Compressive fatigue properties of a commercially available acrylic bone cement for vertebroplasty

Acrylic bone cements are widely used for fixation of joint prostheses as well as for vertebral body augmentation procedures of vertebroplasty and balloon kyphoplasty, with the cement zone(s) being subjected to repeated mechanical loading in each of these applications. Although, in vertebroplasty and balloon kyphoplasty, the cement zone is exposed to mainly cyclical compressive load, the compressive fatigue properties of acrylic bone cements used in these procedures are yet to be determined. The purposes of the present study were to determine the compressive fatigue properties of a commercially available cement brand used in vertebroplasty, including the effect of frequency on these properties; to identify the cement failure modes under compressive cyclical load; and to introduce a screening method that may be used to shorten the lengthy character of the standardized fatigue tests. Osteopal®V was used as the model cement in this study. The combinations of maximum stress and frequency used were 50.0, 55.0, 60.0, 62.5 and 75.5 MPa at 2 Hz; and of 40.0, 55.0, 60.0, 62.5 or 75.5 MPa at 10 Hz. Through analysis of nominal strain-number of loading cycles results, three cement failure modes were identified. The estimated mean fatigue limit at 2 Hz (55.4 MPa) was significantly higher than that at 10 Hz (41.1 MPa). The estimated fatigue limit at 2 Hz is much higher than stresses commonly found in the spine and also higher than that for other acrylic bone cements tested in a full tension–compression fatigue test, which indicates that tension–compression fatigue testing may substantially underestimate the performance of cements intended for vertebroplasty. A screening method was introduced which may be used to shorten the time spent in performing compressive fatigue tests on specimens of acrylic bone cement for use in vertebral body augmentation procedures.