The effects of particulate bone cements at the bone-implant interface

Wimhurst, J.A.; Brooks, Roger A.; Rushton, Nicky

doi:10.1302/0301-620x.83b4.0830588

Cited by 31 publications

(32 citation statements)

References 14 publications

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“…Several in vitro and in vivo studies report that radio-opaque agents, such as BaSO 4 , added to bone cements causes a release of pro-inflammatory cytokines, which produces an osteolytic tissue response [35]. However, the presence of BaSO 4 in the composition of the tested PMMA-based composites does not seem to cause any toxic reaction at either cellular or tissue level, as found in other studies [35,36].…”

Section: Discussionmentioning

confidence: 52%

New PMMA-based composites for preparing spacer devices in prosthetic infections

Giavaresi

Minelli

Sartori

et al. 2012

J Mater Sci: Mater Med

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Even though the systemic antibiotic therapy is usually applied after prosthetic infections surgical treatments, it is unable to reach the infection site in sufficient concentrations to eradicate bacteria. Delivering antibiotics locally with the use of custom made device (spacer or nail coating) might eradicate or reduce the infection and the risk of recolonization, providing a very high concentration of antibiotic. PMMA-based (Mendec Spine) composites with BaSO(4) were enriched with β-tricalcium phosphate (Porosectan-TCP) or only a slightly higher BaSO(4) concentration (Porosectan-BaSO(4)) to obtain higher porosity. The aim of the study was to evaluate: (i) drug absorption capability and drug release kinetics in vitro soaking them with a combined solution of gentamicin and vancomycin, (ii) their in vitro and in vivo biocompatibility, and finally, (iii) they were tested preliminarily in an experimental model of bone infection. The simultaneous presence of β-TCP and BaSO(4) resulted in the formation of a texture of interconnecting channels with different diameters, from a few microns to several hundred microns, which totally filled the material. The porosity, determined by microcomputed tomography, was significantly higher in both tested plain composites (Porosectan-TCP: +17.3%; Porosectan-BaSO(4): +7.5%) in comparison to control composite material (Mendec Spine). The kinetics of antibiotic release from composites was rapid and complete, producing high drug concentrations for a short period of time. Both composites showed a good level of biocompatibility. The osteomyelitic model confirmed that both composites, soaked in antibiotic solution, were able to cure bone infection. These composites could be useful for preparing devices for prosthetic joint infections treatment also allowing the use of antibiotics solution at required concentrations.

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Section: Discussionmentioning

confidence: 52%

New PMMA-based composites for preparing spacer devices in prosthetic infections

Giavaresi

Minelli

Sartori

et al. 2012

J Mater Sci: Mater Med

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“…[39][40][41] In this study, however, the presence or absence of this material had no significant effect on cytokine release. The discrepancy may be due to the evaluation method of the macrophage reaction in each study.…”

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confidence: 61%

Human monocyte response to retrieved polymethylmethacrylate particles

Miyaguchi

Kobayashi

Iwaki

et al. 2002

J. Biomed. Mater. Res.

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The purpose of this study was to compare retrieved polymethylmethacrylate (PMMA) particles from failed total hip arthroplasties in terms of size, shape, and the response of human monocytes with commercially available particles. PMMA particles were isolated from peri-implant tissues of five failed cemented total hip arthroplasties using tissue digestion and a sucrose density gradient technique. Prepolymerized cement powder and those from which barium sulfate had been removed were examined for comparison. After exposure of peripheral human monocytes to PMMA particles, tumor necrosis factor-alpha and interleukin-6 in medium were measured by using enzyme-linked immunosorbent assays. Image analysis revealed that retrieved particles were larger (retrieved: 1.24 microm; prepolymerized cement powder: 0.83 microm; barium sulfate-free powder: 0.87 microm) and were more irregular in shape and rougher than commercially available particles. Cytokine release was increased by all PMMA particle species. However, commercially available PMMA particles stimulated the release of necrosis factor-alpha and interleukin-6 more strongly than did retrieved particles at very high doses. The observed difference in monocyte response might be due to the volume of the challenged particles. Another possible reason for the difference might be alteration of the surface chemistry of particles in situ and the difference in surface morphology between them.

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“…Inflammatory macrophages associated with PMMA wear particles have been shown to be capable of osteoclast differentiation (Wimhurst et al 2001).…”

Section: Discussionmentioning

confidence: 99%

“…Several in vitro studies indicate that PMMA particles containing BaSO 4 or ZrO 2 produce significantly greater releases of tumour necrosis factor alpha, interleukin-6 and interleukin-1 beta, and pro-osteolytic cytokine, which cause a highly significant increase in bone resorption Wimhurst et al 2001;Shardlow et al 2003). The mechanism of bone resorption is by pro-inflammatory cytokines inducing osteoclast differentiation from macrophages, as well the cytokines directly stimulating bone resorption (Sabokbar et al 2003).…”

Section: Discussionmentioning

confidence: 99%

“…Very few reports are available with regards to ZrO 2 , although the development of epithelioid granulomas after the injection of elemental zirconium has been reported (Adams 1976). It has been shown by various groups that polymerized PMMA particles containing barium or zirconium can induce a greater osteolytic response, both in vitro (Sabokbar et al 1997(Sabokbar et al , 1998 and in vivo (Wimhurst et al 2001), than PMMA particles with no added radiopacifying agents. As there is an increase in the number of joint replacements (notably with the use of PMMA bone cement), it is imperative to find alternative radio-contrast media in order to reduce the failure of prosthetic implants or aseptic loosening caused by the biological responses evoked by PMMA particles containing BaSO 4 or ZrO 2 .…”

Section: Introductionmentioning

confidence: 99%

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In vitro and in vivo biological responses to a novel radiopacifying agent for bone cement

Wang

Diaz

Sabokbar

et al. 2005

J. R. Soc. Interface.

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Iodixanol (IDX) and iohexol (IHX) have been investigated as possible radiopacification agents for polymethylmethacrylate (PMMA) bone cement, to replace the currently used barium sulphate and zirconia. IDX and IHX are both water-soluble iodine-based contrast media and for the last 20 years have been used extensively in clinical diagnostic procedures such as contrast media enhanced computed tomography, angiography and urography. One of the major reasons to remove the current radiopacifying agents is their well-documented cytotoxicity and their potential to increase bone resorption.Using in vitro bone resorption assays, the effect of PMMA particles plus IDX or IHX to induce osteoclast formation and lacunar resorption on dentine slices has been investigated. These responses have been compared with the in vitro response to PMMA particles containing the conventional radiopacifying agents, that is, barium sulphate and zirconia. In parallel, the in vivo reaction, in terms of new bone formation, to particles of these materials has been tested using a bone harvest chamber in rabbit tibiae.In vitro cell culture showed that PMMA containing IHX resulted in significantly less bone resorption than PMMA containing the conventional opacifiers. In vivo testing, however, showed no significant differences between the amounts of new bone formed around cement samples containing the two iodine-based opacifying agents in particulate form, although both led to fewer inflammatory cells than particles of PMMA containing zirconia. Our results suggest that a non-ionic radiopacifier could be considered as an alternative to the conventional radiopacifying agents used in biomaterials in orthopaedic surgery.

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The effects of particulate bone cements at the bone-implant interface

Cited by 31 publications

References 14 publications

New PMMA-based composites for preparing spacer devices in prosthetic infections

New PMMA-based composites for preparing spacer devices in prosthetic infections

Human monocyte response to retrieved polymethylmethacrylate particles

In vitro and in vivo biological responses to a novel radiopacifying agent for bone cement

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