Intraoperative, fluoroscopy-based planning for complex osteotomies of the proximal femur.

ABSTRACT

Intertrochanteric osteotomy of the proximal femur is a surgical technique that aims at changing the orientation of the proximal part of the femur in the hip joint by removing a bone wedge between the trochanters. Due to its six degrees of freedom, it presents a complex planning problem for the surgeon. In this paper, we propose an intraoperative planning system for proximal femur osteotomies. Based on two fluoroscopic images taken during the procedure, a primitive femur model is reconstructed, which then allows the user to interactively determine the osteotomy parameters and perform the intervention with the help of a navigation system. Besides the fluoroscopic images, no other imaging is needed. Compared to the traditional approach, this system allows the intervention to be performed with higher precision and less radiation exposure for both patient and surgeon, requiring only little time overhead. An in vitro study has demonstrated the high accuracy and ease of use of this system.