Medical & Biological Engineering & Computing (2022) 60:1497–1510

https://doi.org/10.1007/s11517-022-02548-6

ORIGINAL ARTICLE

Total hip replacement monitoring: numerical models for the acoustic

emission technique
Remya Ampadi Ramachandran1,2 · Christine Lee1,3 · Lu Zhang4,5 · Supriya M. H2 · Divya Bijukumar3 · P. Srinivasa Pai6 ·
Kharma Foucher7 · Sheng‑Wei Chi4 · Didem Ozevin4 · Mathew T. Mathew1,3

Received: 26 June 2021 / Accepted: 6 March 2022 / Published online: 21 March 2022
© International Federation for Medical and Biological Engineering 2022

Abstract
Any mechanical instability associated with total hip replacement (THR) excites elastic waves with different frequencies and
propagates through the surrounding biological layers. Using the acoustic emission (AE) technique as a THR monitoring tool
provides valuable information on structural degradations associated with these implants. However, several factors can com-
promise the reliability of the signals detected by AE sensors, such as attenuation of the detected signal due to the presence of
biological layers in the human body between prosthesis (THR) and AE sensor. The main objective of this study is to develop
a numerical model of THR that evaluates the impact of biological layer thicknesses on AE signal propagation. Adipose tis-
sue thickness, which varies the most between patients, was modeled at two different thicknesses 40 mm and 70 mm, while
the muscle and skin thicknesses were kept to a constant value. The proposed models were tested at different micromotions
of 2 µm, 15–20 µm at modular junctions, and different frequencies of 10–60 kHz. Attenuation of signal is observed to be
more with an increase in the selected boundary conditions along with an increase in distance the signals propagate through.
Thereby, the numerical observations drawn on each interface helped to simulate the effect of tissue thicknesses and their
impact on the attenuation of elastic wave propagation to the AE receiver sensor.

Keywords  Total hip replacements (THR) · Non-invasive techniques · Acoustic emission (AE) · Finite element (FE)
analysis · Numerical modeling

1 Introduction
* Remya Ampadi Ramachandran
rampad2@uic.edu The acoustic emission (AE) technique, one of the non-
invasive testing methods, offers the competence to moni-
* Sheng‑Wei Chi
swchi@uic.edu tor the structural degradations of orthopedic implants both
passively and in real-time [1, 2]. Numerous studies are
1
Department of Biomedical Engineering, University reported in the literature on structural monitoring of total
of Illinois Colleges of Engineering and Medicine, Chicago, hip replacement (THR) implants by the AE technique [3].
IL, USA
Though several factors can compromise the signals detected
2
Department of Electronics, Cochin University of Science by the AE sensors, the presence of several layers of soft tis-
and Technology, Kochi, India
sue with different thicknesses and densities between the hip
3
RMDR Lab, Department of Biomedical Sciences, University implant and sensor can affect the wave propagated from the
of Illinois College of Medicine, Rockford, IL, USA
source to a great extent [4, 5]. Consequently, the initial wave
4
Department of Civil, Materials, and Environmental at the implant becomes distorted by the time it is detected
Engineering, University of Illinois, Chicago, IL, USA
by the AE sensor placed on the skin. As the wave traverses
5
College of Civil Engineering and Architecture, Guilin through different thicknesses, it can become attenuated and
University of Technology, Guilin, China
dispersed before it reaches the AE receiver sensor or skin
6
Department of Mechanical Engineering, NMAM Institute surface. Besides, the wave may also pick up noises as it
of Technology, Nitte, Karnataka, India
propagates through different layers, affecting the magnitude
7
Department of Kinesiology and Nutrition, University of the wave received by the sensor.
of Illinois, Chicago, IL, USA

