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Impact des tissus mous sur les méthodes acoustiques d’évaluation de la stabilité des implants osseux.

Abstract : Abstract:This work studies the biomechanical behavior of a cadaveric model and an in vitro model of total hip arthroplasty. We sought to highlight and study parameters that could allow us to have a method of objective analysis of the stability of the acetabular cup implant.The first part describes the context of the study. We have emphasized the different methods of analysis that make it possible to analyse the stability of a bone implant. Indeed, despite the daily use of implants, the failure rate of osseointegration remains high and failures still happen due to inadequate mechanical behavior of the prosthesis.Among the identified causes of failure, aseptic loosening of the acetabular cup after hip arthroplasty may be related to a primary defect in stability, not achieved during the surgical procedure. It has been shown that loosening of the acetabular cup may result from poor primary stability between the prosthetic cup and the surrounding bone.A method of estimating primary stability could allow the orthopaedic surgeon to better control the stability of the implants he poses in the operating room.The main purpose of this thesis work was to study the impact signals on the prosthetic acetabulum.Firstly, we carried out a study of the insertion of the cup by impacts on a cadaveric model. A correlation was found between impact time and stability (R2 = 0.69). This experimental study has thus shown the potential of the impact signal processing method in predicting the primary stability of the acetabular cup. But we observed changes between the signals obtained on the different subjects. We hypothesized that these changes were related to soft tissue variation between subjects.The third part of this thesis focused on analysing the biomechanical behavior of our model in the presence of soft tissues.We used again the in vitro model that we had developed and added in the impaction system turkey slices of varying thickness.The purpose of this second study was to integrate the parameter related to the existence of a variable thickness of soft tissues in the dynamic interaction between the hammer, the ancillary (and the cup) and the bone tissue during the insertion. The mean and standard deviation of the Im indicator obtained for all samples and configurations at a soft tissue thickness value of 10 mm (30 mm) was 0.592 ± 0.141, (respectively 0.552 ± 0.139). Statistical analysis showed that there was no significant effect of the value of soft tissue thickness on the values of the Im indicator (F = 3.16, p = 0.08). Despite the obvious limitations of an in vitro study on a partial model of total hip arthroplasty, these results, as well as the previous results obtained on anatomical subjects, show the feasibility of developing a medical device dedicated to estimating the stability of the acetabular implant and which could be used as a decision support system by the orthopaedic surgeons.
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https://tel.archives-ouvertes.fr/tel-01940502
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Submitted on : Friday, November 30, 2018 - 12:03:06 PM
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Romain Bosc. Impact des tissus mous sur les méthodes acoustiques d’évaluation de la stabilité des implants osseux.. Médecine humaine et pathologie. Université Paris-Est, 2018. Français. ⟨NNT : 2018PESC0009⟩. ⟨tel-01940502⟩

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