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Evaluation of two novel aluminum-free, zinc-based glass polyalkenoate cements as alternatives to PMMA bone cement for use in vertebroplasty and balloon kyphoplasty

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Abstract

Vertebroplasty (VP) and balloon kyphoplasty (BKP) are now widely used for treating patients in whom the pain due to vertebral compression fractures is severe and has proved to be refractory to conservative treatment. These procedures involve percutaneous delivery of a bolus of an injectable bone cement either directly to the fractured vertebral body, VB (VP) or to a void created in it by an inflatable bone tamp (BKP). Thus, the cement is a vital component of both procedures. In the vast majority of VPs and BKPs, a poly(methyl methacrylate) (PMMA) bone cement is used. This material has many shortcomings, notably lack of bioactivity and very limited resorbability. Thus, there is room for alternative cements. We report here on two variants of a novel, bioactive, Al-free, Zn-based glass polyalkenoate cement (Zn-GPC), and how their properties compare to those of an injectable PMMA bone cement (SIMPL) that is widely used in VP and BKP. The properties determined were injectability, radiopacity, uniaxial compressive strength, and biaxial flexural modulus. In addition, we compared the compression fatigue lives of a validated synthetic osteoporotic VB model (a polyurethane foam cube with an 8 mm-diameter through-thickness cylindrical hole), at 0–2300 N and 3 Hz, when the hole was filled with each of the three cements. A critical review of the results suggests that the performance of each of the Zn-GPCs is comparable to that of SIMPL; thus, the former cements merit further study with a view to being alternatives to an injectable PMMA cement for use in VP and BKP.

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References

  1. Watts NB, Harris ST, Genant HK. Treatment of painful osteoporotic vertebral fractures with percutaneous vertebroplasty kyphoplasty. Osteop Int. 2001;12:429–37.

    Article  CAS  Google Scholar 

  2. Strom O, Borgstrom F, Zethraeus N, Johnell O, Lidgren L, Ponzer S, et al. Long-term cost and effect on quality of life of osteoporosis-related fractures in Sweden. Acta Orthop. 2008;79:269–80.

    Article  PubMed  Google Scholar 

  3. Johnell O. Economic implication of osteoporotic spine disease: cost to society. Eur Spine J. 2003;12 Suppl 2:S168–9.

    Article  PubMed  Google Scholar 

  4. Lin JT, Lane JM. Nonmedical management of osteoporosis. Curr Opin Rheumatol. 2002;14:441–6.

    Article  PubMed  Google Scholar 

  5. Pateder DB, Khanna AJ, Lieberman IH. Vertebroplasty and kyphoplasty for the management of osteoporotic vertebral compression fractures. Orthop Clin North Am. 2007;38:409–18.

    Article  PubMed  Google Scholar 

  6. Peh WCG, Munk PL, Gilula LA. Percutaneous vertebral augmentation: vertebroplasty, kyphoplasty and skyphoplasty. Radiol Clin North Am. 2008;46:611–35.

    Article  PubMed  Google Scholar 

  7. Lewis G. Injectable bone cements for use in vertebroplasty and kyphoplasty: state-of-the-art review. J Biomed Mater Res Part B: Appl Biomater. 2006;76B:456–68.

    Article  CAS  Google Scholar 

  8. Lewis G. Properties of acrylic bone cement: state-of-the-art review. J Biomed Mater Res Part B: Appl Biomater. 1997;38:155–82.

    Article  CAS  Google Scholar 

  9. Becker S, Franz K, Wilke I, Ogon M. Injectable bone cements in the treatment of spinal fractures, osteopromotive capacity and surgical considerations. Eur Cells Mater. 2006;11 Suppl 1:1.

    Google Scholar 

  10. Boger A, Bohner M, Heini P, Verrier S, Schneider E. Properties of an injectable low modulus PMMA bone cement for osteoporotic bone. J Biomed Mater Res Part B: Appl Biomater. 2008;86B:474–82.

    Article  CAS  Google Scholar 

  11. Hernández L, Parra J, Vázquez B, López Bravo A, Collía F, Goñi I, et al. Injectable acrylic bone cements for vertebroplasty based on radiopaque hydroxyapatite. Bioactivity and biocompatibility. J Biomed Mater Res Part B: Appl Biomater. 2009;88B:103–14.

