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Glismann K, Konow T, Lampe F, Ondruschka B, Huber G, Morlock MM. Small design modifications can improve the primary stability of a fully coated tapered wedge hip stem. PLoS One 2024; 19:e0300956. [PMID: 38630711 PMCID: PMC11023602 DOI: 10.1371/journal.pone.0300956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 03/07/2024] [Indexed: 04/19/2024] Open
Abstract
Increasing the stem size during surgery is associated with a higher incidence of intraoperative periprosthetic fractures in cementless total hip arthroplasty with fully coated tapered wedge stems, especially in femurs of Dorr type A. If in contrast a stem is implanted and sufficient primary stability is not achieved, such preventing successful osseointegration due to increased micromotions, it may also fail, especially if the stem is undersized. Stem loosening or periprosthetic fractures due to stem subsidence can be the consequence. The adaptation of an established stem design to femurs of Dorr type A by design modifications, which increase the stem width proximally combined with a smaller stem tip and an overall shorter stem, might reduce the risk of distal locking of a proximally inadequately fixed stem and provide increased stability. The aim of this study was to investigate whether such a modified stem design provides improved primary stability without increasing the periprosthetic fracture risk compared to the established stem design. The established (Corail, DePuy Synthes, Warsaw, IN, US) and modified stem designs (Emphasys, DePuy Synthes, Warsaw, IN, US) were implanted in cadaveric femur pairs (n = 6 pairs) using the respective instruments. Broaching and implantation forces were recorded and the contact areas between the prepared cavity and the stem determined. Implanted stems were subjected to two different cyclic loading conditions according to ISO 7206-4 using a material testing machine (1 Hz, 600 cycles @ 80 to 800 N, 600 cycles @ 80 to 1600 N). Translational and rotational relative motions between stem and femur were recorded using digital image correlation. Broaching and implantation forces for the modified stem were up to 40% higher (p = 0.024), achieving a 23% larger contact area between stem and bone (R2 = 0.694, p = 0.039) resulting in a four times lower subsidence during loading (p = 0.028). The slight design modifications showed the desired effect in this in-vitro study resulting in a higher primary stability suggesting a reduced risk of loosening. The higher forces required during the preparation of the cavity with the new broaches and during implantation of the stem could bare an increased risk for intraoperative periprosthetic fractures, which did not occur in this study.
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Affiliation(s)
- Katja Glismann
- Institute of Biomechanics, TUHH Hamburg University of Technology, Hamburg, Germany
| | - Tobias Konow
- Institute of Biomechanics, TUHH Hamburg University of Technology, Hamburg, Germany
| | | | - Benjamin Ondruschka
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerd Huber
- Institute of Biomechanics, TUHH Hamburg University of Technology, Hamburg, Germany
| | - Michael M. Morlock
- Institute of Biomechanics, TUHH Hamburg University of Technology, Hamburg, Germany
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2
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Wang L. In-silico modelling of multi-strike insertion and torsional resistance of tapered revision hip stems: Insight into spline design philosophy. Med Eng Phys 2023; 118:104020. [PMID: 37536841 DOI: 10.1016/j.medengphy.2023.104020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 05/10/2023] [Accepted: 07/07/2023] [Indexed: 08/05/2023]
Abstract
Despite the clinical success of tapered splined titanium stems, a knowledge gap still exists between spline design and its primary mechanical stability, which is critical to the long-term success of revision hip arthroplasty. Additionally, almost all published pre-clinical studies relied on resource-intensive benchtop and cadaveric testing. Hence, the present study developed a novel computational model to investigate effects of spline geometry and configuration on axial and torsional stability of tapered stem. Dynamic explicit Finite Element Analysis coupled with a state-of-the-art adaptive meshing technique was used to simulate the highly non-linear contacts and large bony material deformations. Hybridising primary straight splines with secondary angled splines results in 41% and 10% increases of peak insertion force and post-seating moment than the predicate device for the same seating position. The primary straight splines cut at multiple circumferential bony locations, enhancing torsional stability; while the alternatively placed secondary angled splines form wedges with the bone, providing reliable seating and additional torsional resistance. To the best knowledge of the author, this is the first in-silico investigation of its kind to simulate multi-strike seating and torsional resistance of revision hip stems, offering an effective and efficient platform for future multi-factorial parametric study and uncertainty quantification.
