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Passive navigation principle for orthopedic interventions with MR fluoroscopy

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Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Of late, computer-assisted surgery has become a novel challenge for orthopedic surgeons. However, for orthopedic interventions magnetic resonance (MR) fluoroscopy is in its early stages of development. The authors have developed an innovative passive navigation concept, which is potentially applicable for many magnetic resonance image (MRI)-guided musculoskeletal interventions. With this method, no switching between different planes is required, since the cross-sectional modality of the MRI is used as a new navigation approach.

Materials and methods

This method was mainly evaluated in retrograde drilling of artificial osteochondral lesions of the talus as an example of difficult navigation in drill placement due to poor visualization with X-ray and complex anatomy. To accomplish this objective, a passive navigation device was constructed and evaluated in nine cadaveric ankle joint specimens. Feasibility and accuracy of navigated drillings were evaluated.

Results

The interactive high-field MR fluoroscopy and the passive aiming device allow precise drilling of osteochondral lesions of the talus, despite the complex anatomy of the ankle. Drillings could be performed with an accuracy of 1.6 mm. The drilling guide was safe and easy to handle.

Conclusion

The MR-assisted retrograde drilling of osteochondral lesions may enable precise and safe treatment without radiation exposure. This passive navigation technique for MR fluoroscopy is potentially applicable for many orthopedic interventions and may present an alternative to other navigation methods. Especially, the treatment of pediatric and adolescent patients may benefit from the typical MRI properties.

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Acknowledgments

The project is financed by a public grant (TSB Technologiestiftung Berlin-Zukunftsfond Berlin). Co-financed by the European Union-fund for regional development. Usage of the cadaveric specimens was approved and authorized by the institutional review board of University Hospital Berlin, Charité. The authors retained full control of all data collected and information submitted for publication.

Conflict of interest statement

There is no conflict of interest.

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Authors and Affiliations

  1. Center for Musculoskeletal Surgery, Charité, Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburgerplatz 1, 13353, Berlin, Germany

    Hermann J. Bail, Florian Wichlas & Christian J. Seebauer

  2. Department of Radiology, Charité, Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany

    Ulf K. M. Teichgräber, Jens C. Rump & Thula Walter

Authors
  1. Hermann J. Bail
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  2. Ulf K. M. Teichgräber
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  3. Florian Wichlas
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  4. Jens C. Rump
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  5. Thula Walter
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  6. Christian J. Seebauer
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Corresponding author

Correspondence to Christian J. Seebauer.

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Bail, H.J., Teichgräber, U.K.M., Wichlas, F. et al. Passive navigation principle for orthopedic interventions with MR fluoroscopy. Arch Orthop Trauma Surg 130, 803–809 (2010). https://doi.org/10.1007/s00402-009-1006-6

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  • DOI: https://doi.org/10.1007/s00402-009-1006-6

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