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Introduction: Chest wall reconstruction in children after large resection of tumors may be performed with rigid or soft materials. Cementoplasty is commonly used with the "Sandwich" method i.e. gore-tex meshes surrounding both faces of the cement., Hypothesis: Is antibiotic loaded single-side gore-tex "Tartine" methyl-methacrylate cementoplasty an interesting alternative to the double-side "sandwich" method for chest wall reconstruction?, Material and Methods: Consecutive patients who were treated from 2011 to 2023 in our hospital were included., Results: Among the ten children treated with a median 5.6 years follow-up, there were no surgical complications related to the reconstruction, loss of function, infections, post operative complications (versus 22.7% in meta-analysis encompassing the 50 rigid reconstructions reported worldwide) nor scoliosis (versus 25%). Three patients have an asymmetric chest wall appearance., Discussion: "Tartine" cementoplasty is a simple, low-cost technique for pediatric chest wall reconstruction. It is well tolerated and checks key demands for chest wall reconstructions., Level of Evidence: IV; retrospective case series., (Copyright © 2024. Published by Elsevier Masson SAS.)

Pelvic bone metastases frequently result in severe pain and disability. Open surgical reconstruction is associated with a high complication and mortality rate. Percutaneous screw fixation is a minimally invasive treatment that is safe and effective for the management of periacetabular metastases. This article details our technique for pelvic screw fixation, including (1) perioperative care, (2) navigation and needle guidance, (3) access, (4) biopsy and ablation, (5) screw placement, and (6) cement augmentation., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Reinforced cementoplasty with spindles is a recently introduced technique that is mainly used for pathological fractures or for bone metastases at risk of fracture in locations with shear stresses. The technique is less challenging to perform than percutaneous screw insertion and does not require equipment sterilization. No general anesthetic is required. A small trocar is all that is needed, and sutures are often unnecessary. Reinforced cementoplasty can therefore be considered as a technical evolution of cementoplasty with the simple addition of material within the trocar. This technique deserves more awareness so that it can be included in interventional radiologists' range of procedures., (Copyright © 2024 SIR. Published by Elsevier Inc. All rights reserved.)

Purpose: To report the rate of fragmentation of the cement plug following percutaneous cementoplasty with polymethylmethacrylate (PMMA) in the bony pelvis (i.e., pelvic bones or sacrum)., Materials and Methods: Post-interventional and follow-up CT scans of 56 patients (36 men; mean age of 68.4 ± 15.4) with a total of 98 percutaneous cementoplasty procedures were analyzed. Indications for treatment included painful malignant tumors (42.9%; 42/98) and insufficiency fractures (57,1%; 56/98). Fragmentation of PMMA was recorded for each cement plug., Results: Mean interval between the procedure and the last available CT scan was 29.3 ± 18.8 months. There was no significant difference between the length of follow-up of malignant lesions (27.6 ± 15.1 months) and insufficiency fractures (29 ± 20.5 months) (p = 0.69). Fragmentation was diagnosed following 2/98 (2%) procedures, both in the malignant lesions group. The time intervals between the procedure and the first visualization of cement fragmentation were 6 for the first and 24 months for the second patient., Conclusion: Fragmentation of the PMMA plug following percutaneous cementoplasty in the bony pelvis is a rare finding at midterm follow-up. It was only observed in cementoplasty performed in malignant lesions and seems to be more a consequence of local mechanical stresses than as a result of porosity.

Objective: For symptomatic metastasis of the long bones, intramedullary nailing has been the most accepted fixation method. Intramedullary nailing has effective control of pain, perioperative bleeding, and local tumor progression by augmentation with bone cement around the nail. Here, we report the preliminary results of a new surgical implant that allows for simultaneous injection of bone cement while inserting a percutaneous, flexible intramedullary nail., Materials and Methods: We performed palliative surgeries for long-bone metastasis using a multi-hole injection nail (MIN) with multiple side holes in the distal one third. When the nail tip entered the metastatic cancer lesion, the bone cement injection was started, and continued until the nail was completely seated. Ten patients with advanced cancer underwent palliative surgery using the new implant with simultaneous bone cement injection for humeral (n = 4), femoral (n = 4), and tibial (n = 2) metastases., Results: The mean operative time was 42 min (range, 36-52 min). The mean length of the injection nail was 23.0 cm (range, 18.0-33.0 cm), and the mean volume of cement was 28.0 ml (range, 14.0-40.0 ml). Marked pain palliation (p < 0.001) and functional recovery (p = 0.01) were verified. The mean Musculoskeletal Tumor Society (MSTS) functional score improved significantly from 12.5 at 6 weeks preoperatively, to 24.9 postoperatively. No acute postoperative complications, including cement embolism, occurred., Conclusion: This minimally invasive surgical method with MIN could be useful for stabilization of long-bone metastases in patients with advanced cancer.

Objective: To evaluate low-pressure bone stenting combined with cementoplasty in extensive lytic lesions., Methods: A single-centre study involving four consecutive patients (four women) with extensive lytic tumours was performed. The average age was 65 years. Surgical treatment was not indicated or not wished for by the patients. Institutional review board approval and informed consent were obtained. Percutaneous consolidation was performed by an interventional radiologist under fluoroscopy guidance. Follow-up was assessed using the visual analogue scale (VAS)., Results: Under general (n = 2) or local (n = 2) anaesthesia, five 11-gauge bone biopsy needles were advanced in four lesions. Five auto-expandable uncovered stents (10-14 mm diameter and 40-60 mm long) were inserted. In all cases, bone cement was successfully placed into the tumours. The volume of cement that was injected through the cannulas into the stents was 5-10 mL. Using VAS, pain decreased from more than 9/10 preoperatively to less than 2/10 after the procedure for all patients (p < 0.05). No complications occurred during the follow-up (8-19 months)., Conclusion: This study suggests that cementoplasty combined with low-pressure bone stenting could allow effective bone stabilization resulting in pain relief., Key Points: • Low-pressure bone stenting is possible. • This technique improves cement injection control. • The procedure allows effective bone stabilization resulting in pain relief.

