A Review of PMMA Bone Cement and Intra-Cardiac Embolism

Overview

Journal Materials (Basel)

Publisher MDPI

Date 2017 Aug 5

PMID 28773942

Citations 27

Authors

Puneeth Shridhar

Yanfei Chen

Ramzi Khalil

Anton Plakseychuk

Sung Kwon Cho

Bryan Tillman

Prashant N Kumta

Youngjae Chun

Affiliations

Soon will be listed here.

Abstract

Percutaneous vertebroplasty procedure is of major importance, given the significantly increasing aging population and the higher number of orthopedic procedures related to vertebral compression fractures. Vertebroplasty is a complex technique involving the injection of polymethylmethacrylate (PMMA) into the compressed vertebral body for mechanical stabilization of the fracture. Our understanding and ability to modify these mechanisms through alterations in cement material is rapidly evolving. However, the rate of cardiac complications secondary to PMMA injection and subsequent cement leakage has increased with time. The following review considers the main effects of PMMA bone cement on the heart, and the extent of influence of the materials on cardiac embolism. Clinically, cement leakage results in life-threatening cardiac injury. The convolution of this outcome through an appropriate balance of complex material properties is highlighted via clinical case reports.

Citing Articles

Methodological Impact on Curing Kinetics of Bone Cement Based on Poly (Styrene--Methyl Methacrylate)-2D Nanofiller Nanocomposites.

Krishnan M, Alsharaeh E Polymers (Basel). 2025; 17(1.

PMID: 39795519 PMC: 11722910. DOI: 10.3390/polym17010116.

Endovascular treatment of a large bone cement pulmonary embolism: Case report.

Lu X, Shen Y, Zhao W, Wang X SAGE Open Med Case Rep. 2024; 12:2050313X241277136.

PMID: 39359622 PMC: 11445775. DOI: 10.1177/2050313X241277136.

Injectable bioactive poly(propylene fumarate) and polycaprolactone based click chemistry bone cement for spinal fusion in rabbits.

Liu X, Astudillo Potes M, Serdiuk V, Dashtdar B, Schreiber A, Rezaei A J Biomed Mater Res A. 2024; 112(10):1803-1816.

PMID: 38644548 PMC: 11806930. DOI: 10.1002/jbm.a.37725.

Impact of Cytogenetic Abnormalities, Induction and Maintenance Regimens on Outcomes After High-Dose Chemotherapy and Autologous Stem Cell Transplantation in Patients With Newly Diagnosed Multiple Myeloma: A Decade-Long Real-World Experience.

Thurlapati A, Wesson W, Davis J, Gaffney K, Weeda E, Velayati A J Hematol. 2024; 12(6):243-254.

PMID: 38188477 PMC: 10769645. DOI: 10.14740/jh1201.

Extensive Intracardiac Cement Embolism in a Patient Undergoing Workup for Bone Marrow Transplant.

Waidyaratne G, Bennett C, Umyarova E, Bumma N J Hematol. 2024; 12(6):283-286.

PMID: 38188473 PMC: 10769642. DOI: 10.14740/jh1202.

References

Schoenes B, Bremerich D, Risteski P, Thalhammer A, Meininger D . [Cardiac perforation after vertebroplasty]. Anaesthesist. 2007; 57(2):147-50. DOI: 10.1007/s00101-007-1276-8. View

Jacobs E, Saralidze K, Roth A, de Jong J, van den Bergh J, Lataster A . Synthesis and characterization of a new vertebroplasty cement based on gold-containing PMMA microspheres. Biomaterials. 2016; 82:60-70. DOI: 10.1016/j.biomaterials.2015.12.024. View

Krebs J, Aebli N, Goss B, Sugiyama S, Bardyn T, Boecken I . Cardiovascular changes after pulmonary embolism from injecting calcium phosphate cement. J Biomed Mater Res B Appl Biomater. 2007; 82(2):526-32. DOI: 10.1002/jbm.b.30758. View

Nieuwenhuijse M, van Erkel A, Dijkstra P . Cement leakage in percutaneous vertebroplasty for osteoporotic vertebral compression fractures: identification of risk factors. Spine J. 2011; 11(9):839-48. DOI: 10.1016/j.spinee.2011.07.027. View

Lin W, Cheng T, Lee Y, Wang T, Cheng Y, Lui C . New vertebral osteoporotic compression fractures after percutaneous vertebroplasty: retrospective analysis of risk factors. J Vasc Interv Radiol. 2008; 19(2 Pt 1):225-31. DOI: 10.1016/j.jvir.2007.09.008. View

