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Computer-Assisted Planning, Simulation, and Navigation System for Periacetabular Osteotomy

  • Li Liu
  • Klaus Siebenrock
  • Lutz-P. Nolte
  • Guoyan Zheng
Chapter
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 1093)

Abstract

Periacetabular osteotomy (PAO) is an effective approach for surgical treatment of hip dysplasia in young adults. However, achieving an optimal acetabular reorientation during PAO is the most critical and challenging step. Routinely, the correct positioning of the acetabular fragment largely depends on the surgeon’s experience and is done under fluoroscopy to provide the surgeon with continuous live x-ray guidance. Our developed system starts with a fully automatic detection of the acetabular rim, which allows for quantifying the acetabular 3D morphology with parameters such as acetabular orientation, femoral head extrusion index (EI), lateral center-edge (LCE) angle, and total and regional femoral head coverage (FHC) ratio for computer-assisted diagnosis, planning, and simulation of PAO. Intraoperative navigation is conducted to implement the preoperative plan. Two validation studies were conducted on four sawbone models to evaluate the efficacy of the system intraoperatively and postoperatively. By comparing the preoperatively planned situation with the intraoperatively achieved situation, average errors of 0.6° ± 0.3°, 0.3° ± 0.2°, and 1.1° ± 1.1° were found, respectively, along three motion directions (flexion/extension, abduction/adduction, and external rotation/internal rotation). In addition, by comparing the preoperatively planned situation with the postoperative results, average errors of 0.9° ± 0.3° and 0.9° ± 0.7° were found for inclination and anteversion, respectively.

Keywords

Hip dysplasia Periacetabular osteotomy (PAO) Planning Simulation Navigation Image-guided surgery Joint preservation surgery 

Notes

Acknowledgments

This work is supported in part by Natural Science Foundation of SZU (grant no. 2017089). This chapter was modified from the paper published by our group in The 7th International Conference on Medical Imaging and Augmented Reality (MIAR2016) (Li et al., MIAR2016; 15-26). The related contents were reused with permission.