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Gao et al. [6] identified a function to determine the result-
ing AE signal after it propagates through biological layers
between the implant and sensor; where the pathway of AE
signal attenuation is determined by the transfer function
(H) of the whole propagation route obtained by dividing the
detected AE signal (G) from the initial/source AE signal (F)
in its frequency domain. That work also shows that the layers
between a total hip replacement (THR) to the sensor to be in
the order of a connective part (α), soft tissue, bone, perios-
teum, subcutaneous tissue, skin, and a connective part that
attaches the sensor to the skin with Tn representing the sensi-
tivity of the receiving AE sensor. Thus, the transfer function
(H) of the whole propagation route (Eq. 1) can be obtained
by multiplying transfer functions associated with these lay-
ers, where Ha ;a = 1, ..., n, corresponds to the transfer func-
tion of each of the above-mentioned layers, respectively.
G
∏
H=
F
= Tn ⋅ Ha (1)
a=1
The influence of biological layers on wave propagation
can be assessed by evaluating the attenuation [7] which
mainly arouses due to scattering and absorption of a wave
during its propagation through a medium. Ultrasonic stud-
ies on tissues [8] showed that frequency and the propaga-
tion distance have a direct impact on the attenuation of the
signal, while Pan et al. [9] considers the effect of skin on
wave attenuation. The impact of muscle, adipose tissue, and
skin on signal attenuation was addressed in [10, 11] by plac-
ing sensors both externally on the skin and directly onto
the femoral stem implant. Literature also confirms various
numerical studies on THR evaluation to simulate the implant
behavior under different conditions. A numerical model sug-
gested by Li et al. [12] predicts the progressive failure of
thick laminated composite femoral components, whereas
Chethan et al. [13] presents a finite element (FE) analysis
demonstrating its efficiency for fatigue tests to predict the
implant life under dynamic conditions. FE analysis of the
vibrational behavior of the prosthesis-femur system was car-
ried out by Pastrav et al. [14] to identify the influence of
changing contact conditions on resonance frequency. How-
ever, a two-dimensional FE model investigation identified
the influence of surface roughness parameters and soft tis-
sue thickness on the ultrasonic response of the bone-implant
interface [15].
Aseptic loosening of THR implants is more likely to be
linked to its stress shielding behavior [16, 17]. Most of the
FE modeling studies work on loading events to perform
implant evaluations such as stress–strain analysis [18–20],
fatigue monitoring [21], and the effect of day-to-day life
activities [22]. FE models were also employed to assess
the stress shielding behavior of hip prosthesis [23, 24] and
obtained a clear picture of the implant’s stress distribution.
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Medical & Biological Engineering & Computing (2022) 60:1497–1510
Development and modeling of hip prosthesis mainly con-
sider the mechanical aspects, an FE modeling study per-
formed by Malau et al. [25] considers stress analysis towards
the development of porous stemmed hip implant for the
pediatric patients, and Çelik et al. [26] considers mechani-
cal stability as well as reduced risk of aseptic loosening
towards hip prosthesis development. FE modeling accurately
depicts what happens in the real world by simply mocking
up the environment and applying the physical effect to the
model with the help of modeling software such as COMSOL
Multiphysics [27]. Chen et al. [28] consider the FE model
approach to analyze different restoration practices of Van-
couver B1 periprosthetic fractures that occurred after THR
surgery and identified a better method with reasonable fixa-
tion power to treat the fracture.
Since FE models suggested so far in literature mainly con-
sider the stress and structural analysis to determine implant
failure, here comes the significance of the devised study.
The proposed scheme is a proof-of-concept study involv-
ing a numerical modeling approach to identify the impact
of soft tissues on acoustic emission signal attenuation and
to determine its significance in obtaining reliable AE data.
Also, a better understanding can be achieved on how AE
techniques should be altered to cater to patients with varying
tissue thicknesses to accurately monitor hip replacements.
This study also paves the way for the development of an
FE numerical model that addresses the effect of acoustic
nonlinearity, elastic modulus, density characteristics on the
propagation of an elastic wave through the biological lay-
ers, and post-processing of these simulation results with the
diagnostic data to provide anatomically rich and clinically
relevant visualizations [29].
2 Materials and methods
2.1 Basic concepts
Longitudinal sound waves travel through any medium,
whereas transverse sound waves travel only through a rela-
tively solid medium [30, 31]. Acoustic speed is greater in
more rigid or less compressible materials and is five times
greater in soft tissue and bone when compared to air. When
a sound wave travels through the tissue, a continuous loss
in its energy can be observed and it is termed attenuation.
Divergence, deflection, hysteresis, and absorption are the
main causes of attenuation which mainly arise due to the
distance from the source or viscosity of the propagation
medium [32]. The proposed study considers the stress
wave propagation in the human body through different soft
tissue layers before it reaches the skin surface. The main
aim of this work is to address the influence of adipose tis-
sue thickness in wave propagation which is initiated at the
Medical & Biological Engineering & Computing (2022) 60:1497–1510
implant interface. Since the adipose tissue has a significant
role related to load transfer due to any bodily movements;
its resistance to deformation and its residual lengthening a
tissue maintains on stretching and relaxation must also be
carefully studied [33]. As a baseline study, this numerical
model assumes the selected tissues as linear elastic materi-
als which in turn paves the way to the development of a
linear and then non-linear viscoelastic model that addresses
the viscous nature of adipose tissue and correspondingly its
hysteresis characteristics.
Computational modeling helps to overcome the restric-
tions on analytical approaches such as problems of simple
geometries or non-realistic assumptions [29]. In this study,
FE modeling (FEM) [34, 35] is employed to compute the
displacement field obtained at each interface point [13]. The
accuracy of an FE model depends on computationally fea-
sible and adequately fine mesh selection. Numerical disper-
sion and dissipation errors in a dynamic model can be con-
trolled by selecting at least 15–20 elements per wavelength
[36]. The following equations (Eqs. 2, 3, and 4) were consid-
ered in this work to calculate the element size for meshing:
𝜆
h≤
n
h denotes the element size, n denotes the number of ele-
ments, and 𝜆 denotes the wavelength
1 signal frequency variation ranging from 10 to 60  kHz.
Δt ≤
20f
Δt denotes the time-step requirement, and f denotes the
wave frequency.
Also, for a signal with wavelength λ, and frequency f fol-
lows the equation:
c=
𝜆
orc = 𝜆.f
T 10 mm, respectively, were considered seeing that they do not
where c represents the wave speed.
2.2 Model setup
As shown in Fig. 1, COMSOL Multiphysics® modeling
