A Conductive Cooling Scheme for Bone Augmentation of the Proximal Femur With PMMA: An Experimental and Finite Element Study

The rate of one-year mortality after osteoporotic hip fracture in elderly is reported to be more than 20%. Hip augmentation using polymethylmethacrylate (PMMA) is an alternative preventive approach for patients at the highest risk of osteoporotic fracture. Excessive injection volumes of PMMA however may introduce the risk of thermal osteonecrosis. We have previously proposed a Finite element (FE) simulation to estimate the bone temperature elevations after cement injection in three key locations and demonstrated an agreement between the simulation results and the temperature measurements during the experiment. Previous study showed that the maximum temperature-rise measured at the hip surface is 10°C. The aim of this study is to introduce a cooling approach to reduce the PMMA’s curing temperature after cement injection during hip augmentation. For this purpose, we perform a conductive cooling experiment with a metallic K-wire attached to an ice-water bath. We also create a finite element simulation model for the proposed cooling system to estimate the peak temperature reduction and compare the simulation results with experimental data. Simulation results demonstrate the decrease of 80% of peak curing temperature during PMMA polymerization; similarly, sawbone experiments also show that on average the peak temperature has been reduced 64% when cooling system is integrated to the hip augmentation procedure.