title: A biomechanical study of periacetabular defects and cement filling.
abstract: Periacetabular bone metastases cause severe pain and functional disability in cancer patients. Percutaneous acetabuloplasty (PCA) is a minimally invasive, image-guided procedure whereby cement is injected into lesion sites. Pain relief and functional restoration have been observed clinically; however, neither the biomechanical consequences of the lesions nor the effectiveness of the PCA technique are well understood. The objective of this study was to investigate how periacetabular lesion size, cortex involvement, and cement modulus affect pelvic bone stresses and strains under single-legged stance loading. Experiments were performed on a male cadaver pelvis under conditions of intact, periacetabular defect, and cement-filling with surface strains recorded at three strain gage locations. The experimental data were then employed to validate three-dimensional finite element models of the same pelvis, developed using computed tomography data. The models demonstrated that increases in cortical stresses were highest along the posterior column of the acetabulum, adjacent to the defect. Cortical stresses were more profoundly affected in the presence of transcortical defects, as compared to those involving only trabecular bone. Cement filling with a modulus of 2.2 GPa was shown to restore cortical stresses to near intact values, while a decrease in cement modulus due to inclusion of BaSO(4) reduced the restorative effect. Peak acetabular contact pressures increased less than 15% for all simulated defect conditions; however, the contact stresses were reduced to levels below intact in the presence of either cement filling. These results suggest that periacetabular defects may increase the vulnerability of the pelvis to fracture depending on size and cortical involvement and that PCA filling may lower the risk of periacetabular fractures.
authors.affiliation: Department of Biomedical Engineering, University of Alabama at Birmingham, Hoehn 370, 1075 13th Street South, Birmingham, AL 35294-4440, USA.
authors.forename: Zuoping
authors.initials: Z
authors.lastname: Li
authors.forename: Neha B
authors.initials: NB
authors.lastname: Butala
authors.forename: Brandon S
authors.initials: BS
authors.lastname: Etheridge
authors.forename: Herrick J
authors.initials: HJ
authors.lastname: Siegel
authors.forename: Jack E
authors.initials: JE
authors.lastname: Lemons
authors.forename: Alan W
authors.initials: AW
authors.lastname: Eberhardt
mesh_terms: D000077:Acetabulum / Q000293:injuries* / Q000503:physiopathology; D000368:Aged; D001466:Barium Sulfate / Q000008:administration & dosage; D001843:Bone Cements / Q000627:therapeutic use*; D002102:Cadaver; D003198:Computer Simulation; D005269:Femur / Q000503:physiopathology; D020342:Finite Element Analysis; D006801:Humans; D008159:Lumbar Vertebrae / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008422:Materials Testing; D008954:Models, Biological; D009362:Neoplasm Metastasis / Q000503:physiopathology; D010384:Pelvic Bones / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D019904:Polymethyl Methacrylate / Q000008:administration & dosage; D012015:Reference Standards; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013314:Stress, Mechanical; D014057:Tomography, X-Ray Computed; D016474:Weight-Bearing
chemical_list: D001843:Bone Cements; D001466:Barium Sulfate; D019904:Polymethyl Methacrylate