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Performance of calcium phosphate cements in the augmentation of sheep vertebrae - An ex vivo study
(2021)
Oil-based calcium phosphate cement (Paste-CPC) shows not only prolonged shelf life and injection times, but also improved cohesion and reproducibility during application, while retaining the advantages of fast setting, mechanical strength, and biocompatibility. In addition, poly(L-lactideco-glycolide) (PLGA) fiber reinforcement may decrease the risk for local extrusion. Bone defects (diameter 5 mm; depth 15 mm) generated ex vivo in lumbar (L) spines of female Merino sheep (2–4 years) were augmented using: (i) water-based CPC with 10% PLGA fiber reinforcement (L3); (ii) Paste-CPC (L4); or (iii) clinically established polymethylmethacrylate (PMMA) bone cement (L5). Untouched (L1) and empty vertebrae (L2) served as controls. Cement performance was analyzed using micro-computed tomography, histology, and biomechanical testing. Extrusion was comparable for Paste-CPC(-PLGA) and PMMA, but significantly lower for CPC + PLGA. Compressive strength and Young’s modulus were similar for Paste-CPC and PMMA, but significantly higher compared to those for empty defects and/or CPC + PLGA. Expectedly, all experimental groups showed significantly or numerically lower compressive strength and Young’s modulus than those of untouched controls. Ready-to-use Paste-CPC demonstrates a performance similar to that of PMMA, but improved biomechanics compared to those of water-based CPC + PLGA, expanding the therapeutic arsenal for bone defects. O, significantly lower extrusion of CPC + PLGA fibers into adjacent lumbar spongiosa may help to reduce the risk of local extrusion in spinal surgery.
Several studies show that thermal and hydrothermal treatment can further improve the excellent properties of UHPC in terms of mechanical strength and durability. While for the thermal treatment the increase in strength is attributed to an intensified pozzolanic and hydraulic reaction, for the hydrothermal treatment previous studies accredited it mostly to the formation of tobermorite. In the presented study thermal and hydrothermal treatment of UHPC samples was systematically varied and the phase formation analysed related to the strength development of a reference sample cured for 28 days in water. For the thermal treatment the results show that the strength increase depends on the protection against desiccation and can be ascribed to an improved pozzolanic reaction of the siliceous fillers. To achieve a significant enhancement of strength, a pre-storage time of few days and a long dwell time at elevated temperature/pressure are required. For the hydrothermal treatment already heating the specimens up to 185 °C in saturated steam followed by an immediate cooling leads to a substantial increase in compressive strength. Pre-storage time did not affect the result as far as a minimum of several hours is guaranteed. The improved performance is due to an increase in the pozzolanic and hydraulic reaction. Surprisingly, tobermorite was only found within a very thin layer at the surface of the sample, but not in the bulk. Sulphate and aluminium stemming from the decomposition of the ettringite are bound in the newly formed phases hydroxylellestadite and hydrogarnet.