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Reliability of computer-assisted periacetabular osteotomy using a minimally invasive approach

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Abstract

Background

Periacetabular osteotomy (PAO) is the treatment of choice for younger patients with developmental hip dysplasia. The procedure aims to normalize the joint configuration, reduce the peak-pressure, and delay the development of osteoarthritis. The procedure is technically demanding and no previous study has validated the use of computer navigation with a minimally invasive transsartorial approach.

Methods

Computer-assisted PAO was performed on ten patients. Patients underwent pre- and postoperative computed tomography (CT) scanning with a standardized protocol. Preoperative preparation consisted of outlining the lunate surface and segmenting the pelvis and femur from CT data. The Biomechanical Guidance System was used intra-operatively to automatically calculate diagnostic angles and peak-pressure measurements. Manual diagnostic angle measurements were performed based on pre- and postoperative CT. Differences in angle measurements were investigated with summary statistics, intraclass correlation coefficient, and Bland–Altman plots. The percentage postoperative change in peak-pressure was calculated.

Results

Intra-operative reported angle measurements show a good agreement with manual angle measurements with intraclass correlation coefficient between 0.94 and 0.98. Computer navigation reported angle measurements were significantly higher for the posterior sector angle (\(1.65^{\circ }\), \(p=0.001\)) and the acetabular anteversion angle (\(1.24^{\circ }\), \(p=0.004\)). No significant difference was found for the center-edge (\(p=0.056\)), acetabular index (\(p=0.212\)), and anterior sector angle (\(p=0.452\)). Peak-pressure after PAO decreased by a mean of 13% and was significantly different (\(p=0.008\)).

Conclusions

We found that computer navigation can reliably be used with a minimally invasive transsartorial approach PAO. Angle measurements generally agree with manual measurements and peak-pressure was shown to decrease postoperatively. With further development, the system will become a valuable tool in the operating room for both experienced and less experienced surgeons performing PAO. Further studies with a larger cohort and follow-up will allow us to investigate the association with peak-pressure and postoperative outcome and pave the way to clinical introduction.

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Acknowledgements

This study was funded by the Danish Rheumatism Association (Gigtforeningen). We would like to acknowledge Netherlands Organisation for Scientific Research (NWO). The BGS was previously developed under grant number R01EB006839 from National Institutes of Health National Institute of Biomedical Imaging and Bioengineering.

Author information

Authors and Affiliations

  1. Department of Orthopaedics, Aarhus University Hospital, Tage-Hansensgade 2, 8000, Aarhus C, Denmark

    Sepp De Raedt, Inger Mechlenburg, Maiken Stilling & Kjeld Søballe

  2. Department of Clinical Medicine, Aarhus University, Brendstrupgårdsvej 100, 8200, Aarhus N, Denmark

    Inger Mechlenburg & Maiken Stilling

  3. Department of Radiology, Aarhus University Hospital, Tage-Hansensgade 2, 8000, Aarhus C, Denmark

    Lone Rømer

  4. Research and Exploratory Development Department, Johns Hopkins University Applied Physics Laboratory, Laurel, MD, USA

    Ryan J. Murphy & Mehran Armand

  5. Department of Mechanical Engineering, Johns Hopkins University, 3400 N Charles Street, Baltimore, MD, USA

    Mehran Armand

  6. ORTON Orthopaedic Hospital, Helsinki, Finland

    Jyri Lepistö

  7. Departments of Radiology and Medical Informatics, Biomedical Imaging Group Rotterdam, Erasmus MC Rotterdam, The Netherlands

    Marleen de Bruijne

  8. Department of Computer Science, University of Copenhagen, Copenhagen, Denmark

    Marleen de Bruijne

Authors
  1. Sepp De Raedt
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  2. Inger Mechlenburg
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  3. Maiken Stilling
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  4. Lone Rømer
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  5. Ryan J. Murphy
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  7. Jyri Lepistö
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  9. Kjeld Søballe
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Correspondence to Sepp De Raedt.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Additional information

Ryan Murphy is currently with Auris Health, Inc., Redwood City, CA.

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De Raedt, S., Mechlenburg, I., Stilling, M. et al. Reliability of computer-assisted periacetabular osteotomy using a minimally invasive approach. Int J CARS 13, 2021–2028 (2018). https://doi.org/10.1007/s11548-018-1802-y

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  • DOI: https://doi.org/10.1007/s11548-018-1802-y

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