Reinforcement of injectable calcium phosphate cement by gelatinized starches

Current injectable calcium phosphate bone cements (CPC) encounter the problems of low strength, high brittleness, and low cohesion in aqueous environment, which greatly hinder their clinical applications for loading-bearing bone substitution and minimally invasive orthopedic surgeries. Here, a strategy of using gelatinized starches to reinforce injectable CPC was investigated. Four types of starches, namely corn starch, crosslinked starch, cationic starch, and Ca-modified starch, were studied for their influence on CPC mechanical properties, injectability, setting times, anticollapsibility, and cytocompatibility. Gelatinized starch significantly improved compressive strength and modulus as well as strain energy density of CPC to different extents. Specifically, both corn starch and Ca-modified starch revealed sixfold and more than twofold increases in the compressive strength and modulus of CPC, respectively. The addition of gelatinized starches with proper contents increased the injectability and anticollapsibility of CPC. In addition, osteoblast proliferation tests on leaching solution of modified cements showed that gelatinized starches had no adverse effect on cell proliferation, and all cement samples resulted in better osteoblast proliferation compared to phosphate-buffered solution control. The mechanisms behind the reinforcing effect of different starches were preliminarily studied. Two possible mechanisms, reinforcement by the second phase of gelatinized starch and strong interlocking of apatite crystals, were proposed based on the results of starch zeta potential and viscosity, cement microstructure, and resultant mechanical properties. In conclusion, incorporating gelatinized starches could be an effective, facile, and bio-friendly strategy to reinforce injectable CPC and improve its mechanical stability, and thus, should be further studied and developed.