Narrative review of PMMA bone cement covering its chemical composition, the four phases of curing, and how endogenous variables (antibiotic content, radiopacifier type/dose, molecular weight) and exogenous variables (air/porosity, blood, temperature, humidity) alter its mechanical and handling properties — then applying that framework to arthroplasty fixation, vertebral augmentation, and infection management.
When preparing antibiotic-loaded PMMA — whether for a two-stage revision spacer or osteomyelitis bead chain — keep antibiotic-to-powder ratio below 1.85% to preserve mechanical integrity, use vacuum or centrifugation mixing to minimize porosity, and select an antibiotic compatible with the heat-stable, water-diffusible, low-allergenic profile PMMA requires (tobramycin and vancomycin are the workhorse combination).
During any cemented procedure, monitor for cardiopulmonary changes at the moment of pressurized cement introduction — fat/marrow embolism and monomer toxicity are the leading proposed mechanisms.
Narrative review of PMMA bone cement covering its chemical composition, the four phases of curing, and how endogenous variables (antibiotic content, radiopacifier type/dose, molecular weight) and exogenous variables (air/porosity, blood, temperature, humidity) alter its mechanical and handling properties — then applying that framework to arthroplasty fixation, vertebral augmentation, and infection management.
When preparing antibiotic-loaded PMMA — whether for a two-stage revision spacer or osteomyelitis bead chain — keep antibiotic-to-powder ratio below 1.85% to preserve mechanical integrity, use vacuum or centrifugation mixing to minimize porosity, and select an antibiotic compatible with the heat-stable, water-diffusible, low-allergenic profile PMMA requires (tobramycin and vancomycin are the workhorse combination).
During any cemented procedure, monitor for cardiopulmonary changes at the moment of pressurized cement introduction — fat/marrow embolism and monomer toxicity are the leading proposed mechanisms.