Low-intensity pulsed ultrasound enhances antibiotic release of gentamicin-loaded, self-setting calcium phosphate cement.

Objective This study aimed to investigate the effect of low-intensity pulsed ultrasound on antibiotic release from gentamicin-loaded, self-setting calcium phosphate cement. Methods A gentamicin-loaded calcium phosphate cement cylinder was eluted in stimulated body fluid. Low-intensity pulsed ultrasound (46.5 kHz, 200 mW/cm2) was used to produce a sinusoidal wave in the experimental group. Non-gentamicin calcium phosphate cement was used in the control group. Results The transient concentration and cumulatively released percentage of gentamicin in the ultrasound group were higher than those in control group at every time point. The duration of gentamicin concentrations over the level of the minimum inhibitory concentration was significantly prolonged in the ultrasound group compared with the control group. Antibacterial efficacy of gentamicin in the ultrasound group was significantly better than that in the control group with the same concentration of gentamicin. Conclusion Low-intensity pulsed ultrasound enhances antibiotic release, providing sustained antibiotic release at high concentrations. This increases the antibacterial effect of gentamicin.

[Stabilization of the pelvic ring with photodynamic bone stabilization (IlluminOss™)]. / Stabilisierung einer Beckeninsuffizienzfraktur mit einem photosensiblen Kunststoff (IlluminOss™).

We describe the case of an 88-year-old woman who presented with painful symptoms of the pelvis after low-energy trauma. Conservative treatment with pain therapy and pain-adapted mobilization was unsuccessful. Diagnostics showed a fragility fracture of the pelvic ring; therefore, we performed photodynamic bone stabilization (IlluminOss™) of the pubic bone and percutaneous cement-augmented fixation of the iliosacral joint assisted by computed tomography (CT) fluoroscopy. Imaging showed a stable healed fracture 4 months after surgery.

Outcome of long-axis percutaneous sacroplasty for the treatment of sacral insufficiency fractures with a radiofrequency-induced, high-viscosity bone cement.

Our goal was to assess the technical results in patients who underwent long-axis sacroplasty for the treatment of sacral insufficiency fractures (SIF) by radiofrequency-induced high-viscosity bone cement augmentation. Twelve patients with bilateral sacral fractures were treated by augmentation with radiofrequency-activated, high-viscosity polymethylmethacrylate (PMMA) bone cement under local anesthesia. CT-guided sacroplasty was performed by using a long-axis approach through a single entry point. Thirty-six vertebrae were treated in 12 sessions under a combination of CT and fluoroscopic guidance using a bilateral access and a cavity-creating osteotome prior to remote-controlled, hydraulically driven cement injection. The visual analogue scale (VAS) score before sacroplasty and at 1 and 3 months after the treatment was obtained. PMMA leaks were evaluated retrospectively using the post-interventional CT. The mean amount of high-viscosity PMMA injected per patient was 7.8 ml. No major adverse events were observed. In the first 4 days after the procedure, the mean VAS score decreased from 8.1 ± 1.9 to mean 3.1 ± 1.2 and was followed by a gradual but continuous decrease throughout the rest of the follow-up period at 24 weeks (mean 2.2 ± 1.1) and 48 weeks (mean 2.1 ± 1.4). CT fluoroscopy-guided sacral augmentation was safe and effective in all 12 patients with osteoporotic SIF.

[Minimally invasive cement augmentation of osteoporotic vertebral compression fractures with the new radiofrequency kyphoplasty]. / Minimal-invasive Zementaugmentation von osteoporotischen Wirbelkörperfrakturen mit der neuen Radiofrequenz-Kyphoplastie.

