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Background: Low-dose following up computed tomography (CT) of percutaneous vertebroplasty (PVP) that involves the use of bone cement usually suffers from lightweight metal artifacts, where conventional techniques for CT metal artifact reduction are often not sufficiently effective. This study aimed to validate an artificial intelligence (AI)-based metal artifact correction (MAC) algorithm for use in low-dose following up CT for PVP. Methods: In experimental validation, an ovine vertebra phantom was designed to simulate the clinical scenario of PVP. With routine-dose images acquired prior to the cement introduction as the reference, low-dose CT scans were taken on the cemented phantom and processed with conventional MAC and AI-MAC. The resulting image quality was compared in CT attenuation, image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR), followed by a quantitative evaluation of the artifact correction accuracy based on adaptive segmentation of the paraspinal muscle. In clinical validation, ten cases of low-dose following up CT after PVP were enrolled to test the performance of diagnosing sarcopenia with measured CT attenuation per cemented vertebral segment, via receiver operating characteristic (ROC) analysis. Results: With respect to the reference image, no significant difference was found for AI-MAC in CT attenuation, image noise, SNRs, and CNR (all P>0.05). The paraspinal muscle segmented on the AI-MAC image was 18.6% and 8.3% more complete to uncorrected and MAC images. Higher area under the curve (AUC) of the ROC analysis was found for AI-MAC (AUC =0.92) compared to the uncorrected (AUC =0.61) and MAC images (AUC =0.70). Conclusions: In low-dose following up CT for PVP, the AI-MAC has been fully validated for its superior ability compared to conventional MAC in suppressing artifacts and may be a reliable alternative for diagnosing sarcopenia.

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Proximal humerus fractures (PHFs) are among the most common upper-extremity fractures, with a rising incidence linked to the growing elderly population. Treatment options include non-surgical and surgical methods, but the best approach for geriatric PHFs remains debated. Patient selection for treatment must consider clinical and functional outcomes and the potential complications of surgery. Osteoporosis, a key factor in elderly PHFs, meaning those in patients over 65 years old, often results from low-energy trauma and necessitates treatments that enhance bone healing. Bone cement, such as calcium phosphate, is widely used to improve fracture stability and healing. However, the benefits of surgical fixation with bone cement augmentation (BCA) for elderly PHF patients remain controversial. Hence, in this article, we searched databases including MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and Web of Science to analyze the evidence on locking plate fixation (LPF) with BCA for proximal humeral fractures. We aim to provide readers with updates concerning the above issues.

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Objective: The objective of this study was to evaluate the effect of blood and artificial salivary contamination of different root-end filling materials on microleakage using a confocal laser scanning microscope and on marginal adaptation using a scanning electron microscope. Materials and Methods: Eighty noncarious single-rooted teeth with mature apices were taken. After retro-cavity preparation, they were randomly assigned into two major groups (n = 40). They were contaminated with blood and artificial saliva, respectively. Each major group was divided randomly into four subgroups (n = 10) and filled as follows: Subgroup A, Biodentine; Subgroup B, bioactive bone cement; Subgroup C, Cention N; and Subgroup D, Bio-C Repair. The samples were sectioned transversely at 1 and 2 mm from the root apex and checked under a confocal laser scanning microscope for microleakage and under an scanning electron microscope for marginal adaptation. The average mean values were calculated. Independent samples t-tests, paired t-tests, and one-way analysis of variance with Tukey's post hoc tests were done to analyze the data. Results: All the tested materials showed marginal gaps and dye leakage. The Bio-C Repair group showed the least mean marginal gap and dye leakage values, followed by bioactive bone cement, Biodentine, and Cention N, respectively, in both blood and artificial saliva contamination. However, the mean marginal gaps and dye leakage between the major groups were statistically insignificant. Conclusion: In an overall comparison, Bio-C Repair was found to be superior in terms of marginal adaptation and sealing ability under the test conditions.

