Smart implants in orthopedic surgery, improving patient outcomes: a review

Abstract

Smart implants are implantable devices that provide not only therapeutic benefits but also have diagnostic capabilities. The integration of smart implants into daily clinical practice has the potential for massive cost savings to the health care system. Applications for smart orthopedic implants have been identified for knee arthroplasty, hip arthroplasty, spine fusion, fracture fixation and others. To date, smart orthopedic implants have been used to measure physical parameters from inside the body, including pressure, force, strain, displacement, proximity and temperature. The measurement of physical stimuli is achieved through integration of application-specific technology with the implant. Data from smart implants have led to refinements in implant design, surgical technique and strategies for postoperative care and rehabilitation. In spite of decades of research, with very few exceptions, smart implants have not yet become a part of daily clinical practice. This is largely because integration of current sensor technology necessitates significant modification to the implants. While the technology underlying smart implants has matured significantly over the last several decades, there are still significant technical challenges that need to be overcome before smart implants become part of mainstream health care. Sensors for next-generation smart implants will be small, simple, robust and inexpensive and will necessitate little to no modification to existing implant designs. With rapidly advancing technology, the widespread implementation of smart implants is near. New sensor technology that minimizes modifications to existing implants is the key to enabling smart implants into daily clinical practice.

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

“…To our knowledge, no detailed reviews focused on major breakthroughs have been carried out in the scope of monitoring technologies for bone-implant integration sensing so far. Ledet et al [74] conducted an overview on sensor technology for instrumented orthopedic implants focused on physical parameters that do not provide an effective indication of the bone-implant integration state (characteristics, strength, stiffness, etc). Soares dos Santos et al [21,75] focused their analyses on all bioelectronic systems (actuation, monitoring, communication, and self-powering) incorporated into instrumented bone implants experimentally validated in vivo, which also confined the measurement technologies to force, moment, and temperature sensors.…”

FDA public workshop: Orthopaedic sensing, measuring, and advanced reporting technology (SMART) devices

“…All authors have (1) provided substantial contributions to research design, or the acquisition, analysis or interpretation of data, (2) contributed to drafting the paper or revising it critically, and 3provided approval of the submitted and final versions. All authors have read and approved the final submitted manuscript.…”

“…into three categories: (1) those that benefit the patient, (2) those that benefit the clinician, and (3) those that benefit the MDM. Of these,…”

Materials and Orthopedic Applications for Bioresorbable Inductively Coupled Resonance Sensors

“…These kinds of applications could reduce unnecessary patient discomfort and facilitate massive savings by detecting adverse events early or by reducing revision surgeries and expensive imaging procedures. 4 , 12 …”