SURGICAL NAVIGATION SYSTEM FOR PERIACETABULAR OSTEOTOMY (PAO) IN HIP DYSPLASIA

Periacetabular Osteotomy (PAO) is a recognized surgical intervention specifically designed to address hip joint instability and acetabular undercoverage, conditions frequently seen in cases of developmental dysplasia of the hip (DDH). Despite the favorable long-term clinical outcomes observed in carefully selected patient populations, PAO is recognized for its challenging surgical demands, which include a complex technique and significant learning curve, alongside a risk profile that includes potential complications. Key challenges associated with PAO surgery are particularly centered around the execution of multi-planar osteotomies around the acetabulum within a limited visual field while avoiding damage to vital surrounding tissues. Furthermore, the accurate reconfiguration and placement of the acetabular fragment post-osteotomy is crucial to ensure adequate femoral head coverage, rendering the procedure highly demanding even for experienced hip surgeons. To address these challenges, we have developed an advanced surgical planning and navigation system leveraging computer-aided and surgical navigation technologies. This novel system enables rapid and precise preoperative measurement of 11 key parameters crucial for DDH assessment, which include the Lateral Center-Edge (LCE) angle, crossover sign, and acetabular coverage rate. By providing a comprehensive evaluation of hip joint deformities, the system facilitates intuitive surgical planning of osteotomies and acetabular adjustments through three-dimensional modeling, thus enhancing surgical precision and outcomes. Central to our approach is the development of a specialized osteotome equipped with calibration target balls and an integrated calibration system, founded on NDI intraoperative registration and tracking technology. This advancement permits real-time, accurate tracking of the osteotome during surgical procedures, correcting for errors and ensuring precise osteotomies. Complementing this is our real-time tracking methodology for monitoring acetabular coverage as the acetabular fragment is repositioned post-osteotomy. This functionality enables continuous assessment of coverage parameters, aiding surgeons in making precise intraoperative adjustments and fixation. Validation studies using Sawbone models and cadavers have demonstrated the effectiveness of our system in supporting traditional PAO surgical techniques. The system has proven to be intuitive, stable, and accurate, with preoperative and postoperative CT analyses indicating an error margin within 1mm. This novel surgical system shows significant promise as a potent clinical tool, poised to enhance both the precision of PAO surgery and its widespread clinical adoption.