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Biomedical Journal 2013Vertebral compression fracture is the most common complication of osteoporosis. It may result in persistent severe pain and limited mobility, and significantly impacts... (Review)
Review
Vertebral compression fracture is the most common complication of osteoporosis. It may result in persistent severe pain and limited mobility, and significantly impacts the quality of life. Vertebroplasty involves a percutaneous injection of bone cement into the collapsed vertebrae by fluorescent guide. The most commonly used bone cement in percutaneous vertebroplasty is based on the polymerization of methylmethacrylate monomers to polymethylmethacrylate (PMMA) polymers. However, information on the properties of bone cement is mostly published in the biomaterial sciences literature, a source with which the clinical community is generally unfamiliar. This review focuses on the chemistry of bone cement polymerization and the physical properties of PMMA. The effects of altering the portions and contents of monomer liquid and polymer powders on the setting time, polymerization temperature, and compressive strength of the cement are also discussed. This information will allow spine surgeons to manipulate bone cement characteristics for specific clinical applications and improve safety.
Topics: Bone Cements; Fractures, Compression; Humans; Polymerization; Polymethyl Methacrylate; Spinal Fractures; Vertebroplasty
PubMed: 23989310
DOI: 10.4103/2319-4170.112750 -
BioMed Research International 2022In this study, the effectiveness and use of bone cement are thoroughly elaborated, and the role of bone cement on percutaneous vertebroplasty (PVP) fixed joints and its...
In this study, the effectiveness and use of bone cement are thoroughly elaborated, and the role of bone cement on percutaneous vertebroplasty (PVP) fixed joints and its distribution on PVP are also elucidated. The aim of this study was to investigate the effect of unilateral and bilateral bone cement distribution on the clinical efficacy of PVP in the treatment of osteoporotic vertebral compression fractures (OVCF) of the thoracolumbar spine. A total of 60 patients with thoracolumbar OVCF (T11-L2) hospitalized in our hospital from January 2020 to January 2021 were studied. All patients had thoracolumbar OVCF. Under the guidance of the C-arm machine, unilateral PVP was performed. According to the distribution of bone cement across the midline, the patients were divided into two groups: the unilateral group (37 cases): bone cement was distributed on one side of the midline of the vertebral body, and the bilateral group (23 cases): bone cement was distributed on both sides of the midline. Visual analogue scale (VAS), vertebral height recovery values, and preoperative and postoperative Cobb's angle were recorded at 3 days, 1 month, 3 months, and 6 months. The differences between the two groups were compared and analyzed to evaluate the clinical efficacy. There was a statistically significant difference in VAS scores between the two groups before and after surgery ( < 0.05), but there was no statistically significant difference in VAS scores between the two groups at 3 days, 1 month, 3 months, and 6 months after surgery ( > 0.05). There were statistically significant differences in vertebral height recovery value and Cobb's angle between the two groups before and after surgery ( < 0.05).
Topics: Bone Cements; Fractures, Compression; Humans; Osteoporotic Fractures; Spinal Fractures; Vertebroplasty
PubMed: 35795309
DOI: 10.1155/2022/6127620 -
Orthopaedics & Traumatology, Surgery &... Feb 2017Hypersensitivity reactions to implants in orthopaedic and trauma surgery are a rare but devastating complication. They are considered as a delayed-type of... (Review)
Review
Hypersensitivity reactions to implants in orthopaedic and trauma surgery are a rare but devastating complication. They are considered as a delayed-type of hypersensitivity reaction (type IV), characterized by an antigen activation of sensitized T-lymphocytes releasing various cytokines and may result in osteoclast activation and bone resorption. Potential haptens are originated from metal alloys or bone-cement. A meta-analysis has confirmed a higher probability of developing a metal hypersensitivity postoperatively and noted a greater risk of failed replacements compared to stable implants. Hypersensitivity to implants may present with a variety of symptoms such as pain, joint effusion, delayed wound/bone healing, persistent secretion, allergic dermatitis (localized or systemic), clicking noises, loss of joint function, instability and failure of the implant. Various diagnostic options have been offered, including patch testing, metal alloy patch testing, histology, lymphocyte transformation test (LTT), memory lymphocyte immunostimulation assay (MELISA), leukocyte migration inhibition test (LIF) and lymphocyte activation test (LAT). No significant differences between in vivo and in vitro methods have been found. Due to unconvincing evidence for screening methods, predictive tests are not recommended for routine performance. Infectious aetiology always needs to be excluded. As there is a lack of evidence on large-scale studies with regards to the optimal treatment option, management currently relies on individual case-by-case decisions. Several options for patients with (suspected) metal-related hypersensitivity exist and may include materials based on ceramic, titanium or oxinium or modified surfaces. Promising results have been reported, but long-term experience is lacking. More large-scaled studies are needed in this context. In patients with bone-cement hypersensitivity, the component suspected for hypersensitivity should be avoided. The development of (predictive) biomarkers is considered as a major contribution for the future.
