Orthopaedic Bone Cements

411 Pages·2008·2.953 MB·English

by  Sanjukta Deb

Orthopaedic bone cements
Related titles:
Bioceramicsandtheirclinicalapplications
(ISBN 978-1-84569-204-9)
Bioceramicsandtheirclinicalapplications provides an authoritative review of this
highly active area of research, written by leading academics from around the world.
Chapters in the first section of the book discuss issues of significance to a range of
bioceramics, such as their structure, mechanical properties and biological interac-
tions. The second part reviews the fabrication, microstructure and properties of
specific bioceramics and glasses, concentrating on the most promising materials. The
final group of chapters reviews the clinical applications of bioceramics.
Jointreplacementtechnology:Newdevelopments
(ISBN 978-1-84569-245-2)
This book comprehensively reviews developments in joint replacement technology,
covering the most pertinent materials science and engineering issues, specific joints,
clinical trial results and sterilisation techniques. Part I discusses biomechanics,
tribology, the chemical environment of the body and an overview of materials and
engineering of joint replacement. The second part of the book reviews specific
materials, bearing surfaces and bone cements, in addition to the failure mechanisms
and lifetime prediction of joints. Part III discusses the biological environment and
interaction of replacement joints. Specific joints are analysed in detail in Part IV.
Biomedicalpolymers
(ISBN 978-1-84569-070-0)
This book reviews the structure, processing and properties of biomedical polymers.
It discusses the various groups of biopolymers including natural polymers, synthetic
biodegradable and non-biodegradable polymers. Chapters also review the applica-
tion of biomedical polymers in such areas as scaffolds for tissue engineering, drug
delivery systems and cell encapsulation. The book also considers the use of polymers
in replacement heart valves and arteries, in joint replacement and in biosensor
applications.
Details of these and other Woodhead Publishing materials books as well as
materials books from Maney Publishing can be obtained by:
• visiting our website at www.woodheadpublishing.com
• contacting Customer Services (e-mail: [email protected]; fax:
[phone]; tel.: [phone] ext.130; address: Woodhead
Publishing Ltd, Abington Hall, Abington, Cambridge CB21 6AH, England)
If you would like to receive information on forthcoming titles, please send your
address details to: Francis Dodds (address, tel. and fax as above; e-mail: francisd@
woodhead-publishing.com). Please confirm which subject areas you are interested
in.
Maney currently publishes 16 peer-reviewed materials science and engineering
journals. For further information visit www.maney.co.uk/journals
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
www.woodheadpublishing.com
Published in North America by CRC Press LLC, 6000 Broken Sound Parkway,
NW, Suite 300, Boca Raton, FL 33487, USA
First published 2008, Woodhead Publishing Limited and CRC Press LLC
The authors have asserted their moral rights.
This book contains information obtained from authentic and highly regarded
sources. Reprinted material is quoted with permission, and sources are indicated.
Reasonable efforts have been made to publish reliable data and information, but
the authors and the publishers cannot assume responsibility for the validity of all
materials. Neither the authors nor the publishers, nor anyone else associated with
this publication, shall be liable for any loss, damage or liability directly or
indirectly caused or alleged to be caused by this book.
Neither this book nor any part may be reproduced or transmitted in any form
or by any means, electronic or mechanical, including photocopying, microfilming
and recording, or by any information storage or retrieval system, without
permission in writing from Woodhead Publishing Limited.
The consent of Woodhead Publishing Limited does not extend to copying for
general distribution, for promotion, for creating new works, or for resale. Specific
permission must be obtained in writing from Woodhead Publishing Limited for
such copying.
Trademark notice: Product or corporate names may be trademarks or registered
trademarks, and are used only for identification and explanation, without intent to
infringe.
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library.
Library of Congress Cataloging in Publication Data
A catalog record for this book is available from the Library of Congress.
