Computer-Assisted Planning, Simulation, and Navigation System for Periacetabular Osteotomy
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.
KeywordsHip dysplasia Periacetabular osteotomy (PAO) Planning Simulation Navigation Image-guided surgery Joint preservation surgery
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.
- 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
- 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.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
- 14.Wiberg G (1939) The anatomy and roentgenographic appearance of a normal hip joint. Acta Chir Scand Suppl 83:7–38Google Scholar
- 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.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
- 23.Olson SA (2010) The Bernese periacetabular osteotomy: a review of surgical technique. Duke Orthop J 1(1):21–26Google Scholar
- 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