OBJECTIVE: Minimally invasive cement augmentation of painful osteoporotic vertebral compression fractures in elderly patients. INDICATIONS: Painful osteoporotic vertebral compression fractures in elderly patients (> 65 years of age) after conservative therapy failure. Painful aggressive primary tumors of the spine or osteolytic metastases to the spine with high risk of vertebral fracture in the palliative care setting. CONTRAINDICATIONS: General contraindications for surgical interventions. Local soft-tissue infection. Osteomyelitis, discitis or systemic infection. Coagulopathy refractory to treatment or bleeding diathesis. Asymptomatic vertebral compression fractures. Burst of the posterior vertebral column with high degree of spinal canal stenosis. Primary or metastatic spinal tumors with epidural growth. SURGICAL TECHNIQUE: Prone position on a radiolucent operating table. Fluoroscopic localization of the fractured vertebra using two conventional C-arm devices (anteroposterior and lateral views). Fluoroscopic localization of the fractured vertebra using two conventional C-arm devices (anteroposterior and lateral views). An introducer is inserted through a small skin incision into the pedicle under fluoroscopic guidance. To create a site- and size-specific three-dimensional cavity in the center of the fractured vertebra, the navigational VertecoR™ MidLine Osteotome was inserted through the correctly sited introducer and guided fluoroscopically. As the MidLine Osteotome allows angulation of the tip up to 90° by rotating the handle, a cavity over the midline of the vertebral body can mainly be created through one pedicle. The radiofrequency activated cohesive ultrahigh viscosity PMMA cement (ER(2) bone cement) is injected stepwise on demand by remote control under continuous pressure from the hydraulic assembly into the vertebral body. POSTOPERATIVE MANAGEMENT: Bed rest for 6 h postoperatively in supine position. Early mobilization without a corset on the day of surgery. Specific back and abdominal exercises that strengthen the back and abdominal muscles. Pain dependent increase of weight bearing. Continue osteoporosis therapy and start specific drug therapy according to the local guidlines if necessary. RESULTS: In all, 44 patients (29 women, 15 men) with a mean age of 73.5 years with a total of 62 painful osteoporotic vertebral fractures were treated with RF kyphoplasty from May 2009 until July 2010, and followed over a period of 12 months. The mean operating time per patient was 36.2 min, the operating time per vertebra was 25.7 min. All the patients studied experienced an early and persistent significant pain relief even 12 months after therapy (8 ± 1.4 vs. 2.7 ± 1.9) according to the visual analogue pain scale. According to the Oswestry Disability Index (ODI) as a disease-specific disability measure all the patients improved significantly (p < 0.001) in the level of disability after operative treatment (56.2 ± 18.8 vs. 34.5 ± 16.6). Cement leakage was detected in 17 out of 62 (27.4 %) augmented vertebrae, whereas all the patients with cement leakage remained asymptomatic. One patient had subsequent vertebral fractures after a period of 6 months.

[Is height restoration possible with a comparatively smaller amount of cement in radiofrequency kyphoplasty using a monopedicle approach?]. / Ist eine Höhenrekonstruktion mit vergleichsweise wenig Zement für die Radiofrequenz-Kyphoplastie über einen monopedikulären Zugang möglich?

BACKGROUND: Percutaneous cement augmentation systems have been proven to be an effective treatment for vertebral compression fractures in the last 10 years. A special form available since 2009 is the radiofrequency kyphoplasty (RF) in which the applied energy raises the viscosity of the cement. The aim of this study is to find out if a smaller cement amount in radiofrequency kyphoplasty can also restore vertebral body height in osteoporotic vertebral compression fractures. METHODS: The treatment was minimally invasive using the StabiliT® vertebral augmentation system by DFine. In a retrospective study from 2011 to January 2012, 35 patients underwent RF kyphoplasty for 49 fresh osteoporotic vertebral compression fractures. From the clinical side the parameters, demographics and pain relief using a visual analogue scale (VAS: 0 to 100 mm) were collected. For the radiological outcome the vertebral body height (anterior, mean and posterior vertebral body height with kyphosis angle) after surgery and after three months was measured and compared to the cement volume. RESULTS: All patients still had permanent pain on the fractured level after conservative treatment. The time from initial painful fracture to treatment was 3.0 weeks ± 1.3. Average visual analogue scale results decreased significantly from 71 ± 9.2 preoperatively to 35 ± 6.2 postoperatively (p < 0.001) and to 30 ± 5.7 (p < 0.001) after three months. With a mean cement volume in the thoracic spine of 2.9 ± 0.7 ml (1.8-4.1) and lumbar spine of 3.0 ± 0.7 ml (2.0-5.0) we had a significant vertebral body height restoration. Anterior and mean vertebral body heights significantly increased by an average of 2.3 and 3.1 mm, kyphosis angle significantly decreased with an average of 2.1° at three-month follow-up (p < 0.05). In two vertebrae (4.1 %) a minimal asymptomatic cement leakage occurred into the upper disc. In two patients (5.7 %) we had new fractures in the directly adjacent segment that were also successfully treated with radiofrequency kyphoplasty. CONCLUSION: With a mean cement volume of 3.0 ml radiofrequency kyphoplasty achieves rapid and short-term improvements of clinical symptoms with a significant restoration of vertebral body height. There was no correlation between restoration of vertebral body height and pain relief. With a cement leakage of 4.1 % RF kyphoplasty is a safe and effective minimally invasive percutaneous cement augmentation procedure. Our data confirm the higher safety described in literature for kyphoplasty in contrast to vertebroplasty.

