Fracture prevention by femoroplasty--cement augmentation of the proximal femur

Abstract

The prevention of hip fractures is a desirable goal to reduce morbidity, mortality, and socio-economic burden. We evaluated the influence on femoral strength of different clinically applicable cementing techniques as "femoroplasty." Twenty-eight human cadaveric femora were augmented by means of four clinically applicable percutaneous cementing techniques and then tested biomechanically against their native contralateral control to determine fracture strength in an established biomechanical model mimicking a fall on the greater trochanter. The energy applied until fracture could be significantly increased by two of the methods by 160% (53.1 Nm vs. 20.4 Nm, p < 0.001) and 164% (47.1 Nm vs. 17.8 Nm, p = 0.008), respectively. The peak load to failure was significantly increased by three of the methods by 23% (3818.3 N vs. 3095.7 N, p = 0.003), 35% (3698.4 N vs. 2737.5 N, p = 0.007), and 12% (3056.8 N vs. 2742.8 N, p = 0.005), respectively. The femora augmented with cemented double drill holes had a lower fracture strength than the single drilled ones. Experimental femoroplasty is a technically feasible procedure for the prophylactic reinforcement of the osteoporotic proximal femur and, hence, could be an auxiliary treatment option to protect the proximal femur against osteoporotic fractures.