Can High-friction Intraannular Material Increase Screw Pullout Strength in Osteoporotic Bone?
Background Osteoporotic bone brings unique challenges to orthopaedic surgery, including a higher likelihood of problematic screw stripping in cancellous bone. Currently, there are limited options to satisfactorily repair stripped screws. Additionally, nonstripped screws hold with less purchase in os...
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| Veröffentlicht in: | Clinical orthopaedics and related research 2015-03, Vol.473 (3), p.1150-1154 |
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| creator | Bronsnick, Daniel Harold, Ryan E. Youderian, Ari Solitro, Giovanni Amirouche, Farid Goldberg, Benjamin |
| description | Background
Osteoporotic bone brings unique challenges to orthopaedic surgery, including a higher likelihood of problematic screw stripping in cancellous bone. Currently, there are limited options to satisfactorily repair stripped screws. Additionally, nonstripped screws hold with less purchase in osteoporotic bone.
Questions/purposes
This study attempts to answer the following questions: (1) Does high-friction intraannular (HFIA) augmentation increase pullout strength in osteoporotic and in severely osteoporotic bone; and (2) can HFIA repair stripped bone thread in osteoporotic and severely osteoporotic bone?
Methods
We measured screw pullout strength using a synthetic bone model in three groups: (1) predrilled nonstripped control holes as controls; (2) predrilled nonstripped augmented with HFIA; and (3) predrilled stripped holes repaired with HFIA. We tested this in osteoporotic and severely osteoporotic synthetic bone for a total of six test groups. We measured screw pullout force using an electromechanical tensile-testing machine comparing pullout force between the test groups and controls.
Results
HFIA augmentation did not increase pullout force compared with the control group in the osteoporotic bone model (489 ± 175 versus 607 ± 76, respectively; effect size = 0.94 [95% confidence interval {CI}, −1.75 to 0.08], p = 0.06). However, in severely osteoporotic cancellous bone that was augmented, the HFIA material generated more pullout force than the control (51 ± 18 versus 35 ± 16, respectively; effect size = 0.94 [95% CI, −0.02 to 1.82], p = 0.05). In stripped holes, HFIA partially restored pullout strength but remained weaker than controls in both osteoporotic and severely osteoporotic bone models (osteoporotic: 320 ± 59 versus 607 ± 76, respectively; effect size = −4.28 [95% CI, −5.57 to −2.51], p |
| doi_str_mv | 10.1007/s11999-014-3975-1 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_4317434</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3579729371</sourcerecordid><originalsourceid>FETCH-LOGICAL-c573t-c1a3c8b5e62e57503ec1d708b337ecb449ac7d34850ad7a5b172031ba11986d3</originalsourceid><addsrcrecordid>eNqNkV9rFDEUxYModq1-AF8k4Isvqbn5M5l5UXSptlCp0D74IiGTye6mzCZrklH67c2wbakFoU-X5P7uuTk5CL0GegSUqvcZoOs6QkEQ3ilJ4AlagGQtAeDsKVpQSjvSMfhxgF7kfFWPXEj2HB0wyVSdgAX6uTQBn_j1hqySt8XHgE9DScaEMI0m4W-muOTNWG9tciY7fFHrH_x9Gsc4FXxRkgvrssE-4PNcXNzFFIu3-HMM7uNL9Gxlxuxe3dRDdPnl-HJ5Qs7Ov54uP50RKxUvxILhtu2la5iTSlLuLAyKtj3nytleiM5YNXDRSmoGZWQPilEOvan-22bgh-jDXnY39Vs3WDc7GPUu-a1J1zoar__tBL_R6_hbCw5KcFEF3t0IpPhrcrnorc_WjaMJLk5ZQ9NQQRU03SNQyYSQvKMVffsAvYpTCvUjZgo4tA2FSsGesinmnNzq7t1A9Ryz3sesa8x6jlnPM2_uG76buM21AmwP5NoKa5furf6v6l_8M7L4</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1651318601</pqid></control><display><type>article</type><title>Can High-friction Intraannular Material Increase Screw Pullout Strength in Osteoporotic Bone?</title><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>PubMed Central</source><source>SpringerLink Journals - AutoHoldings</source><creator>Bronsnick, Daniel ; Harold, Ryan E. ; Youderian, Ari ; Solitro, Giovanni ; Amirouche, Farid ; Goldberg, Benjamin</creator><creatorcontrib>Bronsnick, Daniel ; Harold, Ryan E. ; Youderian, Ari ; Solitro, Giovanni ; Amirouche, Farid ; Goldberg, Benjamin</creatorcontrib><description>Background
Osteoporotic bone brings unique challenges to orthopaedic surgery, including a higher likelihood of problematic screw stripping in cancellous bone. Currently, there are limited options to satisfactorily repair stripped screws. Additionally, nonstripped screws hold with less purchase in osteoporotic bone.
