Assessment of implant stability of cementless hip prostheses through the frequency response function of the stem–bone system

Abstract Cementless joint prostheses require adequate initial press-fitting to achieve sufficient primary stability, which is necessary for bone ingrowth and implant success. A device was developed that measured intra-operatively the stability of a hip stem in the host bone. It included an excitatory piezoelectric system based on a ceramic multilayer bender, which delivered a controlled excitation in the range 1200–2000 Hz to the prosthesis. An accelerometer mounted on the host bone measured the transmitted vibration so as to identify the resonance frequency. Resonance frequency (and its associated shift) was measured immediately after implant press-fitting, and while a torque was applied to the implant. The proposed method was validated in vitro on 5 femurs covering a wide range of bone quality. Each bone was tested with different degrees of implant press-fitting. Implant stability estimated with the vibration method was compared against implant–bone micromotions that were measured simultaneously by a displacement transducer during this validation session. A strong correlation was found between the shift of the resonance frequency caused by load application, and implant stability. A quantitative threshold was identified that enabled consistently discriminating stable implants form quasi-stable ones: when the resonance frequency shifted less than 5 Hz during torque application, the residual micromotion after load removal was always less than 150 μm.

[1]  L Cristofolini,et al.  Preclinical assessment of the long-term endurance of cemented hip stems. Part 1: Effect of daily activities - a comparison of two load histories , 2007, Proceedings of the Institution of Mechanical Engineers. Part H, Journal of engineering in medicine.

[2]  L Cristofolini,et al.  A critical analysis of stress shielding evaluation of hip prostheses. , 1997, Critical reviews in biomedical engineering.

[3]  Michiel Mulier,et al.  Per-operative vibration analysis: a valuable tool for defining correct stem insertion: preliminary report. , 2010, Ortopedia, traumatologia, rehabilitacja.

[4]  L Sennerby,et al.  The application of resonance frequency measurements to study the stability of titanium implants during healing in the rabbit tibia. , 1997, Clinical oral implants research.

[5]  S. Chinchalkar.  DETERMINATION OF CRACK LOCATION IN BEAMS USING NATURAL FREQUENCIES , 2001 .

[6]  L Cristofolini,et al.  Initial stability of uncemented hip stems: an in-vitro protocol to measure torsional interface motion. , 1995, Medical engineering & physics.

[7]  A. Cappello,et al.  Mechanical validation of whole bone composite tibia models. , 2000, Journal of biomechanics.

[8]  Ilse Jonkers,et al.  In vivo evaluation of a vibration analysis technique for the per-operative monitoring of the fixation of hip prostheses , 2009, Journal of orthopaedic surgery and research.

[9]  K. Søballe,et al.  Hydroxyapatite ceramic coating for bone implant fixation. Mechanical and histological studies in dogs. , 1993, Acta orthopaedica Scandinavica. Supplementum.

[10]  L Cristofolini,et al.  Methods for quantitative analysis of the primary stability in uncemented hip prostheses. , 1999, Artificial organs.

[11]  Wolf-Joachim Fischer,et al.  Integration of a wireless lock-in measurement of hip prosthesis vibrations for loosening detection , 2009 .

[12]  B Mjöberg,et al.  The theory of early loosening of hip prostheses. , 1997, Orthopedics.

[13]  G F McCoy,et al.  The Differentiation of Loose and Secure Femoral Implants in Total Hip Replacement Using a Vibrational Technique: An Anatomical and Pilot Clinical Study , 1989, Proceedings of the Institution of Mechanical Engineers. Part H, Journal of engineering in medicine.

[14]  L Cristofolini,et al.  Device to measure intra-operatively the primary stability of cementless hip stems. , 2006, Medical engineering & physics.

[15]  J. M. Lee,et al.  Observations on the Effect of Movement on Bone Ingrowth into Porous‐Surfaced Implants , 1986, Clinical orthopaedics and related research.

[16]  Christopher R. Bowen,et al.  Sensing methodology for in vivo stability evaluation of total hip and knee arthroplasty , 2010 .

