Improved orthopaedic bone cement formulations based on rubber toughening.

Poly(methylmethacrylate) (PMMA) bone cements have been used for the fixation of hip and knee implants since the early 1960s. Aseptic loosening, related to fracture of the PMMA, continues to be the primary mode of failure for these prostheses. Failed prostheses must be replaced causing additional expense and patient trauma. Furthermore, the average lifetime of the revised prosthesis is significantly lower than that of a primary prosthesis. Recent work by Moseley and co-workers led to the development of a promising new rubber toughened cement. It is comprised of a matrix of the traditional PMMA with dispersed rubber particles to modify mechanical properties and, in particular, improve fracture toughness. The fracture toughness of the experimental material was 167% greater than the toughness of a nontoughened control; however, the elastic modulus and compressive strength were reduced. The reductions in properties should not pose a clinical problem based on results of the implant model reported by Moseley. More serious concerns were mixing and delivery problems and high residual monomer concentrations. The formulation and chemical/mechanical characterization of new toughened acrylic formulations that have residual monomer levels equivalent to Simplex and better mixing properties are reported.