Polymethylmethacrylate bone cements and additives: A review of the literature

Abstract

Polymethylmethacrylate (PMMA) bone cement technology has progressed from industrial Plexiglass administration in the 1950s to the recent advent of nanoparticle additives. Additives have been trialed to address problems with modern bone cements such as the loosening of prosthesis, high post-operative infection rates, and inflammatory reduction in interface integrity. This review aims to assess current additives used in PMMA bone cements and offer an insight regarding future directions for this biomaterial. Low index (< 15%) vitamin E and low index (< 5 g) antibiotic impregnated additives significantly address infection and inflammatory problems, with only modest reductions in mechanical strength. Chitosan (15% w/w PMMA) and silver (1% w/w PMMA) nanoparticles have strong antibacterial activity with no significant reduction in mechanical strength. Future work on PMMA bone cements should focus on trialing combinations of these additives as this may enhance favourable properties.

Bone cement

“…The era of modern PMMA bone cements comes from the patent by Degussa and Kulzer (1943), who had described the mechanism of polymerization of methyl methacrylate (MMA) at room temperature if a co-initiator, such as a tertiary aromatic amine, is added. 4 The first bone cement use in Orthopaedics is widely credited to the famous English surgeon, John Charnley, who in 1958, used it for total hip arthroplasty. 5 He had used coldcured PMMA to attach an acrylic cup to the femoral head and to seat a metallic femoral prosthesis.…”

Modified Bone Cement: A Reprieve for Horizontal Bone Defects

“…It also improves cement cytocompatibility. 8 Barium sulfate and zirconium oxide, which are used to render the PMMA radiopaque, reduce its mechanical strength. 28 But addition of radiopaque ceramic nanoparticles like nanoMgO and nanoBaSO 4 does not have a significant effect on mechanical strength of the material.…”

“…4,5 The use of PMMA bone cement in orthopedic surgery is a time-proven and effective treatment modality for vertebral body reconstruction, total joint arthroplasty, repair of open fractures, etc. 7,8 The interface integrity of the material can be considered a valuable asset in its use as a bone cement. 8 The same property can be considered pivotal in its use as a material to reconstruct the horizontal ridge defect.…”

“…7,8 The interface integrity of the material can be considered a valuable asset in its use as a bone cement. 8 The same property can be considered pivotal in its use as a material to reconstruct the horizontal ridge defect. It can be theorized that the cement can act as a foundation for the teeth lacking in support from the natural alveolar process, thereby stabilizing the teeth.…”

“…30 2g per 60g or 2g per 40g of Gentamicin has been shown to reduce post-operative infection rates 31 without a significant alteration in the compressive or diametral tensile strength. 8 Chitosan nanoparticles have been shown to have significant antibacterial activity against Staphylococcus aureus and Staphylococcus epidermidis in in vitro studies. 32 The 1% silver nanoparticles have antibacterial activities against Acinetobacter baumannii, Pseudomonas aeruginosa, Proteus mirabilis, and S. aureus.…”