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Orthopaedic bone cement: do we know what we are using?

J Bridgens1, S Davies, L Tilley

  • 1Northern General Hospital, Herries Road, Sheffield S5 7AU, UK. jpbridgens@doctors.org.uk

The Journal of Bone and Joint Surgery. British Volume
|May 3, 2008
PubMed
Summary
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Newer formulations of Palacos bone cement, specifically Heraeus Palacos and Depuy CMW Smartset, exhibit superior mechanical properties and antibiotic elution compared to the older Schering-Plough Palacos version.

Area of Science:

  • Orthopedic biomaterials
  • Surgical cements
  • Drug delivery systems

Background:

  • Bone cements are crucial in orthopedic surgery, with variations in mechanical properties and antibiotic elution affecting patient outcomes.
  • Formulation changes in bone cements, even subtle ones, can significantly alter their performance characteristics.
  • A change in the supplier of Palacos bone cement with gentamicin in 2005 prompted an investigation into its properties.

Purpose of the Study:

  • To compare the mechanical characteristics and antibiotic elution profiles of different bone cement formulations.
  • To evaluate Schering-Plough Palacos, Heraeus Palacos, and Depuy CMW Smartset bone cements.
  • To assess the impact of vancomycin addition on cement properties.

Main Methods:

  • Mechanical testing (flexural strength) of bone cements with and without vancomycin.

Related Experiment Videos

  • Antibiotic elution studies measuring cumulative gentamicin and vancomycin release.
  • Comparative analysis of three bone cement brands: Schering-Plough Palacos, Heraeus Palacos, and Depuy CMW Smartset.

    • Main Results:

    • Heraeus Palacos and Smartset demonstrated significantly better mechanical properties than Schering-Plough Palacos (p < 0.001).
    • All cements showed reduced flexural strength with increasing vancomycin, but remained above ISO standards.
    • Heraeus Palacos and Smartset exhibited significantly higher cumulative gentamicin elution than Schering-Plough Palacos.
    • Smartset showed significantly higher cumulative vancomycin elution compared to Heraeus Palacos.
    • Enhanced antibiotic elution in Heraeus Palacos and Smartset did not compromise mechanical properties.

    Conclusions:

    • Heraeus Palacos and Depuy CMW Smartset represent improved bone cement formulations compared to the previous Schering-Plough Palacos.
    • The 'original' Palacos (Heraeus) has notably different mechanical and elution characteristics than the commonly used prior version.
    • Surgeons should be aware of these formulation-dependent differences when selecting bone cements for orthopedic procedures.