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OBJECTIVE: To investigate the effectiveness of antibiotic bone cement combined with the vacuum sealing drainage (VSD) technique for repairing sacrococcygeal pressure ulcer wounds. METHODS: A retrospective analysis was conducted on data from 136 patients treated at Yantai Affiliated Hospital of Binzhou Medical College between May 2020 and June 2022. The cases were devided into a control group and a study group according to their treatment regimen. Indicators of postoperative recovery including blood routine recovery time, hospital stay, antibiotic application time, and healing time were compared between the two groups. Before the procedure and 6, 12, 24, and 48 hours following the operation, the pain levels of patients in both groups were examined using a visual analogue scale (VAS). On the 3rd, 7th, 14th, 21st, and 28th days of treatment, the pressure ulcer scale for healing (PUSH) was used to measure the pressure ulcer area between the two groups. On the 7th, 14th, 21st, and 28th days following treatment, the capillary density values were compared between the two groups, along with the levels of interleukin-1ß (IL-1ß), interleukin-12 (IL-12), and c-reactive protein (CRP). The proportions of immunoglobulin M (IgM) and immunoglobulin G (IgG) levels, CD3+, CD4+, and CD8+ T cell subsets, as well as CD4+/CD8+ ratio, were compared between the two groups. RESULTS: The blood routine recovery time, hospital stays, antibiotic usage duration, and healing time were all significantly shorter in the study group compared to those in the control group (all P<0.05). At 6 h, 12 h, 24 h, and 48 h following surgery, the VAS score in study group was significantly lower than that of the control group (P<0.05). The study group also showed a greater reduction in pressure ulcer area, with lower PUSH scores observed on days 14, 21, and 28 (P<0.05). Post-treatment levels of IL-1ß, IL-12, and CRP decreased in both groups, with significantly lower levels in the study group (P<0.05). Following therapy, both groups demonstrated significantly increased levels of CD3+, CD4+, CD4+/CD8+, IgM and IgG and reduced level of CD8+. These improvements were more pronounced in the study group (all P<0.05). CONCLUSION: The combination of antibiotic bone cement and VSD is effective in enhancing recovery, reducing pain and inflammation, and improving immune response in the treatment of sacrococcygeal pressure ulcers.

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Objective: Antibiotic-loaded bone cement (ALBC) plays an indispensable role in the treatment of infectious diseases of bone and joint. Here, we intended to analyze the research status, hot spots and frontiers in the field of ALBC, and to provide reference for future research ideas. Methods: The related English literature in the field of ALBC in the Web of Science Core Collection database was retrieved from January 1, 2009 to July 11, 2023. VOSviewer was used to extract the information of research constituents or bibliometric items such as authors, institutions, countries, and journals. CiteSpace was used to perform cluster analysis and frontier analysis of key words in ALBC research field. Results: A total of 1091 literatures related to ALBC research were retrieved, and the annual number of publications showed a steady upward trend in the past 15 years. The high-yield countries and regions are mainly represented by the United States, China (including Taiwan, China) and several European countries, such as Germany, England, Spain, Italy, the Netherlands, etc. The top three institutions with the highest number of publications were Shanghai Jiao Tong University, Chang Gung University and Chang Gung Memorial Hospital in China. Four of the top 10 influential scholars come from Germany, namely Konstantinos Anagnostakos, Volker Alt, Andrej Trampuz, and Bernd Fink. The top 10 high-yield journals had an average of 25 articles per journal and an average of 618.9 citations. The top 3 high-yield journals were Journal of Arthroplasty (57 articles, 1213 citations), Clinical Orthopaedics and Related Research (35 articles, 1119 times cited), and Journal of Orthopaedic Research (29 papers, 488 times cited). The keywords with high frequency were infection (266 times), vancomycin (239 times), bone-cement (219 times), gentamicin (216 times), antibiotics (168 times), osteomyelitis (163 times), etc. The clustering knowledge map of high-frequency keywords could be divided into 4 categories: (1) elution, release, mechanical and antibacterial properties of ALBC; (2) Application of ALBC in revision of prosthetic joint infections (PJIs); (3) Antibiotic types and application forms of ALBC; (4) Application of ALBC in the treatment of osteomyelitis. The keywords with the strongest citation bursts analysis revealed a core ("replacement/arthroplasty") and two stages of development in the field of ALBC research. The first stage (2009-2018) focused more on ALBC drug delivery, release, and infection prevention, while the second stage (2018-2023) mainly focused on ALBC drug elution, mechanical properties, and PJIs revision. Starting from 2018, the keyword with the strongest citation bursts had shifted from "acrylic bone cement" to "periprosthetic joint infection". Conclusion: ALBC research is steadily on the rise. Arthroplasty related applications continue to be the core of ALBC research. The research hotspot and trend are mainly the application in the prevention and treatment of bone and joint infectious diseases and the elution, release, mechanical and antibacterial properties of ALBC.

