Effect of test specimen cross-sectional shape on the in vitro fatigue life of acrylic bone cement

Constant-amplitude uniaxial tension-compression fatigue tests were conducted on specimens fabricated from 12 sets of acrylic bone cements, covering cement formulations with three different viscosities (so-called "high-", "medium-" and "low-viscosity" varieties), two different methods of mixing the cement constituents (so-called "hand-" and "vacuum-mixed" methods) and two test specimen shapes (rectangular-cross-sectioned or "flat" and circular-cross-sectioned or "round"). The test results-namely, the number of fatigue stress cycles, N(f)-were analyzed using the linearized transformation of the three-parameter Weibull relationship, allowing the values of the Weibull mean, N(WM), to be determined for each set. Values ranged from 14,300 to 1,284,331 for the round specimen sets and from 2898 to 72,960 for the flat specimen sets. Statistical analysis of the ln N(f) data, together with an examination of the N(WM) values, showed that, for any combination of cement formulation and mixing method, round specimens had significantly longer fatigue lives compared to flat ones. These results are explained in terms of two factors. The first is the smaller surface area of the waisted zone in the round specimens compared to that in the flat specimens (nominal value of 157mm(2) versus nominal value of 185mm(2)), leading to the possibility of fewer crack initiation sites on the round specimens compared to the flat ones. Secondly, it is postulated that the crystallinity of the round specimens was higher than that of the flat ones, a consequence of the significantly lower measured residual liquid monomer contents of the former compared to the latter (3.40+/-1.28wt%/wt compared to 3.81+/-1.48wt%/wt). The significance of the present finding is that it indicates that, for a set of bone cement formulation and experimental conditions, discriminating fatigue test results are more likely to be obtained if flat, rather than round, test specimens are used.     

Effect of fabrication pressure on the fatigue performance of Cemex XL acrylic bone cement

During a cemented arthroplasty, the prepared polymerizing dough of acrylic bone cement is subjected to pressurization in a number of ways; first, during delivery into the freshly prepared bone bed, second, during packing in that bed (either digitally or with the aid of a mechanical device), and, third, during the insertion of the prosthesis. Only a few studies have reported on the influence of the level of pressurization experienced during these events (which, depending on the cementing technique used, has been put at between 8 and 273 kPa) on various properties of the cement. That was the focus of the present study, in which the fully reversed tension-compression (+/-15 MPa; 5 Hz) fatigue lives (expressed as number of cycles to fracture, N(f)) of rectangular cross-sectioned "dog-bone" specimens (Type V, per ASTM D 638) fabricated from Cemex XL cement, at pressure applied continuously to the cement dough during curing in the specimen mold, p=75,150, and 300 kPa, were determined. The N(f) results were analyzed using the linearized transformation of the three-parameter Weibull relationship to obtain estimates of the Weibull mean, N(WM), which was taken to be the index of fatigue performance of the specimen set. Over the range of p studied, N(WM) increased as p increased (for example, from 329,118 cycles when p was 75 kPa to 388,496 cycles when p was 300 kPa); however, the increase was not significant over any pair of p increment steps (Mann-Whitney U-test; alpha<0.05).     

The influence of the viscosity classification of an acrylic bone cement on its in vitro fatigue performance

The goal of the present work was to investigate the influence of the viscosity classification of an acrylic bone cement on its in vitro fatigue performance, as determined in fully-reversed tension-compression (+/-15 MPa) fatigue tests. The test matrix comprised six commercially available bone cements [Orthoset1, (OS1), Orthoset(R)3 (OS3), CemexRX (CRX), Cemex XL (CXL), Palacos R (PR) and Osteopal (OP)], two methods of mixing the cement constituents (hand-mixing and vacuum-mixing), two methods of fabricating the test specimens (direct molding and molding followed by machining), two specimen cross-sectional shapes (rectangular or "flat" and circular or "round"), and four test frequencies (1, 2, 5, and 10 Hz). In total, 185 specimens, distributed among 20 sets, were tested. The test results (number of fatigue stress cycles, N_f) were processed using the linearized transformation of the three-parameter Weibull distribution, whence estimates of the Weibull mean, N_[WM], were obtained. Statistical analysis of the ln N_f results (Mann-Whitney test; alpha<0.05) and a comparison of the N_[WM] estimates for specimen sets in which the formulations have essentially the same composition but different viscosity classification (namely, OS1 versus OS3, CRX versus CXL, and PR versus OP) showed that, in the majority of the comparisons carried out, the viscosity classification of a bone cement does not exert a significant influence on its in vitro fatigue performance.     