[17]  G Lowet,et al.  In vivo assessment of bone mechanical properties by vibration and ultrasonic wave propagation analysis. , 1996, Bone.

[18]  Gang Qi,et al.  How much can a vibrational diagnostic tool reveal in total hip arthroplasty loosening? , 2003, Clinical biomechanics.

[19]  Norris Stubbs,et al.  Damage identification in beam-type structures: frequency-based method vs mode-shape-based method , 2003 .

[20]  L Cristofolini,et al.  Preclinical assessment of the long-term endurance of cemented hip stems. Part 2: in-vitro and ex-vivo fatigue damage of the cement mantle , 2007, Proceedings of the Institution of Mechanical Engineers. Part H, Journal of engineering in medicine.

[21]  G Van der Perre,et al.  The relation between resonant frequencies and torsional stiffness of long bones in vitro. Validation of a simple beam model. , 1993, Journal of biomechanics.

[22]  L Cristofolini,et al.  Mechanical validation of whole bone composite femur models. , 1996, Journal of biomechanics.

[23]  Robert Puers,et al.  A telemetry system for the detection of hip prosthesis loosening by vibration analysis , 2000 .

[24]  P L Li,et al.  Vibration analysis in the detection of total hip prosthetic loosening. , 1996, Medical engineering & physics.

[25]  Georges Van der Perre,et al.  Analysis of the fixation quality of cementless hip prostheses using a vibrational technique , 2004 .

[26]  L. Pastrav,et al.  Determination of total hip replacement stem insertion endpoint and stability assessment by vibration analysis: first experiences with per-operative measurements , 2006 .

[27]  A. Georgiou,et al.  Accurate diagnosis of hip prosthesis loosening using a vibrational technique. , 2001, Clinical biomechanics.

[28]  E Schneider,et al.  A comparative study of the initial stability of cementless hip prostheses. , 1989, Clinical orthopaedics and related research.

[29]  W. Maloney,et al.  Biomechanical and histologic investigation of cemented total hip arthroplasties. A study of autopsy-retrieved femurs after in vivo cycling. , 1989, Clinical orthopaedics and related research.

[30]  Fj Guild,et al.  Vibration damping for crack detection in composite laminates , 2004 .

[31]  R Michael Meneghini,et al.  Monitoring femoral component installation using vibration testing. , 2005, Biomedical sciences instrumentation.

[32]  L Sennerby,et al.  Stability measurements of one-stage Brånemark implants during healing in mandibles. A clinical resonance frequency analysis study. , 1999, International journal of oral and maxillofacial surgery.

[33]  B Reggiani,et al.  Predicting the subject-specific primary stability of cementless implants during pre-operative planning: preliminary validation of subject-specific finite-element models. , 2007, Journal of biomechanics.

[34]  W. Hayes,et al.  Cross-sectional geometry of Pecos Pueblo femora and tibiae--a biomechanical investigation: I. Method and general patterns of variation. , 1983, American journal of physical anthropology.

[35]  F. Duck,et al.  Bone vibration measurement using ultrasound: application to detection of hip prosthesis loosening. , 2008, Medical engineering & physics.

[36]  T. Smith,et al.  Cortical bone viscoelasticity and fixation strength of press-fit femoral stems: an in-vitro model. , 2006, Journal of biomechanical engineering.

[37]  Marco Viceconti,et al.  Hip-Op: an innovative software to plan total hip replacement surgery , 2002, Medical informatics and the Internet in medicine.

[38]  Angelo Cappello,et al.  Intra-operative evaluation of cementless hip implant stability: a prototype device based on vibration analysis. , 2007, Medical engineering & physics.

[39]  Robert Y. Liang,et al.  Detection of cracks in beam structures using measurements of natural frequencies , 1991 .

[40]  Angelo Cappello,et al.  INTRA-OPERATIVE TESTS ON CEMENTLESS HIP STEM MECHANICAL STABILITY , 2006 .

[41]  L Sennerby,et al.  Stability assessments and histology of titanium implants placed simultaneously with autogenous onlay bone in the rabbit tibia. , 1998, International journal of oral and maxillofacial surgery.