Calcium-strontium mixed phosphate as novel injectable and radio-opaque hydraulic cement.

Sterile calcium hydrogenophosphate dihydrate (DCPD) (CaHPO(4).2H(2)O), calcium oxide and strontium carbonate powders were mixed in various liquid phases. Among these, ammonium phosphate buffer (0.75 M, pH 6.9) led to a novel strontium-containing calcium phosphate cement. At a 6/2.5/1.5 M ratio and for a liquid to powder ratio (L/P) of 0.5 mlg(-1), the initial paste was fluid and remained injectable for 12 min at 25 degrees C. It was easily obtained by mixing sterile powders and the liquid phase using the push-pull technique, avoiding complex mixing apparatus. The cement set after 15 min at 37 degrees C and was hard after 1h. The compressive strength was in the 20 MPa range, a value higher than that generally assigned to trabecular bone (5-15MPa). This strength appeared sufficient for repairing non-loading sites or reinforcing osteoporotic vertebrae (vertebroplasty). After setting, the initial mixture formed a strontium-calcium-deficient carbonate apatite. The radio-opacity of the resulting cement was three times greater than that of cortical bone because of the presence of strontium ions, a feature that complies with the requirements for vertebroplasty. Furthermore, the cement powder remained stable and retained its properties for at least 4 years.

Computerized thermal characterization tool (CT)2 for complete thermodynamic coefficients mapping at the wavelength of 10.6 microm: a PMMA case report.

OBJECTIVE: This paper details a proposed clinical identification tool, the Computerized Thermal Characterization Tool or (CT)(2), designed to precisely quantify and forecast the ablation capabilities of a CO(2) laser beam and to optimize its usage when human tissue is exposed to 10.6 microm wavelength radiation. BACKGROUND: As seen in other studies by the same author, the correct identification of the optical absorption of polymethylmethacrylate (PMMA) allows isolating other key time-dependent coefficients, all described qualitatively rather than quantitatively in the literature, with better accuracy. Tests on other biological media were performed and reported as potential contribution for minimally invasive surgical procedures. METHODS: The laser in use was configured in different combinations amongst the following parameters: transverse electromagnetic modes (TEM(22)), output power, exposure times, and focal lengths. Several PMMA blocks (1 cm x 4 cm x 4 cm) were exposed to the continuous wave radiation of three commercially available CO(2) medical laser devices with a TEM(11) beam profile. RESULTS: The data were used in a computerized simulation to test a priori the thermal behavior of biological media exposed to a CO(2) laser beam. Interestingly, this behavior could be reproduced on a variety of biological and nonbiological media. Threshold injury conditions were reached for the myocardium at 786 W/cm(2) per pulse, for the aorta at 519 W/cm(2) per pulse, and for the PMMA samples at 393 W/cm(2) per pulse. CONCLUSIONS: These values can be used as reference for both minimally invasive surgery and for transmyocardial laser revascularization protocols, combined with the proposed (CT)(2). Further investigations are needed to completely validate the potential clinical utilization.