software was utilized to create a cross-sectional two-dimen-
sional (2D) model with three linear elastic layers represent-
ing muscle, adipose tissue, and skin [37]. In this numerical
model, elastic wave initiation at the center CoCrMo head,
where the implant would be located, and its propagation
through the three selected biological layers of different thick-
nesses were studied for different conditions such as modu-
lar junction displacement, and frequency wave instigation.
A point on each interface: muscle and adipose tissue (P1),
adipose tissue and skin (P2), and skin and outer boundary
(P3), were evaluated to analyze the received wave on these
1499
Fig. 1  Two-dimensional COMSOL model representing the main bio-
logical layers between total hip replacement and a AE receiver sensor
placed on the skin surface. P1 represents the muscle-adipose tissue
interface point, P2 represents the adipose tissue-skin interface point,
and P3 represents the skin-outer boundary interface point
selected points. The point evaluations helped to analyze how
the initial wave attenuates as it propagates through materials
(2) with different properties.
For the first case, a representative modular junction dis-
placement of 2-µm micromotion is studied and the signal
attenuation and energy loss over the medium are estimated.
Whereas in the second model, the focus is on the initiated
(3)
Frequencies were selected assuming that the hip implant
loosening initiates a wave with a frequency around 20 kHz,
whereas fatigue crack may initiate elastic waves or AE sig-
nals with very high frequencies [38, 39]. Adipose tissue
thickness of 40 mm and 70 mm was taken because this fac-
tor fluctuates the most between 40 and 70 mm [40, 41] from
(4) patient to patient. Muscle and skin thickness of 45 mm and
vary as significantly as adipose tissue.
The speed of sound in any medium is determined by
the medium’s stiffness and density. In a stiffer medium,
the wave will be faster, and if the density ( 𝜌 ) of a medium
is greater, then the wave will be slower [42, 43]. Here, we
have considered the same propagation medium but with
two different thickness characteristics for adipose tissue
layer. Apart from the soft tissue thickness parameters,
other characteristics such as density, bulk modulus, shear
modulus, and thereby Young’s modulus and Poisson’s ratio
are also important. It will help in mimicking a real-world
experimental scenario in this case to simulate the signal
propagation from the prosthesis through a real biological
medium to the AE receiver sensor. Such material charac-
teristics were selected based on the previously established
studies as illustrated in Table 1 [38, 44–46], assuming pop-
ulation age between 40 and 60. Parameters in Table 2 were
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Table 1  Material characteristics of the model To deal with computational efficiency, effectiveness, and
Biological layer Bulk modulus Shear modulus Density (kg/m )3 model accuracy, a mesh convergence study has been per-
formed with 22 ≤ n ≤ 16 . Final models considered n = 20
Muscle 0.00329 (GPa) 2.60e − 5 (GPa) 1090 of Eq. 2 as a representative based on the similarity in the
Adipose-tissue 2.0 (GPa) 1.84 (GPa) 911 displacement recorded. Point evaluations of this model are
Skin 2.0 (GPa) 5.43e − 3 (GPa) 1109 defined by associating the interpolation function concerning
Implant metal Young’s modu- Poisson’s ratio Density (g/cm3) the applied frequency parameter which in turn enables the
lus
developed models to reproduce the selected data points for
CoCrMo 240 (GPa) 0.29 8.4
evaluating the wave propagation.
Figure 2 represents the FE 2D-model created with a tis-
sue thickness of 40 mm and mesh statistics corresponding
Table 2  Parameters selected for the model to a micromotion of 2μm at the modular junction specific to
Name Expression Value
20 kHz frequency [48]. Since the selection of mesh size has
a great impact on the quality of the model being developed,
Muscle thickness (th1) 45 (mm) 0.045 m a keen focus must be given to its calculation. Considering
Adipose tissue thickness (th2) 40 (mm) 0.04 m Eq. 2, the element size of the selected mesh has been limited
70 (mm) 0.07 m to guarantee the accuracy and efficiency of the generated
Skin thickness (th3) 10 (mm) 0.01 m model.
Frequencies 10 (kHz) 1E4 Hz
20 (kHz) 2E4 Hz
30 (kHz) 3E4 Hz 3 Results
40 (kHz) 4E4 Hz
50 (kHz) 5E5 Hz One of the best ways to identify the effect of thickness of the
60 (kHz) 6E5 Hz propagation medium on stress wave propagation is to ana-
lyze the attenuation effect of the wave received at desired
points. This attenuation which refers to a decrease in its signal
selected to consider the variation of model statistics on the strength over the propagation distance mainly results from (a)
signal frequency as well as its tissue thickness values in geometric spreading of the elastic wave; (b) energy loss, (c)
the FE model. Model development parameters are limited absorption, scattering, and diffraction; (d) noise, friction, or
to Tables 1 and 2, as focus of this study is to identify the other obstacles; and (e) dispersion due to its frequency depend-
effect of soft tissues on AE wave propagation. However, ence [49, 50]. Thus, an effort is taken to determine how the
the efficiency of AE for continuous THR monitoring in amplitude of the signal at the selected point differs due to
an in-vitro experimental has been studied [47]. Studies the thickness of the layer as it propagates over the medium,
are still progressing to implement in tissue models, ani- especially on varying adipose tissue thickness factors. Using
mal models, and finally to real patient populations and to this information, the impact of the biological layers between
benefit society. a theoretical THR and the AE sensor placed on the skin is
The governing equation for the implemented study can analyzed. Numerical model building parameters were based
be derived based on the conservation of momentum. on already established studies [38, 44–46] and on one of our
in vitro experimental models [47]. Since with properly cali-
D2 u brated model parameters, a finite element model offers a reli-
𝜌 = ∇.𝜎 + FV (5)
Dt2 able solution for mechanics of materials and structures and
where 𝜎 is the Cauchy stress, and 𝜌 is the density of the allows us to calculate various measurements under various
material, and FV is the body force per unit volume, FV  . A conditions, such as displacement, strain energy, kinetic energy,
default boundary condition (free node) where the outer sur- and stresses, we have taken the named measurements and
face of the model was selected with no constraints or loads depicted them here to discuss the same model but from vari-
acting on this boundary. The four domains or layers were ous perspectives. With current AE technology, the likelihood
discretized with 2D linear triangular elements under plane of placing AE receiver sensor on the skin surface is higher;
strain assumption. The modular junction micromotions unfortunately, this may lead to excessive noise or signal attenu-
considered a representative 2μm, and15 − 20μm displace- ation as the AE signal propagates through different biological
ment conditions with different frequencies of 10 − 60kHz . layers. Therefore, signal attenuation caused by the presence of
Also, the maximum element size was selected according to soft tissue must be analyzed to deploy AE as a structural moni-
the frequency parameter selected with proper time steps. toring tool in medical implant health evaluations. Accordingly,

