30.01.2019 change 30.01.2019

Poland`s first orthopaedic surgery with the use of augmented reality

Photo: Fotolia Photo: Fotolia

Poland`s first implantation of custom-made hip endoprosthesis using augmented reality has been carried out by specialists from the Medical University of Warsaw.

It was also one of the first such procedures in Europe. It was performed by: the head of the Department of Orthopaedics and Traumatology of Locomotor System of the Medical University of Warsaw Prof. Paweł Małdyk, head of Endoprosthetics at the Medical University of Warsaw Dr. Paweł Łęgosz, Marek Gołębiewski, MD, anaesthesiologist Nadia Obuhovskaja and instrumentarian Anna Bystroń.

Dr. Paweł Łęgosz told PAP that hip joint implants were custom-made for the specific patient.

Specialists say that sometimes there is no other option, because in some patients the changes and bone mass defects are too big and it is difficult to fit a standard prosthesis. "We operated on a patient after repeated surgeries, with extensive pelvic destruction, in whom it was impossible to replace the implant with the traditional method" - explained Dr. Łęgosz.

In such situations, 3D printing technique is used to make a prosthesis for a given patient. This is done on the basis of an imaging study, such as computed tomography and magnetic resonance imaging. They show the anatomical situation of the limb in a given patient.

Dr. Paweł Łęgosz is a pioneer in Poland when it comes to using custom-made implants, and Endoprosthetics Division of the Department of Orthopaedics and Traumatology of Locomotor System of the Medical University of Warsaw has become a reference centre for treatment of advanced degenerations and postoperative losses.

Five patients have already had such reconstructive limb surgery at the Department of Orthopaedics and Traumatology of Locomotor System. Four of them underwent hip joint prosthesis implantation and one underwent knee joint, tibia and ankle joint implantation.

All of these patients had preoperative computed tomography and magnetic resonance imaging. A virtual 3D reconstruction was prepared and models of anatomical structures of the patient and current prosthetics were printed.

The new method used in Poland for the first time consisted in performing the implantation of the custom-made hip joint endoprosthesis using augmented reality.

"On the basis of imaging performed with a computer tomograph, the team of engineers from MedApp created a virtual model of the patient`s anatomical structures, the prosthesis, the extent of necessary tissue removal and proper implant placement" - Dr. Łęgosz told PAP.

This visualization was available to surgeons during the procedure thanks to Microsoft HoloLens glasses and software. At any time the surgeon could turn on the virtual models and compare them with the real situation. It was also possible to modify the image, for example by switching off its individual elements, rotating and resizing it.

"This allowed me to follow the virtual image of the limb after the implant removal without taking my eyes off of the operating field, to assess whether the personalized prosthesis can already be implanted" - explained the specialist.

Dr Łęgosz said that thanks to virtual imaging, he could practice the procedure before the actual surgery. The idea was to perform the surgery with high precision.

The specialist intends to use this kind of visualization also for other types of difficult procedures, such as the removal of bone metastases. Augmented reality allows to precisely determine the size of the tumour and its infiltration of neighbouring tissues. (PAP)

Author: Zbigniew Wojtasiński

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