Abstract
Total hip replacement in Germany has been performed in 227293 cases in 2015 and tendency is increasing. Although it is a standard intervention, freehand positioning of cup protheses has frequently poor accuracy. Image-based and image-free navigation systems improve the accuracy but most of them provide target positions as alphanumeric values on large-size screens beneath the patient site. In this case the surgeon always has to move his head frequently to change his eye-focus between incision and display to capture the target values. Already published studies using e.g. IPod-based displays or LED ring displays, show the chance for improvement by alternative approaches. Therefore, we propose a novel solution for an instrument-mounted small display in order to visualise intuitive instructions for instrument guidance directly in the viewing area of the surgeon.
For this purpose a solution consisting of a MicroView OLED display with integrated Arduino microcontroller, equipped with a Bluetooth interface as well as a battery has been developed. We have used an optical tracking system and our custom-designed navigation software to track surgical instruments equipped with reference bodies to acquire the input for the mini-display. The first implementation of the display is adapted to total hip replacement and focuses on assistance while reaming the acetabulum. In this case the reamer has to be centred to the middle point of the acetabular rim circle and its rotation axis must be aligned to the acetabular centre axis by Hakki. By means of these references the actual deviations between instrument and target pose are calculated and indicated. The display contains a cross-hair indicator for current position, two bubble level bars for angular deviation and a square in square indicator for depth control. All display parts are furnished with an adaptive variable scale. Highest possible resolution is 0.5 degrees angular, 1 millimeter for position and depth resolution is set to 2 mm.
Compared to existing approaches for instrument-mounted displays, the small display of our solution offers high flexibility to adjust the mounting position such that it is best visible for the surgeon while not constraining instrument handling. Despite the small size, the proposed visualisation symbols provide all information for instrument positioning in an intuitive way.