Questions/purposes
This study attempts to answer the following questions: (1) Does high-friction intraannular (HFIA) augmentation increase pullout strength in osteoporotic and in severely osteoporotic bone; and (2) can HFIA repair stripped bone thread in osteoporotic and severely osteoporotic bone?
Methods
We measured screw pullout strength using a synthetic bone model in three groups: (1) predrilled nonstripped control holes as controls; (2) predrilled nonstripped augmented with HFIA; and (3) predrilled stripped holes repaired with HFIA. We tested this in osteoporotic and severely osteoporotic synthetic bone for a total of six test groups. We measured screw pullout force using an electromechanical tensile-testing machine comparing pullout force between the test groups and controls.
Results
HFIA augmentation did not increase pullout force compared with the control group in the osteoporotic bone model (489 ± 175 versus 607 ± 76, respectively; effect size = 0.94 [95% confidence interval {CI}, −1.75 to 0.08], p = 0.06). However, in severely osteoporotic cancellous bone that was augmented, the HFIA material generated more pullout force than the control (51 ± 18 versus 35 ± 16, respectively; effect size = 0.94 [95% CI, −0.02 to 1.82], p = 0.05). In stripped holes, HFIA partially restored pullout strength but remained weaker than controls in both osteoporotic and severely osteoporotic bone models (osteoporotic: 320 ± 59 versus 607 ± 76, respectively; effect size = −4.28 [95% CI, −5.57 to −2.51], p < 0.001; severely osteoporotic: 21 ± 8 versus 35 ± 16, respectively; effect size = −1.13 [95% CI, −2.0 to 0.12], p = 0.027).
Conclusions
HFIA effectively augmented severely osteoporotic bone for screw purchase, but this effect was not seen for osteoporotic bone. In a model simulating both osteoporotic and severely osteoporotic bone, we found that HFIA can be used to repair stripped screw holes, but the resulting construct remains weaker than nonstripped controls.
Clinical Relevance
The HFIA material looks promising as a potential solution to stripped screws in osteoporotic bone. However, this material has yet to be tested in human bone. Furthermore, the fine mesh material could be damaged by autoclaving and could break off in vivo causing unknown tissue reactions. We recommend additional testing in a living animal model to better understand how living bone will react to the HFIA material.</description><identifier>ISSN: 0009-921X</identifier><identifier>EISSN: 1528-1132</identifier><identifier>DOI: 10.1007/s11999-014-3975-1</identifier><identifier>PMID: 25273971</identifier><language>eng</language><publisher>Boston: Springer US</publisher><subject>Basic Research ; Biomechanical Phenomena ; Bone Cements ; Bone Screws ; Conservative Orthopedics ; Equipment Design ; Friction ; Humans ; Materials Testing ; Medicine ; Medicine & Public Health ; Orthopedics ; Osteoporosis - surgery ; Sports Medicine ; Surgery ; Surgical Orthopedics</subject><ispartof>Clinical orthopaedics and related research, 2015-03, Vol.473 (3), p.1150-1154</ispartof><rights>The Association of Bone and Joint Surgeons® 2014</rights><rights>The Association of Bone and Joint Surgeons 2015</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c573t-c1a3c8b5e62e57503ec1d708b337ecb449ac7d34850ad7a5b172031ba11986d3</citedby><cites>FETCH-LOGICAL-c573t-c1a3c8b5e62e57503ec1d708b337ecb449ac7d34850ad7a5b172031ba11986d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4317434/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4317434/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,41464,42533,51294,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25273971$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bronsnick, Daniel</creatorcontrib><creatorcontrib>Harold, Ryan E.</creatorcontrib><creatorcontrib>Youderian, Ari</creatorcontrib><creatorcontrib>Solitro, Giovanni</creatorcontrib><creatorcontrib>Amirouche, Farid</creatorcontrib><creatorcontrib>Goldberg, Benjamin</creatorcontrib><title>Can High-friction Intraannular Material Increase Screw Pullout Strength in Osteoporotic Bone?</title><title>Clinical orthopaedics and related research</title><addtitle>Clin Orthop Relat Res</addtitle><addtitle>Clin Orthop Relat Res</addtitle><description>Background
Osteoporotic bone brings unique challenges to orthopaedic surgery, including a higher likelihood of problematic screw stripping in cancellous bone. Currently, there are limited options to satisfactorily repair stripped screws. Additionally, nonstripped screws hold with less purchase in osteoporotic bone.
Questions/purposes
This study attempts to answer the following questions: (1) Does high-friction intraannular (HFIA) augmentation increase pullout strength in osteoporotic and in severely osteoporotic bone; and (2) can HFIA repair stripped bone thread in osteoporotic and severely osteoporotic bone?
