1. Field of the Invention
Embodiments of the invention relate generally to the field of orthopedic implants. More particularly, an embodiment of the invention relates to methods and apparatus for orthopedic implant assessment.
2. Discussion of the Related Art
Advances in surgical techniques and materials have enabled widespread use of complete joint replacements for knees and hips. Though improving, all friction surfaces in orthopedic implants experience load dependent wear that ultimately limits the useful lifetime of the device. Replacement of a worn artificial joint, though possible, is generally avoided, resulting in more limited application of these therapies. For example, joint replacements are often delayed so that the life expectancy of the recipient and the artificial joint are approximately correlated.
Significant research is underway in many commercial and research laboratories to improve the useable lifetime of orthopedic implants through better materials design, simulation models, and advanced techniques for modular replacement of worn friction surfaces. An enabling part of this research is the ability to monitor the implant in terms of load and wear. To date, reported methods for implant condition assessment include external radiometric and vibration-based techniques, or implanted orthopedic devices incorporating strain gauge techniques for force monitoring [1,2]. In addition, an implantable technique employing MEMs-based sensors for detection and elimination of bacterial bio-films has also been reported [3]. However, these reported implanted techniques do not enable direct wear measurement, and use very few sensors allowing only an integrated (i.e., not highly pixelated) assessment of force in the joint. What is needed is an alternative technique enabling accurate measurement of direct wear and force parameters that can be incorporated into both research and clinical implants for continuous or periodic wear and load assessment.
Heretofore, the requirements of joint wear measurement, and highly pixilated assessment of forces in the joint referred to above have not been fully met. What is needed is a solution that solves these problems.
There is a need for the following embodiments of the invention. Of course, the invention is not limited to these embodiments.
According to an embodiment of the invention, a method comprises: characterizing wear of an orthopedic implant including measuring a dimension in a direction that defines a path that passes through an articulating surface of a wear element of the orthopedic implant using at least one thickness sensor. According to another embodiment of the invention, an apparatus comprises: an orthopedic implant including a wear element having an articulating surface; and at least one thickness sensor coupled to the wear element, the at least one thickness sensor measuring a dimension in a direction that defines a path that passes through the articulating surface of the wear element. According to another embodiment of the invention, a method comprises characterizing forces within an orthopedic implant including using a plurality of individually addressable pressure sensors including measuring parasitic impedance between at least two of the plurality of individually addressable pressure sensors.
These, and other, embodiments of the invention will be better appreciated and understood when considered in conjunction with the following description and the accompanying drawings. It should be understood, however, that the following description, while indicating various embodiments of the invention and numerous specific details thereof, is given by way of illustration and not of limitation. Many substitutions, modifications, additions and/or rearrangements may be made within the scope of an embodiment of the invention without departing from the spirit thereof, and embodiments of the invention include all such substitutions, modifications, additions and/or rearrangements.
The drawings accompanying and forming part of this specification are included to depict certain embodiments of the invention. A clearer conception of embodiments of the invention, and of the components combinable with, and operation of systems provided with, embodiments of the invention, will become more readily apparent by referring to the exemplary, and therefore nonlimiting, embodiments illustrated in the drawings, wherein identical reference numerals (if they occur in more than one view) designate the same elements. Embodiments of the invention may be better understood by reference to one or more of these drawings in combination with the description presented herein. It should be noted that the features illustrated in the drawings are not necessarily drawn to scale.
Embodiments of the invention and the various features and advantageous details thereof are explained more fully with reference to the nonlimiting embodiments that are illustrated in the accompanying drawings and detailed in the following description. Descriptions of well known starting materials, processing techniques, components and equipment are omitted so as not to unnecessarily obscure the embodiments of the invention in detail. It should be understood, however, that the detailed description and the specific examples, while indicating preferred embodiments of the invention, are given by way of illustration only and not by way of limitation. Various substitutions, modifications, additions and/or rearrangements within the spirit and/or scope of the underlying inventive concept will become apparent to those skilled in the art from this disclosure.
Within this application several publications are referenced by Arabic numerals, or principal author's name followed by year of publication, within parentheses or brackets. Full citations for these, and other, publications may be found at the end of the specification immediately preceding the claims after the section heading References. The disclosures of all these publications in their entireties are hereby expressly incorporated by reference herein for the purpose of indicating the background of embodiments of the invention and illustrating the state of the art.
