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Compressive fatigue properties of commercially available standard and low-modulus acrylic bone cements intended for vertebroplasty
Uppsala University, Disciplinary Domain of Science and Technology, Technology, Department of Engineering Sciences, Applied Materials Sciences.ORCID iD: 0000-0003-4139-6913
Uppsala University, Disciplinary Domain of Science and Technology, Technology, Department of Engineering Sciences, Applied Materials Sciences.ORCID iD: 0000-0003-2709-9541
Uppsala University, Disciplinary Domain of Science and Technology, Technology, Department of Engineering Sciences, Applied Materials Sciences.ORCID iD: 0000-0001-6663-6536
2018 (English)In: Journal of The Mechanical Behavior of Biomedical Materials, ISSN 1751-6161, E-ISSN 1878-0180, Vol. 82, p. 70-76Article in journal (Other (popular science, discussion, etc.)) Published
Abstract [en]

Vertebroplasty (VP) is a minimally invasive surgical procedure commonly used to relieve severe back pain associated with vertebral compression fractures. The poly(methyl methacrylate) bone cement used during this procedure is however presumed to facilitate the occurrence of additional fractures next to the treated vertebrae. A reason for this is believed to be the difference in stiffness between the bone cement and the surrounding trabecular bone. The use of bone cements with lower mechanical properties could therefore reduce the risk of complications post-surgery. While intensive research has been performed on the quasi-static mechanical properties of these cements, there is no data on their long-term mechanical properties. In the present study, the in vitrocompressive fatigue performance as well as quasi-static mechanical properties of two commercially available acrylic bone cements - a low-modulus cement (Resilience®) and a standard cement (F20) from the same manufacturer - were determined. The quasi-static mechanical properties of the low-modulus and standard cements after 24h of setting were in the range of other vertebroplastic cements (σ=70-75 MPa; E=1600-1900 MPa). F20 displayed similar mechanical properties over time in 37˚C phosphate buffered saline solution, while the mechanical properties of the Resilience®cement decreased gradually due to an increased porosity in the polymeric matrix. The standard cement exhibited a fatigue limit of approx. 47 MPa, whereas the low-modulus cement showed a fatigue limit of approx. 31 MPa. 

In summary, the low-modulus bone cement had a lower fatigue limit than the standard cement, as expected. However, this fatigue limit is still substantially higher than the stresses experienced by vertebral trabecular bone.  

Place, publisher, year, edition, pages
Elsevier, 2018. Vol. 82, p. 70-76
Keywords [en]
Acrylic bone cement, low-modulus, elastic modulus, compression, fatigue, vertebroplasty
National Category
Other Materials Engineering
Research subject
Engineering Science with specialization in Materials Science
Identifiers
URN: urn:nbn:se:uu:diva-349032DOI: 10.1016/j.jmbbm.2018.03.001OAI: oai:DiVA.org:uu-349032DiVA, id: diva2:1199301
Available from: 2018-04-20 Created: 2018-04-20 Last updated: 2018-05-09Bibliographically approved
In thesis
1. Bone-compliant cements for vertebral augmentation
Open this publication in new window or tab >>Bone-compliant cements for vertebral augmentation
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Acrylic bone cement based on poly(methyl methacrylate) (PMMA) is commonly used during vertebral augmentation procedures for the treatment of osteoporosis-induced vertebral compression fractures. However, the high stiffness of the cement compared to that of the surrounding trabecular bone is presumed to facilitate the formation of new fractures shortly after surgery. The aim of the thesis was to develop and evaluate a PMMA-based bone cement that better matches the mechanical properties of vertebral trabecular bone. To fulfill this objective, different compounds were added to the initial formulation of bone cement to modify its functional properties. Linoleic acid (LA) was found to give the best combination of strength and stiffness without negative effects on the handling properties and its use was therefore further investigated. In particular, different application-specific mechanical properties of LA-modified cement as well as itsin vivoperformance in an ovine model were assessed. 

In summary, LA-modified cement exhibited bone-compliant mechanical properties immediately after incorporation of the additive, as well as adequate handling properties, in particular a lower polymerization temperature and appropriate setting time. The screw pullout strength from low-modulus cement was substantially reduced compared to regular PMMA cement, but comparable to some calcium phosphate based cements. The fatigue limit of LA-modified cement was considerably lower compared to regular PMMA bone cement when tested in physiological solution, but still higher than stresses measured in the spine during daily activities. The modified cement displayed similar inflammatory response in vivoto conventional cement, with no evidence of additional cytotoxicity due to the presence of LA. Finally, it was possible to sterilize the additive without significantly compromising its function in the PMMA cement.

The results from this thesis support further evaluation of the material towards the intended clinical application. 

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2018. p. 92
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Science and Technology, ISSN 1651-6214 ; 1676
Keywords
bone cement, low modulus, vertebroplasty
National Category
Materials Engineering
Research subject
Engineering Science with specialization in Materials Science
Identifiers
urn:nbn:se:uu:diva-349028 (URN)978-91-513-0351-2 (ISBN)
Public defence
2018-06-07, Häggsalen, Ångströmlaboratoriet, Lägerhyddsvägen 1, Uppsala, 09:00 (English)
Opponent
Supervisors
Available from: 2018-05-16 Created: 2018-04-20 Last updated: 2018-05-16

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Robo, CélineÖhman, CarolinePersson, Cecilia

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