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Affiliation(s)
- Lin Wang
- DePuy Synthes, St Anthony's Road, Leeds, LS11 8DT, United Kingdom.
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3
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Homma Y, Baba T, Watari T, Hayashi K, Kobayashi H, Matsumoto M, Banno S, Ozaki Y, Ochi H, Jinnai Y, Ishii S, Tanabe H, Shirogane Y, Zhuang X, Yuasa T, Kaneko K, Ishijima M. Recent advances in the direct anterior approach to total hip arthroplasty: a surgeon's perspective. Expert Rev Med Devices 2023; 20:1079-1086. [PMID: 37942898 DOI: 10.1080/17434440.2023.2280986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/05/2023] [Indexed: 11/10/2023]
Abstract
INTRODUCTION The direct anterior approach (DAA) has its origins in the first and oldest approach for hip replacement in the literature, but at the same time it would not be fanciful to suggest its increasing popularity as the latest approach for hip replacement procedures, especially among younger surgeons. However, in a geographical context, the DAA is not considered the major approach in most countries. Moreover, the term DAA encompasses numerous variations in terms of technique. AREAS COVERED In this narrative review, we describe our recent experience of advances in the DAA in terms of improved techniques and devices, along with some of its disadvantages. Also, we express our perspective on its future application. EXPERT OPINIONS The DAA is established as one of exemplary approaches to THA. The use of fluoroscopy, the traction table, and appropriate soft tissue management has become essential in the DAA for a safe and trouble-free procedure with adequate patient comfort. With the combination of recent technologies such as robotics, three-dimensional preoperative planning, and artificial intelligence (AI)-based surgeon assist systems, we can look forward to the DAA being performed more efficiently in the future.
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Affiliation(s)
- Yasuhiro Homma
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Tomonori Baba
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Taiji Watari
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Koju Hayashi
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Hideo Kobayashi
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Mikio Matsumoto
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Sammy Banno
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Yu Ozaki
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Hironori Ochi
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Yuta Jinnai
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Seiya Ishii
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Hiroki Tanabe
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Yuichi Shirogane
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Xu Zhuang
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Takahito Yuasa
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Kazuo Kaneko
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Muneaki Ishijima
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
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4
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Poudrel AS, Rosi G, Nguyen VH, Housset V, Flouzat-Lachaniette CH, Haiat G. Detection of periprosthetic fractures around the femoral stem by resonance frequency analysis: An in vitro study. Proc Inst Mech Eng H 2023:9544119231163632. [PMID: 36992542 DOI: 10.1177/09544119231163632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
Periprosthetic femoral bone fractures are frequent complications of Total Hip Arthroplasty (THA) and may occur during the insertion of uncemented Femoral Stems (FS), due to the nature of the press-fit fixation. Such fracture may lead to the surgical failure of the THA and require a revision surgery, which may have dramatic consequences. Therefore, an early detection of intra-operative fractures is important to avoid worsening the fracture and/or to enable a peroperative treatment. The aim of this in vitro study is to determine the sensitivity of a method based on resonance frequency analysis of the bone-stem-ancillary system for periprosthetic fractures detection. A periprosthetic fracture was artificially created close to the lesser-trochanter of 10 femoral bone mimicking phantoms. The bone-stem-ancillary resonance frequencies in the range (2-12) kHz were measured on an ancillary instrumented with piezoelectric sensors, which was fixed to the femoral stem. The measurements were repeated for different fracture lengths from 4 to 55 mm. The results show a decrease of the resonance frequencies due to the fracture occurrence and propagation. The frequency shift reached up to 170 Hz. The minimum fracture length that can be detected varies from 3.1±1.7 mm to 5.9±1.9 mm according to the mode and to the specimen. A significantly higher sensitivity (p = 0.011) was obtained for a resonance frequency around 10.6 kHz, corresponding to a mode vibrating in a plane perpendicular to the fracture. This study opens new paths toward the development of non-invasive vibration-based methods for intra-operative periprosthetic fractures detection.
