Orthopaedic Bone Cements

406 Pages·2008·10.87 MB·English

by  S. Deb (Eds.)

Orthopaedic bone cements
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Orthopaedic bone
cements
Edited by
Sanjukta Deb
Woodhead Publishing and Maney Publishing
on behalf of
The Institute of Materials, Minerals & Mining
CRC Press
Boca Raton Boston New York Washington, DC
Cambridge England
Woodhead Publishing Limited and Maney Publishing Limited on behalf of The
Institute of Materials, Minerals & Mining
Published by Woodhead Publishing Limited, Abington Hall, Granta Park
Great Abington, Cambridge CB21 6AH, England
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First published 2008, Woodhead Publishing Limited and CRC Press LLC
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Contributor contact details
(* = main contact) Chapter 2
Editor Professor B. M. Wroblewski*,
P. D. Siney and P. A. Fleming
Dr Sanjukta Deb The John Charnley Research
King’s College London Institute
Floor 17 Guy’s Tower Wrightington Hospital
GKT Dental Institute Wigan
London Bridge UK
London SE1 9RT E-mail: [email protected]
UK
E-mail: [email protected] Chapter 3
Chapter 1 H. Pandit* and B. H. van Duren
Nuffi eld Orthopaedic Centre
Dr M. Phillips* Windmill Road
Department of Orthopaedics Headington
King’s College Hospital Oxford OX3 7LD
King’s College London UK
UK E-mail: [email protected]
E-mail: [email protected]
Chapter 4
Kush Joshi
Dr John Yeh
King’s College London Medical
St Bartholomew’s and The Royal
School
London Hospitals
King’s College London
Queen Mary, University of London
UK
Department of Neurosurgery
E-mail: [email protected]
The Royal London Hospital
Whitechapel
London E1 1BB
UK
E-mail: [email protected]
xii
Contributor contact details xiii
Chapter 5 Chapter 8
Dr K. Anagnostakos and Dr Sanjukta Deb* and
Dr J. Kelm Dr Garrit Koller
Klinik für Orthopädie und King’s College London
Orthopädische Chirurgie Floor 17 Guy’s Tower
Universitätsklinikum des GKT Dental Institute
Saarlandes London Bridge
Kirrbergerstr. 1 London SE1 9RT
D-66421 Homburg/Saar UK
Germany E-mail: [email protected]
E-mail: [email protected]
Chapter 9
Chapter 6
Dr B. Vázquez Lasa
Dr R. Kowalski* and Department of Biomaterials
R. Schmaehling Institute of Polymer Science and
DePuy CMW Technology (CSIC)
Cornford Road C/Juan de la Cierva, 3
Marton 28006 Madrid
Blackpool FY4 4QQ Spain
UK E-mail: [email protected]
E-mail: [email protected]
Chapter 10
Chapter 7
Professor Maria-Pau Ginebra
Dr Nilesh Patil* Department of Materials Science
Visiting Assistant Professor and Metallurgical Engineering
Department of Orthopedic Surgery Technical University of Catalonia
Stanford Medical Center (UPC)
300 Pasteur Drive Av. Diagonal 647
Stanford 08028 Barcelona
CA 94305 Spain
USA E-mail: [email protected]
E-mail: [email protected]
Chapter 11
Stuart B. Goodman
Robert L. and Mary Ellenburg Dr Nicholas Dunne
Professor of Surgery School of Mechanical and Aero-
Department of Orthopedic Surgery space Engineering
Stanford University Queen’s University Belfast
300 Pasteur Drive, R153 Ashby Building
Stanford Stranmillis Road
CA 94305 Belfast BT9 5AH
USA UK
E-mail: [email protected] E-mail: [email protected]
xiv Contributor contact details
Chapter 12 Chapter 15
Dr A. B. Lennon Dr J. San Román,*
Trinity Centre for Bioengineering B. Vázquez Lasa, M. R. Aguilar
Parsons Building and L. F. Boesel
School of Engineering Department of Biomaterials
Trinity College Dublin 2 Institute of Polymer Science and
