Abstract
Polymers have been used as biomaterials in Orthopaedic Surgery for decades. Despite reports of complications with some polymeric materials, most are biocompatible and have been used successfully in total joint replacements, for soft tissue reconstruction, for joint fusion, and as fracture fixation devices. In this chapter we will describe the types of polymers used in commercially-available orthopaedic implants, and then give a breakdown by clinical application.
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Abbreviations
- PMMA:
-
Poly(methylmethacrylate)
- PE:
-
Poly(ethylene)
- UHMWPE:
-
Ultra-high molecular weight poly(ethylene)
- HXPE:
-
Highly cross-linked PE
- PEEK:
-
Poly(etheretherketone)
- LPLA:
-
Poly(L-lactide)
- DLPLA:
-
Poly(DL-lactide)
- LDLPLA:
-
Poly(DL-lactide-co-L-lactide)
- PGA:
-
Poly(glycolide)
- LPLG:
-
Poly(L-lactide-co-glycolide)
- DLPLG:
-
Poly(DL-lactide-co-glycolide)
References
Rohm, O.: On the polymerization products of acrylic acid. Chemistry (dissertation). University of Tubingen, Tubingen (1901)
Charnley, J.: The bonding of prostheses to bone by cement. J. Bone Joint Surg. Br. 46, 518–529 (1964)
Smith, D.C.: The genesis and evolution of acrylic bone cement. Orthop. Clin. North Am. 36, 1–10 (2005)
Jaeblon, T.: Polymethylmethacrylate: properties and contemporary uses in orthopaedics. J. Am. Acad. Orthop. Surg. 18, 297–305 (2010)
Lewis, G.: Properties of acrylic bone cement: state of the art review. J. Biomed. Mater. Res. 38, 155–182 (1997)
Lewis, G.: Properties of antibiotic-loaded acrylic bone cements for use in cemented arthroplasties: a state-of-the-art review. J. Biomed. Mater. Res. B Appl. Biomater. 89, 558–574 (2009)
Harper, E.J., Braden, M., Bonfield, W., et al.: Influence of sterilization upon a range of properties of experimental bone cements. J. Mater. Sci.: Mater. Med. 8, 849–853 (1997)
Lewis, G., Mladsi, S.: Effect of sterilization method on properties of Palacos R acrylic bone cement. Biomaterials 19, 117–124 (1998)
Lewis, G.: Apparent fracture toughness of acrylic bone cement: effect of test specimen configuration and sterilization method. Biomaterials 20, 69–78 (1999)
Graham, J., Pruitt, L., Ries, M., Gundiah, N.: Fracture and fatigue properties of acrylic bone cement: the effects of mixing method, sterilization treatment, and molecular weight. J. Arthroplasty 15, 1028–1035 (2000)
An, Y.H., Alvi, F.I., Kang, Q., et al.: Effects of sterilization on implant mechanical property and biocompatibility. Int. J. Artif. Organs 28, 1126–1137 (2005)
Mjoberg, B., Pettersson, H., Rosenqvist, R., Rydholm, A.: Bone cement, thermal injury and the radiolucent zone. Acta Orthop. Scand. 55, 597–600 (1984)
Urrutia, J., Bono, C.M., Mery, P., Rojas, C.: Early histologic changes following polymethylmethacrylate injection (vertebroplasty) in rabbit lumbar vertebrae. Spine 33, 877–882 (2008)
Donaldson, A.J., Thomson, H.E., Harper, N.J., Kenny, N.W.: Bone cement implantation syndrome. Br. J. Anaesth. 102, 12–22 (2009)
Chen, Y.J., Tan, T.S., Chen, W.H., et al.: Intradural cement leakage: a devastatingly rare complication of vertebroplasty. Spine 31, E379–E382 (2006)
