scholarly journals Periacetabular Osteotomy Performed with Imageless Computer-Assisted Navigation: Case Report

2019 ◽  
Vol 2 (1-3) ◽  
pp. 33-39
Author(s):  
Atul F. Kamath ◽  
Rachel R. Mays
Keyword(s):  
Surgical Navigation ◽  
Periacetabular Osteotomy ◽  
Computer Navigation ◽  
Developmental Dysplasia ◽  
Computer Assisted ◽  
Developmental Hip Dysplasia ◽  
Assisted Navigation ◽  
First Case ◽  
Acetabular Fragment ◽  
Pao Surgery

Periacetabular osteotomy (PAO) is an effective surgical treatment for developmental hip dysplasia. The goal of PAO is to reorient the acetabulum to increase acetabular coverage of the femoral head, as well as to reduce contact pressures within the hip joint. The primary challenge of PAO is to accurately achieve the desired acetabular fragment orientation, while maximizing containment and congruency. As key parts of the procedure are performed out of direct field of view of the surgeon, combined with this challenge of precise spatial orientation, there is a potential role for technologies such as surgical navigation. Adjunctive technology may provide information on the orientation of repositioned acetabulum and may offer a useful assist in performing PAO. Here, we present a case of developmental dysplasia of the hip treated via PAO with the addition of an imageless computer navigation device. Surgery was successful, and, at 3 months after procedure, the patient was progressing well. To our best knowledge, this is the first case using imageless computer-assisted navigation in PAO surgery.

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

2021 ◽  
Vol 11 (3) ◽  
pp. 1228
Author(s):  
Joëlle Ackermann ◽  
Florentin Liebmann ◽  
Armando Hoch ◽  
Jess G. Snedeker ◽  
Mazda Farshad ◽  
...  
Keyword(s):  
Augmented Reality ◽  
Motion Compensation ◽  
Preoperative Planning ◽  
Surgical Navigation ◽  
State Of The Art ◽  
Periacetabular Osteotomy ◽  
3D Models ◽  
Acetabular Fragment ◽  
Navigation Accuracy ◽  
Pao Surgery

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.

An Evaluation of the Accuracy of Computer Assisted Surgery in Preoperatively Three Dimensionally Planned Periacetabular Osteotomies

2009 ◽  
Author(s):  
Christine Abraham ◽  
John Rodriguez ◽  
Jenni Buckley ◽  
Shane Burch ◽  
Mohammad Diab
Keyword(s):  
Periacetabular Osteotomy ◽  
Computer Software ◽  
Computer Assisted Surgery ◽  
Developmental Dysplasia ◽  
Computer Assisted ◽  
Complication Rates ◽  
Navigation Systems ◽  
Acetabular Fragment ◽  
Cas A ◽  
Inexperienced Surgeon

Adults with unresolved developmental dysplasia of the hip (DDH) often warrant Pelvic Periacetabular Osteotomy (PAO). Making the correct osteotomies, and then finding the “ideal” position of the acetabular fragment is difficult, even for the experienced surgeon. Due to its 3-D nature, need for precision, and limited direct visualization of the surgical site, the PAO procedure is a good candidate for Computer Assisted Surgery (CAS). Using CAS, a virtual image is created, which is then used to navigate through the procedure in real time. Improved imaging hardware, along with intra-operative navigation systems have the potential to reduce complication rates, and lessen the learning curve in the inexperienced surgeon. PAO cuts have been made using intra-operative navigation and acetabular fragments have been positioned in pre-operative computer models. As of yet, modeled PAO cuts have not been used to navigate intraoperative cuts. Furthermore, modeled acetabular positioning has not been combined with intra-operative navigation to position fragments. The aim of this study is to prove the utility of pre-operative 3D imaging, PAO osteotomy planning and acetabular fragment positioning with computer software. These modeled images can be used to complete highly accurate and effective PAO surgeries.

