Improved Anti-Washout Property of Calcium Sulfate/Tri-Calcium Phosphate Premixed Bone Substitute with Glycerin and Hydroxypropyl Methylcellulose

Abstract

Calcium sulfate/calcium phosphate (CS-CP)-based bone substitutes have been developed in premixed putty for usage in clinical applications. However, it is difficult to completely stop the bleeding during an operation because premixed putty can come into contact with blood or body fluids leading to disintegration. Under certain conditions depending on particle size and morphology, collapsed (washed) particles can cause inflammation and delay bone healing. In this context, anti-washout premixed putty CS-CP was prepared by mixing glycerin with 1, 2, and 4 wt% of hydroxypropyl methylcellulose (HPMC), and the resultant anti-washout properties were evaluated. The results showed that more than 70% of the premixed putty without HPMC was disintegrated after being immersed into simulated body fluid (SBF) for 15 min. The results demonstrated that the more HPMC was contained in the premixed putty, the less disintegration occurred. We conclude that CS-CP pre-mixed putty with glycerin and HPMC is a potential bone substitute that has good anti-washout properties for clinical applications.

Development of Injectable Calcium Sulfate and Self-Setting Calcium Phosphate Composite Bone Graft Materials for Minimally Invasive Surgery

“…The CaP cement is vulnerable to wash out before hardening occurs. The presence of additives such as hydroxyl propyl methyl cellulose (HPMC) was previously shown to affect handling properties, washout resistance, cement hardening behavior, and mechanical properties of calcium phosphate cements [ 18 , 23 ]; thus, 2% of HPMC was added to the powder phase of CSH/CaP (1:1) bone materials and examined ( Table 3 ). The setting time was 54 min or 36 min when CSH/CaP (1:1) bone materials were supplemented with 2% HPMC contained 4% citric acid or 6% citric acid, respectively ( Table 3 ).…”

“…The Synthesis of Calcium Sulfate Hemihydrate (CSH, CaSO 4 •0.5H 2 O) CS has been approved by the U.S. Food and Drug Administration (FDA) as a bone graft material due to its non-toxicity, superb workability, good biocompatibility, and osteoconductivity, and the hemihydrate form of CS (calcium sulfate hemihydrate, CSH, CaSO 4 •0.5H 2 O) is known to be suitable for clinical applications such as a bone void filler and is widely used in orthopedics and dentistry [5,9,[13][14][15][16]. In our previous studies, we have developed a hydrothermal method to produce self-prepared CSH by high vapor pressure of water [17,18]. Figure 1a shows the rod-like morphology of CSH observed by scanning electronic microscopy (SEM) and the size of the CSH specimen is smaller than 40 µm.…”

“…HPMC is one of the most commonly occurring polysaccharides derived from alkali-treated cellulose and is often used as a gelling agent. In terms of HPMC content, our previous study showed that an increased proportion of HPMC exerted an anti-washout property of calcium sulfate/calcium phosphate premixed putty, leading to less decay and larger disintegrating particles [ 18 ]. In this study, 2% of HPMC as a polymer carrier was expected to function as a matrix, increase the viscosity of the paste, and improve the washout resistance of bone cement.…”