Influence of bone cements on bone-screw interfaces in the third metacarpal and third metatarsal bones of horses

Laura J. M. Hirvinen Comparative Orthopedic Research Laboratories, Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210.

Search for other papers by Laura J. M. Hirvinen in
Current site
Google Scholar
PubMed
Close
 DVM
,
Alan S. Litsky Orthopaedic BioMaterials Laboratory, Departments of Orthopaedics and Biomedical Engineering, The Ohio State University, Columbus, OH 43210.

Search for other papers by Alan S. Litsky in
Current site
Google Scholar
PubMed
Close
 MD, ScD
,
Valerie F. Samii Comparative Orthopedic Research Laboratories, Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210.

Search for other papers by Valerie F. Samii in
Current site
Google Scholar
PubMed
Close
 DVM
,
Steven E. Weisbrode Department of Veterinary Biosciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210.

Search for other papers by Steven E. Weisbrode in
Current site
Google Scholar
PubMed
Close
 VMD, PhD
, and
Alicia L. Bertone Comparative Orthopedic Research Laboratories, Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210.

Search for other papers by Alicia L. Bertone in
Current site
Google Scholar
PubMed
Close
 DVM, PhD

Abstract

Objective—To compare biomechanical strength, interface quality, and effects of bone healing in bone-implant interfaces that were untreated or treated with calcium phosphate cement (Ca-cement), magnesium phosphate cement (Mg-cement), or polymethylmethacrylate (PMMA) in horses.

Animals—6 adult horses.

Procedures—4 screw holes were created (day 0) in each third metacarpal and third metatarsal bone of 6 horses. In each bone, a unicortical screw was placed in each hole following application of Ca-cement, Mg-cement, PMMA, or no treatment (24 screw holes/treatment). Screws were inserted to 2.82 N m torque. Horses were euthanized and bones were harvested at day 5 (16 screw holes/treatment) or day 182 (8 screw holes/treatment). Radiography, biomechanical testing, histomorphometry, and micro–computed tomography were performed to characterize the bone-implant interfaces.

Results—Use of Mg-cement increased the peak torque to failure at bone-implant interfaces, compared with the effects of no treatment and Ca-cement, and increased interface toughness, compared with the effects of no treatment, Ca-cement, and PMMA. Histologically, there was 44% less Ca-cement and 69% less Mg-cement at the interfaces at day 182, compared with amounts present at day 5. Within screw threads, Ca-cement increased mineral density, compared with PMMA or no treatment. In the bone adjacent to the screw, Mg-cement increased mineral density, compared with PMMA or no treatment. One untreated and 1 Ca-cement–treated screw backed out after day 5.

Conclusions and Clinical Relevance—In horses, Mg-cement promoted bone-implant bonding and adjacent bone osteogenesis, which may reduce the risk of screw loosening.

Abstract

Objective—To compare biomechanical strength, interface quality, and effects of bone healing in bone-implant interfaces that were untreated or treated with calcium phosphate cement (Ca-cement), magnesium phosphate cement (Mg-cement), or polymethylmethacrylate (PMMA) in horses.

Animals—6 adult horses.

Procedures—4 screw holes were created (day 0) in each third metacarpal and third metatarsal bone of 6 horses. In each bone, a unicortical screw was placed in each hole following application of Ca-cement, Mg-cement, PMMA, or no treatment (24 screw holes/treatment). Screws were inserted to 2.82 N m torque. Horses were euthanized and bones were harvested at day 5 (16 screw holes/treatment) or day 182 (8 screw holes/treatment). Radiography, biomechanical testing, histomorphometry, and micro–computed tomography were performed to characterize the bone-implant interfaces.

Results—Use of Mg-cement increased the peak torque to failure at bone-implant interfaces, compared with the effects of no treatment and Ca-cement, and increased interface toughness, compared with the effects of no treatment, Ca-cement, and PMMA. Histologically, there was 44% less Ca-cement and 69% less Mg-cement at the interfaces at day 182, compared with amounts present at day 5. Within screw threads, Ca-cement increased mineral density, compared with PMMA or no treatment. In the bone adjacent to the screw, Mg-cement increased mineral density, compared with PMMA or no treatment. One untreated and 1 Ca-cement–treated screw backed out after day 5.

Conclusions and Clinical Relevance—In horses, Mg-cement promoted bone-implant bonding and adjacent bone osteogenesis, which may reduce the risk of screw loosening.

Contributor Notes

This manuscript represents a portion of a thesis submitted by Dr. Hirvinen to The Ohio State University as partial fulfillment of the requirements for a Master of Science degree.

Supported by BoneSolutions Incorporated.

