Influence of mixing method on the cement temperature‐mixing time history and doughing time of three acrylic cements for vertebroplasty

Abstract

Acrylic cements are increasingly being used to augment osteoporotic vertebrae in a procedure called vertebroplasty. Two significant factors that may complicate the use of acrylic cements are: (a) short handling time, which may result in insufficient filling of the vertebra; and (b) exothermic setting (curing) behavior, which may result in thermal damage of the surrounding tissue. It has been previously reported 1 that mixing the cement components under oscillation, as compared to manual mixing, increases the handling time. More specifically, it seems that oscillatory mixing slows down the cement polymerization process and, consequently, widens the time window during which cement is injectable. However, the effect of oscillatory mixing on the exothermic setting behavior of cement undergoing polymerization has not been examined. In this study, the exothermic setting behavior of three commercially available acrylic cements-Antibiotic Simplex, DP-Pour&trade, and Vertebroplastic™-were examined for both manual and oscillatory mixing methods. For each combination of cement and mixing method, the parameters that were measured were the exothermic setting curve (and hence the cement setting temperature and setting time) and the cement doughing time. It was found that oscillatory mixing had no significant effect on any of these parameters. Based on the results of this study, it can be concluded that, for the tested cements, the setting process is a reaction-controlled process rather than a diffusion-controlled one. Clinically, this implies that oscillatory mixing may be used to increase the working period for acrylic cements without increasing the risk of thermal damage to surrounding tissue.

Effect of iodixanol particle size on the mechanical properties of a PMMA based bone cement

“…Temperatures in situ are known to be lower than in vitro [23]. The maximum polymerisation temperatures for these materials are nevertheless similar to those reported for commercial cements [24,25].…”

Rheological and Curing Behavior of a Newly Developed, Medium Viscous Acrylic Bone Cement

“…A potential side effect of acrylic cements is heat damage to adjacent tissues and bones that can lead to necrosis [17][18][19]. Nevertheless, to date no vertebro-or kyphoplasty procedure has been described in which such noteworthy side effects could have been attributed to thermal damage [20].…”

A new cannula to ease cement injection during vertebroplasty

“…The liquid was then added to the powder in a plastic beaker, and a spatula was used to mix the cement at approximately 60 beats/ min for approximately 50 s until the powder had visually dissolved in the liquid. To match clinical conditions, the injections with DP-Pour were started once the cement exhibited a dough-like consistency, which was approximately 11 min after the liquid was added to the powder [10].…”