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Lützelberger J, Arneth P, Franck A, Drese KS. Ultrasonic Interferometric Procedure for Quantifying the Bone-Implant Interface. SENSORS (BASEL, SWITZERLAND) 2023; 23:5942. [PMID: 37447790 DOI: 10.3390/s23135942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/19/2023] [Accepted: 06/22/2023] [Indexed: 07/15/2023]
Abstract
The loosening of an artificial joint is a frequent and critical complication in orthopedics and trauma surgery. Due to a lack of accuracy, conventional diagnostic methods such as projection radiography cannot reliably diagnose loosening in its early stages or detect whether it is associated with the formation of a biofilm at the bone-implant interface. In this work, we present a non-invasive ultrasound-based interferometric measurement procedure for quantifying the thickness of the layer between bone and prosthesis as a correlate to loosening. In principle, it also allows for the material characterization of the interface. A well-known analytical model for the superposition of sound waves reflected in a three-layer system was combined with a new method in data processing to be suitable for medical application at the bone-implant interface. By non-linear fitting of the theoretical prediction of the model to the actual shape of the reflected sound waves in the frequency domain, the thickness of the interlayer can be determined and predictions about its physical properties are possible. With respect to determining the layer's thickness, the presented approach was successfully applied to idealized test systems and a bone-implant system in the range of approx. 200 µm to 2 mm. After further optimization and adaptation, as well as further experimental tests, the procedure offers great potential to significantly improve the diagnosis of prosthesis loosening at an early stage and may also be applicable to detecting the formation of a biofilm.
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Affiliation(s)
- Jan Lützelberger
- Institute of Sensor and Actuator Technology (ISAT), Coburg University of Applied Sciences and Arts, Am Hofbräuhaus 1b, 96450 Coburg, Germany
| | - Philipp Arneth
- Institute of Sensor and Actuator Technology (ISAT), Coburg University of Applied Sciences and Arts, Am Hofbräuhaus 1b, 96450 Coburg, Germany
| | - Alexander Franck
- Department of Trauma Surgery and Orthopedics, REGIOMED Clinical Center Coburg, Ketschendorfer Str. 33, 96450 Coburg, Germany
- School of Medicine, University of Split, 21000 Split, Croatia
| | - Klaus Stefan Drese
- Institute of Sensor and Actuator Technology (ISAT), Coburg University of Applied Sciences and Arts, Am Hofbräuhaus 1b, 96450 Coburg, Germany
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2
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Soares Dos Santos MP, Bernardo RMC. Bioelectronic multifunctional bone implants: recent trends. Bioelectron Med 2022; 8:15. [PMID: 36127721 PMCID: PMC9490885 DOI: 10.1186/s42234-022-00097-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 08/23/2022] [Indexed: 12/04/2022] Open
Abstract
The concept of Instrumented Smart Implant emerged as a leading research topic that aims to revolutionize the field of orthopaedic implantology. These implants have been designed incorporating biophysical therapeutic actuation, bone-implant interface sensing, implant-clinician communication and self-powering ability. The ultimate goal is to implement revist interface, controlled by clinicians/surgeons without troubling the quotidian activities of patients. Developing such high-performance technologies is of utmost importance, as bone replacements are among the most performed surgeries worldwide and implant failure rates can still exceed 10%. In this review paper, an overview to the major breakthroughs carried out in the scope of multifunctional smart bone implants is provided. One can conclude that many challenges must be overcome to successfully develop them as revision-free implants, but their many strengths highlight a huge potential to effectively establish a new generation of high-sophisticated biodevices.
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Affiliation(s)
- Marco P Soares Dos Santos
- Department of Mechanical Engineering, Centre for Mechanical Technology & Automation (TEMA), Intelligent Systems Associate Laboratory (LASI), University of Aveiro, Aveiro, Portugal.
| | - Rodrigo M C Bernardo
- Department of Mechanical Engineering, Centre for Mechanical Technology & Automation (TEMA), Intelligent Systems Associate Laboratory (LASI), University of Aveiro, Aveiro, Portugal
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Veletić M, Apu EH, Simić M, Bergsland J, Balasingham I, Contag CH, Ashammakhi N. Implants with Sensing Capabilities. Chem Rev 2022; 122:16329-16363. [PMID: 35981266 DOI: 10.1021/acs.chemrev.2c00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Because of the aging human population and increased numbers of surgical procedures being performed, there is a growing number of biomedical devices being implanted each year. Although the benefits of implants are significant, there are risks to having foreign materials in the body that may lead to complications that may remain undetectable until a time at which the damage done becomes irreversible. To address this challenge, advances in implantable sensors may enable early detection of even minor changes in the implants or the surrounding tissues and provide early cues for intervention. Therefore, integrating sensors with implants will enable real-time monitoring and lead to improvements in implant function. Sensor integration has been mostly applied to cardiovascular, neural, and orthopedic implants, and advances in combined implant-sensor devices have been significant, yet there are needs still to be addressed. Sensor-integrating implants are still in their infancy; however, some have already made it to the clinic. With an interdisciplinary approach, these sensor-integrating devices will become more efficient, providing clear paths to clinical translation in the future.