Presented at the 18th Annual Scientific Meeting of the American College of Veterinary Surgeons, San Diego, October 2008.

The authors thank Michelle Carlton, Dr. Akikazu Ishihara, Dr. Kelly Santangelo, and David Smith for technical and surgical assistance.

Address correspondence to Dr. Bertone.
  • 1.

    Olmstead ML. The canine cemented modular total hip prosthesis. J Am Anim Hosp Assoc 1995;31:109124.

  • 2.

    Massat BJ, Vasseur PB. Clinical and radiographic results of total hip arthroplasty in dogs: 96 cases (1986–1992). J Am Vet Med Assoc 1994;205:448454.

    • Search Google Scholar
    • Export Citation
  • 3.

    Crawford WH, Fretz PB. Long bone fractures in large animals: a retrospective study. Vet Surg 1985;14:295302.

  • 4.

    Hosgood G, Lewis DD. Retrospective evaluation of fixation complications in 49 pelvic osteotomies in 36 dogs. J Small Anim Pract 1993;34:123130.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5.

    Remedios AM, Fries CL. Implant complications in 20 triple pelvic osteotomies. Vet Comp Orthop Traumatol 1993;6:202207.

  • 6.

    Koch DA, Hazewinkel HA, Nap RC, et al. Radiographic evaluation and comparison of plate fixation after triple pelvic osteotomy in 32 dogs with hip dysplasia. Vet Comp Orthop Traumatol 1993;6:915.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7.

    Doornink MT, Nieves MA, Evans R. Evaluation of iliac screw loosening after triple pelvic osteotomy in dogs: 227 cases (1991–1999). J Am Vet Med Assoc 2006;229:535541.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8.

    Slocum B, Slocum TD. Tibial plateau leveling osteotomy for repair of cranial cricuate ligament rupture in the canine. Vet Clin North Am Small Anim Pract 1993;23:777795.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9.

    Conzemius MG, Vandervoort J. Total joint replacement in the dog. Vet Clin North Am Small Anim Pract 2005;35:12131231.

  • 10.

    Bogoni P, Rovesti GL. Early detection of screw loosening in triple pelvic osteotomy. Vet Surg 2005;34:190195.

  • 11.

    Simmons S, Johnson AL, Schaeffer DJ. Risk factors for screw migration after triple pelvic osteotomy. J Am Anim Hosp Assoc 2001;37:269273.

  • 12.

    Hirakawa K, Jacobs JJ, Urban R, et al. Mechanisms of failure of total hip replacements: lessons learned from retrieval studies. Clin Orthop Relat Res 2004;1017.

    • Search Google Scholar
    • Export Citation
  • 13.

    Olmstead ML. Complications of fractures repaired with plates and screws. Vet Clin North Am Small Anim Pract 1991;21:669686.

  • 14.

    Yovich JV, Turner AS, Smith FW. Holding power of orthopedic screws in equine third metacarpal and metatarsal bones. Part I: foal bone. Vet Surg 1985;14:221229.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15.

    Hulse D, Hyman B. Biomechanics of fracture fixation failure. Vet Clin North Am Small Anim Pract 1991;21:647667.

  • 16.

    McKoy BE, An YH, Friedman RJ. Factors affecting the strength of the bone-implant interface. In: An YH, Draughn RA, eds. Mechanical testing of bone and the bone-implant interface. Boca Raton, Fla: CRC Press LLC, 2000;439462.

    • Search Google Scholar
    • Export Citation
  • 17.

    Friedman RJ, An YH, Ming J, et al. Influence of biomaterial surface texture on bone ingrowth in the rabbit femur. J Orthop Res 1996;14:455464.

  • 18.

    Placzek R, Ruffer M, Deuretzbacher G, et al. The fixation strength of hydroxyapatite-coated Schanz screws and standard stainless steel Schanz screws in lower extremity lengthening: a comparison based on a new torque value index: the fixation index. Arch Orthop Trauma Surg 2006;126:369373.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19.

    Edwards TR, Tevelen G, English H, et al. Stripping torque as a predictor of succesful internal fracture fixation. ANZ J Surg 2005;75:10961099.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20.

    Kuehn KD, Ege W, Gopp U. Acrylic bone cements: mechanical and physical properties. Orthop Clin North Am 2005;36:2939.

  • 21.

    Schmalzried TP, Kwong LM, Jasty M, et al. The mechanism of loosening of cemented acetabular components in total hip arthroplasty. Analysis of specimens retrieved at autopsy. Clin Orthop Relat Res 1992;6078.

    • Search Google Scholar
    • Export Citation
  • 22.

    Campoccia D, Montanaro L, Arciola CR. The significance of infection related to orthopedic devices and issues of antibiotic resistance. Biomaterials 2006;27:23312339.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 23.