Woodhead Publishing ISBN 978-1-84569-376-3 (book)
Woodhead Publishing ISBN 978-1-84569-517-0 (e-book)
CRC Press ISBN 978-1-4200-9302-5
CRC Press order number WP9302
The publishers’ policy is to use permanent paper from mills that operate a
sustainable forestry policy, and which has been manufactured from pulp which is
processed using acid-free and elementary chlorine-free practices. Furthermore,
the publishers ensure that the text paper and cover board used have met
acceptable environmental accreditation standards.
Typeset by SNP Best-set Typesetter Ltd., Hong Kong
Printed by TJ International Limited, Padstow, Cornwall, England
Contents
Contributor contact details xii
Part I Bone cements in medicine 1
1 Bone disease 3
M. Phillips and K. Joshi, King’s College London, UK
1.1 Bone disease 3
1.2 Osteoporosis 8
1.3 Osteomalacia and rickets 15
1.4 Paget’s disease (osteitis deformans) 18
1.5 Malignancy 20
1.6 Hyperparathyroidism 25
1.7 Osteomyelitis 26
1.8 Prosthesis-related infection 28
1.9 Current state of the use of bone cement in
the United Kingdom 30
1.10 Other potentially useful applications of cements in bone 33
1.11 Summary 34
1.12 Acknowledgement 34
1.13 References 34
2 Hip replacements 41
B. M. Wroblewski, P. D. Siney and P. A. Fleming,
The John Charnley Research Institute, UK
2.1 Introduction 41
2.2 General principles 42
2.3 Bone cements 43
2.4 Fixation of components with cement 44
2.5 Long-term results 44
v
vi Contents
2.6 Long-term problems 45
2.7 Future trends 46
2.8 References 46
3 Knee replacements 48
H. Pandit and B. H.van Duren, Nuffield Orthopaedic
Centre, UK
3.1 Relevant anatomy of the knee joint 48
3.2 Conditions causing knee arthritis 49
3.3 Clinical and radiological assessment of an arthritic knee 52
3.4 Treatment options for osteoarthritis 54
3.5 Indicators for total knee replacement 56
3.6 Evolution of knee replacements 57
3.7 Implant design rationales 58
3.8 The cemented total knee replacement 63
3.9 Future trends 70
3.10 References 70
4 Vertebroplasty and kyphoplasty 74
J. Yeh, St Bartholomew’s and The Royal London
Hospitals, UK
4.1 Introduction 74
4.2 Vertebral compression fractures 74
4.3 Kyphoplasty and vertebroplasty 77
4.4 Clinical outcomes 78
4.5 Clinical experiences with injectable bone cements 81
4.6 Future trends 86
4.7 References 87
5 Antibiotic-impregnated polymethylmethacrylate
(PMMA) spacers in hip surgery 92
K. Anagnostakos and J. Kelm, Universitätsklinikum des
Saarlandes, Germany
5.1 Introduction 92
5.2 Construction of hip spacers 94
5.3 Diagnosis of infection 95
5.4 Consistency and function of antibiotic-loaded
hip spacers 96
5.5 Mechanical stability and behaviour of hip spacers 97
5.6 Pathogenic organisms 98
5.7 Antibiotic choice 98
5.8 Antibiotic elution 100
5.9 Clinical experience 101
Contents vii
5.10 Girdlestone or spacer? 107
5.11 New techniques 108
5.12 Conclusions 108
5.13 References 109
6 Commercial aspects and delivery systems of
bone cements 113
R. Kowalski and R. Schmaehling, DePuy CMW, UK
6.1 Introduction 113
6.2 Commercial aspects: cemented versus cementless fixation 114
6.3 Mixing and delivery systems of bone cements 121
6.4 Regulatory aspects 135
6.5 Future trends 136
6.6 Conclusions 137
6.7 References 137
7 Wear particles and osteolysis 140
N. Patil and S. B. Goodman, Stanford Medical Center, USA
7.1 Introduction 140
7.2 Cellular cascade and mediators of osteolysis 141
7.3 Morphology and bioreactivity of wear debris 143
7.4 Osteolysis 144
7.5 Cement debris 146
7.6 Polyethylene wear debris 150
7.7 Metallic wear debris 152
