Multi-Stage Platform for (Semi-)Automatic Planning in Reconstructive Orthopedic Surgery

Abstract

Intricate lesions of the musculoskeletal system require reconstructive orthopedic surgery to restore the correct biomechanics. Careful pre-operative planning of the surgical steps on 2D image data is an essential tool to increase the precision and safety of these operations. However, the plan’s effectiveness in the intra-operative workflow is challenged by unpredictable patient and device positioning and complex registration protocols. Here, we develop and analyze a multi-stage algorithm that combines deep learning-based anatomical feature detection and geometric post-processing to enable accurate pre- and intra-operative surgery planning on 2D X-ray images. The algorithm allows granular control over each element of the planning geometry, enabling real-time adjustments directly in the operating room (OR). In the method evaluation of three ligament reconstruction tasks effect on the knee joint, we found high spatial precision in drilling point localization (ε<2.9mm) and low angulation errors for k-wire instrumentation (ε<0.75∘) on 38 diagnostic radiographs. Comparable precision was demonstrated in 15 complex intra-operative trauma cases suffering from strong implant overlap and multi-anatomy exposure. Furthermore, we found that the diverse feature detection tasks can be efficiently solved with a multi-task network topology, improving precision over the single-task case. Our platform will help overcome the limitations of current clinical practice and foster surgical plan generation and adjustment directly in the OR, ultimately motivating the development of novel 2D planning guidelines.

To further incorporate computer-aided designs to improve preoperative planning in total hip arthroplasty: a cohort study

“…Personalized treatment is a current aim in the development of orthopedic surgical treatment because patients require specialized preoperative planning and surgical treatment plans unique to each individual to achieve an accurate diagnosis, treatment, and postoperative rehabilitation ( 19 , 20 ). THA, as the end-stage therapy of choice for numerous hip diseases, is becoming a common surgical procedure with numerous strategies to improve surgical outcomes.…”

Software‐based method for automated intraoperative planning of Schoettle Point in surgical medial patellofemoral ligament reconstruction: A comparative validation study

“…The network can also be trained to additionally predict segmentation masks of the bones to limit the influence of joint angulation during the registration step. 22,23 The detailed, technical aspects of automated, software-based planning of the Schoettle Point have already been published and can be found in the publications by Kordon et al (2019Kordon et al ( -2022). [22][23][24]…”

“…22,23 The detailed, technical aspects of automated, software-based planning of the Schoettle Point have already been published and can be found in the publications by Kordon et al (2019Kordon et al ( -2022). [22][23][24]…”