Fatigue and fracture toughness of acrylic bone cements modified with long-chain amine activators

The composition of acrylic bone cement has been identified as one of the important parameters affecting its mechanical properties and may, in turn, ultimately influence the longevity of a cemented arthroplasty. Our aim in this study was to determine the influence of change of one compositional variable, the activator, on the fatigue performance and fracture toughness of specimens of the fully cured cement. To that end, three sets of cements were prepared, containing either the conventional activator, 4-N,N dimethyl p-toluidine (DMPT), or novel ones that are tertiary amines based on long-chain fatty acids, that is, 4-N,N dimethylaminobenzyl oleate (DMAO) and 4-N,N dimethylaminobenzyl laurate (DMAL). In the fatigue tests, the specimens were subjected to tension-tension loading, and the results (number of cycles to failure, Nf) were analyzed using the linearized form of the three-parameter Weibull equation. The fracture toughness (KIc) tests were conducted with rectangular compact tension specimens. All fracture surfaces were subsequently examined with scanning electron microscopy. We found that the Weibull mean fatigue lives for specimens fabricated using the DMPT, DMAL, and DMAO containing cements were 272,823, 453,551, and 583,396 cycles, respectively. The corresponding values for KIc were 1.94 +/- 0.05, 2.06 +/- 0.09, and 2.00 +/- 0.07 MPa radical m, respectively. Statistical analyses showed that for both the DMAL- and DMAO-containing cements, the mean values of Nf were significantly higher compared to the corresponding value for the DMPT-containing cement (Mann-Whitney test; alpha < 0.10). This result is attributed to the higher molecular weights of the former cements compared to the latter. The same trend was found for the mean KIc values (Mann-Whitney test; alpha < 0.05), with the trend being explained in terms of the differences seen in the crack morphologies. These results thus demonstrate that these novel amines are viable alternatives to DMPT for incorporation into acrylic bone cement formulations in the future.     

Estimation of the minimum number of test specimens for fatigue testing of acrylic bone cement

In the literature on fatigue testing of acrylic bone cements, data sets of various sizes have been used in different test series for the same cement formulation. There are two important consequences of this situation. First, it means that some test series last much longer than others, with all the implications for the cost of testing. Second, it makes drawing conclusions about the fatigue performance of a cement, based on the results of different literature series, a problematic issue. Clearly then, a recommendation as to what should be the minimum number of test specimens to use that would allow for confidence in the results of the statistical treatment of the test results (Gmin) would be desirable. In the present work, a method that could be used to culminate in such a recommendation is described. This method involves (i) obtaining experimental fatigue test results and (ii) analyzing those results using the Weibull probability distribution function and other statistical methods. This methodology is illustrated using fatigue life results obtained from uniaxial tension-compression fatigue tests on specimens fabricated from the polymerizing dough of one commercially available acrylic bone cement. For a tolerable error of 5%, we estimated Gmin to be either 7 (if the fatigue life results are treated using the two-parameter Weibull distribution function) or 11 (if the fatigue life results are treated using the three-parameter Weibull distribution function). To be on the conservative side, we therefore recommend that Gmin be 11. Three key limitations of the methodology presented here are discussed.     

Effect of water storage time and composite cement thickness on fatigue of a glass-ceramic trilayer system

AIM: Static Hertzian contact tests of monolayer glass-ceramics in trilayer configurations (glass-ceramic/cement/composite) have shown that thick cement layers lower strength. This study sought to test the hypothesis that thick resin cement layers lower mouth motion fatigue reliability for flat glass-ceramic/cement/composite trilayer systems and that aging in water reduces reliability. METHODS: Dicor plates (n > or = 12 per group) (10 x 10 x 0.8 mm(3)) were aluminum-oxide abraded (50 microm), etched (60 s), silanized, and bonded (Rely X ARC) to water aged (30 days) Z100 resin blocks (10 x 10 x 4 mm(3)). Four groups were prepared: (1) thick cement layer (>100 microm) stored in water for 24-48 h, (2) thick cement layer stored for 60 days, (3) thin cement layer (< or =100 microm) stored for 24-48 h, and (4) thin cement layer stored for 60 days. The layered structures were fatigued (2 Hz) utilizing mouth motion loading with a step-stress acceleration method. A master Weibull distribution was calculated and reliability determined (with 90% confidence intervals) at a given number of cycles and load. RESULTS: The aged group (60 d) with thick cement layer had statistically lower reliability for 20,000 cycles at 150 N peak load (0.11) compared with both nonaged groups (24-48 h) (thin layer = 0.90 and thick layer = 0.82) and aged group with thin cement layer (0.89). CONCLUSION: Trilayer specimens with thick cement layers exhibited significantly lower reliability under fatigue testing only when stored for 60 days in water. The hypothesis was accepted. These results suggest that diffusion of water into the resin cement and also to the glass-ceramic interface is delayed in the thick cement specimens at 24-48 h. .     

