Antibiotic-free antimicrobial poly (methyl methacrylate) bone cements: A state-of-the-art review

Table 1 Key trends^a in a selection of properties of antibiotic-free antimicrobial poly (methyl methacrylate) bone cements

Property	Loaded additiveb in AFAMBC formulation	Magnitude of trendc	Ref.
Tensile modulus	15%CS; 15% CS NP; 15% QCS NP; 10% QAMA; 5% TPGDA G1.0	↓; approximately; approximately; approximately; approximately	Shi et al[51]; Shi et al[51]; Shi et al[51]; Deb et al[52]; Abid et al[59]
Tensile strength	10% QAMA; 5% TPGDA G1.0	approximately; approximately	Deb et al[52]; Abid et al[59]
Compressive modulus	0.5% Ag NP; 5% TPGDA G1.0; 0.25% Au NP	↓; ↓; approximately	Slane et al[58]; Abid et al[59]; Russo et al[61]
Compressive strength	10% QAMA; 1% Ag-TIOP NP; 30% SBAG; 7% PP NP; 0.05% Ag-OA NP; 0.5% Ag NP; 5% TPGDA G1.0; 0.25% Au NP; 10% Cu-SBA3 NP; 0.3% GO; 15% CS; 0.3% GO-15% CS	approximately; approximately; approximately; approximately; approximately; ↓; approximately; approximately; approximately; approximately; ↓; ↓	Deb et al[52]; Prokopovich et al[54]; Miola et al[55]; Perni et al[56]; Prokopovich et al[57]; Slane et al[58]; Abid et al[59]; Russo et al[61]; Miola et al[62]; Zapata et al[64,66]; Zapata et al[64,66]; Zapata et al[64,66]
Flexural modulus	CS; CS NP; QCS NP; 0.5% Ag NP; 20% Ag-SBA2 NP; 10-50% NAC; 0.3% GO; 15% CS; 0.3% GO-15% CS	↓; approximately; approximately; approximately; approximately; ↓; approximately; ↓; ↓	Shi et al[51]; Shi et al[51]; Shi et al[51]; Slane et al[58]; Verne et al[63]; Sukhonthamarn et al[67]; Zapata et al[66]; Zapata et al[66]; Zapata et al[66]
Flexural strength	0.5% Ag NP; 20% Ag-SBA2 NP; 10-50% NAC; 0.3% GO; 15% CS; 0.3% GO-15% CS	approximately; ↓; ↓; approximately; ↓; approximately	Slane et al[58]; Verne et al[63]; Sukhonthamarn et al[67]; Zapata et al[66]; Zapata et al[66]; Zapata et al[66]
Fracture toughness	0.5% Ag NP	approximately	Slane et al[58]
Storage modulus and loss; modulus vs. time profile	7% PP NP	approximately	Perni et al[56]
Elastic modulus vs. depth	0.05% Ag-OA NP	approximately	Prokopovich et al[57]
Maximum polymerization	10% QAMA; 0.3% GO; 15% CS; 0.3% GO-15% CS; BC-BG-MP-Ag NP	↓; approximately; approximately; ↓; approximately	Deb et al[52]; Zapata et al[66]; Zapata et al[66]; Zapata et al[66]; Wekwejt et al[68]
Setting time	10% QAMA; 0.3% GO; 15% CS; 0.3% GO-15% CS; BC-BG-MP-Ag NP	↑; approximately; ↑; ↑; approximately	Deb et al[52]; Zapata et al[66]; Zapata et al[66]; Zapata et al[66]; Wekwejt et al[68]
Water contact angle	5% TPGDA G1.0; 10% TPDGA G1.0; 0.1% GO; 0.2% GO; 0.3% GO; 0.5% GO; BC-BGII-0.4-Ag NP; BC-BG-MP-Ag NP	↓; ↓; ↓; ↓; ↓; ↓; ↑; ↑	Abid et al[59]; Abid et al[59]; Zapata et al[65]; Zapata et al[65]; Zapata et al[65]; Zapata et al[65]; Wekwejt et al[68]; Wekwejt et al[68]
Radiopacity	10% QAMA; 20% Ag-SBA2 NP	approximately; ↑	Deb et al[52]; Verné et al[63]
Residual monomer content	15% CS; 0.3% GO-15% CS; 0.1% GO; 0.2% GO; 0.3% GO	↑; ↑; approximately; approximately; ↑; ↑	Zapata et al[64]; Zapata et al[64]; Zapata et al[65]; Zapata et al[65]; Zapata et al[65]; Zapata et al[65]
Uptake of PBS, at 37 oC, vs test time profile	0.05% Ag-OA NP; 15% CS; 0.3% GO-15% CS	approximately; ↑; ↑	Prokopovich et al[57]; Zapata et al[64]; Zapata et al[64]

^aTrend is ratio of mean value of property of antibiotic-free antimicrobial poly (methyl methacrylate) bone cement (AFAMBC) to that of a plain counterpart control cement (no antimicrobial additive), except in the study by Shi et al[51], in which the counterpart control cement was an approved antibiotic-loaded bone cement.

^bCS: chitosan.

^c:↓: Ratio is much less than 1 (mean property value for AFAMBC significantly lower than that for control cement); Approximately: Ratio is about 1 (difference in mean property values not significant); ↑: Ratio is much greater than 1 (mean property value for AFAMBC significantly higher than that for control cement). CS NP: Chitosan nanoparticles; QCS NP: Quaternary ammonium chitosan derivative nanoparticles; QAMA: Quaternary amine dimethacrylate; TPGDA G1.0: Generation-1 tripropylene glycol diacrylate dendrimer; Ag NP: Silver nanoparticles; Au NP: Gold nanoparticles; Ag-TIOP NP: Silver nanoparticles capped with tiopronin; SBAG: Particles of Na₂O-CaO-P₂O₅-B2O₃-Al₂O₃-Ag₂O glass; PP NP: Propylparaben nanoparticles; Ag-OA NP: Silver nanoparticles capped with oleic acid; Cu-SBA3 NP: Powder of copper-doped bioactive glass (48% SiO₂-26% Na₂O-22% CaO-3% P₂O₅-0.43% B₂O₃-0.57% Al2O3) nanoparticles; GO: Graphene oxide nanosheets; Ag-SBA2 NP: Powder of silver-doped bioactive glass (SiO₂-Na₂O-CaO-P₂O₅- B₂O₃-Al₂O₃) (< 20 mm) nanoparticles; NAC: N-acetylcysteine; BC-BG-MP-Ag NP: A composite cement comprising bone cement, a Bioglass (70 mol%SiO₂/30 mol%CaO), and silver nanoparticles; BC-BGII-Ag NP: A composite cement comprising a Bioglass and silver nanoparticles.