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Total Hip Arthroplasty Toolbox AR

Good surgical technique and accurate implantation of the components of total hip arthroplasty (THA) are critical factors  for good performance and longevity of THA. Common complications like decreased range of movements, increased rates of impingement, wear rates, acetabular migration, recurrent dislocations, osteolysis, ‘squeaking,  and early failure rates requiring early revision surgery are attributed mainly to poor operational techniques.

Traditional freehand techniques of managing intra-operative parameters rely on surgeon experience to manually place components accurately. These methods, however, rely heavily on surgeon experience and are subject to inaccuracies associated with subjective 3D visual perception or orientation during surgery. Orthopaedic implant companies offer   positioning guides different kind surgeon try to navigate by taking into account  the position of the frame in relation to the floor and the position of the patient pelvis during operation.  Mechanical methods or devices, have been developed; however, these methods generally address various parameters providing  insufficient data and current methods  are deficient.

Although Computer-assisted navigation systems (CAOS) have been developed and explored in total hip arthroplasty (THA) and in our days is proven that improve the precision and help the Orthopaedic Surgeon during operation, remains expensive and time consuming modality available in a handful of orthopaedic centres worldwide. 

Augmented reality (AR) offers a novel method of blending virtual and real word. Costly scientific labs offer these innovative systems. Apple developed and popularised (AR) Augmented Reality technology and incorporated it in its devices. A powerful new set of commands in IOS  and especially the new Lidar sensor in newly developed devices   has converted Apple devices to miniaturise expensive lads by incorporating cutting edge expensive high end  technology readily available in the hands of every human Being in the planet. The apps take advance of augmented reality (AR)  merged with Computer Assisted Orthopaedic Surgery (CAOS) techniques-  and convert iPhones to portable navigation systems in which the surgeon can augment intra operatively the subjective reality. Also major guidelines extracted and distilled by international literature, converted in knowledge and expertise merged with AR, making  readily available intra operatively during procedure.

       

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The  Applications included in Toolbox are merging Augmented reality with Computer Assisted Orthopaedic Surgery (CAOS) techniques and principles in effort to help an orthopaedic surgeon during operation without  the need of expensive CAOS equipment. The TotalHipArthroplastyToolboxAR toolbox contains :

-a. NaviToolHip App. The app is  a navigation tool in  augmented reality (AR ) for improving intraoperative navigation during cup positioning in total hip arthroplasty. App can accurately help adjust objectively the anteversion and inclination of the cup either during sequently reaming or during final impaction of the cup accordingly

-.b. ScrewCupNaviAR App.The App developed for augmented reality (AR) helping the surgeon during operation to navigate and position of the screw properly in cup. The App increase the accuracy, during trans acetabular screw placement. Helps finding not only the optimal positions of screw-holes on cups  but to allow also and predict  safe screw trajectories courses -insertion depth in mm-  avoiding  bearings that could jeopardise periacetabular neurovascular and musculotendinous structures in real time objectively.

-c. FemurOsteotomyTHR App allows the surgeon to expedite intraoperatively  in augmented Reality (AR )the stage of femur neck resection during hip replacement surgery effortlessly by adjusting  intra operatively the femoral neck resection level according to preoperative measurements thus allowing accurate cutting of femur neck.

-d. CupAnteversionInclinationApp The app offers in a simple  standard AP pelvic radiograph,  an easy way to quantify cup anteversion and inclination a quick and comfortable manner without the use of a goniometer or a ruler or to calculate elaborated formulas.(Widmer’s method) taking into account the pelvic tilt.

-e. AcetabularAnteversionApp The App computes the acetabular anteversion based on a pelvic AP radiograph without  the need of CT. The angle of anteversion is calculated through the formula according to Heftis nomogram. The  acetabular orientation (anteversion/retroversion) is determine 

 important to know before performing  total hip arthroplasty.

Three of  five  above applications take advantage of Augmented reality (AR).  Certain delicate stages during total hip arthroplasty surgery that demand good surgeon’s visual assessment of planes, angle, hand craftsmanship and experience to perform can be further aided  by these augmented reality apps and not by any expensive CAOS system intra operatively. Surgeon can be directed in real time by augmenting his vision reality by monitoring the readings of screen and perform, intra operatively adjustments, simultaneously by manipulating the insertion tool by changing the direction or the insertion depth aiming  at the safest path, the use of apps could provide an additional tool in order to achieve a better implants positioning. The Augmented Reality (AR) aided Navigational Orthopaedic Surgery  (ARANOS) Apps offer a economic Solution  

to Common Orthopaedic procedure without the need to have at your disposal expensive Commercial navigational systems.

      All information received from the software output must be clinically reviewed regarding its plausibility before patient treatment! The Apps indicated for assisting during operation the Operator. Judgment and experience are required to properly use these Apps. The software is not for primary image interpretation. General knowledge of the location of the pertinent neural and vascular structures is given based on acetabular quadrant system , while not  anatomical absolute, should be used with extreme caution by the surgeon during surgery. 

       Any influence the operators in making decisions during operation remains Surgeons own responsibility and experience. A surgeon must always rely on his or her own professional clinical judgement when deciding whether to use a particular technique when treating a particular patient. App does not dispense medical advice. It is recommended that surgeons must be trained in the use before using it in real surgery.

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