Plan in 2-D, execute in 3-D: An augmented reality solution for cup placement in total hip arthroplasty

Javad Fotouhi, Clayton P. Alexander, Mathias Unberath, Giacomo Taylor, Sing Chun Lee, Bernhard Fuerst, Alex Johnson, Greg Osgood, Russell H. Taylor, Harpal Khanuja, Mehran Armand, Nassir Navab

Research output: Contribution to journalArticlepeer-review

Abstract

Reproducibly achieving proper implant alignment is a critical step in total hip arthroplasty procedures that has been shown to substantially affect patient outcome. In current practice, correct alignment of the acetabular cup is verified in C-arm x-ray images that are acquired in an anterior-posterior (AP) view. Favorable surgical outcome is, therefore, heavily dependent on the surgeon's experience in understanding the 3-D orientation of a hemispheric implant from 2-D AP projection images. This work proposes an easy to use intraoperative component planning system based on two C-arm x-ray images that are combined with 3-D augmented reality (AR) visualization that simplifies impactor and cup placement according to the planning by providing a real-time RGBD data overlay. We evaluate the feasibility of our system in a user study comprising four orthopedic surgeons at the Johns Hopkins Hospital and report errors in translation, anteversion, and abduction as low as 1.98 mm, 1.10 deg, and 0.53 deg, respectively. The promising performance of this AR solution shows that deploying this system could eliminate the need for excessive radiation, simplify the intervention, and enable reproducibly accurate placement of acetabular implants.

Original languageEnglish (US)
Article number021205
JournalJournal of Medical Imaging
Volume5
Issue number2
DOIs
StatePublished - Apr 1 2018

Keywords

  • RGBD camera
  • augmented reality
  • intraoperative planning
  • total hip arthroplasty.
  • x-ray

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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