Bone metastases are a common finding in oncology. They often induce pain but also fractures which impair quality of life, especially when involving weight-bearing bones. Percutaneous image-guided consolidation techniques play a major role for the management of bone metastases. Cementoplasty aims to stabilize bone and control pain by injecting acrylic cement into a weakened bone. This minimally invasive technique has proven its efficacy for bones submitted to compression forces: vertebra, acetabular roof, and condyles. However, long bone diaphysis should be treated with caution due to lower resistance of the cement subject to torsional forces. The recent improvements of navigation systems allow percutaneous image-guided screw fixation without requiring open surgery. This fast-track procedure avoids postponing introduction of systemic therapies. If needed, cementoplasty can be combined with screw insertion to ensure better anchoring in major osteolysis. Interventional radiology bone consolidation techniques increase the therapeutic field in oncology. A multidisciplinary approach remains mandatory to select the best indications., (Copyright © 2017 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)

Objective: To compare the efficacy of percutaneous long bone cementoplasty (PLBC) with and without embedding a cement-filled catheter in the medullary canal (ECFC) for painful long bone metastases with impending fracture., Methods: A retrospective study was conducted in 36 consecutive patients undergoing PLBC and ECFC combination (n = 17, group A) or PLBC alone (n = 19, group B). All patients had a high risk of impending fracture in the long bone based on Mirels' scoring system. Clinical effects were evaluated using both a pre- and a postoperative visual analogue scale (VAS) and Karnofsky performance scale (KPS)., Results: Overall pain relief rate with excellent (VAS 0-2) and good (VAS 2.5-4.5) results during follow-up was significantly higher in group A than in group B (88.2 % vs. 57.9 %, P<0.05). The average VAS and KPS changes in group A were significantly higher than those in group B at 1, 3 and 6 months postoperatively (P<0.05). Also, the rate of fractures of the treated long bone in group A was significantly lower than that in group B (P<0.05)., Conclusions: Combined PLBC and ECFC is a safe and effective procedure for long bone metastases with impending fracture., Key Points: • Metastases in long bones may cause pain and subsequent pathological fractures. • Cementoplasty resulted in significant pain relief in patients with long bone metastases. • Combination of PLBC and ECFC may reduce the incidence of fractures.

Aims: The purpose of the study was to investigate whether closed intramedullary (IM) nailing with percutaneous cement augmentation is better than conventional closed nailing at relieving pain and suppressing tumours in patients with metastases of the femur and humerus., Patients and Methods: A total of 43 patients (27 men, 16 women, mean age 63.7 years, standard deviation (sd) 12.2; 21 to 84) underwent closed IM nailing with cement augmentation for long bone metastases. A further 27 patients, who underwent conventional closed IM nailing, served as controls. Pain was assessed using a visual analogue scale (VAS) score pre-operatively (pre-operative VAS), one week post-operatively (immediate post-operative VAS), and at six weeks post-operatively (follow-up post-operative VAS). Progression of the tumour was evaluated in subgroups of patients using F-18-fludeoxyglucose (F-18-FDG) positron emission tomography (PET)/computed tomography (CT) and/or bone scintigraphy (BS), at a mean of 8.8 and 7.2 months post-operatively, respectively., Results: The mean pain scores of patients who underwent closed nailing with cement augmentation were significantly lower than those of the control patients post-operatively (immediate post-operative VAS: 3.8, sd 0.9 versus 6.0, sd 0.9; follow-up post-operative VAS: 3.3, sd 2.5 versus 6.6, sd 2.2; all p < 0.001). The progression of the metastasis was suppressed in 50% (10/20) of patients who underwent closed nailing with augmentation, but in only 8% (1/13) of those in the control group., Conclusion: Percutaneous cement augmentation of closed IM nailing improves the relief of pain and limits the progression of the tumour in patients with metastases to the long bones., Take Home Message: Percutaneous cement augmentation while performing closed IM nailing has some advantages for long bone metastases. Cite this article: Bone Joint J 2016;98-B:703-9., (©2016 The British Editorial Society of Bone & Joint Surgery.)

Background: Percutaneous radiofrequency ablation and cementoplasty is an alternative palliative therapy for painful metastases involving axial load-bearing bones. This technical report describes the use of a navigational radiofrequency probe to ablate acetabular metastases from an anterior approach followed by instillation of ultrahigh viscosity cement under CT-fluoroscopic guidance., Materials and Methods: The tumor ablation databases of two institutions were retrospectively reviewed to identify patients who underwent combination acetabular radiofrequency ablation and cementoplasty using the STAR Tumor Ablation and StabiliT Vertebral Augmentation Systems (DFINE; San Jose, CA). Pre-procedure acetabular tumor volume was measured on cross-sectional imaging. Pre- and post-procedure pain scores were measured using the Numeric Rating Scale (10-point scale) and compared. Partial pain improvement was categorically defined as ≥ 2-point pain score reduction. Patients were evaluated for evidence of immediate complications. Electronic medical records were reviewed for evidence of delayed complications., Results: During the study period, 12 patients with acetabular metastases were treated. The median tumor volume was 54.3 mL (range, 28.3-109.8 mL). Pre- and post-procedure pain scores were obtained from 92% (11/12) of the cohort. The median pre-procedure pain score was 8 (range, 3-10). Post-procedure pain scores were obtained 7 days (82%; 9/11), 11 days (9.1%; 1/11) or 21 days (9.1%; 1/11) after treatment. The median post-treatment pain score was 3 (range, 1-8), a statistically significant difference compared with pre-treatment (P = 0.002). Categorically, 73% (8/11) of patients reported partial pain relief after treatment. No immediate symptomatic complications occurred. Three patients (25%; 3/12) were discharged to hospice within 1 week of treatment. No delayed complications occurred in the remaining 75% (9/12) of patients during median clinical follow-up of 62 days (range, 14-178 days)., Conclusions: Palliative percutaneous acetabular radiofrequency ablation and cementoplasty can be feasibly performed from an anterior approach using a navigational ablation probe and ultrahigh viscosity cement instilled under CT-fluoroscopic guidance.