    Charnley J. Anchorage of the femoral head prosthesis to the shaft of femur. J Bone Joint Surg Br 1960;42B:2830.

  • 24.

    Kuehn KD, Ege W, Gopp U. Acrylic bone cements: composition and properties. Orthop Clin North Am 2005;36:1728.

  • 25.

    Goodman S. Wear particulate and osteolysis. Orthop Clin North Am 2005;36:4148.

  • 26.

    Plante J, Dupuis J, Beauregard G, et al. Long-term results of conservative treatment, excision arthroplasty, and triple pelvic osteotomy for the treatment of hip dysplasia in the immature dog. Vet Comp Orthop Traumatol 1997;10:101110.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 27.

    Lee JH, Ryu HS, Lee DS, et al. Biomechanical and histomorphometric study on the bone-screw interface of bioactive ceramiccoated titanium screws. Biomaterials 2005;26:32493257.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 28.

    Yildirim OS, Aksakal B, Celik H. An investigation of the effects of hydroxyapatite coatings on the fixation strength of cortical screws. Med Eng Phys 2005;27:221228.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 29.

    Moroni A, Faldini C, Rocca M, et al. Improvement of the bone-screw interface strength with hydroxyapatite-coated and titanium-coated AO/ASIF cortical screws. J Orthop Trauma 2002;16:257263.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 30.

    Wittenberg RH, Lee KS, Shea M, et al. Effect of screw diameter, insertion technique, and bone cement augmentation of pedicular screw fixation strength. Clin Orthop Relat Res 1993;278287.

    • Search Google Scholar
    • Export Citation
  • 31.

    Hing KA, Wilson LF, Buckland T. Comparative performance of three ceramic bone graft substitutes. Spine J 2007;7:475490.

  • 32.

    Gerhart TN, Roux RD, Horowitz G, et al. Antibiotic release from an experimental biodegradable bone cement. J Orthop Res 1988;6:585592.

  • 33.

    Waselau M, Samii VF, Weisbrode SE, et al. Effects of magnesium adhesive cement on bone stability and healing following a metatarsal osteotomy in horses. Am J Vet Res 2007;68:370378.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 34.

    Nunamaker DM, Richardson DW, Butterweck DM. Mechanical and biological effects of bone luting. J Orthop Trauma 1991;5:138145.

  • 35.

    Charnley J. The reaction of bone to self-curing acrylic cement. A long-term histological study in man. J Bone Joint Surg Br 1970;52:340353.

    • Search Google Scholar
    • Export Citation
  • 36.

    Welsh RP, Pilliar RM, Macnab I. Surgical implants. The role of surface porosity in fixation to bone and acrylic. J Bone Joint Surg Am 1971;53:963977.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 37.

    Smith DC. The genesis and evolution of acrylic bone cement. Orthop Clin North Am 2005;36:110.

  • 38.

    Brunner H, Simpson JP. Fatigue failure of bone plates. Injury 1980;11:203207.

  • 39.

    Bauer TW, Schils J. The pathology of total joint arthroplasty. II. Mechanisms of implant failure. Skeletal Radiol 1999;28:483497.

  • 40.

    Jansen J, Ooms E, Verdonschot N, et al. Injectable calcium phosphate cement for bone repair and implant fixation. Orthop Clin North Am 2005;36:8995.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 41.

    von Doernberg MC, von Rechenberg B, Bohner M, et al. In vivo behaviour of calcium phosphate scaffolds with four different pore sizes. Biomaterials 2006;27:51865198.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 42.

    Apelt D, Theiss F, El-Warrak AO, et al. In vivo behavior of three different injectable hydraulic calcium phosphate cements. Biomaterials 2004;25:14391451.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 43.

    Hutchinson GS, Griffon DJ, Siegel AM, et al. Evaluation of an osteoconductive resorbable calcium phosphate cement and polymethylmethacrylate for augmentation of orthopedic screws in the pelvis of canine cadavers. Am J Vet Res 2005;66:19541960.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 44.

    Rohmiller MT, Schwalm D, Glattes C, et al. Evaluation of calcium sulfate paste for augmentation of lumbar pedicle screw pullout strength. Spine J 2002;2:255260.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 45.

    Frankenburg EP, Golstein SA, Bauer TW, et al. Biomechanical and histological evaluation of a calcium phosphate cement. J Bone Joint Surg Am 1998;80:11121124.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 46.

    Witte F, Ulrich H, Rudert M, et al. Biodegradable magnesium scaffolds: part I: appropriate inflammatory response. J Biomed Mater Res A 2007;81:748756.

    • Search Google Scholar
    • Export Citation
  • 47.

