For 50 years PALACOS® R+G has been synonymous with unique product quality to provide patients with better outcomes. PALACOS® R+G relies on a wide range of people working together to achieve success, including:
forerunners in material development
first users and pioneers in arthroplasty
those who produce and optimise PALACOS® R+G day in, day out
healthcare professionals who use PALACOS® R+G for the benefit of their patients.
PALACOS® R+G is our success story that we can all be proud of.
Thank you for decades of trusted collaboration for best patient outcomes.
Who are the people behind PALACOS® R+G?
For the 50th anniversary, they share their stories about their experiences with the product.
Dr. Pablo Sanz Ruiz, Orthopaedic Surgeon
“The more we got to learn about bone cements, the better we understood that there are big differences. We have chosen PALACOS® R+G since it has the best antibiotic elution.”
Orthopaedic surgeon Dr. Pablo Sanz Ruiz works at the General University Hospital Gregorio Marañon and conducts research at the Complutense University of Madrid, Spain. The reduction of periprosthetic infections is one of his greatest concerns. With PALACOS® R+G he was able to significantly reduce infections rates at his hospital and increase cost-efficiency.
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Dr. Matthew Dietz, Orthopaedic Surgeon and Associate Professor
“What makes PALACOS® R+G so special is the consistency and reliability. In the operating room, it seems like every day there’s something different. To have something be there that you can trust and rely on in each case, I think is really important for the excellent outcomes for the patient.”
Dr. Dietz works as an Orthopaedic Surgeon and Associate Professor at West Virginia University specialicing in hip and knee replacements and complicated revisions with research interest in implant associated infections.
Ralph Bretschneider, Production Manager at Heraeus Medical
"I have been part of the PALACOS® R+G production team since 1987. Even back then, I was impressed by the fact that this bone cement is hard and yet elastic. It is very important that it always cures in the same way. That is a quality criterion. That's why we are very meticulous in the production of PALACOS® R+G. Quality definitely comes before quantity. That is important to us. We want our customers to get a product of which they can be sure that they are holding something good in their hands. In the end, of course, patients should also benefit from it. I myself had a hip replacement and I know how I felt when I was in pain and I couldn't walk. It is something special to produce a product that helps people to be able to walk again and not be in pain."
Bettina Hinkelmann, Laboratory Employee at Heraeus Medical
"I work with PALACOS® R+G in the laboratory, where we test whether changes in the production process affect the quality of the bone cement. Processing times, compressive and bending strength, temperature maximum, intrusion depth into the bone – all this is tested in our laboratory. Personally, I find the test for bending and compressive strength very interesting. These are mechanical tests that focus on the strength and elasticity of the bone cement. It must not be too brittle, so that it breaks quickly. But it must also not be too soft to ensure a certain stability. We carry out these and other tests regularly. In this way, we help to ensure that PALACOS® R+G has a high and consistent quality and can provide patients, who unfortunately need joint replacement, with pain relief and bring them back their quality of life."
Dr. Carel H. Geerdink, Orthopaedic Surgeon
"The choice of bone cement is connected to the implant survival."
Dr. Geerdink works as an orthopaedic surgeon at Ikazia Hospital in Rotterdam, the Netherlands, and specialises in sports orthopaedics and traumatology. The Ikazia Hospital puts special emphasis on the well-being of its patients.
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"I appreciate the consistency of this cement, which always tells me which phase it is in. With this cement you already know by feel what kind of strength it will develop, when it will be ready, when you have to stop."
Andreas Seitz is the operating theatre manager at medius Kliniken, Germany, and responsible for the operating theatre staff at three locations. He oversees a team of 200 operating theatre nurses who provide inpatient care to 46,000 patients and outpatient care to over 125,000 patients each year. The medius Kliniken have an excellent reputation in the Stuttgart area in the field of artificial hip care.
A journey through time with PALACOS® R+G
1901-1941
1943-1959
1969-1981
2004-2012
2018-2022
1901 – It all starts with ‘organic glass’
The chemist Otto Röhm lays the foundation for the manufacture of the new plastic polymethyl methacrylate, or PMMA, with his dissertation entitled ‘Polymerisation products from acrylic acid’ (original: „Über Polymerisationsprodukte der Acrylsäure“). Röhm calls it ‘organic glass’ – today, it is better known as plexiglass.
1928 – Industrial-scale manufacture by Röhm & Haas
Otto Röhm and Otto Haas make refinements to the acrylate at their research lab and develop a method for synthesising methyl methacrylate (MMA) on an industrial scale.
1935 – First artificial dental prosthesis with MMA
Walter Bauer, head of the Röhm & Haas research lab, patents the process for manufacturing dental prostheses using methyl methacrylate (MMA). At the same time, the lab continues to work on further application areas.
