Exploring the Versatility of Multifunctional Additives for PMMA-Based Bone Cements to Improve Clinical Performance: An Update

Poly(methyl methacrylate) (PMMA) bone cement is a biomaterial widely used for over 50 years to stabilize hip and knee implants or as a bone filler. PMMA was used initially in the form of PMMA plexiglass for submarines and airplanes, and, as the interest in the material increased, it was eventually used for medical applications. There are inherent issues with PMMA as a bone cement, including loosening of the prosthesis, a high rate of post-operative infections, differences in mechanical properties between bone and PMMA, and thermal necrosis of the surrounding tissue. Due to the inadequacies of PMMA-based bone cement, the scientific community has investigated combinatorial methods and multifunctional additives to improve the biomaterial's properties. This review evaluates the currently available multifunctional additives to PMMA-based bone cements. The described additives have multiple functions that can address issues with PMMA bone cement. Finally, insights into different additives at the clinical stage are described, highlighting the generation of additives currently being investigated for translating these technologies from bench to bedside.