Development of new delivery systems for precise alignment in Total Hip Replacement (THR)

Abstract

Assistive technologies are becoming more common in Total Hip Replacement (THR) procedures, improving surgeons' abilities to achieve target orientations. These systems can be large, absorbing limited space in the operating theatre, and add complexity to surgery. Furthermore, these systems historically do not enable the surgeon to account for functional changes in pelvic position, with target component placements generally being defined from non-functional safe zones. In this thesis, we developed and investigated newer technologies of image registration and augmented reality, incorporating them into delivery systems for THR. Critically, the developed systems utilised information from patient-specific planning to increase their precision and address the gap between planning and delivering patient-specific safe zones. Two systems were developed to different stages of maturity. The first, an image-based navigation system incorporating Augmented Reality was validated in cadaver testing with surgeons, demonstrating its accuracy and usability. The second, is a 2D/3D image registration solution, that matches 3D pre-operative data to intra-operative fluoroscopy which was tested for accuracy in bench tests using representative images. Both systems showed promising accuracy results with mean absolute errors, compared to ground truth, within clinically acceptable limits. Both are viable alternatives for clinical settings, to assist in the delivery of preoperative target component alignments for THR. This body of work describes the development and testing of these systems and details the proposed application and use in THR surgery.