TY - JOUR
T1 - A biomechanically-guided planning and execution paradigm for osteoporotic hip augmentation
T2 - Experimental evaluation of the biomechanics and temperature-rise
AU - Farvardin, Amirhossein
AU - Bakhtiarinejad, Mahsan
AU - Murphy, Ryan J.
AU - Basafa, Ehsan
AU - Khanuja, Harpal
AU - Oni, Juluis K.
AU - Armand, Mehran
N1 - Funding Information:
We thank Dr. Stephen Belkoff and Mr. Demetries Boston of Johns Hopkins Bayview Medical Center for their help with providing the specimens and the DEXA. This work was supported by grants no. R21 AR063815 and R01 EB0223939 from National Institutes of Health . The funders had no role in the study design, data collection, analysis of the data, writing of the manuscript, or the decision to submit the manuscript for publication.
Funding Information:
We thank Dr. Stephen Belkoff and Mr. Demetries Boston of Johns Hopkins Bayview Medical Center for their help with providing the specimens and the DEXA. This work was supported by grants no. R21 AR063815 and R01 EB0223939 from National Institutes of Health. The funders had no role in the study design, data collection, analysis of the data, writing of the manuscript, or the decision to submit the manuscript for publication.
Publisher Copyright:
© 2021 Elsevier Ltd
PY - 2021/7
Y1 - 2021/7
N2 - Background: Augmentation of the proximal femur with bone cement (femoroplasty) has been identified as a potential preventive approach to reduce the risk of fracture. Femoroplasty, however, is associated with a risk of thermal damage as well as the leakage of bone cement or blockage of blood supply when large volumes of cement are introduced inside the bone. Methods: Six pairs of cadaveric femora were augmented using a newly proposed planning paradigm and an in-house navigation system to control the location and volume of the injected cement. To evaluate the risk of thermal damage, we recorded the peak temperature of bone at three regions of interest as well as the exposure time for temperature rise of 8 °C, 10 °C, and 12 °C in these regions. Augmentation was followed by mechanical testing to failure resembling a sideway fall on the greater trochanter. Findings: Results of the fracture tests correlated with those of simulations for the yield load (R2 = 0.77) and showed that femoroplasty can significantly improve the yield load (42%, P < 0.001) and yield energy (139%, P = 0.062) of the specimens. Meanwhile, temperature recordings of the bone surface showed that the areas close to the greater trochanter will be exposed to more critical temperature rise than the trochanteric crest and femoral neck areas. Interpretation: The new planning paradigm offers a more efficient injection strategy with injection volume of 9.1 ml on average. Meanwhile, temperature recordings of bone surfaces suggest that risk of thermal necrosis remains as a concern with femoroplasty using Polymethylmethacrylate.
AB - Background: Augmentation of the proximal femur with bone cement (femoroplasty) has been identified as a potential preventive approach to reduce the risk of fracture. Femoroplasty, however, is associated with a risk of thermal damage as well as the leakage of bone cement or blockage of blood supply when large volumes of cement are introduced inside the bone. Methods: Six pairs of cadaveric femora were augmented using a newly proposed planning paradigm and an in-house navigation system to control the location and volume of the injected cement. To evaluate the risk of thermal damage, we recorded the peak temperature of bone at three regions of interest as well as the exposure time for temperature rise of 8 °C, 10 °C, and 12 °C in these regions. Augmentation was followed by mechanical testing to failure resembling a sideway fall on the greater trochanter. Findings: Results of the fracture tests correlated with those of simulations for the yield load (R2 = 0.77) and showed that femoroplasty can significantly improve the yield load (42%, P < 0.001) and yield energy (139%, P = 0.062) of the specimens. Meanwhile, temperature recordings of the bone surface showed that the areas close to the greater trochanter will be exposed to more critical temperature rise than the trochanteric crest and femoral neck areas. Interpretation: The new planning paradigm offers a more efficient injection strategy with injection volume of 9.1 ml on average. Meanwhile, temperature recordings of bone surfaces suggest that risk of thermal necrosis remains as a concern with femoroplasty using Polymethylmethacrylate.
KW - Finite element analysis
KW - Osteoporotic hip augmentation
KW - PMMA cement
KW - Surgical planning
UR - http://www.scopus.com/inward/record.url?scp=85108456230&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85108456230&partnerID=8YFLogxK
U2 - 10.1016/j.clinbiomech.2021.105392
DO - 10.1016/j.clinbiomech.2021.105392
M3 - Article
C2 - 34174676
AN - SCOPUS:85108456230
SN - 0268-0033
VL - 87
JO - Clinical Biomechanics
JF - Clinical Biomechanics
M1 - 105392
ER -