Influence of the radiopacifier in an acrylic bone cement on its mechanical, thermal, and physical properties: barium sulfate-containing cement versus iodine-containing cement

In all acrylic bone cement formulations in clinical use today, radiopacity is provided by micron-sized particles (typical mean diameter of between about 1 and 2 microm) of either BaSO(4) or ZrO(2). However, a number of research reports have highlighted the fact that these particles have deleterious effects on various properties of the cured cement. Thus, there is interest in alternative radiopacifiers. The present study focuses on one such alternative. Specifically, a cement that contains covalently bound iodine in the powder (herein designated the I-cement) was compared with a commercially available cement of comparable composition (C-ment3), in which radiopacity is provided by BaSO(4) particles (this cement is herein designated the B-cement), on the basis of the strength (sigma(b)), modulus (E(b)), and work-to-fracture (U(b)), under four-point bending, plane-strain fracture toughness (K(IC)), Weibull mean fatigue life, N(WM) (fatigue conditions: +/-15 MPa; 2 Hz), activation energy (Q), and frequency factor (ln Z) for the cement polymerization process (both determined by using differential scanning calorimetry at heating rates of 5, 10, 15, and 20 K min(-1)), and the diffusion coefficient for the absorption of phosphate-buffered saline at 37 degrees C (D). For the B-cement, the values of sigma(b), E(b), U(b), K(IC), N(WM), Q, ln Z, and D were 53 +/- 3 MPa, 3000 +/- 120 MPa, 108 +/- 15 kJ m(-3), 1.67 +/- 0.02 MPa check mark m, 7197 cycles, 243 +/- 17 kJ mol(-1), 87 +/- 6, and (3.15 +/- 0.94) x 10(-12) m(2) s(-1), respectively. For the I-cement, the corresponding values were 58 +/- 5 MPa, 2790 +/- 140 MPa, 118 +/- 45 kJ m(-3), 1.73 +/- 0.11 MPa check mark m, 5520 cycles, 267 +/- 19 kJ mol(-1), 95 +/- 9, and (3.83 +/- 0.25) x 10(-12) m(2) s(-1). For each of the properties of the fully cured cement, except for the rate constant of the polymerization reaction, at 37 degrees C (k'), as estimated from the Q and ln Z results, there is no statistically significant difference between the two cements. k' for the I-cement was about a third that for the B-cement, suggesting that the former cement has a higher thermal stability. The influence of various characteristics of the starting powder (mean particle size, particle size distribution, and morphology) on the properties of the cured cements appears to be complex. When all the present results are considered, there is a clear indication that the I-cement is a viable candidate cement for use in cemented arthroplasties in place of the B-cement.     

Comparison of two methods of fatigue testing bone cement

Two different methods have been used to fatigue test four bone cements. Each method has been used previously, but the results have not been compared. The ISO 527-based method tests a minimum of 10 samples over a single stress range in tension only and uses Weibull analysis to calculate the median number of cycles to failure and the Weibull modulus. The ASTM F2118 test regime uses fewer specimens at various stress levels tested in fully reversed tension–compression, and generates a stress vs. number of cycles to failure (S–N) or Wöhler curve. Data from specimens with pores greater than 1 mm across is rejected. The ISO 527-based test while quicker to perform, provides only tensile fatigue data, but the material tested includes pores, thus the cement is closer to cement in clinical application. The ASTM regime uses tension and compression loading and multiple stress levels, thus is closer to physiological loading, but excludes specimens with defects obviously greater than 1 mm, so is less representative of cement in vivo. The fatigue lives between the cements were up to a factor 15 different for the single stress level tension only tests, while they were only a factor of 2 different in the fully reversed tension–compression testing. The ISO 527-based results are more sensitive to surface flaws, thus the differences found using ASTM F2118 are more indicative of differences in the fatigue lives. However, ISO 527-based tests are quicker, so are useful for initial screening.     

