Comparison of biomechanical properties of calcium phosphate/polymethyl methacrylate composite bone cement and polymethyl methacrylate bone cement

doi:10.12307/2022.241

Abstract

Abstract: BACKGROUND: Polymethyl methacrylate (PMMA) is the most widely used bone cement in vertebral body reinforcement, but it still has some defects such as excessive elastic modulus. The in vitro mechanical test of bone cement for how to reduce its elastic modulus has a certain significance for guiding clinical practice.
OBJECTIVE: To measure compressive strength of PMMA bone cement and its composite bone cement after adding self-solidifying calcium phosphate artificial bone, and evaluate the effect of adding calcium phosphate artificial bone on the elastic modulus of PMMA bone cement.
METHODS: PMMA (100%), calcium phosphate/PMMA (87%) and calcium phosphate/PMMA (76%) bone cement were prepared by adding calcium phosphate artificial bone (0, 4, 8 g) and PMMA (26 g) to liquid phase monomer, respectively, and injected into the standard experimental module of human cancellous bone to prepare human osteoporosis model. The ultimate compressive strength and elastic modulus of each model were measured by standard compression test. PMMA (100%), calcium phosphate/PMMA (87%) and calcium phosphate/PMMA (76%) bone cement were prepared into cylindrical standard bone cement specimens; the highest curing temperature and the time required for each sample to reach the highest curing temperature were determined; and the ultimate compressive strength and elastic modulus of each model were measured by standard compression test.
RESULTS AND CONCLUSION: (1) In the bone cement standard specimen model, the maximum compressive strength and elastic modulus of calcium phosphate/PMMA (87%) group and calcium phosphate/PMMA (76%) group were lower than those of PMMA (100%) group (P < 0.05), and the compressive strength of calcium phosphate/PMMA (76%) group was lower than that of calcium phosphate/PMMA (87%) (P < 0.05). The maximum curing temperature of calcium phosphate/PMMA composite bone cement was lower than that of PMMA bone cement, and there was no significant change in solidification time. (2) In the osteoporosis model, the maximum compressive strength of calcium phosphate/PMMA (87%) group and calcium phosphate/PMMA (76%) group was lower than that of PMMA (100%) group (P < 0.05); and the elastic modulus of calcium phosphate/PMMA (76%) group was lower than that of calcium phosphate/PMMA (87%) group (P < 0.05). (3) The results show that adding calcium phosphate to PMMA bone cement can reduce the elastic modulus. In a certain range, calcium phosphate/PMMA composite bone cement has better mechanical and structural properties than PMMA bone cement, and there is no obvious change in controllability, so it can be used for vertebral body reinforcement.

Key words: bone cement, biomechanics, vertebroplasty, polymethyl methacrylate, self-curing calcium phosphate artificial bone, polyurethane rigid foam

CLC Number:

Li Shengkai, Li Tao, Wei Chao, Shi Ming. Comparison of biomechanical properties of calcium phosphate/polymethyl methacrylate composite bone cement and polymethyl methacrylate bone cement[J]. Chinese Journal of Tissue Engineering Research, 2022, 26(16): 2461-2466.

