Using Computed Tomography-Based Three-dimensional Modeling and Computer Navigation for Minimally Invasive Core Decompression and Adjuvant Orthobiologic Therapy of Femoral Head Avascular Necrosis

Alborz Feizi; Cameron Ellison Bell; Gregory Ronald Roytman; Nancy Park; Annie Wang; Steven Tommasini; Daniel Wiznia

doi:10.1016/j.artd.2024.101337

Using Computed Tomography-Based Three-dimensional Modeling and Computer Navigation for Minimally Invasive Core Decompression and Adjuvant Orthobiologic Therapy of Femoral Head Avascular Necrosis

Arthroplast Today. 2024 Mar 8:26:101337. doi: 10.1016/j.artd.2024.101337. eCollection 2024 Apr.

Authors

Alborz Feizi^{1

2

3}, Cameron Ellison Bell¹, Gregory Ronald Roytman^{1

4}, Nancy Park², Annie Wang⁵, Steven Tommasini^{1

4

6}, Daniel Wiznia^{1

4

6}

Affiliations

¹ Department of Biomedical Engineering, Yale University, New Haven, CT, USA.
² Yale University, School of Medicine, New Haven, CT, USA.
³ Icahn School of Medicine at Mount Sinai, Department of Diagnostic, Molecular and Interventional Radiology, New York, NY, USA.
⁴ Yale School of Medicine, Department of Orthopaedics & Rehabilitation, New Haven, CT, USA.
⁵ Yale School of Medicine, Department of Radiology & Biomedical Imaging, New Haven, CT, USA.
⁶ Department of Mechanical Engineering & Materials Science, Yale University, New Haven, CT, USA.

Abstract

Avascular necrosis of the femoral head is a debilitating condition that can lead to femoral head collapse. Core decompression with adjuvant cellular therapies, such as bone marrow aspirate concentrate, delays disease progression and improves outcomes. However, inconsistent results in the literature may be due to limitations in surgical technique and difficulty in targeting the necrotic lesions. Here, we present a surgical technique utilizing computed tomography-based three-dimensional modeling and instrument tracking to guide the therapy to the center of the lesion. This method minimizes the number of attempts to reach the lesion and confirms the three-dimensional positioning of the instrumentation within the lesion. Our technique may improve the outcomes of core decompression and adjuvant therapy and prevent or delay hip collapse in patients with femoral head avascular necrosis.

Keywords: 3D navigation; Image-guidance; Minimally-invasive; Osteonecrosis.