Liquid monomer-powder particle interaction in acrylic bone cement

It is known that the method used to mix the liquid monomer and powder of PMMA bone cement influences the quality of the cement that is used in total joint replacements. Mixing theory indicates that the interaction between the liquid monomer and the powder is affected by a number of parameters, such as cement viscosity and degree of agitation, with this knowledge utilized in the design of cement mixing devices. Therefore, the objectives of this study were to: (i) obtain information on the interaction of the liquid monomer and the powder in the case of an PMMA bone cement, (ii) show how this knowledge can be applied to the design of an automated cement mixing device, and (iii) compare the porosity, bending modulus, and bending strength of one commercially-available cement prepared using the automated mixer and prepared using a conventional mixer that is in current clinical use. Experimental data indicated that increasing the velocity and decreasing the viscosity of the systems produced cement that improved mechanical properties, which may contribute to better mechanical integrity and, hence, reduced tendency for aseptic loosening, of cemented hip implants.

Identifying strategies to maximise recruitment and retention of practices and patients in a multicentre randomised controlled trial of an intervention to optimise secondary prevention for coronary heart disease in primary care.

Background Recruitment and retention of patients and healthcare providers in randomised controlled trials (RCTs) is important in order to determine the effectiveness of interventions. However, failure to achieve recruitment targets is common and reasons why a particular recruitment strategy works for one study and not another remain unclear. We sought to describe a strategy used in a multicentre RCT in primary care, to report researchers’ and participants’ experiences of its implementation and to inform future strategies to maximise recruitment and retention. Methods In total 48 general practices and 903 patients were recruited from three different areas of Ireland to a RCT of an intervention designed to optimise secondary prevention of coronary heart disease. The recruitment process involved telephoning practices, posting information, visiting practices, identifying potential participants, posting invitations and obtaining consent. Retention involved patients attending reviews and responding to questionnaires and practices facilitating data collection. Results We achieved high retention rates for practices (100%) and for patients (85%) over an 18-month intervention period. Pilot work, knowledge of the setting, awareness of change in staff and organisation amongst participant sites, rapid responses to queries and acknowledgement of practitioners’ contributions were identified as being important. Minor variations in protocol and research support helped to meet varied, complex and changing individual needs of practitioners and patients and encouraged retention in the trial. A collaborative relationship between researcher and practice staff which required time to develop was perceived as vital for both recruitment and retention. Conclusions Recruiting and retaining the numbers of practices and patients estimated as required to provide findings with adequate power contributes to increased confidence in the validity and generalisability of RCT results. A continuous dynamic process of monitoring progress within trials and tailoring strategies to particular circumstances, whilst not compromising trial protocols, should allow maximal recruitment and retention.

Development of operator independent bone cement vacuum mixing system for joint replacement surgery,

(2006) Vol. 35 No. 8 317

In vitro testing of chitosan in gentamicin-loaded bone cement No antimicrobial effect and reduced mechanical performance

Background and purpose Efforts to prevent infection of arthroplasties, including the use of antibiotic-loaded bone cement, are not always successful. We investigated whether the incorporation of chitosan in gentamicin-loaded bone cement increases antibiotic release, and prevents bacterial adherence and biofilm formation by clinical isolates of Staphylococcus spp. In addition, we performed mechanical and degradation tests.

Effect of temperature and mixing conditions on quality and consistency of poly(methyl methacrylate) bone cement

The mixing of poly(methyl methacrylate) (PMMA) bone cement has been studied to develop methods for preparing a consistently high quality cement. A novel droplet test experimental procedure was developed that characterised the wetting characteristics involved in bone cement mixing. Using this technique it was established that increased wetting occurred by mixing bone cement at a lower temperature (-28 degreesC) than normal mixing at room temperature.

Modelling the performance of self-compacting SIFCON of cement slurries containing limestone powder using genetic programming technique

The paper explores the potential of applicability of Genetic programming approach (GP), adopted in this investigation, to model the combined effects of five independent variables to predict the mini-slump, the plate cohesion meter, the induced bleeding test, the J-fiber penetration value, and the compressive strength at 7 and 28 days of self-compacting slurry infiltrated fiber concrete (SIFCON). The variables investigated were the proportions of limestone powder (LSP) and sand, the dosage rates of superplasticiser (SP) and viscosity modifying agent (VMA), and water-to-binder ratio (W/B). Twenty eight mixtures were made with 10-50% LSP as replacement of cement, 0.02-0.06% VMA by mass of cement, 0.6-1.2% SP and 50-150% sand (% mass of binder) and 0.42-0.48 W/B. The proposed genetic models of the self-compacting SIFCON offer useful modelling approach regarding the mix optimisation in predicting the fluidity, the cohesion, the bleeding, the penetration, and the compressive strength.