7.8 Ceramic wear debris 153
7.9 Future trends 154
7.10 References 155
Part II Materials 165
8 Acrylic bone cement: genesis and evolution 167
S. Deb and G. Koller, King’s College London, UK
8.1 Introduction 167
8.2 Hip and knee joint 169
8.3 Acrylic bone cement 170
8.4 Regulatory perspectives 175
8.5 Sterilization of bone cements 176
8.6 Fluoride and other additives in bone cements 178
8.7 Other applications of acrylic bone cement 179
8.8 Conclusions 180
8.9 References 181
viii Contents
9 Poly(methylmethacrylate) bone cement: chemical
composition and chemistry 183
B. Vázquez Lasa, Institute of Polymer Science and
Technology (CSIC) and CIBER-BBN, Spain
9.1 Introduction 183
9.2 Chemical composition 184
9.3 Setting process 186
9.4 Polymerisation reaction and kinetics 187
9.5 Free radical studies on acrylic bone cements 190
9.6 Curing parameters: standards 191
9.7 Rheology of acrylic bone cements 193
9.8 Low molecular weight residuals after curing 195
9.9 Future trends 197
9.10 References 200
10 Calcium phosphate bone cements 206
M. P. Ginebra, Technical University of Catalonia (UPC),
Spain
10.1 Introduction 206
10.2 Historical overview: calcium phosphate cements versus
acrylic cements 207
10.3 Chemistry of calcium phosphate cements 208
10.4 Basic properties of calcium phosphate cements 213
10.5 Applications of calcium phosphate cements: present and
future perspectives 221
10.6 References 224
Part III Properties of bone cement 231
11 Mechanical properties of bone cements 233
N. Dunne, Queen’s University Belfast, UK
11.1 Introduction 233
11.2 Nature and structure of polymethylmethacrylate
bone cement 234
11.3 Test standards 236
11.4 Mechanical properties: short-term strength of
polymethylmethacrylate bone cement 239
11.5 Factors affecting the microstructure–mechanical
properties relationship 249
11.6 Modification of acrylic bone cements 256
11.7 Summary 256
11.8 References 257
Contents ix
12 Fracture toughness and fatigue characteristics of
bone cements 265
A. B. Lennon, Trinity College Dublin, Ireland
12.1 Introduction 265
12.2 Factors affecting fracture toughness and fatigue
resistance of bone cement 265
12.3 The effect of loading mode on fracture and fatigue 266
12.4 The effect of porosity on fracture and fatigue 272
12.5 The effect of inclusions on fracture and fatigue 274
12.6 The effect of cement chemistry on fracture
and fatigue 275
12.7 Bone cement failure in joint replacements 277
12.8 Failure at interfaces 279
12.9 Residual stress and the initiation of damage 281
12.10 Viscoelasticity, creep and creep–fatigue interaction 282
12.11 Fracture and fatigue properties 283
12.12 References 285
13 Dynamic mechanical properties of bone cements 296
S. N. Nazhat, McGill University, Canada; and
J. V. Cauich Rodríguez, Centro de Investigación
Cientifica de Yucatan A.C., Mexico
13.1 A brief introduction to viscoelasticity in polymers 296
13.2 Regions of viscoelasticity 297
13.3 Theory of dynamic mechanical analysis (DMA) 299
13.4 Material properties measured through dynamic
mechanical analysis 301
13.5 Applications of dynamic mechanical analysis in the
characterisation of polymeric biomaterials 302
13.6 Applications of dynamic mechanical analysis in the
characterisation of bone cements 303
13.7 Future trends 307
13.8 Conclusions 308
13.9 References 308
Part IV Enhancing the properties of bone cements 311
14 Antibiotic-loaded bone cements 313
S. Deb and G. Koller, King’s College London, UK
14.1 Introduction 313
14.2 Demands on acrylic bone cement systems 315
14.3 Antibiotic-loaded bone cements 316