Topics: Bone Cements; Humans; Hypersensitivity; Orthopedic Procedures; Postoperative Complications; Prostheses and Implants
PubMed: 28043850
DOI: 10.1016/j.otsr.2016.06.021 -
Journal of Orthopaedic Surgery (Hong... 2022Treatment of bone lesions involved with the articular cartilage at the talus is challenging. We report the management of talus lesions, particularly tumors and avascular...
BACKGROUND
Treatment of bone lesions involved with the articular cartilage at the talus is challenging. We report the management of talus lesions, particularly tumors and avascular necrosis (AVN), at the articular surface through treatment with cement augmentation and autologous bone graft.
METHODS
Eight benign bone tumors and three cases of AVN were reviewed retrospectively at a mean follow-up of 56 months (range, 12-162). The mean age of all patients was 36.1 years old (range, 15-73) when assessed between February 2005 and November 2021. Curettage of tumorous and necrotic lesions resulted in significant bone defects filled with bone cement augmentation. Cartilage defects of the talar dome were supported with autologous cancellous bone graft. Tolerable weight-bearing ambulation was permitted immediately after surgery. Radiological and functional evaluations were recorded.
RESULTS
We observed an increase in the average The American Orthopaedic Foot and Ankle Score (AOFAS) ( = .003) and a decrease in the average Visual Analogue Scale pain score ( = .003). There was no statistically significant decrease in ROM before or after surgery ( = .114). Additionally, no talus collapse of the ankle joint occurred. Talar dome status did not aggravate before or after surgery, except for one patient. Despite no radiographic osteoarthritis exacerbation before or after surgery in six patients, five patients had osteoarthritic change.
CONCLUSION
Cement implantation and autologous bone graft performed simultaneously for benign bone tumors with joint cartilage damage and AVN are technically simple, have good outcomes, and may be a suitable alternative to standard treatments.
Topics: Adolescent; Adult; Aged; Bone Cements; Bone Neoplasms; Bone Transplantation; Cartilage Diseases; Humans; Middle Aged; Retrospective Studies; Talus; Transplantation, Autologous; Young Adult
PubMed: 36176213
DOI: 10.1177/10225536221131159 -
Orthopaedic Surgery Feb 2021To investigate the incidence and risk factors of bone cement implantation syndrome (BCIS) in bone tumor surgeries. (Observational Study)
Observational Study
OBJECTIVE
To investigate the incidence and risk factors of bone cement implantation syndrome (BCIS) in bone tumor surgeries.
METHODS
This was a retrospective observational study. We investigated patients who underwent bone tumor surgeries requiring cementation as part of the surgery between March 2016 and January 2018. We reviewed medical records, including formal anesthesia records and operation notes. Patients with complete data files were included. To investigate the general incidence of BCIS in tumor surgeries, patients of all ages, genders and tumor types were included. Vital signs, including oxygen saturation, blood pressure, heart rate, and respiratory rate, were checked and recorded once every 1-2 min after cementation. Accurate time points of cementation were recorded on formal anesthesia record sheets by the anesthesiologists. The definition and severity of BCIS were based on the classification system proposed in previous studies: grade I, moderate hypoxia (SpO <94%) or hypotension (fall in systolic blood pressure >20%); grade II, severe hypoxia (SpO <88%) or hypotension (fall in systolic blood pressure >40%) or unexpected loss of consciousness; and grade III, cardiovascular collapse requiring cardiopulmonary resuscitation. We also compared the incidence of BCIS between those patients with and without possible risk factors, including intraoperative blood loss, arthroplasty, use of an intramedullary device, patient age, gender, tumor location, and preexisting lung cancer or lung metastasis.
RESULTS
A total of 88 patients were included. BCIS occurred in 23 patients, with an incidence of 26.1%. Among them, 19 had grade I and 4 had grade II BCIS. There was no patients with grade III BCIS. The lowest blood pressure occurred within 10 min in 21 (87.5%) patients and within 20 min for all patients. A total of 9 grade I BCIS were self-limiting. The other 10 grade I hypotension cases and all grade II hypotension cases recovered after administration of a vasoconstrictor medication. Preexisting lung cancer or lung metastasis was the risk factor for BCIS; 40.0% of patients (16 in 40 patients) with preexisting lung cancer or metastasis had BCIS, whereas only 14.6% of patients (7 in 48 patients) without lung lesions had BCIS. There was no risk difference in terms of arthroplasty, old age, and increased blood loss. Apart from grades I and II bone cement implantation syndrome, there were no other major complications, including death, cardiovascular events, or cerebrovascular events.