Ireland Technology (CSIC)
E-mail: [email protected] C/Juan de la Cierva, 3
28006 Madrid
Chapter 13 Spain
E-mail: [email protected]
Dr Showan N. Nazhat*
Department of Mining and
Chapter 16
Materials Engineering
McGill University Dr T. Miyazaki*
MH Wong Building Graduate School of Life Science
3610 University Street and Systems Engineering
Montreal, Quebec Kyushu Institute of Technology
Canada H3A 2B2 2-4 Hibikino, Wakamatsu-ku
E-mail: [email protected] Kitakyushu 808-0196
Japan
Dr Juan V. Cauich Rodríguez E-mail: [email protected]
Centro de Investigación Cientifi ca
de Yucatan A.C. Professor C. Ohtsuki
Calle 43 # 130 Department of Crystalline Materi-
Col. Chuburna De Hidalgo als Science
Merida, Yucatan Graduate School of Engineering
Mexico Nagoya University
E-mail: [email protected] Furo-cho, Chikusa-ku
Nagoya 464-8603
Chapter 14 Japan
Dr Sanjukta Deb and
Chapter 17
Dr Garrit Koller
King’s College London Professor Sune Larsson
Floor 17 Guy’s Tower Department of Orthopedics
GKT Dental Institute Uppsala University Hospital
London Bridge S-751 85 Uppsala
London SE1 9RT Sweden
UK E-mail: sune.larsson@ortopedi.
E-mail: [email protected] uu.se
1
Bone disease
M. PHILLIPS and K. JOSHI, King’s College London, UK
Abstract: Bone diseases are conditions that result in the impairment of
normal bone function and can make bones physically weaker by the
deterioration of their structure. The most common result in bone
disease is fracture of the affected bone but many other problems are
encountered by patients. This chapter fi rst discusses bone remodelling,
resorption and formation processes in detail, and then gives a
description of the many conditions that can result in impaired bone
quality (e.g. osteoporosis, osteomalacia, etc.). Section 1.9 outlines the
current state of the use of bone cements in the United Kingdom and this
is followed by a description of other potential applications of cements as
their formulations are improved and developed.
Key words: bone disease, bone fracture, osteoporosis, bone cement.
1.1 Bone disease
Bone diseases are conditions that result in the impairment of normal bone
function and can make bones physically weaker by the deterioration of
their structure. Fracture of the affected bone is generally the main result of
bone disease; however, fractures are just one of many problems encoun-
tered by patients. In defi ning bone diseases, which may be alleviated by
cement reconstruction or reinforcement, the processes within bone may be
classifi ed by aetiology, and then by whether the lesions produced by the
disease tend to be monofocal or polyfocal.
Insertion of cement into the axial or appendicular skeleton is clearly an
invasive procedure, and so treatment of polyfocal or diffuse generalised
bone disease in the clinical setting would be directed at the areas of the
skeleton most at risk of mechanical insuffi ciency. These rather obvious
assertions give us a framework for which bone diseases may, currently and
in the future, be amenable to tissue augmentation with cement.
The common bone diseases that currently lead to mechanical insuffi -
ciency of the skeleton are listed in Table 1.1. These disease processes are
further classifi ed in the right-hand column into whether they are usually
involved in only one bone, i.e. are monostotic (MO), or are involved in more
than one bone (polystotic (PO)), or whether they can be both (MO/PO).
Currently, very few conditions are treated by insertion of cement.