Augmentation of acrylic bone cement with multiwall carbon nanotubes

Acrylic bone cement, based on polymethylmethacrylate (PMMA), is a proven polymer having important applications in medicine and dentistry, but this polymer continues to have less than ideal resistance to mechanical fatigue and impact. A variety of materials have been added to bone cement to augment its mechanical strength, but none of these augmentative materials has proven successful. Carbon nanotubes, a new hollow multiwalled tubular material 10-40 nm in diameter, 10-100 microm long, and 50-100 times the strength of steel at 1/6 the weight, have emerged as a viable augmentation candidate because of their large surface area to volume ratio. The objective of this study was to determine if the addition of multiwall carbon nanotubes to bone cement can alter its static or dynamic mechanical properties. Bar-shaped specimens made from six different (0-10% by weight) concentrations of multiwall carbon nanotubes were tested to failure in quasi-static 3-point bending and in 4-point bending fatigue (5 Hz). Analyses of variance and the 3-Parameter Weibull model were used to analyze the material performance data. The 2 wt % MWNT concentration enhanced flexural strength by 12.8% (p=0.003) and produced a 13.1% enhancement in yield stress (p=0.002). Bending modulus increased slightly with the smaller (<5 wt % MWNT) concentrations, but increased 24.1% (p<0.001) in response to the 10 wt % loading. While the 2 wt % loading produced slightly improved quasi-static test results, it was associated with clearly superior fatigue performance (3.3x increase in the Weibull mean fatigue life). Weibull minimum fatigue life (No), Weibull modulus (alpha), and characteristic fatigue life (beta) for bone cement augmented with carbon nanotubes were enhanced versus that observed in the control group. These data unambiguously showed that the bone cement-MWNT polymer system has an enhanced fatigue life compared to "control" bone cement (no added nanotubes). It is concluded that specific multiwall carbon nanotube loadings can favorably improve the mechanical performance of bone cement.     

Effect of mixing method and storage temperature of cement constituents on the fatigue and porosity of acrylic bone cement.

The influence of the storage temperature of the cement constituents prior to mixing (21 vs. 4 degrees C) and the mixing method (hand mixing vs. vacuum mixing) on the uniaxial tension-compression fatigue performance and porosity of Palacos R acrylic bone cement was studied. The fatigue results were analyzed using the three-parameter Weibull equation. The fatigue performance was expressed as an index I, which was defined as the product of the Weibull characteristic fatigue life and the square root of the Weibull slope. Statistical analyses of these results show that although the mixing method (for a given storage temperature) exerts a significant influence on the fatigue performance and areal porosity, the effect of storage temperature (for a given mixing method) on either of these parameters is not significant.     

Reliability of one-piece ceramic implant

The fundamental aspects of damage initiation and accumulation in one-piece zirconium oxide endosseous dental implants remain to be investigated. Aims: This study tested the null hypothesis that there is no influence on mouth-motion fatigue reliability and failure modes between as-received and after full crown preparation on one-piece ceramic implants. Methods: Forty-eight one-piece Y-TZP ceramic implants (Nobel Biocare, Goteborg, Sweden) were utilized. All specimens were embedded in acrylic resin exposing the first two threads at 30 degrees angulation with respect to the vertical axis (as per ISO specification 14801). Full crown preparations were performed following prosthodontic guidelines for half of the specimens. As-received and prepared specimens were distributed among three step-stress profiles based on the specimens ultimate fracture strength. Specimens were step-stress fatigued until failure or survival. A master Weibull curve was generated from the data and the reliability for completion of a mission of 50,000 cycles at 600 N load calculated. Results: No differences between the groups' reliability was observed. Failure mode for both groups was similar, where cracks initiated mainly at the tensile bending side of the second thread's internal diameter. The low Weibull modulus (<1) indicates that fatigue (<150,000 cycles) did not influence failure. Failure depended upon the applied load. Conclusion: Crown preparation did not influence the reliability of the one-piece ceramic implant. The null hypothesis was accepted. Fatigue did not influence the life time of ceramic implants at loads under 600 N.     

