Computer Assisted Planning and Navigation of Periacetabular Osteotomy with Range of Motion Optimization

Abstract

Femoroacetabular impingement (FAI) before or after Periacetabular Osteotomy (PAO) is surprisingly frequent and surgeons need to be aware of the risk preoperatively and be able to avoid it intraoperatively. In this paper we present a novel computer assisted planning and navigation system for PAO with impingement analysis and range of motion (ROM) optimization. Our system starts with a fully automatic detection of the acetabular rim, which allows for quantifying the acetabular morphology with parameters such as acetabular version, inclination and femoral head coverage ratio for a computer assisted diagnosis and planning. The planned situation was optimized with impingement simulation by balancing acetabuar coverage with ROM. Intra-operatively navigation was conducted until the optimized planning situation was achieved. Our experimental results demonstrated: 1) The fully automated acetabular rim detection was validated with accuracy 1.1 ± 0.7mm; 2) The optimized PAO planning improved ROM significantly compared to that without ROM optimization; 3) By comparing the pre-operatively planned situation and the intra-operatively achieved situation, sub-degree accuracy was achieved for all directions.

What Is the Early/Mid-term Survivorship and Functional Outcome After Bernese Periacetabular Osteotomy in a Pediatric Surgeon Practice?

“…Our experience and outcomes, reflecting on such a surgical practice, are satisfactory and would advocate it. Nevertheless, it is likely that with improved technology and preoperative three-dimensional imaging, patient-specific correction will be the target in the future [12]. To our knowledge this is the first study that addresses the learning in achieving the desired acetabular correction target post-PAO.…”

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

“…The osteotomies were directly drawn onto the plastic bones by an experienced orthopaedic surgeon (TME) and then cut using a coping saw. For comparison and validation purposes, we simultaneously ran a previously developed navigation system using an optical tracking camera (Polaris, NDI Canada) as ground truth [7]. The optical tracking system works the same way as the sensor application, only considering rotations and not translation.…”

“…For visualization purposes a patient-specific computer model which is acquired from segmented CT data (using AMIRA, Visage Imaging, San Diego, USA) is used (see [7] we estimate the femoral head center by fitting a sphere to the femoral head. Additionally, to compute acetabular orientation (inclination and anteversion) the acetabular cup plane normal has to be known ( Figure 5).…”

“…Additionally, to compute acetabular orientation (inclination and anteversion) the acetabular cup plane normal has to be known ( Figure 5). To compute the cup plane, the PAO planning system fully automatically detects the acetabular rim points and a plane is fitted through the points to get the plane normal [7].…”

“…Liu et al [7] proposed a computer-assisted planning and navigation system for PAO surgery including range of motion optimization. Their system offers different modules including a navigation and planning module which allows the virtual simulation of the reorientation procedure including fully automatic detection of the acetabular rim and estimation of the femoral head center.…”