Properties of nanofiller-loaded poly (methyl methacrylate) bone cement composites for orthopedic applications: a review.

There is a large body of literature on new generations of poly (methyl methacrylate) bone cements that address one or more of the material's shortcomings. Among these are cements in which one of the constituents is a nanofiller, such as nano-sized barium sulfate, multiwalled carbon nanotubes, natural nanoclay, mesoporous silica nanoparticles, or oleic acid-capped silver nanoparticles. This article is a review of the literature on the properties of these nanofiller-loaded bone cements (NFLBCs). Some key characteristics of the literature are that (1) in a number of studies, clinically relevant properties were determined, examples being maximum exotherm, setting time, fatigue life, and compressive modulus; (2) in some studies, properties were not determined in accordance with approved bone cement testing specifications, an example being fatigue life; and (3) there are a number of clinically relevant properties that were not determined in any of the studies, examples being fatigue crack propagation rate and dynamic compression creep life. These observations, as well as other considerations, suggest 12 areas for future study, such as determination of dynamic creep compliance (using nanoindentation), determination of compressive fatigue life for cements to be used in vertebral compression fracture augmentation, elucidation of toughening mechanism(s) in each type of NFLBC, and conducting well-designed clinical trials.