Enhancing effects of radiopaque agent BaSO4 on mechanical and biocompatibility properties of injectable calcium phosphate composite cement.

Kyphoplasty is an effective minimally invasive surgical treatment of osteoporotic vertebral compression fractures. Current problems associated with kyphoplasty require better injectable bone cements with improved biodegradability and osseointegrative property as an alternative to polymethyl methacrylate (PMMA) bone cement. Calcium phosphate cements (CPCs) possess superior biodegradability and osteoconductivity but inferior injectability and mechanical strengths, rendering them unsuitable for kyphoplasty applications. Our previous studies developed a corn starch-reinforced CPC with improved handling, injectable and mechanical properties, yet for kyphoplasty applications the reinforced CPC needs to have radiopacity and further enhanced mechanical strength. This work therefore developed a CPC-Starch-BaSO 4 (CSB) system and investigated the effects of radiopaque agent BaSO 4 on injectability, radiopacity, mechanical and biocompatibility properties of the system. Results showed that the addition of BaSO 4 significantly improved radiopacity and mechanical strengths of CPC cement. In addition, in vitro evaluations including apoptosis, hemolysis and endotoxin tests and in vivo evaluation of subcutaneous implantation all revealed that CSB was biocompatible. This study demonstrates that CSB could meet the clinical requirements for minimally invasive surgery and thus have great potential for kyphoplasty applications. • Radiopaque agent barium sulfate could enhance mechanical property of calcium phosphate cement. • Good biocompatibility of calcium phosphate-starch-barium sulfate composite system • Injectable, biodegradable and osseointegration of calcium phosphate composite cement [ABSTRACT FROM AUTHOR]