Pose Estimation of Periacetabular Osteotomy Fragments with Intraoperative X-Ray Navigation

Objective: State of the art navigation systems for pelvic osteotomies use optical systems with external fiducials. We propose the use of X-Ray navigation for pose estimation of periacetabular fragments without fiducials. Methods: A 2D/3D registration pipeline was developed to recover fragment pose. This pipeline was tested through an extensive simulation study and 6 cadaveric surgeries. Using osteotomy boundaries in the fluoroscopic images, the preoperative plan is refined to more accurately match the intraoperative shape. Results: In simulation, average fragment pose errors were 1.3{\deg}/1.7 mm when the planned fragment matched the intraoperative fragment, 2.2{\deg}/2.1 mm when the plan was not updated to match the true shape, and 1.9{\deg}/2.0 mm when the fragment shape was intraoperatively estimated. In cadaver experiments, the average pose errors were 2.2{\deg}/2.2 mm, 3.8{\deg}/2.5 mm, and 3.5{\deg}/2.2 mm when registering with the actual fragment shape, a preoperative plan, and an intraoperatively refined plan, respectively. Average errors of the lateral center edge angle were less than 2{\deg} for all fragment shapes in simulation and cadaver experiments. Conclusion: The proposed pipeline is capable of accurately reporting femoral head coverage within a range clinically identified for long-term joint survivability. Significance: Human interpretation of fragment pose is challenging and usually restricted to rotation about a single anatomical axis. The proposed pipeline provides an intraoperative estimate of rigid pose with respect to all anatomical axes, is compatible with minimally invasive incisions, and has no dependence on external fiducials.

Plan in 2D, execute in 3D: An augmented reality solution for cup placement in total hip arthroplasty

Reproducibly achieving proper implant alignment is a critical step in total hip arthroplasty (THA) procedures that has been shown to substantially affect patient outcome. In current practice, correct alignment of the acetabular cup is verified in C-arm X-ray images that are acquired in an anterior-posterior (AP) view. Favorable surgical outcome is, therefore, heavily dependent on the surgeon's experience in understanding the 3D orientation of a hemispheric implant from 2D AP projection images. This work proposes an easy to use intra-operative component planning system based on two C-arm X-ray images that is combined with 3D augmented reality (AR) visualization that simplifies impactor and cup placement according to the planning by providing a real-time RGBD data overlay. We evaluate the feasibility of our system in a user study comprising four orthopedic surgeons at the Johns Hopkins Hospital, and also report errors in translation, anteversion, and abduction as low as 1.98 mm, 1.10 degrees, and 0.53 degrees, respectively. The promising performance of this AR solution shows that deploying this system could eliminate the need for excessive radiation, simplify the intervention, and enable reproducibly accurate placement of acetabular implants.