scholarly journals Periacetabular osteotomy using an imageless computer-assisted navigation system: a new surgical technique

2019 ◽  
Vol 6 (4) ◽  
pp. 426-431
Author(s):  
Jessica M Hooper ◽  
Rachel R Mays ◽  
Lazaros A Poultsides ◽  
Pablo G Castaneda ◽  
Jeffrey M Muir ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Navigation System ◽  
Periacetabular Osteotomy ◽  
Weight Bearing ◽  
Computer Assisted ◽  
Joint Stability ◽  
Modified Technique ◽  
Assisted Navigation ◽  
Acetabular Fragment ◽  
Imageless Navigation

Abstract Periacetabular osteotomy (PAO) is an effective surgical treatment for hip dysplasia. The goal of PAO is to reorient the acetabulum to improve joint stability, lessen contact stresses and slow the development of hip arthrosis. During PAO, the acetabulum is repositioned to adequately cover the femoral head. PAO preserves the weight-bearing posterior column of the pelvis, maintains the acetabular blood supply and retains the hip abductor musculature. The surgical technique needed to perform PAO is technically demanding, with correct repositioning of the acetabulum the most important—and challenging—aspect of the procedure. Imageless navigation has proven useful in other technically challenging surgeries, although its use in PAO has not yet been investigated. We have modified the standard technique for PAO to include the use of an imageless navigation system to confirm acetabular fragment position following osteotomy. Here, we describe the surgical technique and discuss the potential of this modified technique to improve patient-related outcomes.

scholarly journals Patient-specific template and electromagnetic navigation assisted bilateral periacetabular osteotomy for staged correction of bilateral injury-induced hip dysplasia: a case report

2021 ◽  
Author(s):  
Peter Brumat ◽  
Rene Mihalič ◽  
Črt Benulič ◽  
Anže Kristan ◽  
Rihard Trebše
Keyword(s):  
Case Report ◽  
Hip Dysplasia ◽  
Periacetabular Osteotomy ◽  
Patient Specific ◽  
Computer Assisted ◽  
Electromagnetic Navigation ◽  
Assisted Navigation ◽  
High Surgical Risk ◽  
Unique Method ◽  
Post Traumatic

ABSTRACT Periacetabular osteotomy (PAO) for pelvic fracture sequelae presents a challenge in hip preservation surgery due to a combination of complex conditions involving post-traumatic altered anatomy and technically demanding procedure, with high surgical risk involved. To address these challenging conditions and evade potential devastating complications, a combination of patient-specific template (PST) and electromagnetic navigation (EMN) guidance can be used to increase the safety of the procedure and the accuracy of the acetabular reorientation. Herein we report our experience utilizing a combined PST- and EMN-assisted bilateral PAO for staged correction of bilateral severe, injury-induced hip dysplasia. The presented case report describes a unique method of successful surgical treatment of severe, bilateral injury-induced hip dysplasia with combined 3-D printing technology (PST) and intra-operative electromagnetic computer-assisted navigation (EMN) aided technically demanding surgical procedure (PAO), which emphasizes the benefits of PST and EMN use in hip preservation surgery in patients with complex pathoanatomic circumstances.

scholarly journals Three-Dimensional Digital Surgical Planning and Rapid Prototyped Surgical Guides in Bernese Periacetabular Osteotomy

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Bruno Gonçalves Schröder e Souza ◽  
Flavia de Souza Bastos ◽  
Valdeci Manoel de Oliveira ◽  
Alfredo Chaoubah
Keyword(s):  
Periacetabular Osteotomy ◽  
Three Dimensional ◽  
Developmental Dysplasia ◽  
Production Costs ◽  
Steep Learning Curve ◽  
Safety Issues ◽  
Surgical Guides ◽  
Early Results ◽  
Planning Guide ◽  
Pao Surgery

