use of bone cement and enhanced screw design in orthopedic

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Conference Session B3
Paper #6080
Disclaimer — This paper partially fulfills a writing requirement for first year (freshman) engineering students at the University
of Pittsburgh Swanson School of Engineering. This paper is a student, not a professional, paper. This paper is based on
publicly available information and may not be provide complete analyses of all relevant data. If this paper is used for any
purpose other than these authors’ partial fulfillment of a writing requirement for first year (freshman) engineering students at
the University of Pittsburgh Swanson School of Engineering, the user does so at his or her own risk.
USE OF BONE CEMENT AND ENHANCED SCREW DESIGN IN
ORTHOPEDIC SURGERY FOR IMPROVED AUGMENTATION AND
STABILITY IN OSTEOPOROTIC BONE
John Driggers, [email protected], Mahboobin 4:00, Louis McLinden, [email protected], Bursic 2:00
Revised Proposal — Osteoporosis is a disease that affects
roughly three million people per year [1]. This disease leads
to many complications for patients that need to undergo
orthopedic surgery. A common issue in orthopedic surgery is
the failure of screw fixation. Catastrophic results can occur
from screw loosening or failure, especially when this problem
occurs in pedicle screws used for spinal fusion [2]. This issue
is much more prevalent in those patients who suffer from
osteoporosis due to their weak and brittle bones. Recently,
new technologies have become available to prevent this
problem.
One new development in the field of orthopedic engineering
that is proving to be a realistic solution to this problem is
known as “bone cement”. Bone cement is a type of bonding
agent that is used to stabilize a screw in bone and prevent
loosening over time. There are many different types of bone
cement, and various methods of application. It is clear that
this new technology increases the pullout strength of the
screws when compared to screws mounted without cement [1].
Future orthopedic surgeries that involve screws, such as
spinal fusion surgeries, will most likely utilize bone cement in
patients with osteoporosis.
This paper will discuss new bone screw technologies,
various types of bone cements, ways to implement these bone
cements, and types of surgeries that might benefit from this
technology. The information will be brought from various case
studies, professional journals, and other academic articles.
Some of these sources will bring information from lab data and
quantitative testing, while others will bring information from
real life implementation and qualitative analysis. Ethical
implications of this technology that could possibly arise will
also be discussed citing similar ethical dilemmas.
This technology is important because it will affect a large
percentage of the population. Almost all elderly people suffer
from some level of osteoporosis, and the elderly are also the
most likely candidates to need major orthopedic surgery.
More importantly, complications arising from improper screw
augmentation are more serious for elderly patients, and could
be potentially life-threatening. This new bone cement
technology could prove to not only provide a lower chance of
follow up surgery, but in turn save lives.
University of Pittsburgh Swanson School of Engineering 1
2016/01/28
REFERENCES
[1] T. Juvonen, J. Nuutinen, A.P. Koistinen, H. Kroger, R.
Lappalainen (2015). “Biomechanical evaluation of bone screw
fixation with a novel bone cement.” Biomedical Engineering
Online,
14(1).
(Online
article).
http://web.a.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=2
&sid=c4e79cfc-0f1c-44c8-a124cf9f74090864%40sessionmgr4003&hid=4112. p. 1
[2] C. Tai, T. Tsai, P. Lai, Y. Chen, M. Liu, L. Chen (2015).
“A Biomechanical Comparison of Expansive Pedicle Screws
for Severe Osteoporosis: The Effects of Screw Design and
Cement Augmentation. Plos ONE, 10(12). (Online
article).http://web.b.ebscohost.com/ehost/pdfviewer/pdfviewe
r?sid=2f65547b-871b-40af-a9a56a97dfde0150%40sessionmgr120&vid=51&hid=106. p. 1
ANNOTATED BIBLIOGRAPHY
J. Capozzi, R. Rhodes (2015). “Ethical challenges in
orthopedic surgery.” National Center for Biotechnology
Information,
(Online
article).
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4596168/
This professional article from the National Center for
Biotechnology Information evaluates the different ethical
issues in orthopedic practices. The authors take a look into four
different case studies. From there, they go into details on the
various cases and the medical ethics involved. Specifically
with the ethics involved in new technology. With this
influential research, we will be able to go into detail about the
ethical involved in the new innovations in orthopedic
surgeries.
T. Juvonen, J. Nuutinen, A.P. Koistinen, H. Kroger, R.
Lappalainen (2015). “Biomechanical evaluation of bone screw
fixation with a novel bone cement.” Biomedical Engineering
Online,
14(1).
(Online
article).
http://web.a.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=2
&sid=c4e79cfc-0f1c-44c8-a124cf9f74090864%40sessionmgr4003&hid=4112. p. 1
This article is from a professional peer reviewed journal
John Driggers
Louis McLinden
called BioMed Central, which specializes in current
biomedical technologies. In this article, two specific bone
cements are tested for compressive strength and compressive
elastic modulus. The tests are also done specifically on
osteoporotic bone models. The information from this article
will help us quantitatively analyze the effects of various bone
cements, and also help us to relate it to our specific area of
interest in osteoporotic bone.