Optical absorption coefficient, time of thermal relaxation, time of surface threshold, and time of heat incubation for PMMA samples at the CO2 laser-beam wavelength of 10.6 microm.

OBJECTIVE: This paper discusses in detail the mathematical identification of the optical absorption alpha (cm(1)) of Beer's law, a crucial parameter to study the development of laser beam craters into dry poly(methyl methacrylate) (PMMA) samples exposed to steady CO(2) laser beams emitting radiation at lambda = 10.6 microm in continuous- wave (CW) mode. Three additional time-dependent coefficients have been determined as well. In clinical applications, these results are important in order to precisely quantify and forecast the ablation capabilities of the CO(2) laser beam, to optimize its usage in the operating room, and to address the safety issues related to surgical interventions on human tissue. BACKGROUND DATA: Currently, the data available in the literature do not allow the identification of the numerical value of alpha (cm(1)) for PMMA at lambda = 10.6 microm with enough, and therefore satisfactory, accuracy. Additionally, the correct identification of the optical absorption of PMMA would allow the isolation, with better accuracy, of other key time-dependent coefficients, such as relaxation time, surface threshold time, and heat incubation time, which are all described in the literature in a qualitative rather than quantitative fashion. Correct bone cement preparation depends on the value of alpha (cm(1)) of the PMMA in order to avoid unwanted complications in patients during cement removal via laser techniques. METHODS: The laser in use was configured in different combinations with the following parameters: transverse electromagnetic modes (TEMnm), output power (I0), exposure times (te), and focal lengths (fk). Several PMMA blocks (1 cm x 4 cm x 4 cm) were exposed to CW radiation of three commercially available CO(2) medical laser devices showing a TEM11 mode. Each block was exposed to the beam on a horizontal and well-polished surface of each sample. Four focal lengths (2.5", 5", 7.5", and 15.75" [400 mm]) were used to focus the beam on the well-polished and dry surface of the PMMA samples. The resulting dimensions of the craters were measured after each exposure, which has been kept at a 10-Watt CW beam. Exposure time ranged from 0.5 to 2 sec. RESULTS: The value of alpha = 502 (cm(1)) for PMMAat 10.6 microm was identified, matching other results reported in the literature for similar compact media in the absence of water content, such as PMMA. The time of thermal relaxation was 9.358 x 10(4) sec, the time of surface threshold was 9.365 x 10(4) sec, and the time of heat incubation was 3.6 x 10(7) sec (all three for PMMAat 10.6 microm for any exposure). Using the calculated value of alpha, one of the practical clinical recommendations would be, for instance, to reduce or to abolish the utilization of colorant dopants in the preparation of the bone cement mixture and therefore reduce the danger of bone damage possible during the removal of bone cement via laser techniques. Other examples refer to other clinical bone and dental treatments.

The effect of antioxidants on oxidative DNA damage induced by visible-light-irradiated camphorquinone/N,N-dimethyl-p-toluidine.

Previous investigations have found that visible-light (VL)-irradiated camphorquinone (CQ), in the presence of a tertiary amine (e.g., N,N-dimethyl-p-toluidine, DMT), generates reactive oxygen species and causes oxidative DNA damage in vitro. In this study, oxidative DNA damage produced by VL-irradiated CQ/DMT, in the presence and absence of antioxidants (glutathione, N-acetyl-L-cysteine (NAC), mannitol, vitamin C, and vitamin E), was measured by the conversion of PhiX-174 RF I supercoiled (SC) double-stranded plasmid DNA into open and linear forms. VL-irradiated CQ/DMT, lacking antioxidant, damaged 99.4 +/- 1% of the PhiX-174 RF I SC double-stranded plasmid DNA. Our results revealed that glutathione (10.0, 5.0, 2.5, 1.0, and 0.5 mm) and NAC (10.0, 5.0, and 2.5 mm) significantly (p < 0.02) reduced oxidative DNA damage produced by VL-irradiated CQ/DMT. Vitamin E, vitamin C, and mannitol were ineffective at reducing oxidative DNA damage produced by VL-irradiated CQ/DMT. Furthermore, vitamin E (10.0 and 5.0 mm) and vitamin C (10.0, 5.0, 2.5, 1.0, 0.5 mm) treatment significantly (p < 0.02) enhanced VL-irradiated CQ/DMT-induced oxidative DNA damage and caused significant (p < 0.001) DNA damage following VL-irradiation in the absence of CQ/DMT. As a result, future studies should evaluate whether glutathione and NAC effectively reduce or prevent oxidative damage induced by VL-irradiated CQ/DMT in vivo.

