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.
John Driggers, jwd30@pitt.edu, Mahboobin 4:00, Louis McLinden, lkm29@pitt.edu, 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
[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-a9a5-
6a97dfde0150%40sessionmgr120&vid=51&hid=106. p. 1
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.
C. Lih-Huei, T. Ching-Lung, L. De-Mei, L. Po-Liang, L. Yen-
Chen, 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-a9a5-
6a97dfde0150%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.
“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.
“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.
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-a9a5-
6a97dfde0150%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.
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-a9a5-
6a97dfde0150%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.
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-a9a5-
6a97dfde0150%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.
2