Abstract
A large number of total hip arthroplasties (THA) are performed each year, of which 60 % use cementless femoral fixation. This means that the implant is press-fitted in the bone by hammer blows. The initial fixation is one of the most important factors for a long lasting fixation [Gheduzzi 2007]. It is not easy to obtain the point of optimal initial fixation, because excessively press-fitting the implant by the hammer blows can cause peak stresses resulting in femoral fracture. In order to reduce these peak stresses during reaming, IMT Integral Medizintechnik (Luzern, Switzerland) designed the Woodpecker, a pneumatic reaming device using a vibrating tool. This study explores the feasibility of using this Woodpecker for implant insertion and detection of optimal fixation by analyzing the vibrational response of the implant and Woodpecker. The press-fit of the implant is quantified by measuring the strain in the cortical bone surrounding the implant. An in vitro study is presented.
Two replica femur models (Sawbones Europe AB, Malmo Sweden) were used in this study. One of the femur models was instrumented with three rectangular strain gauge rosettes (Micro-Measurements, Raleigh, USA). The rosettes were placed medially, posteriorly and anteriorly on the proximal femur. Five paired implant insertions were performed on both bone models, alternating between standard hammer blow insertions and using the Woodpecker. The vibrational response was measured during the insertion process, at the implant and Woodpecker side using two shock accelerometers (PCB Piezotronics, Depew, NY, USA). The endpoint of insertion was defined as the point when the static strain stopped increasing.
Significant trends were observed in the bandpower feature that was calculated from the vibrational spectrum at the implant side during the Woodpecker insertion. The bandpower is defined as the percentage power of the spectrum in the band 0–1000 Hz. Peak stress values calculated from the strain measurement during the insertion showed to be significantly (p < 0.05) lower at two locations using the Woodpecker compared to the hammer blows at the same level of static strain. However, the final static strain at the endpoint of insertion was approximately a factor two lower using the Woodpecker compared to the hammer.
A decreasing trend was observed in the bandpower feature, followed by a stagnation. This point of stagnation was correlated with the stagnation of the periprosthetic stress in the bone measured by the strain gages. The behavior of this bandpower feature shows the possibility of using vibrational measurements during insertion to assess the endpoint of insertion. However it needs to be taken into account that it was not possible to reach the same level of static strain using the Woodpecker as with the hammer insertion. This could mean that either extra hammer blows or a more powerful pneumatic device could be needed for proper implant insertion.
