Sarasota, FL (WorkersCompensation.com) – Since the late 1980’s, spine surgeons have used polymethylmethacrylate (PMMA), a lightweight acrylic medical cement, for back surgeries, and is frequently used today. Although most often used in placing implants and remodeling bone, PMMA has multiple health related applications outside of orthopedics, such as dentures, ocular prostheses, and injectable cosmetic uses. Although PMMA is considered biologically compatible, the liquid methyl methacrylate (MMA) that is used to create PMMA is considered to be a respiratory irritant, and PMMA itself is somewhat controversial.
While the FDA recognizes some level of risk with PMMA, some studies have shown 26 to 31 percent complication rates in hip replacements. One study on cosmetic injections found issues with chronic inflammation, fibrotic nodules, jaundice, and eyelid deformities with use. According to one report from Healthcare In Europe, the side effects of PMMA were discussed as far back as 1998, with an estimated 95 percent death rate for reported events.
PMMA is activated by an exothermic reaction, which potentially damages bone and surrounding tissue, often resulting in severe cardiac and pulmonary complications. Other complications can include the PMMA hardening and damaging organs. One such life-threatening event was recently published in the New England Journal of Medicine.
According to the report, a 56 year old male presented to the emergency department after 2 days of breathing difficulties and chest pain, and a recent vertebral compression fracture. A week earlier, the patient had undergone a lumbar kyphoplasty with PMMA. Five days later, he had right side pleuritic chest pain that radiated to his shoulder and jaw.
Upon exploration, it was found that the PMMA used in the kyphoplasty surgery had embolized and perforated the right atrium, and punctured the right lung.
In another case from 2015, a 77 year old patient who had undergone a previous hip replacement with cemented prosthesis, presented to the ER with the same difficulty breathing and chest pain. At the time of surgery, there had not been any complications. After fluoroscopic examination revealed an object overlying her heart, the patient underwent open heart surgery. It was discovered that a 54mm object, which was later determined to be a cement embolus, had penetrated the right auricle, and had caused inflammation in the pericardium.