This study investigated the use of injectable poly(propylene fumarate) (PPF) formulations for mandibular fracture stabilization applications. A full factorial design with main effects analysis was employed to evaluate the effects of the PPF:N-vinyl pyrrolidone (NVP, crosslinking agent) ratio and dimethyl toluidine (DMT, accelerator) concentration on key physicochemical properties including setting time, maximum temperature, mechanical properties, sol fraction, and swelling ratio. Additionally, the effects of formulation crosslinking time on the mechanical and swelling properties were investigated. The results showed that increasing the PPF:NVP ratio from 3:1 to 4:1 or decreasing the DMT concentration from 0.05 to 0.01 v/w % significantly decreased all mechanical properties as well as significantly increased the sol fraction and swelling ratio. Also, increasing the crosslinking time at 37°C from 1 to 7 days significantly increased all mechanical properties and decreased both the sol fraction and swelling ratio. This study further showed that the flexural stiffness of ex vivo stabilized rabbit mandibles increased from 1.7 ± 0.3 N/mm with a traditional mini-plate fixator to 14.5 ± 4.1 N/mm for the 4:1 (0.05 v/w % DMT) PPF formulation at day 1. Overall, the formulations tested in this study were found to have properties suitable for potential further consideration in mandibular fracture fixation applications., (© 2014 Wiley Periodicals, Inc.)

Background: Conventional water-free polymethylmethacrylate cements are not MRI visible due to the lack of free protons. A new MRI-visible bone cement was developed through the addition of a contrast agent and either a saline solution or a hydroxyapatite (Wichlas et al., 2010). The purposes of the study were to examine the influence of the two MRI-signal-inducing cements on the biomechanical behavior of cadaveric osteoporotic vertebral bodies after vertebroplasty and to compare the performance of the cements with conventional polymethylmethacrylate cement., Methods: Three different cements were used: standard polymethylmethacrylate cement and two modified MRI-signal-inducing cements that were mixed with either a 0.9% saline solution or a hydroxyapatite. The modulus of elasticity for the standard polymethylmethacrylate cement was 2040MPa, and the moduli for the MRI-signal-inducing cements that were mixed with a 0.9% saline solution and a hydroxyapatite were 1477 and 1225MPa, respectively. The lumbar vertebral bodies from nine osteoporotic spines (mean age=87 years, range=78-99 years) of female cadavers were examined. Three groups were formed: polymethylmethacrylate cement with saline solution (n=14), polymethylmethacrylate cement with hydroxyapatite (n=12) and polymethylmethacrylate cement (n=13). The vertebral bodies were biomechanically tested before and after vertebroplasty. Stiffness was chosen as the primary biomechanical parameter., Findings: The vertebral body stiffness was nearly two-fold greater after vertebroplasty, and this increase was statistically significant for every group. All the groups had similar vertebral body stiffness value before and after the vertebroplasty. The UNIANOVA test for multivariate analysis of variance showed no influence of lumbar level, injected cement volume and initial vertebral body stiffness., Interpretation: The elastic moduli of the cements appear to exert little influence on the biomechanical values when the cement is in the vertebral body. Based on the direct comparison with the classic polymethylmethacrylate cement, we believe that the implementation of such cements for MRI-guided vertebroplasties is feasible., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

The study presents comparative analysis of porous composites made of chitosan, alginate, fibrin with beta-tricalcium phosphate. Histological findings on Wistar rat condyles showed that fibrin-beta-TCP-based composite had the most effective positive biological response.

We evaluate the efficacy-safety of percutaneous vertebroplasty (PV) as primary treatment in adult degenerative scoliosis. During the last 4 years, PV was performed in 18 adult patients (68 vertebral bodies) with back pain due to degenerative scoliotic spine. Under anaesthesia and fluoroscopy, direct access to most deformed vertebral bodies was obtained by 13G needles, and PMMA for vertebroplasty was injected. Scoliosis' inner arch was supported. Clinical evaluation included immediate and delayed studies of patient's general condition and neurological status. An NVS scale helped assessing pain relief, life quality, and mobility improvement. Comparing patients' scores prior to (mean value 8.06 ± 1.3 NVS units), the morning after (mean value 3.11 ± 1.2 NVS units), at 12 (mean value 1.67 ± 1.5 NVS units), and 24 months after vertebroplasty (mean value 1.67 ± 1.5 NVS units) treatment, patients presented a mean decrease of 6.39 ± 1.6 NVS units on terms of life quality improvement and pain relief (P = 0.000). Overall mobility improved in 18/18 (100%) patients. No complications were observed. During follow-up period (mean value 17.66 months), all patients underwent a mean of 1.3 sessions for facet joint and nerve root infiltrations. Percutaneous vertebroplasty in the inner arch seems to be an effective technique for supporting adult degenerative scoliotic spine.

The aim of this study is to assess the interest of cementoplasty in the management of bone metastases, based on a retrospective study involving 42 cementoplasty procedures. The median age of the patients is 59 years, with 24 women (57%) and 18 men, all of them presenting with an advanced disease. The cementoplasty was situated in long bones (ten patients), dorsal or lumbar vertebrae (13) and flat bones (20). The principal indication was pain, sometimes with consolidation. The intensity of pain decreases between the day before and the month following the treatment (P = 0.04) among the 25 patients who had pain assessment before and after the procedure. We note 57% good results (24 patients), 9.5% failures (4 patients), and 31% with partial results (13 patients), that is, a total of 88% with "partial or full" alleviation. 16 patients out of 22 (73%) who were no longer able to walk (because of the pain or risk of fracture) were able to resume walking. We observed in this series 40.5% of complications, all of them benign. Cementoplasty improves the quality of life of patients with bone metastases, by decreasing the pain in 88% of cases and allowing the resumption of walking in almost three-quarters of the patients who had lost the ability to walk.

