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Vet Comp Orthop Traumatol 1988; 01(02): 74-79
DOI: 10.1055/s-0038-1633168
Short Communication
Schattauer GmbH

Polymethylmethacrylate: a Review of the Implications and Complications of its Use in Orthopaedic Surgery

G. I. Anderson
1   From the Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario NIG 2W1
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Publication History

Publication Date:
22 February 2018 (online)

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Polymethylmethacrylate has application in the fixation of endoprostheses and void-filling in reconstructive and neurological surgery in both veterinary and human surgery. It also has extensive dental and ophthalmic applications. Literature detailing the nature of the bone/cement interface is reviewed along with the local effect of polymethylmethacrylate on bone and cartilage. The repercussions of the cellular effects of polymethylmethacrylate on the development of loosening are discussed. The immunosuppressive effects of polymethylmethacrylate to the patient are outlined. A review of the cardiovascular, pulmonary and hepatic toxicity problems of polymethylmethacrylate is included. Contact sensitisation of the user is briefly discussed in conclusion.

Key words

Polymethylmethacrylate - Toxicity - Bone/cement interface
 

  • References

  • 1 Rouse G P. Cervical Spine Stabilization with Methylmethacrylate. Vet Surg 1979; 8: 1-6.
    CrossrefPubMedGoogle Scholar
  • 2 Cantu R C. Anterior spinal fusion using methylmethacrylate (acrylic). Int Surg 1974; 58: 110.
    PubMedGoogle Scholar
  • 3 Carlson D H, Adams R. The use of methylmethacrylate in the repair of neoplastic lesion in bone. Radiology 1974; 112: 43.
    CrossrefPubMedGoogle Scholar
  • 4 Nunamaker D M, Bowman K F, Richardson D W, Herring M. Plate Luting: A Preliminary Report of its use in horses. Vet Surg 1986; 15 (04) 289-93.
    CrossrefPubMedGoogle Scholar
  • 5 Oh I, Bourne R B, Harris W H. The Femoral Cement Compactor – An Improvement in Cementing Technique in THR. J Bone and Joint Surg 1983; 65-A: 9.
    PubMedGoogle Scholar
  • 6 Harvey C E. Diseases of the Oral Cavity and Pharynx in Textbook of Small Animal Surgery. Slatter D H. (Ed). W B Saunders & Co.; Toronto: 1985: 626.
    Google Scholar
  • 7 Humason G. In Animal Tissue Techniques. 4th edition. W H Freeman & Co.; San Francisco: 1979: 453.
    Google Scholar
  • 8 Cameron H U, Mills R H, Jackson R W, Macnab I. Structure of Polymethylmethacrylate Cement. Clin Orthop 1974; 100: 287-91.
    PubMedGoogle Scholar
  • 9 Charnley J. Reaction of Bone to Self-curing Acrylic Cement. A Long-term Histological Study in Man. J Bone and Joint Surg 1970; 52-B: 340-53.
    CrossrefPubMedGoogle Scholar
  • 10 Lindwer J, van der Hooff A. The Influence of Acrylic Cement on the Femur of the Dog. Acta Orthop Scand 1975; 46: 657-71.
    CrossrefPubMedGoogle Scholar
  • 11 Ryan J R, Begeman P C. The Effects of Filling Experimental Large Cortical Defects with MMA. Clin Orthop 1984; 185: 306-10.
    PubMedGoogle Scholar
  • 12 Iida M, Furuya Kohtaro, Kawaachi S, Masuhara E, Tarumi J. New Improved Bone Cement (MMA-TBB). Clin Orthop 1974; 100: 279-86.
    PubMedGoogle Scholar
  • 13 McMaster W C, Bradley G, Waugh T R. Blood Pressure Lowering Effect of MMA Monomer. Potentiation by Blood Volume Deficit. Clin Orthop 1974; 98: 254-7.
    CrossrefPubMedGoogle Scholar
  • 14 Noble P C, Swarts E. Penetration of Acrylic Bone Cement into Cancellous Bone. Acta Orthop Scand 1983; 54: 566-73.
    CrossrefPubMedGoogle Scholar
  • 15 Harris W H. Femoral Cement Compactor. J Bone and Joint Surg 1984; 66-A: 808.
    PubMedGoogle Scholar
  • 16 Askew M J, Steege J W, Lewis J L, Ranieri J R, Wixson R L. The Effect of Cement Pressure and Bone Strength on Polymethylmethacrylate Fixation. J Orthop Res 1984; 1 (04) 412-20.
    PubMedGoogle Scholar
