/ijms20122938] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 06/09/2019] [Accepted: 06/12/2019] [Indexed: 02/06/2023] Open
Abstract
Acrylic bone cements (ABCs) have played a key role in orthopedic surgery mainly in arthroplasties, but their use is increasingly extending to other applications, such as remodeling of cancerous bones, cranioplasties, and vertebroplasties. However, these materials present some limitations related to their inert behavior and the risk of infection after implantation, which leads to a lack of attachment and makes necessary new surgical interventions. In this research, the physicochemical, thermal, mechanical, and biological properties of ABCs modified with chitosan (CS) and graphene oxide (GO) were studied. Fourier transform infrared (FTIR) spectroscopy, proton nuclear magnetic resonance (1H-NMR) scanning electron microscopy (SEM), Raman mapping, thermogravimetric analysis (TGA), differential scanning calorimetry (DSC), compression resistance, mechanical dynamic analysis (DMA), hydrolytic degradation, cell viability, alkaline phosphatase (ALP) activity with human osteoblasts (HOb), and antibacterial activity against Gram-negative bacteria Escherichia coli were used to characterize the ABCs. The results revealed good dispersion of GO nanosheets in the ABCs. GO provided an increase in antibacterial activity, roughness, and flexural behavior, while CS generated porosity, increased the rate of degradation, and decreased compression properties. All ABCs were not cytotoxic and support good cell viability of HOb. The novel formulation of ABCs containing GO and CS simultaneously, increased the thermal stability, flexural modulus, antibacterial behavior, and osteogenic activity, which gives it a high potential for its uses in orthopedic applications.
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Affiliation(s)
- Mayra Eliana Valencia Zapata
- Grupo de Materiales Compuestos, Escuela de Ingeniería de Materiales, Universidad del Valle, Calle 13 # 100-00, Cali 76001, Colombia.
| | - José Herminsul Mina Hernandez
- Grupo de Materiales Compuestos, Escuela de Ingeniería de Materiales, Universidad del Valle, Calle 13 # 100-00, Cali 76001, Colombia.
| | - Carlos David Grande Tovar
- Grupo de Investigación de Fotoquímica y Fotobiología, Universidad del Atlántico, Carrera 30 Número 8-49, Puerto Colombia 081008, Colombia.
| | | | - José Alfredo Diaz Escobar
- Departamento de Ciencias Básicas, Institución Universitaria Antonio José Camacho, Avenida 6N # 28N - 102, Cali 76001, Colombia.
| | - Blanca Vázquez-Lasa
- Instituto de Ciencia y Tecnología de Polímeros, ICTP-CSIC, C/Juan de la Cierva 3, 28006 Madrid, Spain.
- Consorcio Centro de Investigación Biomedica en red, CIBER-BBN, 28029 Madrid, Spain.
| | - Julio San Román
- Instituto de Ciencia y Tecnología de Polímeros, ICTP-CSIC, C/Juan de la Cierva 3, 28006 Madrid, Spain.
- Consorcio Centro de Investigación Biomedica en red, CIBER-BBN, 28029 Madrid, Spain.
| | - Luis Rojo
- Instituto de Ciencia y Tecnología de Polímeros, ICTP-CSIC, C/Juan de la Cierva 3, 28006 Madrid, Spain.
- Consorcio Centro de Investigación Biomedica en red, CIBER-BBN, 28029 Madrid, Spain.
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Jørgensen PB, Lamm M, Søballe K, Stilling M. Equivalent hip stem fixation by Hi-Fatigue G and Palacos R + G bone cement: a randomized radiostereometric controlled trial of 52 patients with 2 years' follow-up. Acta Orthop 2019; 90:237-242. [PMID: 30931663 PMCID: PMC6534245 DOI: 10.1080/17453674.2019.1595390] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Long-term fixation of cemented femoral stems relies on several factors including cement adhesion and fatigue. Hi-Fatigue is a newer third-generation bone cement with low-viscosity properties at room temperature, good mechanical strength, and stable bone-cement interface in a laboratory testing environment. Palacos bone cement has excellent 10-year survival and is considered gold standard. We compared stem subsidence after fixation with Hi-Fatigue and Palacos bone cements using radiostereometry. Patients and methods - In a patient-blinded randomized controlled trial, 52 patients (30 women) at mean age 76 years (71-87) with osteoarthrosis and no osteoporosis received Hi-Fatigue G or Palacos R + G cement fixation of collarless, polished, double-tapered stems (CPT). Tantalum beads were inserted in the periprosthetic bone. Supine stereoradiographs were obtained postoperatively, 3 months, 6 months, 1 year, and 2 years after surgery. Oxford Hip Score (OHS) and VAS pain were recorded preoperatively and 1 and 2 years after surgery. Cement working times and properties were registered. Results - At 2 years, mean stem subsidence of 1.12 mm (95% CI 0.96-1.29) for Hi-Fatigue and 1.19 mm (CI 1.03-1.34) for Palacos was similar. Likewise, stem version was comparable between cement groups. Mean OHS and VAS pain were similar between cement groups. Cement working times were similar between cement groups, but the mean curing time was longer for Hi-Fatigue (13.7 min) than for Palacos (11.6 min). Interpretation - We found similar and generally low migration of CPT femoral stems inserted with Hi-Fatigue and Palacos bone cement until 2 years' follow-up, which indicates a good long-term survival of polished taper femoral stems inserted with both cement types.
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Affiliation(s)
- Peter B Jørgensen
- Department of Orthopedic Surgery, Aarhus University Hospital;; ,Department of Clinical Medicine, Aarhus University, Denmark,Correspondence:
| | - Martin Lamm
- Department of Orthopedic Surgery, Aarhus University Hospital;;
| | - Kjeld Søballe
- Department of Orthopedic Surgery, Aarhus University Hospital;; ,Department of Clinical Medicine, Aarhus University, Denmark
| | - Maiken Stilling
- Department of Orthopedic Surgery, Aarhus University Hospital;; ,Department of Clinical Medicine, Aarhus University, Denmark
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