Injectable, biomechanically robust, biodegradable and osseointegrative bone cement for percutaneous kyphoplasty and vertebroplasty

Purpose Poly(methyl methacrylate) (PMMA) cement is widely used for percutaneous kyphoplasty and vertebroplasty (PKP and PVP) but possesses formidable shortcomings due to non-degradability. Here, a biodegradable replacement is developed. Methods Calcium phosphate cement (CPC) was redesigned by incorporating starch and BaSO4 (new cement named as CPB). The biomechanical, biocompatibility, osseointegrative and handling properties of CPB were systematically evaluated in vitro and in vivo by the models of osteoporotic sheep vertebra, rat subcutaneous implantation and rat femoral defect. Results CPB revealed appropriate injectability and setting ability for PKP and PVP. More importantly, its biomechanical strengths measured by in vitro and in vivo models were not less than that of PMMA, while its biodegradability and osseointegrative capacities were significantly enhanced compared to PMMA. Conclusions CPB is injectable, biomechanically robust, biodegradable and osseointegrative, demonstrating revolutionary potential for the application in PKP and PVP.