Advanced Tools for Computer Assisted Orthopaedic Surgery

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Objectives*I propose to develop three complementary and innovative technologies -local-phase-enhanced 3D ultrasound, bracing and small robots, and quantitative analysis of pre- and post-operative kinematics and implant motion - in order to significantly improve the performance, safety and cost-effectiveness of high-impact orthopaedic interventions in joint repair, joint replacement and trauma.*Background*Arthritis and trauma are two of the most prevalent conditions requiring surgery in our society, with millions of procedures expected to be performed annually in North America by 2030 with costs in the tens of billions of dollars. Computer-Assisted Orthopaedic Surgery (CAOS) techniques, along with robotic devices, have been developed to try to optimize surgical results by using advanced imaging and guidance technologies to improve the accuracy and precision of surgical procedures, but there has not yet been strong evidence of benefits in terms of functional improvement, pain reduction or reduced need for revision surgery, so a number of health insurance organizations classify CAOS as still investigational. *Scientific Approach*My overall program seeks to build on three core strengths in our lab to achieve clear gains in reducing use of radiation, quickly and cheaply implementing bone cuts for bone-conserving implants, and accelerating our understanding of the fundamental mechanisms of implant failure. These broad thrusts will serve as the basis for a suite of independently funded translational and commercialization-related follow-on projects. *The three main program areas in this proposal are:*1. Local-Phase-Enhanced 3D Ultrasound: We plan to port our current local-phase processing algorithms to a common platform suitable for use in developing live applications. In the longer term, we will incorporate principles of elastography to make estimating bone surfaces in ultrasound images more reliable.*2. Bracing and Small Robots: We will extend our Dynamic Physical Constraint concept to a 3D prototype robot suitable for cadaveric testing. We will also validate and apply a framework for designing bracing systems (which are intended to be faster to set up than robots, but with better accuracy than conventional techniques) to enhance bone-shaping performance in key selected surgical tasks.*3. Quantitative Analysis of Pre- and Post-Operative Kinematics and Implant Motion: We will lay the foundations for accurate quantitative study of function and early implant failure using a Roentgen Stereophotogrammetric Analysis (RSA) protocol for assessing joint and implant motion using clinically-available imaging equipment. We will then use this technique to conduct pilot studies to assess joint and implant motion in patients experiencing loosening. We will also complete our current Open-MRI-based evaluation of femoroacetabular impingement. *Anticipated Significance*Collectively, the projects proposed here focus on addressing the most significant barriers to widespread acceptance of computer- and robot-assisted techniques by reducing radiation exposure for the surgical team, simplifying and shortening the bone shaping process and improving its accuracy (particularly for the newer bone-conserving implants being used in unicompartmental knee arthroplasties) and providing a faster and more direct process for evaluating claims of improved outcomes for new CAOS procedures. We anticipate that surgeons will benefit from these technologies by being able to quantify key aspects of their surgical performance and using the measured results to improve their practice. Patients will benefit from fewer complications, shorter recovery times and hopefully longer lifespans of their implants, and society will benefit from reduced costs.