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Affiliation(s)
- Anne-Sophie Poudrel
- CNRS, Univ Paris Est Creteil, Univ Gustave Eiffel, UMR 8208, MSME, F-96010 Créteil
| | - Giuseppe Rosi
- Univ Paris Est Creteil, Univ Gustave Eiffel, UMR 8208, MSME, F-96010 Créteil, France
| | - Vu-Hieu Nguyen
- Univ Paris Est Creteil, Univ Gustave Eiffel, UMR 8208, MSME, F-96010 Créteil, France
| | - Victor Housset
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Henri Mondor AP-HP, CHU Paris 12, Université Paris-Est Créteil, Créteil, France
- INSERM U955, IMRB, Université Paris-Est Créteil, Créteil, France
| | - Charles-Henri Flouzat-Lachaniette
- Service de Chirurgie Orthopédique et Traumatologique, Hôpital Henri Mondor AP-HP, CHU Paris 12, Université Paris-Est Créteil, Créteil, France
- INSERM U955, IMRB, Université Paris-Est Créteil, Créteil, France
| | - Guillaume Haiat
- CNRS, Univ Paris Est Creteil, Univ Gustave Eiffel, UMR 8208, MSME, F-96010 Créteil
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Bas dit Nugues M, Rosi G, Hériveaux Y, Haïat G. Using an Instrumented Hammer to Predict the Rupture of Bone Samples Subject to an Osteotomy. SENSORS (BASEL, SWITZERLAND) 2023; 23:2304. [PMID: 36850902 PMCID: PMC9965419 DOI: 10.3390/s23042304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/09/2023] [Accepted: 02/14/2023] [Indexed: 06/18/2023]
Abstract
Osteotomies are common procedures in maxillofacial and orthopedic surgery. The surgeons still rely on their proprioception to control the progression of the osteotome. Our group has developed an instrumented hammer that was shown to provide information on the biomechanical properties of the tissue located around the osteotome tip. The objective of this study is to determine if this approach may be used to predict the rupture of a bone sample thanks to an instrumented hammer equipped with a force sensor. For each impact, an indicator τ is extracted from the signal corresponding to the variation of the force as a function of time. A linear by part regression analysis is applied to the curve corresponding to the variation of τ as a function of the distance d between the tip of the osteotome and the end of the sample. The experiments were conducted with plywood and bovine trabecular bone samples. The results show that τ starts increasing when the value of d is lower than 2.6 mm on average, which therefore corresponds to a typical threshold detection distance between the osteotome tip and the sample end. These findings open new paths for the development of this instrumented surgical hammer.
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Affiliation(s)
- Manon Bas dit Nugues
- Laboratoire Modelisation et Simulation Multi Echelle, Centre National de la Recherche Scientifique, MSME UMR 8208 CNRS, 61 Avenue du General de Gaulle, 94010 Creteil, France
| | - Giuseppe Rosi
- Laboratoire Modelisation et Simulation Multi Echelle, Universite Paris Est Creteil, MSME UMR 8208 CNRS, 61 Avenue du General de Gaulle, 94010 Creteil, France
| | - Yoann Hériveaux
- Laboratoire Modelisation et Simulation Multi Echelle, Centre National de la Recherche Scientifique, MSME UMR 8208 CNRS, 61 Avenue du General de Gaulle, 94010 Creteil, France
| | - Guillaume Haïat
- Laboratoire Modelisation et Simulation Multi Echelle, Centre National de la Recherche Scientifique, MSME UMR 8208 CNRS, 61 Avenue du General de Gaulle, 94010 Creteil, France
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Bishop NE, Wright P, Preutenborbeck M. A parametric numerical analysis of femoral stem impaction. PLoS One 2022; 17:e0268561. [PMID: 35594265 PMCID: PMC9122192 DOI: 10.1371/journal.pone.0268561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 05/02/2022] [Indexed: 11/19/2022] Open
Abstract
Press-fitted implants are implanted by impaction to ensure adequate seating, but without overloading the components, the surgeon, or the patient. To understand this interrelationship a uniaxial discretised model of the hammer/introducer/implant/bone/soft-tissues was developed. A parametric analysis of applied energy, component materials and geometry, and interactions between implant and bone and between bone and soft-tissues was performed, with implant seating and component stresses as outcome variables. To reduce the impaction effort (energy) required by the surgeon for implant seating and also reduce stresses in the hardware the following outcomes were observed: Reduce energy per hit with more hits / Increase hammer mass / Decrease introducer mass / Increase implant-bone resistance (eg stem roughness). Hardware stiffness and patient mechanics were found to be less important and soft tissue forces, due to inertial protection by the bone mass, were so low that their damage would be unlikely. This simple model provides a basic understanding of how stress waves travel through the impacted system, and an understanding of their relevance to implantation technique and component design.
