Loosening detection of the femoral component of hip prostheses with extracorporeal shockwaves: a pilot study

Multiscale Sensing of Bone-Implant Loosening for Multifunctional Smart Bone Implants: Using Capacitive Technologies for Precision Controllability

The world population growth and average life expectancy rise have increased the number of people suffering from non-communicable diseases, namely osteoarthritis, a disorder that causes a significant increase in the years lived with disability. Many people who suffer from osteoarthritis undergo replacement surgery. Despite the relatively high success rate, around 10% of patients require revision surgeries, mostly because existing implant technologies lack sensing devices capable of monitoring the bone–implant interface. Among the several monitoring methodologies already proposed as substitutes for traditional imaging methods, cosurface capacitive sensing systems hold the potential to monitor the bone–implant fixation states, a mandatory capability for long-term implant survival. A multifaceted study is offered here, which covers research on the following points: (1) the ability of a cosurface capacitor network to effectively monitor bone loosening in extended peri-implant regions and according to different stimulation frequencies; (2) the ability of these capacitive architectures to provide effective sensing in interfaces with hydroxyapatite-based layers; (3) the ability to control the operation of cosurface capacitive networks using extracorporeal informatic systems. In vitro tests were performed using a web-based network sensor composed of striped and interdigitated capacitive sensors. Hydroxyapatite-based layers have a minor effect on determining the fixation states; the effective operation of a sensor network-based solution communicating through a web server hosted on Raspberry Pi was shown. Previous studies highlight the inability of current bone–implant fixation monitoring methods to significantly reduce the number of revision surgeries, as well as promising results of capacitive sensing systems to monitor micro-scale and macro-scale bone–interface states. In this study, we found that extracorporeal informatic systems enable continuous patient monitoring using cosurface capacitive networks with or without hydroxyapatite-based layers. Findings presented here represent significant advancements toward the design of future multifunctional smart implants.

Differentiation between mechanically loose and fixed press-fit implants using quantitative acoustics and load self-referencing: A phantom study on shoulder prostheses in polyurethane foam

This study proposes to use cross-interface quantitative acoustics (ci-qA) and load self-referencing (LSR) to assess implant stability in a radiation-free, inexpensive, rapid, and quantitative manner. Eight bone analog specimens, made from polyurethane foam, were implanted with a cementless stemless shoulder implant—first in a fixed and later in a loose configuration—and measured using ci-qA under two load conditions. The loose implants exhibited higher micromotion and lower pull-out strength than their stable counterparts, with all values falling within the range of reported reference values. All acoustic characteristics differentiated between loose and fixed implants (maximum area-under-curve AUC = 1.0 for mean total signal energy, AUC = 1.0 for mean total signal energy ratio, AUC = 0.8 for harmonic ratio, and AUC = 0.92 for load self-referencing coefficient). While these results on bone substitute material will need to be confirmed on real bone specimen, ci-qA could ultimately facilitate the assessment of primary stability during implantation surgery and avoid unnecessary revision through quantitative evaluation of secondary stability during follow-up.

A Vibrational Technique for In Vitro Intraoperative Prosthesis Fixation Monitoring

OBJECTIVE

In this paper, a new vibrational modal analysis technique was developed for intraoperative cementless prosthesis fixation evaluation upon hammering.

METHODS

An artificial bone (Sawbones)-prosthesis system was excited by sweeping of a sine signal over a wide frequency range. The exponential sine sweep technique was implemented to the response signal in order to determine the linear impulse response. Recursive Fourier transform enhancement (RFTE) technique was applied to the linear impulse response signal in order to enhance the frequency spectrum with sharp and distinguishable peak values indicating distinct high natural frequencies of the system (ranging from 15 kHz to 90 kHz). The experiment was repeated with 5 Sawbones-prosthesis samples. Upon successive hammering during the prosthesis insertion, variation of each natural frequency was traced.

RESULTS

Compared to classical Fast Fourier Transform, RFTE provided a better tracing and enhancement of frequency components during insertion. Three different types of frequency evolving trends (monotonically increasing, insensitive, and plateau-like) were observed for all samples, as confirmed by a new finite element simulation of the prosthesis dynamic insertion. Two main mechanical phenomena (i.e., geometrical compaction and compressive stress) were shown to govern these trends in opposite ways. Follow-up of the plateau-like trend upon hammering showed that the frequency shift is a good indicator of fixation.