Analysis of the shelf life of a two-solution bone cement.

Two-solution bone cement consists of methyl methacrylate monomer and poly(methyl methacrylate) polymer dissolved together to yield a viscous solution. Two solutions are used such that the initiator, benzoyl peroxide (BPO), is placed in one solution and the activator, N,N, dimethyl-para-toluidine, is placed in the other. This approach to bone cement provides for a simplified use during surgery and eliminates some of the sources of porosity formation. However, the BPO-containing solution cement will spontaneously polymerize over time and will limit the useful shelf life of this component of the system. The activator-containing component is much more stable and is not as susceptible to spontaneous polymerization. In making two-solution cements, it is envisioned that antibiotics may be incorporated and that the polymer may be sterilized using gamma(gamma)-irradiation. Therefore, this study investigated the shelf life of the initiator-containing solution bone cement and studied the effects of initiator concentration, gamma-irradiation, gentamicin addition, and the role of storage temperature. Isothermal differential scanning calorimetry (Iso-DSC) techniques were used to monitor the polymerization of BPO-containing solutions. It was found that the shelf life was highly temperature dependent and followed an Arrhenius expression where refrigeration storage (4 degrees C) yielded approximately a 12-month storage time, while 70 degrees C storage results in setting in about 5-7 min. gamma-irradiation and gentamicin addition did not significantly affect the shelf life. Initiator concentration affected storage time with higher levels resulting in shorter shelf life.

A new ESR dosimeter based on bioglass material.

Bioglass (Bio-G) samples were irradiated with 60Co gamma-rays to study radicals for dosimetric materials with electron spin resonance (ESR). The ESR spectrum of Bio-G is characterized by two main signals. The first signal at g approximately = 4.3 corresponds to Fe3+ impurities and the second signal at g approximately = 2.0130 with line-width 10.85 G is ascribed as a hole center. The gamma-ray dose response and thermal stability were studied to establish the suitability of bioglass as an ESR dosimeter. A radical formation efficiency, G-value, of 0.53 +/- 0.11 was obtained. The lifetime of radicals and the activation energy were estimated from Arrhenius plots to be approximately 255 +/- 46 days and 0.71 eV, respectively.

Effects of pre-cooling and pre-heating procedures on cement polymerization and thermal osteonecrosis in cemented hip replacements.

Numerical studies were performed to investigate bone cement polymerization, temperature history and thermal osteonecrosis in cemented hip replacements with finite element methods. In this paper, the effects of pre-cooling and pre-heating of the prosthesis and/or the cement prior to implantation were simulated. It was found that the cement polymerization initiated near the bone-cement interface and progressed toward the prosthesis when both the cement and prosthesis were initially at room temperature. When the prosthesis and/or cement were pre-cooled, a reduction of the peak temperature at the bone-cement interface resulted, and this may reduce thermal osteonecrosis. However, this also slowed the polymerization process, and may result in a weaker bone cement. If the prosthesis was significantly initially heated, bone cement polymerization reversed reaction direction, started from the cement-prosthesis interface and proceeded toward the bone. Such polymerization direction may reduce or eliminate the formation of voids at the cement-prosthesis interface. Numerical results also showed that pre-heating seemed unlikely to produce significant thermal damage to the bone. The method of pre-heating the prosthesis prior to implantation may decrease the likelihood of cement-prosthesis loosening and increase the life of total hip arthroplasty.

Self-setting kinetics of new type calcium phosphate bioactive bone cement: a thermokinetics study.