Zhang, J.D., Poffyn, B., Sys, G., Uyttendaele, D.: Comparison of vertebroplasty and kyphoplasty for complications. Orthop. Surg. 3, 158–160 (2011)
Wang, L., Gardner, A.W., Kwek, E.B., Naidu, G.R.: Retrograde cement arteriovenogram of nutrient vessels following hemiarthroplasty of the hip. Acta Orthop. Belg. 78, 431–435 (2012)
Corcos, G., Dbjay, J., Mastier, C., et al.: Cement leakage in percutaneous vertebroplasty for spinal metastases: a retrospective evaluation of incidence and risk factors. Spine 39, E332–E338 (2014)
Krause, W., Mathis, R.S.: Fatigue properties of acrylic bone cements: review of the literature. J. Biomed. Mater. Res. 22, 37–53 (1988)
Cuckler, J.M.: If hip implant retrievals could speak, what would they tell us? J. Bone Joint Surg. Br. 94, 11–13 (2012)
Goodman, S.: Wear particulate and osteolysis. Orthop. Clin. North. Am. 36(1), 41–48 (2005)
Rajpura, A., Kendoff, D., Board, T.N.: The current state of bearing surfaces in total hip replacement. Bone Joint J. 96(2), 147–156 (2014)
Gordon, A.C., D’Lima, D.D., Colwell Jr, C.W.: Highly cross-linked polyethylene in total hip arthroplasty. J. Am. Acad. Orthop. Surg. 14, 511–523 (2006)
Oral, E., Muratoglu, O.K.: Vitamin E diffused, highly crosslinked UHMWPE: a review. Int. Orthop. 35, 215–223 (2011)
Goodman, S.B., Gibon, E., Yao, Z.: The basic science of periprosthetic osteolysis. Instr. Course Lect. 62, 201–206 (2013)
Ulrich, S.D., Seyler, T.M., Bennett, D., et al.: Total hip arthroplasties: what are the reasons for revision? Int. Orthop. 32, 597–604 (2008)
Bozic, K.J., Kurtz, S.M., Lau, E., et al.: The epidemiology of revision total hip arthroplasty in the United States. J. Bone Joint Surg. Am. 91, 128–133 (2009)
Bozic, K.J., Kurtz, S.M., Lau, E., et al.: The epidemiology of revision total knee arthroplasty in the United States. Clin. Orthop. Relat. Res. 468, 45–51 (2010)
Eschbach, L.: Nonresorbable polymers in bone surgery. Injury 31(Suppl 4), 22–27 (2000)
Kurtz, S.M., Devine, J.N.: PEEK biomaterials in trauma, orthopedic, and spinal implants. Biomaterials 28, 4845–4869 (2007)
Nino Gomez, D., Eslava, S., Federico, A., et al.: Use of poly(ether ether ketone) cages in foot and ankle surgery. Foot Ankle Clin. 17, 449–457 (2012)
Chen, Y., Wang, X., Lu, X., et al.: Comparison of titanium and polyetheretherketone (PEEK) cages in the surgical treatment of multilevel cervical spondylotic myelopathy: a prospective, randomized, control study with over 7-year follow-up. Eur. Spine J. 22, 1539–1546 (2013)
Kersten, R.F., van Gaalen, S.M., de Gast, A., Oner, F.C.: Polyetheretherketone (PEEK) cages in cervical applications: a systematic review. Spine J.: Official J. North Am. Spine Soc. (2013)
Barber, F.A., Herbert, M.A., Beavis, R.C., Barrera Oro, F.: Suture anchor materials, eyelets, and designs: update 2008. Arthroscopy 24, 859–867 (2008)
Barber, F.A., Herbert, M.A., Hapa, O., et al.: Biomechanical analysis of pullout strengths of rotator cuff and glenoid anchors: 2011 update. Arthroscopy 27, 895–905 (2011)
Uzumcugil, O., Yalcinkaya, M., Ozturkmen, Y., et al.: Effect of PEEK polymer on tunnel widening after hamstring ACL reconstruction. Orthopedics 35, e654–e659 (2012)
