Alice Ajit Mutum, of Future Market Insights, looks at the rapidly evolving products and technologies in the bone cement industry
The emergence of personalised medicine and penetration of many technologies are adding to the uncertainty of global health economy – thereby compelling healthcare organizations to plan their future moves. The products and technologies surrounding orthopaedic implants in particular are rapidly evolving. Digital revolution is taking hold in line with surgeons benefiting from the incorporation of robotic-guidance systems. Additionally, orthopaedic surgery is on a path towards minimally invasive and highly precise operations, with a greater proportion of outpatient procedures. Today, as accuracy and comparable approaches take the front seat in assessment of the quality of care and outcomes, new tools and techniques are entering the field of orthopaedics.
The technology underlying long-term stability of fixation in bone achieved with cemented anchorage has matured significantly since its first usage in the 1940s, which was to close gaps in the human skull. Today, key advantages of bone cemented prosthesis depend on the optimal primary fixation between bone and implant, and subsequently in a faster patient recuperation. Well adapted to bone complex cavities, bone cement had long been a gold standard in the field of joint replacement. However, several shortcomings such as long-term prosthesis loosening and the potential breakdown of cement, side effects, and toxicity of bone cement are being effectively addressed recently. Moreover, the use of bone cement is marginally reduced with the advent of cementless or press-fit implant that encourages the natural bone to grow onto it.
The quest for promising material for bone cement remains strong
Bone cement based on polymethyl methacrylate (PMMA), also known as acrylic bone cement, is widely used for its self-polymerising and minimal adhesive attributes. Originally developed for dental applications, fixation in the bone with PMMA bone cement has largely contributed to the success of modern joint replacement. In stark contrast to this, the polymerisation reaction of methyl methacrylate is highly exothermic which can lead to cellular necrosis in the surrounding tissue. Much progress has been made in modelling fatigue failure of bulk cement and its interfaces with implant and bone. However, there still remains a scope for improvement.
Calcium polyphosphate (CPP) emerged as a new type of bio-ceramic for bone repair and continues to garner research interests. Many additives are further being tested to improve the biological properties of bone cement, while aiding in self-healing, improved infection resistance, and an increase in osteogenic up-regulation.
A recent study published in the Journal of Orthopaedic Surgery and Research analyses how a bio-composite bone cement could be advantageous over its PMMA counterpart in terms of structural stability. The former composed of chitosan and tri-calcium as additives to acrylic bone cement experiences relatively less ‘stress-shielding’, which accounts for its abilities to deliver structural stabi