Methods
We measured screw pullout strength using a synthetic bone model in three groups: (1) predrilled nonstripped control holes as controls; (2) predrilled nonstripped augmented with HFIA; and (3) predrilled stripped holes repaired with HFIA. We tested this in osteoporotic and severely osteoporotic synthetic bone for a total of six test groups. We measured screw pullout force using an electromechanical tensile-testing machine comparing pullout force between the test groups and controls.
Results
HFIA augmentation did not increase pullout force compared with the control group in the osteoporotic bone model (489 ± 175 versus 607 ± 76, respectively; effect size = 0.94 [95% confidence interval {CI}, −1.75 to 0.08], p = 0.06). However, in severely osteoporotic cancellous bone that was augmented, the HFIA material generated more pullout force than the control (51 ± 18 versus 35 ± 16, respectively; effect size = 0.94 [95% CI, −0.02 to 1.82], p = 0.05). In stripped holes, HFIA partially restored pullout strength but remained weaker than controls in both osteoporotic and severely osteoporotic bone models (osteoporotic: 320 ± 59 versus 607 ± 76, respectively; effect size = −4.28 [95% CI, −5.57 to −2.51], p < 0.001; severely osteoporotic: 21 ± 8 versus 35 ± 16, respectively; effect size = −1.13 [95% CI, −2.0 to 0.12], p = 0.027).
Conclusions
HFIA effectively augmented severely osteoporotic bone for screw purchase, but this effect was not seen for osteoporotic bone. In a model simulating both osteoporotic and severely osteoporotic bone, we found that HFIA can be used to repair stripped screw holes, but the resulting construct remains weaker than nonstripped controls.
Clinical Relevance
The HFIA material looks promising as a potential solution to stripped screws in osteoporotic bone. However, this material has yet to be tested in human bone. Furthermore, the fine mesh material could be damaged by autoclaving and could break off in vivo causing unknown tissue reactions. We recommend additional testing in a living animal model to better understand how living bone will react to the HFIA material.</description><subject>Basic Research</subject><subject>Biomechanical Phenomena</subject><subject>Bone Cements</subject><subject>Bone Screws</subject><subject>Conservative Orthopedics</subject><subject>Equipment Design</subject><subject>Friction</subject><subject>Humans</subject><subject>Materials Testing</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Orthopedics</subject><subject>Osteoporosis - surgery</subject><subject>Sports Medicine</subject><subject>Surgery</subject><subject>Surgical Orthopedics</subject><issn>0009-921X</issn><issn>1528-1132</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqNkV9rFDEUxYModq1-AF8k4Isvqbn5M5l5UXSptlCp0D74IiGTye6mzCZrklH67c2wbakFoU-X5P7uuTk5CL0GegSUqvcZoOs6QkEQ3ilJ4AlagGQtAeDsKVpQSjvSMfhxgF7kfFWPXEj2HB0wyVSdgAX6uTQBn_j1hqySt8XHgE9DScaEMI0m4W-muOTNWG9tciY7fFHrH_x9Gsc4FXxRkgvrssE-4PNcXNzFFIu3-HMM7uNL9Gxlxuxe3dRDdPnl-HJ5Qs7Ov54uP50RKxUvxILhtu2la5iTSlLuLAyKtj3nytleiM5YNXDRSmoGZWQPilEOvan-22bgh-jDXnY39Vs3WDc7GPUu-a1J1zoar__tBL_R6_hbCw5KcFEF3t0IpPhrcrnorc_WjaMJLk5ZQ9NQQRU03SNQyYSQvKMVffsAvYpTCvUjZgo4tA2FSsGesinmnNzq7t1A9Ryz3sesa8x6jlnPM2_uG76buM21AmwP5NoKa5furf6v6l_8M7L4</recordid><startdate>20150301</startdate><enddate>20150301</enddate><creator>Bronsnick, Daniel</creator><creator>Harold, Ryan E.</creator><creator>Youderian, Ari</creator><creator>Solitro, Giovanni</creator><creator>Amirouche, Farid</creator><creator>Goldberg, Benjamin</creator><general>Springer US</general><general>Lippincott Williams & Wilkins Ovid Technologies</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QP</scope><scope>7RV</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20150301</creationdate><title>Can High-friction Intraannular Material Increase Screw Pullout Strength in Osteoporotic Bone?</title><author>Bronsnick, Daniel ; Harold, Ryan E. ; Youderian, Ari ; Solitro, Giovanni ; Amirouche, Farid ; Goldberg, Benjamin</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c573t-c1a3c8b5e62e57503ec1d708b337ecb449ac7d34850ad7a5b172031ba11986d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Basic Research</topic><topic>Biomechanical Phenomena</topic><topic>Bone Cements</topic><topic>Bone Screws</topic><topic>Conservative Orthopedics</topic><topic>Equipment Design</topic><topic>Friction</topic><topic>Humans</topic><topic>Materials Testing</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Orthopedics</topic><topic>Osteoporosis - surgery</topic><topic>Sports Medicine</topic><topic>Surgery</topic><topic>Surgical Orthopedics</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bronsnick, Daniel</creatorcontrib><creatorcontrib>Harold, Ryan E.