    Article  CAS  Google Scholar 

  12. Wang X, Ye J, Wang Y. Influence of a novel radiopacifier on the properties of an injectable calcium phosphate cement. Acta Biomater. 2007;3:757–63.

    Article  PubMed  CAS  Google Scholar 

  13. Vlad MD, del Valle LJ, Poeata I, Barraco M, Lopez J, Torres R, et al. Injectable iron-modified apatitic bone cement intended for kyphoplasty: cytocompatibility study. J Mater Sci: Mater Med. 2008;19:3575–83.

    Article  CAS  Google Scholar 

  14. Hernandez L, Munoz ME, Goni I, Gurruchaga M. New injectable and radiopaque antibiotic loaded acrylic bone cement. J Biomed Mater Res Part B: Appl Biomater. 2008;87B:312–20.

    Article  CAS  Google Scholar 

  15. Lewis G, Schwardt J, Slater T, Janna S. Evaluation of a synthetic vertebral body augmentation model for rapid and reliable cyclic compression testing of materials for balloon kyphoplasty. J Biomed Mater Res Part B: Appl Biomater. 2008;87B:179–88.

    Article  CAS  Google Scholar 

  16. Boyd D, Towler MR, Wren A, Clarkin OM. Comparison of an experimental bone cement with Surgical Simplex®P, Spineplex® and Cortoss®. J Mater Sci: Mater Med. 2008;19:1745–52.

    Article  CAS  Google Scholar 

  17. Boyd D, Clarkin OM, Wren A, Towler MR. Zn-based glass polyalkenoate cements with improved setting times and mechanical properties. Acta Biomater. 2008;4:425–31.

    Article  PubMed  CAS  Google Scholar 

  18. Khairoun I, Boltong MG, Driessens FCM, Planell JA. Some factors controlling the injectability of calcium phosphate bone cements. J Mater Sci: Mater Med. 1998;9:425–8.

    Article  CAS  Google Scholar 

  19. Gbureck U, Spatz K, Thull R, Barralet JE. Rheological enhancement of mechanically activated α−tricalcium phosphate cements. J Biomed Mater Res Part B: Appl Biomater. 2005;73B:1–6.

    Article  CAS  Google Scholar 

  20. ISO 4049:2000. Dentistry—polymer-based filling, restorative and luting materials. Geneva, Switzerland: International Organization for Standardization (ISO); 2000.

  21. ISO 9917-1:2003. Dental water based cements. Geneva, Switzerland: International Organization for Standardization; 2003.

  22. Williams JA, Billington RW, Pearson GJ. The effect of the disc support system on biaxial tensile strength of a glass ionomer cement. Dent Mater. 2002;18:376–9.

    Article  PubMed  CAS  Google Scholar 

  23. Higgs WAJ, Lucksanasombool P, Higgs RJED, Swain MV. A simple method of determining the modulus of orthopaedic bone cement. J Biomed Mater Res Appl Biomater. 2001;58:188–95.

    Article  CAS  Google Scholar 

  24. Akinmade AO, Nicholson JW. Poisson’s ratio of glass polyalkenoate (“glass-ionomer”) cements determined by an ultrasonic pulse method. J Mater Sci: Mater Med. 1995;6:483–5.

    Article  CAS  Google Scholar 

  25. Diamond TH, Champion B, Clark WA. Management of acute osteoporotic vertebral fractures: a nonrandomized trial comparing percutaneous vertebroplasty with conservative therapy. Am J Med. 2003;114:257–65.

    Article  PubMed  Google Scholar 

  26. Gaitanis IN, Hadjipavlou AG, Katonis PG, Tzermiadianos MN, Pasku DS, Patwardhan AG. Balloon kyphoplasty for the treatment of pathological vertebral compressive fractures. Eur Spine J. 2005;14:250–60.

    Article  PubMed  Google Scholar 

  27. Molloy S, Mathis JM, Belkoff SM. The effect of vertebral body percentage fill on mechanical behavior during percutaneous vertebroplasty. Spine. 2003;28:1549–54.

    Article  PubMed  Google Scholar 

  28. Coumans J-VCE, Reinhardt M-K, Lieberman IH. Kyphoplasty for vertebral compression fractures: 1-year clinical outcomes from a prospective study. J Neurosurg: Spine. 2003;99:44–50.

    Article  Google Scholar 

  29. Kasperk C, Hillmeier J, Noldge G, Grafe IA, Da Fonseca K, Raupp D, et al. Treatment of painful vertebral fractures by kyphoplasty in patients with primary osteoporosis; a prospective nonrandomized controlled study. J Bone Miner Res. 2005;20:604–12.

