Numerical description and experimental validation of a rheology model for non-Newtonian fluid flow in cancellous bone

Fluids present or used in biology, medicine and (biomedical) engineering are often significantly non-Newtonian. Furthermore, they are chemically complex and can interact with the porous matrix through which they flow. The porous structures themselves display complex morphological inhomogeneities on a wide range of length scales. In vertebroplasty, a shear-thinning fluid, e.g. poly(methyl methacrylate) (PMMA), is injected into the cavities of vertebral trabecular bone for the stabilization of fractures and metastatic lesions. The main objective of this study was therefore to provide a protocol for numerically investigating the rheological properties of PMMA-based bone cements to predict its spreading behavior while flowing through vertebral trabecular bone. A numerical upscaling scheme based on a dimensionless formulation of the Navier-Stokes equation is proposed in order to relate the pore-scale rheological properties of the PMMA that were experimentally estimated using a plate rheometer, to the continuum-scale. On the pore length scale, a viscosity change on the order of one magnitude was observed whilst the shear-thinning properties caused a viscosity change on the order of only 10% on the continuum length scale and in a flow regime that is relevant for vertebroplasty. An experimental validation, performed on human cadaveric vertebrae (n=9), showed a significant improvement of the cement spreading prediction accuracy with a non-Newtonian formulation. A root mean square cement surface prediction error of 1.53mm (assuming a Newtonian fluid) and 1.37mm (assuming a shear-thinning fluid) was found. Our findings highlight the importance of incorporating the non-Newtonian fluids properties in computational models of porous media at the appropriate length scale.