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OBJECTIVE: To investigate the clinical significance of using 3D printing guides in modified unilateral puncture percutaneous vertebroplasty (PVP) for the treatment of osteoporotic vertebral compression fractures (OVCF), and to explore a new method for preventing paravertebral vein leakage during PVP in conjunction with a previous study of the optimal puncture-side bone cement/vertebral volume ratio(PSBCV/VV%). METHODS: This retrospective study analyzed 99 patients who underwent unilateral puncture PVP between January 2023 and December 2023. Patients were divided into a guide plate group (46 patients) and a conventional group (53 patients). The guide plate group underwent modified unilateral puncture PVP with the guidance of 3D printing guides, while the conventional group underwent unilateral puncture PVP using the conventional pedicle approach. The distribution of bone cement, surgical outcomes, and the occurrence of cement leakage into paravertebral veins were observed in both groups. RESULTS: The guide plate group had significantly shorter operating time and required fewer fluoroscopies compared to the conventional group. The amount of bone cement volume (BCV) used in the guide plate group was higher, but the amount of bone cement volume on the puncture side(PSBCV), the PSBCV/VV%, and the rate of paravertebral vein leakage were lower in the guide plate group compared to the conventional group (P < 0.05). Within each group, significant improvements in anterior vertebral margin height, Cobb angle, visual analog scale (VAS) score, and Oswestry Disability Index (ODI) were observed at 1 day and 1 month postoperatively compared to preoperative values (P < 0.05). CONCLUSION: Using 3D printing guides in modified unilateral puncture PVP is a safe and effective method for treating OVCF. And it has the advantages of short operation time, less fluoroscopy, even distribution of bone cement, and a low rate of paravertebral vein leakage.

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Minimally invasive spine treatments have been sought after for elderly patients with comorbidities suffering from advanced degenerative disc disease. Percutaneous cement discoplasty (PCD) is one such technique where cement is injected into a degenerated disc with a vacuum phenomenon to relieve patients from pain. Adjacent vertebral fractures (AVFs) are however an inherent risk, particularly for osteoporotic patients, due to the high stiffness of the used cements. While low-modulus cements have been developed for vertebroplasty through the addition of linoleic acid, there are no such variations with a high-viscosity base cement, which is likely needed for the discoplasty application. Therefore, a low-modulus polymethyl methacrylate was developed by the addition of 12%vol. linoleic acid to a high-viscosity bone cement (hv-LA-PMMA). Initial experimental validation of the cement was performed by mechanical testing under compression over a period of 24 weeks, after storage in 37 °C phosphate buffer saline (PBS) solution. Furthermore, cement extracts were used to evaluate residual monomer release and the cytotoxicity of hv-LA-PMMA using fibroblastic cells. Relative to the base commercial cement, a significant reduction of Young's modulus and compressive strength of 36% and 42% was observed, respectively. Compression-tension fatigue tests at 5 MPa gave an average fatigue limit of 31,078 cycles. This was higher than another low-modulus cement and comparable to the fatigue properties of the disc annulus tissue. Monomer release tests showed that hv-LA-PMMA had a significantly higher release between 24 h and 7 days compared to the original bone cement, similarly to other low-modulus cements. Also, the control cement showed cytocompatibility at all time points of extract collection for 20-fold dilution, while hv-LA-PMMA only showed the same for extract collections at day 7. However, the 20-fold dilution was needed for both the control and the hv-LA-PMMA extracts to demonstrate more than 70% fibroblast viability at day 7. In conclusion, the mechanical testing showed promise in the use of linoleic acid in combination with a high-viscosity PMMA cement to achieve properties adequate to the application. Further testing and in vivo studies are however required to fully evaluate the mechanical performance and biocompatibility of hv-LA-PMMA for possible future clinical application.

