# Osseointegration of Antimicrobial Acrylic Bone Cements Modified with Graphene Oxide and Chitosan  
[PERSON]  
1 Grupo de Materiales Compuestos, Escuela de Ingenieria de Materiales, Universidad del Valle, Calle 13 # 100-00, Cali 76001, Colombia; [EMAIL_ADDRESS]  
[PERSON]  
1 Grupo de Materiales Compuestos, Escuela de Ingenieria de Materiales, Universidad del Valle, Calle 13 # 100-00, Cali 76001, Colombia; [EMAIL_ADDRESS]  
[PERSON]  
2 Grupo de Investigacion de Fotoquimica y Fotobiopia, Universidad del Atlantico, Carrera 30 Numero 8-49 Puerto Colombia, Atlantico 081008, Colombia; [EMAIL_ADDRESS]  
[PERSON]  
3 Grupo Biomateriales Dentales, Escuela de Odontologia, Universidad del Valle, Calle 4B No. 36-00, Cali 76001, Colombia; [EMAIL_ADDRESS]  
[PERSON]  
45  
The bone-cement interface plays a key role for the longevity of the implanted prostheses [5]. Due to this, in recent decades there has been a strong effort to overcome one of the biggest problems associated with ABCs, which is the lack of biological activity [6; 7] and osseointegration [2], thus promoting ABC function based on mechanical interlocking with bone rather than adhesive chemical bonding to form a stable cement-bone interface [8]. Moreover, bone necrosis produced by high exothermic temperatures during the polymerization reaction and the susceptibility of some pathogenic bacteria [9; 10] generated premature failure [7], increasing the patient complications and leading to additional interventions what is safety risky for the patient [11; 12; 13]. Bioactive fillers such as hydroxyapatite and tricalcium phosphate have been added to overcome the low prosthesis biological performance and promote direct bone apposition rather than encapsulation of the implant by fibrous tissue [14; 15; 16; 17; 18; 19]. This bioactive filler addition promoted bone growth based on strong chemical interactions between cement and bone [2; 20]. However, some bioactive fillers make the cement more brittle and additional modifications on the polymeric matrix are need in order to increase ductility but at expense of decreasing the modulus [12]. The presence of biodegradable substances in ABC facilitates the replacement and growth of new bone inside the cement in the pores produced by hydrolytic and enzymatic degradation in the biological medium and improves mechanical anchorage [21; 22]. However, high porosity percentages in the cement produce a significant loss of mechanical properties, which is inadequate for orthopedic applications [20]. Chitosan (CS) is a linear and semi-crystalline polysaccharide consisting of \(\beta\)-(1\(\rightarrow\)4)-\(N\)-acetyl-d-glucosamine and \(\beta\)-(1\(\rightarrow\)4)-p-glucosamine units [22] widely used in bone regeneration due to its non-toxic, non-allergenic and non-immunogenic properties [23; 24]. Moreover, it is mucoadhesive, biocompatible, biodegradable [25], bioactive [23], and osteoconductive, with a capacity to mimic the extracellular matrix due to the glycosaminoglycans (GAGs) similar structure [24; 26]. Chitosan introduction to different biomaterials also provides very convenient antimicrobial properties in biomedical applications [24; 27; 28; 29; 30]. However, the high water affinity intrinsic property of the polysaccharide produces a serious limitation due to poor mechanical properties compared to the natural bones [22; 26]. Antimicrobial fillers, such as low concentrations of graphene oxide (GO) incorporated in ABCs are interesting to promote asepsis and mechanical reinforcement to joint prostheses [7; 31]. GO can be dispersed in both aqueous and organic solvents [32], and under certain conditions it can be considered biocompatible [33] and antimicrobial [34]. In addition, it has been demonstrated that GO improves the viability and osteogenic differentiation of human bone marrow mesenchymal stem cells [35] and can be biodegraded by neutrophils [36], macrophages [37] and enzymes [33; 38], suggesting its prospective for biomedical applications [39; 40].