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

Harmonic Vibration Analysis in a Simplified Model for Monitoring Transfemoral Implant Loosening

A simplified axisymmetric model of a transfemoral osseointegration implant was used to investigate the influence of the contact condition at the bone-implant interface on the vibrational response. The experimental setup allowed the degree of implant tightness to be controlled using a circumferential compression device affixed to the bone. Diametrically placed sensors allowed torsional modes to be distinguished from flexural modes. The results showed that the structural resonant frequencies did not shift significantly with tightness levels. The first torsional mode of vibration was found to be particularly sensitive to interface loosening. Harmonics in the vibrational response became prominent when the amplitude of the applied torque increased beyond a critical level. The torque level at which the third harmonic begins to rise correlated with implant criticality, suggesting a potential strategy for early detection of implant loosening based on monitoring the amplitude of the third harmonic of the torsional mode.

Surface Acoustic Wave (SAW) Sensors for Hip Implant: A Numerical and Computational Feasibility Investigation Using Finite Element Methods

In this paper, a surface acoustic wave (SAW) sensor for hip implant geometry was proposed for the application of total hip replacement. A two-port SAW device was numerically investigated for implementation with an operating frequency of 872 MHz that can be used in more common radio frequency interrogator units. A finite element analysis of the device was developed for a lithium niobate (LiNBO3) substrate with a Rayleigh velocity of 3488 m/s on COMSOL Multiphysics. The Multiphysics loading and frequency results highlighted a good uniformity with numerical results. Afterwards, a hip implant geometry was developed. The SAW sensor was mounted at two locations on the implant corresponding to two regions along the shaft of the femur bone. Three discrete conditions were studied for the feasibility of the implant with upper- and lower-body loading. The loading simulations highlighted that the stresses experienced do not exceed the yield strengths. The voltage output results indicated that the SAW sensor can be implanted in the hip implant for hip implant-loosening detection applications.

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.

Defect localization by an extended laser source on a hemisphere

The primary goal of this study is to localize a defect (cavity) in a curved geometry. Curved topologies exhibit multiple resonances and the presence of hotspots for acoustic waves. Launching acoustic waves along a specific direction e.g. by means of an extended laser source reduces the complexity of the scattering problem. We performed experiments to demonstrate the use of a laser line source and verified the experimental results in FEM simulations. In both cases, we could locate and determine the size of a pit in a steel hemisphere which allowed us to visualize the defect on a 3D model of the sample. Such an approach could benefit patients by enabling contactless inspection of acetabular cups.

Relationship between use of screws and acetabular cup stability in total hip arthroplasty: a meta-analysis

Objective

The relationship between the use of screws and acetabular cup stability in total hip arthroplasty (THA) remains controversial. We evaluated cup stability in THA with and without the use of screws.

Methods

We performed a systematic literature search to identify studies on cup stability relative to the use of screws in patients undergoing THA before October 2018. Methodological quality assessment and data collection were performed by two individual reviewers. Meta-analysis was performed using Review Manager version 5.3.5.

Results

We included seven trials involving 1402 patients (1469 THAs): 767 patients (809 THAs) with screws and 635 patients (660 THAs) without screws. The findings of meta-analysis indicated that uncemented acetabular component fixation with the use of additional screws was not correlated with migration of the cup, migration on roentgen stereophotogrammetry, or reoperation after THA. Moreover, operation time was not significantly different according to whether screws were used. There was no relationship between use of additional screws and osteoporosis or Harris Hip Score; however, THA with or without the use of screws might be related to bone sclerosis in the C1 region.

Conclusion

Currently, limited evidence shows that the use of screws during THA may not improve cup stability.

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.

Ex Vivo Evaluation of Cementless Acetabular Cup Stability Using Impact Analyses with a Hammer Instrumented with Strain Sensors

The acetabular cup (AC) implant stability is determinant for the success of cementless hip arthroplasty. A method based on the analysis of the impact force applied during the press-fit insertion of the AC implant using a hammer instrumented with a force sensor was developed to assess the AC implant stability. The aim of the present study was to investigate the performance of a method using a hammer equipped with strain sensors to retrieve the AC implant stability. Different AC implants were inserted in five bovine samples with different stability conditions leading to 57 configurations. The AC implant was impacted 16 times by the two hammers consecutively. For each impact; an indicator I_S (respectively I_F) determined by analyzing the time variation of the signal corresponding to the averaged strain (respectively force) obtained with the stress (respectively strain) hammer was calculated. The pull-out force F was measured for each configuration. F was significantly correlated with I_S (R² = 0.79) and I_F (R² = 0.80). The present method has the advantage of not modifying the shape of the hammer that can be sterilized easily. This study opens new paths towards the development of a decision support system to assess the AC implant stability.