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Introduction: Bone cementation has various effects on hemodynamics including potentially fatal bone cement implantation syndrome (BCIS). Most of the studies on BCIS are from developed countries. We have studied the effect of bone cement on hemodynamics in hip arthroplasty in the eastern Indian population and compared it with the available literature. Materials and Methods: This prospective study was done by a team of orthopedic surgeons and anesthesiologists in a tertiary center in eastern India between March 2020 and December 2022. Result: Seventy-two patients (Male 38: and Female 34) of age between 25 and 100 years fulfilling the inclusion criteria were included. In 43 patients (43/72, 59.72%) systolic and diastolic blood pressure fell in the range of 10 mmHg, in 22 patients (22/72, 30.56%) fall in blood pressure was in the range of 10-20 mmHg, and more than 20 mmHg fall in blood pressure were seen in seven patients (7/72, 9.72%). SPO2 decreased from 97-100% to 94-96% in 28 patients and 90-93% in six patients, which began to rise after 5 min of cementing and returned to normal after 10 min. Arrhythmias were seen in 16 patients with multiple comorbidity. Two patients had a cardiac arrest and one patient died after 6 h in the intensive care unit. Conclusion: Pre-operative evaluation, perioperative monitoring of hemodynamic parameters during cementing especially in high-risk patients with multiple comorbidities, and taking essential precautions during cemented arthroplasty are the key to preventing complications like BCIS.

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Background: The placement of immediate dental implants intrinsically displays crestal gaps, which may compromise implant osseointegration. Several grafting materials have been used to overcome this issue. Of the available materials, the use of bone cement is relatively new in oral implantology. This study aimed to examine the available literature on the utilization of bone cements in immediate placement of dental implants and assess its potential in oral implantology. Objectives: To synthesize evidence for appraising the impact of bone cements on implant stability and bone-to-implant contact (BIC) of dental implants placed immediately after extraction in humans and animals after 3 months of healing from tooth extraction. Methods: A systematic search was conducted in PubMed, Medline, and ScienceDirect for relevant studies published from inception to September 2021 using relevant search terms. Of the 1624 studies, 4 were selected for this systematic review. Results: Three of the four studies concluded that bone cements enhanced implant stability and/or BIC with better quality and/or quantity of bone surrounding the immediate dental implant. The conclusion drawn by one article remained indecisive. Meta-analysis could not be performed owing to the presence of substantial heterogeneity. Conclusion: Bone cement is a promising treatment alternative as it augments implant stability and/or BIC in immediate dental implants. Nonetheless, further prospective human clinical trials are required to establish its clinical effectiveness and arrive at a definitive conclusion to recommend its clinical use.

