title: Hammering sound frequency analysis and prevention of intraoperative periprosthetic fractures during total hip arthroplasty.
abstract: Adequate fixation at the time of cementless stem implantation depends on the operator's experience. An objective evaluation method to determine whether the stem has been appropriately implanted may be helpful. We studied the relationship between the hammering sound frequency during stem implantation and internal stress in a femoral model, and evaluated the possible usefulness of hammering sound frequency analysis for preventing intraoperative fracture. Three types of cementless stem (BiCONTACT®, SL-PLUS®, and AI-Hip®) were used. Surgeons performed stem insertion using a procedure similar to that employed in a routine operation. Stress was estimated by finite element analysis, the hammering force was measured, and frequency analysis of hammering sound data obtained using a microphone. Finite element analysis showed a decrease in the hammering sound frequency with an increase in the estimated maximum stress. When a decrease in frequency was observed, adequate hammering had occurred, and the continuation of hammering risked fracture. Based on the relationship between stress and frequency, the evaluation of changes in frequency may be useful for preventing the development of intraoperative fractures. Using our method, when a decrease in frequency is observed, the hammering force should be reduced. Hammering sound frequency analysis may allow the prediction of bone fractures that can be visually confirmed, and may be a useful objective evaluation method for the prevention of intraoperative periprosthetic fractures during stem insertion.
authors.affiliation: Department of Medical Engineering and Technology, School of Allied Health Sciences, Kitasato University, Sagamihara City, Kanagawa, Japan. rinax@kitasato-u.ac.jp
authors.forename: Rina
authors.initials: R
authors.lastname: Sakai
authors.forename: Aki
authors.initials: A
authors.lastname: Kikuchi
authors.forename: Towa
authors.initials: T
authors.lastname: Morita
authors.forename: Naonobu
authors.initials: N
authors.lastname: Takahira
authors.forename: Katsufumi
authors.initials: K
authors.lastname: Uchiyama
authors.forename: Takeaki
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Mistutoshi
authors.initials: M
authors.lastname: Moriya
authors.forename: Kentaro
authors.initials: K
authors.lastname: Uchida
authors.forename: Kensuke
authors.initials: K
authors.lastname: Fukushima
authors.forename: Kensei
authors.initials: K
authors.lastname: Tanaka
authors.forename: Masashi
authors.initials: M
authors.lastname: Takaso
authors.forename: Moritoshi
authors.initials: M
authors.lastname: Itoman
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Mabuchi
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000295:instrumentation; D002484:Cementation; D005264:Femoral Fractures / Q000175:diagnosis / Q000209:etiology*; D006622:Hip Prosthesis; D006801:Humans; D007431:Intraoperative Complications; D007432:Intraoperative Period; D008953:Models, Anatomic; D057068:Periprosthetic Fractures / Q000175:diagnosis / Q000517:prevention & control*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D013016:Sound; D013018:Sound Spectrography / Q000379:methods*; D013314:Stress, Mechanical