CONCLUSION

Alongside the individual follow-up of frequency shifts, combinatorial frequency analysis provides new objective information on the mechanical stability of Sawbone-prosthesis fixation.

SIGNIFICANCE

The proposed vibrational technique based on RTFE can provide the surgeon with a new assistive diagnostic technique during the surgery by indicating when the bone-prosthesis fixation is acceptable, and beyond of which further hammering should be done cautiously to avoid bone fracture.

Altering the Course of Technologies to Monitor Loosening States of Endoprosthetic Implants

Musculoskeletal disorders are becoming an ever-growing societal burden and, as a result, millions of bone replacements surgeries are performed per year worldwide. Despite total joint replacements being recognized among the most successful surgeries of the last century, implant failure rates exceeding 10% are still reported. These numbers highlight the necessity of technologies to provide an accurate monitoring of the bone–implant interface state. This study provides a detailed review of the most relevant methodologies and technologies already proposed to monitor the loosening states of endoprosthetic implants, as well as their performance and experimental validation. A total of forty-two papers describing both intracorporeal and extracorporeal technologies for cemented or cementless fixation were thoroughly analyzed. Thirty-eight technologies were identified, which are categorized into five methodologies: vibrometric, acoustic, bioelectric impedance, magnetic induction, and strain. Research efforts were mainly focused on vibrometric and acoustic technologies. Differently, approaches based on bioelectric impedance, magnetic induction and strain have been less explored. Although most technologies are noninvasive and are able to monitor different loosening stages of endoprosthetic implants, they are not able to provide effective monitoring during daily living of patients.

Sensitivity of low-frequency axial transmission acoustics to axially and azimuthally varying cortical thickness: A phantom-based study

Purpose

Cortical thickness (cTh) is one of the main factors determining a bone’s mechanical properties, and its quantification is therefore critical for understanding and monitoring bone pathologies such as osteoporosis. Axial quantitative acoustics (ax-QA) offers a non-radiative, non-invasive method to measure cTh. Even though previous works have ascertained ax-QA’s ability to measure azimuthally varying cTh, the effect of axially varying cTh remains unclear. Furthermore, previous experiments and theoretical predictions indicate that measurement of the fundamental flexural mode at low frequencies in the kHz range could increase sensitivity to cTh. However, due to the associated long wavelengths, the approximation of bone geometry as a tube could break down at such frequencies. The presented study therefore investigates a) the sensitivity of ax-QA measurements to cTh in the kHz-regime, b) the applicability of tube theory in this regime, and c) the effect of varying cTh along the long axis on the bone.

Materials and methods

Axial-transmission acoustic measurements were performed at 3kHz on 14 bone phantoms with a femur-like cross-section and a) axially varying cortical thickness or b) axially and azimuthally varying cortical thickness (cTh-range: 1.5mm-7.5mm). Experimental results were compared to theoretical predictions based on an exact elastic tube theory.

Results and discussion

Phase velocity measurements using low-frequency ax-QA exhibited a high sensitivity to local cTh less than 4mm, albeit with a complex, not yet understood pattern. Tube theory failed to predict the wave’s behavior in the kHz range, indicating that due to the corresponding long wavelengths the bone can no longer be approximated by a tube, thus requiring more faithful modelling of the bone geometry. The fact that results from both types of phantoms were similar (Pearson correlation coefficient: 0.94) further indicates that the slowly varying cTh along the bone’s long axis did not strongly affect wave propagation as measured by ax-QA measurements.

Non-invasive vibrometry-based diagnostic detection of acetabular cup loosening in total hip replacement (THR)

Total hip replacement is aimed at relieving pain and restoring function. Currently, imaging techniques are primarily used as a clinical diagnosis and follow-up method. However, these are unreliable for detecting early loosening, and this has led to the proposal of novel techniques such as vibrometry. The present study had two aims, namely, the validation of the outcomes of a previous work related to loosening detection, and the provision of a more realistic anatomical representation of the clinical scenario. The acetabular cup loosening conditions (secure, and 1 and 2 mm spherical loosening) considered were simulated using Sawbones composite bones. The excitation signal was introduced in the femoral lateral condyle region using a frequency range of 100-1500 Hz. Both the 1 and 2 mm spherical loosening conditions were successfully distinguished from the secure condition, with a favourable frequency range of 500-1500 Hz. The results of this study represent a key advance on previous research into vibrometric detection of acetabular loosening using geometrically realistic model, and demonstrate the clinical potential of this technique.