title: Effect of storage temperature and equilibration time on polymethyl methacrylate (PMMA) bone cement polymerization in joint replacement surgery.
abstract: BACKGROUND
  In cemented joint arthroplasty, the handling characteristics (doughing, working, and setting times) of polymethyl methacrylate (PMMA) bone cement is important as it determines the amount of time surgeons have to optimally position an implant. Storage conditions (temperature and humidity) and the time given for PMMA cement to equilibrate to ambient operating theater (OT) temperatures are often unregulated and may lead to inconsistencies in its handling characteristics. This has not been previously studied. Hence, the purpose of this study was to investigate the effect of storage temperatures on the handling characteristics of PMMA cement and the duration of equilibration time needed at each storage temperature to produce consistent and reproducible doughing, setting, and working times.
  
  
  METHODS
  SmartSet® HV cement was stored at three different controlled temperatures: 20 °C (control), 24 °C, and 28 °C for at least 24 h prior to mixing. The cement components were then brought into a room kept at 20 °C and 50 % humidity. Samples were allowed to equilibrate to ambient conditions for 15, 30, 45, and 60 min. The cement components were mixed and the dough time, temperature-versus-time curve (Lutron TM-947SD, Lutron Electronics, Inc., Coopersburg, PA), and setting time were recorded. Analysis was performed using the two-way ANOVA test (IBM SPSS Statistics V.22).
  
  
  RESULTS
  At 20 °C (control) storage temperature, the mean setting time was 534 ± 17 s. At 24 °C storage temperature, the mean setting time was 414 ± 6 s (p < 0.001*) with 15 min of equilibration, 446 ± 11 s (p < 0.001*) with 30 min of equilibration, 501 ± 12 s (p < 0.001*) with 45 min of equilibration, and 528 ± 15 (p > 0.05) with 60 min of equilibration. At 28 °C storage temperature, the mean setting time was 381 ± 8 s (p < 0.001*) with 15 min of equilibration, 432 ± 30 s (p < 0.001*) with 30 min of equilibration, 487 ± 9 (p < 0.001*) with 45 min of equilibration, and 520 ± 16 s (p > 0.05) with 60 min of equilibration.
  
  
  CONCLUSIONS
  This study reflects the extent to which storage temperatures and equilibration times can potentially affect the handling characteristics of PMMA cement. We recommend institutions to have a well-regulated temperature and humidity-controlled facility for storage of bone cements and a protocol to standardize the equilibration time of cements prior to use in the OT to improve consistency and reproducibility of the handling characteristics of PMMA cement.
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore (NUS), 1E Kent Ridge Road, NUHS Tower Block Level 11, Singapore, 119228, Singapore. bryankohth@hotmail.com.
authors.forename: Bryan T H
authors.initials: BT
authors.lastname: Koh
authors.affiliation: Department of Orthopedic Surgery, National University Hospital (NUH), 1E Kent Ridge Road, NUHS Tower Block Level 11, Singapore, 119228, Singapore. jonathan_jh_tan@nuhs.edu.sg.
authors.forename: J H
authors.initials: JH
authors.lastname: Tan
authors.affiliation: Department of Orthopedic Surgery, National University Hospital (NUH), 1E Kent Ridge Road, NUHS Tower Block Level 11, Singapore, 119228, Singapore. dosrak@nus.edu.sg.
authors.forename: Amit Kumarsing
authors.initials: AK
authors.lastname: Ramruttun
authors.affiliation: Department of Orthopedic Surgery, National University Hospital (NUH), 1E Kent Ridge Road, NUHS Tower Block Level 11, Singapore, 119228, Singapore. a0091109@nus.edu.sg.
authors.forename: Wilson
authors.initials: W
authors.lastname: Wang
mesh_terms: D019643:Arthroplasty, Replacement / Q000592:standards*; D001843:Bone Cements / Q000737:chemistry / Q000592:standards*; D004355:Drug Stability; D004356:Drug Storage / Q000592:standards; D006801:Humans; D058105:Polymerization; D019904:Polymethyl Methacrylate / Q000737:chemistry / Q000592:standards*; D013696:Temperature; D013997:Time Factors
chemical_list: D001843:Bone Cements; D019904:Polymethyl Methacrylate