Fracture toughness of acrylic bone cements

Clinical experience has shown that fracture of PMMA-based bone cements is a significant factor in the failure of orthopaedic joint replacements. Earlier studies of the fracture toughness properties of bone cement have been limited to relatively large test specimens — ASTM standard test methods require the use of specimens with dimensions considerably larger that those associated with bone cement in clinical use. In this study, a miniature short-rod specimen was used to measure the fracture toughness (K _IC) or two bone cements (Simplex-P and Zimmer LVC). The dimension of our mini specimens approaches the cross-section of bone cements as usedin vivo. The short-rod elastic-plastic fracture toughness test method introduced by Barker was utilized to ascertain the effect of specimen preparation and ageing in distilled water on fracture toughness. Our study indicated that slow hand-mixed specimens possess comparable fracture toughness to centrifuged specimens. After ageing in water, however, centrifuged and slow hand-mixed specimens are more fracture resistant than specimens prepared by mixing the cement quickly. An optimum void content for the bone cements studied was suggested by the experimental results; for Simplex-P bone cement it appeared to be less than 1.6% whereas it was between 1.6 and 3.6% for Zimmer LVC cement. Simplex-P bone cement also showed superior fracture toughness compared to Zimmer LVC cement after storage in water for 60 days at 37° C.     

On the magnitude and variability of the fatigue strength of acrylic bone cement

When used for the fixation of orthopaedic implants poly(methyl methacrylate) bone cement is prepared during surgery, and polymerises in situ. The technique for preparation of the bone cement involves mixing the liquid monomer and powder: two common mixing methods are hand mixing and vacuum mixing. Previous studies have shown that porosity depends on mixing technique. In this study, the fatigue strength of hand-mixed and vacuum-mixed cements is measured and correlated with the pore distribution resulting from each mixing technique. S–N curves show that vacuum mixing improves the fatigue strength by an order of magnitude. However, there is greater variability of fatigue strength associated with vacuum-mixed cement. This is correlated with the appearance of an occasional large pore in the vacuum-mixed cement. If the cross-sectional area is corrected to take account of porosity in vacuum-mixed cement, an 8% increase in the association of the data is found. Using a two-parameter Weibull model, it can be shown that the vacuum-mixed cement has a greater Weibull life at the 50% probability-of-survival level. However, if a probability-of-survival close to 100% is required (i.e. high reliability), the hand-mixed cement is found to have superior fatigue behaviour. The S–N curves can be explained by examination of the fracture surface features. The initiation stage of fatigue cracking is notably different for the two different mixing techniques. The lower fatigue strength of the hand-mixed cement can be explained by the interactions of pores on the fracture surface causing stress concentrations, whereas no such pore interactions occur in the vacuum-mixed cement.     

Mechanical and thermal behaviour of an acrylic bone cement modified with a triblock copolymer

The basic formulation of an acrylic bone cement has been modified by the addition of a block copolymer, Nanostrength^® (NS), in order to augment the mechanical properties and particularly the fracture toughness of the bone cement. Two grades of NS at different levels of loading, between 1 and 10 wt.%, have been used. Mechanical tests were conducted to study the behaviour of the modified cements; specific tests measured the bend, compression and fracture toughness properties. The failure mode of the fracture test specimens was analysed using scanning electron microscopy (SEM). The effect of NS addition on the thermal properties was also determined, and the polymerisation reaction using differential scanning calorimetry. It was observed that the addition of NS produced an improvement in the fracture toughness and ductility of the cement, which could have a positive contribution by reducing the premature fracture of the cement mantle. The residual monomer content was reduced when the NS was added. However this also produced an increase in the maximum temperature and the heat delivered during the polymerisation of the cement.     

Influence of poly(acrylic acid) content on the fracture behaviour of glass polyalkenoate cements

A linear elastic fracture mechanics approach (LEFM) was used to study glass polyalkenoate cements as a function of the poly(acrylic acid) content. Cement specimens were tested at three time intervals after mixing; one, seven and twenty eight days. Two series of cements were investigated one with a glass volume fraction of 0.4 and the other with a glass volume fraction of 0.5. The fracture toughness, toughness, Young's modulus and un-notched fracture strength increased significantly with the percentage polyacid content. The Young's modulus increased with time for all the cement samples studied. In many cases the moduli values at twenty eight days were twice the values at one day. This is consistent with increased ionic crosslinking of the polyacrylate matrix. The toughness increased with the polyacid content as predicted by the chain pull-out model for fracture and did not change significantly on increasing the glass volume fraction from 0.4 to 0.5. Fracture toughness and Young's modulus increased significantly with glass volume fraction consistent with the residual glass particles acting as a reinforcing filler.     