Influence of a pre-blended antibiotic (gentamicin sulfate powder) on various mechanical, thermal, and physical properties of three acrylic bone cements

The aim of this work was to determine an array of mechanical, physical, and thermal properties of three pairs of commercially available acrylic bone cement brands, with the brands in each pair having the same compositions except that one contains 4.22 wt/wt% gentamicin sulfate blended with the powder by the manufacturer and the other one does not. The difference between the pairs was in the viscosity of the curing cement dough, with one pair of 'low-viscosity', one pair of 'medium-viscosity', and one pair of 'high-viscosity' brands being used. Thus, the brands studied cover the range of those used in anchoring some total joint replacements (TJRs). The properties determined were the strength, modulus, and work-to-fracture (all under four-point bending), plane-strain fracture toughness, Weibull mean fatigue life (fatigue conditions: 15 MPa; 2 Hz), activation energy and frequency factor for the cement polymerization process (both determined, using differential scanning calorimetry, at heating rates of 5, 10, 15, and 20 K min (1)), and the diffusion coefficient for the absorption of phosphate-buffered saline at 37 C by the cured cement. For each property determined, there was no significant difference in the mean values for the brands in each of the pairs. These results indicate that over the range of cement brands that are widely used in the anchoring of cemented TJRs, the addition of gentamicin sulfate powder does not degrade the properties of the cement, and, hence, may not adversely affect the in vivo longevity of the replacement.     

Static and fatigue mechanical behavior of bone cement with elevated barium sulfate content for treatment of vertebral compression fractures

The use of bone cement to treat vertebral compression fractures in a percutaneous manner requires placement of the cement under fluoroscopic image guidance. To enhance visualization of the flow during injection and to monitor and prevent leakage beyond the confines of the vertebral body, the orthopedic community has described increasing the amount of radiopacifier in the bone cement. In this study, static tensile and compressive testing, as well as fully reversed fatigue testing, was performed on three PMMA-based bone cements. Cements tested were SimplexP with 10% barium sulfate (Stryker Orthopedics, Mahwah, NJ) which served as a control; SimplexP with 36% barium sulfate prepared according to the clinical recommendation of Theodorou et al.; and KyphX HV-R with 30% barium sulfate (Kyphon Inc., Sunnyvale, CA). Static tensile and compressive testing was performed in accordance with ASTM F451-99a. Fatigue testing was conducted in accordance with ASTM F2118-01a under fully reversed, +/-10-, +/-15-, and +/-20-MPa stress ranges. Survival analysis was performed using three-parameter Weibull modeling techniques. KyphX HV-R was found to have comparable static mechanical properties and significantly greater fatigue life than either of the two control materials evaluated in the present study. The static tensile and compressive strengths for all three PMMA-based bone cements were found to be an order of magnitude greater than the expected stress levels within a treated vertebral body. The static and fatigue testing data collected in this study indicate that bone cement can be designed with barium sulfate levels sufficiently high to permit fluoroscopic visualization while retaining the overall mechanical profile of a conventional bone cement under typical in vivo loading conditions.     

Relative roles of cement molecular weight and mixing method on the fatigue performance of acrylic bone cement: Simplex P versus Osteopal

The weight-average molecular weight (MW(w)) of a cement and the method used to mix its powder and liquid monomer constituents have been identified in the literature as key variables that affect mechanical properties of the fully polymerized cement that are relevant to its performance as a grouting agent in cemented arthroplasties. The goal of the present work was to identify which of these two variables exerts the greater effect in the case of fully reversed tension-compression fatigue performance. A judicious choice of cement brands, Surgical Simplex P and Osteopal, and the use of hand versus vacuum mixing, permitted this identification to be achieved. Three key observations were made in this work. First, for a given cement, the fatigue performance of vacuum-mixed specimens is far superior to that of hand-mixed ones, which may be a consequence of the substantially lower percentage areal porosity of the former specimens. Second, regardless of the mixing method, the fatigue performance of Osteopal outstrips that of Simplex P, a result that is attributed to the much higher MW(w) of the former cement. Third, hand-mixed Osteopal outperforms vacuum-mixed Simplex P (especially at low alternating stress levels), indicating that MW(w) of a bone cement is more influential than mixing method on its fatigue performance.     

Effect of two variables on the fatigue performance of acrylic bone cement: mixing method and viscosity

The goal of the present work was to establish the relative influence of one exogenous variable versus one endogenous variable on the fully-reversed tension-compression fatigue performance of bone cement. The method used to mix the cement constituents was the exogenous variable, while the viscosity of the mixed cement dough was the endogenous variable. Two commercial cement formulations (Palacos R and Osteopal) and two cement mixing methods (hand mixing and vacuum mixing) were used. It was found that for a given mixing method, cement viscosity exerts a marginal influence on fatigue performance. On the other hand, for a given cement formulation, vacuum mixing led to a statistically significant improvement in fatigue performance. The present results demonstrate the superior influence of mixing method over cement viscosity.     