The below-referenced U.S. Patent discloses embodiments that are useful for the purposes for which they are intended. The entire contents of U.S. Pat. No. 5,197,488 are hereby expressly incorporated by reference herein for all purposes.
The invention is a technique enabling accurate measurement of direct wear and force parameters that can be incorporated into both research and clinical implants for continuous or periodic wear and load assessment. In addition, the invention can incorporate different sensor types allowing monitoring of surrounding physiological parameters including tissue encapsulation, bone condition, osteointegration status including implant loosening, and the presence of infection. The invention is suitable for use with many different implant types including artificial knee (tibial plate, patella), hip, shoulder, and elbow joints, and may find use in spinal or other applications where bone is involved.
The invention can include high-resolution monitoring of both forces in prosthetic devices and the associated polymer-metal surface wear (one of the primary long-term failure mechanism in orthopedic implant devices). The invention can include direct wear measurement, including loss of material in the joint or deformation resulting in thin spots. The invention can be highly miniaturized and biocompatible, making it suitable for complete integration into existing prosthetic devices. The invention can include using low-power integrated circuits for sensing and telemetry allowing the sensor to be configured in a number of different ways, thereby enabling real-time continuous reporting, periodic reporting, and/or reporting only when requested. The invention can include different sensor types including capacitance-based, piezo-based, inductive, ultrasonic, MEMs-based pressure sensors, temperature sensors, vibration sensors and optical sensors will allow complete monitoring of wear, pressure, temperature, and surrounding physiological parameters including tissue encapsulation, bone condition, osteointegration status including implant loosening and the presence of infection.
The invention can include a capacitance-based sensing technique yielding direct wear measurement including capacitive dielectric enhancement and a dual-use sensor plate concept. The invention can include time-domain-reflectrometry and acoustic measurement techniques. The invention can include acoustic telemetry. The invention can include photonics-based sensing for infection, scarring, and bone condition monitoring. The invention can include MEMs-based sensors.
Sensing Method
This section describes a preferred sensing method and provides an overview of a preferred implant system including data telemetry. The sensing approach can involve placement of a capacitive sensor array in the polymer portion of a tibial plate.
Referring to
Since the capacitance sensor array 210 is integrated with readout electronics 220, the invention allows for pixelated determination of wear at the friction surfaces (articulated surface). In a preferred configuration of the invention, the metal femoral portion of the prosthesis serves as a common node (or common capacitor plate) allowing accurate measurement of the distance between the polymer-embedded plates and the common node. In this configuration, the wear of the friction surfaces reduces the distance between the sensing plates as the capacitance of a parallel plate capacitor is linearly dependent on the distance between the plates. Neglecting fringing fields, this relationship is given by
where ε is the effective dielectric constant of the material between the plates, A is the area of the plate, and d is the distance between the plates. Polymer thickness d is a direct indicator of wear.
In addition, there is a so-called ‘fringe’ capacitance caused by the electric field emanating from the edges of the capacitor plate to the surrounding surfaces [13-14]. Similar to wear measurements, force measurements can be obtained by incorporating additional capacitive plates (or a common plate) in the tibial device. The additional capacitive plates can be spaced apart from the wear sensing capacitive plates with a (reversibly) compressible polymer. In this configuration, compression of the polymer will result in variations in the distance between the two plates that can be measured as a change in capacitance. An example of this third layer configuration is illustrated in
Referring to
Electronics Readout Configuration
There are a number of different readout techniques that have been shown effective for use with capacitance-based sensors. Using the configuration shown in
Referring to
Still referring to
where Vin is a voltage applied to an operational amplifier (e.g., step function), Vout is a voltage from the operational amplifier, Csensor is a measured capacitance of a pressure sensor (variable; e.g., as a function of thickness, pressure, etc.) and Cf is a reference (e.g., feedback) capacitance. By adding switch elements, each capacitor sensor in a set of sensors can be individually addressed. Switching of one and/or a plurality of sensors in the overall network that includes the set of sensors can enable the measurement of individual and nearest neighbor parasitic capacitances and associated crosstalk between sensing elements. For instance, the parasitic capacitance with regard to each of the adjacent sensors nearest neighbors can be characterized and used to adjust (normalize) measured capacitance of one or more sensors. The implementation of the invention via an architecture composed of a multi-channel set of sensor amplifiers for wear and force sensing, feedback capacitors, switch elements, and control and support electronics is completely compatible with common low-power, low-voltage, integrated circuit fabrication processes.
