Effects of various adjuvants (lactic acid, glycerol, and chitosan) on the injectability of a calcium phosphate cement.

Calcium phosphate cements are well-known orthopedic materials for filling bone. Various formulations are proposed. The current challenge is to place the material in the surgical site by methods as least invasive as possible. One approach consists of making the cement injectable by incorporation of various adjuvants. However, the requirement properties of the cement must be preserved: setting times suited to a convenient delay with surgical intervention, limited disintegration in aqueous medium, and sufficient mechanical resistance. Various additives were studied: in particular, lactic acid, glycerol, chitosan, and sodium glycerophosphate. Injectability, setting time, disintegration, and toughness after 10 days were followed in vitro. Glycerol greatly improved injectability and increased setting time, but decreased mechanical properties. Lactic acid reduced setting time, increased toughness of the material, but limited the dissolution rate. After injection, the cement did not present any disintegration. The effects lactic acid were correlated with the formation of calcium complex. Its association with sodium glycerophosphate is particularly interesting. Chitosan alone improved injectability, increased setting time, and limited the evolution of the cement by maintaining the OCP phase. Only slight disintegration was observed. These first results show that is possible to transform the cement into an injectable paste by addition of adjuvants without fundamentally modifying the chemical reactions occurring during setting and hardening.