Figures/Tables 3

References

[1] HE Z, ZHAI Q, HU M, et al. Bone cements for percutaneous vertebroplasty and balloon kyphoplasty: Current status and future developments. J Orthop Translat. 2014;3(1):1-11.
[2] RIEK AE, TOWLER DA. The pharmacological management of osteoporosis. Mo Med. 2011;108(2):118-123.
[3] KALLMES DF, JENSEN ME. Percutaneous vertebroplasty. Radiology. 2003;229(1):27-36.
[4] WANG H, SRIBASTAV SS, YE F, et al. Comparison of Percutaneous Vertebroplasty and Balloon Kyphoplasty for the Treatment of Single Level Vertebral Compression Fractures: A Meta-analysis of the Literature. Pain Physician. 2015;18(3):209-222.
[5] HEINI PF, WÄLCHLI B, BERLEMANN U. Percutaneous transpedicular vertebroplasty with PMMA: operative technique and early results. A prospective study for the treatment of osteoporotic compression fractures. Eur Spine J. 2000;9(5):445-450.
[6] LIN D, HAO J, LI L, et al. Effect of Bone Cement Volume Fraction on Adjacent Vertebral Fractures After Unilateral Percutaneous Kyphoplasty. Clin Spine Surg. 2017;30(3):E270-E275.
[7] FRIEDMAN CD, COSTANTINO PD, TAKAGI S, et al. BoneSource hydroxyapatite cement: a novel biomaterial for craniofacial skeletal tissue engineering and reconstruction. J Biomed Mater Res. 1998;43(4): 428-432.
[8] MILLER PD. Management of severe osteoporosis. Expert Opin Pharmacother. 2016;17(4):473-488.
[9] KHANNA AJ, LEE S, VILLARRAGA M, et al. Biomechanical evaluation of kyphoplasty with calcium phosphate cement in a 2-functional spinal unit vertebral compression fracture model. Spine J. 2008;8(5):770-777.
[10] KIM SB, KIM YJ, YOON TL, et al. The characteristics of a hydroxyapatite-chitosan-PMMA bone cement. Biomaterials. 2004;25(26):5715-5723.
[11] ORYAN A, ALIDADI S, BIGHAM-SADEGH A, et al. Healing potentials of polymethylmethacrylate bone cement combined with platelet gel in the critical-sized radial bone defect of rats. PLoS One. 2018;13(4): e0194751.
[12] PAHLEVANZADEH F, BAKHSHESHI-RAD HR, ISMAIL AF, et al.
Development of PMMA-Mon-CNT bone cement with superiormechanical properties and favorable biological properties for use in bone-defect treatment. Mater Lett. 2019;240:9-12.
[13] BUCHTOVÁ N, D’ORLANDO A, JUDEINSTEIN P, et al. Water dynamics in silanized hydroxypropyl methylcellulose based hydrogels designed for tissue engineering. Carbohydr Polym. 2018;202:404-408.
[14] BAUDÍN C, BENET T, PENA P. Effect of graphene on setting and mechanical behaviour of tricalcium phosphate bioactive cements. J Mech Behav Biomed Mater. 2019;89:33-47.
[15] SMITH BT, LU A, WATSON E, SANTORO M, et al. Incorporation of fast dissolving glucose porogens and poly(lactic-co-glycolic acid) microparticles within calcium phosphate cements for bone tissue regeneration. Acta Biomater. 2018;78:341-350.
[16] APARICIO JL, RUEDA C, MANCHÓN Á, et al. Effect of physicochemical properties of a cement based on silicocarnotite/calcium silicate on in vitro cell adhesion and in vivo cement degradation. Biomed Mater. 2016;11(4):045005.
[17] CHEN Z, LIU H, LIU X, et al. Injectable calcium sulfate/mineralized collagen-based bone repair materials with regulable self-setting properties. J Biomed Mater Res A. 2011;99(4):554-563.
[18] BAE H, SHEN M, MAURER P, et al. Clinical experience using Cortoss for treating vertebral compression fractures with vertebroplasty and kyphoplasty: twenty four-month follow-up. Spine (Phila Pa 1976). 2010;35(20):E1030-1036.
[19] YANG J, ZHANG KR, FAN JP, et al.Preparation of calcium phosphate cement and polymethyl methacrylate for biological composite bone cements. Med Sci Monit. 2015;21:1162-1172.
[20] HOLUB O, LÓPEZ A, BORSE V, et al. Biomechanics of low-modulus and standard acrylic bone cements in simulated vertebroplasty: A human ex vivo study. J Biomech. 2015;48(12):3258-3266.
[21] ROBO C, HULSART-BILLSTRÖM G, NILSSON M, et al. In vivo response to a low-modulus PMMA bone cement in an ovine model. Acta Biomater. 2018;72:362-370.
[22] RHO JY, KUHN-SPEARING L, ZIOUPOS P. Mechanical properties and the hierarchical structure of bone. Med Eng Phys. 1998;20(2):92-102.
[23] PHAKATKAR AH, SHIRDAR MR, QI ML, et al. Novel PMMA bone cement nanocomposites containing magnesium phosphate nanosheets and hydroxyapatite nanofibers. Mater Sci Eng C Mater Biol Appl. 2020; 109:110497.
