Published for the British Editorial Society of Bone & Joint Surgery by Churchill Livingstone
Journal of Bone and Joint Surgery. British Volume vol:Proceedings 91-B pages:475
Annual Meeting of the European Orthopaedic Research Society edition:17 location:Madrid date:24-26 April 2008
In total hip replacement (THR), the initial fixation of the femoral stem has a critical influence on its long term stability. Objective intra-operative assessment of primary stability is a challenge, surgeons having to rely mainly on their clinical experience. Excessive press-fitting of the stem can cause intra-operative fractures in up to 30% of revision cases. In a previous study we demonstrated the feasibility and validity of a vibrational technique for the assessment of the femur-stem fixation in vitro.
In this in vivo study the vibration analysis was applied for the per-operative assessment of stem fixation in 30 THR patients who obtained an intra-operatively manufactured, hydroxyapatite coated, cementless prosthesis.
The surgeon inserted the stem through repetitive controlled hammer blows. After each blow, the frequency response function (FRF) of the stem-bone structure was measured directly on the prosthesis neck in the range 0–10 kHz. The hammering was stopped when the FRF graph did not change anymore. Extra blows would not improve the stability but would increase the fracture risk.
In 26 out of 30 cases (86.7%), the correlation coefficient between the last two FRFs was above 0.99 when the insertion was stopped. In four cases, when the surgeon decided to stop the insertion because of suspected bone fragility, the final correlation coefficient attained lower values.
During the insertion of a cementless prosthesis, the changes of boundary conditions and implant stability between subsequent stages are reflected by the FRF evolution. The higher resonance frequencies are more sensitive to the stability change. The correlation between successive FRFs can be used as a criterion for the detection of the insertion endpoint. Moreover, the FRF analysis can be used to detect dangerous situations during surgery like stem blockage and fracture risk. This study should be completed and validated by a post-operative follow-up of the patients.