Choice of Mixing System

  • Jian-Sheng Wang
  • Steffen J. Breusch


Studies have shown that pores in bone cement adversely affect the cement’s mechanical strength and that removal of these air inclusions can significantly enhance fatigue properties. Currently, the most popular cement mixing technique is vacuum mixing, and there is extensive evidence that vacuum mixing reduces cement porosity. However, in clinical use vacuum mixing systems and cement brands are arbitrarily combined, precluding conclusive analysis on the effectiveness of the combinations used. This chapter compares various systems in the market and discusses the influence of mixing systems and cements on cement quality and monomer evaporation.


Bone Cement Vacuum Level Biomed Mater Acrylic Bone Cement Fume Exposure 
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  1. 1.
    Alkire M, Dabezies E, Hastings P. High vacuum as a method of reducing porosity of polymethylmethacrylate. Othopaedics. 1987; 10:1533–39Google Scholar
  2. 2.
    Askew MJ, Kufel MF, Fleissner Jr. PR, Gradisar, Jr. IA, Salstrom SJ, Tan J. Effect of vacuum mixing on the mechanical properties of antibiotic-impregnated polymethylmethacrylate bone cement. J Biomed Mater Res. 1990;24:573–80CrossRefPubMedGoogle Scholar
  3. 3.
    Bettencourt A, Calado A, Amaral J, Vale FM, Rico JM, Monteiro J, Castro M. The influence of vacuum mixing on methylmethacrylate liberation from acrylic cement powder. Int J Pharm. 2001;219:89–93CrossRefPubMedGoogle Scholar
  4. 4.
    Bishop NE, Ferguson S, Tepic S. Porosity reduction in bone cement at the cement-stem interface. J Bone Joint Surg (Br). 1996;78(3):349–56Google Scholar
  5. 5.
    Darre E, Gottlieb J, Nielsen PM, Jensen JS. A method to determine methylmethacrylate in air. Acta Orthop Scand. 1988;59:270–1PubMedGoogle Scholar
  6. 6.
    Davies JP, Harris WH. Optimization and comparison of three vacuum mixing systems for porosity reduction of Simplex P Cement. Clin Orthop. 1990;254:261–69PubMedGoogle Scholar
  7. 7.
    Dunne N-J, Orr J. Influence of mixing techniques on the physical properties of acrylic bone cement. Biomaterials. 2001;22:1819–26CrossRefPubMedGoogle Scholar
  8. 8.
    Eyerer P, Jin R. Influence of mixing technique on some properties of PMMA bone cement. J Biomed Mater Res. 1986;20:1057–1094CrossRefPubMedGoogle Scholar
  9. 9.
    Graham J, Pruitt L, Ries M, Gundiah N. Fracture and fatigue properties of acrylic bone cement: the effects of mixing method, sterilization treatment, and molecular weight. J Arthroplasty. 2000;15(8):1028–35CrossRefPubMedGoogle Scholar
  10. 10.
    Hansen D, Jensen JS. Mixing does not improve mechanical properties of all bone cements. Manual and centrifugation-vacuum mixing compared for 10 cement brands. Acta Orthop Scand. 1992;63(1):13–8PubMedGoogle Scholar
  11. 11.
    Harper EJ, Bonfield W. Tensile characteristics of ten commercial acrylic bone cements. J. Biomed Mater Res (Appl Biomater) 2000;53:605–16CrossRefGoogle Scholar
  12. 12.
    Jafri AA, Green SM, Partington, McCaskie AW, Muller SD. Pre-heating of components in cemented total hip arthroplasty. J Bone Joint Surg (Br). 2004;86:1214–19CrossRefGoogle Scholar
  13. 13.
    Kühn KD (2000) Bone cement. Springer, Berlin HeidelbergGoogle Scholar
  14. 14.
    Lewis G. Properties of acrylic bone cement: state of art review. J Biomed Mater Res (Appl Biomater). 1997;38:155–82Google Scholar
  15. 15.
    Lidgren L, Bodelind B, Möller J. Bone cement improved by vacuum mixing and chilling. Acta Orthop Scand. 1987;57:27–32Google Scholar
  16. 16.
    Lidgren L, Drar H, Moller J. Strength of polymethylmethacrylate increased by vacuum mixing, Acta Orthop Scand. 1984;55(5):536–41PubMedGoogle Scholar
