A Polymethyl Methacrylate Bone Cement With Reduced Stress Concentration

Abstract

Polymethyl methacrylate (PMMA) bone cement is the earliest and most widely used in clinical applications. However, PMMA bone cement has high hardness and high modulus, which leads to secondary fracture of adjacent vertebrae. In this study, a PMMA/polylactic acid (PLA)/carbon nanotube (CNT) compound bone cement with decreased compression modulus is developed for overcoming the limitation of PMMA commercial bone cement (CBC). Compared with CBC, the compression modulus of composite PMMA/PLA/CNT bone cements is reduced from 893.34 MPa (CBC) to 487.25 MPa (54.54% of the CBC), which is beneficial for reducing stress concentration at the bone implantation site. The cytotoxicity studies also indicate that the prepared composite cements are nontoxic and harmless, which has the necessary condition for orthopedic clinical applications.

Keywords

adjustable compressive modulus / CNT / PLA / PMMA bone cement

References

[1] I. Foessl, H. P. Dimai, and B. Obermayer-Pietsch, “Long-Term and Sequential Treatment for Osteoporosis,” Nature Reviews Endocrinology 19, no. 9 (2023): 520–533, https://doi.org/10.1038/s41574-023-00866-9.

[2] C. Lei, J.-h Song, S. Li, et al., “Advances in Materials-Based Therapeutic Strategies Against Osteoporosis,” Biomaterials 296 (2023): 122066, https://doi.org/10.1016/j.biomaterials.2023.122066.

[3] B. Liang, G. Burley, S. Lin, and Y. C. Shi, “Osteoporosis Pathogenesis and Treatment: Existing and Emerging Avenues,” Cellular and Molecular Biology Letters 27, no. 1 (2022): 72, https://doi.org/10.1186/s11658-022-00371-3.

[4] J. Li, X. Huang, and G. Zhong, “Evaluation of Efficacy and Safety of Vertebroplasty in the Treatment of Osteoporotic Vertebral Compression Fracture: A Protocol for Systematic Review and Meta-Analysis,” Medicine 100, no. 42 (2021): e27408, https://doi.org/10.1097/md.0000000000027408.

[5] J. Wang, H. Xiao, and Y. Liang, “Integration of Small Needle Knife in Treating Inflammatory Factors, Th17 Cell Function, and Magnetic Resonance Imaging Evaluation in Osteoporosis Complicated by Compression Fractures in Elderly Patients,” Experimental Gerontology 202 (2025): 112719, https://doi.org/10.1016/j.exger.2025.112719.

[6] D. Liu, H. Zhang, and X. Fan, “Robot-Assisted Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fracture Treatment and Risk Factor Screening for Postoperative Refracture,” Journal of Robotic Surgery. 18, no. 1 (2024): 23, https://doi.org/10.1007/s11701-023-01776-8.

[7] B. He, J. Zhao, M. Zhang, G. Jiang, K. Tang, and Z. Quan, “Effect of Surgical Timing on the Refracture Rate After Percutaneous Vertebroplasty: A Retrospective Analysis of at Least 4-Year Follow-Up,” BioMed Research International 2021, no. 1 (2021): 5503022, https://doi.org/10.1155/2021/5503022.

[8] Y. Chen, H. Zhang, H. Chen, Z. Ou, and J. Zhang, “Comparison of the Effectiveness and Safety of Unilateral and Bilateral Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures: A Protocol for Systematic Review and Meta-Analysis,” Medicine 100, no. 51 (2021): e28453, https://doi.org/10.1097/md.0000000000028453.

[9] J. Cerny, J. Soukup, K. Petrosian, L. Loukotova, and T. Novotny, “Efficacy and Complication Rates of Percutaneous Vertebroplasty and Kyphoplasty in the Treatment of Vertebral Compression Fractures: A Retrospective Analysis of 280 Patients,” Journal of Clinical Medicine 13, no. 5 (2024): 1495, https://doi.org/10.3390/jcm13051495.

[10] H. Zhang, Y. Cui, X. Zhuo, et al., “Biological Fixation of Bioactive Bone Cement in Vertebroplasty: The First Clinical Investigation of Borosilicate Glass (BSG) Reinforced PMMA Bone Cement,” ACS Applied Materials and Interfaces 14, no. 46 (2022): 51711–51727, https://doi.org/10.1021/acsami.2c15250.

[11] T. You, X. Ding, H. Zhao, et al., “Functionalized Hydroxyapatite and Curcumin Incorporated Stimuli-Responsive Low-Exothermic and Injectable Poly(Methyl Methacrylate) Bone Cement for the Treatment of Osteomyelitis,” Advanced Functional Materials 34, no. 42 (2024): 2406817, https://doi.org/10.1002/adfm.202406817.

