Fonseca Ulloa CA 1 , Schreynemackers S 2 , Harz T 3 , Lang FW 3 , Fölsch C 4 , Rickert M 4, Jahnke A 3 , Ishaque BA 4
Clin Biomech (Bristol, Avon). 2023 Oct:109:106079.doi:10.1016/j.clinbiomech.2023.106079 
. Epub 2023 Aug 22.
- Laboratory of Biomechanics, Justus-Liebig-University Giessen, Klinikstrasse 29, 35392 Giessen, Germany. Electronic address: carlosalffo@hotmail.com.
- Laboratory of Biomechanics, Justus-Liebig-University Giessen, Klinikstrasse 29, 35392 Giessen, Germany; Faculty of Health Sciences, University of Applied Sciences (THM), Wiesenstraße 14, 35390 Giessen, Germany.
- Laboratory of Biomechanics, Justus-Liebig-University Giessen, Klinikstrasse 29, 35392 Giessen, Germany.
- Laboratory of Biomechanics, Justus-Liebig-University Giessen, Klinikstrasse 29, 35392 Giessen, Germany; Department of Orthopaedics and Orthopaedic Surgery, University Hospital Giessen and Marburg (UKGM), Klinikstrasse 33, 35392 Giessen, Germany.
Abstract
Background: Preparing the medullary space of the femur aims to create an ideal form-fitting of cementless implants to provide sufficient initial stability, which is crucial for osseous integration, ensuring good long-term results. Hammering the implant into the proximal femur creates a press-fit anchoring of the endoprosthesis in the medullary space. Implanting the optimal size of the shaft for best fitting should avoid damage to the bone. Modified acoustic signals in connection with implantation are being detected by surgeons and might be related to the primary stability of the implant.
Methods: This study aims to explore the relationship between frequency sound patterns and the change in stem stability. For this purpose, n = 32 Metha® short stems were implanted in a clinical setting by the same surgeon. During implantation, the sounds were recorded. To define a change in the acoustic system response during the operation, the individual blows of the implantation sequence were correlated with one another.
Findings: An algorithm was able to subdivide through sound analysis two groups of hammer blows (area 1 and area 2) since the characteristics of these groups showed significant differences within the frequency range of 100 Hz to 24 kHz. The edge between both groups, detected by the algorithm, was validated with expert surgeons‘ classifications of the same data.
Interpretation: In conclusion, monitoring, the hammer blows sound might allow quantification of the primary stability of the implant. Sound analysis including patient parameters and a classification algorithm could provide a precise characterization of implant stability.
Keywords: Operation monitoring; Primary stability; Total hip arthroplasty; Vibro-acoustic analysis.