Computer-Assisted Orthopedic Surgery for Hip Osteotomy

Abstract

Developmental dysplasia of the hip (DDH) is a common cause of secondary osteoarthritis. Various types of periacetabular osteotomy that reorient the dysplastic acetabulum have been developed to prevent the early onset of secondary osteoarthritis. Bernese periacetabular osteotomy and rotational acetabular osteotomy are now commonly used as surgical treatments for symptomatic DDH. Periacetabular osteotomies are technically demanding procedures that require detailed anatomical knowledge of the pelvic anatomy and three-dimensional (3D) cognitive skills because surgeons must avoid intra-articular perforation of chisels, thin acetabular fragments, posterior column fracture, and vascular and nerve injury. Preoperative 3D simulation of the osteotomy would be useful to avoid these perioperative complications. Computer-assisted systems such as navigation and custom cutting guides would be powerful tools with which to accurately execute the 3D osteotomy plan. A few reports have described the clinical application of a navigation system or custom cutting guide for periacetabular osteotomy. However, no navigation system that can track movement of the acetabular fragment has been developed. Some researchers have been developing such navigation systems with a focus on tracking the acetabular fragment.