Providing visual information to validate 2-D to 3-D registration.

This paper addresses a key issue of providing clinicians with visual information to validate the accuracy of 2-D/3-D registration for robot-assisted total hip replacement (THR) surgery. Although numerous registration approaches have been presented, the topic of registration validation has scarcely been addressed in the literature. In practice, clinicians rely on post-operative X-rays to assess the accuracy of implant placement. Motivated by this, we simulate a set of post-operative X-ray images by superimposing the implant positioned pre-operatively onto the intra-operatively collected and calibrated images of the femur, through a transformation computed by the 2-D/3-D registration. With these images, a judgment on the registration accuracy can be made. In addition, this paper introduces methods for superimposing pre-operative data on intra-operative X-ray images that were not corrected for distortion, by applying the same image distortion to the data. This paper also introduces a new framework for incorporating surface normals in the objective function for registration. A comparison between marker-based and image-based registration is conducted. The advantage of our approach is that the simulated post-operative X-ray images are very familiar to clinicians and, therefore, easy for them to interpret. As an added benefit, this technique provides new means for comparing the marker-based and image-based registration for robot-assisted THR surgery. This approach can be extended to other interventions where intra-operative images are used for registration.

Computer-integrated revision total hip replacement surgery: concept and preliminary results.

This paper describes an ongoing project to develop a computer-integrated system to assist surgeons in revision total hip replacement (RTHR) surgery. In RTHR surgery, a failing orthopedic hip implant, typically cemented, is replaced with a new one by removing the old implant, removing the cement and fitting a new implant into an enlarged canal broached in the femur. RTHR surgery is a difficult procedure fraught with technical challenges and a high incidence of complications. The goals of the computer-based system are the significant reduction of cement removal labor and time, the elimination of cortical wall penetration and femur fracture, the improved positioning and fit of the new implant resulting from precise, high-quality canal milling and the reduction of bone sacrificed to fit the new implant. Our starting points are the ROBODOC system for primary hip replacement surgery and the manual RTHR surgical protocol. We first discuss the main difficulties of computer-integrated RTHR surgery and identify key issues and possible solutions. We then describe possible system architectures and protocols for preoperative planning and intraoperative execution. We present a summary of methods and preliminary results in CT image metal artifact removal, interactive cement cut-volume definition and cement machining, anatomy-based registration using fluoroscopic X-ray images and clinical trials using an extended RTHR version of ROBODOC. We conclude with a summary of lessons learned and a discussion of current and future work.