Optimization and comparison of three vacuum mixing systems for porosity reduction of simplex P cement

Simplex P bone cement was prepared in three commercially available vacuum mixing systems, the Enhancement Mixer, the Mixevac II High Vacuum System, and the Mitab Vacuum System, to determine the improvement in fatigue strength associated with porosity reduction of the cement in all three systems. The results of the fatigue tests of vacuum-mixed Simplex P were also compared to the fatigue strength of Simplex P prepared by centrifugation of the cement immediately after mixing. Vacuum mixing one pack of Simplex P per syringe in all three systems was not effective in complete removal of all the large voids from the cement. Fatigue failure occurred very early in those specimens containing the large voids. There was no significant difference in fatigue life between one pack of cement per syringe mixed under vacuum in the three systems and the control cement (no vacuum, uncentrifuged). Vacuum mixing two packs of cement per syringe was more effective than one pack per syringe, and all three systems significantly increased the cycles to failure of Simplex P over the control cement. However, the Enhancement and Mitab vacuum mixing systems still produced some very weak specimens in fatigue. Two packs of cement per syringe prepared in the Mixevac II vacuum mixing system were significantly stronger in fatigue than two packs mixed in either the Enhancement or Mitab vacuum system. The Mixevac II vacuum mixing system was the most effective technique of the three vacuum mixing systems tested. Centrifugation of one or two packs of Simplex P per syringe produced a more uniform cement that was free of large voids and thus eliminated the very weak specimens.