Bernese periacetabular osteotomy (PAO) developed by Ganz is currently the treatment of choice for skeletally mature symptomatic patients with developmental dysplasia of the hip (DDH) without osteoarthritis. However, the steep learning curve and considerable number of severe complications lead surgeons to seek for alternatives to promote greater reproducibility and safety of this procedure. This is a report of a DDH case surgically treated with the aid of a digital three-dimensional (3D) planning and rapidly prototyped sterile ABS plastic osteotomy guide, developed in Brazil. We present details regarding the planning, guide production, and surgical technique and report the early results of this treatment approach in a single patient. Digital 3D planning and rapidly prototyped surgical guides are applicable and helpful in PAO surgery as shown in this case. We noted no safety issues, good accuracy, and low production costs with this approach.

Computer Assisted Navigation Systems for Hip and Knee Reconstructive Surgery: Evaluation of Traditional Surgical Technique

2001 ◽  
Author(s):  
Anthony M. DiGioia ◽  
Frederic Picard ◽  
Branislav Jaramaz ◽  
David Sell ◽  
James C. Moody ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Patient Outcomes ◽  
Reconstructive Surgery ◽  
Surgical Navigation ◽  
Surgical Techniques ◽  
Measurement Tool ◽  
Computer Assisted ◽  
Navigation Systems ◽  
Assisted Navigation ◽  
Surgical Navigation System

Abstract In this paper we describe a surgical navigation system named HipNav (Hip-Navigation) for THR and KneeNav (Knee-Navigation) for TKR with an emphasis on using these systems as a real time intraoperative measurement tool (these enabling technologies are the surgical toolbox of the future). This approach will permit the direct comparison of patient outcomes with measurable surgical techniques.

scholarly journals Computer-Assisted Resection and Reconstruction of Pelvic Tumor Sarcoma

Sarcoma ◽  
2010 ◽  
Vol 2010 ◽  
pp. 1-8 ◽  
Author(s):  
Pierre-Louis Docquier ◽  
Laurent Paul ◽  
Olivier Cartiaux ◽  
Christian Delloye ◽  
Xavier Banse
Keyword(s):  
Surgical Navigation ◽  
Tumor Resection ◽  
Surgical Margin ◽  
Surgical Oncology ◽  
Tumor Location ◽  
Resection Margins ◽  
Computer Assisted ◽  
Navigation Systems ◽  
First Case ◽  
Saw Blade

Pelvic sarcoma is associated with a relatively poor prognosis, due to the difficulty in obtaining an adequate surgical margin given the complex pelvic anatomy. Magnetic resonance imaging and computerized tomography allow valuable surgical resection planning, but intraoperative localization remains hazardous. Surgical navigation systems could be of great benefit in surgical oncology, especially in difficult tumor location; however, no commercial surgical oncology software is currently available. A customized navigation software was developed and used to perform a synovial sarcoma resection and allograft reconstruction. The software permitted preoperative planning with defined target planes and intraoperative navigation with a free-hand saw blade. The allograft was cut according to the same planes. Histological examination revealed tumor-free resection margins. Allograft fitting to the pelvis of the patient was excellent and allowed stable osteosynthesis. We believe this to be the first case of combined computer-assisted tumor resection and reconstruction with an allograft.

scholarly journals A Detailed analysis of Time taken in Robotic Surgery for Total Knee Replacement Arthroplasty and comparison with computer assisted navigation in Total Knee Replacement Arthroplasty

10.29007/65qr ◽  
2020 ◽  
Author(s):  
Kamal Deep ◽  
Frederic Picard
Keyword(s):  
Total Knee Replacement ◽  
Ct Scan ◽  
Knee Replacement ◽  
Soft Tissues ◽  
Computer Navigation ◽  
Computer Assisted ◽  
Assisted Navigation ◽  
Replacement Arthroplasty ◽  
Knee Replacement Arthroplasty ◽  
Total Knee

