Does navigation improves accuracy of femoral head osteoplasty? - experimental case control study on CT based printed models
Author(s):
Strazar K. (Slovenia)
Strazar K. (Slovenia)
Affiliations:
ESSKA Academy. Strazar K. 05/09/18; 209837; P19-1854 Topic: Arthroscopic Surgery
Klemen Strazar
Klemen Strazar
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Abstract
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Objectives: According to published data, arthroscopic osteoplasty has a tendency to under- or over-correct the femoral head sphericity. Computer navigation of arthroscopic instruments has been considered as a potential solution to improve accuracy of resection of CAM deformity but its positive contribution has not been well tested yet.

Methods: CT scans of the hip of 16 patients, previously treated for CAM impingement, were used to print models of proximal femur from gypsum-like material. Two identical pieces were obtained for each case. Prior performing osteoplasty on the model, a kinematic plan was used to define zones of impingement for each case. The model with pre-planned volume of bone to be resected was transferred to the surgical navigation system which is based on the electromagnetic tracking. Arthroscopic osteoplasty assisted by computer aided navigation of surgical instruments was performed on the first model and osteoplasty without navigation performed on the second model of the same case, both by single highly experienced hip arthroscopist. Restructured shape was then scanned by optical scanner and compared to the desired shape acquired by pre-planning. Accuracy of osteoplasty obtained with navigaton was compared to that obtained without navigation. T-tests where used to compare results obtained in two groups with p<0,05 to present statistical significance.

Results: In navigated group, average of 10 % of bone volume was found yet to be under-resected and 26 % over-resected. The accuracy was significantly better compared to the non-navigated group with average of 35 % of bone volume to be under-resected and 29 % over-resected. The maximum depth of persisted CAM in navigated group was significantly lower than in non-navigated group (1,06 mm and 3,13 mm, respectively). It was roughly estimated that navigated osteoplasty was performed with accuracy being twice better compared to non-navigated osteoplasty.

Conclusions: According to results of our study on printed gypsum models, navigation improves accuracy of arthroscopic resection of CAM deformity significantly. Navigated osteoplasty was proven to be more effective in avoiding persisted CAM impingement after arthroscopic osteoplasty compared to non-navigated osteoplasty. Some technical advances of the navigation system with knowledge from robotic assistance may be considered to further improve accuracy of arthroscopic osteoplasty.

Keywords:
osteoplasty, CAM deformity, computer navigation
Objectives: According to published data, arthroscopic osteoplasty has a tendency to under- or over-correct the femoral head sphericity. Computer navigation of arthroscopic instruments has been considered as a potential solution to improve accuracy of resection of CAM deformity but its positive contribution has not been well tested yet.

Methods: CT scans of the hip of 16 patients, previously treated for CAM impingement, were used to print models of proximal femur from gypsum-like material. Two identical pieces were obtained for each case. Prior performing osteoplasty on the model, a kinematic plan was used to define zones of impingement for each case. The model with pre-planned volume of bone to be resected was transferred to the surgical navigation system which is based on the electromagnetic tracking. Arthroscopic osteoplasty assisted by computer aided navigation of surgical instruments was performed on the first model and osteoplasty without navigation performed on the second model of the same case, both by single highly experienced hip arthroscopist. Restructured shape was then scanned by optical scanner and compared to the desired shape acquired by pre-planning. Accuracy of osteoplasty obtained with navigaton was compared to that obtained without navigation. T-tests where used to compare results obtained in two groups with p<0,05 to present statistical significance.

Results: In navigated group, average of 10 % of bone volume was found yet to be under-resected and 26 % over-resected. The accuracy was significantly better compared to the non-navigated group with average of 35 % of bone volume to be under-resected and 29 % over-resected. The maximum depth of persisted CAM in navigated group was significantly lower than in non-navigated group (1,06 mm and 3,13 mm, respectively). It was roughly estimated that navigated osteoplasty was performed with accuracy being twice better compared to non-navigated osteoplasty.

Conclusions: According to results of our study on printed gypsum models, navigation improves accuracy of arthroscopic resection of CAM deformity significantly. Navigated osteoplasty was proven to be more effective in avoiding persisted CAM impingement after arthroscopic osteoplasty compared to non-navigated osteoplasty. Some technical advances of the navigation system with knowledge from robotic assistance may be considered to further improve accuracy of arthroscopic osteoplasty.

Keywords:
osteoplasty, CAM deformity, computer navigation
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