The Role of Navigation in Periacetabular Ostetotomy - Where Are We?

Description

The speaker, Ajay Malviya, discusses advancements in navigation techniques for periacetabular osteotomy (PAO) for hip dysplasia in his presentation. He begins by highlighting the significance of the Non-Arthroplasty Hip Registry, celebrating its 10th anniversary and acknowledging its contributions to hip preservation. The complexity of PAO is addressed, particularly the challenges associated with anatomical accuracy and complication rates. Malviya emphasizes the need for precise acetabular orientation during surgery, noting that current methods rely heavily on two-dimensional imaging, which can introduce errors in a three-dimensional procedure. He references a study from a high-volume surgical center regarding the precision of various angles measured during PAO, revealing a margin of error that raises concerns about the surgical outcome.



With advancements in technology in 2022, including robotics, Malviya discusses the potential of navigation systems like the Stryker Nav3i to enhance surgical accuracy. He presents a detailed workflow for implementing navigation in PAO, from surgical planning with CT scans to real-time guidance during osteotomy cuts. The navigation system is described as significantly improving the precision of osteotomy placement and reducing the risk of complications, such as inadvertent nerve damage.



Although he acknowledges the effectiveness of navigation systems, he identifies limitations in the current generation of systems, particularly the inability to accurately orient the acetabular fragment. Malviya suggests utilizing digital techniques, like burr hole digitization and tracking devices on bone structures, as areas for future development. The presentation concludes with an optimistic outlook on the future of navigation in hip surgeries, encouraging continued research and insight into improvements that could lead to more reliable clinical applications.

DOI: 10.1302/3114-230393

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