Aseptic acetabular component failure rates have been reported to be similar or even slightly higher than femoral component failure. Obtaining proper initial stability by press fitting the cementless acetabular cup into an undersized cavity is crucial to allow for secondary osseous integration. However, finding the insertion endpoint that corresponds to an optimal initial stability is challenging. This in vitro study presents an alternative method that allows tracking the insertion progress of acetabular implants in a non-destructive, real-time manner. A simplified acetabular bone model was used for a series of insertion experiments. The bone model consisted of polyurethane solid foam blocks (Sawbones #1522-04 and #1522-05) into which a hemispherical cavity and cylindrical wall, representing the acetabular rim, were machined using a computer numerically controlled (CNC) milling machine (Haas Automation Inc., Oxnard, CA, USA). Fig. 1 depicts the bone model and setup used. A total of 10 insertions were carried out, 5 on a low density block, 5 on a high density block. The acetabular cups were press fitted into the bone models by succeeding hammer hits. The acceleration of the implant-insertor combination was measured using 2 shock accelerometers mounted on the insertor during the insertion process (PCB 350C03, PCB Depew, NY, USA). The force applied to the implant-insertor combination was also measured. 15 hammer hits were applied per insertion experiment. Two features were extracted from the acceleration time signal; total signal energy (E) and signal length (LS). Two features and one correlation measure were extracted from the acceleration frequency spectra; the relative signal power in the low frequency band (PL, from 500–2500Hz) and the signal power in the high frequency band (P Hf, from 4000–4800 Hz). The changes in the low frequency spectra (P Lf, from 500–2500 Hz) between two steps were tracked by calculating the Frequency Response Assurance Criterion (FRAC). Force features similar to the ones proposed by Mathieu et al., 2013 were obtained from the force time data. The convergence behavior of the features was tracked as insertion progressed.Introduction
Materials and Methods
Each year, a large number of total hip arthroplasties (THA) are performed, of which 60 % use cementless fixation. The initial fixation is one of the most important factors for a long lasting fixation [Gheduzzi 2007]. The point of optimal initial fixation, the endpoint of insertion, is not easy to achieve, as the margin between optimal fixation and a femoral fracture is small. Femoral fractures are caused by peak stresses induced during broaching or by the hammer blows when the implant is excessively press-fitted in the femur. In order to reduce the peak stresses during broaching, IMT Integral Medizintechnik (Luzern, Switzerland) designed the Woodpecker, a pneumatic broach that generates impulses at a frequency of 70 Hz. This study explores the feasibility of using the Woodpecker for implant insertion by measuring both the strain in the cortical bone and the vibrational response. An in vitro study is presented. A Profemur Gladiator modular stem (MicroPort Orthopedics Inc. Arlington, TN, USA) and two artificial femora (composite bone 4th generation #3403, Sawbones Europe AB, Malmö, Sweden) were used. One artificial femur was instrumented with three rectangular strain gauge rosettes (Micro-Measurements, Raleigh, NC, USA). The rosettes were placed medially, posteriorly and anteriorly proximally on the cortical bone. Five paired implant insertions were repeated on both artificial bones, alternating between standard hammering and Woodpecker insertions. During the insertion processes the vibrational response was measured at the implant and Woodpecker side (fig. 1) using two shock accelerometers (PCB Piezotronics, Depew, NY, USA). Frequency spectra were derived from the vibrational responses. The endpoint of insertion was defined as the point when the static strain stopped increasing during the insertion.Introduction
Material and Methods
The success of cementless total hip arthroplasty (THA), primary as well as for revision, largely depends on the initial stability of the femoral implant. In this respect, several studies have estimated that the micromotion at the bone-implant interface should not exceed 150µm (Jasty 1997, Viceconti 2000) in order to ensure optimal bonding between bone and implant. Therefore, evaluating the initial stability through micromotion measurements serves as a valid method towards reviewing implant design and its potential for uncemented THAs. In general, the methods used to measure the micromotion assume that the implant behaves as a rigid body. While this could be valid for some primary stems (Østbyhaug 2010), studies that support the same assumption related to revision implants were not found. The aim of this study is to assess the initial stability of a femoral revision stem, taking into account possible non-rigid behaviour of the implant. A new in vitro measuring method to determine the micromotion of femoral revision implants is presented. Both implant and bone induced displacements under cyclic load are measured locally. A Profemur R modular revision stem (MicroPort Orthopedics Inc. Arlington, TN, United States of America) and artificial femora (composite bone 4th generation #3403, Sawbones Europe AB, Malmö, Sweden) prepared by a surgeon were used. The micromotions were measured in proximal-distal, medial-lateral or anterior-posterior directions at four locations situated in two transverse planes, using pin and bushing combinations. At each measuring location an Ø8mm bushing was attached to the bone, and a concentric Ø3mm pin was attached to the implant [Fig.1 and 2]. A supporting structure used to hold either guiding bushings or linear variable displacement transducers (LVDT) is attached to the proximal part of the implant. The whole system was installed on a hydraulic force bench (PC160N, Schenck GmbH, Darmstadt, Germany) and 250 physiological loading cycles were applied [Fig.3].Introduction
Methods
Cementless femoral hip stems crucially depend on the initial stability to ensure a long survival of the prosthesis. There is only a small margin between obtaining the optimal press fit and a femoral fracture. The incidence of an intraoperative fracture is reported to be as high as 30% for revision surgery. The aim of this study is to assess what information is contained in the acoustic sound produced by the insertion hammer blows and explore whether this information can be used to assess optimal seating and warn for impeding fractures. Acoustic measurements of the stem insertion hammer blows were taken intra-operatively during 7 cementless primary (Wright Profemur Primary) and 2 cementless revision surgeries (Wright Profemur R Revision). All surgeries were carried out by the same experienced surgeon. The sound was recorded using 6 microphones (PCB 130E2), mounted at a distance of approximately 1 meter from the surgical theater. The 7 primary implants were inserted without complication, 1 revision stem induced a fracture distally during the insertion process. Two surgeons were asked to listen independently to the acoustic sounds post-surgery and to label the hits in the signal they would associate with either a fully fixated implant or with a fracture sound. For 3 out of 7 primary measurements the data was labeled the same by the two surgeons, 4 were labeled differently or undecided and both indicated several hits that would be associated with fracture for the fractured revision case. The acquired time signals were processed using a number of time and frequency domain processing techniques.Introduction
Materials and Methods