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BACKGROUND: Bone cement implantation syndrome characteristically involves acute alterations in the function of respiratory and cardiovascular systems. We present a case report of cement reaction with unusual presentation, that is, hypoxia, hypertension and tachycardia. A 74-year-old hypertensive male on regular medications sustained a slip and fall, presented with a right intertrochanteric neck of femur fracture, now posted for cemented hemiarthroplasty. Intraoperatively, after applying bone cement, the patient developed sweating, dyspnoea, bilateral wheezing and tachypnoea and desaturation of up to 80%-84%. Respiratory symptoms were associated with tachycardia (140-160 bpm) and hypertension (220/110 mm Hg). The surgeon was alerted about the event, the patient was reassured, and respiration was assisted with positive pressure ventilation with supplementation of 100% oxygen. DISCUSSION: Several mechanisms have been proposed, such as the toxic effect of systemically absorbed methyl methacrylate, exothermic reaction, fat and marrow embolism, high marrow pressure during cementing and anaphylactic reaction. The administration of adrenaline, which can worsen the clinical picture, is the mainstay in managing anaphylaxis. CONCLUSION: The association of hypertension and tachycardia with bone cement implantation syndrome, previously not reported, can have distinct pathomechanisms and cause a diagnostic and management dilemma.

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OBJECTIVE: To evaluate the clinical effectiveness of antibiotic bone cement combined with the lobulated perforator flap based on the descending branch of the lateral circumflex femoral artery (d-LCFA) in the treatment of infected traumatic tissue defects in the foot, in accordance with the Enhanced Recovery after Surgery (ERAS) concept. METHODS: From December 2019 to November 2022, 10 patients with infected traumatic tissue defects of the foot were treated with antibiotic bone cement combined with the d-LCFA lobulated perforator flap. The cohort comprised 6 males and 4 females, aged 21 to 67 years. Initial infection control was achieved through debridement and coverage with antibiotic bone cement, requiring one debridement in nine cases and two debridements in one case. Following infection control, the tissue defects were reconstructed utilizing the d-LCFA lobulated perforator flap, with the donor site closed primarily. The flap area ranged from 12 cm×6 cm to 31 cm×7 cm. Postoperative follow-up included evaluation of flap survival, donor site healing, and ambulatory function of the foot. RESULTS: The follow-up period ranged from 7 to 24 months, averaging 14 months. Infection control was achieved successfully in all cases. The flaps exhibited excellent survival rates and the donor site healed by first intention. Based on the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, pain and function were evaluated as excellent in 3 cases, good in 5 cases, and moderate in 2 cases. CONCLUSION: The application of antibiotic bone cement combined with the d-LCFA lobulated perforator flap is an effective treatment for infected traumatic tissue defects of the foot with the advantages of simplicity, high repeatability, and precise curative effects. The application of the d-LCFA lobulated perforator flap in wound repair causes minimal damage to the donor site, shortens hospital stays, lowers medical expenses, and accelerates patient rehabilitation, aligning with the ERAS concept. Therefore, it is a practice worth promoting in clinical use.

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BACKGROUND: Polymethylmethacrylate (PMMA) bone cement is used in orthopedics and dentistry to get primary fixation to bone but doesn't provide a mechanically and biologically stable bone interface. Therefore, there was a great demand to improve the properties of the PMMA bone cement to reduce its clinical usage limitations and enhance its success rate. Recent studies demonstrated that the addition of halloysite nanotubes (HNTs) to a polymeric-based material can improve its mechanical and thermal characteristics. OBJECTIVES: The purpose of the study is to assess the compressive strength, flexural strength, maximum temperature, and setting time of traditional PMMA bone cements that have been manually blended with 7 wt% HNT fillers. METHODS: PMMA powder and monomer liquid were combined to create the control group, the reinforced group was made by mixing the PMMA powder with 7 wt% HNT fillers before liquid mixing. Chemical characterization of the HNT fillers was employed by X-ray fluorescence (XRF). The morphological examination of the cements was done using a scanning electron microscope (SEM). Analytical measurements were made for the compressive strength, flexural strength, maximum temperature, and setting time. Utilizing independent sample t-tests, the data was statistically assessed to compare mean values (p < 0.05). RESULTS: The findings demonstrated that the novel reinforced PMMA-based bone cement with 7 wt% HNT fillers showed higher mean compressive strength values (93 MPa) and higher flexural strength (72 MPa). and lower maximum temperature values (34.8 °C) than the conventional PMMA bone cement control group, which was (76 MPa), (51 MPa), and (40 °C), respectively (P < 0.05). While there was no significant difference in the setting time between the control and the modified groups. CONCLUSION: The novel PMMA-based bone cement with the addition of 7 wt% HNTs can effectively be used in orthopedic and dental applications, as they have the potential to enhance the compressive and flexural strength and reduce the maximum temperatures.

