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

Abstract

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.

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

“…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].…”

Influence of strontia on various properties of Surgical Simplex® P acrylic bone cement and experimental variants

“…There is widespread agreement on the toxicity and other undesirable characteristics of DMPT [9][10][11]. Thus, there is ongoing research on modifying the composition of commercially available acrylic bone cement brands by, for example, eliminating the pre-polymerized PMMA beads [12], developing alternative radiopacifiers and accelerators [8,13,14] and, in cases where DMPT is retained, reducing its concentration [12].…”

Antibiotic bone cement prophylaxis in joint arthroplasty

“…Il tasso annuale d'infezione è intorno a 0-4% per le protesi cementate [6,7]. Il numero di casi infetti è elevato, in considerazione del grande volume di interventi di artroplastica di ginocchio e anca eseguiti ogni anno (?1 milione di procedure a livello mondiale [8]). L'infezione rappresenta un evento nefasto per il paziente, una macchia per la reputazione del chirurgo, e comporta un elevato costo sociale.…”