Thermokinetics method was used to study the self-setting kinetics of a new kind of calcium phosphate cement (CPC) in the present study. A calcium-deficient hydroxyapatite CPC was developed by using alpha-TCP and other calcium phosphate bioceramics. The mixing liquids used were deionized water and 0.25 M NaH2PO4/Na2HPO4, respectively. The calorimetric curves, heat evolution curves and total heat evolution in the setting and hardening process of CPC were determined. It has been found that mixing liquids, reaction temperature had influences on the calorimetric curves and heat evolution, and mixing liquids exhibited the greatest influence on the kinetics of CPC during the self-setting and hardening process. Based on the calorimetric curves obtained, the kinetic model equation was simulated, and the reaction control step was determined.

Modelling heat transfer in a bone-cement-prosthesis system.

The heat transfer in a general bone-cement-prosthesis system was modelled. A quantitative understanding of the heat transfer and the polymerization kinetics in the system is necessary because injury of the bone tissue and the mechanical properties of the cement have been suggested to be effected by the thermal and chemical history of the system. The mathematical model of the heat transfer was based on first principles from polymerization kinetics and heat transfer, rather than certain in vitro observed properties, which has been the common approach. Our model was valid for general three-dimensional geometries and an arbitrary bone cement consisting of an initiator and monomer. The model was simulated for a cross-section of a hip with a potential femoral stem prosthesis and for a cement similar to Palacos R. The simulations were conducted by using the finite element method. These simulations showed that this general model described an auto accelerating heat production and a residual monomer concentration, which are two phenomena suggested to cause bone tissue damage and effect the mechanical properties of the cement.

[Morphologic evaluation of the bonding between adhesive/composite resin and dentin irradiated with Er:YAG and Nd:YAG lasers: comparative study using scanning microscopy]. / Avaliação morfológica da união entre adesivo/resina composta e dentina irradiada com laser Er:YAG e laser Nd:YAG: estudo comparativo por microscopia de varredura.

Since bonding systems were introduced in the restorative procedures carried out with esthetic materials, the treatment of dentin surfaces has been widely studied in order to establish the ideal technique. The application of 37% phosphoric acid on dentin is still the best known method. However, alternative methods for treating the dentin surface have been discussed in the literature, including the utilization of some kinds of laser irradiation. The purpose of this research was to morphologically evaluate the bond between adhesive materials and the dentin treated with Er:YAG and Nd:YAG lasers, in a comparative study by means of scanning electron microscopy (SEM). Irradiation either substituted acid etching, or was associated to it. Recently extracted bovine incisors were utilized. They received class V cavity preparations and were restored with a bonding system and a light-cured composite resin. Meanwhile, some of the teeth underwent irradiation with Er:YAG laser or Nd:YAG laser before the application of the bonding agent and the composite resin. The samples were selected, prepared for SEM and submitted to morphological analysis. Data were registered in photomicrographs. Based on the microscopic observations, we concluded that only in the dentin surfaces submitted to irradiation with Er:YAG laser and to acid conditioning there was penetration of resin into the dentine. With the Nd:YAG laser treatment, there was only visual superposition of resin over the dentin surface, which suggests that there was only occlusion of the tubules, with characteristics of fusion in the superficial dentine.

Fracture and fatigue properties of acrylic bone cement: the effects of mixing method, sterilization treatment, and molecular weight.

