Influence of oscillatory mixing on the injectability of three acrylic and two calcium‐phosphate bone cements for vertebroplasty

Baroud, Gamal; Matsushita, C.; Samara, Mazen; Beckman, Lorne; Steffen, Thomas

doi:10.1002/jbm.b.20010

Cited by 40 publications

(49 citation statements)

References 14 publications

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“…This is contrary to the more standardized laboratory investigations, which reveal a high correlation between cement viscosity during hardening and the ambient temperature. The scattering in the clinical setting is likely due to the number of other influences on hardening behavior such as atmospheric conditions [9] (e.g., oxygen concentration, humidity, temperature), Values shown are mean ± SD n number of portions of cement measured Constant flow rate of 0.1 ml/s was assumed [13] a Estimated by using the Law of Hagen-Poiseuille variation of the cement composition (e.g., fluid to powder ratio) due to preparation, method of mixing [2] and others. The time needed to reach 20 Pa s was in a relatively high range of 200 s and had high variation.…”

Section: Discussionmentioning

confidence: 99%

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Clinical investigations of polymethylmethacrylate cement viscosity during vertebroplasty and related in vitro measurements

Böger¹,

Wheeler²,

Schenk³

et al. 2009

Eur Spine J

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Percutaneous vertebroplasty, comprising an injection of polymethylmethacrylate (PMMA) into vertebral bodies, is a practical procedure for the stabilization of osteoporotic compression fractures as well as other weakening lesions. Cement leakage is considered to be one of the major and most severe complications during percutaneous vertebroplasty. The viscosity of the material plays a key role in this context. In order to enhance the safety for the patient, a rheometer system was developed to measure the cement viscosity intraoperatively. For this development, it is of great importance to know the proper viscosity to start the procedure determined by experienced surgeons and the relation between the time period when different injection devices are used and the cement viscosity. The purpose of the study was to investigate the viscosity ranges for different injection systems during conventional vertebroplasty. Clinically observed viscosity values and related time periods showed high scattering. In order to get a better understanding of the clinical observations, cement viscosity during hardening at different ambient temperatures and by simulation of the body temperature was investigated in vitro. It could be concluded, that the direct viscosity assessment with a rheometer during vertebroplasty can help clinicians to define a lower threshold viscosity and thereby decrease the risk of leakage and make adjustments to their injection technique in real time. Secondly, the acceleration in hardening of PMMA-based cements at body temperature can be useful in minimizing leakages by addressing them with a short injection break.

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Section: Discussionmentioning

confidence: 99%

“…The time needed to reach 20 Pa s was in a relatively high range of 200 s and had high variation. Although the mixing procedures were essentially the same, small differences in mixing techniques among the different nurses involved in the study may have influenced cement hardening [2].…”

Section: Discussionmentioning

confidence: 99%

Clinical investigations of polymethylmethacrylate cement viscosity during vertebroplasty and related in vitro measurements

Böger¹,

Wheeler²,

Schenk³

et al. 2009

Eur Spine J

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“…Baroud et al 1 examined the effect of two methods of cement mixing-manual and oscillatory -on cement viscosity and on the reproducibility of viscosity, which was inferred from the coefficient of variation of five repeats. It was found that oscillatory mixing significantly decreased the mean viscosity of the cements and also increased the reproducibility of cement viscosity from different trials.…”

Section: Introductionmentioning

confidence: 99%

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

2003

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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.

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“…Among these factors, the cement viscosity is the only one not determined by the bony structure, suggesting that the adjustment of cement viscosity may be used as an independent approach to control the bone cement leakage. Viscosity is affected by a number of factors: polymer particle parameters, composition of the polymer particles, molecular weight distribution of the polymer component, storage conditions and room temperature [22][23][24][25]. Two processes might contribute to rise of viscosity of bone cement: swelling of the polymer in the early phase and polymerization of the monomer in the later phase [26].…”

Section: Discussionmentioning

confidence: 99%

Biomechanical characteristics of cement/gelatin mixture for prevention of cement leakage in vertebral augmentation

et al. 2013

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Purpose This study evaluated whether or not the addition of gelatin micro-particles into the polymethyl methacrylate (PMMA) could reduce cement infiltration in cancellous bone of vertebra. Methods Gelatin micro-particles were prepared in various sizes and mixed with PMMA in different densities. Dynamic viscosity of the mixture was measured by a rotational rheometer. Fresh bovine vertebral bodies were sectioned into cylindrical samples. Permeability of the mixture through the samples was tested on a mechanical test machine, and calculated using Darcy's law. The PMMA/gelatin mixture also underwent compressive and bending tests, and their structures were examined by scanning electron microscopy. Results The cement/gelatin mixture increased the viscosity. Significant reduction of cement permeability in cancellous bone was determined after the addition of the micro-particles. Micro-particles of 2 % in density and 125-250 lm in size decreased the permeability by 1/3 without any significant change of the cement viscosity. The biomechanical strength was unchanged in compression but decreased by up to 20 % in bending. Conclusions Gelatin micro-particles significantly increased the cement viscosity, reduced the permeability in cancellous bone of vertebra, decreased the flexural strength, but did not affect the compressive strength. Although it suggested a manageable approach in vertebral augmentation, the outcome should be further verified on a cadaveric model or an animal model before the mixture could be used safely and effectively in the clinical treatment.

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Influence of oscillatory mixing on the injectability of three acrylic and two calcium‐phosphate bone cements for vertebroplasty

Cited by 40 publications

References 14 publications

Clinical investigations of polymethylmethacrylate cement viscosity during vertebroplasty and related in vitro measurements

Clinical investigations of polymethylmethacrylate cement viscosity during vertebroplasty and related in vitro measurements

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

Biomechanical characteristics of cement/gelatin mixture for prevention of cement leakage in vertebral augmentation

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