  • 17 Debrunner H U, Wettstein A, Hofer P. The Polymerisation of Self-curing Acrylic Cements and Problems due to the Cement Anchorage of Joint Prostheses. In: Schaldach M, Hohman D. (Eds). Advances in Artificial Hip and Knee Joint Technology. Springer-Verlag; Berlin: 1976: 297.
    Google Scholar
  • 18 Gates E I, Carter D R, Harris W H. Comparative Fatigue Behaviour of Different Bone Cements. Clin Orthop 1984; 189: 194-299.
    PubMedGoogle Scholar
  • 19 Lidgren L, Drar H, Moller J. Strength of PMMA Increased by Vacuum Mixing. Acta Orthop Scand 1984; 55: 536-41.
    CrossrefPubMedGoogle Scholar
  • 20 Charnley J. Acrylic Cement in Orthopaedic Surgery. London: E & S Livingstone; 1970: 23.
    Google Scholar
  • 21 Jarty M J, Floyd W E, Schiller A L, Goldring S R, Harris W H. Localised osteolysis in stable nonseptic total hip arthroplasty. J Bone & Joint Surg 1986; 68A (06) 912-9.
    PubMedGoogle Scholar
  • 22 Chambers T J. The Cellular Basis of Bone Resorption. Clin Orthop 1980; 151: 283-93.
    PubMedGoogle Scholar
  • 23 Freeman M A R, Bradley G W, Revell P A. Observations upon the Interface between Bone and Polymethylmethacrylate Cement. J Bone and Joint Surg 1982; 64-B: 489-93.
    CrossrefPubMedGoogle Scholar
  • 24 Goldring S R, Schiller A L, Roelke M, Rourke C M, O’Neill D A, Harris W H. The Synovial-like membrane at the bonecement interface in loose total hip replacements and its proposed role in bone lysis. J Bone & Joint Surg 1983; 65 A (05) 575-84.
    PubMedGoogle Scholar
  • 25 Drachman D B, Soholoff L. The role of movement in embryonic joint development. Devel Biol 1966; 14: 401-20.
    CrossrefPubMedGoogle Scholar
  • 26 Willert H G, Ludwig J, Semlitsch M. Reaction of Bone to Methylmethacrylate After Hip Arthroplasty. J Bone and Joint Surg. 1974: 1368-82.
    PubMedGoogle Scholar
  • 27 Albrektsson T, Lindner L. Bone Injury Caused by Curing Bone Cement. A Vital Microscopic Study in the Rabbit Tibia. Clin Orthop 1984; 183: 280-7.
    PubMedGoogle Scholar
  • 28 Feith R. Side Effects of Acrylic Cement Implanted into Bone. Acta Orthop Scand. 1975 Suppl 1 161.
    PubMedGoogle Scholar
  • 29 Altchek M. A Readily Available Improvised Acetabular Cement Pressuriser. Clin Orthop 1983; 174: 164-5.
    PubMedGoogle Scholar
  • 30 Breed A L. Experimental Production of Vascular Hypotension and Bone Marrow Fat Embolism with Methylmethacrylate Cement. Clin Orthop 1974; 102: 227.
    CrossrefPubMedGoogle Scholar
  • 31 Herndon J H, Bechtol C O, Crichenberger D P. Fat Embolism During THR. J Bone and Joint Surg 1974; 56-A: 1350.
    PubMedGoogle Scholar
  • 32 Kallos T, Eris J E, Gollan F, Davis J H. Intramedullary Pressure and Pulmonary Embolism of Femoral Medullary Contents in Dogs during Insertion of Bone Cement and a Prosthesis. J Bone and Joint Surg 1974; 56-A: 1363.
    PubMedGoogle Scholar
  • 33 Sherman R M P, Waddell J P, Kay J C, Byrick R J. Large Airway Response to Cemented Arthroplasty: Relationship to Hypoxaemia. An Experimental Study in Dogs. Acta Anaesth Scand 1984; 28: 426-31.
    CrossrefPubMedGoogle Scholar
  • 34 Homsy C A, Tullos H S, Anderson M S, Diferrante N M, King J W. Some Physiological Aspects of Prosthesis Stabilisation with Acrylic Polymer. Clin Orthop 1972; 83: 317-28.
    CrossrefPubMedGoogle Scholar
  • 35 Johansen I, Benumof J L. MMA: a Myocardial Depressant and Peripheral Dilator. Anaesthesiol 1979; 51: 77.
    CrossrefPubMedGoogle Scholar
  • 36 Svartling N, Pfaffli P, Tarkkanen L. Methylmethacrylate Blood Levels in Patients with Femoral Neck Fractures. Arch Orthop Traum Surg 1985; 104: 242-6.
    CrossrefPubMedGoogle Scholar
  • 37 Weissman B N, Sosman J L, Braunstein E M, Dadkhahipoor H, Kandarpa K, Thornhill T S, Lowell J D, Sledge C B. Intravenous Methylmethacrylate after THR. J of Bone and Joint Surg 1984; 66-A: 443-9.
    PubMedGoogle Scholar
