PALACOS® Bone Cements

Your Element of Success in Joint Replacement.

The PALACOS® product portfolio comprises an extensive range of high-quality bone cements for anchoring endoprosthetic implants. Since its launch in the 1950s, PALACOS® has been used in over 30 million cases worldwide and is known as the gold standard in total joint arthroplasty.1,2

Characteristically green in color, PALACOS® contrasts optically with the surrounding tissue to facilitate easier handling during surgery, and is available in three different viscosities (low, medium and high) for differing orthopedic procedures. PALACOS® bone cements demonstrate excellent mechanical stength3,4 which helps drive outstanding survivorship in joint arthroplasty.5

One PALACOS®, Many Options.

The most used bone cement in Australia6 and the United Kingdom;7 PALACOS® has been used in over 30 million procedures.7-9 In a recent award-winning study by the Hospital for Special Surgery, PALACOS® R was associated with 3x fewer revisions for early aseptic loosening than Cobalt® HV and Simplex® HV bone cements.10

PALACOS® R provides one of the longest working times of any bone cement and stays in a workable, doughy phase longer than Smartset® HV, Simplex® P, and Refobacin® Bone Cements.11,12

PALACOS® R is optimally prepared within a cartridge vacuum mixing system like the PALAMIX® or PALACOS® pro All-In-One-Fixation-SystemTM.13

510(k) Number PALACOS® R: K030902

Originally promoted under the name PALAMED®, PALACOS® MV* is a medium-viscosity bone cement providing a longer polymerization reaction compared to PALACOS® R.14  Early results from National Joint Registries have shown that like PALACOS® R, PALACOS® MV has outstanding survivorship in total knee arthroplasty.15

PALACOS® MV is recommended for use with a cartridge vacuum mixing system like the PALAMIX®.

510(k) Number PALACOS® MV: K030904

* PALACOS® MV was originally promoted under the name PALAMED.

The lowest viscosity bone cement in the PALACOS® portfolio, PALACOS® LV enables precise application even through thin nozzles, making it an excellent choice for cementing small and medium-sized joints like the shoulder and elbow.

PALACOS® LV is recommended for use with a cartridge vacuum mixing system like the PALAMIX®.

510(k) Number PALACOS® LV: K030903

For total hip fixation, recent evidence supports a shift toward cementing more hips. While National Joint Registries show better survivorship when cement is used to affix the femoral component,16-17 the survivorship advantage for cemented implants is especially significant in femoral neck fracture patients,18 female patients over 60 years of age,19 and male patients over 75 years of age.20 Importantly, in these populations cementless fixation appears to give rise to greater risk of periprosthetic fracture, which is a devastating economic and clinical complication.18-19, 21-22

In total knee arthroplasty, the promise of new implant designs with better ingrowth have led some surgeons to call for reconsideration of cementless knee designs.23 Importantly, many of the studies being used to justify a reboot of cementless TKA contain very small sample sizes and are arguably underpowered to detect differences in survivorship and complications.24-25 Global registries continue to show better survivorship with cemented TKA and have reinforced that cemented fixation remains the gold standard.26-28 In 2019, the Australian Registry reported an 2.25-fold increased risk of aseptic loosening within 18 months after cementless TKA (p<0.001).27 In the New Zealand registry, 10 year survival rates for cemented total knee designs were significantly better (97% vs. 94.5%, p<0.001).28

1 Data on file.

2 Olerud F, et al. Comparison of Refobacin bone cement and Palacos with gentamicin in total hip arthroplasty: an RSA study with two years follow-up. Hip Int. 2014;24(1):56-62.

3 Barletta A, et al.  Testing and comparison of the mechanical properties of commercial bone cements: which technique is the best?.  Exp Techniq 2008; 32: 48-53.

4 Lewis G.  Not all approved antibiotic-loaded PMMA bone cement brands are the same: ranking using the utility materials selection concept. J Mater Sci Mater Med. 2015; 26: 5388.

5 Hampton CB, et al.  Aseptic loosening at the tibia in total knee arthroplasty: a function of cement mantle quality? J Arthroplasty 2020; 35: 190-6.

6 Table C9: 10 Most Used Cement Types for Tibial Prosthesis in Primary Knee Replacement. AOA National Joint Replacement Registry Supplementary Report on Cement in Hip & Knee Arthroplasty. 2017. Page 9.