Gogolewski, S.: Bioresorbable polymers in trauma and bone surgery. Injury 31(Suppl 4), 28–32 (2000)
Rokkanen, P.U., Bostman, O., Hirvensalo, E., et al.: Bioabsorbable fixation in orthopaedic surgery and traumatology. Biomaterials 21, 2607–2613 (2000)
Ambrose, C.G., Clanton, T.O.: Bioabsorbable implants: review of clinical experience in orthopedic surgery. Ann. Biomed. Eng. 32, 171–177 (2004)
Kontakis, G.M., Pagkalos, J.E., Tosounidis, T.I., et al.: Bioabsorbable materials in orthopaedics. Acta Orthop. Belg. 73, 159–169 (2007)
Mukherjee, D.P., Pietrzak, W.S.: Bioabsorbable fixation: scientific, technical, and clinical concepts. J Craniofac. Surg. 22, 679–689 (2011)
Bostman, O.M.: Metallic or absorbable fracture fixation devices: a cost minimization analysis. Clin. Orthop. Relat. Res. 329, 233–239 (1996)
Nair, L.S., Laurencin, C.T.: Polymers as biomaterials for tissue engineering and controlled drug delivery. Adv. Biochem. Eng. Biotechnol. 102, 47–90 (2006)
Kluin, O.S., van der Mei, H.C., Busscher, H.J., Neut, D.: Biodegradable vs non-biodegradable antibiotic delivery devices in the treatment of osteomyelitis. Expert Opin. Drug Deliv. 10, 341–351 (2013)
Ciccone 2nd, W.J., Motz, C., Bentley, C., Tasto, J.P.: Bioabsorbable implants in orthopaedics: new developments and clinical applications. J. Am. Acad. Orthop. Surg. 9, 280–288 (2001)
Knight, S.R., Aujla, R., Biswas, S.P.: Total hip arthroplasty—over 100 years of operative history. Orthop. Rev. 3, e16 (2011)
Callaghan, J.J., Albright, J.C., Goetz, D.D., et al.: Charnley total hip arthroplasty with cement minimum twenty-five-year follow-up. J. Bone Joint Surg. Am. 82(4), 487–497 (2000)
Cason, G.W., Herkowitz, H.N.: Cervical intervertebral disc replacement. J. Bone Joint Surg. Am. 95, 279–285 (2013)
Jacobs, W., Van der Gaag, N.A., Tuschel, A., et al. Total disc replacement for chronic back pain in the presence of disc degeneration. Cochrane Database Syst. Rev. 9, CD008326 (2012)
Abdul-Jalil, Y., Bartels, J., Alberti, O., Becker, R.: Delayed presentation of pulmonary polymethylmethacrylate emboli after percutaneous vertebroplasty. Spine 32, E589–E593 (2007)
Bose, R., Choi, J.W.: Successful percutaneous retrieval of methyl methacrylate orthopedic cement embolism from the pulmonary artery. Cathet. Cardiovasc. Interv. 76, 198–201 (2010)
Esses, S.I., McGuire, R., Jenkins, J., et al.: American academy of orthopaedic surgeons clinical practice guideline on: the treatment of osteoporotic spinal compression fractures. J. Bone Joint Surg. Am. 93, 1934–1936 (2011)
Waris, E., Konttinen, Y.T., Ashammakhi, N., et al.: Bioabsorbable fixation devices in trauma and bone surgery: current clinical standing. Expert Rev. Med. Devices 1, 229–240 (2004)
Yetkin, H., Senkoylu, A.: Biomaterials in orthopaedic surgery and traumatology. Technol. Health Care 10, 173–175 (2002)
Cotic, M., Vogt, S., Hinterwimmer, S., et al. A matched-pair comparison of two different locking plates for valgus-producing medial open-wedge high tibial osteotomy: peek-carbon composite plate versus titanium plate. Knee Surg. Sports Traumatol. Arthrosc. 1–9 (2014)
