Augmented reality-guided periacetabular osteotomy\u2014proof of concept

Pascal Kiarostami,Simon Roner,Patrick O Zingg,Philipp Fürnstahl,Cyrill Dennler,Reto Sutter,Stefan Rahm,Mazda Farshad

doi:10.1186/s13018-020-02066-x

Pascal Kiarostami, Simon Roner + Show 6 more

Open Access

https://doi.org/10.1186/s13018-020-02066-x

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Abstract

BackgroundThe Ganz’ periacetabular osteotomy (PAO) consists of four technically challenging osteotomies (OT), namely, supraacetabular (saOT), pubic (pOT), ischial (iOT), and retroacetabular OT (raOT).PurposeWe performed a proof of concept study to test (1) the feasibility of augmented reality (AR) guidance for PAO, (2) precision of the OTs guided by AR compared to the freehand technique performed by an experienced PAO surgeon, and (3) the effect of AR on performance depending on experience.MethodsA 3D preoperative plan of a PAO was created from segmented computed tomography (CT) data of an anatomic plastic pelvis model (PPM). The plan was then embedded in a software application for an AR head-mounted device. Soft tissue coverage was imitated using foam rubber. The 3D plan was then registered onto the PPM using an anatomical landmark registration. Two surgeons (one experienced and one novice PAO surgeon) each performed 15 freehand (FH) and 15 AR-guided PAOs. The starting point distances and angulation between the planned and executed OT planes for the FH and the AR-guided PAOs were compared in post-intervention CTs.ResultsAR guidance did not affect the performance of the expert surgeon in terms of the mean differences between the planned and executed starting points, but the raOT angle was more accurate as compared to FH PAO (p = 0.0027). AR guidance increased the accuracy of the performance of the novice surgeon for iOT (p = 0.03). An intraarticular osteotomy performed by the novice surgeon with the FH technique could be observed only once.ConclusionAR guidance of osteotomies for PAOs is feasible and seems to increase accuracy. The effect is more accentuated for less-experienced surgeons.Clinical relevanceThis is the first proof of concept study documenting the feasibility of AR guidance for PAO. Based on these findings, further studies are essential for elaborating on the potential merits of AR guidance to increase the accuracy of complex surgical procedures.

Highlights

Periacetabular osteotomy (PAO) is a well-established procedure for the treatment of hip dysplasia [1, 2] and femoroacetabular impingement caused by true acetabular retroversion [3]
Clinical relevance: This is the first proof of concept study documenting the feasibility of augmented reality (AR) guidance for periacetabular osteotomy (PAO)
Further studies are essential for elaborating on the potential merits of AR guidance to increase the accuracy of complex surgical procedures

Summary

Introduction

Periacetabular osteotomy (PAO) is a well-established procedure for the treatment of hip dysplasia [1, 2] and femoroacetabular impingement caused by true acetabular retroversion [3]. More sophisticated techniques for the navigation of PAO have been suggested and investigated, including optical tracking systems [7,8,9,10] and planar marking and tracking with an inertial measurement unit (IMU) combined into a small hybrid navigation system for PAO [11] as well as patient-specific template guides [12]. Such techniques, require additional expensive operating room equipment and/or more extensive surgical exposures. Purpose: We performed a proof of concept study to test (1) the feasibility of augmented reality (AR) guidance for PAO, (2) precision of the OTs guided by AR compared to the freehand technique performed by an experienced PAO surgeon, and (3) the effect of AR on performance depending on experience

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