Flow intrusion characteristics and fracture properties of titanium-fibre-reinforced bone cement

Two clinically relevant considerations for a new bone cement are its fracture properties and flow intrusion characteristics. We present data for a titanium-fibre-reinforced poly(methyl methacrylate) (Ti-PMMA). The fracture properties presented are a concise review of previously published material, while the flow intrusion observations are new. We performed fracture toughness and fatigue fracture experiments. Two types of fatigue specimens were designed and tested. A 'smooth' specimen represented the extreme case of minimum surface flaws. The lifetime of a 'smooth' specimen incorporates fatigue crack initiation (FCI) and fatigue crack propagation (FCP). 'Notched' specimens were created by machining a sharp notch into cylindrical specimens. The sharp notch effectively eliminated FCI from a random surface flaw and thus we made the assumption that the lifetime of the notched specimen was a function of FCP only. Fatigue testing was performed on rotating-bending fatigue machines until failure. Fibre addition resulted in a significant increase in fracture toughness over the control bone cement. Fibre addition and the combination of fibre addition and centrifugation increased the fatigue crack initiation and propagation resistance of the bone cement. For the intrusion studies, eight femurs were obtained from four dogs. The femurs were prepared following a procedure similar to that in human hip replacement surgery. One of the pair of femurs from each dog was filled with non-reinforced bone cement and the other was filled with Ti-PMMA. A stainless-steel rod was inserted into the cement to simulate the insertion of a prosthesis stem. The cemented bones were sectioned and then stained with Alizarin Red S to distinguish the bone from the PMMA or Ti-PMMA. Because of the irregular bone morphology, it was not practical to quantify intrusion depth, but instead to make general observations on the intrusion characteristics. The Ti fibres did not generally flow into the small openings; however, fibre addition did not hinder the bone cement's ability to penetrate into bone interstices.