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Otosclerosis is a complex skeletal condition that originates from both hereditary and environmental factors. Gradual conductive hearing loss is the main character. Aim to contrast and assess the postoperative results, such as hearing improvement, following the use of bone cement to fix the Titanium versus Teflon stapes piston. 50 patients who had endoscopic stapedotomy with different prostheses insertions were included in this prospective, randomized research. They were splitted into two groups in the: group A consisted of 25 ears in which titanium prostheses with bone cement were applied, while group B consisted of 25 ears Teflon prostheses with bone cement were used. A statistically significant difference was observed in average air conduction (better hearing) between groups A and B at 3, 6, and 12 months postoperatively based on audiometric results. When comparing groups B and A after 3, 6, and 12 months after surgery, the average air bone gap (ABG) was greater in group B, and this difference was statistically significant. Between the two groups, there was no discernible variation in any of the preoperative metrics. 96% of groups A and B were successful. Using bone cement in primary stapedotomy may help fix the procedure and reduce the chance of persistent hearing loss in patients with otosclerosis. This is especially true when titanium is used, as titanium has the ideal mass and stiffness to support acoustic transmission with a low rate of adverse effects and better average ABG.

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With the increasing use of primary hip arthroplasty for management of intertrochanteric fractures, firm fixation and union of the greater trochanteric (GT) fragment are required during hip arthroplasty for management of intertrochanteric fractures. Various methods have been suggested to address this issue. However, displacement of the GT is a frequent occurrence. We have introduced a cement-filling technique for performance of hip arthroplasty of the proximal femur for achievement of immediate firm fixation of the GT. Cement filling during performance of hip arthroplasty for management of femoral intertrochanteric fractures is a valuable technique for preventing displacement of the GT and to encourage early mobilization.

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This research aims to identify the prevalence of failure for Birmingham Hip Prosthesis (BHR) in total hip arthroplasty and to analyze its reasons from biomaterials and biofunctional perspectives. We present our current analysis and tests on a series of different BHR-retrieved prostheses after premature failure. Relevant clinical data, such as X-ray investigations and intraoperative images for clinical case studies, were analyzed to better understand all factors involved in BHR prosthesis failure. A detailed analysis of the failures highlighted uneven cement distribution, overloading in certain areas, and void formation in the material. A closer investigation using microscopical techniques revealed the presence of a crack originating from the gap between the cement mantle and human bone. Additionally, scanning electron microscopy analyses were conducted as part of the investigation to examine bone cement morphology in detail and better understand the interactions at the interfaces between implant, cement, and bone. In conclusion, this research emphasizes the importance of surgical technique planning and the cementation procedure in the success rate of BHR prostheses. It also underscores the need to carefully evaluate patient characteristics and bone quality to minimize the risk of BHR prosthesis failure. The cementation procedure seems to be essential for the long-term functionality of the BHR prosthesis.

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The increasing numbers of total joint replacements and related implant-associated infections demand solutions, which can provide a high-dose local delivery of antibiotics. Antibiotic-loaded bone cement (ALBC) is an accepted treatment method for infected joint arthroplasties. The mechanical properties of low-dose gentamicin-loaded bone cement (BC) in medium- and high-viscosity versions were compared to unloaded BC using a vacuum mixing system. As an additional control group, manual mixed unloaded BC was used. In a uniaxial compression test, ultimate compressive strength, compressive yield strength, and compression modulus of elasticity, as well as ultimate and yield strain, were determined according to ISO 5833-2022 guidelines. All groups exceeded the minimum compressive strength (70 MPa) specified in the ISO 5833 guidelines. Both ALBC groups showed a similar ultimate compressive and yield strength to the unloaded BC. The results showed that vacuum mixing increased the compression strength of BC. ALBC showed similar compressive strength to their non-antibiotic counterparts when vacuum mixing was performed. Added low-dose gentamicin acted as a plasticizer on bone cement. From a biomechanical point of view, the usage of gentamicin-based ALBC formulations is viable.

