A new method to compare planned and achieved position of an orthopaedic implant

The present study describes an automatic method to evaluate the efficacy of a computer aided orthopaedic surgery system by comparing the position of the joint implant, as derived from post-operative computed tomography (CT) scans, to that planned by the surgeon before the operation. The method relies on two spatial registrations, one to align the post-operative femur with the pre-operative femur, the second to compute the planned versus achieved (PVA) accuracy as the roto-translation that registers the pre-operative implant position with the post-operative position. Two surface registration algorithms (a generic average distance minimisation and the specialised iterative closest point (ICP) method) were comparatively evaluated first on a set of test cases to measure the absolute accuracy and robustness with respect to peculiar situations such as a distant starting point. The average distance method failed the registration of one test case and showed peak errors of 0.97° on the rotations and 3.09 mm on the translations. The ICP method was found much more efficient and was able to register all test cases. The peak error was 0.44° on the rotations and 0.67 mm on the translations. The ICP method was then used to compute the PVA accuracy on six clinical cases treated with a CT-based planning system in combination with conventional surgical procedures. The method successfully processed all cases demonstrating the efficacy of the proposed procedure in the specific application.