Dual setting α-tricalcium phosphate cements

An extension of the application of calcium phosphate cements (CPC) to load-bearing defects, e.g. in vertebroplasty, would require less brittle cements with an increased fracture toughness. Here we report the modification of CPC made of alpha-tricalcium phosphate (α-TCP) with 2-hydroxyethylmethacrylate (HEMA), which is polymerised during setting to obtain a mechanically stable polymer-ceramic composite with interpenetrating organic and inorganic networks. The cement liquid was modified by the addition of 30–70 % HEMA and ammoniumpersulfate/tetramethylethylendiamine as initiator. Modification of α-TCP cement paste with HEMA decreased the setting time from 14 min to 3–8 min depending on the initiator concentration. The 4-point bending strength was increased from 9 MPa to more than 14 MPa when using 50 % HEMA, while the bending modulus decreased from 18 GPa to approx. 4 GPa. The addition of ≥50 % HEMA reduced the brittle fracture behaviour of the cements and resulted in an increase of the work of fracture by more than an order of magnitude. X-ray diffraction analyses revealed that the degree of transformation of α-TCP to calcium deficient hydroxyapatite was lower for polymer modified cements (82 % for polymer free cement and 55 % for 70 % HEMA) after 24 h setting, while the polymerisation of HEMA in the cement liquid was quantitative according to FT-IR spectroscopy. This work demonstrated the feasibility of producing fracture resistant dual-setting calcium phosphate cements by adding water soluble polymerisable monomers to the liquid cement phase, which may be suitable for an application in load-bearing bone defects.     

A comparison of mechanical properties of discontinuous Kevlar 29 fibre reinforced bone and dental cements

A comparative study of the fracture behaviour of Kevlar 29 reinforced bone and dental cements is undertaken using both linear elastic and non-linear elastic fracture mechanics approaches. Results from both approaches reflect improved fracture toughness at very low fibre contents. Flexural modulus is not apparently improved in either system, and flexural strength is only improved in the bone cement system probably because of poor interfacial bonding and the presence of voids in the dental cement. In all cases, however, bone cement is seen to be superior to dental cement. This is interpreted in terms of smaller voids and better fibre distribution due to the lower viscosity of the bone cement material. When compared to carbon-polymethyl methacrylate (PMMA) cements, Kevlar 29 reinforced systems appear to be superior. More work is underway to optimize the properties of these systems with regard to structural parameters.     

Improved mechanical properties of acrylic bone cement with short titanium fiber reinforcement

Acrylic bone cements are widely used in total joint arthroplasties to grout the prosthesis to bone. The changes in the tensile properties and fracture toughness of polymethylmethacrylate (PMMA) bone cements obtained by the addition of control and heat treated short titanium fibers are studied. Heat treatment of titanium fibers is conducted to precipitate titania particles on the fiber surface, which may improve the biocompatibility of the metal. Control (non-heat treated) and heat treated short titanium fibers (250 μm long and 20μm diameter) were used as reinforcements at 3 volume %. X-ray diffraction indicated the presence of a rutile form of titania due to the heat treatments. Results indicate that the tensile and fracture properties of unfilled bone cement were improved by the addition of control and heat-treated fibers. The fracture properties of bone cements reinforced with control titanium fibers were at least 10% higher than those reinforced with heat treated titanium fibers. Therefore, we recommend further studies on the use of non-heat treated titanium fibers to reinforce acrylic bone cement.     

