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Augmented Reality Navigation-Guided Core Decompression for Osteonecrosis of Femoral Head
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Knee Osteonecrosis: Cell Therapy with Computer-assisted Navigation.

Philippe Hernigou1, David Gerber2, Jean Charles Auregan3

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Computer navigation significantly improved drilling precision for knee osteonecrosis stem cell injections, reducing radiation and improving patient outcomes. This technique offers a safer, more accurate approach for treating this condition.

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Area of Science:

  • Orthopedic surgery
  • Biomedical engineering
  • Regenerative medicine

Background:

  • Knee osteonecrosis is less common than hip osteonecrosis.
  • Precise drilling for core decompression in knee osteonecrosis is challenging, especially in obese patients.
  • Accurate localization is crucial for effective cell therapy and avoiding intra-articular injection.

Purpose of the Study:

  • To compare the precision of computer-based navigation versus conventional fluoroscopy for core decompression in knee osteonecrosis.
  • To evaluate the safety and efficacy of computer-assisted navigation for stem cell injection in patients with knee osteonecrosis.

Main Methods:

  • A prospective, randomized study comparing computer navigation and fluoroscopy for core decompression on cadavers and patients.
  • Surgical trainees and expert surgeons performed the procedure using both techniques.
  • Patient outcomes were assessed based on trocar placement accuracy, intra-articular penetration risk, and long-term joint collapse and repair volume.

Main Results:

  • Computer navigation demonstrated significantly higher precision in cadaver tests, with less deviation from the target lesion center.
  • Navigated procedures required fewer drilling corrections, less radiation, and had a lower risk of intra-articular penetration and ligament injury.
  • In patients, computer navigation led to better trocar placement, reduced joint collapse (4 vs. 1), and improved repair volume (11.4 vs. 4.2 cm3) over 5 years.

Conclusions:

  • Computer-assisted navigation enhances precision and reduces radiation exposure in core decompression for knee osteonecrosis.
  • The study suggests computer navigation is a safe and effective tool for stem cell injection in knee osteonecrosis treatment.