</creatorcontrib><creatorcontrib>Youderian, Ari</creatorcontrib><creatorcontrib>Solitro, Giovanni</creatorcontrib><creatorcontrib>Amirouche, Farid</creatorcontrib><creatorcontrib>Goldberg, Benjamin</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Clinical orthopaedics and related research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bronsnick, Daniel</au><au>Harold, Ryan E.</au><au>Youderian, Ari</au><au>Solitro, Giovanni</au><au>Amirouche, Farid</au><au>Goldberg, Benjamin</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Can High-friction Intraannular Material Increase Screw Pullout Strength in Osteoporotic Bone?</atitle><jtitle>Clinical orthopaedics and related research</jtitle><stitle>Clin Orthop Relat Res</stitle><addtitle>Clin Orthop Relat Res</addtitle><date>2015-03-01</date><risdate>2015</risdate><volume>473</volume><issue>3</issue><spage>1150</spage><epage>1154</epage><pages>1150-1154</pages><issn>0009-921X</issn><eissn>1528-1132</eissn><abstract>Background
Osteoporotic bone brings unique challenges to orthopaedic surgery, including a higher likelihood of problematic screw stripping in cancellous bone. Currently, there are limited options to satisfactorily repair stripped screws. Additionally, nonstripped screws hold with less purchase in osteoporotic bone.
Questions/purposes
This study attempts to answer the following questions: (1) Does high-friction intraannular (HFIA) augmentation increase pullout strength in osteoporotic and in severely osteoporotic bone; and (2) can HFIA repair stripped bone thread in osteoporotic and severely osteoporotic bone?
Methods
We measured screw pullout strength using a synthetic bone model in three groups: (1) predrilled nonstripped control holes as controls; (2) predrilled nonstripped augmented with HFIA; and (3) predrilled stripped holes repaired with HFIA. We tested this in osteoporotic and severely osteoporotic synthetic bone for a total of six test groups. We measured screw pullout force using an electromechanical tensile-testing machine comparing pullout force between the test groups and controls.
Results
HFIA augmentation did not increase pullout force compared with the control group in the osteoporotic bone model (489 ± 175 versus 607 ± 76, respectively; effect size = 0.94 [95% confidence interval {CI}, −1.75 to 0.08], p = 0.06). However, in severely osteoporotic cancellous bone that was augmented, the HFIA material generated more pullout force than the control (51 ± 18 versus 35 ± 16, respectively; effect size = 0.94 [95% CI, −0.02 to 1.82], p = 0.05). In stripped holes, HFIA partially restored pullout strength but remained weaker than controls in both osteoporotic and severely osteoporotic bone models (osteoporotic: 320 ± 59 versus 607 ± 76, respectively; effect size = −4.28 [95% CI, −5.57 to −2.51], p < 0.001; severely osteoporotic: 21 ± 8 versus 35 ± 16, respectively; effect size = −1.13 [95% CI, −2.0 to 0.12], p = 0.027).
Conclusions
HFIA effectively augmented severely osteoporotic bone for screw purchase, but this effect was not seen for osteoporotic bone. In a model simulating both osteoporotic and severely osteoporotic bone, we found that HFIA can be used to repair stripped screw holes, but the resulting construct remains weaker than nonstripped controls.
Clinical Relevance
The HFIA material looks promising as a potential solution to stripped screws in osteoporotic bone. However, this material has yet to be tested in human bone. Furthermore, the fine mesh material could be damaged by autoclaving and could break off in vivo causing unknown tissue reactions. We recommend additional testing in a living animal model to better understand how living bone will react to the HFIA material.</abstract><cop>Boston</cop><pub>Springer US</pub><pmid>25273971</pmid><doi>10.1007/s11999-014-3975-1</doi><tpages>5</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Clinical orthopaedics and related research, 2015-03, Vol.473 (3), p.1150-1154 |
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| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; SpringerLink Journals - AutoHoldings |
| subjects | Basic Research Biomechanical Phenomena Bone Cements Bone Screws Conservative Orthopedics Equipment Design Friction Humans Materials Testing Medicine Medicine & Public Health Orthopedics Osteoporosis - surgery Sports Medicine Surgery Surgical Orthopedics |
| title | Can High-friction Intraannular Material Increase Screw Pullout Strength in Osteoporotic Bone? |
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