CONCLUSION
Bone cement implantation syndrome is not unusual in bone tumor surgeries, and preexisting lung cancer or lung metastasis is a risk factor.
Topics: Adult; Aged; Bone Cements; Bone Neoplasms; Female; Humans; Incidence; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Risk Factors; Syndrome
PubMed: 33274603
DOI: 10.1111/os.12842 -
World Neurosurgery Apr 2022To study the relationship between distribution of bone cement and intravertebral cleft of patients with Kummell disease on the clinical effect of percutaneous...
OBJECTIVE
To study the relationship between distribution of bone cement and intravertebral cleft of patients with Kummell disease on the clinical effect of percutaneous kyphoplasty (PKP).
METHODS
According to the relationship between the distribution of bone cement and the cleft in the vertebrae, a total of 92 patients with Kummell disease who underwent PKP in our hospital were divided into 2 groups. Specifically, the bone cement of patients in group A was localized in the cleft of the vertebrae and did not infiltrate around the cleft, while that of group B patients not only filled the cleft of the vertebrae, but also distributed diffusely around the cleft of the vertebrae. The amount of bone cement injected, leakage rate, visual analogue scale (VAS) score, Oswestry Disability Index (ODI), and vertebral imaging changes before operation, and 2 days and 1 year after operation were compared between the 2 groups.
RESULTS
The amount of bone cement injected and the permeability of bone cement in group B were higher than those in group A (P < 0.05). The scores of VAS and ODI in both groups were significantly improved after operation, but the two scores in group B were better than those in group A one year after operation. The height of anterior vertebral body and Cobb's angle of kyphosis in the 2 groups were significantly improved after operation, but 1 year after operation, those in group B were better than those in group A.
CONCLUSIONS
PKP was an effective method for treating Kummell disease. At the same time, the relationship between the distribution of bone cement and the cleft in the vertebral body was an important factor affecting the curative effect after PKP. The effect of the distribution pattern of bone cement filled with intravertebral cleft and diffusely distributed around the fissures was better than that of bone cement confined in the vertebral cleft.
Topics: Bone Cements; Fractures, Compression; Humans; Kyphoplasty; Osteoporotic Fractures; Retrospective Studies; Spinal Fractures; Treatment Outcome
PubMed: 35051635
DOI: 10.1016/j.wneu.2022.01.050 -
Orthopaedics & Traumatology, Surgery &... Sep 2022The application of antibiotics loaded bone cement (ALBC) in the revision of failed total knee arthroplasty (TKA) has been widely accepted to reduce risk of... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
The application of antibiotics loaded bone cement (ALBC) in the revision of failed total knee arthroplasty (TKA) has been widely accepted to reduce risk of peri-prosthetic infection. However, the prophylactic use of ALBC in primary TKA remains controversial. This study was aimed to identify the prophylactic effect on peri-prosthetic infection and safety of ALBC in primary TKA.
HYPOTHESIS
The application of ALBC could reduce the risk of peri-prosthetic infection in primary TKA.
MATERIALS AND METHODS
Electronic platforms including PubMed, EMBASE, and CENTRAL were retrieved to identify studies comparing outcomes of prophylactic ALBC and plain cement in primary TKA. For outcomes reported as dichotomous variable and continuous variable, risk ratio (RR) and weighted mean difference (WMD) as well as their 95% confidence intervals (95% CI) were selected as the effect sizes for pooling. While for those outcomes reported the adjusted effect sizes such as odds ratio (OR, derived from multivariate logistic regression), and hazard ratio (HR, derived from multivariate COX proportional hazard model), the reported effect sizes were selected for pooling.
RESULTS
A total of 17 studies with 2,074,844 patients (1,093,920 in ALBC group and 980,924 in plain cement group) were eligible for final inclusion. No significant difference was found between ALBC and plain cement groups both for the unadjusted (RR=1.02, 95% CI: 0.86∼1.21, p=0.832) and adjusted (OR=0.94, 95% CI: 0.76∼1.17, p=0.596) peri-prosthetic infection rate. ALBC application was related to significantly increased length of hospital stay (WMD=0.13, 95% CI: 0.10∼0.17, p<0.001). There was no significance on the difference of operation related adverse events between two groups (RR=1.31, 95% CI: 0.68∼2.52, p=0.420). Significantly increased risks of acute renal failure and readmission, and temporarily increased ototoxicity in ALBC group were reported in one of the primary study.
DISCUSSION
There is no sufficient evidence supporting decreased peri-prosthetic infection rate with ALBC application in primary TKA. What's more, it must be taken into consideration about the safety and added cost of additional impregnated antibiotics.