T. M. Shea, J. J. Doulgeris, S. A. Gonzalez-Blohm, W. E. Lee,
K. Aghayev, F. D. Vrionis (2015). “Balancing Rigidity and
Safety of Pedicle Screw Fixation via a Novel Expansion
Mechanism in a Severely Osteoporotic Model.” Biomed
Research
International.
(Online
article).
http://web.b.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=2
f65547b-871b-40af-a9a56a97dfde0150%40sessionmgr120&vid=47&hid=106. p. 1
This article is from a professional peer reviewed journal
called Biomed Research International. The article is written
about the use of a new expansive screw design that enhances
the stability and pullout strength in pedicle screws used for
spinal fusion. This information will be used in our paper to
relate to a specific surgery that this technology can benefit, and
will be used to cite a specific technical innovation in screw
design.
C. Lih-Huei, T. Ching-Lung, L. De-Mei, L. Po-Liang, L. YenChen, N. Chi-Chien, C. Wen-Jer. (2011). “Pullout strength of
pedicle screws with the cement augmentation in severe
osteoporosis: A comparative study between cannulated screws
with cement injection and solid screws with cement prefilling.” BMC Musculoskeletal Disorders, 12(1). (Online
article).
http://web.b.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=5
9&sid=2f65547b-871b-40af-a9a56a97dfde0150%40sessionmgr120&hid=106. p. 1
A professional peer reviewed source from BMC
Musculoskeletal Disorders, this article offers an overview of
two different types of screw cementing techniques in
osteoporotic spines. The two various approaches are cement
injection and cement prefilling. Here the researchers will test
the pullout strengths of each different technique. The
capability of the cement prefilling is a more effective method.
Information from this article will help us demonstrate the most
effective way to use innovations in bone cement to fix
problems in osteoporotic spines.
L. Shua, Q. Wei, Z. Yang, W. Zi-Xiang, Y. Ya-Bo, L. Wei
(2014). “Effect of bone material properties on effective region
in screw-bone model: an experimental and finite element
study.” Biomedical Engineering Online, 13(1). (Online
article).http://web.b.ebscohost.com/ehost/pdfviewer/pdfviewe
r?sid=2f65547b-871b-40af-a9a56a97dfde0150%40sessionmgr120&vid=58&hid=106. p. 1
This peer reviewed journal article from Biomedical
Engineering Online discusses testing bones with different
material properties and the pullout strength of pedicle screws
from them. Two separate foams were experimented with,
along with bone material properties from three age groups. The
results show the proper amount of cement injection to treat
osteoporosis. Consequently, these results will aid us in
demonstrating the most adequate procedures to use among
different age groups.
“Orthopedic Innovations Expand the Possibilities of
Movement.” (2013). HSS on the Move. (Online article).
https://www.hss.edu/playbook/orthopedic-innovationsexpand-the-possibilities-of-movement/#.VpWOcRUrLIU. p.
1
This article is sponsored by the Hospital for Special Surgery
in New York, which is ranked as the number one orthopedic
surgery hospital in the world. The article provides an overview
of the use of a new spinal fusion system that incorporates state
of the art new spinal bone screws. Information from this article
will be useful in demonstrating some current breakthroughs in
the field of bone screws, and will provide a specific surgery
this technology is useful for.
C. Tai, T. Tsai, P. Lai, Y. Chen, M. Liu, L. Chen (2015). “A
Biomechanical Comparison of Expansive Pedicle Screws for
Severe Osteoporosis: The Effects of Screw Design and Cement
Augmentation.
Plos
ONE,
10(12).
(Online
article).http://web.b.ebscohost.com/ehost/pdfviewer/pdfviewe
r?sid=2f65547b-871b-40af-a9a56a97dfde0150%40sessionmgr120&vid=51&hid=106. p. 1
This peer reviewed research article from a credible source
introduces the comparison between pedicle screws that are
used with or without cement augmentation. Recent findings
suggest that pedicle screws with cement augmentation
extremely benefit screw fixation and screw pullout strength.
This articles goes into detail on the effects of differently
designed screws. With this information, we will be able to
thoroughly explain the benefits of bone cement and how we
can use this innovation in the future.
“Precision CNC-Swiss Surgical Screws for Superior
Performance” (2016). Autocam Medical. (Online article).
http://www.autocam-medical.com/products/orthopedicimplants/orthopedic-bone-screws/
This article is on the web page for Autocam Medical which
is an engineering company that supplies various surgical tools
throughout the world. The article discusses some of their
current bone screw materials and designs. This information
will be helpful in our paper to show how new bone screw
technologies are being applied by engineering companies
today.
2
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