Effects on articular cartilage of subchondral replacement with polymethylmethacrylate and calcium phosphate cement

Abstract

Bone defects were created in rabbit medial femoral condyle in a model where subchondral bone was completely removed or about 2 mm of subchondral bone was maintained. Groups without augmentation and augmented with autogenous bone, polymethylmethacrylate, or calcium phosphate cement were sacrificed at 3, 12, and 24 weeks for evaluation of articular cartilage and observation of bone formation. In the model in which subchondral bone was completely removed, collapse of the subchondral bone together with exfoliation and prolapse of cartilage developed early in all cases. In the model in which 2 mm of subchondral bone was maintained, degeneration of articular cartilage developed at 12 weeks in the group augmented with polymethylmethacrylate, showing a significant difference when compared to the contralateral untreated control group. The group augmented with calcium phosphate cement did not demonstrate any evident difference from the control group. Mechanical properties after subchondral replacement did not differ between the groups augmented with polymethylmethacrylate and calcium phosphate cement, although calcium phosphate cement was considered histologically superior. Calcium phosphate cement was a reliable subchondral replacement material when the bone defect is adjacent to the articular cartilage.

Standardised cement augmentation of the PFNA using a perforated blade: A new technique and preliminary clinical results. A prospective multicentre trial

“…It has to be noticed that a subchondral presence of the PMMA could possibly influence the overlying cartilage. 44 We did not find any correlation with the amount of injected cement and pain or mobility at follow-up. Due to an exothermic reaction during PMMA cement polymerisation, it is suspected that local bone damage may be induced.…”

Short segment pedicle screw instrumentation and augmentation vertebroplasty in lumbar burst fractures: an experience

“…Combined anterior/posterior approaches are major surgical undertakings for the patient and do not seem to provide any real advantages over the anterior procedure alone [9,[14][15][16]. Transpedicular spongiosaplasty, in which autologous bone grafts are impacted in the vertebral body through the pedicles after reduction to increase the stiffness of the anterior column, was developed and promoted by Daniaux in 1986 as an interesting addition to posterior surgery [17]. Recent studies have shown that this technique does not prevent the recurrence of kyphosis reliably and reproducibly [5,18].…”

Supplemental Bone Grafting in Giant Cell Tumor of the Extremity Reduces Nononcologic Complications

“…It has been suggested that thermal damage from PMMA can contribute to postoperative degenerative changes [8,16,22,23,25,30]. When used in conjunction with PMMA, bone graft increases the distance between the exothermic reaction of PMMA and the articular cartilage, which may protect against thermal injury [3,13,21,23]. Wilkins et al suggested irrigation of the periarticular area with chilled saline as the cement cures as a method of prevention from heat necrosis [33].…”

“…PMMA has a modulus that is between cortical bone and cancellous bone and well above articular cartilage. PMMA acts as a rigid surface, concentrating pressure on the already thin cartilage and subchondral plate tissue [13,15,24]. This may result in cartilage damage, fracture, and arthrosis [13,15,28].…”

“…When the cement polymerizes directly adjacent to a chondral surface, the exothermal reaction may cause thermal necrosis to the articular chondrocytes and increase the time needed for healing in local tissues [16,19,21,23,28,30]. Furthermore, the modulus of PMMA is greater than subchondral bone and cartilage [8,12,13,15,28]. PMMA directly adjacent to articular cartilage may make the patient more susceptible to postoperative articular fractures and early degenerative osteoarthritis [2,8,20,24].…”