A review of calcium phosphate cements and acrylic bone cements as injectable materials for bone repair and implant fixation

Abstract

Treatment of bone defects caused by trauma or disease is a major burden on human healthcare systems. Although autologous bone grafts are considered as the gold standard, they are limited in availability and are associated with post-operative complications. Minimally invasive alternatives using injectable bone cements are currently used in certain clinical procedures, such as vertebroplasty and balloon kyphoplasty. Nevertheless, given the high incidence of fractures and pathologies that result in bone voids, there is an unmet need for injectable materials with desired properties for minimally invasive procedures. This paper provides an overview of the most common injectable bone cement materials for clinical use. The emphasis has been placed on calcium phosphate cements and acrylic bone cements, while enabling the readers to compare the opportunities and challenges for these two classes of bone cements. This paper also briefly reviews antibiotic-loaded bone cements used in bone repair and implant fixation, including their efficacy and cost for healthcare systems. A summary of the current challenges and recommendations for future directions has been brought in the concluding section of this paper.

Synergistic anti-inflammatory and osteogenic n-HA/resveratrol/chitosan composite microspheres for osteoporotic bone regeneration

“…Injectable fillers offer significant advantages over preformed implants, as the former can be administered using non-invasive or minimally invasive techniques while also conforming to bone defects with a complex geometry [ 6 ]. Meanwhile, the fillers with tissue-specific functions, serving both as a drug delivery system and as an osteoconductive support that coordinately enhance tissue regeneration, are essential for the success of bone repair [ 7 ]. Microsphere has received extrinsic research due to its unique properties such as uniform size and shape which enable the delivery of drugs or osteogenic factors to specific target sites accurately, maintaining its local effective concentration and long-term effect [ 8 ].…”

Finite element analysis of subtalar joint arthroereisis on adult-acquired flexible flatfoot deformity using customised sinus tarsi implant

“…The customised sinus tarsi implant resulted in localised stress at the sulcus tali reaching 15.29 ​MPa ​at 75% stance, which was remarkable compared with the intact condition, despite the fact that it did not exceed the required strength (70 ​MPa) [ 43 ] However, it shall be noted that the sinus tarsi are covered with artery and large venous plexus. Additional stress may disturb venous outflow and could be the potential cause of sinus tarsi pain and syndrome [ 44 ].…”

Development of Natural-Based Bone Cement for a Controlled Doxorubicin-Drug Release

“…In general, the 40/60 composition was found to perform best under increasing levels of force, while mimicking the percentage of CP found in natural bones. Cements classified as CPCs are described as second-generation biomaterials, with compositions closely resembling natural bone (Yousefi, 2019). CPCs with decreased powder components, like NHA, result in decreased mechanical properties (Barralet et al, 2004), seen in the 50/50, 60/40 and 70/30 cements, presented in Figure 1C.…”

“…Broadly, it was observed a trend of increased injectability with the increasing of biopolymers content,. The reduction of the powder-to-liquid ratio has been found to improve CPC injectability due to changes in viscosity, however, it prolongs setting time while jeopardizing the cement mechanical properties ( Yousefi, 2019 ). On this regard, the injectability of the 40/60 composition was found to be 98.6 ± 0.3% effective with minimal cement loss during the process with the highest young’s compressive modulus (97.04 ± 18.04 kPa), offering a good compromise between mechanical properties and easy handling that makes it a suitable injectable cement ( Bohner, 2010 ).…”