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Developing and verifying an unobtrusive surgical navigation procedure for total shoulder arthroplasty

University of British Columbia

Glenoid implantation accuracy in total shoulder arthroplasty (TSA) has been significantly improved by the use of surgical navigation systems. Despite its benefits, surgical navigation has not been widely implemented into TSA procedures. Based on feedback from orthopaedic surgeons, we believe this lack of adoption is due to the obtrusiveness of the optical trackers that protrude into the surgeon’s workspace. Furthermore, these systems require time to calibrate during surgery and offer limited options for camera placement, which may cause inconvenience intra-operatively. To tackle these challenges, we developed and assessed a new TSA protocol based on a less-intrusive dental navigation system developed by Navigate Surgical Technologies (NST). Our proposed system consists of laser-engraved surgical drills which are calibrated once when manufactured, and do not require calibration in the operating room. Similarly, we present a design for a substantially smaller bone tracker that can be tracked from almost all directions due to its curved pattern design. To assess our system’s performance, we modified the NST software to support guidance of a TSA procedure. We then conducted a user study in which three participants used the system to drill multiple holes in a glenoid model. Using a CMM (coordinate measuring machine), we determined the resulting trajectory of the surgical drill and compared this to the pre-planned trajectory. Since we used a model glenoid rather than anatomical specimens, we were unable to test a realistic registration process, so were limited to reporting precision only and not accuracy. We found that our system’s targeting precision was markedly lower than the end-to-end precision achieved by the main commercially-available TSA navigation system (ExactechGPS) - < 1 degree in standard deviation for both version and inclination in the targeting phase compared with 2.8/4.8 degrees end-to-end for Exactech. Our system’s translational precision in locating the entry hole was sub-millimetric. The primary implication of this work is that a less obtrusive navigation system for TSA is likely feasible, which could potentially improve the uptake rates of surgical navigation for TSA and thereby potentially improve overall surgical outcomes. These findings justify further development of the system and evaluation on cadaveric specimens.

Text

2021-02-12

Attribution-NonCommercial-NoDerivatives 4.0 International

http://hdl.handle.net/2429/77285

Biomedical Engineering

University of British Columbia

UBCV

http://creativecommons.org/licenses/by-nc-nd/4.0/