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World J Orthop. Apr 18, 2013; 4(2): 67-74
Published online Apr 18, 2013. doi: 10.5312/wjo.v4.i2.67
Polymethylmethacrylate bone cements and additives: A review of the literature
Manit Arora, Edward KS Chan, Sunil Gupta, Ashish D Diwan
Manit Arora, St George Clinical School, University of New South Wales, Kogarah, New South Wales 2217, Australia
Edward KS Chan, Royal Prince Alfred Clinical School, University of Sydney, Camperdown, New South Wales 2050, Australia
Sunil Gupta, South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales 2170, Australia
Ashish D Diwan, Orthopaedics Research Institute and Department of Orthopaedic Surgery, St George Hospital, Kogarah, New South Wales 2217, Australia
Author contributions: Arora M, Chan EKS and Gupta S primarily wrote, revised and approved the final manuscript; Diwan AD critically revised, did secondary writing, and approved the final manuscript.
Correspondence to: Sunil Gupta, MBBS, South Western Sydney Clinical School, University of New South Wales, Education Building, Elizabeth Drive, Liverpool Hospital, Liverpool, New South Wales 2170, Australia.
Telephone: +61-404-706200 Fax: +61-2-94156264
Received: June 11, 2012
Revised: October 9, 2012
Accepted: December 6, 2012
Published online: April 18, 2013

Polymethylmethacrylate (PMMA) bone cement technology has progressed from industrial Plexiglass administration in the 1950s to the recent advent of nanoparticle additives. Additives have been trialed to address problems with modern bone cements such as the loosening of prosthesis, high post-operative infection rates, and inflammatory reduction in interface integrity. This review aims to assess current additives used in PMMA bone cements and offer an insight regarding future directions for this biomaterial. Low index (< 15%) vitamin E and low index (< 5 g) antibiotic impregnated additives significantly address infection and inflammatory problems, with only modest reductions in mechanical strength. Chitosan (15% w/w PMMA) and silver (1% w/w PMMA) nanoparticles have strong antibacterial activity with no significant reduction in mechanical strength. Future work on PMMA bone cements should focus on trialing combinations of these additives as this may enhance favourable properties.

Keywords: Polymethylmethacrylate, Bone cement, Cement nanoparticle, Vitamin E additive, Arthroplasty, Artificial joint fixation, Post-operative infection, Mechanical weakness, Fat additive, Antibiotics