The purpose of this study was to characterize the relative and combined effects of sterilization, molecular weight, and mixing method on the fracture and fatigue performance of acrylic bone cement. Palacos R brand bone cement powder was sterilized using ethylene oxide gas (EtO) or gamma irradiation. Nonsterile material was used as a control. Molecular weights of the bone-cement powders and cured cements were measured using gel permeation chromatography. Hand and vacuum mixing were employed to mold single edge-notched bend specimens for fracture toughness testing. Molded dog-bone specimens were used for fatigue tests. Electron microscopy was used to study fracture mechanisms. Analysis of variance and Student t-tests were used to compare fracture and fatigue performance between sterilization and mixing groups. Our results indicate that vacuum mixing improved significantly the fracture and fatigue resistance (P<.05, P<.07) over hand mixing in radiation-sterilized and EtO-sterilized groups. In vacuum-mixed cement, the degradation in molecular weight resulting from gamma irradiation decreased fracture resistance significantly when compared with EtO sterilization and control (P<.05). A corresponding decrease in fatigue resistance was observed in the cement that was degraded severely by a radiation dose of 10 MRad (P<.05). In contrast, EtO sterilization did not result in a significantly different fracture resistance when compared with unsterilized controls for vacuum-mixed cement (P>.1). For hand-mixed cement, fracture and fatigue resistance appeared to be independent of sterilization method. This independence is believed to be the result of higher porosity that compromised the mechanical properties and obscures any effect of sterilization. Our results indicate that a combination of nonionizing sterilization and vacuum mixing resulted in the best mechanical performance and is most likely to contribute to enhanced longevity in vivo.

Apparent fracture toughness of acrylic bone cement: effect of test specimen configuration and sterilization method.

The plane strain fracture toughness of Palacos R bone cement was determined using linear elastic fracture mechanics (LEFM) principles and three different test specimen configurations: single edge notched three-point (SENB), rectangular compact tension (RCT), and chevron notched short rod (CNSR). Another aspect of the study was an investigation of the effect of three methods used to sterilize the powder constituents of the cement-none, gamma irradiation and ethylene oxide--on the fracture toughness of the fully polymerized material. A detailed justification is provided for using LEFM. The fracture toughness results obtained using the CNSR specimens were, on average, 14 and 16% higher than those obtained using the SENB and RCT types, respectively. These differences are accounted for in terms of differences in four aspects of these specimen configuration (namely, residual stress effects, loading rate, material inhomogeneity, and the nature of the test). For a given specimen configuration, gamma irradiation produced a statistically significant decrease in fracture toughness which, it is suggested, is due to the concomitant depreciation in molecular weight. For a given cement type, there is no statistically significant difference in fracture toughness results obtained using SENB and RCT specimens. It is thus suggested that either of these configurations can be used to determine the fracture toughness of acrylic bone cement.

Ablation of polymethylmethacrylate by Ho:YAG, Nd:YAG, and Erb:YAG lasers.

Ho:YAG, Nd:YAG, and Erb:YAG laser ablation of Polymethylmethacrylate (PMMA) was investigated under in vitro and simulated clinical conditions. Ablation rates were measured for all lasers and after ablation, macroscopic and microscopic appearance of the ablation site was investigated. The mean ablation rates of the Erb:YAG, Ho:YAG, and Nd:YAG laser increased from 8 microns per pulse at 100 mJ to 44 microns per pulse at 300 mJ from 100 microns per pulse at 200 mJ to 222 microns per pulse at 800 mJ and from 28 microns per pulse at 100 mJ to 189 microns per pulse at 800 mJ, respectively. Macroscopic investigation exhibited melting of bone cement for the Ho:YAG and Nd:YAG lasers and pulse-to-pulse vaporization for the Erb:YAG laser. The width of thermal alteration, however, was comparable for all lasers used. Removal of cement from bone specimens under simulated clinical conditions showed good detachment of cement when the fiber was used parallel; in case of perpendicular use, remainders of cement and carbonization of bone could be observed upon histological investigation.

Experimental Nd:YAG laser disintegration of methylmethacrylate. Analysis of gaseous products.

The difficulty of removing intramedullary methylmethacrylate (MM) in revision of hip prostheses is considerable. To facilitate its removal from bone, Nd:YAG laser energy was delivered to a bovine anatomic specimen of the femur with the medullary canal filled with MM. Through an endoscope the laser was observed to soften and ablate the methyl methacrylate. The vapors generated by this process were analyzed by mass spectrometry. The two chief components were hydrogen and carbon monoxide, followed by carbon dioxide, methane, acetylene, and C3 unsaturated hydrocarbons. A high capacity smoke evacuator must be used in conjunction with laser vaporization of methylmethacrylate. The method should be evaluated under in vivo conditions in dogs before it is attempted in patients.