Exploring bioactive bone cement pastes: A promising solution for orthopedic surgeries

Bone cement is a biomaterial that has been used effectively in orthopedic surgery for almost 50 years. The cement hardens after injection in the defect site without needing any external agent. Bone cement is commonly used in implant fixation, joint replacement, trauma surgery, osteoporosis management, and antibiotic delivery. Since the bone anatomy of patients is different, the final hardening of bone cement in the body corrects the abnormalities and gaps between the implant and the bone. The most universal injectable bone cements are based on ceramic or polymer compounds. The chemical composition of ceramic cement is similar to that of bone and hardens by chemical reaction, while polymerization promotes hardening in polymer-based bone cement. Despite the significant progress of bone cement in orthopedic surgery, its limitations and accompanying considerations must be acknowledged. Long-term degradation potentially leads to loosening of the implant and an exothermic reaction during hardening, leading to tissue necrosis. To address these limitations various approaches have been continuously evaluated. The major objective of this review is to comprehensively evaluate ceramic and polymer-based bone cement as a promising approach in orthopedic surgery. Adequate knowledge can lead to the induction of strategies to improve the performance of bone cement.