Augmented Reality Navigation-Guided Core Decompression for Osteonecrosis of Femoral Head

Summary

Augmented reality technology was applied to core decompression for osteonecrosis of the femoral head to realize real-time visualization of this surgical procedure. This method can effectively improve the safety and precision of core decompression.

Abstract

Osteonecrosis of the femoral head (ONFH) is a common joint disease in young and middle-aged patients, which seriously burdens their lives and work. For early-stage ONFH, core decompression surgery is a classical and effective hip preservation therapy. In traditional procedures of core decompression with Kirschner wire, there are still many problems such as X-ray exposure, repeated puncture verification, and damage to normal bone tissue. The blindness of the puncture process and the inability to provide real-time visualization are crucial reasons for these problems.

To optimize this procedure, our team developed an intraoperative navigation system on the basis of augmented reality (AR) technology. This surgical system can intuitively display the anatomy of the surgical areas and render preoperative images and virtual needles to intraoperative video in real-time. With the guide of the navigation system, surgeons can accurately insert Kirschner wires into the targeted lesion area and minimize the collateral damage. We conducted 10 cases of core decompression surgery with this system. The efficiency of positioning and fluoroscopy is greatly improved compared to the traditional procedures, and the accuracy of puncture is also guaranteed.

Introduction

Osteonecrosis of the femoral head (ONFH) is a common disabling disease occurring in young adults¹. Clinically, it is necessary to determine the staging of ONFH based on X-ray, CT, and MRI to decide the treatment strategy (Figure 1). For early-stage ONFH, hip preservation therapy is usually adopted². Core decompression (CD) surgery is one of the most frequently used hip preservation methods for ONFH. Certain curative effects of core decompression with or without bone grafting in treating early-stage ONFH have been reported, which can avoid or delay subsequent total hip arthroplasty (THA) for ....

Protocol

This study was approved by the ethics committee of the China-Japan Friendship Hospital (approval number: 2021-12-K04). All of the following steps were performed according to standardized procedures to avoid injury to the patients and the surgeons. Informed patient consent was obtained for this study. The surgeon must be skilled in conventional core decompression procedures to ensure that the surgery can be performed in a traditional way in case of inaccurate navigation or other unexpected situations.

1. Preoperative diagnosis and grading of ONFH

1. Identify patients with clinical symptoms of ONFH; typical symptoms ....

Results

Operation characteristics
The surgical navigation system was applied in continuative 10 hips of nine patients. The average total positioning time of the surgery was 10.1 min (median 9.5 min, range 8.0-14.0 min). The mean C-ARM fluoroscopies was 5.5 times (median 5.5 times, range 4-8 times). The mean error of puncture accuracy was 1.61 mm (median 1.2 mm, range -5.76-19.73 mm; Table 1). The results show that the positioning time and fluoroscopy times are obviously shortened compared to.......

Discussion

Although THA has developed rapidly in recent years and become an effective ultimate method for ONFH, hip preservation therapy still plays an important role in treating early-stage ONFH^18,19. CD is a basic and effective hip preservation surgery, which can release hip pain and delay the development of femoral head collapse²⁰. The puncture positioning of the focal necrosis is the crucial procedure of CD, as it determines the success or failur.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
AR-assisted Orthopedic Surgery System	Self development	None	An operating software that implements AR for orthopedic surgery
Depth camera	Stereolabs	ZED depth camera(ZED mini)	shoot video and sent back to the workstation.
Image processing software	Adobe Systems Incorporated	Adobe Photoshop CS6	Image processing software
Infrared positioning device	Northern Digital Inc.	NDI Polaris Spectra optical tracking device	Tracking markers in the surgical area.
Puncture device	Stryker	Stryker System 7 Cordless driver and Sabo	Insert kirschner wire into the necrotic area.