  • 38 Modig J, Busch C, Olerud S, Saldeen T, Waernbaum G. Arterial Hypotension and Hypoxaemia During THR: The Importance of Thromboplastic Products: Fat Embolism and Acrylic Monomers. Acta Anaesth Scand 1975; 19: 28-43.
    CrossrefPubMedGoogle Scholar
  • 39 Crout D H G, Corkhill J A, James M L, Ling R S M. Methylmethacrylate Metabolism in Man. The Hydrolysis of Methylmethacrylate to Methacrylic Acid During Total Hip Replacement. Clin Orthop 1979; 141: 90-5.
    PubMedGoogle Scholar
  • 40 Mir G N, Lawrence W H, Autian J. Toxicological and Pharmalogical Actions of Methylmethacrylate Monomers I: Effects on Isolated Perfused Rabbit Heart. J Pharm Sci 1973; 62: 778.
    CrossrefPubMedGoogle Scholar
  • 41 Schuh F T, Schuh S M, Vigurea M G. Circulatory Changes Following Implantation of MMA Bone Cement. Anaesthesiol 1973; 39: 455-7.
    CrossrefPubMedGoogle Scholar
  • 42 Brown D L, Parmley C L. Methylmethacrylate and Atrioventricular Conduction in Dogs. Acta Anaesth Scand 1984; 28: 77-80.
    CrossrefPubMedGoogle Scholar
  • 43 Peebles D J, Ellis R H, Stride S D K, Simpson B R J. Cardiovascular Effects of MMA Cement. Br Med J 1972; 1: 349-51.
    CrossrefPubMedGoogle Scholar
  • 44 Berman A T, Price H L, Hahn J F. The Cardiovascular Effects of Methylmethacrylate in Dogs. Clin Orthop 1974; 100: 265-9.
    PubMedGoogle Scholar
  • 45 Ritter M A, Gioe T J, Sieber J M. Systemic Effects of Polymethylmethacrylate. Increased Serum Levels of Gammaglutamyl-transpeptidase Following Arthroplasty. Acta Orthop Scand 1984; 55: 411-3.
    CrossrefPubMedGoogle Scholar
  • 46 Petty W, Caldwell J R. The Effect of MMA on Complement Activity. Clin Orthop 1977; 128: 354-9.
    PubMedGoogle Scholar
  • 47 Pamish R S, Petty R W. Inhibition of Human Lymphocyte Responses by MMA. Clin Orthop 1978; 134: 356-63.
    PubMedGoogle Scholar
  • 48 Pedersen J G, Lund B, Reimann I. Depressive Effects of Acrylic Cement Components on Bone Metabolism: Isotope Release and Phosphatase Production Studied in vitro. Acta Orthop Scand 1983; 54: 796-801.
    CrossrefPubMedGoogle Scholar
  • 49 Garcia D A, Sullivan T M, O’Neill D M. The Biochemistry of Dental Implants in an Animal Model. J Dent Res 1981; 60: 40-9.
    PubMedGoogle Scholar
  • 50 Bartucci E J, Gonzalez M H, Cooperman D R, Freedberg H I, Barmada R, Laros G S. The Effect of Adjunctive Methylmethacrylate on Failures of Fixation and Function in Patients with Intertrochanteric Fractures and Osteoporosis. J Bone and Joint Surg 1985; 67-A: 1094-107.
    PubMedGoogle Scholar
  • 51 Rhinelander R, Nelson C, Stewart R, Stewart C. Experimental Reaming of the Proximal Femur and Acrylic Cement Implantation. Clin Orthop 1979; 141: 74-89.
    PubMedGoogle Scholar
  • 52 Boyd A D, Goldberg V M, Miller L M, Malemud C J. Effects of Polymethylmethacrylate on Rabbit Articular Chondrocytes in Monolayer Culture. Clin Orthop 1984; 189: 279-93.
    PubMedGoogle Scholar
  • 53 Manley P A, McKeown D B, Schatzker J, Palmer N, Carman S. Replacement of Epiphyseal Bone with MMA; its Effect on Articular Cartilage. Arch Orthop Trauma Surg 1982; 100: 3-10.
    CrossrefPubMedGoogle Scholar
  • 54 Ewald R C, Poss R, Pugh J, Schiller A L, Sledge D B. Hip cartilage supported by methacrylate in canine arthroplasty. Clin Orthop 1982; 171: 273-9.
    PubMedGoogle Scholar
  • 55 Fregert S. Occupational Hazards of Acrylic Bone Cement in Orthopaedic Surgery. Acta Orthop Scand 1983; 54: 787-9.
    CrossrefPubMedGoogle Scholar
  • 56 Fisher A A. Paresthesia of the Fingers Accompanying Dermatitis Due to Methylmethacrylate Bone Cement. Contact Dermatitis 1979; 5: 56-7.
    PubMedGoogle Scholar
  • 57 Waegemaekers T H J M, Seulter E, ben Avend J A C, Malten K E. Permeability of Surgeon’s Gloves to MMA. Acta Orthop Scand 1983; 54: 790-5.
    CrossrefPubMedGoogle Scholar
  • 58 Eftekhar N S. Acrylic Cement for Fixation of Total Hip Prostheses. In: Principles of Total Hip Arthroplasty. St. Louis: C V Mosby; 1978: 125.
    Google Scholar