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Affiliation(s)
- Mladen Veletić
- Department of Electronic Systems, Norwegian University of Science and Technology, 7491 Trondheim, Norway.,The Intervention Centre, Technology and Innovation Clinic, Oslo University Hospital, 0372 Oslo, Norway
| | - Ehsanul Hoque Apu
- Institute for Quantitative Health Science and Engineering (IQ) and Department of Biomedical Engineering (BME), Michigan State University, East Lansing, Michigan 48824, United States.,Division of Hematology and Oncology, Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan 48105, United States
| | - Mitar Simić
- Faculty of Electrical Engineering, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina
| | - Jacob Bergsland
- The Intervention Centre, Technology and Innovation Clinic, Oslo University Hospital, 0372 Oslo, Norway
| | - Ilangko Balasingham
- Department of Electronic Systems, Norwegian University of Science and Technology, 7491 Trondheim, Norway.,The Intervention Centre, Technology and Innovation Clinic, Oslo University Hospital, 0372 Oslo, Norway
| | - Christopher H Contag
- Institute for Quantitative Health Science and Engineering (IQ) and Department of Biomedical Engineering (BME), Michigan State University, East Lansing, Michigan 48824, United States
| | - Nureddin Ashammakhi
- Institute for Quantitative Health Science and Engineering (IQ) and Department of Biomedical Engineering (BME), Michigan State University, East Lansing, Michigan 48824, United States.,Department of Bioengineering, University of California, Los Angeles, California 90095, United States
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Cachão JH, Soares dos Santos MP, Bernardo R, Ramos A, Bader R, Ferreira JAF, Torres Marques A, Simões JAO. Altering the Course of Technologies to Monitor Loosening States of Endoprosthetic Implants. SENSORS 2019; 20:s20010104. [PMID: 31878028 PMCID: PMC6982938 DOI: 10.3390/s20010104] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/07/2019] [Accepted: 11/10/2019] [Indexed: 02/02/2023]
Abstract
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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Affiliation(s)
- João Henrique Cachão
- Department of Mechanical Engineering, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Marco P. Soares dos Santos
- Department of Mechanical Engineering, University of Aveiro, 3810-193 Aveiro, Portugal
- Center for Mechanical Technology & Automation (TEMA), University of Aveiro, 3810-193 Aveiro, Portugal
- Associated Laboratory for Energy, Transports and Aeronautics (LAETA), 4150-179 Porto, Portugal
- Correspondence:
| | - Rodrigo Bernardo
- Department of Mechanical Engineering, University of Aveiro, 3810-193 Aveiro, Portugal
| | - António Ramos
- Department of Mechanical Engineering, University of Aveiro, 3810-193 Aveiro, Portugal
- Center for Mechanical Technology & Automation (TEMA), University of Aveiro, 3810-193 Aveiro, Portugal
| | - Rainer Bader
- Department of Orthopedics, University Medicine Rostock, 18057 Rostock, Germany
| | - Jorge A. F. Ferreira
- Department of Mechanical Engineering, University of Aveiro, 3810-193 Aveiro, Portugal
- Center for Mechanical Technology & Automation (TEMA), University of Aveiro, 3810-193 Aveiro, Portugal
| | - António Torres Marques
- Associated Laboratory for Energy, Transports and Aeronautics (LAETA), 4150-179 Porto, Portugal
- Mechanical Engineering Department, University of Porto, 4200-465 Porto, Portugal
| | - José A. O. Simões
- Department of Mechanical Engineering, University of Aveiro, 3810-193 Aveiro, Portugal
- Center for Mechanical Technology & Automation (TEMA), University of Aveiro, 3810-193 Aveiro, Portugal
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Alshuhri AA, Holsgrove TP, Miles AW, Cunningham JL. Non-invasive vibrometry-based diagnostic detection of acetabular cup loosening in total hip replacement (THR). Med Eng Phys 2017; 48:188-195. [PMID: 28709931 DOI: 10.1016/j.medengphy.2017.06.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 06/19/2017] [Accepted: 06/21/2017] [Indexed: 10/19/2022]
Abstract
Total hip replacement is aimed at relieving pain and restoring function. Currently, imaging techniques are primarily used as a clinical diagnosis and follow-up method. However, these are unreliable for detecting early loosening, and this has led to the proposal of novel techniques such as vibrometry. The present study had two aims, namely, the validation of the outcomes of a previous work related to loosening detection, and the provision of a more realistic anatomical representation of the clinical scenario. The acetabular cup loosening conditions (secure, and 1 and 2 mm spherical loosening) considered were simulated using Sawbones composite bones. The excitation signal was introduced in the femoral lateral condyle region using a frequency range of 100-1500 Hz. Both the 1 and 2 mm spherical loosening conditions were successfully distinguished from the secure condition, with a favourable frequency range of 500-1500 Hz. The results of this study represent a key advance on previous research into vibrometric detection of acetabular loosening using geometrically realistic model, and demonstrate the clinical potential of this technique.
