What is the clinical utility of acoustic and vibrational analyses in uncemented total hip arthroplasty?

Abstract

Background: Despite recent developments in THA, a more objective method is needed to assist orthopedic surgeons in identifying the insertion endpoint of the broaching procedure. Therefore, this systematic review evaluated the in-vivo efficacy of various acoustic and vibration analyses in detecting proper implant seating, identifying intraoperative complications, and quantifying the accuracy of predictive modeling using acoustics.

Methods: Four electronic databases were searched on July 23rd, 2023, to retrieve articles evaluating the use of acoustic analysis during THA. The search identified 835 unique articles, which were subsequently screened by two independent reviewers as per our inclusion and exclusion criteria. In total, 12 studies evaluating 580 THAs were found to satisfy our criteria and were included in this review.

Results: Methodologically, analyses have suggested stopping broaching when consecutive blows emit similar acoustic profiles (maximum peak frequency ± 0.5 kHz), which indicates proper implant seating in terms of stability and mitigates subsidence. Also, abrupt large deviations from the typical progression of acoustic signals while broaching are indicative of an intraoperative fracture. Since height, weight, femoral morphological parameters, and implant type have been shown to alter acoustic emissions while hammering, incorporating these factors into models to predict subsidence or intraoperative fracture yielded virtually 100% accuracy in identifying these adverse events.

Conclusion: These findings support that acoustic analyses during THA show promise as an accurate, objective, and non-invasive method to predict and detect proper implant fixation as well as to identify intraoperative fractures.

Trial registration: PROSPERO registration of the study protocol: CRD42023447889, 23 July 2023.