In addition to the non-inverting voltage amplifier of
Referring to
Embodiments of the invention can include incorporation of signal processing either in the implant or external to the patient (or a combination of these). For instance, a computer program can be used to compensate for parasitic impedance between sensors and thereby provide improved response of individual sensors by minimizing the effects of adjacent sensors. An embodiment of the invention can also utilize data processing methods that transform signals from raw data to (pre)processed data. For example, sensor outputs can be accumulated (e.g., integrated) and/or statistically processed (e.g., averaged, smoothed, etc.). Embodiments of the invention can be combined with instrumentation to obtain state variable information to actuate interconnected discrete hardware elements. For instance, an embodiment of the invention can include the use of temperature and/or vibration sensors to control the rate of data acquisition/transmission and drive characteristics where sensors requiring drive signals are employed.
Assessment of the soft tissue and bone surrounding the implant can be performed using a combination of optical, ultrasonics-based, and vibration measurements. An embodiment of the invention can include monitoring with any combination of optical, ultrasonic, and/or vibration sensors that are located peripherally with regard to a sensor set to probe into the soft tissue and/or bone surrounding the implant.
Thickness measurement of wear elements can be performed using optical absorption. For example, a nondispersive infrared light source can be chosen such that a portion of the light is absorbed by a polymeric wear element. The amplitude of the transmitted light can then be related to the thickness of the wear element. Referring to
Optical techniques can also be employed in the context of the invention to monitor the condition or formation of soft tissue inflammation. Inflamed tissue is characterized by fluid accumulation primarily in the interstitial spaces. This results in an increase in local tissue (soft-tissue) volume at the infection site detectable by a decrease in the measured tissue optical density or by the increase in the water absorption due to edema.
Optical techniques can be employed in the context of the invention to monitor the condition or formation of infection. Infection causative agents can be detected by optical means using DNA/antibody coated probes that bind to specific pathogens or toxins generating detectable optical signals or detected non specifically by the changes in scattering due to their presence. In addition, specific molecular species associated with infection and inflammatory processes can be measured using optical techniques.
Optical techniques can be employed in the context of the invention to monitor the condition or formation of scar tissue. Scar tissue is characterized by the presence of collagen-which has a very distinct auto-fluorescence signature that is detectable with a multi-spectral optical sensor[5,6]
Ultrasonic techniques can be utilized to detect the implant associated conditions such as bone mass deposition. Bone mass changes are detectable by attenuation changes in an ultrasound signal.
Ultrasonic techniques can be utilized to detect the implant associated conditions such as bone cement condition (deterioration). Bone cement changes (deterioration) will also be detectable by attenuation changes in an ultrasound signal[7].
Ultrasonic techniques can be utilized to detect the implant associated conditions such as long-term wear (thinning) of the implant by utilizing time-domain reflectometry.
Ultrasonic techniques can be utilized to detect the implant associated conditions such as real-time compression of the implant wear material by utilizing time-domain reflectometry.
The optical and/or ultrasonic sensors can be placed on the perimeter of the prosthesis where optical and ultrasonic access to the surrounding tissue can be established. Also, the optical and/or ultrasonic sensors can be located elsewhere on the prosthesis, for example to monitor the condition and/or performance of the prosthesis, the wear sensor(s) and/or the force/pressure sensor(s).
Instrument System
The individual sensors can be arranged into sets that define one or more arrays. When arranged in an array, the sensors can be termed pixilated sensors. The pixelated sensors can be configured in a number of ways to allow measurement of wear in the implant device. In
The sensing methods described above can be integrated with control and data telemetry electronics to provide a highly miniaturized low-power sensing system. Outputs from the multiple force and wear sensors can be digitized, and a data packet including sensor data, unit identification, etcetera can be transmitted to a localized receiver. Many options exist for the data telemetry including straight-forward amplitude modulation or frequency modulation, or more robust techniques employing spread spectrum. The power requirements of the sensor system depend on a number of factors including channel number, data acquisition rate, level of integrated signal processing, and data telemetry format. Options for implant powering include the use of an internal battery, inductive power coupling, or a combination of the two.