[12] V. S. Seesala, L. Sheikh, B. Basu, and S. Mukherjee, “Mechanical and Bioactive Properties of PMMA Bone Cement: A Review,” ACS Biomaterials Science & Engineering 10, no. 10 (2024): 5939–5959, https://doi.org/10.1021/acsbiomaterials.4c00779.

[13] M. Du, Q. Li, J. Chen, K. Liu, and C. Song, “Design and Characterization of Injectable Abalone Shell/Calcium Sulfate Bone Cement Scaffold for Bone Defect Repair,” Chemical Engineering Journal 420 (2021): 129866, https://doi.org/10.1016/j.cej.2021.129866.

[14] X. Lv, H. Yu, J. Han, et al., “Tunicate Cellulose Nanocrystals Reinforced Modified Calcium Sulfate Bone Cement With Enhanced Mechanical Properties for Bone Repair,” Carbohydrate Polymers 323 (2024): 121380, https://doi.org/10.1016/j.carbpol.2023.121380.

[15] Y. Zhu, Y. Li, X. Zhou, M. Guo, and P. Zhang, “Glucose Microenvironment Sensitive Degradation of Arginine Modified Calcium Sulfate Reinforced Poly(lactide-co-glycolide) Composite Scaffolds,” Journal of Materials Chemistry B 12, no. 2 (2024): 508–524, https://doi.org/10.1039/d3tb01595e.

[16] B. He, M. Zhang, L. Yin, Z. Quan, Y. Ou, and W. Huang, “bFGF-Incorporated Composite Biomaterial for Bone Regeneration,” Materials and Design 215 (2022): 110469, https://doi.org/10.1016/j.matdes.2022.110469.

[17] C. Cui, D. Liu, X. Xie, et al., “Carvacrol-Loaded Premixed Calcium Phosphate Bone Cements With Exceptional Osteogenic and Antibacterial Properties to Heal Infected Bone Defects,” Composites Part B: Engineering 287 (2024): 111812, https://doi.org/10.1016/j.compositesb.2024.111812.

[18] S. Zhang, Z. Lian, X. Chen, et al., “Preparation and Properties of Chitosan Quaternary Ammonium Salt/α-Calcium Sulfate Hemihydrate/β-Tricalcium Phosphate Composite Bone Cement,” Colloids and Surfaces B 253 (2025): 114738, https://doi.org/10.1016/j.colsurfb.2025.114738.

[19] M. G. Raucci, U. D'Amora, A. Ronca, et al., “Injectable Functional Biomaterials for Minimally Invasive Surgery,” Advanced Healthcare Materials 9, no. 13 (2020): 2000349, https://doi.org/10.1002/adhm.202000349.

[20] P. Cai, S. Lu, J. Yu, et al., “Injectable Nanofiber-Reinforced Bone Cement With Controlled Biodegradability for Minimally-Invasive Bone Regeneration,” Bioactive Materials 21 (2023): 267–283, https://doi.org/10.1016/j.bioactmat.2022.08.009.

[21] Z. Zheng, S. Chen, X. Liu, et al., “A Bioactive Polymethylmethacrylate Bone Cement for Prosthesis Fixation in Osteoporotic Hip Replacement Surgery,” Materials & Design 209 (2021): 109966, https://doi.org/10.1016/j.matdes.2021.109966.

[22] Y. Wu, Y. Lin, Z. Cong, et al., “Peptide Polymer-Doped Cement Acting as an Effective Treatment of MRSA-Infected Chronic Osteomyelitis,” Advanced Functional Materials 32, no. 7 (2022): 2107942, https://doi.org/10.1002/adfm.202107942.

[23] X. Wang, Z. Cui, Q. Jia, et al., “Injectable Bismuth-Based Composite Enable Bone Defect Repair for Osteosarcoma Treatment and Mild Magnetothermal Bone Regeneration,” Advanced Functional Materials 35, no. 36 (2025): 2501317, https://doi.org/10.1002/adfm.202501317.

[24] X. Lu, Y. Zhao, X. Peng, et al., “Comprehensive Overview of Interface Strategies in Implant Osseointegration,” Advanced Functional Materials 35, no. 16 (2025): 2418849, https://doi.org/10.1002/adfm.202418849.

[25] Y. Wang, S. Shen, T. Hu, et al., “Layered Double Hydroxide Modified Bone Cement Promoting Osseointegration via Multiple Osteogenic Signal Pathways,” ACS Nano 15, no. 6 (2021): 9732–9745, https://doi.org/10.1021/acsnano.1c00461.

[26] Z. Wang, S. Luo, L. Yang, et al., “Intelligent and Bioactive Osseointegration of the Implanted Piezoelectric Bone Cement With the Host Bone Is Realized by Biomechanical Energy,” ACS Applied Materials and Interfaces 16, no. 16 (2024): 20157–20168, https://doi.org/10.1021/acsami.4c00632.