The accuracy of implantation using computer navigation and robotic total knee replacement (TKR) has been proven. Time taken during surgery has been a factor for surgeons for not using the technology. Aim of this study was to analyse time taken in different steps and identify which part needs improvement. Robotic time was compared to computer navigation. Methods: 15TKR were performed with MAKO robot. Software for the ligament balancing was used. All had CT scan preoperatively. Time of different surgical steps was recorded. Time for computer navigation was recorded too. After joint exposure, trackers and verification pins for tibia and femur were inserted. Femoral registration matching started at 10.8 minutes (SD3.3 Range7-20). It took 3.2 minutes to match femoral anatomy to CT scan. Tibial registration done at 14.1minutes (SD3 Range10- 23). Once matching was accepted to required accuracy, tibial cut was made at 22.2 minutes (SD4.4 Range 15-30). Next the soft tissues were assessed with tensioner. It took 6.3 minutes (SD 5.6). Final femoral preparation done at 35.7 minutes (SD 5.6 Range25-45). Trial performed at 52 minutes (SD7.3 Range42-63). Implants were cemented at 63.4 minutes (SD8 Range50-72). Wound closed at 77.6 minutes (SD9.5 Range65-97). The computer navigated TKR surgery took 70 minutes on an average. Compared to navigation, robotic technique took approximately 7 minutes longer, not significantly different. This could be due to learning curve of the surgical and theatre team. Improvement is required in different steps. The familiarity of staff will increase the efficiency. Registration matching took 11.4 minutes. Femoral preparation took 17 minutes. These steps could be streamlined.

Imageless Navigation Accurately Measures Component Orientation during Total Hip Arthroplasty: A Comparison with Postoperative Radiographs

2019 ◽  
Vol 03 (01) ◽  
pp. 053-058 ◽  
Author(s):  
Wayne Paprosky ◽  
Jeffrey Muir ◽  
Jennifer Sostak
Keyword(s):  
Revision Surgery ◽  
Surgical Navigation ◽  
Absolute Difference ◽  
Computer Assisted ◽  
Leg Length ◽  
Acetabular Cup ◽  
Mean Absolute Difference ◽  
Assisted Navigation ◽  
Navigation Tool ◽  
The Mean

AbstractAccurate placement of acetabular components during total hip arthroplasty (THA) is paramount in ensuring long-term stability. Current methods for monitoring cup position and leg length intraoperatively are lacking due to susceptibility to inaccuracy or prohibitive cost. The purpose of this study was to evaluate the ability of an imageless surgical navigation tool to accurately measure acetabular cup inclination and leg length differential during THA. The authors retrospectively reviewed the medical records of patients who underwent primary or revision THA (posterolateral approach) at their facility with the assistance of computer-assisted navigation between February 2016 and March 2017. Pre- and postoperative radiographs were analyzed for leg length discrepancies and acetabular cup inclination. Radiographic values were compared with intraoperative values provided by the surgical navigation tool. The mean difference between inclination as measured from radiographs (44.4 ± 5.9 degrees) and navigation (43.0 ± 4.4 degrees) was −1.4 ± 4.6 degrees (mean absolute difference: 3.8 ± 2.8 degrees). Seventy-seven percent (48/62) of navigation measurements were within 5 degrees of radiographs. The mean difference between radiographic (7.39 ± 5.67 mm) and navigation (7.44 ± 4.81 mm) measurements of leg length differential was 0.29 ± 4.20 mm (mean absolute difference: 3.20 ± 2.69 mm). Navigation tool measurements were within 5 mm of radiographic values in 85% (39/46) of cases. At 90 days, idiopathic dislocation requiring revision surgery occurred in one patient (1.2%) with one additional patient (1.2%) requiring revision surgery due to a traumatic injury (fall). Computer-assisted navigation provided accurate intraoperative data regarding inclination and changes in leg length and was associated with a low rate of dislocation and revision surgery at 90-day follow-up.

Sign in / Sign up

Export Citation Format

Share Document