Experimental magnesium phosphate cement paste increases torque of trochanteric fixation nail advanced™ blades in human femoral heads

• Published in: Clinical biomechanics (Bristol) 2023-10, Vol.109, p.106088-106088, Article 106088
• Main Authors: Hoelscher-Doht, Stefanie, Heilig, Maximilian, von Hertzberg-Boelch, Sebastian Philipp, Jordan, Martin Cornelius, Gbureck, Uwe, Meffert, Rainer Heribert, Heilig, Philipp
• Format: Article
• Language: English
• Subjects: Cement augmentation; Fragility fracture; Implant anchorage; Magnesium phosphate cement; Osteoporotic bone; TFNA
• ISSN: 0268-0033; 1879-1271
• DOI: 10.1016/j.clinbiomech.2023.106088

The use of polymethylmethacrylate cement for in-situ implant augmentation has considerable disadvantages: it is potentially cytotoxic, exothermic and non-degradable. Therefore, the primary aim of this study was to develop a magnesium phosphate cement which meets the requirements for in-situ implant augmentation as an alternative. Secondly, this experimental cement was compared to commercial bone cements in a biomechanical test set-up using augmented femoral head blades. A total of 40 human femoral heads were obtained from patients who underwent total hip arthroplasty. After bone mineral density was quantified, specimens were assigned to four treatment groups. A blade of the Trochanteric Fixation Nail Advanced™ was inserted into each specimen and augmented with either Traumacem™ V+, Paste-CPC, the experimental magnesium phosphate cement or no cement. A rotational load-to-failure-test (0° to 90°) was performed. A conventional two-component magnesium phosphate cement failed in-situ implant augmentation consistently due to filter pressing. Only a glycerol-based magnesium phosphate paste was suitable for the augmentation of femoral head blades. While the blades augmented with Traumacem™ V+ yielded the highest maximum torque overall (22.1 Nm), the blades augmented with Paste-CPC and the magnesium phosphate paste also showed higher maximum torque values (15.8 and 12.8 Nm) than the control group (10.8 Nm). This study shows for the first time the development of a degradable magnesium phosphate cement paste which fulfills the requirements for in-situ implant augmentation. Simultaneously, a 48% increase in stability is demonstrated for a scenario where implant anchorage is difficult in osteoporotic bone. [Display omitted] •Two component cement systems fail in-situ augmentation due to filter-pressing.•Bimodal magnesium phosphate cement paste allows in-situ augmentation for the first time.•Magnesium paste augmented blades yield 48% higher stability in human femoral heads.•Polymethylmethacrylate and calcium phosphate cement paste also increase stability.•Correlation of torque, cement volume and bone marrow density.