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Fig. 2  Schematic diagram representing a hip implant with an effect face point, with its output parameters, c von-Mises stress experienced
of 2 µm micromotion at the modular junction, b FE stress model with at the implant-muscle interface, and d total surface displacement
its 2D-cross sectional mesh generated for tissue thickness 40  mm at experienced at the implant-muscle interface
20 kHz frequency and 2 µm displacement at the implant-muscle inter-

the developed models consider two extreme values of tissue

thickness at varying frequencies and loads.
A mesh convergence [51] study is performed to confirm the
selection of n (Eq. 2) so as to obtain an accurate FE model,
since mesh convergence and mesh independence analyses help
to develop an accurate and efficient FE model. Here, mesh
convergence study also considers responses at the selected
points to confirm its impact on the true solution [52, 53]. This
process works iteratively with an increase in the number of
elements. Figure 3 shows the displacement data obtained at the
tissue-skin interface point P2 for different mesh sizes accord-
ing to n = 22, 20, 18, and 16 in Eq. 2 and for a frequency of
20 kHz. The trend of the displacement graphs is almost similar
with minimal amplitude fluctuation. However, in this study,
mesh size and corresponding time-step relative to n = 20 are
Fig. 3  Displacement field obtained at the adipose tissue-skin interface
selected as a representative to examine the effect of adipose point P2 for different mesh sizes where n = 22, 20, 18, and 16 in Eq. 2
tissue thickness in AE wave propagation.

3.1 Models based on micromotion (displacement
parameter) at the modular junction
This model assumes a representative 2-µm micromotion
[54] at the modular junction and the subsequent elastic wave
initiation and propagation over the biological layers. Proper
consideration has been given to the nearly incompressible
mechanical property of human soft tissues [38, 39] where
the COMSOL FE model employs a mixed formulation with
pressure as an independent variable.

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3.1.1 Amplitude loss due to geometric spreading
at interface points
Simulated waveforms at P1, P2, and P3 for an applied
boundary condition of 2μm micromotions at the modu-
lar junction with a frequency of 20 kHz for adipose tissue
thickness of 40 mm and 70 mm, respectively, are plotted in
Fig. 4. In this figure, the blue plots depict the signal varia-
tion received at P1, while red and yellow plots represent the
signal variation received at points P2, and P3, respectively.
For the same 20 kHz frequency, the signals received at P1,
P2, and P3 of adipose-tissue thickness of 70 mm (Fig. 4b)
show a considerable reduction in its magnitude compared
to the respective plots of adipose-tissue thickness of 40 mm
(Fig. 4a). This reduction in magnitude represents the impact
of adipose tissue thickness in stress wave propagation and
the possibility of receiving a stronger or weaker signal at the
sensor placed on the skin surface.
3.1.2 Attenuation analysis based on von Mises stress
The von-Mises stress represents the effective stress experi-
enced at a specific point (time) after the beginning of wave
excitation, which in turn is representative of strain energy;
the material undergoes due to the load impact. Analyzing
von-Mises stress also shows the energy attenuation brought
by varying the thickness of the propagation medium [55–57].
Figure 5a and b shows how the stress distribution varies
with an increase in thickness for a 2μm micromotion at the
implant interface. The stress experienced at the interface
points P1, P2, and P3 are found to be lower for the increased
thickness condition (Fig. 5b) associating a decreased mate-
rial deformation.
3.1.3 Signal attenuation over the propagation distance
To understand how a signal is attenuated with a variation
in its propagation distance, a signal is recorded at the outer
boundary where the receiver sensor is placed and plotted
for different thicknesses characteristics. In Fig. 6, the black
plot shows the signal received for 40 mm and the red plot
for 70 mm thickness at the adipose tissue layer. This figure
is a clear indicator of how the propagated waveform loses its
strength as the traveling distance increases and encounters
more obstacles or friction over the propagation distance.
3.1.4 Energy distribution at the interface points
A decrease in amplitude can be viewed as the energy loss
over the propagation channel. Since this study considers
isotropic layers [58–60] with finite propagation distances,
the attenuation of the wave over the propagation medium
is non-negligible. Elastic strain energy or elastic potential
energy on an object represents the stored energy at each
element when a force is applied to deform the object [61].
Figure 7a and b represents the elastic strain energy variation

