Osteoporotic Bone Augmentation Utilizing Curved Pattern of PMMA Injection: A Combined Finite Element and Optimization Investigation

A potential effective treatment for prevention of osteoporotic hip fractures is augmentation of the mechanical properties of the femur by injecting it with Polymethyl-Methacrylate (PMMA). We have previously developed a preoperative planning workstation to optimize the pattern of cement injection. In this planning paradigm, injections occur on a straight line limiting the overall match between the optimal and injected volumes of the cement. In addition, new advancements in drilling techniques has made it possible to plan and drill the bone based on a curved trajectory. In this study, we introduced a methodology to find the optimal drill path for PMMA injection. With the aid of Finite Element (FE) and hydrodynamic simulations, the effectiveness of the proposed approach was evaluated. Results showed that with an average injection of 7.2 ml, the proposed method can increase the yield load of the femur by 69%. Future works involve experimental validation of this method in cadaveric studies.