Inger Mechlenburg

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

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avisTidsskriftartikelForskningpeer review

DOI

  • Sepp De Raedt
  • Inger Mechlenburg
  • Maiken Stilling
  • Lone Rømer
  • ,
  • Ryan J Murphy, Research and Exploratory Development Department, Johns Hopkins University Applied Physics Laboratory, Laurel, MD, USA.
  • ,
  • Mehran Armand, Department of Mechanical Engineering, Johns Hopkins University, 3400 N Charles Street, Baltimore, MD, USA.
  • ,
  • Jyri Lepistö, ORTON Orthopaedic Hospital, Helsinki, Finland.
  • ,
  • Marleen de Bruijne, Computer Science Department, University of Copenhagen, Copenhagen, Denmark. mh.khanmohammadi@gmail.com.
  • ,
  • Kjeld Søballe

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 ([Formula: see text], [Formula: see text]) and the acetabular anteversion angle ([Formula: see text], [Formula: see text]). No significant difference was found for the center-edge ([Formula: see text]), acetabular index ([Formula: see text]), and anterior sector angle ([Formula: see text]). Peak-pressure after PAO decreased by a mean of 13% and was significantly different ([Formula: see text]).

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.

OriginalsprogEngelsk
TidsskriftInternational Journal of Computer Assisted Radiology and Surgery
Vol/bind13
Nummer12
Sider (fra-til)2021–2028
Antal sider8
ISSN1861-6410
DOI
StatusUdgivet - dec. 2018

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