Biomechanics of low-modulus and standard acrylic bone cements in simulated vertebroplasty: A human ex vivo study

Holub, Ondrej; López, Alejandro; Borse, Vishal; Engqvist, Håkan; Kapur, Nikil; Hall, Richard M.; Persson, Cecilia

doi:10.1016/j.jbiomech.2015.06.026

Cited by 18 publications

(7 citation statements)

References 48 publications

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“…It was injectable for more than 15 min and exhibited both high flexibility and a screw holding power similar to CaP cement. Similar formulations (LA-modified PMMA cements) have previously shown reinforcement of the vertebral body in an ex vivo study [26], and been found to give an adequate biological response in both in vitro and in vivo scenarios. [44,47].…”

Section: Discussionmentioning

confidence: 81%

“…In fact, it has been suggested that vertebral augmentation with stiff PMMA bone cement may facilitate additional osteoporotic fractures in the vicinity of the treated vertebrae [20][21][22][23]. Although additional fractures are likely to appear due to the natural course of osteoporosis, the disproportionally high number of new fractures occurring next to the treated vertebrae [24,25] suggest that the high cement stiffness [26][27][28][29], and/or high volume fill [29][30][31] may facilitate new fractures. Indeed, ex vivo and finite element studies have reported an increase of the overall vertebral body stiffness of 13% to 33% due to the injection of PMMA bone cement [26,27,32,33].…”

Section: Introductionmentioning

confidence: 99%

“…Others have suggested using bone cement based on poly(ethylmethacrylate-co-n-butylmethacrylate) monomers (PEMA-nBMA) [42,43]. More recently, the use of fatty acids (FA) and triglyceride oils has shown promising results in reducing the stiffness of PMMA bone cement [26,39,[44][45][46][47]. In particular, López et al [45] added 12 wt% Castor oil into the vertebroplastic bone cement Osteopal ® V (Heraeus Medical GmbH, Hanau, Germany) and reported a reduction in strength and elastic modulus of 83% and 70%, respectively.…”

Section: Introductionmentioning

confidence: 99%

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Functional Properties of Low-Modulus PMMA Bone Cements Containing Linoleic Acid

Robo

Wenner

Ubhayasekera

et al. 2021

JFB

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Acrylic bone cements modified with linoleic acid are a promising low-modulus alternative to traditional high-modulus bone cements. However, several key properties remain unexplored, including the effect of autoclave sterilization and the potential use of low-modulus cements in other applications than vertebral augmentation. In this work, we evaluate the effect of sterilization on the structure and stability of linoleic acid, as well as in the handling properties, glass transition temperature, mechanical properties, and screw augmentation potential of low-modulus cement containing the fatty acid. Neither 1H NMR nor SFC-MS/MS analysis showed any detectable differences in autoclaved linoleic acid compared to fresh one. The peak polymerization temperature of the low-modulus cement was much lower (28–30 °C) than that of the high-modulus cement (67 °C), whereas the setting time remained comparable (20–25 min). The Tg of the low-modulus cement was lower (75–78 °C) than that of the high-stiffness cement (103 °C). It was shown that sterilization of linoleic acid by autoclaving did not significantly affect the functional properties of low-modulus PMMA bone cement, making the component suitable for sterile production. Ultimately, the low-modulus cement exhibited handling and mechanical properties that more closely match those of osteoporotic vertebral bone with a screw holding capacity of under 2000 N, making it a promising alternative for use in combination with orthopedic hardware in applications where high-stiffness augmentation materials can result in undesired effects.

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Section: Discussionmentioning

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Functional Properties of Low-Modulus PMMA Bone Cements Containing Linoleic Acid

Robo

Wenner

Ubhayasekera

et al. 2021

JFB

Self Cite

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“…Optimizing the modulus of PMMA could prove to be useful in this case. Low-modulus PMMA was previously proposed for spinal applications (López et al, 2011(López et al, , 2014Holub et al, 2015;Persson et al, 2015) and could be beneficial in PCD, particularly for osteoporotic patients. This method could also serve as a screening phase where different surgical advancements can be evaluated without putting patients at risk.…”

Section: Figure 12mentioning

confidence: 99%

An ex-vivo model for the biomechanical assessment of cement discoplasty

Ghandour

Pazarlis

Lewin

et al. 2022

Front. Bioeng. Biotechnol.

