BONE CEMENT IN ORTHOPAEDIC SURGERY: PROPERTIES, GOOD PRACTICE AND INDICATIONS

Polymethylmethacrylate (PMMA) bone cement has been used in orthopaedic surgery for more than sixty years. It is not a glue: it acts as a grout, through mechanical interlock with bone, and distributes loads between the implant and the bone. This review describes its composition, its physico-chemical and mechanical properties, the phases of its handling and its main indications.
Polymerisation is an exothermic reaction, but the in vivo temperature remains moderate (40 to 46 °C). The quality of cementation depends mainly on technique: vacuum mixing, canal lavage, cement restrictor and pressurisation. Antibiotic-loaded cement plays a major role in the prevention and treatment of infection. Indications extend beyond arthroplasty to spacers, tumour surgery, the induced membrane technique and vertebroplasty. Bone cement implantation syndrome remains the most serious complication.