Acoustic characteristics of broaching procedure for post-operative stem subsidence in cementless total hip arthroplasty

Abstract

Purpose: Avoiding stem subsidence is crucial for achieving better outcome for cementless Total hip arthroplasty (THA). The aim of this study was to develop a prediction model for the incidence of post-operative stem subsidence using fullquantitative acoustic parameters in hammering sound during the broaching procedure and to assess the accuracy of this prediction model. Methods:The acoustic parameters of the hammering sounds during a broaching procedure for 55 hips in 49 patients underwent THAs with cementless taper-wedged stem were analyzed. The stem subsidence was assessed at 1-month postoperatively, and relationship between the acoustic parameters and value of stem subsidence was investigated. Results:The average stem subsidence was 2.15±2.91mm. The subsidence 3 mm or more was observed in eleven hips (20%), 5mm or more was 7 hips (12.7%). Basic patient's characteristics, pre-operative femoral morphology and immediate postoperative canal fil ratio, and stem alignment were not significantly related to the volume of stem subsidence. Nine acoustic parameters were significantly correlated with the value of subsidence. The prediction model for post-operative subsidence using only acoustic parameters during broaching procedure was established, and this model showed a positive prediction value of 100%, and a negative prediction value of 90.6% for postoperative stem subsidence at 5mm or more. Conclusion:Postoperative stem subsidence can be predicted by using acoustic parameters of the hammering sound during the broaching procedure. Our results suggest that we are at the start of a new era in which novel and innovative smart technologies can be used to assist in orthopaedic surgeries.

Selection of Hammering Sound Collection Devices for the Development of Total Hip Arthroplasty Support Systems

“…The frequency components that constitute the hammering sound are the characteristic frequencies of the hammer and the inserter [11]. Zhuang et al stated that the frequency components of the hammering sound are almost independent of the manufacturers of the inserter and hammer [1]. Based on previous research, we reported that the peak frequency is approximately 3 kHz [10].…”

“…Total hip arthroplasty (THA) is a surgical procedure to replace a hip joint, with hip prostheses, that Open Access has lost its functionality. The developments in hip arthroplasty over recent years have aimed to improve outcomes, reduce complications [1][2][3]. However, it has been reported that during surgery, serious intraoperative fractures occur at a rate between 0.4% and 4.9% [3][4][5].…”

Factors Influence on the Broaching Hammering Sound during Cementless Total Hip Arthroplasty

“…Goossens et al reported that frequency below 2 kHz was crucial to reflect the process of implant insertion [15]. And our previous study demonstrated a successful result that used both low and high range frequency acoustic parameters to predict postoperative stem subsidence [16].…”

Patients With Shorter Stature Exhibit Minimal Hammering Sound Changes During Cementless Stem Insertion in Total Hip Arthroplasty

“…We believe that quantitative evaluation of the hammering sounds should be the future gold standard in cementless THA, as auditory sensations are subjective and differ among individuals; in contrast, acoustic analysis is objective and far more precise and accurate. Many recent studies have demonstrated the potential usefulness of acoustic assistance in THA [ 10 , [12] , [13] , [14] , [15] ]. Better clinical outcomes of cementless THA have resulted from improvements in the cementless stem itself as well as technologies such as preoperative three-dimensional templating [ 16 , 17 ], navigation systems [ 18 , 19 ], and robotics [ [20] , [21] , [22] ].…”