With an ageing population, hip fractures are a progressively worsening global burden that impact both the patient and healthcare systems. More than half of hip fractures are intracapsular and the majority of them are treated with arthroplasty surgery for pain relief and restoration of mobility. For most hip fracture patients, who are generally older and frail, the aim of the surgeon is to provide treatment with the lowest possible mortality, complication and revision rates, coupled with improved health-related quality of life. Registry data show more favourable outcomes with cemented rather than cementless hemiarthroplasty in this challenging patient group. This article describes the techniques for cementing the femur during a hemiarthroplasty to recreate the patient's anatomy, as well as how to perform safe cementing techniques to reduce the risk of cement related complications. [ABSTRACT FROM AUTHOR]

Inflammatory conditions such as chronic otitis media (COM) can cause irreversible impairments in the microarchitecture and functions of the incus, which subsequently leads to conductive hearing loss. To investigate bone mineral density (BMD) of the incus body (IB) and long process (ILP) on preoperative temporal CT in COM patients with and without incudo-stapedial joint discontinuity (ISJD), and also to determine the association between BMD values and the postoperative air-bone gap (ABG) in the ISJD group. The mean IB density (IBD)/occipital bone density (OBD) and ILP density (ILPD)/OBD values were compared between the patients with and without ISJD. The correlation between ABG gain and preoperative incus density values was assessed in the ISJD group. The mean IBD/OBD and ILPD/OBD values were significantly higher in patients with intact ISJ. There was a moderate positive correlation between postoperative ABG gain and ILPD/OBD values in the ISJD group. The decrease in BMD of the incus may involve ILP as well as IB in patients with ISJD caused by ILP lysis in COM. A higher preoperative ILPD/OBD was correlated with a higher postoperative ABG gain in COM patients with ISJD. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to evaluate the use of percutaneous curved vertebroplasty procedure (PCVP) and bilateral-pedicle-approach percutaneous vertebroplasty (bPVP) for the treatment of osteoporotic vertebral compression fractures (OVCFs) through a systematic review and meta-analysis of the scientific literature. Methods: A systematic review of the scientific literature in PubMed, China National Knowledge Infrastructure (CNKI), Wanfang and other databases was conducted in conjunction with different keywords. Nine studies were included; all but 3 were randomised controlled studies and all were prospective or retrospective cohort studies. Results: We observed statistically significant differences between the PCVP group and the bPCVP group in terms of postoperative visual analogue scale (VAS) scores (mean difference [MD]: −.08; 95% confidence intervals [CI]: −.15 to.00), bone cement leakage rates (OR =.33; 95%CI:.20 to.54), bone cement injection (MD: −1.52; 95%CI: −1.58 to 1.45), operative times (MD: −16.69; 95%CI: −17.40 to −15.99) and intraoperative fluoroscopies (MD: −8.16; 95%CI: −9.56 to −6.67), with the PCVP group being more dominant. There were no statistical differences in postoperative Oswestry Disability Index (ODI) scores (MD: −.72; 95%CI: −2.11 to.67) and overall bone cement distribution rates (MD: 2.14; 95%CI:.99 to 4.65) between the 2 groups. Conclusions: Meta-analysis showed more favourable outcomes in the PCVP group compared to the bPVP group. PCVP might be effective and safe in the treatment of OVCFs because it relieves postoperative patient pain, reduces operative time and cement injection, and decreases the risk of cement leakage and radiation exposure to the surgeon and patient. [ABSTRACT FROM AUTHOR]

Objectives: To assess the feasibility and technical outcomes of pelvic bone cementoplasty using an electromagnetic navigation system (EMNS) in standard practice. Materials and methods: Monocentric retrospective study of all consecutive patients treated with cementoplasty or reinforced cementoplasty of the pelvic bone with EMNS-assisted procedures. The endpoints were periprocedural adverse events, needle repositioning rates, procedure duration, and radiation exposure. Results: A detailed description of the technical steps is provided. Thirty-three patients (68 years ± 10) were treated between February 2016 and February 2020. Needle repositioning was required for 1/33 patients (3%). The main minor technical adverse event was soft tissue PMMA cement leaks. No major adverse event was noted. The median number of CT acquisitions throughout the procedures was 4 (range: 2 to 8). Radiation exposure and mean procedure duration are provided. Conclusion: Electromagnetic navigation system–assisted percutaneous interventions for the pelvic bone are feasible and lead to low rates of minor technical adverse events and needle repositioning. Procedure duration and radiation exposure were low. Key Points: • Initial experience for 33 patients treated with an electromagnetic navigation assistance for pelvic cementoplasty shows feasibility and safety. • The use of an electromagnetic navigation system does not expose to high procedure duration or radiation exposure. • The system is efficient in assisting the radiologist for extra-axial planes in challenging approaches. [ABSTRACT FROM AUTHOR]

