Biomechanical analysis of impending femoral neck fractures: The role of percutaneous cement augmentation for osteolytic lesions

Palumbo, Brian T.; Nalley, Charles; Gaskins, Roger B.; Gutiérrez, Sergio; Alexander, Gerald; Anijar, Leon; Nayak, Aniruddh N.; Cheong, David; Santoni, Brandon G.

doi:10.1016/j.clinbiomech.2013.12.001

Cited by 21 publications

(19 citation statements)

References 15 publications

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“…They suggest augmentation of the postero-superior aspect of the greater trochanter and the neck areas close to the cortical shell. This is in agreement with the recent experimental findings of Palumbo et al (2014). By closer examination, one can notice the thicker augmentation in the superior of the neck, compared to the inferior aspect.…”

Section: Discussionsupporting

confidence: 93%

Subject-specific planning of femoroplasty: A combined evolutionary optimization and particle diffusion model approach

Basafa

Armand

2014

Journal of Biomechanics

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A potential effective treatment for prevention of osteoporotic hip fractures is augmentation of the mechanical properties of the femur by injecting it with agents such as (PMMA) bone cement – femoroplasty. The operation, however, is only in research stage and can benefit substantially from computer planning and optimization. We report the results of computational planning and optimization of the procedure for biomechanical evaluation. An evolutionary optimization method was used to optimally place the cement in finite element (FE) models of seven osteoporotic bone specimens. The optimization, with some inter-specimen variations, suggested that areas close to the cortex in the superior and inferior of the neck and supero-lateral aspect of the greater trochanter will benefit from augmentation. We then used a particle-based model for bone cement diffusion simulation to match the optimized pattern, taking into account the limitations of the actual surgery, including limited volume of injection to prevent thermal necrosis. Simulations showed that the yield load can be significantly increased by more than 30%, using only 9ml of bone cement. This increase is comparable to previous literature reports where gross filling of the bone was employed instead, using more than 40ml of cement. These findings, along with the differences in the optimized plans between specimens, emphasize the need for subject-specific models for effective planning of femoral augmentation.

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Section: Discussionsupporting

confidence: 93%

Subject-specific planning of femoroplasty: A combined evolutionary optimization and particle diffusion model approach

Basafa

Armand

2014

Journal of Biomechanics

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“…A recent study showed that, for single-legged stance loading condition, augmentation of superior and inferior of the femoral neck close to the cortex results in the most favorable outcome (Palumbo et al, 2014), which is consistent with what optimizations suggested in the current study. However, backward falls or even daily activities such as walking can cause fracture in osteoporotic hips.…”

Section: Discussionsupporting

confidence: 92%

Subject-specific planning of femoroplasty: An experimental verification study

Basafa

Murphy

Otake

et al. 2015

Journal of Biomechanics

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The risk of osteoporotic hip fractures may be reduced by augmenting susceptible femora with acrylic polymethylmethacrylate (PMMA) bone cement. Grossly filling the proximal femur with PMMA has shown promise, but the augmented bones can suffer from thermal necrosis or cement leakage, among other side effects. We hypothesized that, using subject-specific planning and computer-assisted augmentation, we can minimize cement volume while increasing bone strength and reducing the risk of fracture. We mechanically tested eight pairs of osteoporotic femora, after augmenting one from each pair following patient-specific planning reported earlier, which optimized cement distribution and strength increase. An average of 9.5(±1.7)ml of cement was injected in the augmented set. Augmentation significantly (P<0.05) increased the yield load by 33%, maximum load by 30%, yield energy by 118%, and maximum energy by 94% relative to the non-augmented controls. Also predicted yield loads correlated well (R2=0.74) with the experiments and, for augmented specimens, cement profiles were predicted with an average surface error of <2mm, further validating our simulation techniques. Results of the current study suggest that subject-specific planning of femoroplasty reduces the risk of hip fracture while minimizing the amount of cement required.

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“…Although theoretically more likely for InF/PF than ImF, we did not encounter any clinically relevant leakage in either group similar to other series [30]. Additionally, several biomechanical and clinical studies suggest that cementoplasty may enhance screw fixation and optimise biomechanics [25][26][27][28][29]; and all our unfavourable local cement augmentation evolution rated at imaging follow-up occurred in non-cemented cases. Although definitive proof is lacking [24], it is probably an effective and safe option to optimise screw fixation with PMMA injection when it is performed under continuous fluoroscopic guidance.…”

Section: Discussionsupporting

confidence: 66%

“…Conversely, screw fixation is commonly used by orthopaedic surgeons in patients unsuitable for invasive surgery in a variety of locations and settings [14,22,23,32,42]. In particular, several clinical and biomechanical studies support the use of an ''inverted triangle'' screw-configuration with/without cement augmentation to provide intramedullary reinforcement in proximal femoral neck fractures [22,23,25,43]. The PIGSF technique described herein and elsewhere [16] is comparable to existing surgical techniques, and probably represents the most appropriate procedure for most lesions.…”

Section: Discussionmentioning

confidence: 67%

Percutaneous Image-Guided Screw Fixation of Bone Lesions in Cancer Patients: Double-Centre Analysis of Outcomes including Local Evolution of the Treated Focus

Cazzato

Koch

Buy

et al. 2016

Cardiovasc Intervent Radiol

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Biomechanical analysis of impending femoral neck fractures: The role of percutaneous cement augmentation for osteolytic lesions

Cited by 21 publications

References 15 publications

Subject-specific planning of femoroplasty: A combined evolutionary optimization and particle diffusion model approach

Subject-specific planning of femoroplasty: A combined evolutionary optimization and particle diffusion model approach

Subject-specific planning of femoroplasty: An experimental verification study

Percutaneous Image-Guided Screw Fixation of Bone Lesions in Cancer Patients: Double-Centre Analysis of Outcomes including Local Evolution of the Treated Focus

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