Development of Portland cement for orthopedic applications, establishing injectability and decreasing setting times

The injectability of Portland cement (PC) with calcium chloride and calcium nitrate additives was investigated using a syringe with a 2 mm aperture for potential clinical applications such as vertebroplasty. Addition of either additive at 10 wt % increased the quantity of cement extruded through the syringe from approximately 25 wt % for the PC standard, to over 95 wt %. 10 wt % additions of either additive also decreased setting times from over 2 h to below 25 min. The compressive strength of the modified cements was all greater than the compressive strength of a human vertebral body. Decreasing either additive to 5 wt % generated compressive strengths after 24 h setting equal to polymethylmethacrylate, the cement used for the majority of vertebroplasty procedures. An initial early exotherm in the chloride cements was coupled with an X-ray diffraction (XRD) peak that indicated the early formation of the ettringite cement phase. In contrast, Fourier transform infrared (FTIR) spectroscopy and XRD data indicated that calcium nitrate may have stimulated early calcium silicate hydrate (C-S-H) production (the main strength producing phase of PC). Combining the two additives produced a synergistic effect with cements having increased injectabilities and compressive strengths compared with either addition used individually. This study has demonstrated that by modifying PC with nonproprietary chemicals it was possible to significantly increase cement injectability and reduce setting times whilst maintaining compressive strengths, making PC suitable for potential orthopedic applications.