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Reproducibly achieving proper implant alignment is a critical step in totalhip arthroplasty (THA) procedures that has been shown to substantially affectpatient outcome. In current practice, correct alignment of the acetabular cupis verified in C-arm X-ray images that are acquired in an anterior-posterior(AP) view. Favorable surgical outcome is, therefore, heavily dependent on thesurgeon's experience in understanding the 3D orientation of a hemisphericimplant from 2D AP projection images. This work proposes an easy to useintra-operative component planning system based on two C-arm X-ray images thatis combined with 3D augmented reality (AR) visualization that simplifiesimpactor and cup placement according to the planning by providing a real-timeRGBD data overlay. We evaluate the feasibility of our system in a user studycomprising four orthopedic surgeons at the Johns Hopkins Hospital, and alsoreport errors in translation, anteversion, and abduction as low as 1.98 mm,1.10 degrees, and 0.53 degrees, respectively. The promising performance of thisAR solution shows that deploying this system could eliminate the need forexcessive radiation, simplify the intervention, and enable reproduciblyaccurate placement of acetabular implants.

Plan in 2D, execute in 3D: An augmented reality solution for cup placement in total hip arthroplasty