A cost-effective surgical navigation solution for periacetabular osteotomy (PAO) surgery

Pflugi, Silvio; Liu, Li; Ecker, Timo M.; Schumann, Steffen; Cullmann, Jennifer; Siebenrock, Klaus A.; Zheng, Guoyan

doi:10.1007/s11548-015-1267-1

Cited by 28 publications

(28 citation statements)

References 29 publications

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“…All of the aforementioned approaches employ external optical tracking systems, which come along with line-of-sight impediment and, consequently, with poor usability. Pflugi et al [37] came up with an alternative idea, proposing the registration and tracking for fragment reorientation through inertial measurement units (IMU). One IMU was fixated on the pelvis, the other one on the fragment.…”

Section: Introductionmentioning

confidence: 99%

Augmented Reality Based Surgical Navigation of Complex Pelvic Osteotomies—A Feasibility Study on Cadavers

et al. 2021

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Augmented reality (AR)-based surgical navigation may offer new possibilities for safe and accurate surgical execution of complex osteotomies. In this study we investigated the feasibility of navigating the periacetabular osteotomy of Ganz (PAO), known as one of the most complex orthopedic interventions, on two cadaveric pelves under realistic operating room conditions. Preoperative planning was conducted on computed tomography (CT)-reconstructed 3D models using an in-house developed software, which allowed creating cutting plane objects for planning of the osteotomies and reorientation of the acetabular fragment. An AR application was developed comprising point-based registration, motion compensation and guidance for osteotomies as well as fragment reorientation. Navigation accuracy was evaluated on CT-reconstructed 3D models, resulting in an error of 10.8 mm for osteotomy starting points and 5.4° for osteotomy directions. The reorientation errors were 6.7°, 7.0° and 0.9° for the x-, y- and z-axis, respectively. Average postoperative error of LCE angle was 4.5°. Our study demonstrated that the AR-based execution of complex osteotomies is feasible. Fragment realignment navigation needs further improvement, although it is more accurate than the state of the art in PAO surgery.

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Section: Introductionmentioning

confidence: 99%

Augmented Reality Based Surgical Navigation of Complex Pelvic Osteotomies—A Feasibility Study on Cadavers

et al. 2021

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“…Tracking the correction of the acetabular fragment during PAO is challenging and affords intraoperative radiographs or fluoroscopy. For this reason, different analogous [18], and digital [19][20][21] techniques have been developed to improve the accuracy of acetabular reorientation. By developing a measuring device for intraoperative assessment of the acetabular index (AI) and the center edge angle (CE), Troelsen et al have provided a useful tool for controlling these parameters by means of intraoperative fluoroscopy.…”

Section: Discussionmentioning

confidence: 99%

Three-dimensional acetabular orientation during periacetabular osteotomy: a video analysis of acetabular rim position using an external fixator as navigation tool during reorientation procedure

Schwarz¹,

Maderbacher²,

Leiß³

et al. 2020

Arch Orthop Trauma Surg

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Introduction Bernese periacetabular osteotomy is an effective procedure for treating acetabular dysplasia. However, limited visual control of the acetabular position during surgery may result in under- or overcorrection with residual dysplasia or femoroacetabular impingement. Thus, we wanted to find a simple method to control the effect of correction in the sagittal and coronal plane. Method The acetabular coordinates are shown by two perpendicular tubes of an external fixator mounted onto a third tube that is fixed to the acetabular fragment with two Schanz screws. This method enables the isolated acetabular reorientation in the coronal, sagittal, and transverse plane. In a sawbone pelvis model, the acetabular rim is marked with a copper wire and a silicon adherent. To show the radiographic effect on acetabular parameters and the rim position, we visualized correction in the coronal and sagittal plane under fluoroscopic control. Results Lateral rotation of the acetabular fragment had the highest impact on radiographic lateral coverage of the femoral head. But also ventral coverage increased during isolated lateral rotation. Anterior rotation showed almost no effect on lateral coverage and just a little effect on ventral coverage but caused severe total acetabular retroversion. Conclusion Three-dimensional control of the acetabular orientation during periacetabular osteotomy is important to avoid over- and under-correction. Isolated lateral rotation of the acetabular fragment should be the predominant direction of correction during periacetabular osteotomy. Ambitious anterior correction may be the main source for severe acetabular retroversion following periacetabular osteotomy.

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“…Different approaches are nowadays applied, such as discrete element analysis [ 105 ] or finite element analysis [ 106–109 ]. Potential benefits include the possibility of preoperative planning, visual feedback and intraoperative navigation [ 110 ]. One of the first studies was published by Hipp et al .…”

Section: Computer-assisted Planning Of Paomentioning

confidence: 99%

Preoperative planning for redirective, periacetabular osteotomies

Albers

Rogers

Wambeek

et al. 2017

Journal of Hip Preservation Surgery

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Redirective, periacetabular osteotomies (PAO) represent a group of surgical procedures for treatment of developmental dysplasia of the hip (DDH) in skeletally mature and immature patients. The ultimate goal of all procedures is to reduce symptoms, improve function and delay or prevent progression of osteoarthritis. During the last two decades, the understanding of the underlying pathomechanisms has continuously evolved. This is mainly attributable to the development of the femoroacetabular impingement concept that has increased the awareness of the underlying three-dimensional complexity associated with DDH. With increasing knowledge about the pathobiomechanics of dysplastic hips, diagnostic tools have improved allowing for sophisticated preoperative analyses of the morphological and pathobiomechanical features, and early recognition of degenerative changes, which may alter the long-term outcome. As redirective, PAO are technically demanding procedures, preoperative planning is crucial to avoid intraoperative obstacles and to sufficiently address the patient-specific deformity. Although conventional radiography has been used for decades, it has not lost its primary role in the diagnostic work-up of patients with DDH. Furthermore, an increasing number of modern imaging techniques exists allowing for assessment of early cartilage degeneration (biochemical magnetic resonance imaging) as well as 3D planning and computer-based virtual treatment simulation of PAO. This article reviews the literature with regard to the current concepts of imaging of DDH, preoperative planning and treatment recommendations for redirective, PAO.

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A cost-effective surgical navigation solution for periacetabular osteotomy (PAO) surgery

Cited by 28 publications

References 29 publications

Augmented Reality Based Surgical Navigation of Complex Pelvic Osteotomies—A Feasibility Study on Cadavers

Augmented Reality Based Surgical Navigation of Complex Pelvic Osteotomies—A Feasibility Study on Cadavers

Three-dimensional acetabular orientation during periacetabular osteotomy: a video analysis of acetabular rim position using an external fixator as navigation tool during reorientation procedure

Preoperative planning for redirective, periacetabular osteotomies

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