Objective: Examine the feasibility, safety, and results of a novel sacral percutaneous injection technique ("XX") addressing both the vertical and horizontal aspects of sacral insufficiency fractures (SIF). Methods: Prospective cohort study. Eight consecutive SIF patients with immobility and pain investigated using CT and nuclear imaging confirmed "H"-type fracture. Demographics, pain level, and ambulation status were recorded. The long-term quality of life was evaluated using the ODI questionnaire and pain VAS scores. Sacroplasty procedures in prone positioning using fluoroscopy were used to insert 2 bone trochars through the S1 pedicles and 2 trochars through the sacral ale aiming toward the SIJ, thus forming 2 "X" trochar formations. Balloon kyphoplasty was done through the trocars, and PMM was injected. Postoperative ambulation and VAS were recorded. Results: Average age was 81.5 years (±3.4 years). The time from presenting symptoms to hospital admission was 2 days to 4 months. All patients were significantly limited with ambulation. None had a neurologic compromise. Sacroplasty was performed with 2 cases that required additional lumbar kyphoplasty. The mean operative time was 54 min (±14). The average exposure was 19 mGy (±12 mGy). Two patients had cement leaks. CT and X-rays revealed good cement filling of the fractures sacral alae and body of S1. The average postoperative hospitalization was 10 days. All patients reported postoperatively pain relief immediately and were able to walk better. Follow-up time was 17 ± 12 months. Follow-up VAS was 2.7 (±2) and ODI was 57.3% (±21%). Conclusion: "XX" technique showed good outcomes for patients with higher complexity SIF, using the same principles as for lumbar VPL/KPL, and was found to be safe and effective. [ABSTRACT FROM AUTHOR]

Background: Socket fixation with bone grafting for dysplastic hips is technically demanding, and inadequate coverage of the socket may cause poor results in patients with severely dysplastic hips. An accurate technique to form a bone graft to fit into the defect is necessary. We aim to introduce the simple method of bone grafting, "inverted reamer technique" in cemented total hip arthroplasty (cTHA). Methods: After acetabular preparation with a normal acetabular reamer, the bone graft was prepared from the resected femoral head with the inverted reamer. The graft can be press-fit into the defect of the acetabulum with good compatibility through this method. Then, the bone graft was fixed with 1–3 screws and the socket was implanted with bone cement. Results: The "inverted reamer technique" can easily and automatically create a well-fit graft. This method is simple and technically less demanding; it can be performed by every surgeon, including trainee and inexperienced surgeons. Conclusion: This method can improve the outcome of cTHA for dysplastic hips by preserving bone stock and increasing bone coverage of the socket implanted in the anatomic position. [ABSTRACT FROM AUTHOR]

Percutaneous osteoplasty (POP) is defined as the injection of bone cement into various painful bony lesions, refractory to conventional therapy, as an extended technique of percutaneous vertebroplasty (PVP). POP can be applied to benign osteochondral lesions and malignant metastatic lesions throughout the whole skeleton, whereas PVP is restricted to the vertebral body. Common spinal metastases occur in the thoracic (70%), lumbosacral (20%), and cervical (10%) vertebrae, in order of frequency. Extraspinal metastases into the ribs, scapulae, sternum, and humeral head commonly originate from lung and breast cancers; extraspinal metastases into the pelvis and femoral head come from prostate, urinary bladder, colon, and uterine cervical cancers. Pain is aggravated in the dependent (or weight bearing) position, or during movement (or respiration). The tenderness and imaging diagnosis should match. The supposed mechanism of pain relief in POP is the augmentation of damaged bones, thermal and chemical ablation of the nociceptive nerves, and local inhibition of tumor invasion. Adjacent (facet) joint injections may be needed prior to POP (PVP). The length and thickness of the applied needle should be chosen according to the targeted bone. Bone cement is also selected by its osteoconduction, osteoinduction, and osteogenesis. Needle route should be chosen as a shortcut to reach the target bony lesions, without damage to the nerves and vessels. POP is a promising minimally invasive procedure for immediate pain relief. This review provides a technical survey for POPs in painful bony lesions. [ABSTRACT FROM AUTHOR]

Introduction: Current guidelines recommend treating displaced femoral neck fractures with a total hip replacement in fit and active elderly patients. Dislocation remains the main complication. Dual-mobility cup (DMC) hip replacements maybe a solution to decrease dislocation, with the benefit of increasing stability, achieving better range of motion and functional outcomes. Patients and methods: This is a prospective randomised controlled trial which included 62 patients with Garden III and IV femoral neck fractures. The mean age was 67.2 years. 30 males and 32 females were included, randomised and allocated to 2 treatment groups; a cemented DMC replacement group, or a cemented 32-mm head total hip replacement (THR). The posterior approach was used in all patients. Postoperative functional outcome was assessed using Harris Hip Score (HHS). Health-related quality of life (HRQoL) was assessed using the SF-36 questionnaire. Results: The mean HHS for the DMC group at 4, 6 and 12 months were higher than mean HHS scores for the THR group (p < 0.001). The range of motion at 1 year was statistically better in the DMC group compared to the THR group (p < 0.001). The DMC showed a statistically better effect on the HRQoL measurements as compared to the THR group. There were no dislocations in both groups. Conclusions: DMC hip replacements provide better functional, patient reported outcomes, and range of motion than the conventional THR. Combined with its stability, DMC replacements are a useful solution in managing femoral neck fractures in active elderly patients. Trial serial number 020841 (IRB Number 00007555). [ABSTRACT FROM AUTHOR]

To evaluate the risk factors of cemented vertebral refracture after percutaneous vertebral augmentation (PVA) for patients with osteoporotic vertebral compression fractures (OVCFs). We performed a literature search on cemented vertebral refracture after PVA using the PubMed, EMBASE, and Cochrane Library medical databases. The clinical data, including literature information, basic patient information, observational factors, and interventional factors, were extracted by two authors. The pooled results and related heterogeneity of each factor between the refracture group and the non-refracture group were evaluated using Review Manager software 5.35. A total of 3185 patients from 10 studies were included, with 195 patients in the refracture group and 2990 patients in the non-refracture group. The mean follow-up duration was 18.9 months. According to the meta-analysis, age, low bone marrow density (BMD), intravertebral cleft (IVC), high anterior vertebral height (AVH) restoration/high Cobb angle restoration, and low cement dose were the risk factors of cemented vertebral refracture after PVA. Our results showed that age, low BMD, IVC, high AVH restoration, high Cobb angle restoration, and low cement dose were the risk factors for cemented vertebral refracture after PVA. [ABSTRACT FROM AUTHOR]