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Affiliation(s)
- Abdullah A Alshuhri
- The Centre for Orthopaedic Biomechanics, Department of Mechanical Engineering, University of Bath, Bath BA2 7AY, United Kingdom.
| | - Timothy P Holsgrove
- The Centre for Orthopaedic Biomechanics, Department of Mechanical Engineering, University of Bath, Bath BA2 7AY, United Kingdom; Department of Engineering, College of Engineering, Mathematics & Physical Sciences, University of Exeter, Exeter EX4 4RN, United Kingdom.
| | - Anthony W Miles
- The Centre for Orthopaedic Biomechanics, Department of Mechanical Engineering, University of Bath, Bath BA2 7AY, United Kingdom.
| | - James L Cunningham
- The Centre for Orthopaedic Biomechanics, Department of Mechanical Engineering, University of Bath, Bath BA2 7AY, United Kingdom.
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Alshuhri AA, Holsgrove TP, Miles AW, Cunningham JL. Development of a non-invasive diagnostic technique for acetabular component loosening in total hip replacements. Med Eng Phys 2015; 37:739-45. [PMID: 26054805 DOI: 10.1016/j.medengphy.2015.05.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 03/10/2015] [Accepted: 05/03/2015] [Indexed: 10/23/2022]
Abstract
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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Affiliation(s)
- Abdullah A Alshuhri
- The Centre for Orthopaedic Biomechanics, Department of Mechanical Engineering, University of Bath, Bath, BA2 7AY, United Kingdom.
| | - Timothy P Holsgrove
- The Centre for Orthopaedic Biomechanics, Department of Mechanical Engineering, University of Bath, Bath, BA2 7AY, United Kingdom.
| | - Anthony W Miles
- The Centre for Orthopaedic Biomechanics, Department of Mechanical Engineering, University of Bath, Bath, BA2 7AY, United Kingdom.
| | - James L Cunningham
- The Centre for Orthopaedic Biomechanics, Department of Mechanical Engineering, University of Bath, Bath, BA2 7AY, United Kingdom.
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Ruther C, Gabler C, Ewald H, Ellenrieder M, Haenle M, Lindner T, Mittelmeier W, Bader R, Kluess D. In vivo monitoring of implant osseointegration in a rabbit model using acoustic sound analysis. J Orthop Res 2014; 32:606-12. [PMID: 24391086 DOI: 10.1002/jor.22574] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 12/06/2013] [Indexed: 02/04/2023]
Abstract
Implant osseointegration can currently only be assessed reliably post mortem. A novel method that relies on the principle of acoustic sound analysis was developed to enable examination of the longitudinal progress of osseointegration. The method is based on a magnetic sphere inside a hollow cylinder of the implant. By excitation using an external magnetic field, collision of the sphere inside the implant produces a sound signal. Custom-made titanium implants equipped thusly were inserted in each lateral femoral epicondyle of 20 New Zealand White Rabbits. Two groups were investigated: Uncoated, machined surface versus antiadhesive surface; and calcium phosphate-coated surface versus antiadhesive surface. The sound analysis was performed postoperatively and weekly. After 4 weeks, the animals were euthanized, and the axial pull-out strengths of the implants were determined. A significant increase in the central frequency was observed for the loose implants (mean pull-out strength 21.1 ± 16.9 N), up to 6.4 kHz over 4 weeks. In comparison, the central frequency of the osseointegrated implants (105.2 ± 25.3 N) dropped to its initial value. The presented method shows potential for monitoring the osseointegration of different implant surfaces and could considerably reduce the number of animals needed for experiments.
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Affiliation(s)
- Cathérine Ruther
- Department of Orthopedics, University Medicine Rostock, Doberaner Strasse 142, D-18057, Rostock, Germany
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