  17. 17.
    Linden U, Gillquist J. Air inclusion in bone cement. Importance of the mixing technique. Clin Orthop. 1989;247:148–51PubMedGoogle Scholar
  18. 18.
    Mau H, Schelling K, Heisel C, Wang JS, Breusch SJ. Comparison of different vacuum mixing systems and bone cements with respect to reliability, porosity and bending strength. Acta Orthop Scand. 2004;75:160–72CrossRefPubMedGoogle Scholar
  19. 19.
    Müller-Wille P, Wang J-S, Lidgren L (1996) Integrated system for preparation of bone cement and effects on cement quality and environment. J Biomed Mater Res (Applied Biomater) 38:135–142Google Scholar
  20. 20.
    Murphy BP, Prendergast PJ. The relationship between stress, porosity, and nonlinear damage accumulation in acrylic bone cement. J Biomed Mater Res. 2002;59(4):646–54CrossRefPubMedGoogle Scholar
  21. 21.
    Rimnace CM, Wright TM, McGill DL. The effect of centrifugation on the fracture properties of acrylic bone cements. J Bone Joint Surg (Am) 1986;68:281–7Google Scholar
  22. 22.
    Schelling K, Breusch SJ. Efficacy of a new prepacked vacuum mixing system with Palamed G bone cement. In: Walenkamp GHIM, Murray DW (eds) Bone cement and cementing technique. Springer, Berlin Heidelberg New York Tokyo, 2001, pp 97–107Google Scholar
  23. 23.
    Schlegel UJ, Sturm M, Ewerbeck V, Breusch S. Efficacy of vacuum mixing systems in reducing methylmethacrylate fume exposure. Comparison of 7 different vacuum mixing devices and open bowl mixing. Acta Scand Orthop. 2004; 75(5):559–566Google Scholar
  24. 24.
    Schreurs BW, Spierings PT, Huiskes R, Slooff TJ. Effects of preparation techniques on the porosity of acrylic cements. Acta Orthop Scand. 1988;59:403–9PubMedGoogle Scholar
  25. 25.
    Wang JS, Kjellson F. The effect of volume of the mixing cartridge on bone cement porosity in vacuum mixing. Combined Orthopedic Research Society Meeting, June1–3, Rhodes, Greece. 2001, P 230Google Scholar
  26. 26.
    Wang JS, Kjellson F. Bone cement porosity in Vacuum Mixing system. In Bone cements and Cementing technique. In: Walenkamp GHIM, Murray DW (eds) Bone cement and cementing technique. Springer, Berlin Heidelberg New York Tokyo, 2001, pp 81–95Google Scholar
  27. 27.
    Wang JS, Franzén H, Jonsson E, Lidgren L. Porosity of bone cement reduced by mixing and collecting under vacuum. Acta Orthop Scand 1993;64(2):143–46PubMedGoogle Scholar
  28. 28.
    Wang JS, Taylor M, Flivik G, Lidgren L. Factors affecting the static shear strength of the prosthetic stem-bone cement interface. J of Mater Science: Mater in Med. 2003;14:55–61Google Scholar
  29. 29.
    Wang J-S, Toksvig-Larsen S, Müller-Wille P, Franzén H. Is their any difference between vacuum mixing systems in reducing bone cement porosity? J Biomed Mater Res (Applied Biomaterials) 1996;33:115–19Google Scholar
  30. 30.
    Wilkinson JM, Eveleigh R, Hamer AJ, Milne A, Miles AW, Stockely I. Effect of mixing technique on the properties of acrylic bone cement. J of Arthroplasty. 2000;15:663–7Google Scholar
  31. 31.
    Wixon RL, Lautenschlager EP, Novak MA. Vacuum mixing of acrylic bone cement. J Arthroplasty. 1987;2:141–49Google Scholar
  32. 32.
    Yau WP, Ng TP, Chiu KY, Poon KC, Ho WY, Luk DK. The performance of three vacuum mixing cement guns-acomparison of the fatigue properties of Simplex P cement. International Orthopaedics. 2001;25:290–293PubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag Heidelberg 2005

Authors and Affiliations

  • Jian-Sheng Wang
    • 1
  • Steffen J. Breusch
    • 2
  1. 1.Dept. of OrthopedicsLund University HospitalLundSweden
  2. 2.Orthopaedic DepartmentUniversity of EdinburghEdinburghUK

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