Comparison of various vacuum mixing systems and bone cements as regards reliability, porosity and bending strength

Background There are several vacuum mixing systems on the market which are arbitrarily used with various bone cements in clinical work. Hardly any studies have been done on the performance and handling of these systems in combination with different cement brands.Material and methods We therefore tested 6 vacuum mixing systems (Palamix, Summit, Cemvac, Optivac, Vacumix, MixOR) in combination with 6 cement brands (Palacos R, Simplex P, CWM 1, CWM 2000, Palamed G, VersaBond) concerning their reliability, user-friendliness, porosity and bending strength.Results Our study indicated that each system has weak points. The preparation of the mixed cement for gun injection can present problems. If cement collection under vacuum fails, porosity is increased. Manual collection without a vacuum carries the risk of intermixing air. For comfortable and effective retrograde cement application, cement guns should have a stable connection with the cartridge and a high piston stroke. There are marked differences between the systems as regards overall porosity when all tested cements are considered (range 2–18%), and between the cements when all tested systems are considered (range 2–17%). All test samples exceeded the required bending strength of 50 MPa, according to ISO 5833. Palacos specimens showed excessive plastic deformation in the bending test.Interpretation There are better and worse mixing system/cement combinations for a given system and a given cement. Systems with cement collection under vacuum reduce porosity best.