Acetabular dysplasia (a shallow hip socket) is a significant cause of osteoarthritis in young adults. The affected patients are usually unable to walk long distances, suffer from chronic pain, and usually limp. The major goals of osteotomy surgery are to 1) reduce patient pain and maintain his/her ability to perform normal daily physical activities, and 2) slow down or prevent the process of joint degeneration by reorienting the acetabulum to contain the femoral head and, therefore, reduce joint subluxation. In theory, both of these goals can be achieved by improving the contact pressure distribution on the acetabulum. Furthermore, one can hypothesize that reducing the maximum contact pressure of the acetabular cartilage will help to slow or prevent additional joint degeneration and reduce the incidence of osteoarthritis in dysplastic hips. PAO is inherently a challenging surgery performed only by a handful of surgeons in the United States. The few existing PAO navigation systems use optical system to track tools, and do not provide real-time tracking of the osteotomized fragment, 3D measurement of the realignment angles, and the osteotomy lines. Furthermore, surgeons use fluoroscopy to verify the joint realignment in the anterior-posterior plane only, limiting abilities to quantify the realignment of the joint in three-dimensional space. Our goal i to develop and evaluate a fluoroscopic guided system that performs three dimensional, real- time, intra-operative biomechanical analysis and fragment tracking to help surgeons improve the outcome of the periacetabular osteotomy (PAO). While the focus here is PAO surgery, applications of this research can be extended to other types of hip osteotomies, knee osteotomies, joint osteotomies, total hip replacement, and hip resurfacing techniques.

Public Health Relevance

The methodology developed in this project will demonstrate the utility of developing an x-ray image-based navigation technique that provides quantitative surgical information not currently available to surgeons using conventional techniques.

Agency
National Institute of Health (NIH)
Institute
National Institute of Biomedical Imaging and Bioengineering (NIBIB)
Type
Exploratory/Developmental Grants (R21)
Project #
5R21EB020113-02
Application #
9055681
Study Section
Special Emphasis Panel (ZRG1)
Program Officer
Krosnick, Steven
Project Start
2015-05-01
Project End
2017-02-28
Budget Start
2016-03-01
Budget End
2017-02-28
Support Year
2
Fiscal Year
2016
Total Cost
Indirect Cost
Name
Johns Hopkins University
Department
Engineering (All Types)
Type
Biomed Engr/Col Engr/Engr Sta
DUNS #
001910777
City
Baltimore
State
MD
Country
United States
Zip Code
21205
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Fotouhi, Javad; Fuerst, Bernhard; Johnson, Alex et al. (2017) Pose-aware C-arm for automatic re-initialization of interventional 2D/3D image registration. Int J Comput Assist Radiol Surg 12:1221-1230
Gordon, Chad R; Murphy, Ryan J; Armand, Mehran et al. (2016) Discussion on: Usefulness of an Osteotomy Template for Skull Tumorectomy and Simultaneous Skull Reconstruction. J Craniofac Surg 27:1568-70
Murphy, Ryan J; Armiger, Robert S; Lepistö, Jyri et al. (2015) Development of a biomechanical guidance system for periacetabular osteotomy. Int J Comput Assist Radiol Surg 10:497-508