Fig. 4  Time vs displacement
field recorded at the muscle-
tissue interface (P1), tissue-skin
interface (P2), and skin surface
(P3) at an adipose tissue thick-
ness of a 40 mm and b 70 mm
for a 2-µm micromotion at the
modular junction

Fig. 5  Time vs von-Mises stress

recorded at the muscle-tissue
interface (P1), tissue-skin inter-
face (P2), and skin surface (P3)
at a adipose tissue thickness
of 40 mm and b adipose tissue
thickness of 70. The increase in
adipose tissue thickness dimin-
ishes the stress rate experienced
in the selected points

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obstacles specifically at the adipose tissue-skin interface

point P2. Kinetic energy (KE) is mainly generated because
of the vibration of material particles and radiated as elas-
tic waves. Also, a large part of the total energy comprises
the KE and the measured AE energy was observed to be
scaled with the incident KE of the particles. Analyzing the
variations of KE received at the selected points can reveal
the energy loss obtained at each point and thus the signal
attenuation [62–65]. Figure 8 a and b represents the KE
due to the increase in adipose-tissue thickness or increase
in the distance the wave propagates. In this figure, higher
energy loss and lower KE can be observed for the model
with adipose tissue thickness of 70 mm when compared to
the 40-mm model.

Fig. 6  Time vs amplitude of the signal recorded at the outer layer
with an adipose tissue thickness of 40 mm, 70 mm, and 2 µm micro-
motion at the modular junction
experienced for an adipose-tissue thickness of 40 mm and
70 mm, respectively. In other words, each group in Fig. 7a
and b corresponds to the different load conditions due to
various thickness characteristics, and we can observe a
lesser deformation with increased thickness resulting in
more loss due to a longer propagation distance and other
3.2 Attenuation characteristics
concerning the frequency
To understand the effect of frequency variations in elastic
wave transmission, a range of frequencies from 10 to 60 kHz
have been considered and its energy loss observations are
depicted in Fig. 9 a and b. As expected, an increase in fre-
quency corresponds to greater energy release good enough
to deform the object and radiated as elastic waves which
in turn depicts the signal loss effect due to an increase

Fig. 7  Time vs elastic strain

energy recorded at the muscle-
tissue interface (P1), tissue-skin
interface (P2), and skin surface
(P3). a Adipose tissue thickness
of 40 mm; b adipose tissue
thickness of 70 mm, when 2 µm
displacement is applied at the
modular junction. Frequency
parameter considered in this
model is 20 kHz

Fig. 8  Time vs kinetic energy

recorded at the muscle-tissue
interface (P1), tissue-skin
interface (P2), and skin surface
(P3). a Adipose tissue thickness
of 40 mm; b adipose tissue
thickness of 70 mm, when 2 µm
displacement is applied at the
modular junction. Frequency
parameter considered in this
model is 20 kHz