Krebs J, Aebli N, Goss B, Wilson K, Williams R, Ferguson S . Cardiovascular changes after pulmonary cement embolism: an experimental study in sheep. AJNR Am J Neuroradiol. 2007; 28(6):1046-50. PMC: 8134139. DOI: 10.3174/ajnr.A0499. View

Mathis J, Barr J, Belkoff S, Barr M, Jensen M, Deramond H . Percutaneous vertebroplasty: a developing standard of care for vertebral compression fractures. AJNR Am J Neuroradiol. 2001; 22(2):373-81. PMC: 7973930. View

Chen W, Kao Y, Yang S, Yu S, Tu Y, Chung K . Impact of cement leakage into disks on the development of adjacent vertebral compression fractures. J Spinal Disord Tech. 2010; 23(1):35-9. DOI: 10.1097/BSD.0b013e3181981843. View

Rajzer I, Piekarczyk W, Castano O . An ultrasonic through-transmission technique for monitoring the setting of injectable calcium phosphate cement. Mater Sci Eng C Mater Biol Appl. 2016; 67:20-25. DOI: 10.1016/j.msec.2016.04.083. View

10.

Son K, Chung J, Sun K, Son H . Cardiac perforation and tricuspid regurgitation as a complication of percutaneous vertebroplasty. Eur J Cardiothorac Surg. 2008; 33(3):508-9. DOI: 10.1016/j.ejcts.2007.11.027. View

11.

Balkovec C, Vernengo A, Stevenson P, McGill S . Evaluation of an injectable hydrogel and polymethyl methacrylate in restoring mechanics to compressively fractured spine motion segments. Spine J. 2016; 16(11):1404-1412. DOI: 10.1016/j.spinee.2016.06.021. View

12.

Ginebra M, Albuixech L, Fernandez-Barragan E, Aparicio C, Gil F, San R . Mechanical performance of acrylic bone cements containing different radiopacifying agents. Biomaterials. 2002; 23(8):1873-82. DOI: 10.1016/s0142-9612(01)00314-3. View

13.

Bou-Francis A, Lopez A, Persson C, Hall R, Kapur N . Assessing cement injection behaviour in cancellous bone: an in vitro study using flow models. J Biomater Appl. 2014; 29(4):582-94. DOI: 10.1177/0885328214537858. View

14.

Duran C, Sirvanci M, Aydogan M, Ozturk E, Ozturk C, Akman C . Pulmonary cement embolism: a complication of percutaneous vertebroplasty. Acta Radiol. 2007; 48(8):854-9. DOI: 10.1080/02841850701422153. View

15.

Krueger A, Bliemel C, Zettl R, Ruchholtz S . Management of pulmonary cement embolism after percutaneous vertebroplasty and kyphoplasty: a systematic review of the literature. Eur Spine J. 2009; 18(9):1257-65. PMC: 2899525. DOI: 10.1007/s00586-009-1073-y. View

16.

Hernandez L, Fernandez M, Collia F, Gurruchaga M, Goni I . Preparation of acrylic bone cements for vertebroplasty with bismuth salicylate as radiopaque agent. Biomaterials. 2005; 27(1):100-7. DOI: 10.1016/j.biomaterials.2005.05.074. View

17.

Boger A, Benneker L, Krebs J, Boner V, Heini P, Gisep A . The effect of pulsed jet lavage in vertebroplasty on injection forces of PMMA bone cement: an animal study. Eur Spine J. 2009; 18(12):1957-62. PMC: 2899445. DOI: 10.1007/s00586-009-1079-5. View

18.

Li K, Li A, Hsieh C, Chen H . Transpedicle body augmenter in painful osteoporotic compression fractures. Eur Spine J. 2006; 16(5):589-98. PMC: 2213539. DOI: 10.1007/s00586-006-0197-6. View

19.

Pannirselvam V, Hee H . Asymptomatic cement embolism in the right atrium after vertebroplasty using high-viscosity cement: a case report. J Orthop Surg (Hong Kong). 2014; 22(2):244-7. DOI: 10.1177/230949901402200228. View

20.

Ding T, Yang H, Maltenfort M, Xie R . Silk fibroin added to calcium phosphate cement to prevent severe cardiovascular complications. Med Sci Monit. 2010; 16(9):HY23-6. View