Heraeus (Kulzer) discovers that mixing ground PMMA cement powder and monomer liquid creates a pasty compound, which sets when heated to 100°C with benzoyl peroxide (BPO). This process is known as ‘heat curing’.
1941 – PMMA used in plastic surgery for the first time
Kleinschmitt uses pre-formed and pre-cured PMMA plates of the heat-curing polymer PALADON® 65 for the first time to repair cranial defects.
1943 – PMMA bone cement makes its debut
Heraeus (Kulzer) and Degussa patent a process for ‘cold curing’ a PMMA cement mixture at room temperature. This discovery lays the foundation for the chemical processes still used today.
1951 – Cold-curing PMMA used for the first time
The surgeon Sven Kiaer uses cold-curing PMMA as a pure anchoring material for the first time. The process involves anchoring acrylic glass caps on the femoral head after cartilage is removed.
1958 – Pioneering work in arthroplasty
British orthopaedic surgeon Sir John Charnley anchors a total hip endoprosthesis for the first time using cold-curing PMMA. Charnley refers to this as ‘acrylic-based bone cement’. Early studies show excellent tissue tolerance and implant survival of up to 30 years.
1959 – PALACOS® is the first bone cement used in Germany
Heraeus (Kulzer) introduces Germany’s first bone cement. The company manufactures it in-house according to its own formula. The PALACOS® success story begins, with a market share of over 80% by the end of the 1960s. The formula with the green colourant, which is based on chlorophyll, is still in use today.
1969 – A revolution reduces the number of revisions
Prof. Hans-Wilhelm Buchholz writes to Heraeus (Kulzer), saying the following: “If it were possible to impregnate Palacos with individual antibiotics … it would be extremely significant from a clinical perspective”. There is also the question of whether it might be possible to release an active substance from the cement matrix. Sir John Charnley is sceptical: “My dear Buchholz, nothing leaks out of a stone.” However, adding gentamicin sulphate to PALACOS® R yields promising results, with fewer infections arising following a joint replacement.
1972 – Europe-wide distribution through Merck and Schering Plough
To this day, Heraeus (Kulzer) still manufactures and holds the rights to PALACOS® with and without gentamicin. With the German Drug Law coming into force and without the necessary authorisation to produce pharmaceuticals (the company is registered as a dental firm) at this time, Heraeus (Kulzer) entrusts the authorisation and distribution of PALACOS® and Refobacin® PALACOS® R (today PALACOS® R+G) to two companies: Merck and Schering Plough.
1981 – Reduction in periprosthetic infections
Long-term studies show that the antibacterial efficacy of PALACOS® R+G helps to reduce periprosthetic infections in the long term.3
2004 – One-stop shop: Heraeus Medical takes over distribution
Heraeus Medical is founded as a subsidiary of Heraeus (Kulzer). As well as continuing with the development and manufacture of its proven PALACOS® bone cements, the company also begins selling its own products.
2008 – PALAMIX® optimises the use of PALACOS®
Mixing under vacuum reduces porosity and strengthens the bond between bone cement and prosthesis. PALAMIX® enables bone cements like PALACOS® R+G to be mixed in a reproducibly high quality.
2012 – Ready-to-Mix with PALACOS® R+G pro
PALACOS® R+G pro is launched. The closed All-in-One Fixation SystemTM is a combination of the gold standard PALACOS® R+G and a vacuum mixing and application system. This enables bone cement components to be handled safely and without contact.
2018 – Not all cements are the same
Cement quality has been shown to be a key for factor long-term implant survival.1 PALACOS® is the most studied bone cement and leads in clinical evidence.2
2019 – PALACOS® at home in the world
PALACOS® has been used in arthroplasty for 60 years and is available in over 90 countries around the world.
2021 – The gold standard in arthroplasty
PALACOS® has been used in over 34 million procedures to date.
2022 – Advancing, Together
We are celebrating 50 years of PALACOS® R+G. We would like to say thank you to all who have contributed to this success, those who have helped to develop, produce, optimise and use PALACOS® R+G.
1 Furnes O., Havelin L., Espehaug B. Properties of bone cement - which cement should we choose for primary THA? In: Breusch S, Malchau H, eds. The Well- Cemented Total Hip Arthroplasty. Springer Verlag 2005; 103–106.
2 Pilz V., Hanstein T. Literature Review of the Clinical Evidence Situation of Bone Cements. RRJMHS Vol. 7 Issue 1 March, 2018; 31–36.
3 Buchholz et al. Management of deep infection of total hip replacement. J Bone Joint Surg Br 1981; 63-B(3): 342–353.
Heraeus Medical
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