13
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in frequency [66, 67]. Since more amplitude peaks are
expected as frequency increases an increase in frequency
from 10 to 60 kHz, more cycles are generated. The wave-
length decreases as the frequency increases, indicating that
the distance between the cycles decreases. As a result, with
more cycles occurring, more signal scattering will occur
and lead to an attenuation of the amplitude. That is, more
energy loss and magnitude reduction are experienced for
higher frequencies of the initiated wave as well as with an
increase in the distance the wave propagates through. This
directly reveals the effect of frequency and propagation dis-
tance on signal dampening. The same tendency is observed
for an adipose tissue thickness of 40 mm as well. So proper
consideration must be taken to address different frequencies
occurring due to various damages or events associated with
a hip implant failure.
3.3 Attenuation studies with different thickness
parameters
The amplitude value obtained at the muscle interface is
generally the highest, followed by the skin and/or the adi-
pose tissue. The highest magnitude values at the muscle
may generally be due to it being the first layer in the
numerical model. It does not mean that the signal propa-
gated from the center of the model travels through the
muscle layer and scatters less compared to the following
layers. Due to the smaller distance the wave propagates,
scattering may be less, and hence, the signal is less atten-
uated and displays higher amplitude when compared to
the subsequent layers. Although the skin layer is the last
interface in the numerical model, the amplitude of the sig-
nals at this layer is not attenuated as significantly as the
previous layers due to it being the thinnest layer. There-
fore, the signals propagate through the skin layer with-
out heavy attenuation and scattering. The adipose tissue
layer shows the lowest amplitude in most models might
be due to its higher thickness properties. Also, the signal
amplitude significantly decreases as the adipose tissue
Fig. 9  a Elastic strain-energy
and b kinetic energy recorded
at the skin-AE receiver sensor
(P3) for an adipose tissue thick-
ness of 70 mm for frequencies
10–60 kHz. Representative plots
indicates that energy loss, and
thus, wave dispersion increases
with an increase in frequency
from 10 to 60 kHz, same as the
energy loss effect observed with
an increase in adipose tissue
thickness from 40 to 70 mm
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Medical & Biological Engineering & Computing (2022) 60:1497–1510
thickness is increased from 40 to 70 mm because they
become heavily scattered. In [68], elastic wave propaga-
tion studies in human femur bone samples also confirmed
the effect of distance in wave attenuation by placing four
broadband AE sensors on the femur diaphysis separated
by a specific distance of 10 mm.
To verify the effect of thickness of the biological layers in
wave propagation, a parametric sweep study with an adipose
tissue thickness of 40 to 70 mm has been conducted for a
frequency of 20 kHz. For each of these trials, the amplitude
values of the received signals were found to be attenuated
(Fig. 10) and von Mises stress appeared to be decreasing
(Fig. 11) with an increase in adipose tissue thickness. The
rate at which a signal is attenuated can be identified with its
attenuation coefficient (α) which is directly related to the
path length (L), frequency (f), and attenuation (a) of the sig-
nal. Wave attenuation at each point was calculated assuming
the average attenuation coefficient (db∕cm∕MHz) of muscle,
tissue, and skin as 1.09, 0.54, and 0.8, respectively [7, 68].
Shear wave propagation related to MRI studies [70] also
shows the effect of tissue elasticity in wave attenuation.
3.4 Convergence study based on micromotion
at modular junction
Auxiliary sweep study in the COMSOL Multiphysics enables
the resolution of the developed simulation model with a set
of parameters rather than changing the parameters manually.
For the numerical model where micromotion at the modular
junction is taken as the boundary condition, the parametric
sweep considers 15μm, 16μm, 17μm, 18μm, 19μm, and20μm
micromotions for adipose tissue thicknesses of 40 mm and
70 mm, respectively [71, 72]. Figure 12 a and b shows the
amplitude variation that occurred at the interface point P2
on varying micromotion boundary conditions at the modu-
lar junction. These findings match with the results obtained
for load acting on the implant interface and thus confirm
the focus of this study where an increase in adipose tissue
Medical & Biological Engineering & Computing (2022) 60:1497–1510 1505

4 Discussion

In this study, mainly two different numerical model cat-

Fig. 10  Wave attenuation evaluated at the adipose tissue-skin inter-
face point P2 for frequency of 20 kHz for adipose tissue thicknesses
ranges between 40 and 70 mm
Fig. 11  von Mises stress recorded at the adipose tissue-skin inter-
face point P2 for frequency of 20 kHz for adipose tissue thicknesses
ranges between 40 and 70 mm
thickness degrades the elastic waves as it propagates over
the biological medium.
egories have been developed that consider the effect of
adipose tissue thickness in stress wave transmission of a
THR prosthesis [73]. The initial signal propagates through
different layers of varying densities and thicknesses to
reach the AE sensor placed on the skin surface, where
the sensor would theoretically be located. As the thick-
ness increases, the signal must travel through a greater
distance and have to interact with additional noise. This
noise can be caused by the scattering of waves across dif-
ferent biological interfaces, or by the distance between the
AE sensor and skin interface. Thus, an increase in tissue
thickness increases signal attenuation, and a decrease in
signal amplitude when detected at the AE sensor.
Some of the guided wave propagation studies pre-
sented in the literature determine the effect of soft tissue
on detecting degenerative disorders. Vavva et al. [67] and
Protopappas et al. [68] employed the first-arriving signal
in ultrasonic evaluation to show the influence of overlying
soft tissue in detecting the received wave velocity. Vibra-
tional mode evaluation [76] also depicts the effect of vary-
ing soft tissue thickness and other properties with vary-
ing frequencies. This paper also delivers the same results
depicting the adverse impact of soft tissue in the received
signal. In a real-time scenario, proper attention should be
given to the tissue characteristics since it varies for each
person even though some studies [77] consider a constant
thickness for the tissue, and thus excludes its effect for the
measurement of ultrasound wave velocity.
The signal attenuation (Fig. 10) and von-Mises stress
(Fig. 11) at the adipose tissue-skin interface point P2 for
the different thickness values show the attenuation effect
occurred due to the distance the wave needs to propagate
or thickness of the medium when the same frequency
parameter is considered. It shows that with an increase
in tissue thickness, the signal undergoes more absorption
and scattering, thereby causing a reduction in its amplitude

