Plan in 2D, execute in 3D: An augmented reality solution for cup placement in total hip arthroplasty

TL;DR

This paper introduces an augmented reality system that uses 2D X-ray images and real-time 3D visualization to improve the accuracy and ease of cup placement in total hip arthroplasty, reducing radiation exposure.

Contribution

It presents a novel intra-operative AR-based planning system combining 2D X-ray images with 3D visualization for precise implant placement in THA.

Findings

Errors in placement as low as 1.98 mm, 1.10 degrees, and 0.53 degrees.

System feasibility demonstrated with four surgeons in a clinical setting.

Potential to reduce radiation and improve surgical reproducibility.

Abstract

Reproducibly achieving proper implant alignment is a critical step in total hip arthroplasty (THA) procedures that has been shown to substantially affect patient outcome. In current practice, correct alignment of the acetabular cup is verified in C-arm X-ray images that are acquired in an anterior-posterior (AP) view. Favorable surgical outcome is, therefore, heavily dependent on the surgeon's experience in understanding the 3D orientation of a hemispheric implant from 2D AP projection images. This work proposes an easy to use intra-operative component planning system based on two C-arm X-ray images that is combined with 3D augmented reality (AR) visualization that simplifies impactor and cup placement according to the planning by providing a real-time RGBD data overlay. We evaluate the feasibility of our system in a user study comprising four orthopedic surgeons at the Johns Hopkins Hospital, and also report errors in translation, anteversion, and abduction as low as 1.98 mm, 1.10 degrees, and 0.53 degrees, respectively. The promising performance of this AR solution shows that deploying this system could eliminate the need for excessive radiation, simplify the intervention, and enable reproducibly accurate placement of acetabular implants.