BONE CEMENT - BOON OR BANE (AN OVERVIEW)
Authors: Girdhar Sahil , Raheja Parveen 
Published: August 2023

Polymethyl methacrylate (PMMA), is commonly known as bone
cement, and is widely used for implant xation in various Orthopedic
and trauma surgery. In reality, “cement” is a misnomer because, the
word cement is used to describe a substance that bonds two things
together. However, PMMA acts as a space-ller that creates a tight
space which holds the implant against the bone and thus acts as a
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'grout'. Bone cements have no intrinsic adhesive properties, but they
rely instead on close mechanical interlock between the irregular bone
surface and the prosthesis. Other types of commercially available bone
cement like calcium phosphate cements (CPCs) and Glass
polyalkenoate (ionomer) cements (GPCs) are successfully used in a
variety of orthopedic and dental applications. CPCs are bio resorbable
and biocompatible, but are mainly used in cranial and maxillo-facial
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surgeries because of their low mechanical strength. HistoryThe
pioneering work on PMMA technology is widely credited to German
chemist Dr. Otto Rohm. In 1933, he patented Plexiglas, a PMMA
product used in submarine periscopes and airplane canopies. This led
to a sharp increase in demand and interest before and during the war.
Kulzer (1936) found that a dough made by mixing his pulverized
PMMA powder and liquid monomer hardened when he added benzoyl
4. peroxide and heated it to 100°C in a stone mold, making it malleable
His rst clinical use of this PMMA mixture was in 1938, for the
purpose of plugging a skull defect in a monkey. Surgeons used the
heat-stable polymer Paladon 65 to close a human skull defect. This
material was assembled into sheets in the laboratory and then molded
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in the operating room . His modern day PMMA bone cement dates
back to a patent by Degussa and Kulzer (1943). The patent described
how MMA polymerizes at room temperature upon the addition of coinitiators (eg tertiary aromatic amines). Dentists were the rst to use
this technology in dental xatives and dental instruments. British
surgeon Dr. David Martin is widely credited for the rst use of bone
cement in orthopedics. By John Charnley using "Dentacryl" for total
hip arthroplasty in 19585. Initial clinical results were unsatisfactory
due to mechanical and biological reasons for both the cement and the
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loading platform . Dr. Charnley developed a new product called "bone
cement" (Plexiglas) with more adaptive biological properties, which
he actively marketed to the global orthopedic community. American
orthopedic surgeon trained under Dr. Charnley learned
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groundbreaking techniques at Wrightington Hospital . When these
surgeons returned to the United States, they often brought back bags of
bone cement, but this illegal trade began in the mid-1970s when the
Food and Drug Administration approved the use of bone cement
technology in the United States.Component PMMA is an acrylic
polymer made by mixing two sterile ingredients (Table 1).A liquid
8 MMA monomer and a powdered MMA-styrene copolymer. When the
two components are mixed, the liquid monomer polymerizes around
the prepolymerized powder particles and hardens to form PMMA.An
exothermic reaction produces heat.