The Effect of Cement Placement on Augmentation of the Osteoporotic Proximal Femur

Abstract

Femoroplasty, the augmentation of the proximal femur, has been shown in biomechanical studies to increase the energy required to produce a fracture and therefore may reduce the risk of such injuries. The purpose of our study was to test the hypotheses that: (1) 15 mL of cement was sufficient to mechanically augment the proximal femur, (2) there was no difference in augmentation effect between cement placement in the intertrochanteric region and in the femoral neck, and (3) cement placement in the femoral neck would predispose the proximal femur to an intertrochanteric fracture, whereas trochanteric placement would result in subtrochanteric fractures. In each of 18 pairs of osteoporotic human cadaveric femora, 15 mL of polymethylmethacrylate bone cement was injected into the trochanteric or femoral neck region of 1 femur, and the noninjected femur was used as the control. The augmentation effect of femoroplasty was evaluated under simulated fall conditions using a materials testing machine. Multiple linear regressions incorporating random effects were used to check for associations between covariates (bone mineral density, cement location, and treatment) and the parameters of interest (stiffness, yield energy, yield load, ultimate load, and ultimate energy). Significance was set at P < .05. It was found that femoroplasty with 15 mL of cement did not significantly increase stiffness, yield energy, yield load, ultimate load, or ultimate energy relative to paired controls. There were no significant differences in parameters of interest or fracture patterns in specimens augmented in the femoral neck versus the trochanter. It was concluded that 15 mL of cement was not sufficient to augment the proximal femur and that there was no biomechanical advantage to the placement of cement within the femoral neck versus the trochanter.

Can be the cement augmentation na improvement method of preventing hip fractures in osteoporotic patients?

“…As negative possible outcomes, most of them described the possibility of thermal injury, a more difficult surgery for treatment in case of fracture occurrence and a chance of happening different patterns, more complex or unusual, of fracture due to the local density change. [15][16][17][18][19][20] The results of studies using the CPC showed an increase in the peak loading to fracture occurrence in values ranging from 21 to 43%, but the augmentation volumes used of such substance weren't described, but observing the radiography images of their articles we noted that the one with best results showed a complete filling of the proximal femur, a questionable fact for its application in vivo. There was no significant rise of temperature during polymerization of this product, as it was not observed description of optimization reFerences in their positioning.…”

“…Although one of these studies found an increase of resistance to the possibility of the fracture, using a mean volume of 36 mL, 15 the other one found no enhancement of mechanical strength, with a mean volume of 15 mL. 16 The other papers, with favorable results, had PMMA, elastomers, CPC and metal implants as material for the femoral augmentation.…”

“…The materials used in all experimental studies were cadaveric femurs with mineral density compatible with osteoporotic bones, and the augments were of many types: PMMA (seven studies), [10][11][12][13][14][15][16] CPC (two studies), 17,18 elastomers (four studies), [19][20][21][22] metal implants (two studies). 23,24 The metal implants were of two types, a titanium screw and a steel spiral shaped implant.…”

Contralateral Prophylactic Reinforcement in Case of First Low-Energy Hip Fracture: First-in-Man Clinical Data of a New Percutaneous Internal Fixation Device

“…Otherwise, the technique of cementoplasty studied in several articles has major disadvantages due to the use of a gross amount of cement to achieve reinforcement leading to the risk of difficult revision and subtrochanteric fracture [17,18]. In this new technique, cement is needed to improve the contact surface and fix the implants into the bone and a very low amount of cement is used (8 ± 1.6 ml) comparing to Heini and Sutter (36 ml and 47 ml, respectively) [17,18].…”

“…In this new technique, cement is needed to improve the contact surface and fix the implants into the bone and a very low amount of cement is used (8 ± 1.6 ml) comparing to Heini and Sutter (36 ml and 47 ml, respectively) [17,18].…”