References

  1. 1.
    Murphy SB, Millis MB, Hall JE (1999) Surgical correction of acetabular dysplasia in the adult. A Boston experience. Clin Orthop 363:38–44CrossRefGoogle Scholar
  2. 2.
    Ganz R, Klaue K, Vinh T, Mast J (1988) A new periacetabular osteotomy for the treatment of hip dysplasia. Technique and preliminary results. Clin Orthop 232:26–36Google Scholar
  3. 3.
    Hipp JA, Sugano N, Millis MB, Murphy SB (1999) Planning acetabular redirection osteotomies based on joint contact pressures. Clin Orthop 364:134–142CrossRefGoogle Scholar
  4. 4.
    Ziebarth K, Balakumar J, Domayer S et al (2011) Bernese periacetabular osteotomy in males: is there an increased risk of femoroacetabular impingement (FAI) after Bernese periacetabular osteotomy? Clin Orthop Relat Res 469:447–453CrossRefPubMedCentralGoogle Scholar
  5. 5.
    Myers SR, Eijer H, Ganz R (1999) Anterior femoroacetabular impingement after periacetabular osteotomy. Clin Orthop Relat Res 363:93–99CrossRefGoogle Scholar
  6. 6.
    Crockaress J Jr, Trousdale RT, Cabanela ME, Berry DJ (1999) Early experience and results with the periacetabular osteotomy. The Mayo Clinic experience. Clin Orthop 363:45–53Google Scholar
  7. 7.
    Abraham C, Rodriguez J, Buckley JM, Diab M, Burch S (2010) An evaluation of the accuracy of computer assisted surgery in preoperatively three dimensionally planned periacetabular osteotomies. In: Proceedings of the 56th annual meeting of the Orthopaedic Research Society; 2010 Mar 6–9; New Orleans, USAGoogle Scholar
  8. 8.
    Hsieh PH, Chang YH, Shih CH (2006) Image-guided periacetabular osteotomy: computer-assisted navigation compared with the conventional technique: a randomized study of 36 patients followed for 2 years. Acta Orthop 77(4):591–597CrossRefPubMedCentralGoogle Scholar
  9. 9.
    Langlotz F, Bachler R, Berlemann U, Nolte LP, Ganz R (1998) Computer assistance for pelvic osteotomies. Clin Orthop 354:92–102CrossRefGoogle Scholar
  10. 10.
    Murphy RJ, Armiger RS, Lepistö J, Mears SC, Taylor RH, Armand M (2014) Development of a biomechanical guidance system for periacetabular osteotomy. Int J Comput Assist Radiol Surg 10(4):497–508CrossRefPubMedCentralGoogle Scholar
  11. 11.
    Chu C, Bai J, Wu X, Zheng G (2015) Mascg: multi-atlas segmentation constrained graph method for accurate segmentation of hip ct images. Med Image Anal 26(1):173–184CrossRefPubMedCentralGoogle Scholar
  12. 12.
    Zheng G, Marx A, Langlotz U, Widmer KH, Buttaro M, Nolte LP (2002) A hybrid CT-free navigation system for total hip arthroplasty. Comput Aided Surg 7(3):129–145CrossRefPubMedCentralGoogle Scholar
  13. 13.
    Murray DW (1993) The definition and measurement of acetabular orientation. J Bone Joint Surg Br 75(B):228–232CrossRefPubMedCentralGoogle Scholar
  14. 14.
    Wiberg G (1939) The anatomy and roentgenographic appearance of a normal hip joint. Acta Chir Scand Suppl 83:7–38Google Scholar
  15. 15.
    Murphy SB, Ganz R, Muller ME (1995) The prognosis in untreated dysplasia of the hip. A study of radiographic factors that predict the outcome. J Bone Joint Surg Am 77:985–989CrossRefPubMedCentralGoogle Scholar
  16. 16.
    Konishi N, Mieno T (1993) Determination of acetabular coverage of the femoral head with use of a single anteroposterior radiograph. A new computerized technique. J Bone Joint Surg Am 75(9):1318–1333CrossRefPubMedCentralGoogle Scholar
  17. 17.
    Liu L, Ecker TM, Schumann S, Siebenrock KA, Nolte LP, Zheng G (2014) Computer assisted planning and navigation of periacetabular osteotomy (PAO) with range of motion (ROM) optimization. Medical Image Computing and Computer-Assisted Intervention–MICCAI 2014. Springer, 2014: pp 643–650Google Scholar
  18. 18.
    Cheng H, Liu L, Yu W, Zhang H, Luo D, Zheng G (2015) Comparison of 2.5D and 3D quantification of femoral head coverage in normal control subjects and patients with hip dysplasia. Plos One (under review)Google Scholar
  19. 19.
    Steppacher SD, Tannast M, Werlen S, Siebenrock K (2008) Femoral morphology differs between deficient and excessive acetabular coverage. Clin Orthop Relat Res 466(4):782–790CrossRefPubMedCentralGoogle Scholar
  20. 20.
    Dandachli W, Kannan V, Richards R, Shah Z, Hall-Craggs M, Witt J (2008) Analysis of cover of the femoral head in normal and dysplastic hips: new CT-based technique. J Bone Joint Surg Br 90(11):1428–1434CrossRefPubMedCentralGoogle Scholar
  21. 21.
    Zou Z, Chavez-Arreola A, Mandal P, Board TN, Alonso-Rasgado T (2012) Optimization of the position of the acetabulum in a Ganz periacetabular osteotomy by finite element analysis. J Orthop Res 31(3):472–479CrossRefPubMedCentralGoogle Scholar
  22. 22.
    Bächler R, Bunke H, Nolte LP (2001) Restricted surface matching - numerical optimization and technical evaluation. Comput Aided Surg 6:143–152CrossRefPubMedCentralGoogle Scholar
  23. 23.
    Olson SA (2010) The Bernese periacetabular osteotomy: a review of surgical technique. Duke Orthop J 1(1):21–26Google Scholar
  24. 24.
    Jäger M, Westhoff B, Wild A, Krauspe R (2004) Computer-assisted periacetabular triple osteotomy for treatment of dysplasia of the hip. Z Orthop Ihre Grenzgeb 142(1):51–59CrossRefPubMedCentralGoogle Scholar
  25. 25.
    Liu L, Zheng G, Bastian JD, Keel MJB, Nolte LP, Siebenrock KA, Ecker TM (2015) Periacetabular osteotomy through the pararectus approach: technical feasibility and control of fragment mobility by a validated surgical navigation system in a cadaver experiment. Int orthop:1–8Google Scholar
  26. 26.
    Puls M, Ecker TM, Steppacher SD, Tannast M, Siebenrock KA, Kowal JH (2011) Automated detection of the osseous acetabular rim using three-dimensional models of the pelvis. Comput Biol Med 41(5):285–291CrossRefPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  • Li Liu
    • 1
    • 2
  • Klaus Siebenrock
    • 3
  • Lutz-P. Nolte
    • 2
  • Guoyan Zheng
    • 2
  1. 1.National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, School of Biomedical Engineering, Health Science CenterShenzhen UniversityShenzhenChina
  2. 2.Institute for Surgical Technology and BiomechanicsUniversity of BernBernSwitzerland
  3. 3.Department of Orthopedic Surgery, InselspitalUniversity of BernBernSwitzerland

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