Purpose: To study the interobserver agreement for the analysis of lesion filling following cementoplasty of an acetabular osteolytic lesion, and investigate how subjective analysis compares to volumetric analysis.Materials and Methods: A total of 21 acetabular osteolysis were retrospectively analysed on pre- and immediate post-cementoplasty CT-scans by two senior interventional radiologists and one resident using a 4 grade scale to quantify lesion filling (Fsubjective): F ≤ 25%, 25% < F ≤ 50%, 50% < F ≤ 75% or F > 75%. Volumetric analysis (Fvolumetric) was performed with the delineation of the osteolysis and the cement using regions of interest. The interobserver agreement for Fsubjective was evaluated using the Fleiss' Kappa test for the 4 grade scale and for a simplified 2 grades scale (F ≤ 50% and F > 50%). The performance of Fsubjective versus Fvolumetric (considered as the gold standard) was then evaluated for each reader using the calculation of accuracy and error to reference for the 4 grades scale and accuracy, sensitivity, specificity, positive predictive value and negative predictive value for the 2 grade scale.Results: Interobserver agreement was considered as very low (< 0.2) for the 4 grade scale analysis and as low (> 0.2 and < 0.4) for the 2 grade scales analysis with kappa factors of 0.196 and 0.36 respectively. Compared to volumetric analysis, the overall accuracy of the 4- and 2- grade scales were 36.5% and 60% respectively.Conclusion: Subjective evaluation of cement filling of an acetabular osteolytic lesion is associated with poor interobserver agreement and overestimation of the percentage compared to volumetric analysis. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate electromagnetic navigation system (ENS) for percutaneous fixation by internal cemented screw (FICS) under CT guidance.Background: FICS is a recently developed modality that consists in inserting screws, under imaging guidance, into bone through a minimal skin incision. FICS recently showed good efficacy for the palliation or prevention of pathologic fractures of the pelvic ring and femoral neck.Materials and Methods: In this single-center retrospective study, we reviewed all consecutive cancer patients treated with percutaneous FICS under ENS-assisted CT guidance for the prevention or palliation of pelvic or femoral neck fractures. The primary endpoint was technical success. Secondary endpoints were screw placement accuracy (defined by proximal deviation p, distal deviation d, and angle deviation θ), radiation dose exposure, number of CT acquisitions, duration of procedures, and complications.Results: Mean duration of FICS procedures was 111 ± 51 min. Mean post-procedure hospitalization length was 2.1 days. Technical success was achieved in 48 cases (96%) with a total of 76 screws inserted. Mean distance p, mean distance d, and mean angle θ were respectively 8.0 ± 4.5 mm, 7.5 ± 4.4 mm, and 5.4 ± 2°. Angle θ accuracy was higher for screws with a craniocaudal angulation of less than 20° (4.4° vs 6.4°, p = 0.02). The mean number of CT acquisitions during procedures was 6.4 ± 3.0. The mean dose length product was 1524 ± 953 mGy cm and the mean dose area product was 12 ± 8 Gy cm2. Five complications occurred in 4 patients.Conclusion: CT guidance assisted by ENS is an effective approach for percutaneous FICS.Key Points: • ENS-assisted CT enables screw insertion in the pelvic ring and femoral neck, with a wide range of trajectories, even when a significant craniocaudal angulation is required. • ENS-assisted CT can be used as an alternative to CBCT guidance for percutaneous fixation by internal cemented screw. • ENS-assisted CT provides high technical success rate with excellent placement accuracy. [ABSTRACT FROM AUTHOR]

Metastatic disease involving the pelvis is common, often resulting in significant pain and disability. Several percutaneous interventions for unstable pelvic metastatic disease have been described, including osteoplasty, ablation, and screw fixation, that when used alone or in combination can significantly reduce pain and disability from metastatic bone disease. While it is possible to make a significant impact in patient care with basic principles and techniques, certain advanced techniques can extend the application of percutaneous interventions while minimizing morbidity. [ABSTRACT FROM AUTHOR]

Loosened/pulled-out iliac screws can be a challenging complication, as revision opportunities are limited because more distal anchorage is impossible. Insertion of thick-diameter screws is an option in cases with loosened thin-diameter screws. However, this is occasionally infeasible in patients with loosened thick-diameter screws. Therefore, this study aimed to biomechanically analyze whether loosened/pulled-out thick iliac screws regain strong anchorage following cement augmentation. Six human pelvis specimens were dissected to isolate 12 hemipelves, and 9 × 80 mm iliac screws were implanted. The pullout maneuver was performed followed by cement augmentation of the same screw within the same screw hole. After cement hardening, pullout was performed again. Forces needed for pullout and the insertion torque were measured for the 12 iliac screws. Cement augmentation significantly increased stability, with the pullout forces required being as high as 953.23 N (standard deviation [SD] 1070.46 N; median 306.30 N) for the uncemented screws and 2897.53 N (SD 585.83 N; median 2907.81 N) after cement augmentation (p < 0.001). No correlation was found between insertion torques and pullout forces. While revision of loosened iliac screws can often be achieved using higher diameters, this method is limited by the thickness of the screws already in place. We demonstrated that cement augmentation significantly increases stability even in thick-diameter screws, achieving more pullout stability than before the initial pullout. This method may be a cost-effective and rapid option for revision, even with significant defects and with no thicker-diameter iliac screw being available. • Loosened/pulled-out iliac screws can be a challenging complication. • Thick-diameter screws may be used to replace loosened thin-diameter screws. • However, this is occasionally infeasible with loosened thick-diameter screws. • Cement augmentation significantly increases stability with thick-diameter screws. • Cement augmentation seems a cost-effective and rapid option for revision surgery. [ABSTRACT FROM AUTHOR]

