## 4 Discussion
Traditional threaded implants rely on compressive torque for stability and are highly dependent on bone quality; they do not integrate bone collection or compaction and typically involve multiple surgical steps that increase the risk of contamination. BKS simplifies the procedure by combining drilling and insertion into a single step, preserving bone integrity and allowing for potential autograft use. However, the BKS remains in an early stage of clinical adoption, with ongoing studies required to validate its long-term outcomes across applications. It demands precise manufacturing and surgical technique, and although its mechanical advantage is well established in controlled settings, broader implementation will depend on further in vivo research and surgeon training (Table 2). The BKS has demonstrated strong potential as an alternative to cemented screws in osteoporonic femur fixation, though it cannot yet be considered a full replacement in all clinical scenarios without further in vivo evidence. Cemented screws are currently used to enhance fixation in osteoporonic bone by filling the trabecular spaces with PMMA, increasing pullout strength. However, this method carries risks such as thermal necrosis, cement leakage, difficulty during revision, and potential long-term inflammation or foreign-body reaction. BKS addresses many of these limitations by avoiding cement entirely. Instead, it achieves high mechanical stability through a unique process of cutting, collecting, and compacting local bone material during insertion. This leads to a FCF that stabilizes the implant without lateral pressure or chemical augmentation. In synthetic bone models simulating osteoporonic conditions, BKS consistently produced MRT values greater than the MIT, indicating improved anchorage and potential for durable fixation. Importantly, BKS preserves the biological vitality of bone, eliminates the need for additional biomaterials, and allows for simpler revision procedures, as there is no hardened \begin{table}
\begin{tabular}{l l l l l} \hline \hline
**Feature** & **BKS** & **Expanding Screws** & **Cemented Systems** & **Traditional Implants** \\ \hline Lateral Compression & No & Yes & Yes & Yes \\ Compacts/Collects Bone & Yes & No & No & No \\ Requires Cement & No & No & Yes & No \\ Risk of Thermal Necrosis & Minimal & Moderate & High & Moderate \\ Revision Friendly & Yes & Variable & No & Yes \\ Dependence on Bone Density & Low & Moderate & Low & High \\ Autograft Potential & Yes & No & No & No \\ Clinical Maturity & Emerging & Moderate & Established & Established \\ \hline \hline \end{tabular}
\end{table} 
Table 2: Comparative summary of the advantages and limitations of the Bioactive Kinetic Screw (BKS) versus Expanding Screws, Cemented Systems, and Traditional Threaded Implants. cement to remove. It also reduces the number of surgical steps by combining drilling and insertion, which minimizes contamination risk and operative time. However, large-scale clinical trials in osteoporotic femur fractures have not yet confirmed the long-term outcomes of BKS in comparison with cemented systems. Moreover, in severely osteoporotic or pathologic bone, where minimal native structure remains, cement augmentation may still provide the necessary bulk reinforcement that BKS alone cannot yet replicate. In summary, BKS shows significant promise and could potentially replace cemented screws in many osteoporotic femur cases, especially where bone compaction and mechanical cohesion are sufficient. Caution is advised when using BKS in temporary fixations, particularly in osseoin-tegrable applications where long-term bonding may not be desired. Further studies are needed to extend its utility to bioinert or synthetic materials while maintaining its unique cohesive mechanism. The study's quantitative findings (MIT vs. MRT) directly support the device's mechanical superiority, while its broad applicability across biomedical, civil, and aerospace sectors provides a compelling case for its adoption.