Differentiation between mechanically loose and fixed press-fit implants using quantitative acoustics and load self-referencing: A phantom study on shoulder prostheses in polyurethane foam

PLoS One. 2020 May 29;15(5):e0233548. doi: 10.1371/journal.pone.0233548. eCollection 2020.

Abstract

This study proposes to use cross-interface quantitative acoustics (ci-qA) and load self-referencing (LSR) to assess implant stability in a radiation-free, inexpensive, rapid, and quantitative manner. Eight bone analog specimens, made from polyurethane foam, were implanted with a cementless stemless shoulder implant-first in a fixed and later in a loose configuration-and measured using ci-qA under two load conditions. The loose implants exhibited higher micromotion and lower pull-out strength than their stable counterparts, with all values falling within the range of reported reference values. All acoustic characteristics differentiated between loose and fixed implants (maximum area-under-curve AUC = 1.0 for mean total signal energy, AUC = 1.0 for mean total signal energy ratio, AUC = 0.8 for harmonic ratio, and AUC = 0.92 for load self-referencing coefficient). While these results on bone substitute material will need to be confirmed on real bone specimen, ci-qA could ultimately facilitate the assessment of primary stability during implantation surgery and avoid unnecessary revision through quantitative evaluation of secondary stability during follow-up.

MeSH terms

  • Acoustics*
  • Humans
  • Mechanical Phenomena
  • Polyurethanes*
  • Shoulder Prosthesis / standards*

Substances

  • Polyurethanes
  • polyurethane foam

Grants and funding

Zimmer Biomet, Sulzerallee 8, Winterthur, Switzerland, (https://www.zimmerbiomet.ch/) provided support in the form of salaries for authors PF and PT and through providing experimental infrastructure but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ‘author contributions’ section.