A new, reliable, and simple-to-use method for the analysis of a population of values of a random variable using the Weibull probability distribution: application to acrylic bone cement fatigue results

In cases where the Weibull probability distribution is being investigated as a possible fit to experimentally obtained results of a random variable (V), there is, currently, no accurate and reliable but simple-to-use method available for simultaneously (a) establishing if the fit is of the two- or three-parameter variant of the distribution, and/or (b) estimating the minimum value of the variable (V(0)), in cases where the three-parameter variant is shown to be applicable. In the present work, the details of such a method -- which uses a simple nonlinear regression analysis -- are presented, together with results of its use when applied to 4 sets of number-of-cycles-to-fracture results from fatigue tests, performed in our laboratory, using specimens fabricated from 3 different acrylic bone cement formulations. The key result of the method is that the two- or three-parameter variant of the probability distribution is applicable if the estimate of V(0) obtained is less than or greater than zero, respectively.     

Mechanical performance of acrylic bone cements containing different radiopacifying agents

The effect that three different radiopacifying agents, two of them inorganic (BaSO4, ZrO2) and one organic (an iodine containing monomer, IHQM) have on the static and dynamic mechanical properties of acrylic bone cements was studied. Compressive and tensile strength, fracture toughness and fatigue crack propagation were evaluated. The effect of the inorganic fillers depends on their size and morphology. In relation to the radiolucent cement, the addition of zirconium dioxide improved significantly the tensile strength, the fracture toughness and the fatigue crack propagation resistance. In contrast, the addition of barium sulphate produced a decrease of the tensile strength, but did not affect the fracture toughness and improved the crack propagation resistance. When the iodine containing monomer was used, although the tensile strength and the fracture toughness increased, the fatigue crack propagation resistance remained as low as it was for the radiolucent cement.     

Influence of the activator in an acrylic bone cement on an array of cement properties

In all but one of the acrylic bone cement brands used in cemented arthroplasties, N,N-dimethyl-4-toluidine (DMPT) serves as the activator of the polymerization reaction. However, many concerns have been raised about this activator, all related to its toxicity. Thus, various workers have assessed a number of alternative activators, with two examples being N,N-dimethylamino-4-benzyl laurate (DMAL) and N,N-dimethylamino-4-benzyl oleate (DMAO). The results of limited characterization of cements that contain DMAL or DMAO have been reported in the literature. The present work is a comprehensive comparison of cements that contain one of these three activators, in which the values of a large array of their properties were determined. These properties range from the setting time and maximum exotherm temperature of the curing cement to the variation of the loss elastic modulus of the cured cement with frequency of the applied indenting force in dynamic nanoindentation tests. The present results, taken in conjunction with those presented in previous reports by the present authors and co-workers on other properties of these cements, indicate that both DMAL and DMPT are suitable alternatives to DMPT.     

Tensile characteristics of ten commercial acrylic bone cements

The mechanical properties of acrylic bone cement, used in orthopedic surgery, are very influential in determining successful long-term stability of a prosthesis. A large number of commercial formulations are available, differing in chemical composition and physical properties of both powder and monomer constituents. In this study, the static and dynamic tensile characteristics of a number of the most commonly used bone cements (Palacos R, Simplex P, CMW 1 & 3, Sulfix-60, Zimmer Dough), along with some newer formulations (Endurance, Duracem 3, Osteobondtrade mark and Boneloc), have been investigated under the same testing regimes. Testing was performed in air at room temperature. Significant differences in both static and fatigue properties were found between the various bone cements. Tensile tests revealed that Palacos R, Sulfix-60, and Simplex P had the highest values of ultimate tensile strength, closely followed by CMW 3, while Zimmer Dough cement had the lowest strength. Fatigue testing was performed under stress control, using sinusoidal loading in tension-tension, with an upper stress level of 22MPa. The two outstanding cements when tested in these cyclic conditions were Simplex P and Palacos R, with the highest values of Weibull median cycles to failure. Boneloc bone cement demonstrated the lowest cycles to failure. While the testing regimes were not designed to replicate exact conditions experienced by the bone cement mantle in vivo, there was a correlation between these results and clinical outcome.