The invention can enable high-resolution pixelated sensing of wear and pressure, such as from approximately 1 micron to approximately 1 cm, preferably from approximately 10 microns to approximately 1 mm. The pixels can be defined by the spatial configuration of one or more associated sensor unit cell(s).
The invention can enable direct measurement of wear rather than a direct indication of force that can be used to solve for wear. The measurement of capacitance across wear element(s), inversely proportional to remaining wear element (and therefore wear) is an important aspect of the invention.
The invention can utilize the prosthetic elements as part of the sensing ‘circuit’ (e.g. for the knee prosthetic device, either the femoral implant, or the tibial implant (both metal), or both. The invention can also utilize the prosthetic elements for housing data storage, data processing, signal processing and/or signal transmission/reception elements.
The invention can enable dual use of the sensor plates. Sensor plates may be used both for sensing and for communications. The sensor plates may be configured to operate as either part of the sensing array or as communication devices. The two functions may be performed sequentially by switching control between sensing and communicating with regard to time separation. These two functions may be performed in parallel and separated in frequency allowing simultaneous functioning of both sensing and communication.
The sensor plates may be configured for use as a planar patch antenna with the tibial plate (metal portion), the femoral component (metal) or both acting as an image plane. The tibial plate (metal portion) or femoral component (metal portion) may be used as a transmitting antenna for communication of data to a receiving antenna located outside of the body. Similarly, the invention can include the use of a transmitter located outside the body to address the sensor, storage, processing and/or communication components of the implant.
The device may utilize the planar sensing plates for unmodulated baseband capacitive communications. Furthermore, modulation may be applied to these waveforms including BPSK, OOK, QPSK, ultrawideband, and other standard modulation/transmission formats.
The invention can include the use of inductive sensors. The inductive sensors (if utilized) may be employed for inductive communications with an externally place antenna or coil.
The invention may incorporate additional capacitive plates or inductive coils (in addition to those used for sensing) to enable data telemetry function. The telemetry function can be one-way or two-way.
The invention enables measurement of parameters indicating the presence or absence of infection. This may be implemented as a temperature sensor that measures small temperature variations that may be indicative of a localized infection or other immunological activity.
The invention enables measurement of surrounding tissue condition and infection status using single or multiple wavelength optical absorption spectroscopy. Polarization techniques may provide optimized discrimination. The invention enables measurement of surrounding bone condition and bone cement condition using miniature ultrasonic transducers.
The invention enables the incorporation of piezo-based sensors for force measurement. These piezo-based sensors may be used in the place of the pixelated capacitive sensors or can be stacked with the capacitance-based sensors.
The invention enables the use of ultrasonic-based sensors in addition to or in place of the capacitance-based sensors for direct wear measurement. An acoustic signal emitted from the sensor can pass through a polymer plate, reflect off of the femoral metal component (in the specific case of the knee prosthesis) and be detected by the sensor array. Time domain reflectometry (TDR) can then be employed to measure the thickness of the polymer and directly determine wear status. The phase of the reflected acoustic waveform may also be used to determine polymer spacer thickness. The use of acoustic TDR also allows for acoustic telemetry.
The invention enables the use of MEMs-based pressure sensors in addition to or in place of the capacitance-based sensors for force detection. These may be in the form of coated cantilevers or membrane-based sensors.
The invention enables the use of inductive sensors where inductive coils are used in place of or in addition to the capacitance-based plates. The inductance of these inductive coils will vary as the femoral portion of the implant (metal) is moved closer or farther from the coils. This will enable a direct determination of polymer spacer thickness (directly indicating wear) using inductance-based measurement techniques including RLC oscillators, L division, and LC shaping networks using zero-crossing techniques. In RLC oscillators, the R and C are fixed elements and L is the sensor inductance. Changes in L are indicated by changes in frequency allowing the polymer thickness to be approximated. L division employs two inductors placed in series. One L is a fixed reference device with the other is the sensor. The string is driven by a shaped pulse on one side and the pulse is measured between the two devices where changes in the sensor L are indicated by changes in the pulse characteristics.