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Affiliation(s)
- Nicholas E. Bishop
- Hamburg University of Applied Sciences, Faculty of Life Sciences, Hamburg, Germany
- * E-mail:
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7
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Modal Analysis of the Ancillary During Femoral Stem Insertion: A Study on Bone Mimicking Phantoms. Ann Biomed Eng 2022; 50:16-28. [PMID: 34993695 DOI: 10.1007/s10439-021-02887-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 11/03/2021] [Indexed: 11/01/2022]
Abstract
The femoral stem primary stability achieved by the impaction of an ancillary during its insertion is an important factor of success in cementless surgery. However, surgeons still rely on their proprioception, making the process highly subjective. The use of Experimental Modal Analysis (EMA) without sensor nor probe fixation on the implant or on the bone is a promising non destructive approach to determine the femoral stem stability. The aim of this study is to investigate whether EMA performed directly on the ancillary could be used to monitor the femoral stem insertion into the bone. To do so, a cementless femoral stem was inserted into 10 bone phantoms of human femurs and EMA was carried out on the ancillary using a dedicated impact hammer for each insertion step. Two bending modes could be identified in the frequency range [400-8000] Hz for which the resonance frequency was shown to be sensitive to the insertion step and to the bone-implant interface properties. A significant correlation was obtained between the two modal frequencies and the implant insertion depth (R2 = 0.95 ± 0.04 and R2 = 0.94 ± 0.06). This study opens new paths towards the development of noninvasive vibration based evaluation methods to monitor cementless implant insertion.
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8
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Hériveaux Y, Nguyen VH, Haïat G. Ultrasonic Evaluation of the Bone-Implant Interface. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1364:373-396. [DOI: 10.1007/978-3-030-91979-5_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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9
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Lamassoure L, Giunta J, Rosi G, Poudrel AS, Meningaud JP, Bosc R, Haïat G. Anatomical subject validation of an instrumented hammer using machine learning for the classification of osteotomy fracture in rhinoplasty. Med Eng Phys 2021; 95:111-116. [PMID: 34479687 DOI: 10.1016/j.medengphy.2021.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 08/08/2021] [Accepted: 08/10/2021] [Indexed: 11/24/2022]
Abstract
Osteotomies during rhinoplasty are usually based on the surgeon's proprioception to determine the number and the strength of the impacts. The aim of this study is to determine whether a hammer instrumented with a force sensor can be used to classify fractures and to determine the location of the osteotome tip. Two lateral osteotomies were realized in nine anatomical subjects using an instrumented hammer recording the evolution of the impact force. Two indicators τ and λ were derived from the signal, and video analysis was used to determine whether the osteotome tip was located in nasal or frontal bone as well as the condition of the bone tissue around the osteotome tip. A machine-learning algorithm was used to predict the condition of bone tissue after each impact. The algorithm was able to predict the condition of the bone after the impacts with an accuracy of 83%, 91%, and 93% when considering a tolerance of 0, 1, and 2 impacts, respectively. Moreover, in nasal bone, the values of τ and λ were significantly lower (p < 10-10) and higher (p < 10-4) than in frontal bone, respectively. This study paves the way for the development of the instrumented hammer as a decision support system.
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Affiliation(s)
- Léo Lamassoure
- CNRS, Laboratoire de Modélisation et de Simulation Multi Échelle, UMR CRNS 8208, 61 avenue du Général de Gaulle, Créteil 94010, France
| | - Justine Giunta
- Aesthetic and Maxillofacial Surgery Department, Hôpital Henri Mondor, Plastic, Reconstructive, 50 avenue du Maréchal de Lattre de Tassigny 94000 Créteil, France
| | - Giuseppe Rosi
- CNRS, Laboratoire de Modélisation et de Simulation Multi Échelle, UMR CRNS 8208, 61 avenue du Général de Gaulle, Créteil 94010, France
| | - Anne-Sophie Poudrel
- CNRS, Laboratoire de Modélisation et de Simulation Multi Échelle, UMR CRNS 8208, 61 avenue du Général de Gaulle, Créteil 94010, France
| | - Jean-Paul Meningaud
- Aesthetic and Maxillofacial Surgery Department, Hôpital Henri Mondor, Plastic, Reconstructive, 50 avenue du Maréchal de Lattre de Tassigny 94000 Créteil, France
| | - Romain Bosc
- Aesthetic and Maxillofacial Surgery Department, Hôpital Henri Mondor, Plastic, Reconstructive, 50 avenue du Maréchal de Lattre de Tassigny 94000 Créteil, France; Faculty of Medicine, INSERM U955 IMRB, UPEC Paris Est-Creteil University, Team 10, Creteil F-94000, France
| | - Guillaume Haïat
- CNRS, Laboratoire de Modélisation et de Simulation Multi Échelle, UMR CRNS 8208, 61 avenue du Général de Gaulle, Créteil 94010, France.
