Augmentation of Pedicle Screw Fixation Strength Using an Injectable Calcium Phosphate Cement as a Function of Injection Timing and Method

Renner, Susan M.; Lim, Tae-Hong; Kim, Whoan Jeang; Katolik, Leonid I.; An, Howard S.; Andersson, Gunnar

doi:10.1097/00007632-200406010-00020

Cited by 164 publications

(151 citation statements)

References 19 publications

Supporting

Mentioning

134

Contrasting

Unclassified

Order By: Relevance

“…There was no difference between the PMMA and tricalcium phosphate groups statistically. Renner et al [18] similarly tested pedicle screws augmented with PMMA or tricalcium phosphate in osteoporotic spines. Pedicle screws were tested after injecting tricalcium phosphate or PMMA along the length of a stripped screw hole representing a revision case, and in intact pedicles before screw insertion, representing a primary augmentation case.…”

Section: Discussionmentioning

confidence: 99%

“…Power analysis was performed based on estimates from prior studies [3,7,9,15,16,18,19]. An effect size of a 30% increase in load to failure was estimated based on these studies.…”

Section: Methodsmentioning

confidence: 99%

“…A new suture anchor then was inserted into each hole (Fig. 1) and the cement was allowed to fully cure for 24 hours at 37°C, per manufacturer's instructions and according to prior studies using tricalcium phosphate cement [3,7,15,16,18].…”

Section: Methodsmentioning

confidence: 99%

“…PMMA bone cement has been used to augment screw fixation in spine [4,10,16,18,19,22] and trauma [3,7,15,17] applications. These studies all showed increases in failure strength of constructs augmented with PMMA.…”

Section: Introductionmentioning

confidence: 99%

“…Several studies have examined the use of tricalcium phosphate cement to increase fixation of pedicle screws [16,18,19], hip screws [7,15], and 4.5 mm cortical screws [3]. These studies all show increases in failure strength of tricalcium phosphate augmented constructs over controls where screws were placed without the addition of cement.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Bioabsorbable Tricalcium Phosphate Bone Cement Strengthens Fixation of Suture Anchors

Oshtory¹,

Lindsey

Giori

et al. 2010

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

Background Failure of suture anchor fixation in rotator cuff repair can occur at different interfaces. Prior studies show fixation at the bone-anchor interface can be augmented using polymethylmethacrylate (PMMA) cement, and screw fixation into bone can be strengthened using bioabsorbable tricalcium phosphate cement. Questions/purposes We wished to determine whether augmentation of suture anchor fixation using bioabsorbable tricalcium phosphate cement would increase pullout strength of suture anchors from bone and the number of cycles to failure, to determine the mode of failure after cement augmentation, and to compare strength and mode of failure with those after augmentation with PMMA.Methods We used 10 matched pairs of cadaveric proximal humeri and implanted a metal screw-type suture anchor in one side and on the other side injected tricalcium phosphate cement into the anchor holes before anchor placement. We tested all specimens to failure using a ramped cyclic loading protocol. Results Tricalcium phosphate cement augmentation increased the final load to failure by 29% and the number of cycles to failure by 20%. Visual inspection confirmed that failure occurred at the cement-bone interface. Conclusions Tricalcium phosphate cement appears to augment suture anchor fixation into bone, reducing the risk of anchor pullout and failure. Clinical Relevance When relying on suture anchor fixation in bone of questionable quality, we suggest considering augmentation of suture anchor fixation with bioabsorbable cement. This method also provides potential for bioabsorbability and may be more amenable to arthroscopic application.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Power analysis was performed based on estimates from prior studies [3,7,9,15,16,18,19]. An effect size of a 30% increase in load to failure was estimated based on these studies.…”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Bioabsorbable Tricalcium Phosphate Bone Cement Strengthens Fixation of Suture Anchors

Oshtory¹,

Lindsey

Giori

et al. 2010

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

show abstract

Controlled radical polymerization of N‐vinylphthalimide using carboxyl‐terminated trithiocarbonate as RAFT agent and preparation of microfibers via electrospinning technique

Chikhaoui-Grioune

Aqil

Zalfen

et al. 2010

J of Applied Polymer Sci

View full text Add to dashboard Cite

Reversible addition-fragmentation chain transfer (RAFT) polymerization of N-vinylphthalimide in N,N-dimethylformamide (DMF) solution was carried out using 2-carboxypropan-2-yl dodecyl trithiocarbonate as a reversible chain transfer agent in the presence of 2,2 0 -azobisisobutyronitrile. The molecular weights of the polymers increased linearly with the monomer conversion and the molecular weight distributions were relatively narrow (PDI < 1.2). It is confirmed by chain extension reaction that the polymer prepared via RAFT polymerization can be used as a macro-RAFT agent. The structure of both polymers was characterized and confirmed by size-exclusion chromatography and 1 H-NMR techniques. Ultrafine microfibers were prepared by electrospinning of poly(N-vinylphthalimide) in DMF solution. The effects of electrospinning process parameters such as voltage, tip-to-collector distance, and solution concentration on the morphology and the average size of the electrospun fibers were studied. To evaluate the fiber diameters, scanning electron microscope micrographs of the microfibers were performed.

show abstract

An in vitro optimized injectable calcium phosphate cement for augmenting screw fixation in osteopenic goats

Leung

Siu

et al. 2005

J Biomed Mater Res

View full text Add to dashboard Cite

This study reports the proportioning and standardized mixing procedures for preparing a hydroxylapatite cement (tetracalcium phosphate and dicalcium phosphate) of desired viscosity and mechanical strength reproducibly for application in trauma surgery. The behavior and the biomechanical properties of the resulting bone cement in screw augmentation were then evaluated in our osteopenic goat model. The use of a shaker standardized the mixing procedure. The optimal volume of Na2HPO4 used to prepare the injectable cement was 0.45 mL/g, with averaged in vitro compressive strength of 48.29 +/- 5.62 MPa. Histology showed increasing tightly-coupled bone apposition on the cement surface without fibrous encapsulation as observed in the screw-only controls with time in the osteopenic goat model. The cement increased the initial screw pull-out force (54.7%, p = 0.005) significantly and the energy required to failure (54.7%, p < 0.05) significantly, and remained higher than the screw-only controls after 3 months (9.8% and 20.2%, respectively) and 6 months (20.2% and 44.7%, respectively). These results imply potential in the prevention of interfacial micromotions and subsequent fibrous tissue formation at the implant-bone interface resulting in a decreased risk of implant failure. The optimized cement in this study may serve as a good candidate for augmenting fixation of osteoporotic bone.

show abstract

Augmentation of Pedicle Screw Fixation Strength Using an Injectable Calcium Phosphate Cement as a Function of Injection Timing and Method

Cited by 164 publications

References 19 publications

Bioabsorbable Tricalcium Phosphate Bone Cement Strengthens Fixation of Suture Anchors

Bioabsorbable Tricalcium Phosphate Bone Cement Strengthens Fixation of Suture Anchors

Controlled radical polymerization of N‐vinylphthalimide using carboxyl‐terminated trithiocarbonate as RAFT agent and preparation of microfibers via electrospinning technique

An in vitro optimized injectable calcium phosphate cement for augmenting screw fixation in osteopenic goats

Contact Info

Product

Resources

About