PMMA-Based Bone Cements and the Problem of Joint Arthroplasty Infections: Status and New Perspectives

Abstract

Polymethyl methacrylate (PMMA)-based bone cement is a biomaterial that has been used over the last 50 years to stabilize hip and knee implants or as a bone filler. Although PMMA-based bone cement is widely used and allows a fast-primary fixation to the bone, it does not guarantee a mechanically and biologically stable interface with bone, and most of all it is prone to bacteria adhesion and infection development. In the 1970s, antibiotic-loaded bone cements were introduced to reduce the infection rate in arthroplasty; however, the efficiency of antibiotic-containing bone cement is still a debated issue. For these reasons, in recent years, the scientific community has investigated new approaches to impart antibacterial properties to PMMA bone cement. The aim of this review is to summarize the current status regarding antibiotic-loaded PMMA-based bone cements, fill the gap regarding the lack of data on antibacterial bone cement, and explore the progress of antibacterial bone cement formulations, focusing attention on the new perspectives. In particular, this review highlights the innovative study of composite bone cements containing inorganic antibacterial and bioactive phases, which are a fascinating alternative that can impart both osteointegration and antibacterial properties to PMMA-based bone cement.

Effect of Physiological Saline Solution Contamination on Selected Mechanical Properties of Seasoned Acrylic Bone Cements of Medium and High Viscosity

“…The degree of admixture is qualified in case of antibiotics admixture as small for up to 5% w/w and as large dose at the amount > 5% w/w. In the case of high doses, the possible risk of changes in the characteristics of the cement itself, including its strength, has been confirmed [ 36 ]. Nevertheless, organic fillers, which perform antibacterial functions, were tested.…”

“…Polymethyl methacrylate (PMMA) is a polymer belonging to the category of acrylic resins. It is obtained from a mixture of a monomer (methyl methacrylate, MMA) and polymer (particles of pre-polymerised methyl methacrylate) in the presence of an initiator, activator and stabiliser [ 36 , 40 ]. The liquid component of bone cement is a colourless, flammable liquid with a characteristic smell, whose main ingredient is methyl methacrylate monomer.…”

“…There are many hypotheses saying that aseptic loosening of the implant is preceded by destruction of bone cement [ 32 , 33 , 34 , 35 ]. Although bone cements based on polymer composites are widely used, they do not guarantee mechanically and biologically stable bonding to the bone and, above all, are susceptible to bacterial adhesion and infection development [ 36 ]. It is estimated that more than 25% of prosthetic implants may indicate signs of aseptic loosening [ 37 , 38 , 39 ].…”

Biodegradable materials for bone defect repair

“…The structure and properties of the material in this area are different from those of any one phase of the two or more materials, which is called the interface phase (IP). The IP is not only a link between the two phases of the materials but also a bridge for the transmission of stress and other signals [ 256 ]. In scaffolds made of composite materials, the common IPs include agents (such as zirconate, titanate and silane) and compatibilizers (such as poly(methyl methacrylate-co-methacrylic acid) and lysine triisocyanate) [ 257 ].…”

Innovative Options for Bone Metastasis Treatment: An Extensive Analysis on Biomaterials-Based Strategies for Orthopedic Surgeons

“…PMMA is a thermoplastic polymer, characterized by ease of manufacturing and handling, good biocompatibility, appropriate mechanical strength and elastic modulus. However, its use raises several health concerns ( Bose et al, 2017 ; Gohil et al, 2017 ; Bistolfi et al, 2019 ). For these reasons, even if PMMA has been widely used in spinal vertebroplasty or as bone filler in primary tumor or metastatic patients, nowadays new applications for its use have been developed almost exclusively in composite materials and in 3D-printing of customized bioimplants ( Kawashita et al, 2010 ; Han et al, 2011 ; Teo et al, 2016 ; Robo et al, 2018 ).…”