Evaluation of the reaction kinetics of CORTOSS, a thermoset cortical bone void filler.

The primary objective of this research is to evaluate the reaction kinetics of CORTOSS(TM), a thermoset, Bis-GMA (2,2-bis[4-(2-hydroxymethacryloxypropyl) phenyl]propane) composite system as a function of time, material storage temperature and the temperature of the surrounding environment (site temperature). This study utilizes probability theory to predict the percentage of bifunctional monomers with 0,1 and 2 functional groups that have been reacted. This is a strong indicator of the potential for leaching unreacted components. A differential scanning calorimeter (DSC) was used to measure the isothermal enthalpy at varying site temperatures. After isothermal monitoring, the samples were dynamically heated from the respective isothermal temperature to 175 degrees C at 15 degrees C/min to measure the residual enthalpy from the unreacted functional groups. The experimental results indicate that the degree of conversion for this bifunctional system ranged from 76% to 86%. Applying probability theory it has been determined that approximately 95% of the bifunctional monomers are present with at least one double bond reacted and up to 5% of monomers remain unreacted. This is consistent with theoretical values postulated for various diffusion controlled thermoset systems (Macromolecules 32 (1999) 3913). Overall, curing under physiological conditions yielded a faster reaction rate and a significantly higher degree of conversion as compared to the lower site temperature conditions.

Potential of an ultraporous beta-tricalcium phosphate synthetic cancellous bone void filler and bone marrow aspirate composite graft.

Autogenous cancellous bone is considered to be the best bone grafting material. Autogenous bone grafts provide scaffolding for osteoconduction, growth factors for osteoinduction, and progenitor stem cells for osteogenesis. However, the procurement morbidity, limited availability, and expense associated with the use of autogenous bone grafts are significant disadvantages. Allografts and xenografts lack the osteoinduction and osteogenesis properties of autogenous bone, and they introduce the potential for both transferring disease and triggering a host immune response. Synthetic bone grafts [hydroxyapatite or tricalcium phosphate (TCP)], while good platforms for osteoconduction, lack any intrinsic properties of osteoinduction and osteogenesis. A composite graft that combines synthetic scaffold with autogenous osteoprogenitor cells from bone marrow aspirate (BMA), a low-morbidity procedure, could potentially deliver the advantages of autogenous bone grafts without the disadvantages. A new ultraporous beta-TCP construct, engineered using solution-derived nano-particle technology, may prove to be an ideal carrier for BMA in such a composite. The unique, interconnected macroporosity, mesoporosity, and microporosity of this synthetic cancellous bone void filler allows it to wick in cells and nutrients via enhanced capillarity. Preliminary canine data support this expectation, demonstrating bone formation that suggests good penetration of cells and nutrients. These results suggest that BMA cells, absorbed into such a scaffold, may remain viable, thereby potentially making such a composite a true synthetic replacement for autogenous cancellous bone.

Comparison of a new bisphenol-a-glycidyl dimethacrylate-based cortical bone void filler with polymethyl methacrylate.

A newly formulated and reinforced bisphenol-a-glycidyl dimethacrylate (bis-GMA) resin (Cortoss/Orthovita, Malvern, Pa.) was compared with Simplex P polymethyl methacrylate (Stryker Howmedica Osteonics, East Rutherford, N.J.) in rabbits for up to 52 weeks and in sheep for up to 78 weeks. As seen in scanning electron microscopy and histology examinations, both implant materials were surrounded by bone at late time periods, with fibrous layers of connective tissue seen in half the Simplex P specimens. No clinically significant safety differences between implant materials were apparent. Interfacial bond strengths between the implant and bone generally increased with time, but were 4.5-fold greater with Cortoss than Simplex P at 24 weeks, and 100-fold greater at 52 weeks. Forces required to displace 316SS rods held in place with Cortoss were consistently greater than forces to displace rods held in place with Simplex P. No statistically significant differences in displacement forces were found between rods held in place with Cortoss polymerized in situ and rods held with prepolymerized Cortoss. Interfacial bond strengths were greater for Simplex P that was polymerized in situ than for prepolymerized polymethyl methacrylate specimens. Cortoss synthetic cortical bone void filler is a good candidate material to fix implants in bone. It has characteristics consistent with long-term safety and has a better ability to bond to bone than Simplex P.

Biomechanical evaluation of a new bone cement for use in vertebroplasty.

STUDY DESIGN: Comparative ex vivobiomechanical study. OBJECTIVES: To determine the strength and stiffness of osteoporotic vertebral bodies subjected to compression fractures and subsequently stabilized via bipedicular injection of one of two bone cements: one is a commercially available polymethylmethacrylate (Simplex P) and one is a proprietary glass-ceramic-reinforced BisGMA/BisEMA/TEGDMA matrix composite that is being developed for use in vertebroplasty (Orthocomp). SUMMARY OF BACKGROUND DATA: Osteoporotic compression fractures present diagnostic and therapeutic challenges for the clinician. Vertebroplasty, a new technique for treating such fractures, stabilizes vertebral bodies by injection of cement. Little is known, however, about the biomechanics of this treatment. METHODS: Five vertebral bodies (L1-L5) from each of four fresh spines were harvested from female cadavers (age, 80 +/- 5 years), screened for bone density using DEXA (t = -3.4 to -6.4), disarticulated, and compressed in a materials testing machine to determine initial strength and stiffness. The fractures then were repaired using a transpedicular injection of either Orthocomp or Simplex P and recrushed. RESULTS: For both cement treatments, vertebral body strength after injection of cement was significantly greater than initial strength values. Vertebral bodies augmented with Orthocomp recovered their initial stiffness; however, vertebral bodies augmented with Simplex P were significantly less stiff than they were in their initial condition. CONCLUSIONS: Augmentation with Orthocomp results in similar or greater mechanical properties compared with Simplex P, but these biomechanical results have yet to be substantiated in clinical studies.

Chemical durability of Y2O3-Al2O3-SiO2 glasses for the in vivo delivery of beta radiation.

Microspheres made from Y2O3-Al2O3-SiO2 (YAS) glasses, which contain radioactive Y-90, are currently being used to treat liver cancer in humans, where their chemical durability is of prime importance. In deionized water or saline at 37 degrees C, the weight percent Yttrium (Y) dissolved from eight different YAS glasses ranged from only 0.02-0.13% of the total Y present and their dissolution rate was barely measurable, < or = 1.0 x 10(-9) g/cm2-min. The most chemically durable YAS glass was 17Y2O3-19Al2O3-64SiO2, mol%. The small amount of Y released from microspheres, 25-35 microns diameter, of this glass after corrosion in saline or deionized water at 37 degrees C was essentially the same as for bulk glass samples. Based on their excellent chemical durability, it is concluded that YAS glass microspheres are suitable for in vivo use.