The large bone defect treatment is a challenge issue in modern orthopaedic trauma surgery. One of the most used technique is the Masquelet's technique. In this case report we used a modified Masquelet technique to fill a six centimeters bone gap in the proximal femur. A 18-year-old boy with a septic pseudoarthrosis was treated with a two stages procedure: in the first step we used a hollow antibiotic spacer and an intramedullary nail. In the second step, we used both omologous (6 cm of bone allograft) and autologous bone graft with a new intramedullary nail. Immediate partial weight bearing was allowed and after 3 months the patient started walking with complete weight bearing. A year later the fracture had healed uneventfully. The modification of the Masquelet Technique that we have made allows the patient to immediately weight bearing safely, speeding up the functional recovery. Further studies are needed to standardize this type of combined technique. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this prospective, randomised study was to examine the feasibility and clinical outcome of balloon sacroplasty and radiofrequency sacroplasty.Methods: In 40 patients with a total of 57 sacral fractures, CT-guided cement augmentation was performed by means of BSP or RFS. For BSP, the balloon catheter was inflated and deflated in the fracture zone, and the hollow space, thus, created was then filled with PMMA cement. For RFS, the spongious space in the fracture zone was initially extended using a flexible osteotome, and the highly viscous PMMA cement, activated by radiofrequency, was then inserted into the prepared fracture zone. Pain intensity was determined on a VAS before the intervention, on the second day, and 6, 12 and 18 months after the intervention. The results were tested for significance by means of paired Wilcoxon rank-sum tests and Mann-Whitney U tests.Results: BSP and RFS were technically fully feasible in all patients. An average of 6.3 ml cement per fracture was inserted in the BSP group and an average of 6.1 ml per fracture in the RFS group. Leakage could be ruled out for both procedures. The mean pain score on the VAS before the intervention was 8.6 ± 0.55 in the BSP group and 8.8 ± 0.58 in the RFS group. On the second postoperative day, a significant pain reduction was seen (p < 0.001), with an average value of 2.5 (BSP ± 0.28, RFS ± 0.38) for both groups. After 6 (12; 18) months, these values were stable for the BSP group at 2.3 ± 0.27 (2.3 ± 0.24; 2.0 ± 0.34) and for the RFS group at 2.4 ± 0.34 (2.2 ± 0.26; 2.0 ± 0.31). With regard to pain, exceedance probability values of p = 0.86 (6 months), p = 0.94 (12 months) and p = 1 (18 months) were seen, so that neither treatment method leads to differences in results.Conclusions: BSP and RFS are interventional, minimally invasive procedures that enable reliable cement augmentation and achieve equally good clinical outcomes in the medium term. [ABSTRACT FROM AUTHOR]

Objectives: In long bones, cementoplasty alone does not provide sufficient stability, which may cause secondary fractures. This study reviewed the safety and efficacy of reinforced cementoplasty (RC) (percutaneous internal fixation using dedicated spindles combined with cementoplasty) for unstable malignant lesions of the cervicotrochanteric region (CTR) of the proximal femur.Methods: Eighteen consecutive patients (nine women [50%] and nine men [50%]; mean age 55.1 ± 16.2 years; range 22-85) underwent RC for 19 unstable lesions of the CTR (16/19 [84.2%] bone metastases, 3/19 [15.8%] multiple myeloma lesions). All the patients were considered unsuitable for surgery. Clinical outcome was judged with a mean follow-up of 8.8 ± 7.2 months (range 1-27). The primary endpoints were occurrence of secondary fractures during the follow-up period and local pain relief measured by a visual analogue scale (VAS).Results: No secondary fracture occurred. Mean VAS improved from 5.9 ± 3.1 (range 0-10) to 2.3 ± 2.4 (range 0-7) at 1 month (p = 0.001) to 1.6 ± 1.7 (range 0-5) at final follow-up (p = 0.0002). One symptomatic cement pulmonary embolism was recorded.Conclusion: RC is an original minimally invasive technique providing pain relief and effective bone stability for unstable malignant lesions of the cervicotrochanteric region in patients unsuitable for open surgery.Key Points: • Reinforced cementoplasty (RC) combines intralesional spindling with cementoplasty. • RC provides effective bone stability and pain relief. • RC is a suitable minimally invasive option for patients in poor general condition. [ABSTRACT FROM AUTHOR]

Pulmonary bone cement embolism (PCE) is an uncommon event occurring after implantation of polymethylmethacrylate (PMMA) in orthopaedic surgeries involving adult patients, more so in the elderly. Its incidence in the paediatric population is extremely rare. We herein describe a case of PCE in a 15-year-old girl, 9 days after she underwent total elbow replacement with PMMA placement for a primitive neuroectodermal tumour (PNET) of the distal humerus. This report describes the occurrence of a common post-operative complication of bone cement embolism in an uncommon scenario of total elbow replacement for a bone tumour in a child, which masqueraded initially as acute pneumonitis. [ABSTRACT FROM AUTHOR]

