Polymethyl Methacrylate-Based Bone Cements Containing Carbon Nanotubes and Graphene Oxide: An Overview of Physical, Mechanical, and Biological Properties

Abstract

Every year, millions of people in the world get bone diseases and need orthopedic surgery as one of the most important treatments. Owing to their superior properties, such as acceptable biocompatibility and providing great primary bone fixation with the implant, polymethyl methacrylate (PMMA)-based bone cements (BCs) are among the essential materials as fixation implants in different orthopedic and trauma surgeries. On the other hand, these BCs have some disadvantages, including Lack of bone formation and bioactivity, and low mechanical properties, which can lead to bone cement (BC) failure. Hence, plenty of studies have been concentrating on eliminating BC failures by using different kinds of ceramics and polymers for reinforcement and also by producing composite materials. This review article aims to evaluate mechanical properties, self-setting characteristics, biocompatibility, and bioactivity of the PMMA-based BCs composites containing carbon nanotubes (CNTs), graphene oxide (GO), and carbon-based compounds. In the present study, we compared the effects of CNTs and GO as reinforcement agents in the PMMA-based BCs. Upcoming study on the PMMA-based BCs should concentrate on trialing combinations of these carbon-based reinforcing agents as this might improve beneficial characteristics.

Keywords: bone cements; carbon; polymethylmethacrylate; reinforcement materials.

Figure 1

Scheme of (a) Hip osteoarthritis and (b) Hip rheumatoid arthritis [2].

Figure 2

Chemical structures and properties of (a) MMA and (b) PMMA [11].

Figure 3

Four polymerization steps for PMMA-based BCs are introduced with four distinct phases that change as a function of the ambient temperature, I: mixing phase; II: waiting phase; III: application phase and IV: setting phase [3].

Figure 4

Schematic figure of the morphological structure of: (a) CNTs and (b) single-layer graphene sheet [58].

Figure 5

Biomedical application of carbon-based nanomaterial [53,69].

Figure 6

Schematic figure of interactions of CNTs and graphene with biological systems: (a) interaction of CNTs with cell, (b) adsorption of protein biomolecules on CNTs, (c) interaction of nucleic acids with CNTs, (d) interaction of graphene with cell, (e) adsorption of protein on graphene, and (f) interaction of nucleic acid with graphene [106].

Figure 7

Schematic demonstration of the antibacterial activity of GO-based materials and killing activity of the GO towards bacteria [112].

Figure 8

The future trend of PMMA/CBNs-based BCs.