Ex vivo estimation of cementless femoral stem stability using an instrumented hammer

Abstract

Background: The success of cementless hip arthroplasty depends on the primary stability of the femoral stem. It remains difficult to assess the optimal number of impacts to guarantee the femoral stem stability while avoiding bone fracture. The aim of this study is to validate a method using a hammer instrumented with a force sensor to monitor the insertion of femoral stem in bovine femoral samples.

Methods: Different cementless femoral stem were impacted into five bovine femur samples, leading to 99 configurations. Three methods were used to quantify the insertion endpoint: the impact hammer, video motion tracking and the surgeon proprioception. For each configuration, the number of impacts performed by the surgeon until he felt a correct insertion was noted N_surg. The insertion depth E was measured through video motion tracking, and the impact number N_vid corresponding to the end of the insertion was estimated. Two indicators, noted I and D, were determined from the analysis of the time variation of the force, and the impact number N_d corresponding to a threshold reached in D variation was estimated.

Findings: The pullout force of the femoral stem was significantly correlated with I (R² = 0.81). The values of N_surg, N_vid and N_d were similar for all configurations.

Interpretation: The results validate the use of the impact hammer to assess the primary stability of the femoral stem and the moment when the surgeon should stop the impaction procedure for an optimal insertion, which could lead to the development of a decision support system.

Keywords: Cementless femoral stem; Hip arthroplasty; Impact hammer; Primary stability.