Purpose: Dual mobility (DM) socket has been associated with a low rate of dislocation following both primary and revision total hip arthroplasty (THA). However, little is known about the long-term efficiency of DM in the treatment of THA instability. The purpose of this retrospective study was to evaluate the outcome of a cemented DM socket to treat recurrent dislocation after a minimum of five year follow-up.Methods: The series included 51 patients with a mean age of 71.3 ± 11.5 (range, 41-98) years presenting with recurrent dislocation (mean 3.3). A single DM socket design was used consisting of a stainless steel outer shell with grooves with a highly polished inner surface articulating with a mobile polyethylene component. The femoral head was captured in the polyethylene component using a snap-fit type mechanism, the latter acting as a large unconstrained head inside the metal cup.Results: At the minimum five year follow-up evaluation, 18 of the 51 patients deceased at a mean of 4.8 ± 2.3 years, three were lost to follow-up at a mean of 1.4 years, seven had been revised at a mean of 4.7 ± 3.1 years (range, 1.5-9.1), and the remaining 23 were still alive and did not have revision at a mean of 8.2 ± 2.4 years (range, 5-13 years). Of the seven revision, three were performed for further episodes of dislocation (at the large bearing for one patient and intra-prosthetic for two patients) after a mean 5.9 ± 2.9 years (range, 2.7-9.1), whereas two were performed for late sepsis and two for aseptic loosening of the acetabular component. Radiographic analysis did not reveal any further loosening on the acetabular side. The survival rate of the cup at ten years, using re-dislocation as the end-point, was 86.1 ± 8.4% (95% confidence interval, 69.7-100%). The survival rate of the cup at ten years, using revision for any reason as the end-point, was 75.2 ± 9.3% (95% confidence interval, 56.9-93.5%).Conclusion: A cemented dual mobility cup was able to restore hip stability in 94% of patients presenting with recurrent dislocating hips up to 13-year follow-up with none of the complications associated with constrained devices, as mechanical failure occurred in only 3.9% of the patients of this series. The overall reduced survival using revision for any reason as the end-point at ten years was related to this specific patients population that had various co-morbidities. [ABSTRACT FROM AUTHOR]

Aims: To develop a Glass Polyalkenoate Cement that is suitable for vertebroplasty. Methods: Testing was carried out to assess the effect of gamma irradiation used for sterilisation, on the glass transition temperature as well as its mechanical properties, including compressive strength and biflexural strength in vivo as well as testing GPC and PMMA cements post injection in cadaveric human vertebral bone. Results: There was a trend to a higher failure load required for the GPC cement group compared to the current standard PMMA injected group but this was not statistically significant with this small sample size. Conclusion: The results are encouraging for future research to continue on GPC cements for use in vertebroplasty. [ABSTRACT FROM AUTHOR]

Vertebral cementoplasty is a well-known mini-invasive treatment to obtain pain relief in patients affected by vertebral porotic fractures, primary or secondary spine lesions and spine trauma through intrametameric cement injection. Two major categories of treatment are included within the term vertebral cementoplasty: the first is vertebroplasty in which a simple cement injection in the vertebral body is performed; the second is assisted technique in which a device is positioned inside the metamer before the cement injection to restore vertebral height and allow a better cement distribution, reducing the kyphotic deformity of the spine, trying to obtain an almost normal spine biomechanics. We will describe the most advanced techniques and indications of vertebral cementoplasty, having recently expanded the field of applications to not only patients with porotic fractures but also spine tumours and trauma. [ABSTRACT FROM AUTHOR]

Background and purpose —There have been few comparative studies on total knee replacement (TKR) with cemented tibia and uncemented femur (hybrid TKR). Previous studies have not shown any difference in revision rate between cemented and hybrid fixation, but these studies had few hybrid prostheses. We have evaluated the outcome of hybrid TKR based on data from the Norwegian Arthroplasty Register (NAR). Patients and methods —We compared 4,585 hybrid TKRs to 20,095 cemented TKRs with risk of revision for any cause as the primary endpoint. We included primary TKRs without patella resurfacing that were reported to the NAR during the years 1999–2012. To minimize the possible confounding effect of prosthesis brands, only brands that were used both as hybrids and cemented in more than 200 cases were included. Kaplan-Meier survival analysis and Cox regression analysis were done with adjustment for age, sex, and preoperative diagnosis. To include death as a competing risk, cumulative incidence function estimates were calculated. Results —Estimated survival at 11 years was 94.3% (95% CI: 93.9–94.7) in the cemented TKR group and 96.3% (CI: 95.3–97.3) in the hybrid TKR group. The adjusted Cox regression analysis showed a lower risk of revision in the hybrid group (relative risk = 0.58, CI: 0.48–0.72, p < 0.001). The hybrid group included 3 brands of prostheses: LCS classic, LCS complete, and Profix. Profix hybrid TKR had lower risk of revision than cemented TKR, but the LCS classic and LCS complete did not. Kaplan-Meier estimated survival at 11 years was 96.8% (CI: 95.6–98.0) in the hybrid Profix group and 95.2% (CI: 94.6–95.8) in the cemented Profix group. Mean operating time was 17 min longer in the cemented group. Interpretation —Survivorship of the hybrid TKR at 11 years was better than that for cemented TKR, or the same, depending on the brand of prosthesis. Hybrid fixation appears to be a safe and time-efficient alternative to cemented fixation in total knee replacement surgery. [ABSTRACT FROM PUBLISHER]

Purpose: Percutaneous cementoplasty (PC) is rarely applied to long bone tumours, since cement is not considered to be sufficiently resistant to torsional forces. We reviewed the literature to understand the effects of percutaneous long bone cementoplasty (PLBC) in terms of analgesia, limb function and complications.Materials and Methods: This study followed the Cochrane's guidelines for systematic reviews of interventions. Inclusion criteria were (1) prospective/retrospective studies concerning PC; (2) cohort including at least ten patients; (3) at least one patient in the cohort undergoing PLBC; (5) published in English; (6) results not published by the same author more than once.Results: One thousand five hundred and ninety-eight articles were screened and 13 matched the inclusion criteria covering 196 PLBC patients. Pain improvement was high in 68.2% patients (σ = 0.2) and mild in 27.4% (σ = 0.2). Functional improvement was high in 71.9% patients (σ = 0.1) and mild in 6% (σ = 0.1). Use of PLBC correlated with pain reduction (P < 0.001). Secondary fractures occurred in 16 cases (8%, σ = 2.5); other complications in 2% cases. Percutaneous stabilisation (PS) was coupled with PLBC in 17% of cases without any subsequent fracture. PS was not associated with absence of secondary fracture (P = 0.08).Conclusion: PLBC is safe, offering good pain relief and recovery of impaired limb function. Secondary fractures are uncommon and PS may reduce their occurrence. However, no evidence is currently available to support PS plus PLBC as compared to PLBC alone. [ABSTRACT FROM AUTHOR]