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

G. I. Anderson

doi:10.1055/s-0038-1633168

Veterinary and Comparative Orthopaedics and Traumatology, Table of Contents

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

Authors

G. I. Anderson

¹From the Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario NIG 2W1

Abstract

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

Full Text

References

References
1 Rouse G P. Cervical Spine Stabilization with Methylmethacrylate. Vet Surg 1979; 8: 1-6.
2 Cantu R C. Anterior spinal fusion using methylmethacrylate (acrylic). Int Surg 1974; 58: 110.
3 Carlson D H, Adams R. The use of methylmethacrylate in the repair of neoplastic lesion in bone. Radiology 1974; 112: 43.
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.
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.
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.
7 Humason G. In Animal Tissue Techniques. 4th edition. W H Freeman & Co.; San Francisco: 1979: 453.
8 Cameron H U, Mills R H, Jackson R W, Macnab I. Structure of Polymethylmethacrylate Cement. Clin Orthop 1974; 100: 287-91.
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.
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.
11 Ryan J R, Begeman P C. The Effects of Filling Experimental Large Cortical Defects with MMA. Clin Orthop 1984; 185: 306-10.
12 Iida M, Furuya Kohtaro, Kawaachi S, Masuhara E, Tarumi J. New Improved Bone Cement (MMA-TBB). Clin Orthop 1974; 100: 279-86.
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.
14 Noble P C, Swarts E. Penetration of Acrylic Bone Cement into Cancellous Bone. Acta Orthop Scand 1983; 54: 566-73.
15 Harris W H. Femoral Cement Compactor. J Bone and Joint Surg 1984; 66-A: 808.
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.
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.
18 Gates E I, Carter D R, Harris W H. Comparative Fatigue Behaviour of Different Bone Cements. Clin Orthop 1984; 189: 194-299.
19 Lidgren L, Drar H, Moller J. Strength of PMMA Increased by Vacuum Mixing. Acta Orthop Scand 1984; 55: 536-41.
20 Charnley J. Acrylic Cement in Orthopaedic Surgery. London: E & S Livingstone; 1970: 23.
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.
22 Chambers T J. The Cellular Basis of Bone Resorption. Clin Orthop 1980; 151: 283-93.
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.
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.
25 Drachman D B, Soholoff L. The role of movement in embryonic joint development. Devel Biol 1966; 14: 401-20.
26 Willert H G, Ludwig J, Semlitsch M. Reaction of Bone to Methylmethacrylate After Hip Arthroplasty. J Bone and Joint Surg. 1974: 1368-82.
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.
28 Feith R. Side Effects of Acrylic Cement Implanted into Bone. Acta Orthop Scand. 1975 Suppl 1 161.
29 Altchek M. A Readily Available Improvised Acetabular Cement Pressuriser. Clin Orthop 1983; 174: 164-5.
30 Breed A L. Experimental Production of Vascular Hypotension and Bone Marrow Fat Embolism with Methylmethacrylate Cement. Clin Orthop 1974; 102: 227.
31 Herndon J H, Bechtol C O, Crichenberger D P. Fat Embolism During THR. J Bone and Joint Surg 1974; 56-A: 1350.
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.
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.
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.
35 Johansen I, Benumof J L. MMA: a Myocardial Depressant and Peripheral Dilator. Anaesthesiol 1979; 51: 77.
36 Svartling N, Pfaffli P, Tarkkanen L. Methylmethacrylate Blood Levels in Patients with Femoral Neck Fractures. Arch Orthop Traum Surg 1985; 104: 242-6.
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.
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.
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.
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.
41 Schuh F T, Schuh S M, Vigurea M G. Circulatory Changes Following Implantation of MMA Bone Cement. Anaesthesiol 1973; 39: 455-7.
42 Brown D L, Parmley C L. Methylmethacrylate and Atrioventricular Conduction in Dogs. Acta Anaesth Scand 1984; 28: 77-80.
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.
44 Berman A T, Price H L, Hahn J F. The Cardiovascular Effects of Methylmethacrylate in Dogs. Clin Orthop 1974; 100: 265-9.
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.
46 Petty W, Caldwell J R. The Effect of MMA on Complement Activity. Clin Orthop 1977; 128: 354-9.
47 Pamish R S, Petty R W. Inhibition of Human Lymphocyte Responses by MMA. Clin Orthop 1978; 134: 356-63.
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.
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.
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.
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.
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.
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.
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.
55 Fregert S. Occupational Hazards of Acrylic Bone Cement in Orthopaedic Surgery. Acta Orthop Scand 1983; 54: 787-9.
56 Fisher A A. Paresthesia of the Fingers Accompanying Dermatitis Due to Methylmethacrylate Bone Cement. Contact Dermatitis 1979; 5: 56-7.
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.
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.