Augmented reality-guided periacetabular osteotomy-proof of concept

Area of Science:

• Orthopedic surgery
• Surgical technology
• Medical imaging

Background:

• Periacetabular osteotomy (PAO) involves four complex osteotomies: supraacetabular (saOT), pubic (pOT), ischial (iOT), and retroacetabular (raOT).
• Technical challenges in PAO necessitate innovative approaches to improve precision and outcomes.

Purpose of the Study:

• To evaluate the feasibility of augmented reality (AR) guidance for periacetabular osteotomy (PAO).
• To compare the precision of AR-guided osteotomies versus freehand techniques.
• To assess the impact of surgeon experience on AR-guided PAO performance.

Main Methods:

• A 3D preoperative PAO plan was created from CT data and integrated into an AR head-mounted device.
• Two surgeons (experienced and novice) performed 15 freehand (FH) and 15 AR-guided PAOs on a plastic pelvis model.
• Post-intervention CT scans compared planned versus executed osteotomy distances and angles for both techniques.

Main Results:

• AR guidance did not significantly alter the expert surgeon's overall performance but improved retroacetabular OT (raOT) angle accuracy (p = 0.0027).
• AR guidance significantly enhanced the novice surgeon's accuracy for ischial OT (iOT) (p = 0.03).
• Intraarticular osteotomies by the novice surgeon were avoided with AR guidance.

Conclusions:

• Augmented reality (AR) guidance is a feasible technology for periacetabular osteotomy (PAO) osteotomies.
• AR guidance demonstrates potential to increase surgical accuracy, particularly benefiting less experienced surgeons.
• Further research is warranted to explore AR's role in improving complex surgical procedure accuracy.