Basic Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Dec 18, 2017; 8(12): 881-890
Published online Dec 18, 2017. doi: 10.5312/wjo.v8.i12.881
Role of fast-setting cements in arthroplasty: A comparative analysis of characteristics
Neil Ayron Caraan, Reinhard Windhager, Jason Webb, Nadine Zentgraf, Klaus-Dieter Kuehn
Neil Ayron Caraan, Reinhard Windhager, Department of Orthopaedics and Orthopaedic Surgery, Medical University of Vienna, Vienna 1090, Austria
Jason Webb, Avon Orthopaedic Centre, North Bristol NHS Trust, Southmead Hospital, Bristol BS10 5NB, United Kingdom
Nadine Zentgraf, Klaus-Dieter Kuehn, Heraeus Medical GmbH, Wehrheim 61273, Germany
Nadine Zentgraf, Klaus-Dieter Kuehn, Medical University of Vienna, Vienna 1090, Austria
Author contributions: Caraan NA, Windhager R and Kuehn KD designed the research; Caraan NA and Kuehn KD performed the research; Caraan NA and Kuehn KD performed data analysis; Webb J provided oversight to manuscript development; Caraan NA, Zentgraf N and Kuehn KD wrote and edited the manuscript; all authors read and approved the final manuscript.
Institutional review board statement: This manuscript does not involve human or human subjects.
Institutional animal care and use committee statement: This manuscript does not involve animal or animal subjects.
Conflict-of-interest statement: The authors have no conflicts of interest to disclose.
Data sharing statement: Technical appendix, statistical code and dataset available from the corresponding author at neil.caraan@gmx.at.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Neil Ayron Caraan, MD, Department of Orthopaedics and Orthopaedic Surgery, Medical University of Vienna, Währinger Gürtel 18-20, Vienna 1090, Austria. neil.caraan@gmx.at
Telephone: +43-67-64223760 Fax: +43-140-40040290
Received: December 17, 2016
Peer-review started: December 30, 2016
First decision: March 27, 2017
Revised: October 9, 2017
Accepted: November 8, 2017
Article in press: November 8, 2017
Published online: December 18, 2017
Processing time: 356 Days and 1.3 Hours
Abstract
AIM

To evaluate the behaviour of two fast-setting polymethylmethacrylate (PMMA) cements CMW® 2G and Palacos® fast R + G, as reference: Standard-setting Palacos® R + G.

METHODS

The fast-setting cements CMW® 2G and Palacos® fast R + G were studied, using standard-setting high viscosity Palacos® R + G as a reference. Eleven units (of two batch numbers) of each cement were tested. All cements were mixed as specified by the manufacturer and analysed on the following parameters: Handling properties (mixing, waiting, working and hardening phase) according to Kuehn, Mechanical properties according to ISO 5833 and DIN 53435, Fatigue strength according to ISO 16402, Benzoyl Peroxide (BPO) - Content by titration, powder/liquid-ratio by weighing, antibiotic elution profile by High Performance Liquid Chromatography. All tests were done in an acclimatised laboratory with temperatures set at 23.5 °C ± 0.5 °C and a humidity of > 40%.

RESULTS

Palacos® fast R + G showed slightly shorter handling properties (doughing, hardening phase, n = 12) than CMW® 2G, allowing to reduce operative time and to optimise cemented cup implantation. Data of the quasistatic properties of ISO 5833 and DIN 53435 of both cements tested was comparable. The ISO compressive strength (MPa) of Palacos® fast R + G was significantly higher than CMW® 2G, resulting in ANOVA (P < 0.01) and two sample t-test (P < 0.01) at 0.05 level of significance (n = 20). Palacos® fast R + G showed a higher fatigue strength of about 18% mean (ISO 16402) of 15.3 MPa instead of 13.0 MPa for CMW® 2G (n = 5 × 106 cycles). Palacos® fast R + G and CMW® 2G differed only by 0.11% (n = 6) with the former having the higher content. The BPO-content of both cements were therefore comparable. CMW® 2G had a powder/liquid ratio of 2:1, Palacos® fast R + G of 2.550:1 due to a higher powder content. Despite its higher gentamicin content, CMW® 2G showed a significantly lower antibiotic elution over time than Palacos® fast R + G (n = 3).

CONCLUSION

Both cements are compliant with international standards and are highly suitable for their specified surgical indications, affording a time-saving measure without detriment to the mechanical properties.

Keywords: Polymethylmethacrylate; Elution; Fast-setting; Viscosity; Antibiotic; Fatigue; Arthroplasty

Core tip: Polymethylmethacrylate (PMMA) cements provide reliable fixation of the implants in joint arthroplasty. Fast-setting high viscosity PMMA cements exist that have altered setting characteristics compared to standard setting cements. These potentially offer benefits to surgeons based upon their handling properties. Such cements have gained popularity in arthroplasty surgery as described in the United Kingdom and Australian National Joint Registries. The use of fast-setting cements has various beneficial as well as economic effects, such as time-saving and better antibiotic elution.