Alan Barber, F., Boothby, M.H., Richards, D.P.: New sutures and suture anchors in sports medicine. Sports Med. Arthrosc. 14, 177–184 (2006)
Gunja, N.J., Athanasiou, K.A.: Biodegradable materials in arthroscopy. Sports Med. Arthrosc. 14, 112–119 (2006)
Denard, P.J., Burkhart, S.S.: The evolution of suture anchors in arthroscopic rotator cuff repair. Arthroscopy 29, 1589–1595 (2013)
Dhawan, A., Ghodadra, N., Karas, V., et al.: Complications of bioabsorbable suture anchors in the shoulder. Am. J. Sports Med. 40, 1424–1430 (2012)
McCarty 3rd, L.P., Buss, D.D., Datta, M.W., et al.: Complications observed following labral or rotator cuff repair with use of poly-L-lactic acid implants. J. Bone Joint Surg. Am. 95, 507–511 (2013)
Papalia, R., Franceschi, F., Diaz Balzani, L., et al. The arthroscopic treatment of shoulder instability: bioabsorbable and standard metallic anchors produce equivalent clinical results. Arthroscopy (2014)
Gardner, M.P., Chong, A.C., Pollock, A.G., Wooley, P.H.: Mechanical evaluation of large-size fourth-generation composite femur and tibia models. Ann. Biomed. Eng. 38, 613–620 (2010)
Grover, P., Albert, C., Wang, M., Harris, G.F. Mechanical characterization of fourth generation composite humerus. Proc. Inst. Mech. Eng. Part H J. Eng. Med. 225, 1169–1176 (2011)
Elfar, J., Menorca, R.M., Reed, J.D., Stanbury, S.: Composite bone models in orthopaedic surgery research and education. J. Am. Acad. Orthop. Surg. 22, 111–120 (2014)
Saito, N., Murakami, N., Takahashi, J., et al.: Synthetic biodegradable polymers as drug delivery systems for bone morphogenetic proteins. Adv. Drug Deliv. Rev. 57, 1037–1048 (2005)
Tan, H.L., Lin, W.T., Tang, T.T.: The use of antimicrobial-impregnated PMMA to manage periprosthetic infections: controversial issues and the latest developments. Int. J. Artif. Organs 35, 832–839 (2012)
Ambrose, C.G., Clyburn, T.A., Mika, J., et al.: Evaluation of antibiotic-impregnated microspheres for the prevention of implant-associated orthopaedic infections. J. Bone Joint Surg. Am. 96, 128–134 (2014)
Fedorovich, N.E., Alblas, J., de Wijn, J.R., et al.: Hydrogels as extracellular matrices for skeletal tissue engineering: state-of-the-art and novel application in organ printing. Tissue Eng. 13, 1905–1925 (2007)
Spiller, K.L., Maher, S.A., Lowman, A.M.: Hydrogels for the repair of articular cartilage defects. Tissue Eng. Part B, Rev. 17, 281–299 (2011)
Kosuge, D., Khan, W.S., Haddad, B., Marsh, D.: Biomaterials and scaffolds in bone and musculoskeletal engineering. Curr. Stem Cell Res. Ther. 8, 185–191 (2013)
Raftery, R., O’Brien, F.J., Cryan, S.A. Chitosan for gene delivery and orthopedic tissue engineering applications. Molecules (Basel, Switzerland) 18(5), 5611–5647 (2013)
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Ambrose, C.G., Hartline, B.E., Clanton, T.O., Lowe, W.R., McGarvey, W.C. (2015). Polymers in Orthopaedic Surgery. In: Puoci, F. (eds) Advanced Polymers in Medicine. Springer, Cham. https://doi.org/10.1007/978-3-319-12478-0_5
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DOI: https://doi.org/10.1007/978-3-319-12478-0_5
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