[27] X. Yuan, W. Zhu, Z. Yang, et al., “Recent Advances in 3D Printing of Smart Scaffolds for Bone Tissue Engineering and Regeneration,” Advanced Materials 36, no. 34 (2024): 2403641, https://doi.org/10.1002/adma.202403641.

[28] X. Liu, E. T. Camilleri, L. Li, et al., “Injectable Catalyst-Free ‘Click’ Organic-Inorganic Nanohybrid (click-ON) Cement for Minimally Invasive in vivo Bone Repair,” Biomaterials 276 (2021): 121014, https://doi.org/10.1016/j.biomaterials.2021.121014.

[29] A. R. Armiento, L. P. Hatt, G. Sanchez Rosenberg, K. Thompson, and M. J. Stoddart, “Functional Biomaterials for Bone Regeneration: A Lesson in Complex Biology,” Advanced Functional Materials 30, no. 44 (2020): 1909874, https://doi.org/10.1002/adfm.201909874.

[30] X. Liu, L. Li, B. Gaihre, et al., “Scaffold-Free Spheroids With Two-Dimensional Heteronano-Layers (2DHNL) Enabling Stem Cell and Osteogenic Factor Codelivery for Bone Repair,” ACS Nano 16, no. 2 (2022): 2741–2755, https://doi.org/10.1021/acsnano.1c09688.

[31] M. N. Collins, G. Ren, K. Young, S. Pina, R. L. Reis, and J. M. Oliveira, “Scaffold Fabrication Technologies and Structure/Function Properties in Bone Tissue Engineering,” Advanced Functional Materials 31, no. 21 (2021): 2010609, https://doi.org/10.1002/adfm.202010609.

[32] C. Wang, H. Wang, Q. Chen, et al., “Polylactic Acid Scaffold With Directional Porous Structure for Large-Segment Bone Repair,” International Journal of Biological Macromolecules 216 (2022): 810–819, https://doi.org/10.1016/j.ijbiomac.2022.07.207.

[33] B. Zhang, L. Wang, P. Song, et al., “3D Printed Bone Tissue Regenerative PLA/HA Scaffolds With Comprehensive Performance Optimizations,” Materials & Design 201 (2021): 109490, https://doi.org/10.1016/j.matdes.2021.109490.

[34] M. Aminul Islam, M. Hasan, M. Rahman, M. Hosne Mobarak, M. Akter Mimona, and N. Hossain, “Advances and Significances of Carbon Nanotube Applications: A Comprehensive Review,” European Polymer Journal 220 (2024): 113443, https://doi.org/10.1016/j.eurpolymj.2024.113443.

[35] F. Pahlevanzadeh, H. R. Bakhsheshi-Rad, A. F. Ismail, M. Aziz, and X. Chen, “Development of PMMA-Mon-CNT Bone Cement With Superior Mechanical Properties and Favorable Biological Properties for Use in Bone-Defect Treatment,” Materials Letters 240 (2019): 9–12, https://doi.org/10.1016/j.matlet.2018.12.049.

[36] S. Ramesh, K. H. Leen, K. Kumutha, and A. Arof, “FTIR Studies of PVC/PMMA Blend Based Polymer Electrolytes,” Spectrochimica Acta 66, no. 4 (2007): 1237–1242, https://doi.org/10.1016/j.saa.2006.06.012.

[37] H.-D. Huang, C.-Y. Liu, L.-Q. Zhang, G. J. Zhong, and Z. M. Li, “Simultaneous Reinforcement and Toughening of Carbon Nanotube/Cellulose Conductive Nanocomposite Films by Interfacial Hydrogen Bonding,” ACS Sustainable Chemistry & Engineering 3, no. 2 (2015): 317–324, https://doi.org/10.1021/sc500681v.

[38] H. Jiang, J. Xu, Z. Qiu, et al., “Mechanical Properties and Cytocompatibility Improvement of Vertebroplasty PMMA Bone Cements by Incorporating Mineralized Collagen,” Materials 8, no. 5 (2015): 2616–2634, https://doi.org/10.3390/ma8052616.

[39] A. Boger, M. Bohner, P. Heini, S. Verrier, and E. Schneider, “Properties of an Injectable Low Modulus PMMA Bone Cement for Osteoporotic Bone,” Journal of Biomedical Materials Research Part B: Applied Biomaterials 86, no. 2 (2008): 474–482, https://doi.org/10.1002/jbm.b.31044.

RIGHTS & PERMISSIONS

2026 The Author(s). Electron published by Harbin Institute of Technology and John Wiley & Sons Australia, Ltd.