Current Possibilities for Detection of Loosening of Total Hip Replacements and How Intelligent Implants Could Improve Diagnostic Accuracy

Ruther, Cathérine; Timm, U.; Ewald, Hartmut; Mittelmeier, Wolfram; Bader, Rainer; Schmelter, Rico; Lohrengel, Armin; Kluess, Daniel

doi:10.5772/25772

Cited by 11 publications

(16 citation statements)

References 64 publications

(64 reference statements)

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“…Within the first ten years of THR, around 10% of all implants are expected to fail, with loosening being the most common reason [2]. The diagnostic approaches to detect loosening are generally categorised into two groups: imaging and non-imaging approaches [3].…”

Section: Introductionmentioning

confidence: 99%

Development of a non-invasive diagnostic technique for acetabular component loosening in total hip replacements

Alshuhri

Holsgrove

Miles

et al. 2015

Medical Engineering & Physics

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Current techniques for diagnosing early loosening of a total hip replacement (THR) are ineffective, especially for the acetabular component. Accordingly, new, accurate, and quantifiable methods are required. The aim of this study was to investigate the viability of vibrational analysis for accurately detecting acetabular component loosening. A simplified acetabular model was constructed using a Sawbones(®) foam block. By placing a thin silicone layer between the acetabular component and the Sawbones block, 2- and 4-mm soft tissue membranes were simulated representing different loosening scenarios. A constant amplitude sinusoidal excitation with a sweep range of 100-1500 Hz was used. Output vibration from the model was measured using an accelerometer and an ultrasound probe. Loosening was determined from output signal features such as the number and relative strength of observed harmonic frequencies. Both measurement methods were sufficient to measure the output vibration. Vibrational analysis reliably detected loosening corresponding to both 2 and 4 mm tissue membranes at driving frequencies between 100 and 1000 Hz (p < 0.01) using the accelerometer. In contrast, ultrasound detected 2-mm loosening at a frequency range of 850-1050 Hz (p < 0.01) and 4-mm loosening at 500-950 Hz (p < 0.01).

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Section: Introductionmentioning

confidence: 99%

Development of a non-invasive diagnostic technique for acetabular component loosening in total hip replacements

Alshuhri

Holsgrove

Miles

et al. 2015

Medical Engineering & Physics

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“…Another point for consideration is the measurement system, which has to be adjusted to the resonant eigenfrequencies of the oscillators. The functionality of acoustic sound and structural vibration detection was demonstrated on overdimensioned models [24] and in in vitro studies using porcine forelegs [27,28]. Further work requires the determination of the sensitivity of the passive sensor array to implant loosening.…”

Section: Resultsmentioning

confidence: 99%

Investigation of a Passive Sensor Array for Diagnosis of Loosening of Endoprosthetic Implants

Ruther¹,

Schulze²,

Boehme³

et al. 2012

Sensors

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Currently, imaging methods are used to diagnose loosening of endoprosthetic implants, but fail to achieve 100% accuracy. In this study, a passive sensor array which is based on the interaction between magnetic oscillators inside the implant and an excitation coil outside the patient was investigated. The excited oscillators produce sound in the audible range, which varies according to the extent of loosening. By performing several experimental tests, the sensor array was optimized to guarantee reproducible and selective excitation of the sound emission. Variation in the distance between the oscillators demonstrated a definite influence on the quality of the generated sound signal. Furthermore, a numerical design analysis using the boundary element method was generated for consideration of the magnetic field and the selectivity of the oscillators during excitation. The numerical simulation of the coil showed the higher selectivity of a coil with a C-shape compared to a cylindrical coil. Based on these investigations, the passive sensor system reveals the potential for detection of implant loosening. Future aims include the further miniaturization of the oscillators and measurements to determine the sensitivity of the proposed sensor system.

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“…O'Connor and Kiourti [78] only briefly enumerated three technologies for loosening detection of hip implants. Finally, Ruther et al [28] summarized the current imaging methods used for diagnostic of post-operative total hip replacement and presented ten methods, using mechanical vibrations and acoustics, for bone-implant loosening detection. However, these studies did not perform detailed analyses to all monitoring approaches already proposed.…”

Section: Discussionmentioning

confidence: 99%

“…Included are those incorporated inside instrumented active implants or those operating extracorporeally as adjuvant technologies. To date, conventional monitoring of loosening states is performed by imaging methods, such as radiography, arthrography, scintigraphy, stereophotogrammetry, among others [28]. Although these methods are considered accurate techniques to detect loosening states of both cementeless and cemented implants, the clinical follow-up can only be carried out in clinical laboratories, and thus the monitoring cannot be established throughout the daily life of patients.…”

Section: Introductionmentioning

confidence: 99%

Altering the Course of Technologies to Monitor Loosening States of Endoprosthetic Implants

Cachão

Santos

Bernardo

et al. 2019

Sensors

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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.

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Current Possibilities for Detection of Loosening of Total Hip Replacements and How Intelligent Implants Could Improve Diagnostic Accuracy

Cited by 11 publications

References 64 publications

Development of a non-invasive diagnostic technique for acetabular component loosening in total hip replacements

Development of a non-invasive diagnostic technique for acetabular component loosening in total hip replacements

Investigation of a Passive Sensor Array for Diagnosis of Loosening of Endoprosthetic Implants

Altering the Course of Technologies to Monitor Loosening States of Endoprosthetic Implants

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