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

  • Li Liu
  • Timo Ecker
  • Steffen Schumann
  • Klaus Siebenrock
  • Lutz Nolte
  • Guoyan Zheng
Part of the Lecture Notes in Computer Science book series (LNCS, volume 8674)


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 intra-operatively. 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.


Periacetabular osteotomy surgical planning range of motion hip impingement analysis 


  1. 1.
    Ganz, R., Klaue, K., Vinh, T., Mast, J.: A New Periacetabular Osteotomy for the Treatment of Hip Dysplasia. Technique and Preliminary Results. Clin. Orthop. 232, 26–36 (1988)Google Scholar
  2. 2.
    Crockaress Jr., J., Trousdale, R.T., Cabanela, M.E., Berry, D.J.: Early Experience and Results with the Periacetabular Osteotomy. The Mayo Clinic experience. Clin. Orthop. 363, 45–53 (1999)Google Scholar
  3. 3.
    Rodriguez, A.C., Buckley, J.M., Diab, M., Burch, S.: An Evaluation of the Accuracy of Computer Assisted Surgery in Preoperatively Three Dimensionally Planned Periacetabular Osteotomies. In: 56th Annual Meeting of the Orthopaedic Research Society (2009)Google Scholar
  4. 4.
    Jager, M., Westhoff, B., Wild, A., Krauspe, R.: Computer-assisted Periacetabular Triple Osteotomy for Treatment of Dysplasia of the Hip. Z Orthop Ihre Grenzgeb 142, 51–59 (2004)CrossRefGoogle Scholar
  5. 5.
    Langlotz, F., Bachler, R., Berlemann, U., Nolte, L.P., Ganz, R.: Computer Assistance for Pelvic Osteotomies. Clin. Orthop. 354, 92–102 (1998)CrossRefGoogle Scholar
  6. 6.
    Armand, M., Lepisto, J.V.S., Merkle, A.C., Tallroth, K., Liu, X., Taylor, R.H., Wenz, J.: Computer-aided Orthopedic Surgery with Near-real-time Biomechanical Feedback. Johns Hopkins APL Technical Digest 25, 242–252 (2004)Google Scholar
  7. 7.
    Ziebarth, K., Balakumar, J., Domayer, S., Kim, Y.J., Millis, M.B.: Bernese Periacetabular Osteotomy in Males: Is There An Increased Risk of Femoroacetabular Impingement (FAI) after Bernese Periacetabular Osteotomy? Clin. Orthop. 469, 447–453 (2011)CrossRefGoogle Scholar
  8. 8.
    Zheng, G., Marx, A., Langlotz, U., Widmer, K.H., Buttaro, M., Nolte, L.P.: A Hybrid CT–free Navigation System for Total Hip Arthroplasty. Computer Aided Surgery 7, 129–145 (2002)CrossRefGoogle Scholar
  9. 9.
    Murphy, S.B., Simon, S.R., Kijewski, P.K., Wilkinson, R.H., Griscom, N.T.: Femoral Anteversion. J. Bone Joint Surg. Am. 69, 1169–1176 (1987)Google Scholar
  10. 10.
    Puls, M., Ecker, T.M., Steppacher, S.D., Tannast, M., Siebenrock, K.A., Kowal, J.H.: Automated Detection of the Acetabular Rim Using Three-dimensional Models of the Pelvis. Comput. Biol. Med. 41, 285–291 (2011)CrossRefGoogle Scholar
  11. 11.
    Murray, D.W.: The Definition and Measurement of Acetabular Orientation. J. Bone Joint Surg. Br. 75(B), 228–232 (1993)Google Scholar
  12. 12.
    Wiberg, G.: The Anatomy and Roentgenographic Appearance of A Normal Hip Joint. Acta Chir. Scand. Suppl. 83, 7–38 (1939)Google Scholar
  13. 13.
    Murphy, S.B., Ganz, R., Muller, M.E.: The Prognosis in Untreated Dysplasia of the Hip. A Study of Radiographic Factors that Predict the Outcome. J. Bone Joint Surg. Am. 77, 985–989 (1995)Google Scholar
  14. 14.
    Tannast, M., Kubiak-Langer, M., Langlotz, F., Puls, M., Murphy, S.B., Siebenrock, K.A.: Noninvasive Three-dimensional Assessment of Femoroacetabular Impingement. J. Orthop. Res. 25, 122–131 (2007)CrossRefGoogle Scholar
  15. 15.
    Gottschalk, S., Lin, M.C., Manocha, D.: Obbtree: A Hierachical Structure for Rapid Interference Detection. In: Rushmeier, H. (ed.) Proceedings of SIGGRAPH 1996, pp. 1169–1176. Addison Wesley (1996)Google Scholar
  16. 16.
    Thornberry, R.L., Hogan, A.J.: The Combined Use of Simulation and Navigation to Demonstrate Hip kinematics. J. Bone Joint Surg. Am. 91, 144–152 (2009)CrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • Li Liu
    • 1
  • Timo Ecker
    • 2
  • Steffen Schumann
    • 1
  • Klaus Siebenrock
    • 2
  • Lutz Nolte
    • 1
  • Guoyan Zheng
    • 1
  1. 1.Institute for Surgical Technology and BiomechanicsUniversity of BernSwitzerland
  2. 2.Department of Orthopaedic Surgery, InselspitalUniversity of BernSwitzerland

Personalised recommendations