7 NJR Supplier Feedback Report, 2020. 

8 Espehaug B, et al.  The type of cement and failure of total hip replacements.  J Bone Joint Surg (Br) 2002; 84: 832-8.

9 Malchau H, et al. Prognosis of total hip replacement. Update and Validation of Results from the Swedish National Hip Arthroplasty Registry 1979-1998.. In: Scientific Exhibition presented at the 67th Annual Meeting of the American Academy of Orthopaedic Surgeons, March 15-19, 2000, Orlando, USA.

10 Buller LT, et al. Primary Total Knee Arthroplasty Performed Using High-Viscosity Cement is Associated with High Odds of Revision for Aseptic Loosening. J Arthroplasty 2020; 35: 182-9.

11 Kuehn KD. PMMA Cements. Properties of PMMA Cement Dough (Figure 7.8) Springer, Berlin, Heidelberg.

12 Dall GF, et al.  Inter- and intra-batch variability in the handling characteristics and viscosity of commonly used antibiotic-loaded bone cements.  Acta Orthop 2007; 78: 412-20.

13 Wilkinson JM, et al.  Effect of mixing technique on the properties of acrylic bone-cement: a comparison of syringe and bowl mixing systems.  J Arthroplasty 2000; 15: 663-7.

14 Specht R, et al. (2001) Mechanical Testing of Palamed®. In: Walenkamp GHIM, Murray DW, Henze U, Kock HJ (eds) Bone Cement and Cementing Technique. Springer, Berlin, Heidelberg.

15 Gunkelman RF, et al.  Clinical performance of Palacos and Simplex bone cements in total knee arthroplasty for osteoarthritis: a registry study of 58,684 knee replacements between 1999 and 2016.  Rheumatology 2018; 8: 31.

16 Table 3.7. KM estimates of cumulative revision (95% CI) by fixation and bearing, in primary hip replacements.  The National Joint Register.  16th Annual Report. 2018-2019. Page 56.

17 Figure HT17.  Cumulative percent revision of primary total conventional hip replacement by fixation. The Australian Orthopaedic Association National Joint Replacement Registry.  Annual Report 2018.  Page 107.

18 Richardson CG, et al.  Increased mortality with the use of cementless fixation for femoral neck fractures: analysis of 5883 hip arthroplasty cases.  J Arthroplasty 2020; Epub ahead of print.

19 Omari A, et al.  Introduction of a new treatment algorithm reduces the number of periprosthetic femoral fractures following primary THA in elderly females.  J Arthroplasty 2020; Epub ahead of print.

20 Tanzer M, et al.  Is cemented or cementless femoral stem fixation more durable in patients older than 75 years of age?  A comparison of the best- performing stems.  Clin Orthop Relat Res 2018; 476: 1428-37.

21 Springer BD, et al.  Perioperative periprosthetic femur fractures are strongly correlated with fixation method: an analysis from the American Joint Replacement Registry.  J Arthroplasty 2019; 34: S352-4.

22 Luzzi AJ, et al.  The "Bundle Busters": Incidence and costs of postacute complications following total joint arthroplasty.  J Arthroplasty 2018; 33: 2734-9.

23 Aprato A, et al.  Cementless total knee arthroplasty.  Ann Transl Med 2016; 4(7): 129.

24 Nam D, et al. Perioperative and early postoperative comparison of a modern cemented and cementless total knee arthroplasty of the same design. J Arthroplasty 2017; 32: 2151-5.

25 Fricka KB, et al.  To cement or not? Two-year results of a prospective, randomized study comparing cemented vs. Cementless total knee arthroplasty (TKA).  J Arthroplasty 2015; 30: 55-8.

26 Jorgensen NB, et al.  Major aseptic revision following total knee replacement. A study of 478,081 total knee replacements from the Australian Orthopaedic Association National Joint Replacement Registry. J Bone Joint Surg (Am) 2019; 101: 302-10.

27 Nugent M, et al. Despite improved survivorship of uncemented fixation in total knee arthroplasty for osteoarthritis, cemented fixation remains the gold standard: an analysis of a National Joint Registry.  J Arthroplasty 2019; 34: 1626-33.

28 Table 3.25. KM estimates of cumulative revision (95% CI) by fixation, constraint, and bearing, in primary knee replacements.  The National Joint Register.  15th Annual Report. 2017-2018.  Page 112.