Steps in Naviguated Surgery Femur/Acetabulum Acetabulum/Femur - - PowerPoint PPT Presentation

Steps in Naviguated Surgery

Parameters Femur acquisition Navigation femur Acquisition Bassin Navigation Bassin Validation Navigation femur Acquisition Bassin Navigation Bassin Femur/Acetabulum Acetabulum/Femur Lewinnek (Optional)

Parameters: Surgical datas

• 1. Enter in the system :
• Surgeon name
• Patient name
• Right or left side
• 2. Enter in the system :
• Choice of bassin reference
• Implant choice
• Choice of the protocole
• Length to achieve

Parameter: Calibratre stylus

Goal: To know the position of the tip of the stylus on the rigid body. Procedure: Place the tip of the stylus on the RG fixed on the iliac bone in two different position.

Parameters: confident point

Goal: Check if the RGs have moved during surgery. Procedure: Place the tip of the stylus on the base of the RGs.

Parameters: Calibrate the screen

Procedure: Keep the stylus in direction

• f the sceen and validate.

Goal: To allow the system to know the position of the screen from the surgeon.

Lewinnek: acquisitions…

… three points ???

Femoral acquisition: transfert position

2 goals:

• Create the Bassin

reference(if not for Lewinnek).

• Transfer the head center of

the femur in the Bassin. Procedure: Place the leg so to simulate a person standing up,then validate.

Femoral acquisition : head center

Goal: To know the center of the femoral head. This is the target in order to navigate the reamer. Procedure: Take several points on the femoral head surface until the diameter doesn’t change any more and validate.

Femoral acquisition : knee centre

Procedure: Reproduce the epicondyle axis. Acquition of one point centre

• f the patella.

This point is projected on the epicondyle axis and considered as the knee centre.

Femoral acquisition : Ankle centre

Goal: Find the sagital plan of the leg. Procedure: Place the leg in flexion then take a point in the center of the ankle.

Bassin acquisition : Circle of the Acetabulum

Goal: Have a reference de hauteur et de centrage anteroposteriorly. Procedure: Validate one point at the top

• f obturator hole. Validate
• ne point on both anterior

and posterior crest.

Bassin Acquisition : quadrilateral blade

Goal: To have a reference of depth for reaming and impaction. Procedure: Take 10 points on the quadrilateral blade & validate.

Navigation of the femur: the menu

Medullar axis acquisition Navigation of the rasp Navigation of the stem Anatomical Acquisitions

Navigation of the femur: medullar axis

Goal: To know the medullar axis of the femur in order to calculate anatomical anteversion and to estimate the valgus/varus angle of the rasp . Procedure: Descend the medullar rod in the femoral canal and validate.

Femoral navigation : Rasp

Goal: Positionning of the prosthetic head on the anatomical head. Parameters:

• Length
• Medialisation
• Anteversion
• Collar

Femoral navigation: Stem

Goal: Positionning definitive head

• n the trial head.

Parameters

• Length
• Medialisation
• Anteversion
• Collar
• Impingement curves

Bassin navigation : the menu

Reamer navigation Trial cup navigation Definitive navigation cup Anatomical acquisitions

Goal: To ream respecting planified inclination and anteversion angles. Parameters:

• Inclination
• Anteversion
• Depth
• Distance to the obturator hole
• Impingement curves
• Diameter of the head
• Diameter of the reamer

Bassin navigation : the reamer

Bassin navigation: Trial cup

Goal: To Impact the same direction and depth than the reamer.

Bassin navigation : Definitive cup

Goal: To Impact the same direction and depth than the reamer. Length and lateralisation As the rasp was navigated, the system can calculate the definitive length of the limb according to the position of the cup.

Validation

Goal: Detect prosthetic & soft tissues conflicts. Procedure:

• The colour of the prosthetic

head becomes red when happens luxation.

• The circle becomes red

when happens a prosthetic conflict.