聚丙烯纤维水泥稳定碎石断裂性能试验研究

通过30个尺寸为100mm×100mm×515mm的聚丙烯纤维水泥稳定碎石和普通水泥稳定碎石三点弯曲试件断裂试验,探讨了聚丙烯纤维对水泥稳定碎石断裂韧度(KIC)、断裂能(GF)、临界裂缝嘴张开位移(CMODC)、临界裂缝尖端张开位移(CTODC)、极限裂缝嘴张开位移(CMODmax)和极限裂缝尖端张开位移(CTODmax)的影响。试验结果表明:聚丙烯纤维的掺入可增大水泥稳定碎石的断裂韧度、断裂能、临界裂缝嘴张开位移、极限裂缝嘴张开位移、临界裂缝尖端张开位移和极限裂缝尖端张开位移;随着聚丙烯纤维体积掺量的增加,断裂韧度、临界裂缝嘴张开位移和临界裂缝尖端位移的变化无明显规律,但断裂能、极限裂缝嘴张开位移和极限裂缝尖端位移基本上呈线性增加的。     

Creep and fatigue behavior of a novel 2-component paste-like formulation of acrylic bone cements

The fatigue and creep performance of two novel acrylic bone cement formulations (one bone cement without antibiotics, one with antibiotics) was compared to the performance of clinically used bone cements (Osteopal V, Palacos R, Simplex P, SmartSet GHV, Palacos R+G and CMW1 with Gentamicin). The preparation of the novel bone cement formulations involves the mixing of two paste-like substances in a static mixer integrated into the cartridge which is used to apply the bone cement. The fatigue performance of the two novel bone cement formulations is comparable to the performance of the reference bone cements. The creep compliance of the bone cements is significantly influenced by the effects of physical ageing. The model parameters of Struik’s creep law are used to compare the creep behavior of different bone cements. The novel 2-component paste-like bone cement formulations are in the group of bone cements which exhibit a higher creep resistance.     

Biocompatibility of calcium phosphate bone cement with optimised mechanical properties: an in vivo study

This work establishes the in vivo performance of modified calcium phosphate bone cements for vertebroplasty of spinal fractures using a lapine model. A non-modified calcium phosphate bone cement and collagen-calcium phosphate bone cements composites with enhanced mechanical properties, utilising either bovine collagen or collagen from a marine sponge, were compared to a commercial poly(methyl methacrylate) cement. Conical cement samples (8?mm height?×?4?mm base diameter) were press-fit into distal femoral condyle defects in New Zealand White rabbits and assessed after 5 and 10 weeks. Bone apposition and tartrate-resistant acid phosphatase activity around cements were assessed. All implants were well tolerated, but bone apposition was higher on calcium phosphate bone cements than on poly(methyl methacrylate) cement. Incorporation of collagen showed no evidence of inflammatory or immune reactions. Presence of positive tartrate-resistant acid phosphatase staining within cracks formed in calcium phosphate bone cements suggested active osteoclasts were present within the implants and were actively remodelling within the cements. Bone growth was also observed within these cracks. These findings confirm the biological advantages of calcium phosphate bone cements over poly(methyl methacrylate) and, coupled with previous work on enhancement of mechanical properties through collagen incorporation, suggest collagen-calcium phosphate bone cement composite may offer an alternative to calcium phosphate bone cements in applications where low setting times and higher mechanical stability are important.     

Nano-Indentation Measurement of Fracture Toughness of Dental Enamel

Effect of orthodontic bracket bonding-debonding on fracture toughness of human dental enamel was investigated by using nano-indentation test. For this purpose, some ceramic brackets were bonded by a dental adhesive on the buccal surface of sound human teeth enamel. All clinical requirements were considered for bracket bonding and sample preparation. After debonding of the brackets, the teeth were sectioned transverse to their longitudinal axes and from the middle of the bracket region to prepare the samples required for nano-indentation tests. The nanoindentation test was performed on both the enamel under bracket and the intact enamel. The values of fracture toughness of dental enamel in both regions were calculated from the analysis of nano-scale holes observed after the nano-indentation tests. A comparison between the results obtained from the two regions indicated that bracket bonding-debonding significantly decreased the fracture toughness of human dental enamel.     

Determination of interfacial fracture toughness of bone-cement interface using sandwich Brazilian disks

The long-term stability of cemented total hip replacements critically depends on the lasting integrity of the bond between bone and bone cement. Conventionally, the bonding strength of bone-cement is obtained by mechanical tests that tend to produce a large variability between specimens and test methods. In this work, interfacial fracture toughness of synthetic bone-cement interface has been studied using sandwiched Brazilian disk specimens. Experiments were carried out using polyurethane foams as substrates and a common bone cement as an interlayer. Selected loading angles from 0° to 25° were used to achieve full loading conditions from mode I to mode II. Finite element analyses were carried out to obtain the solutions for strain energy release rates at given phase angles associated with the experimental models. The effects of crack length on the measured interfacial fracture toughness were examined. Microscopic studies were also carried out to obtain the morphology of the fractured interfaces at selected loading angles.The implication of the results on the assessment of fixation in acetabular replacements is discussed in the light of preliminary work on bovine cancellous bone-cement interface.     

