Control of methyl methacrylate during the preparation of orthopedic bone cements

The use of methyl methacrylate (MMA) bone cement during orthopedic procedures has been seen as a potential exposure hazard to health care professionals. However, that assessment is based on a number of investigations with problems in experimental design, analysis, and data interpretation. The current investigation quantified differences in MMA vapors produced during the preparation of competing bone cements using various methods of preparation. Unlike previous investigations, this effort employs modern validated sampling and analytical methods, and considers the affect of censored results. Measurements of sufficient quality and number were collected to allow for a statistical treatment of the data. The ability of two controlled preparation techniques to reduce MMA emissions were compared with a traditional open container. The results confirmed that the preparation of bone cement releases MMA vapors into the breathing zone of the preparer. One preparation technique (Stryker Bowl) controlled emissions during mixing and curing and affected a 73% reduction in measured MMA concentrations. In addition to mixing and curing, the second technique (UltraMix System) also controlled the MMA during pouring of the monomer and affected a 90% reduction in MMA concentrations. An ANOVA test of interaction indicates that the reductions are attributable to the preparation technique regardless of the type of cement being used. Both a Fisher's PLSD and Games/Howell post hoc test of the results indicate that the mean differences between the uncontrolled open container and the controlled preparation techniques are significant (p < 0.05).