## 1 Introduction  
Polymethyl methacrylate (PMMA) bone cement was a breakthrough discovery in the orthopedic field, revolutionizing surgical practices and patient outcomes. Before its introduction, orthopedic surgery faced significant challenges. Managing bone defects, especially those associated with tumors, infections, or other bone diseases, was particularly difficult. Traditional methods like autologous and allogeneic grafts were limited by donor site morbidity, scarce availability, and the potential for disease transmission. Materials available at the time were inadequate for crafting implants designed for individual bone defects, leading to suboptimal surgical outcomes [1]. Achieving a stable fixation of implants, especially in joint replacements and fracture fixation, was challenging due to the lack of materials that provide immediate mechanical stability. Additionally, higher infection risks were associated with materials that were difficult to sterilize and manipulate during surgery, and their poor biocompatibility often led to adverse postoperative reactions. The roots of PMMA bone cement use date back to the mid-20 th century, with its first documented use in the 1940s in the dental medicine field [2]. The British surgeon Sir [PERSON] and his colleagues began utilizing PMMA bone cement in orthopedics in the 1950s for the fixation of femoral prostheses. They employed a cold-curing acrylic denture repair material called Nu-Life, which demonstrated satisfactory results in both laboratory and clinical trials. By 1958, [PERSON] had successfully performed the operation in six patients, marking the beginning of the clinical use of PMMA bone cement [3]. The chemical composition and properties of PMMA bone cement considerably contribute to its biocompatibility and mechanical strength. Its primary component is polymerized methyl methacrylate (MMA), which forms a structural matrix with mechanical strength comparable to denture base materials. Factors such as residual monomer content and porosity influence its mechanical properties; as the cement ages and residual monomer content decreases, its strength is enhanced [1]. Biocompatibility is essential, and the addition of various fillers and chemical moieties enhances its bioactivity. For instance, incorporating phosphate functional groups and calcium ions improves its apatite-forming ability, which is essential for adhesion to bone tissues [4]. The use of nanoparticles like strontium-substituted hydroxyapatite can enhance osteoblast proliferation and bioactivity by mimicking the bone's natural apatite structure [5]. Mechanical properties are further improved by adding reinforcing agents such as multi-walled carbon nanotubes (MWCNTs), which increase tensile and bending strengths without affecting cytotoxicity [6]. However, limitations like high exothermic polymerization and potential fibrous tissue formation around the implant exist. Strategies to mitigate these issues include using porogenic compounds to create a porous structure, reducing the polymerization temperature, and improving osteoconductivity [5]. The initial success of PMMA bone cement in arthroplasty led to its widespread adoption in orthopedic procedures. Its excellent biocompatibility, high mechanical strength, and favorable handling properties made it the preferred method for fixation in joint replacements and other applications. These include acting as a bone substitute to correct bone defects and in orthopedic oncology for limb-salvage procedures and soft tissue tumors during the 1960s [2; 7; 8]. Recent advancements have focused on enhancing the mechanical properties, biocompatibility, and osteogenic potential of PMMA bone cement. Additives like tantalum carbide have been used as radiopacifiers, significantly enhancing mechanical strength, radiopacity, and osteogenic performance [9; 10]. Modifications such as the addition of layered double hydroxides promote osseogeintegration by enhancing bone growth and reducing aseptic loosening [5; 11].