Fig. 12  Amplitude values
recorded at the adipose tissue-
skin interface point P2 for fre-
quency of 20 kHz for an adipose
tissue thickness of a 40 mm and
b 70 mm with varying displace-
ment parameters at the modular
junction interface

13
1506
and intensity characteristics. The same trend was observed
with an increase in frequency value as well. This in turn
leads to the fact that as the distance between the AE source
and receiver sensor increases, the arrived signal may be
diminished in strength resulting in an imprecise structural
assessment. Apart from the distance and frequency char-
acteristics, the density of the medium also has a direct
impact on the signal decay rate. The density of the skin is
generally greater than that of the adipose tissue, so propa-
gated signal suffers scattering and absorption even in the
thinner skin medium might contribute to increased attenu-
ation effect.
Comparing the models developed for different micromo-
tions, and frequencies, the AE wave was found to be attenu-
ated as the thickness or distance increases, which corrobo-
rates the focus of this study and matches with the results
presented in the research [6, 8, 10, 11] that addresses the
impact of biological layers over the stress wave propaga-
tion route. Also, an increase in frequency does significantly
impact the attenuation characteristics of the signal like vary-
ing the adipose tissue thickness does. Hip implant loosening
initiates a wave with a frequency around 20 kHz, whereas
fatigue crack may initiate elastic waves with very high fre-
quencies of AE signals [38, 39]. It may also be noted that the
frequency of the stress wave generated is entirely depending
on the damage level associated with the implant, such as
mechanical instability, crack initiation, or severity of tissue
infection. Considering all these facts, the AE signal received
at the receiver sensor may vary based on the propagation dis-
tance, frequency of the generated event, energy loss over the
propagation medium, and hence the accuracy of the signal.
Thus, to implement AE as an implant monitoring tool focus
must be given to identify the effect of tissue thickness as
well as to receive the accurate high-frequency elastic waves
by identifying a proper place to position the AE receiver
sensor.
4.1 Clinical implications
In clinical applications, the distance between the THR and
the AE sensor is significant because it can heavily impact
the quality of AE signals detected. In other words, it can
compromise the effectiveness of utilizing AE as a tech-
nique to detect material degradations. When examining the
cause of signal attenuation in a clinical setting, the source
of stress waves, AE sensor placement, transducer proper-
ties, and complex geometry of the structure being evaluated
must be considered. As the strategic sensor placement on
the skin can reduce noise and attenuation of the recorded
signals to obtain more accurate information on the damage
progression of the implant. For example, attenuation results
from the scattering and absorption of waves generated from
the implant across several biological layers with different
13
Medical & Biological Engineering & Computing (2022) 60:1497–1510
material properties before arriving at the sensor. AE sen-
sor can also pick up noise at the skin-to-sensor interface,
depending on how it is attached to the skin. Since signal
attenuation does not allow accurate evaluation of the damage
source, methods to reduce or account for attenuation should
be in place to utilize AE clinically.
4.2 Challenges
Even though AE evaluation can non-intrusively analyze the
damage mechanisms associated with orthopedic implants,
several factors can deter its effectiveness in real-time clini-
cal applications. The main challenges are (i) hip being
one of the most complex biological structures, variations
of the anatomical structures of patients with hip implant
having varying biomechanics and mobility factors are key
challenges while considering AE as an effective diagnostic
tool. (ii) There are additional biological factors like syno-
vial fluid and tissue thickness of each patient that must be
considered as a prerequisite before deploying AE as a non-
invasive early structural monitoring tool in orthopedics. (iii)
It is imperative that the experimental and numerical data
should be validated in a human motion lab with real patient
groups. (iv) A cloud-based or on-premise database is not
available to correlate AE signatures with hip implant abnor-
malities and malfunction and provide clinical advice to the
physician and patients. The featuring studies address these
challenges by considering multiple AE sensor locations to
obtain accurate signals and building a large set of numerical
models to mimic the biological variabilities integrated with
deep neural network models. Accurate positioning the AE
sensor is derived considering the biomechanics and mobil-
ity aspects in numerical modeling performed, and the same
will be applied in experimental and clinical settings. Imple-
menting the same concept for monitoring other prosthetic
interventions is also under consideration but with different
databases for each case.
4.3 Future perspective
An enhancement to this FE study, considering the nonlin-
earity, viscosity, and anisotropic characteristics to under-
stand the effect of attenuation over the variable thickness
medium, is ongoing [78–80]. The attenuation of signals
caused by the presence of biological layers must be bet-
ter understood. This knowledge can be applied to create
a standard evaluation curve that can clinically predict the
AE signal emitted from specific failure modes. To elabo-
rate, estimated signal attenuation at the implant-to-sensor
interface can be predicted based on the patients’ biologi-
cal layer properties and thus the original signal. Since
we could not replicate the entire clinical set up, continu-
ing studies deal with the simulation of a wide range of
Medical & Biological Engineering & Computing (2022) 60:1497–1510
biological structures from tissue models to animal models
and patient models, and its success metric evaluation by