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10
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Giunta J, Lamassoure L, Nokovitch L, Rosi G, Poudrel AS, Meningaud JP, Haïat G, Bosc R. Validation of an Instrumented Hammer for Rhinoplasty Osteotomies: A Cadaveric Study. Facial Plast Surg Aesthet Med 2021; 24:369-374. [PMID: 34449254 DOI: 10.1089/fpsam.2021.0107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Osteotomies during rhinoplasty are usually based on surgeon's proprioception to determine the number, energy, and trajectory of impacts. Objective: The first objective was to detect the occurrence of fractures. The second objective was to determine when the thicker frontal bone was encountered by the osteotome. Materials and Methods: An instrumented hammer was used to measure the impact force during lateral osteotomies on nine human anatomic specimens. A prediction algorithm was developed using machine learning techniques, to detect the occurrence of fractures, and the proximity of the osteotome to the frontal bone. Results: The algorithm was able to predict the occurrence of fractures and the proximity to the frontal bone with a prediction rate of 83%, 91%, and 93% when allowing for an error of 0, 1, and 2 impacts, respectively. The location of the osteotome in the frontal bone was predicted with an error of 7.7%. Conclusion: An osteotomy hammer measuring the impact force when performing lateral osteotomies can predict the occurrence of fractures and the proximity to the frontal bone, providing the surgeon with instant feedback.
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Affiliation(s)
- Justine Giunta
- Plastic, Reconstructive, Aesthetic and Maxillofacial Surgery Department, Hôpital Henri Mondor, Créteil, France.,CNRS, Laboratoire de Modélisation et de Simulation Multi Échelle, UMR CRNS 8208, Créteil, France
| | - Léo Lamassoure
- CNRS, Laboratoire de Modélisation et de Simulation Multi Échelle, UMR CRNS 8208, Créteil, France
| | - Lara Nokovitch
- Maxillo-Facial Surgery Department, Hôpital Beaujon, Clichy, France
| | - Giuseppe Rosi
- CNRS, Laboratoire de Modélisation et de Simulation Multi Échelle, UMR CRNS 8208, Créteil, France
| | - Anne-Sophie Poudrel
- CNRS, Laboratoire de Modélisation et de Simulation Multi Échelle, UMR CRNS 8208, Créteil, France
| | - Jean-Paul Meningaud
- Plastic, Reconstructive, Aesthetic and Maxillofacial Surgery Department, Hôpital Henri Mondor, Créteil, France
| | - Guillaume Haïat
- CNRS, Laboratoire de Modélisation et de Simulation Multi Échelle, UMR CRNS 8208, Créteil, France
| | - Romain Bosc
- Plastic, Reconstructive, Aesthetic and Maxillofacial Surgery Department, Hôpital Henri Mondor, Créteil, France.,INSERM U955 IMRB, Team 10, Creteil, France.,Faculty of Medicine, UPEC Paris Est-Creteil University, Creteil, France
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11
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Kwak Y, Nguyen VH, Hériveaux Y, Belanger P, Park J, Haïat G. Ultrasonic assessment of osseointegration phenomena at the bone-implant interface using convolutional neural network. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2021; 149:4337. [PMID: 34241416 DOI: 10.1121/10.0005272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 05/21/2021] [Indexed: 06/13/2023]
Abstract
Although endosseous implants are widely used in the clinic, failures still occur and their clinical performance depends on the quality of osseointegration phenomena at the bone-implant interface (BII), which are given by bone ingrowth around the BII. The difficulties in ensuring clinical reliability come from the complex nature of this interphase related to the implant surface roughness and the presence of a soft tissue layer (non-mineralized bone tissue) at the BII. The aim of the present study is to develop a method to assess the soft tissue thickness at the BII based on the analysis of its ultrasonic response using a simulation based-convolution neural network (CNN). A large-annotated dataset was constructed using a two-dimensional finite element model in the frequency domain considering a sinusoidal description of the BII. The proposed network was trained by the synthesized ultrasound responses and was validated by a separate dataset from the training process. The linear correlation between actual and estimated soft tissue thickness shows excellent R2 values equal to 99.52% and 99.65% and a narrow limit of agreement corresponding to [ -2.56, 4.32 μm] and [ -15.75, 30.35 μm] of microscopic and macroscopic roughness, respectively, supporting the reliability of the proposed assessment of osseointegration phenomena.
