The effect of intramedullary polymethylmethacrylate on healing of intercalary cortical allografts in a canine model

Abstract

The purpose of this study was to evaluate the effect of intramedullary polymethylmethacrylate (PMMA) bone cement on the healing of intercalary allografts. Thirteen adult beagles had bilateral intercalary femoral allografts implanted. The medullary canal of one randomly assigned allograft in each dog was filled with PMMA. Healing was followed clinically and femora were evaluated radiographically, biomechanically, histologically, and histomorphometrically 9 months after surgery. There was an increased percent of eroded surface at the endosteal area of the center region of grafts containing PMMA and there was an increased percent osteoblast surface in this area in grafts not containing PMMA. There was an increased percent eroded surface at the periosteal area in the center region in grafts not containing PMMA and there was an increased percent osteoblast surface at the periosteal area in the graft adjacent to the host junction in grafts containing PMMA. There was no significant difference between PMMA-treated and untreated allografts in any other parameters measured. The results from this study suggest that, although the pattern of incorporation is altered, intramedullary PMMA does not appear to effect allograft healing adversely.

Large segment allograft survival is improved with intramedullary cement

“…Intramedullary cement used in conjunction with dynamic compression plates significantly reduces the magnitude of these effects by load sharing, providing improved initial fixation requiring only a small number of unicortical screws placed into the cement column, and reducing the risk that the bone-cementscrew fixation will fail mechanically. The low allograft fracture rate in this study using intramedullary cement and plate fixation supports previous animal and human investigations of this technique [3,[12][13][14]. The MSTS 1987 score range (0-35) was converted to a percentage.…”

Results of 32 Allograft-prosthesis Composite Reconstructions of the Proximal Femur

“…Factors affecting bone union are bone grafting at the junction, postoperative chemotherapy, and radiotherapy [17,19]. Although use of intramedullary cement reportedly offers stability without adverse effects on healing [40], it is important that no cement be placed at the host-bone allograft junction during fixation of the stem and that cancellous bone be added at the periosteal surface [17]. McGoveran et al proposed using an uncemented stem to improve the chances of hostgraft bone union through compression loading [30] ( Table 5).…”

Tissue responses around polymethylmethacrylate particles implanted into bone: Analysis of expression of bone matrix protein mRNAs by in situ hybridization

“…PMMA bone cement has been used in orthopedic surgery with good results, although a fibrous capsule attributed to aseptic loosening forms around the implants. [8][9][10][11][12] However, the biological effects of PMMA cement on osteoblast differentiation are unclear. This is the first study on the effects of PMMA cement on osteoblast differentiation using in situ hybridization.…”

“…For example, polymethylmethacrylate (PMMA) is widely used as a bone cement for prosthetic fixation but does not bond to bone directly, leading eventually to aseptic loosening. [8][9][10][11][12] To overcome these drawbacks, many researchers have tried to give these biomaterials the ability to bond to bone directly, [13][14][15][16] and there are several reports regarding the interactions between bone cement particles and periprosthetic tissues. However, because most of these findings have been based on histological and histomorphometric analysis [8][9][10][11][12] or in vitro analysis, 17,18 little is known about the series of events occurring at the cellular level in vivo.…”