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Bone cement based on magnesium phosphate has extremely favorable properties for its application as a bioactive bone substitute. However, further improvement is still expected due to difficult injectability and high brittleness. This paper reported the preparation of novel biocomposite cement, classified as dual-setting, obtained through ceramic hydration reaction and polymer cross-linking. Cement was composed of magnesium potassium phosphate and sodium alginate cross-linked with calcium carbonate and gluconolactone. The properties of the obtained composite material and the influence of sodium alginate modification on cement reaction were investigated. Our results indicated that proposed cements have several advantages compared to ceramic cement, like shortened curing time, diverse microstructure, increased wettability and biodegradability and improved paste cohesion and injectability. The magnesium phosphate cement with 1.50% sodium alginate obtained using a powder-to-liquid ratio of 2.5 g/mL and cross-linking ratio 90/120 of GDL/CC showed the most favorable properties, with no adverse effect on mechanical strength and osteoblasts cytocompatibility. Overall, our research suggested that this novel cement might have promising medical application prospects, especially in minimally invasive procedures.

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Prosthetic joint infections (PJIs) can have disastrous consequences for patient health, including removal of the device, and placement of cemented implants is often required during surgery to eradicate PJIs. In translational research, in vivo models are widely used to assess the biocompatibility and antimicrobial efficacy of antimicrobial coatings and compounds. Here, we aim to utilize Galleria mellonella implant infection models to assess the antimicrobial activity of antibiotic-loaded bone cement (ALBC) implants. Therefore, we used commercially available bone cement loaded with either gentamicin alone (PALACOS R+G) or with a combination of gentamicin and vancomycin (COPAL G+V), compared to bone cement without antibiotics (PALACOS R). Firstly, the in vitro antimicrobial activity of ALBC was determined against Staphylococcus aureus. Next, the efficacy of ALBC implants was analyzed in both the G. mellonella hematogenous and early-stage biofilm implant infection model, by monitoring the survival of larvae over time. After 24 h, the number of bacteria on the implant surface and in the tissue was determined. Larvae receiving dual-loaded COPAL G+V implants showed higher survival rates compared to implants loaded with only gentamicin (PALACOS R+G) and the control implants without antibiotics (PALACOS R). In conclusion, G. mellonella larvae infection models with antibiotic-loaded bone cements are an excellent option to study (novel) antimicrobial approaches.

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Both cementless and cemented stems have exhibited favorable long-term outcomes in total hip arthroplasty. Nonetheless, in elderly patients, cemented hips offer an advantage due to their reduced risk of periprosthetic fractures. This study aimed to assess the initial outcomes of 28 patients who underwent unilateral cemented total hip arthroplasty utilizing a calcar-guided A2 stem (ARTIQO GmbH, Lüdinghausen, Germany). Various types of antibiotic-loaded bone cement were employed. During follow-up, we recorded demographic data and comorbidities and employed standardized clinical assessment tools, including the Harris Hip Score. Radiographic assessments included preoperative, postoperative, and follow-up imaging to evaluate subsidence, osteolysis, and bone resorption. The results indicated that among the 28 patients, 5 withdrew consent and 2 patients passed away from unrelated causes. Additionally, one prosthesis was explanted due to the undersizing of the cement stopper, which resulted in an inadequate cement mantle. As a result, 20 patients underwent a 1-year follow-up, revealing noteworthy enhancements in clinical scores, with no instances of radiolucent lines or osteolysis. No infections were detected. In summary, our short-term experience with this particular cemented short-stem design yielded promising results, exhibiting excellent functional outcomes, no aseptic loosening attributable to the stem, and no infections. Further clinical studies and registry data are essential to corroborate these findings.