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Percutaneous Cement Discoplasty (PCD) is a surgical technique developed to relieve pain in patients with advanced degenerative disc disease characterized by a vacuum phenomenon. It has been hypothesized that injecting bone cement into the disc improves the overall stability of the spinal segment. However, there is limited knowledge on the biomechanics of the spine postoperatively and a lack of models to assess the effect of PCD ex-vivo. This study aimed to develop a biomechanical model to study PCD in a repeatable and clinically relevant manner. Eleven ovine functional spinal units were dissected and tested under compression in three conditions: healthy, injured and treated. Injury was induced by a papain buffer and the treatment was conducted using PMMA cement. Each sample was scanned with micro-computed tomography (CT) and segmented for the three conditions. Similar cement volumes (in %) were injected in the ovine samples compared to volumes measured on clinical PCD CT images. Anterior and posterior disc heights decreased on average by 22.5% and 23.9% after injury. After treatment, the anterior and posterior disc height was restored on average to 98.5% and 83.6%, respectively, of their original healthy height. Compression testing showed a similar stiffness behavior between samples in the same group. A decrease of 51.5% in segment stiffness was found after injury, as expected. The following PCD treatment was found to result in a restoration of stiffness—showing only a difference of 5% in comparison to the uninjured state. The developed ex-vivo model gave an adequate representation of the clinical vacuum phenomena in terms of volume, and a repeatable mechanical response between samples. Discoplasty treatment was found to give a restoration in stiffness after injury. The data presented confirm the effectiveness of the PCD procedure in terms of restoration of axial stiffness in the spinal segment. The model can be used in the future to test more complex loading scenarios, novel materials, and different surgical techniques.

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“…The values of each component before and after immersion ranged from 0.43 ± 0.11 to1.17 ± 0.96 GPa, and the decreased elastic modulus compared to PMMA bone cement could effectively reduce the risk of fractures in the adjacent vertebrae of osteoporotic bone. 40,41,25 The improved mechanical properties of the DMBC were mainly due to the high mechanical properties of the lamellar GO, 42,43 which interacted with the molecular chain in the bulk, thus leading to the internal threedimensional network structure more stable. While P(MMA-AA)-GO preserved the unique two-dimensional lamellar structure of GO, and its large specific surface area provided more geometric constraints for the flow of P(MMA-AA) molecular chains in the bone cement.…”

Section: Mechanical Propertiesmentioning

confidence: 99%

High water‐absorbent and fast‐expanding PMMA bone cement with double‐bridged structure

Chen

Tang

Zhao

et al. 2021

J of Applied Polymer Sci

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The volume shrinkage of polymethyl methacrylate (PMMA) bone cement has been solved by the expandable additives. However, the water absorption and swelling capacity of composite were not maximized as the rapid solidification of the cement and the poor connectivity of the additives in the matrix. In this study, the double-bridged structure was constructed in PMMA-based bone cement. Poly(methyl methacrylate-acrylic acid)-graphene oxide [P(MMA-AA)-GO] was synthesized by the dispersion polymerization, graphene oxide (GO) with sheet layer formed a bridging effect between the poly(methyl methacrylate-acrylic acid) [P(MMA-AA)], accelerating water absorption; hydroxyethyl methacrylate in the liquid formed capillary networks, which bridged all the expansion units, increasing the pathways of water transfer in the matrix. The double-bridged structure in the composite synergistically accelerated water absorption and swelling, causing complete water absorption and swelling performance before solidification, with maximum water absorption and swelling ratios of 125.2 ± 3.2% and 115.2 ± 4.7%, respectively. Surprisingly, the compressive strength of the composite had also been improved, and the maximum value was 78.3 ± 3.2 MPa, which satisfied the minimum compressive strength of acrylic implants in ISO 5833-2002 and ASTM F451-2016. This biomaterial exhibited a promising application prospect as its excellent expansion capacity and mechanical properties. K E Y W O R D S double-bridged structure, PMMA bone cement, solidification time, water absorption and expansion, water absorption rate 1 | INTRODUCTION Polymethyl methacrylate (PMMA) bone cement, as a rapid molding bone repair material, has been widely used in the clinical range of prosthetic joint fixation and repair of bone defects. 1-5 The molecular rearrangement occurring during polymerization produced a volumetric shrinkage of PMMA bone cement. 6-8 To address this problem, previous studies have focused on controlling the number of hydroxyl groups and the threedimensional network structure in the additives of the bone cement to eliminate shrinkage and impart swelling properties to the matrix. 9-13 However, the following problems have been found in the study of expandable bone cement: (a) The swelling capacity of expandable PMMA bone cement is considered to be not fully utilized as the

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Biomechanics of low-modulus and standard acrylic bone cements in simulated vertebroplasty: A human ex vivo study

Cited by 18 publications

References 48 publications

Functional Properties of Low-Modulus PMMA Bone Cements Containing Linoleic Acid

Functional Properties of Low-Modulus PMMA Bone Cements Containing Linoleic Acid

An ex-vivo model for the biomechanical assessment of cement discoplasty

High water‐absorbent and fast‐expanding PMMA bone cement with double‐bridged structure

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