The invention enables the use of capacitance sensor dielectric enhancement. In the capacitance-based case, stress-related mechanical compression will cause changes in both the dielectric properties of the media between the plates (joint polymer material) and plate separation. In addition, the acoustic velocity of propagation of the polymer will change as a function of pressure. These components can be utilized to provide increased sensitivity for both force and wear (thickness of polymer) monitoring. Wear will be observed as a long-term shift in the signal baseline while stress will involve temporal variations in capacitance.
The invention enables improved temperature tolerance. Temperature effects associated with capacitance-based monitoring will be minimized as temperature variations are limited by the damping thermal mass of the human body.
The invention can incorporate sensor node switching for pixilated sensor control allowing multiplexing of sensors to sensor interfacing/readout electronics. The invention can incorporate sensor node switching and signal processing allowing minimization of the effects of adjacent sensors on each pixel measurement.
The invention can be integrated with measurement, signal processing, and data telemetry electronics. Options for implant powering include the use of an internal battery, inductive power coupling, or a combination of the two.
The invention can incorporate different sensor types for wear and pressure sensing including capacitance-based, inductive based, piezo-based, and MEMs-based pressure sensors. The invention may incorporate ultrasonic-based sensors implementing time domain reflectometry (TDR) techniques for thickness measurement. The invention can incorporate of additional sensors for immunological assessment (infection, rejection, tissue encapsulation, scarring) including temperature sensors, MEMs-based sensors, and optical sensors. The invention can incorporate additional sensors for assessing integration of the implant with surrounding soft tissue and bone including optical and ultrasonic sensors.
Options for data telemetry including inductive, capacitive, optical, acoustic, and RF-modulated approaches including spread spectrum (direct sequence or frequency hopping approaches) and hybrid spread spectrum approaches. The telemetry can include real-time continuous reporting, periodic reporting, or reporting only when requested (e.g., polled). The invention may be configured with an internal receiver allowing programmability using one of the aforementioned communications methods.
An embodiment of the invention can also be included in a kit-of-parts. The kit-of-parts can include some, or all, of the components that an embodiment of the invention includes. The kit-of-parts can be an in-the-field retrofit kit-of-parts to improve existing systems that are capable of incorporating an embodiment of the invention. The kit-of-parts can include software, firmware and/or hardware for carrying out an embodiment of the invention. The kit-of-parts can also contain instructions for practicing an embodiment of the invention. Unless otherwise specified, the components, software, firmware, hardware and/or instructions of the kit-of-parts can be the same as those used in an embodiment of the invention.
A practical application of an embodiment of the invention that has value within the technological arts is for orthopedic implants. The invention is suitable for use with many different implant types including artificial knee (tibial plate, patella), hip, shoulder, and elbow joints, and may find use in spinal or other applications where bone is involved. There are virtually innumerable uses for an embodiment of the invention, all of which need not be detailed here.
Embodiments of the invention can be cost effective and advantageous for at least the following reasons. The invention is a technique enabling accurate measurement of direct wear and force parameters that can be incorporated into both research and clinical implants for continuous or periodic wear and load assessment. In addition, the invention can incorporate different sensor types allowing monitoring of surrounding physiological parameters including tissue encapsulation, bone condition, and the presence of infection. Embodiments of the invention improve quality and/or reduce costs compared to previous approaches.
The term reactance is intended to mean opposition to alternating current by storage in an electrical field (by a capacitor) or in a magnetic field (by an inductor), measured in ohms. The term susceptance is intended to mean the reciprocal of reactance, measured in siemens. The term program and/or the phrase computer program are intended to mean a sequence of instructions designed for execution on a computer system (e.g., a program and/or computer program, may include a subroutine, a function, a procedure, an object method, an object implementation, an executable application, an applet, a servlet, a source code, an object code, a shared library/dynamic load library and/or other sequence of instructions designed for execution on a computer or computer system). The phrase radio frequency (RF) is intended to mean frequencies less than or equal to approximately 300 GHz as well as the infrared spectrum.