Curing characteristics of acrylic bone cement

Commercial acrylic bone cements are supplied as two components, a polymer powder and a liquid monomer. Mixing of the two components is followed by a progressive polymerization of the liquid monomer to yield a solid mass, a high level of heat being generated during this exothermic reaction. The exposure of bone to high temperatures has led to incidences of bone necrosis and tissue damage, ultimately resulting in failure of the prosthetic fixation. The aim of this study was to determine the thermal properties of two acrylic bone cements as they progress through their polymerization cycles. It was also felt that there was a need to quantify the variations in the curing characteristics as a function of preparing bone cement by different techniques, hand mixing and vacuum mixing. A number of parameters were calculated using the data gathered from the investigation: peak temperature, cure temperature, cure time, and the cumulative thermal necrosis damage index. The results show the temperature profile recorded during polymerization was lowest when the cement was prepared using the Howmedica Mix-Kit I® system: 36 °C for Palacos R® and 41 °C for CMW³® respectively. When the acrylic cements were prepared in any vacuum mixing system there was evidence of an increase in the cure temperature. The main factor that contributed to this rise in temperature was an imbalance in the polymer powder : liquid monomer ratio, there was a high incidence of unmixed powder visible in the mixing barrel of some contemporary vacuum mixing devices. Observing the thermal characteristics of the polymethyl methacrylate (PMMA) bone cements assessed, it was found that particular formulations of bone cements are suited to certain mixing methodologies. It is vital that a full investigation is conducted on a cement mixing/delivery system prior to its introduction into the orthopaedic market.     

Microstructural aspects of the fracture process in human cortical bone

Fracture toughness tests were conducted in the transverse and longitudinal directions to the osteonal orientation of human femoral cortical bone tissue to investigate the resulting damage patterns and their interaction with the microstructure. The time history of damage accumulation was monitored with acoustic emission (AE) during testing and was spatially observed histologically following testing. The fracture toughness of the transverse specimens was almost two times greater than the fracture toughness of the longitudinal specimens (3.47 MNm^–3/2 vs. 1.71 MNm^–3/2, respectively). The energy content of the AE waveforms of transverse specimens were greater than those of the longitudinal specimens implying higher fracture resistance in the transverse crack growth direction. The results showed that the propagation of the main crack involved weakening of the tissue by ultrastructural (diffuse) damage at the fracture plane and formation of linear microcracks away from the fracture plane for the transverse specimens. For the longitudinal specimens, the growth of the main crack occurred in the form of separations at lamellar interfaces. The lamellar separations generally arrested at the cement lines. Linear microcracks occurred primarily in the interstitial tissue for both crack growth directions.     

Improved mechanical properties of acrylic bone cement with short titanium fiber reinforcement

Acrylic bone cements are widely used in total joint arthroplasties to grout the prosthesis to bone. The changes in the tensile properties and fracture toughness of polymethylmethacrylate (PMMA) bone cements obtained by the addition of control and heat treated short titanium fibers are studied. Heat treatment of titanium fibers is conducted to precipitate titania particles on the fiber surface to improve the biocompatibility of the metal. Control and heat treated short titanium fibers (250 μ long and 20 μ diameter) were used as reinforcements at 3 volume %. X-ray diffraction indicated the presence of a rutile form of titania due to the heat treatments. The tensile and fracture properties were improved by the addition of fibers. Bone cements reinforced with titanium fibers heated at 550^∘C for 1 h followed by 800^∘C for 30 minutes show the largest increase in fracture toughness along with the smallest changes in elastic modulus and needs to be further investigated.     