    Article  PubMed  Google Scholar 

  30. Li B, Aspden RM. Composition and mechanical properties of cancellous bone from the femoral head of patients with osteoporosis or osteoarthritis. J Bone Miner Res. 1997;12:641–51.

    Article  PubMed  CAS  Google Scholar 

  31. Banse X, Sims TJ, Bailey AJ. Mechanical properties of adult vertebral cancellous bone: correlation with collagen intermolecular cross-links. J Bone Miner Res. 2002;17:1621–8.

    Article  PubMed  CAS  Google Scholar 

  32. Baroud G, Bohner M. Biomechanical impact of vertebroplasty. Joint Bone Spine. 2006;73:144–50.

    Article  PubMed  Google Scholar 

  33. Schwardt J, Slater T, Lee S, Meyer J, Wenz R. KyphOs FSTM calcium phosphate for balloon kyphoplasty: verification of compressive strength and instructions for use. Eur Cells Mater. 2006;11 Suppl 1:28.

    Google Scholar 

  34. Boyd D, Towler MR. The processing, mechanical properties and bioactivity of zinc based glass ionomer cements. J Mater Sci: Mater Med. 2005;16:843–50.

    Article  CAS  Google Scholar 

  35. Lewis G. Alternative acrylic bone cement formulations for cemented arthroplasties: present status, key issues, and future prospects. J Biomed Mater Res Part B: App Biomater. 2008;84B:301–9.

    Article  CAS  Google Scholar 

  36. Arlot ME, Roux JP, Boivin G, Perrat B, Tsouderos Y, Delofire P. Effects of a strontium salt (S12911) on both tibial metaphysis and epiphysis in normal growing rats. J Bone Mineral Res. 1995;10:S356.

    Google Scholar 

  37. Belkoff SM, Mathis JM, Erbe EM, Fenton DC. Biomechanical evaluation of a new bone cement for use in vertebroplasty. Spine. 2000;25:1061–4.

    Article  PubMed  CAS  Google Scholar 

  38. Tomita S, Molloy S, Jasper LE, Abe M, Belkoff SM. Biomechanical comparison of kyphoplasty with different bone cements. Spine. 2004;29:1203–7.

    Article  PubMed  Google Scholar 

  39. Alvarez L, Perez-Higueras A. Percutaneous vertebroplasty in the treatment of osteoporotic fractures. In: Lewandrowski K-U, Wise DL, Trantolo DJ, Yaszemski MJ, White III AA, editors. Advances in spinal fusion: molecular science, biomechanics, and clinical management. New York: Marcel Dekker Inc.; 2004. p. 13–21.

    Google Scholar 

  40. Lewis G. Putting insoles through the paces. Mech Eng. 1989;111(4):96–8.

    Google Scholar 

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Acknowledgements

The authors thank Mr. Yuan Li and Dr. Si Janna, for their contributions to the compression cyclic fatigue life testing and the financial assistance of Enterprise Ireland for facilitating this work.

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Authors and Affiliations

  1. Department of Mechanical Engineering, The University of Memphis, Memphis, TN, 38152, USA

    Gladius Lewis

  2. Materials and Surface Science Institute, University of Limerick, National Technological Park, Limerick, Ireland

    Mark R. Towler, Anthony W. Wren & Owen M. Clarkin

  3. Medical Engineering Design Innovation Centre, Cork Institute of Technology, Cork, Ireland

    Daniel Boyd

  4. Dental Materials Unit, School of Dental Sciences, Newcastle University, Newcastle upon Tyne, NE2 4BW, UK

    Matthew J. German & Andrew Yates

Authors
  1. Gladius Lewis
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  2. Mark R. Towler
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  3. Daniel Boyd
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  6. Owen M. Clarkin
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  7. Andrew Yates
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Correspondence to Gladius Lewis.

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Lewis, G., Towler, M.R., Boyd, D. et al. Evaluation of two novel aluminum-free, zinc-based glass polyalkenoate cements as alternatives to PMMA bone cement for use in vertebroplasty and balloon kyphoplasty. J Mater Sci: Mater Med 21, 59–66 (2010). https://doi.org/10.1007/s10856-009-3845-7

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  • DOI: https://doi.org/10.1007/s10856-009-3845-7

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