A biomechanically-guided planning and execution paradigm for osteoporotic hip augmentation: Experimental evaluation of the biomechanics and temperature-rise

Farvardin, Amirhossein; Bakhtiarinejad, Mahsan; Murphy, Ryan J.; Basafa, Ehsan; Khanuja, Harpal S.; Oni, Juluis K.; Armand, Mehran

doi:10.1016/j.clinbiomech.2021.105392

Cited by 5 publications

(8 citation statements)

References 22 publications

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“…Varga et al [20] proposed new injection strategies, based on the principles of bone remodeling, for use in femoroplasty, and concluded that "compression bridge" injections aligned with the femoral neck axis showed the greatest biomechanical efficiency. Thanks to a new planning paradigm and an in-house navigation system, Farvardin et al [21] were able to demonstrate that a planned injection of PMMA into the proximal femur can significantly improve its fracture-related biomechanical properties. However, temperature recordings of bone surfaces suggest that the risk of thermal necrosis remains a concern.…”

Section: Cement Augmentationsmentioning

confidence: 99%

Osteo-enhancement procedures in hip fracture prevention: definition and local interventions

et al. 2022

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Fragility hip fractures are associated with increased morbidity and mortality in elderly patients and place a large medical and economic burden on affected individuals, families, and healthcare systems. Furthermore, in patients with a recent hip fracture, the risk of a second contralateral hip fracture is doubled at 1 year, and increases to 9–20% after 5 years. Mortality can be up to three times higher following a contralateral hip fracture. Currently available pharmaceutical treatments to improve bone mineral density in fragility fracture of the proximal femur can take up to 18 months to significantly reduce the risk of fracture, and have patient compliance issues. Thus, given the limitations of existing methods, there is a significant need for new approaches to reduce hip fractures through so-called surgical osteo-enhancement. “Osteo-enhancement” might be defined as any procedure in which a new material is surgically introduced with the aim of strengthening the proximal femur, increasing the resistance of the femoral neck to compression and distraction forces acting on it, and thereby preventing fall-related fractures. In the past decade, several groups have presented various prophylactic augmentation approaches for the osteoporotic proximal femur and evaluated them by means of experimental biomechanical testing; however, none of them met the ideal requirements for in vivo application. Ideally, a surgical procedure should be minimally invasive and safe. The intervention must not increase the immediate risk of hip fracture, must provide long-term fracture risk reduction, and, if a subsequent fracture does occur, the intervention should not interfere with a standard approach for fracture repair. More recently, to address local osteoporotic bone loss, a resorbable implant material named AGN1 was introduced as a new device for strengthening the proximal femur. The implant material sets in situ and is designed to be resorbed and replaced with new bone to improve femoral strength and reduce hip fracture risk in osteoporotic patients.

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Section: Cement Augmentationsmentioning

confidence: 99%

Osteo-enhancement procedures in hip fracture prevention: definition and local interventions

et al. 2022

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“…A total of 60% of studies embedded their specimen in the popular Hayes-fall (or Courtney-fall) configuration, with the femoral neck at 15°anteversion and the shaft at 10°to the horizontal. 27 We found little agreement in how studies represented soft tissue over the greater trochanter; authors used approaches like custom-shaped bone cement, 26,28 a rubber mat, 16 or silicone. 15,29,30 Measured outcomes varied across studies but tended to use comparative measures like change in fracture load and energy as primary end points (Table S1).…”

Section: Resultsmentioning

confidence: 99%

“…15 Beyond experimental methods, 20% of authors supplemented mechanical evaluation with computational analyses such as the finite element method 13,18,24 or a subject-specific approach to determine optimal injection volume and pattern. 25,26 Authors mounted and aligned their specimens in various ways, mostly depending on test type and simulated loading scenario. Almost all methods transected the femur at the shaft and embedded the distal end in a rigid fixation.…”

Section: Resultsmentioning

confidence: 99%

“…16 Other studies also reported a trend of higher strength increases observed in specimens with more severe osteoporosis (as determined by bone mineral density), regardless of augmentation type. 26,32…”

Section: Resultsmentioning

confidence: 99%

“…More recent research has investigated novel techniques such as 3D-printed implants, 15 bio-active materials 32,38 or computer-assisted augmentation. 25,26 both of which present encouraging options for future directions in mechanical augmentation. Unfortunately, the ex vivo nature of testing cadaveric specimens prohibits drawing conclusions on any structural benefits attributed to biological interactions between these technologies and the bone, requiring clinical studies to determine efficacy.…”

Section: Current State Of Femoral Augmentationmentioning

confidence: 99%

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Evaluating femoral augmentation to prevent geriatric hip fracture: A scoping review of experimental methods

Bliven

Fung

Cripton

et al. 2023

Journal Orthopaedic Research

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Various femoral augmentation designs have been investigated over the past decade for the prevention of geriatric hip fracture. The experimental methods used to evaluate the efficacy of these augmentations have not been critically evaluated or compared in terms of biofidelity, robustness, or ease of application. Such parameters have significant relevance in characterizing future clinical success. In this study we aimed to use a scoping review to summarize the experimental studies that evaluate femoral augmentation approaches, and critically evaluate commonly applied protocols and identify areas for concordance with the clinical situation. We conducted a literature search targeting studies that used experimental test methods to evaluate femoral augmentation to prevent geriatric fragility fracture. A total of 25 studies met the eligibility criteria. The most commonly investigated augmentation to date is the injection of bone cement or another material that cured in situ, and a popular subsequent method for biomechanical evaluation was to load the augmented proximal femur until fracture in a sideways fall configuration. We noted limitations in the clinical relevance of sideways fall scenarios being modeled and large variance in the concordance of many of the studies identified. Our review brings about recommendations for enhancing the fidelity of experimental methods modeling clinical sideways falls, which include an improved representation of soft tissue effects, using outcome metrics beyond load‐to‐failure, and applying loads inertially. Effective augmentations are encouraging for their potential to reduce the burden of hip fracture; however, the likelihood of this success is only as strong as the methods used in their evaluation.

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On the Fly Robotic-Assisted Medical Instrument Planning and Execution Using Mixed Reality

Ai,

Liu,

Armand

et al. 2024

2024 IEEE International Conference on Robotics and Automation (ICRA)

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A biomechanically-guided planning and execution paradigm for osteoporotic hip augmentation: Experimental evaluation of the biomechanics and temperature-rise

Cited by 5 publications

References 22 publications

Osteo-enhancement procedures in hip fracture prevention: definition and local interventions

Osteo-enhancement procedures in hip fracture prevention: definition and local interventions

Evaluating femoral augmentation to prevent geriatric hip fracture: A scoping review of experimental methods

On the Fly Robotic-Assisted Medical Instrument Planning and Execution Using Mixed Reality

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