Weak hammering sounds are associated with postoperative subsidence in cementless total hip arthroplasty

The aim of this study was to investigate the relationship between the hammering sound level and the presence of postoperative subsidence.

The last five hammering sounds during the final-size broaching procedure and during the real stem insertion were recorded and analysed in 95 patients who were operated on by one of seven surgeons using two implants (Trident cup, Accolade II, Stryker; G7 cup, Taperloc Complete Microplasty Stem, Zimmer Biomet). The maximum peak was semi-automatically identified and analysed to determine the maximum C-weighted sound pressure level (LCpeak) of each of the five hammering sounds and the equivalent continuous A-weighted sound pressure (LAeq) of the entire five-sound hammering procedure.

Among the 95 hips, 25 (26.3%) had ≥ 3 mm of postoperative subsidence. Therefore, 125 of 475 hammering sounds (LCpeak) and 25 of 95 hammering procedures (LAeq) in both the broaching procedure and stem insertion procedure were associated with postoperative subsidence. The hammering sound level in both the broaching and stem insertion procedures were significantly weaker in patients with postoperative subsidence than in those without subsidence. Among the seven surgeons, there was intra-surgeon and inter-surgeon heterogeneity with large variance regarding the sound levels. With univariate and multivariate analyses, the hammering sound level was independently associated with postoperative subsidence in the two models.

A weak hammering sound level was associated with postoperative subsidence in THA with a cementless stem. An objective evaluation of the hammering procedure might be useful to decrease the incidence of postoperative subsidence.