LEVEL OF EVIDENCE
III; meta-analysis.
Topics: Anti-Bacterial Agents; Arthroplasty, Replacement, Knee; Bone Cements; Humans; Length of Stay; Prosthesis-Related Infections
PubMed: 35552043
DOI: 10.1016/j.otsr.2022.103295 -
World Neurosurgery Aug 2023Percutaneous vertebroplasty and percutaneous kyphoplasty are effective methods to treat acute osteoporotic vertebral compression fractures that can quickly provide... (Review)
Review
Percutaneous vertebroplasty and percutaneous kyphoplasty are effective methods to treat acute osteoporotic vertebral compression fractures that can quickly provide patients with pain relief, prevent further height loss of the vertebral body, and help correct kyphosis. Many clinical studies have investigated the characteristics of bone cement. Bone cement is a biomaterial injected into the vertebral body that must have good biocompatibility and biosafety. The optimization of the characteristics of bone cement has become of great interest. Bone cement can be mainly divided into 3 types: polymethyl methacrylate, calcium phosphate cement, and calcium sulfate cement. Each type of cement has its own advantages and disadvantages. In the past 10 years, the performance of bone cement has been greatly improved via different methods. The aim of our review is to provide an overview of the current progress in the types of modified bone cement and summarize the key clinical findings.
Topics: Humans; Bone Cements; Fractures, Compression; Spinal Fractures; Spine; Vertebroplasty; Osteoporotic Fractures; Kyphoplasty; Treatment Outcome; Retrospective Studies
PubMed: 37087028
DOI: 10.1016/j.wneu.2023.04.048 -
Acta Orthopaedica Sep 2022The evaluation of metaphyseal angular deformities in children includes indication and timing for corrective osteotomy, and possible need for several operations during...
BACKGROUND AND PURPOSE
The evaluation of metaphyseal angular deformities in children includes indication and timing for corrective osteotomy, and possible need for several operations during growth. Gap-fillers are usually autologous bone grafts, which might cause donor site problems. Calcium phosphate (CaP) bone cement may be a possible alternative.
PATIENTS AND METHODS
We performed 15 corrective osteotomies from 2007 to 2013 in 10 children, ages 5 to 18, with Norian SRS bone cement as a gap-filler, in the distal radius (12), proximal radius (1), and proximal humerus (2). Due to growth arrest and gradually increasing malalignments 3/10 children needed 1-3 additional corrections. Locking plates and screws were used except in 1 case at first surgery, aged 5 (K-wires). 2 children needed additional limb lengthening with external fixator.
RESULTS
All osteotomies healed. Postoperative radiographs and CT scans showed good alignment and gradual transformation of cement into bone. Remodeling was visible intraoperatively in patients needing multiple surgeries. Return to earlier osteotomy sites was unproblematic. No adverse events from using CaP cement were experienced.
INTERPRETATION
CaP cement is an alternative to bone grafts in upper extremity metaphyseal corrective osteotomies in children, and also when greater corrections are necessary or several surgeries indicated during the growth period.
Topics: Bone Cements; Calcium Phosphates; Child; Follow-Up Studies; Humans; Humerus; Osteotomy; Radius Fractures; Upper Extremity
PubMed: 36161337
DOI: 10.2340/17453674.2022.4589 -
International Journal of Nanomedicine 2015Osteoporosis is a serious public health problem affecting hundreds of millions of aged people worldwide, with severe consequences including vertebral fractures that are... (Review)
Review
Osteoporosis is a serious public health problem affecting hundreds of millions of aged people worldwide, with severe consequences including vertebral fractures that are associated with significant morbidity and mortality. To augment or treat osteoporotic vertebral fractures, a number of surgical approaches including minimally invasive vertebroplasty and kyphoplasty have been developed. However, these approaches face problems and difficulties with efficacy and long-term stability. Recent advances and progress in nanotechnology are opening up new opportunities to improve the surgical procedures for treating osteoporotic vertebral fractures. This article reviews the improvements enabled by new nanomaterials and focuses on new injectable biomaterials like bone cements and surgical instruments for treating vertebral fractures. This article also provides an introduction to osteoporotic vertebral fractures and current clinical treatments, along with the rationale and efficacy of utilizing nanomaterials to modify and improve biomaterials or instruments. In addition, perspectives on future trends with injectable bone cements and surgical instruments enhanced by nanotechnology are provided.
Topics: Biocompatible Materials; Bone Cements; Humans; Nanomedicine; Nanostructures; Osteoporosis; Spinal Fractures
PubMed: 26316746
DOI: 10.2147/IJN.S85037