    Witte F, Ulrich H, Palm C, et al. Biodegradable magnesium scaffolds: part II: peri-implant bone remodeling. J Biomed Mater Res A 2007;81:757765.

    • Search Google Scholar
    • Export Citation
  • 48.

    Witte F, Fischer J, Nellesen J, et al. In vitro and in vivo corrosion measurements of magnesium alloys. Biomaterials 2006;27:10131018.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 49.

    Gulotta LV, Kovacevic D, Ying L, et al. Augmentation of tendon-to-bone healing with a magnesium-based bone adhesive. Am J Sports Med 2008;36:12901297.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 50.

    Staiger MP, Pietak AM, Huadmai J, et al. Magnesium and its alloys as orthopedic biomaterials: a review. Biomaterials 2006;27:17281734.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 51.

    McBride E. Absorbable metal in bone surgery. J Am Vet Med Assoc 1938;111:24642467.

  • 52.

    Howlett CR, Zreiqat H, Wu Y, et al. Effect of ion modification of commonly used orthopedic materials on the attachment of human bone-derived cells. J Biomed Mater Res 1999;45:345354.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 53.

    Zreiqat H, Evans P, Howlett CR. Effect of surface chemical modification of bioceramic on phenotype of human bone-derived cells. J Biomed Mater Res 1999;44:389396.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 54.

    Bilek MMM, Evans P, McKenzie DR, et al. Metal ion implantation using a filtered cathodic vacuum arc. J Appl Phys 2000;87:41984204.

  • 55.

    Howlett CR, Chen N, Zhang X, et al. Effect of biomaterial chemistries on the osteoblastic molecular phenotype and osteogenesis: in vitro and in vivo studies. In: Davies JE, ed. Bone tissue engineering. Toronto: EM Squared Inc, 2000;240255.

    • Search Google Scholar
    • Export Citation
  • 56.

    Gronowicz G, McCarthy MB. Response to human osteoblasts to implant materials: integrin-mediated adhesion. J Orthop Res 1996;14:878887.

  • 57.

    Longhurst CM, Jennings LK. Integrin-mediated signal transduction. Cell Mol Life Sci 1998;54:514526.

  • 58.

    Damsky CH. Extracellular matrix-integrin interactions in osteoblast function and tissue remodeling. Bone 1999;25:9596.

  • 59.

    Backstrom KC, Bertone AL, Wisner ER, et al. Response of induced bone defects in horses to collagen matrix containing the human parathyroid hormone gene. Am J Vet Res 2004;65:12231232.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 60.

    American Association of Equine Practitioners. Lameness scoring system. Available at: www.aaep.org. Accessed Apr 1, 2008.

  • 61.

    Schoenau E, Saggese G, Peter F, et al. From bone biology to bone analysis. Horm Res 2004;61:257269.

  • 62.

    Zreiqat H, Howlett CR, Zannettino A, et al. Mechanisms of magnesium-stimulated adhesion of osteoblastic cells to commonly used orthopaedic implants. J Biomed Mater Res 2002;62:175184.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 63.

    Yamasaki Y, Yoshida Y, Okazaki M, et al. Action of FGMgCO3Apcollagen composite in promoting bone formation. Biomaterials 2003;24:49134920.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 64.

    Yamasaki Y, Yoshida Y, Okazaki M, et al. Synthesis of functionally graded MgCO3 apatite accelerating osteoblast adhesion. J Biomed Mater Res 2002;62:99105.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 65.

    Fürst A, Meier D, Michel S, et al. Effect of age on bone mineral density and micro architecture in the radius and tibia of horses: an Xtreme computed tomographic study. BMC Vet Res 2008;4:3.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 66.

    Huja SS, Litsky AS, Beck FM, et al. Pull-out strength of monocortical screws placed in the maxillae and mandibles of dogs. Am J Orthod Dentofacial Orthop 2005;127:307313.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 67.

    Kleeman BC, Takeuchi T, Gerhart TN, et al. Holding power and reinforcement of cancellous screws in human bone. Clin Orthop Relat Res 1992;260266.

    • Search Google Scholar
    • Export Citation
  • 68.

    Motzkin NE, Chao EY, An KN, et al. Pull-out strength of screws from polymethylmethacrylate cement. J Bone Joint Surg Br 1994;76:320323.

    • Search Google Scholar
    • Export Citation
  • 69.

    Berzins A, Sumner DR. Implant pushout and pullout test. In: An YH, Draughn RA, eds. Mechanical testing of bone and the bone-implant interface. Boca Raton, Fla: CRC Press LLC, 2000;463476.

    • Search Google Scholar
    • Export Citation

Advertisement