Fatigue testing and performance of acrylic bone‐cement materials: State‐of‐the‐art review

Abstract

Over the past three decades or so, a very large volume of literature has been generated on the impact of an assortment of variables on the fatigue lifetimes of a large number of acrylic bone-cement formulations. In the present article, this literature is examined critically to reveal areas of agreement, areas of disagreement, as well as a welter of underexplored and unexplored topics. For example, there is unanimity of support for the notion that an increase in the molecular weight of the powder constituents or the fully cured cement leads to an increase in the cement's fatigue life, whereas there is disagreement as to whether vacuum mixing the cement constituents leads to an increase in the fatigue life of the fully cured cement (relative to the hand-mixed counterpart). Among the underexplored topics is systematic study of the effect of test frequency on the fatigue results, whereas determination of the optimal concentration of the antibiotic in an antibiotic-loaded cement is an example of the unexplored topics. It is pointed out that resolving the controversies, addressing the underexplored topics, and filling the lacunae will allow comprehensive evaluations of acrylic bone-cement materials to be made. This enhanced body of knowledge will prove invaluable in the continued use of acrylic bone cement as the anchoring agent in cemented arthroplasties.

Compressive fatigue properties of a commercially available acrylic bone cement for vertebroplasty

“…bone!cements!used!in!TJRs!have!been!extensively!investigated! (Charnley!1960;! Lewis!2003),!there!are!very!few!reports!on!the!fatigue!properties!of!acrylic!bone!…”

Nanoparticulate fillers improve the mechanical strength of bone cement

“…Commercial acrylic or polymethylmethacrylate (PMMA) bone cements have been used successfully in total joint replacement surgery for over four decades, and have been thoroughly characterized (Saha and Pal 1984, Krause and Mathis 1988, Demian and McDermott 1998, Lewis 2003. Fatigue and fracture properties of cement continue to be investigated since cement failure can lead to undesirable particle shedding or fracture.…”

An Approach for Determining Antibiotic Loading for a Physician-directed Antibiotic-loaded PMMA Bone Cement Formulation

“…Nonetheless, these properties are relevant to the in vivo performance of cemented total joint arthroplasties. It has been postulated that fatigue of one or more of the cement zones (implant-cement interface, cement mantle, and cement-bone interface) is a key factor adversely affecting the in vivo longevity of a cemented arthroplasty [17,18]. We recognize, however, that there are other possible limiting phenomena for cemented arthroplasties, such as aseptic loosening caused by particleinduced osteolysis [11].…”