The common usage of poly(methylmethacrylate) (PMMA) cement in
3
4 Orthopaedic bone cements
Table 1.1 Common bone diseases that currently lead to mechanical
insuffi ciency of the skeleton
Congenital Osteogenesis imperfecta PO
Vitamin D-resistant rickets PO
Osteopetrosis PO
Melorheostosis
Fibrous dysplasia MO/PO
Haemophilic pseudotumour MO
Metabolic Renal osteodystrophy PO
Diabetes mellitus (Charcot neuropathic joints) MO
Gout MO
Osteomalacia PO
Endocrine Hyperparathyroidism MO/PO
Neoplastic Benign (aneurysmal and simple bone cysts) MO
enchondromata
Giant cell tumours MO/PO
or
Malignant MO
secondary deposits and PO
primary sarcomas MO
Iatrogenic Steroid-induced osteoporosis PO
Cavitation produced by loose implants PO
MO
Traumatic Stress fractures MO
High-impact fractures with bone loss MO
Fracture non-union MO
Infective Osteomyelitis (acute bacterial, tuberculous and other MO
rarer organisms)
Idiopathic Paget’s disease MO/PO
Degenerative Osteoporosis PO
Ganglion cysts of bone MO
Osteoarthritis (to stabilise implants) MO/PO
Arthrosis (to fuse joints) MO
Vascular Avascular necrosis of bone (most commonly hip, MO
lunate, second metatarsal head)
Intraosseous haemangioma MO
orthopaedic surgical practice is illustrated in Table 1.2. Other, usually mono-
stotic, cavitary defects are normally treated by insertion of cancellous bone
graft, harvested from the patient’s iliac wing, in order to provide a matrix
that will become incorporated. In contained defects, graft under load incor-
porates well in most cases; however, in uncontained defects, surgical mea-
sures are taken to contain the graft, such as using metallic mesh.
The disadvantage of bone grafting is that the harvest site is often very
painful postoperatively, and has a signifi cant risk of developing complica-
Bone disease 5
Table 1.2 Current common usage of poly(methylmethacrylate) (PMMA) cement
in orthopaedic surgical practice
Malignant neoplasia In pathological fractures with extensive bone loss, and
patients with relatively short life expectancy
Joint replacement Following infection of a joint prosthesis, antibiotic-
loaded PMMA often used as temporary spacer
Osteomyelitis May occasionally be used with antibiotic in bone at risk
of fracture or with a view to later removal (as
antibiotic carrier)
Osteoporosis To augment fi xation, cement is occasionally inserted into
medulla and once set, drilled to allow screws to hold
more effectively
In vertebral collapse, bone cement is inserted into the
vertebra after balloon kyphoplasty
tions. The most common complications are haematoma or infection. Nerve
injury can occur, often leaving an area of numbness down the lateral thigh.
The donor site can lead to the propagation of a fracture, which can cause
prolonged immobility, and in the most severe cases may require internal
fi xation.
Cancellous bone has little structural strength, and so if structural proper-
ties are required, a cortico-cancellous graft is usually taken. Again, the iliac
wing is the commonest site for harvest. Neighbouring bone can frequently
be used for donor bone, and so the distal radius provides bone for scaphoid
fracture grafting, the calcaneus provides for subtalar joint fusion, the fi bula
or tibia for ankle fusion, or the tibia for midfoot fusions. Cortico-cancellous
grafts revascularise only very slowly, from the ends towards the centre, and
the risk of fracture persists for several years for larger grafts. For this reason,
vascularised grafts have been developed. The most frequently used free
vascularised graft is the fi bula. Donation of a fi bula seems to cause only
moderate morbidity, and it has a reasonable vascular pedicle for anastomo-
sis. However, the operation is often lengthy and persistence of fl ow in the
graft cannot be guaranteed.
With these hazards of bone graft donation and the inherent properties
of graft occasionally not being ideal (e.g. not strong enough, not enough
volume), it is natural that orthopaedic surgeons should be keen to see
progress in the fi eld of biomaterials as applied to the reconstruction of bone
defects. Other chapters in this book will deal with the properties of bone
cements, and this chapter will outline the areas of clinical orthopaedics in
which bone cements are being successfully used. Bone diseases and condi-
tions that mimic bone disease where bone cements can be used are also
discussed. The use of bone cements is primarily related to fi xation of frac-
tures; however, they can also be used in palliation and treatment of joint