[24] BOGER A, BOHNER M, HEINI P, et al. Properties of an injectable low modulus PMMA bone cement for osteoporotic bone. J Biomed Mater Res B Appl Biomater. 2008;86(2):474-482.
[25] BOGER A, BISIG A, BOHNER M, et al. Variation of the mechanical properties of PMMA to suit osteoporotic cancellous bone. J Biomater Sci Polym Ed. 2008;19(9):1125-1142.
[26] GUTIÉRREZ-MEJÍA A, HERRERA-KAO W, DUARTE-ARANDA S, et al. Synthesis and characterization of core-shell nanoparticles and their influence on the mechanical behavior of acrylic bone cements. Mater Sci Eng C Mater Biol Appl. 2013;33(3):1737-1743.
[27] LÓPEZ A, HOESS A, THERSLEFF T, et al. Low-modulus PMMA bone cement modified with castor oil. Biomed Mater Eng. 2011;21(5-6): 323-332.
[28] CUCURUZ AT, ANDRONESCU E, FICAI A, et al. Synthesis and characterization of new composite materials based on poly(methacrylic acid) and hydroxyapatite with applications in dentistry. Int J Pharm. 2016;510(2):516-523.
[29] BAI H, WALSH F, GLUDOVATZ B, et al. Bioinspired Hydroxyapatite/Poly(methyl methacrylate) Composite with a Nacre-Mimetic Architecture by a Bidirectional Freezing Method. Adv Mater. 2016; 28(1):50-56.
[30] BAI M, YIN H, ZHAO J, et al. Application of PMMA bone cement composited with bone-mineralized collagen in percutaneous kyphoplasty. Regen Biomater. 2017;4(4):251-255.
[31] CHEN LH, TAI CL, LEE DM, et al. Pullout strength of pedicle screws with cement augmentation in severe osteoporosis: a comparative study between cannulated screws with cement injection and solid screws with cement pre-filling. BMC Musculoskelet Disord. 2011;12:33.
[32] GOLDSTEIN SA. The mechanical properties of trabecular bone: dependence on anatomic location and function. J Biomech. 1987; 20(11-12):1055-1061.
[33] MORGAN EF, KEAVENY TM. Dependence of yield strain of human trabecular bone on anatomic site. J Biomech. 2001;34(5):569-577.
[34] GÓMEZ S, VLAD MD, LÓPEZ J, et al. Characterization and three-dimensional reconstruction of synthetic bone model foams. Mater Sci Eng C Mater Biol Appl. 2013;33(6):3329-3335.
[35] Sawbones®EuropeAB[http://www.sawbones.com/products/bio/testblocks/rigidfoam.aspx]
[36] International Organization for Standardization standard 5833 (ISO 5833). https://www.iso.org/home.html
[37] MONTAÑO CJ, CAMPOS TPR, LEMOS BRS, et al. Effects of hydroxyapatite on PMMA-HAp cement for biomedical applications. Biomed Mater Eng. 2020;31(3):191-201.
[38] BOGER A, WHEELER KD, SCHENK B, et al. Clinical investigations of polymethylmethacrylate cement viscosity during vertebroplasty and related in vitro measurements. Eur Spine J. 2009;18(9):1272-1278.
[39] LU Q, LIU C, WANG D, et al. Biomechanical evaluation of calcium phosphate-based nanocomposite versus polymethylmethacrylate cement for percutaneous kyphoplasty. Spine J. 2019;19(11):1871-1884.
[40] GHAFFARI S, SOLATI-HASHJIN M, ZABIHI-NEYSHABOURI E, et al. Novel calcium phosphate coated calcium silicate-based cement: in vitro evaluation. Biomed Mater. 2020;15(3):035008.
[41] AGHYARIAN S, HU X, HADDAS R, et al. Biomechanical behavior of novel composite PMMA-CaP bone cements in an anatomically accurate cadaveric vertebroplasty model. J Orthop Res. 2017;35(9):2067-2074.
[42] DENG XG, XIONG XM, CUI W, et al. Preliminary application of CPC/PMMA composite bone cement in kyphoplasty for the elderly. Zhongguo Gu Shang. 2020;33(9):831-836.
[43] JI X, XU F, DONG G, et al. Loading necrostatin-1 composite bone cement inhibits necroptosis of bone tissue in rabbit. Regen Biomater. 2019; 6(2):113-119.
[44] KIM HW, KIM HE, SALIH V. Stimulation of osteoblast responses to biomimetic nanocomposites of gelatin-hydroxyapatite for tissue engineering scaffolds. Biomaterials. 2005;26(25):5221-5230.
[45] TAN F, NACIRI M, DOWLING D, et al. In vitro and in vivo bioactivity of CoBlast hydroxyapatite coating and the effect of impaction on its osteoconductivity. Biotechnol Adv. 2012;30(1):352-362.
[46] CAMPANA V, MILANO G, PAGANO E, et al. Bone substitutes in orthopaedic surgery: from basic science to clinical practice. J Mater Sci Mater Med. 2014;25(10):2445-2461.
[47] DALBY MJ, DI SILVIO L, HARPER EJ, et al. Increasing hydroxyapatite incorporation into poly(methylmethacrylate) cement increases osteoblast adhesion and response. Biomaterials. 2002;23(2):569-576.