computational time (~ 1 h per simulation) using reduced
finite element models. Also, numerical model complexity
will be adjusted to minimize the significant differences
in experimental and numerical models (if present) and to
mimic the complex biological structures. By better under-
standing the specific signals emitted from different failure
modes in correlation with the impact of the tissue-skin
interface, AE can be utilized in a clinical setting to evalu-
ate the material progression of an implant despite attenu-
ation or noise produced.
In summary, the current study is purely a proof of concept
with few limitations but highlighting the impact of adipose-
tissue thickness on AE signal transmission and detectability
of AE signals at the skin surface or receiver sensor. Future
research will address various aspects to correlate the sig-
nal received at AE receiver sensor and signal sources at
the implant interfaces. This will assist in developing an
enhanced AE-based monitoring system for the orthopedic
application.
5 Conclusions
The main findings of this study include the following:
The variation in adipose tissue thickness in the numerical
model impacted the amplitude of the signal propagated
through the biological layers between the THR and the
AE receiver sensor. Thus, an increase in signal-to-sensor
distance does have an impact on the quality of the signals
being detected by an AE sensor due to its attenuation
effect. Therefore, biological layers must be accounted for
when utilizing AE in a clinical setting for the accurate
evaluation of material degradations.
Depending on the load or the micromotion the THR expe-
riences, the strength of the initiated AE signal will vary
and proper evaluations must be in place to identify the
events happening in the implant.
A better understanding of these layer properties can help
predict their impact on AE signals. Through this, AE can
be utilized to non-invasively and non-destructively moni-
tor the material degradations of a THR through strategic
AE sensor placement on the skin.
Declarations  femoral component. J Bone Joint Surg 66:280–286
Conflict of interest  The authors declare no competing interests.
1507
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Publisher's note Springer Nature remains neutral with regard to
jurisdictional claims in published maps and institutional affiliations.
Remya Ampadi Ramachandran  : Ph.D. in Technology, postdoc
researcher and research specialist at the Department of Biomedical
Engineering, University of Illinois at Chicago. Research interests
include acoustics and speaker recognition, biomedical implant monitor-
ing through acoustic emission, signal processing, computational meth-
ods for biomedical applications, machine learning, and deep learning
models for biomedical applications, biotribocorrosion.
Christine Lee  : M.S. in Bioengineering, University of Illinois at Chi-
cago, IL, USA. The research focused on noninvasive early detection
of mechanical failure in total hip replacements via acoustic emission
technique.
Lu Zhang  : Ph.D. in Civil Engineering, assistant professor at College of
Civil Engineering and Architecture, Guilin University of Technology,
Guilin, China. Research interests include quantitative acoustic emission
(AE) method, computational methods for biomedical applications, and
AE monitoring in biomedical implants.
Supriya M. H  : Ph.D. in Electronics, professor and head at the Depart-
ment of Electronics, Cochin University of Science and Technology,
India. Research interests include Signal processing, underwater acous-
tics target identification, and biometric recognition.
Divya Bijukumar  : Ph.D. in Biotechnology, assistant professor at the
Department of Biomedical Sciences, University of Illinois College of
Medicine at Rockford. Research interests include nanotechnology, sur-
face modification, drug delivery, and toxicity.
P Srinivasa Pai  : Ph.D. in Mechanical Engineering, professor at Depart-
ment of Mechanical Engineering, NMAM Institute of Technology,
Nitte,India. Research interests are tool condition monitoring acoustic
emission,vibration monitoring, artificial neural networks maintenance
engineering andmanagement, wavelet and its applications to machin-
ing related areas, high-speedmachining–related areas including wear
studies, and surface roughness analysis.
Kharma Foucher  : Ph.D. in Bioengineering, associate professor at
the Department of Kinesiology and Nutrition. Research interests
include on biomechanics, motion analysis, musculoskeletal modeling
of people with and without hip implants, and clinical outcomes.
Sheng‑Wei Chi  : Ph.D. in Civil and Environmental Engineering, asso-
ciate professor at Department of Civil, Materials, and Environmen-
tal Engineering, University of Illinois, Chicago, IL, USA. Research
interests include image-based computational methods for biomedical
applications; multiscale material modeling; advanced numerical meth-
ods, including meshfree methods, collocation methods, and generalized
13
1510
finite element methods; large deformation and contact mechanics, frag-
ment; and impact simulations
Didem Ozevin  : Ph.D. in Materials Engineering, associate professor
at Department of Civil, Materials, and Environmental Engineering,
University of Illinois, Chicago, IL, USA. Research interests include
sensor development to combine a variety of sensing elements and to
develop new structural evaluation methods for understanding the dam-
age states using a variety of structural health-monitoring techniques,
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Medical & Biological Engineering & Computing (2022) 60:1497–1510
such as acoustic emission and low-frequency ultrasounds. Acoustic
emission and numerical models for biomedical applications.
Mathew T Mathew  : Ph.D. in Mechanical Engineering, associate
professor at Department of Biomedical Science, Director of Faculty
Research, UIC School of Medicine, Rockford, IL, USA. Leading the
Regenerative Medicine and Disability Lab at UIC Rockford. Research
interests include biomaterials, biomedical implants, corrosion, tribo-
corrosion, and biotribocorrosion.