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Affiliation(s)
- Yunsang Kwak
- Centre National de la Recherche Scientifique, MSME, Université Paris-Est Créteil, Université Gustave Eiffel, F-94010 Creteil, France
| | - Vu-Hieu Nguyen
- University of Paris Est Creteil, Centre National de la Recherche Scientifique, Multiscale Simulation and Modeling Laboratory, F-94010 Creteil, France
| | - Yoann Hériveaux
- Centre National de la Recherche Scientifique, MSME, Université Paris-Est Créteil, Université Gustave Eiffel, F-94010 Creteil, France
| | - Pierre Belanger
- Department of Mechanical Engineering, École de Technologie Supérieure, 1100 Rue Notre-Dame O, Montreal, Quebec, H3C 1K3, Canada
| | - Junhong Park
- Department of Mechanical Engineering, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, 04763 Seoul, South Korea
| | - Guillaume Haïat
- Centre National de la Recherche Scientifique, MSME, Université Paris-Est Créteil, Université Gustave Eiffel, F-94010 Creteil, France
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12
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Lamassoure L, Giunta J, Rosi G, Poudrel AS, Bosc R, Haïat G. Using an impact hammer to perform biomechanical measurements during osteotomies: Study of an animal model. Proc Inst Mech Eng H 2021; 235:838-845. [PMID: 33892610 DOI: 10.1177/09544119211011824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Osteotomies are common surgical procedures used for instance in rhinoplasty and usually performed using an osteotome impacted by a mallet. Visual control being difficult, osteotomies are often based on the surgeon proprioception to determine the number and energy of each impact. The aim of this study is to determine whether a hammer instrumented with a piezoelectric force sensor can be used to (i) follow the displacement of the osteotome and (ii) determine when the tip of the osteotome arrives in frontal bone, which corresponds to the end of the osteotomy pathway. Seven New Zealand White rabbit heads were collected, and two osteotomies were performed on their left and right nasal bones using the instrumented hammer to record the variation of the force as a function of time during each impact. The second peak time τ was derived from each signal while the displacement of the osteotome tip D was determined using video motion tracking. The results showed a significant correlation between τ and D (ρ2 = 0.74), allowing to estimate the displacement of the osteotome through the measurement of τ. The values of τ measured in the frontal bone were significantly lower than in the nasal bone (p<10-10), which allows to determine the transition between the nasal and frontal bones when τ becomes lower than 0.78 its initial averaged value. Although results should be validated clinically, this technology could be used by surgeons in the future as a decision support system to help assessing the osteotome environment.
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Affiliation(s)
- Léo Lamassoure
- CNRS, Laboratoire Modélisation et Simulation Multi Echelle, MSME UMR 8208 CNRS, Créteil Cedex, France
| | - Justine Giunta
- Service de Chirurgie Plastique, reconstructrice, esthétique et Maxillo-faciale du Centre Hospitalier Universitaire Henri Mondor, Créteil, France
| | - Giuseppe Rosi
- Laboratoire Modélisation et Simulation Multi Echelle, MSME UMR 8208 CNRS, Université Paris-Est, Créteil Cedex, France
| | - Anne-Sophie Poudrel
- CNRS, Laboratoire Modélisation et Simulation Multi Echelle, MSME UMR 8208 CNRS, Créteil Cedex, France
| | - Romain Bosc
- Service de Chirurgie Plastique, reconstructrice, esthétique et Maxillo-faciale du Centre Hospitalier Universitaire Henri Mondor, Créteil, France.,Équipe 10, Groupe 5, IMRB U955, INSERM/UPEC, Créteil, France
| | - Guillaume Haïat
- CNRS, Laboratoire Modélisation et Simulation Multi Echelle, MSME UMR 8208 CNRS, Créteil Cedex, France
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