Elastomer femoroplasty prevents hip fracture displacement

Steenhoven, T.J. van der; Schaasberg, W.; Vries, A.C. de; Valstar, Edward R.; Nelissen, Rob G H H

doi:10.1016/j.clinbiomech.2010.12.009

Cited by 13 publications

(4 citation statements)

References 20 publications

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“…A few recent studies reported attempts at restoring the mechanical strength of femur specimens by relatively small amount of injection of bone cement, with limited or no success (Sutter et al, 2010b; Beckmann et al, 2011; Fliri et al, 2012; van der Steenhoven et al, 2011). Our preliminary experiments on eight pairs of osteoporotic femora showed that we can achieve significant improvement in the mechanical response of the specimens by injecting less than 10ml of PMMA bone cement.…”

Section: Discussionmentioning

confidence: 99%

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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Section: Discussionmentioning

confidence: 99%

Subject-specific planning of femoroplasty: An experimental verification study

Basafa

Murphy

Otake

et al. 2015

Journal of Biomechanics

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“…They then injected the bone with 10.8ml of cement that increased the fracture energy of the specimens, but did not affect the yield or fracture loads. van der Steenhoven et al (2011) used a slightly different technique where they pre-drilled a cavity inside the femoral neck, either using an inflatable balloon or an eccentric drill, and then filled the cavity with Elastomer material. The augmentation resulted in less fracture displacement, but neither technique affected the fracture load of the specimens.…”

Section: Introductionmentioning

confidence: 99%

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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“…A silicone‐based femoroplasty method was by far the most comprehensively assessed augmentation that we found. Its performance was evaluated in tests that simulated a sideways fall, postfracture stability, cyclic loading, and then alongside supplementary osteosynthesis 17,21–23 . Only one study shared testing details of their design and selection process: the doctoral thesis evaluated various augmentation designs with a four‐point bending test of the intervention sans femur surrogate, per ASTM C‐1685, before proceeding to ex vivo femur insertion and testing 15 .…”

Section: Resultsmentioning

confidence: 99%

“…Although less common, embalmed specimens are another option, despite documentation of altered mechanical properties compared to freshfrozen specimens. 35 The trend to incorporate donated femurs with osteoporotic or osteopenic bone quality into study designs, which was chosen by many authors, 15,17,18,[21][22][23]25,28,29,31,32,36,37 reflects the target population for prophylactic augmentation: individuals whose native femoral strength is deficient, renders them vulnerable to fracture in a sideways fall, and merits increasing. One study justified their choice of synthetic femur specimens as a means of avoiding the type II error that may come into play with the large spread in fracture loads when testing cadaveric specimens.…”

Section: Current State Of Femoral Augmentationmentioning

confidence: 99%

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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Elastomer femoroplasty prevents hip fracture displacement

Cited by 13 publications

References 20 publications

Subject-specific planning of femoroplasty: An experimental verification study

Subject-specific planning of femoroplasty: An experimental verification study

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

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

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