The term substantially is intended to mean largely but not necessarily wholly that which is specified. The term approximately is intended to mean at least close to a given value (e.g., within 10% of). The term generally is intended to mean at least approaching a given state. The term coupled is intended to mean connected, although not necessarily directly, and not necessarily mechanically. The term proximate, as used herein, is intended to mean close, near adjacent and/or coincident; and includes spatial situations where specified functions and/or results (if any) can be carried out and/or achieved. The term deploying is intended to mean designing, building, shipping, installing and/or operating.
The terms first or one, and the phrases at least a first or at least one, are intended to mean the singular or the plural unless it is clear from the intrinsic text of this document that it is meant otherwise. The terms second or another, and the phrases at least a second or at least another, are intended to mean the singular or the plural unless it is clear from the intrinsic text of this document that it is meant otherwise. Unless expressly stated to the contrary in the intrinsic text of this document, the term or is intended to mean an inclusive or and not an exclusive or. Specifically, a condition A or B is satisfied by any one of the following: A is true (or present) and B is false (or not present), A is false (or not present) and B is true (or present), and both A and B are true (or present). The terms a or an are employed for grammatical style and merely for convenience.
The term plurality is intended to mean two or more than two. The term any is intended to mean all applicable members of a set or at least a subset of all applicable members of the set. The term means, when followed by the term “for” is intended to mean hardware, firmware and/or software for achieving a result. The term step, when followed by the term “for” is intended to mean a (sub)method, (sub)process and/or (sub)routine for achieving the recited result.
The terms “comprises,” “comprising,” “includes,” “including,” “has,” “having” or any other variation thereof, are intended to cover a non-exclusive inclusion. For example, a process, method, article, or apparatus that comprises a list of elements is not necessarily limited to only those elements but may include other elements not expressly listed or inherent to such process, method, article, or apparatus. The terms “consisting” (consists, consisted) and/or “composing” (composes, composed) are intended to mean closed language that does not leave the recited method, apparatus or composition to the inclusion of procedures, structure(s) and/or ingredient(s) other than those recited except for ancillaries, adjuncts and/or impurities ordinarily associated therewith. The recital of the term “essentially” along with the term “consisting” (consists, consisted) and/or “composing” (composes, composed), is intended to mean modified close language that leaves the recited method, apparatus and/or composition open only for the inclusion of unspecified procedure(s), structure(s) and/or ingredient(s) which do not materially affect the basic novel characteristics of the recited method, apparatus and/or composition.
Unless otherwise defined, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this invention belongs. In case of conflict, the present specification, including definitions, will control.
The described embodiments and examples are illustrative only and not intended to be limiting.
Although embodiments of the invention can be implemented separately, embodiments of the invention may be integrated into the system(s) with which they are associated. All the embodiments of the invention disclosed herein can be made and used without undue experimentation in light of the disclosure. Although the best mode of the invention contemplated by the inventor(s) is disclosed, embodiments of the invention are not limited thereto. Embodiments of the invention are not limited by theoretical statements (if any) recited herein. The individual steps of embodiments of the invention need not be performed in the disclosed manner, or combined in the disclosed sequences, but may be performed in any and all manner and/or combined in any and all sequences. The individual components of embodiments of the invention need not be formed in the disclosed shapes, or combined in the disclosed configurations, but could be provided in any and all shapes, and/or combined in any and all configurations.
It can be appreciated by those of ordinary skill in the art to which embodiments of the invention pertain that various substitutions, modifications, additions and/or rearrangements of the features of embodiments of the invention may be made without deviating from the spirit and/or scope of the underlying inventive concept. All the disclosed elements and features of each disclosed embodiment can be combined with, or substituted for, the disclosed elements and features of every other disclosed embodiment except where such elements or features are mutually exclusive. The spirit and/or scope of the underlying inventive concept as defined by the appended claims and their equivalents cover all such substitutions, modifications, additions and/or rearrangements.
The appended claims are not to be interpreted as including means-plus-function limitations, unless such a limitation is explicitly recited in a given claim using the phrase(s) “means for” and/or “step for.” Subgeneric embodiments of the invention are delineated by the appended independent claims and their equivalents. Specific embodiments of the invention are differentiated by the appended dependent claims and their equivalents.
This invention was made with United States Government support under prime contract No. DE-AC05-00OR22725 to UT-Battelle, L.L.C. awarded by the Department of Energy. The Government has certain rights in this invention.