Background: Preparing the medullary space of the femur aims to create an ideal form-fitting of cementless implants to provide sufficient initial stability, which is crucial for osseous integration, ensuring good long-term
results. Hammering the implant into the proximal femur creates a press-fit anchoring of the endoprosthesis in the medullary space. Implanting the optimal size of the shaft for best fitting should avoid damage to the bone.
Modified acoustic signals in connection with implantation are being detected by surgeons and might be related to the primary stability of the implant. 

Methods: This study aims to explore the relationship between frequency sound patterns and the change in stem stability. For this purpose, n = 32 Metha® short stems were implanted in a clinical setting by the same surgeon. During implantation, the sounds were recorded. To define a change in the acoustic system response during the
operation, the individual blows of the implantation sequence were correlated with one another. 

Findings: An algorithm was able to subdivide through sound analysis two groups of hammer blows (area 1 and area 2) since the characteristics of these groups showed significant differences within the frequency range of 100 Hz to 24 kHz. The edge between both groups, detected by the algorithm, was validated with expert surgeons’ classifications of the same data. 

Interpretation: In conclusion, monitoring, the hammer blows sound might allow quantification of the primary
stability of the implant. Sound analysis including patient parameters and a classification algorithm could provide
a precise characterization of implant stability.