Improvement of the mechanical properties of acrylic bone cements by substitution of the radio-opaque agent

Acrylic bone cements become radio-opaque by the addition of an inorganic compound, commonly BaSO₄ or ZrO₂. However, the use of these additives has some negative effects such as loss of mechanical properties, risk of release and bone resorption. The use of the monomer 2,5-diiodo-8-quinolyl methacrylate (IHQM), which shows adequate polymerization and radio-opacity properties, is proposed as a new X-ray opaque, methacrylate iodine-containing agent. The aim of this study is to determine the effect of this new radio-opaque agent on the mechanical properties of acrylic bone cements. The addition of the iodine-containing methacrylate provides a statistically significant increase in the tensile strength, fracture toughness and ductility, with respect to the barium sulphate-containing cement. This effect can be attributed to the fact that the use of a radio-opaque monomer eliminates the porosity associated with the barium sulfate particles, which show no adhesion to the matrix. However, some reinforcing effect must also be attributed to the iodine-containing monomer, since the tensile and fracture toughness values reached are even higher than those shown by the radiolucent cement. © 1999 Kluwer Academic Publishers     

Mechanical properties and size effects in lightweight mortars containing expanded perlite aggregate

The study presented here investigates the effect of density in cementitious mortar on its mechanical properties under quasi-static loading. The reduction in density was achieved through the addition of expanded perlite as a lightweight aggregate into cement paste by volume replacement of cement in the ratio from 0 to 8. This yielded a range of densities between 1000 and 2000 kg/m³. The compressive and flexural response of these mixes were determined for geometrically scaled specimens to study the size effect. Some mixes were reinforced with polymer microfibres and the Mode I fracture toughness parameters were evaluated through flexural testing of notched beams. When compared with a reference Portland cement paste, the compressive strength and elastic modulus scaled as the cube of the density, while the fracture toughness varied linearly with it. The study shows that the specimen size effect on compressive and flexural strength decreases with a drop in the density of the mix and also with fibre reinforcement. On the other hand, the specimen size effect on the critical crack mouth opening displacement was more pronounced at lower densities.     

Sulfate resistance of plain and blended cement

This paper presents a laboratory study on the sulfate resistance of blended cement combination of reference Portland cement with high volume ground granulated blast-furnace slag (GGBS) and natural pozzolan (NP). The exposure solutions were tap water containing 5% magnesium sulfate solution and 5% sodium sulfate solution. Two types of grinding method (separately grinding and intergrinding, two finenesses (250 m²/kg and 500 m²/kg) and three different proportions (10%, 20%, and 30% by weight of mixture)) of each of two different additives (GGBS and NP) in equal amounts were employed. In addition to these blends, plain Portland cements without additives were prepared as references specimens. Standard Rilem sample size (40 mm × 40 mm × 160 mm) was used for the experimental study.It was observed that the sulfate resistances of blended cements were significantly higher both against sodium sulfate and magnesium sulfate attacks than references cement. Final strength reductions for finer mixes attacked by magnesium sulfate were marginally lower than those attacked by sodium sulfate. On the other hand, no particular relation was found between the sulfate resistance of the mortars and the grinding methods.     

Analysis of rheological properties of bone cements

The rheological properties of three commercially available bone cements, CMW 1, Palacos R and Cemex ISOPLASTIC, were investigated. Testing was undertaken at both 25 and 37 °C using an oscillating parallel plate rheometer. Results showed that the three high viscosity cements exhibited distinct differences in curing rate, with CMW 1 curing in 8.7 min, Palacos R and Cemex ISOPLASTIC in 13 min at 25 °C. Furthermore it was found that these curing rates were strongly temperature dependent, with curing rates being halved at 37 °C. By monitoring the change of viscosity with time over the entire curing process, the results showed that these cements had differing viscosity profiles and hence exhibit very different handling characteristics. However, all the cements reached the same maximum viscosity of 75 × 10³ Pa s. Also, the change in elastic/viscous moduli and tan δ with time, show the cements changing from a viscous material to an elastic solid with a clear peak in the viscous modulus during the latter stages of curing. These results give valuable information about the changes in rheological properties for each commercial bone cement, especially during the final curing process.     

Fracture toughness of composite acrylic bone cements

Composite bone cements incorporating one of four different filler particles (hydroxyapatite powder, graphite flakes or one of two types of rubber-modified acrylic particles) were made and the fracture toughness properties (K _lc) and curing characteristics (peak curing temperature and cement extrudability while in the doughy state) assessed. The results showed that all filler types studied resulted in significant increases in fracture toughness while maintaining acceptable working and curing characteristics of the composite cements. The increase inK _lc was related to the amount of filler incorporation. The observed dependence of the change inK _lc on the wt% filler could be rationalized through the application of proposed mechanisms for toughening of particle-reinforced polymers.