Efficacy of vacuum bone cement mixing systems in reducing methylmethacrylate fume exposureComparison of 7 different mixing devices and handmixing

Abstract

Background Polymethylmethacrylate (PMMA) bone cements are mainly used for implant fixation in joint replacement surgery. During cement preparation for application, all staff in the operating theatre are exposed to methylmethacrylate (MMA) fumes, which are known to have toxic side effects.Methods and results In this study we found that vacuum mixing of bone cement with 7 commercially available mixing devices significantly reduced the emission of MMA vapors in the breathing zone when compared with classic hand mixing in an open bowl. Gas chromatography appears to be more sensitive for detection of MMA fumes than Photo Inonization Detection.Interpretation According to present knowledge, even repeated mixing of PMMA bone cement during a normal working day does not seem to constitute an increased health risk, particularly if vacuum mixing is implemented.

Airborne Exposure of Methyl Methacrylate During Simulated Total Hip Arthroplasty and Fabrication of Antibiotic Beads

“…Schlegel et al in 2004, evaluated the effect of vacuum mixing on MMA vapor levels seen by the scrub technician [25]. Open-bowl, hand mixing resulted in peak MMA levels of approximately 18 ppm, similar to our peak levels.…”

Custom-Made Antibiotic Cement Nails in Orthopaedic Trauma: Review of Outcomes, New Approaches, and Perspectives

“…However, the lack of consistency in the results of various studies and the absence of dose response lead to the conclusion that MMA in not carcinogenic to humans under normal conditions of use [ 104 ]. Moreover, the evidence shows that even repeated mixing of PMMA bone cement does not pose an additional risk to operative theatres' personnel [ 105 ]. In a study comparing ionically dissolved or precipitated metals with MMA toxicity, MMA monomer toxicity was found to be low compared to metal toxicity [ 47 ].…”

Commercial aspects and delivery systems of bone cements

“…29,30 Mixing the cement in a closed vacuum is one of the means of effectively reducing cement porosity; 22 vacuum mixing has become widely accepted as the best method for reducing porosity in the cement. Published studies suggest that most vacuum mixing syringe systems signifi cantly reduce methylmethacrylate exposure as compared with open-bowl hand mixing.…”