Skip to main content

Advertisement

SpringerLink
Log in

Development of a biomechanical guidance system for periacetabular osteotomy

  • Original Article
  • Published:
International Journal of Computer Assisted Radiology and Surgery Aims and scope Submit manuscript

Abstract

Purpose

   This paper presents and validates a computer-navigated system for performing periacetabular osteotomy (PAO) to treat developmental dysplasia of the hip. The main motivation of the biomechanical guidance system (BGS) is to plan and track the osteotomy fragment in real time during PAO while simplifying the procedure for less-experienced surgeons. The BGS aims at developing a platform for comparing biomechanical states of the joint with the current gold standard geometric assessment of anatomical angles. The purpose of this study was to (1) determine the accuracy with which the BGS tracks the hip joint through repositioning and (2) identify improvements to the workflow.

Methods

   Nineteen cadaveric validation studies quantified system accuracy, verified system application, and helped to refine surgical protocol. In two surgeries, navigation and registration accuracy were computed by affixing fiducials to two cadavers prior to surgery. All scenarios compared anatomical angle measurements and joint positioning as measured intraoperatively to postoperatively.

Results

   In the two cases with fiducials, computed fragment transformations deviated from measured fiducial transformations by 1.4 and 1.8 mm in translation and \(1.0^{\circ }\) and \(2.2^{\circ }\) in rotation, respectively. The additional seventeen surgeries showed strong agreement between intraoperative and postoperative anatomical angles, helped to refine the surgical protocol, and demonstrated system robustness.

Conclusion

   Estimated accuracy with BGS appeared acceptable for future surgical applications. Several major system requirements were identified and addressed, improving the BGS and making it feasible for clinical studies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Ganz R, Klaue K, Vinh TS, Mast JW (1988) A new periacetabular osteotomy for the treatment of hip dysplasias. Technique and preliminary results. Clin Orthop Relat Res 232:26–36

    PubMed  Google Scholar 

  2. Hussell JG, Rodriguez JA, Ganz R (1999) Technical complications of the Bernese periacetabular osteotomy. Clin Orthop Relat Res 363: 81–92

  3. Cooperman DR, Wallensten R, Stulberg SD (1983) Acetabular dysplasia in the adult. Clin Orthop Relat Res 175:79–85

    PubMed  Google Scholar 

  4. Troelsen A (2009) Surgical advances in periacetabular osteotomy for treatment of hip dysplasia in adults. Acta Orthop Suppl 80:1–33

    Article  PubMed  Google Scholar 

  5. Albers CE, Steppacher SD, Ganz R, Tannast M, Siebenrock KA (2013) Impingement adversely affects 10-year survivorship after periacetabular osteotomy for DDH. Clin Orthop Relat Res 471:1602–1614

    Article  PubMed Central  PubMed  Google Scholar 

  6. Troelsen A, Elmengaard B, Søballe K (2009) Medium-term outcome of periacetabular osteotomy and predictors of conversion to total hip replacement. J Bone Joint Surg Am 91:2169–2179

    Article  PubMed  Google Scholar 

  7. Langlotz F, Bachler R, Berlemann U, Nolte LP, Ganz R (1998) Computer assistance for pelvic osteotomies. Clin Orthop Relat Res 354: 92–102

  8. Langlotz F, Stucki M, Bachler R, Scheer C, Ganz R, Berlemann U et al (1997) The first twelve cases of computer assisted periacetabular osteotomy. Comput Aided Surg 2:317–326

    Article  CAS  PubMed  Google Scholar 

  9. Armand M, Lepistö J, Tallroth K, Elias J, Chao E (2005) Outcome of periacetabular osteotomy: joint contact pressure calculation using standing AP radiographs, 12 patients followed for average 2 years. Acta Orthop 76:303–313

    PubMed Central  PubMed  Google Scholar 

  10. Armiger RS, Armand M, Tallroth K, Lepistö J, Mears SC (2009) Three-dimensional mechanical evaluation of joint contact pressure in 12 periacetabular osteotomy patients with 10-year follow-up. Acta Orthop 80:155–161

    Article  PubMed Central  PubMed  Google Scholar 

  11. Hipp JA, Sugano N, Millis MB, Murphy SB (1999) Planning acetabular redirection osteotomies based on joint contact pressures. Clin Orthop Relat Res 364: 134–143

  12. Tsumura H, Kaku N, Ikeda S, Torisu T (2005) A computer simulation of rotational acetabular osteotomy for dysplastic hip joint: does the optimal transposition of the acetabular fragment exist? J Orthop Sci 10:145–151

    Article  PubMed  Google Scholar 

  13. Armiger RS (2006) Development of a surgical guidance system for real-time biomechanical feedback during periacetabular osteotomy (Master’s thesis). Master’s thesis, Johns Hopkins University, Baltimore, MD

  14. Lepistö J, Armand M, Armiger RS (2008) Periacetabular osteotomy in adult hip dysplasia—developing a computer aided real-time biomechanical guiding system (BGS). Suom Ortoped Traumatol 31:186–190

    PubMed Central  PubMed  Google Scholar 

  15. Armiger RS, Armand M, Lepistö J, Minhas D, Tallroth K, Mears SC et al (2007) Evaluation of a computerized measurement technique for joint alignment before and during periacetabular osteotomy. Comput Aided Surg 12:215–224

    Article  PubMed Central  PubMed  Google Scholar 

  16. An KN, Himeno S, Tsumura H, Kawai T, Chao EY (1990) Pressure distribution on articular surfaces: application to joint stability evaluation. J Biomech 23:1013–1020

    Article  CAS  PubMed  Google Scholar 

  17. Genda E, Konishi N, Hasegawa Y, Miura T (1995) A computer simulation study of normal and abnormal hip joint contact pressure. Arch Orthop Trauma Surg 114:202–206

    Article  CAS  PubMed  Google Scholar 

  18. Volokh K, Chao E, Armand M (2007) On foundations of discrete element analysis of contact in diarthrodial joints. Mol Cell Biomech 4:67–73

    PubMed Central  CAS  PubMed  Google Scholar 

  19. Armand M, Merkle A, Sukal T, Kleinberger M (2002) Experimental evaluation of a model of contact pressure distribution in the hip joint. In: Proceedings of world congress on biomechanics, Calgary, Alberta

  20. Elias J, Wilson D, Adamson R, Cosgarea A (2004) Evaluation of a computational model used to predict the patellofemoral contact pressure distribution. J Biomech 37:295–302

    Article  PubMed  Google Scholar 

  21. Michaeli DA, Murphy SB, Hipp JA (1997) Comparison of predicted and measured contact pressures in normal and dysplastic hips. Med Eng Phys 19:180–186

    Article  CAS  PubMed  Google Scholar 

  22. Schuind F, Cooney W, Linscheid R, An K, Chao E (1995) Force and pressure transmission through the normal wrist. J Biomech 28:587–601

    Article  CAS  PubMed  Google Scholar 

  23. Murphy SB, Kijewski PK, Millis MB, Harless A (1990) Acetabular dysplasia in the adolescent and young adult. Clin Orthop Relat Res 214–223

  24. Tallroth K (2006) Developmental dysplasia of the Hip 2: adult. In: Davies AM, Johnson KJ, Whitehouse RW (eds) Imaging of the hip and bony pelvis: techniques and applications, medical radiology. Springer, Berlin, pp 125–140

    Chapter  Google Scholar 

  25. Lepistö J, Tallroth K, Alho A (1998) Three-dimensional measures of acetabulum in periacetabular osteotomy. In: Orthopaedic research society 44th annual meeting

  26. Anda S, Terjesen T, Kvistad KA (1991) Computed tomography measurements of the acetabulum in adult dysplastic hips: which level is appropriate? Skeletal Radiol 20:267–271

    Article  CAS  PubMed  Google Scholar 

  27. Anda S, Terjesen T, Kvistad KA, Svenningsen S (1991) Acetabular angles and femoral anteversion in dysplastic hips in adults: CT investigation. J Comput Assist Tomogr 15:115–120

    Article  CAS  PubMed  Google Scholar 

  28. Wiberg G (1939) Studies on dysplastic acetabula and congenital subluxation of the hip joint with special reference to the complications of osteoarthritis. Acta Chir Scand 83:53–68

    Google Scholar 

  29. Tönnis D (1987) Congenital dysplasia and dislocation of the hip in children and adults. Springer, Berlin

    Book  Google Scholar 

  30. Besl PJ, McKay ND (1992) A method for registration of 3-d shapes. IEEE Trans Pattern Anal Mach Intell 14:239–256

    Article  Google Scholar 

  31. Moghari MH, Abolmaesumi P (2005) A novel incremental technique for ultrasound to CT bone surface registration using unscented Kalman filtering. Med Image Comput Comput Assist Interv 8:197–204

    PubMed  Google Scholar 

  32. Sadowsky O, Cohen JD, Taylor RH (2005) Rendering tetrahedral meshes with higher-order attenuation functions for digitial radiograph reconstruction. In: Visualization conference, IEEE p 39

  33. Sadowsky O, Cohen JD, Taylor RH (2006) Projected tetrahedra revisited: a barycentric formulation applied to digitial radiograph reocnsturation using higher-order attenuation functions. IEEE Trans Vis Comput Graph 12:461–473

  34. Chintalapani G, Murphy R, Armiger R, Lepisto J, Otake Y, Sugano N, et al (2010) Statistical atlas based extrapolation of CT data. In: SPIE medical imaging, international society for optics and photonics, p 762539

  35. Kutty S, Schneider P, Faris P, Kiefer G, Firzzel B, Park R, Powell JN (2012) Reliability and predicatability of the centre-edge angle in the assessment of pincer femoroacetabular impingement. Int Orthop 36(3):505–510

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank Dr. Stephen Belkoff for the use of his cadaver lab, and Mr. Demetries Boston for his assistance during cadaveric testing. This work was funded through Grant R01EB006839-01 National Institute of Biomedical Imaging and Bioengineering (NIBIB) of the National Institutes of Health (NIH), and internal funds from the Johns Hopkins University.

Author information

Authors and Affiliations

  1. Research and Exploratory Development Department, Johns Hopkins University Applied Physics Laboratory, 11100 Johns Hopkins Rd, 21-S100, Laurel, MD, 20723, USA

    Ryan J. Murphy, Robert S. Armiger & Mehran Armand

  2. Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD, USA

    Ryan J. Murphy & Mehran Armand

  3. Orton Orthopaedic Hospital, Helsinki, Finland

    Jyri Lepistö

  4. Department of Orthopedic Surgery, Baylor Regional Medical Center at Plano, Plano, TX, USA

    Simon C. Mears

  5. Department of Computer Science, Johns Hopkins University, Baltimore, MD, USA

    Russell H. Taylor

Authors
  1. Ryan J. Murphy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robert S. Armiger
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jyri Lepistö
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Simon C. Mears
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Russell H. Taylor
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mehran Armand
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ryan J. Murphy.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Murphy, R.J., Armiger, R.S., Lepistö, J. et al. Development of a biomechanical guidance system for periacetabular osteotomy. Int J CARS 10, 497–508 (2015). https://doi.org/10.1007/s11548-014-1116-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11548-014-1116-7

Keywords

Search

Navigation