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Biomechanical Evaluation of Reality-Based Navigation in Total Hip Replacement


Project Description

While total hip replacement is a very successful orthopaedic procedure, there continues to be considerable unwanted surgical variation with regard to restoration of femoral head centre (FHC). Failure to restore FHC can result in dislocation, increased wear, and leg length discrepancy. The most common errors are making the femoral neck cut too high and using a femoral stem of inappropriate offset. This variation can be reduced by using navigation, e.g. physical patient-specific instrumentation (reality-based) and/or intra-operative medical imaging (image-based). Both these options can be expensive, plus intra-operative imaging is difficult to use when the patient is in the typical operating position of lateral decubitus (lying on their side).

Professor David Beverland (Musgrave Park Hospital) has been working on the development of a simplified surgical navigation device, which allows the surgeon to set the femoral neck resection after locating FHC. This design has now been adopted by a leading orthopaedic company who have patented it and are developing it for use in the orthopaedic theatre. One of the critical points is being able to check femoral offset during surgery.

Pre-operative planning and post-operative assessment of FHC restoration are key steps to ensuring that any new device can be evaluated relative to established surgical workflows. To this end, other work by Queen’s University Belfast and Musgrave Park Hospital has investigated the distortion in apparent proximal femoral geometry that occurs as a result of flexion in combination with external rotation of the femur [1]. Such radiographic distortion is a particular barrier to pre-operative surgical planning and post-operative assessment as it affects estimation of FHC. Improving estimates of FHC from radiographic data by accounting for such distortion is therefore an important step towards improving both planning and post-operative analysis of any new surgical interventions aimed at improving FHC restoration.

Aims and Objectives
The overall aim of this project is to develop a biomechanical analysis framework that can assess the potential of reality-based navigation techniques for restoring FHC, using a recently developed navigation device as an exemplar application. Three specific research questions will be used to pursue this aim:
1. Can restoration of FHC, and thus femoral offset, be controlled using the new device?
2. To what extent would the new device be better at restoring FHC than current conventional techniques?
3. What is the biomechanical impact of levels of FHC restoration achieved with the new device compared to conventional radiograph-based planning?

Methodology
Four studies are proposed that aim to:
1. Use a large computed tomography (CT) dataset to establish the likely variation to be expected from current operative planning and the proposed device-based technique to restore FHC. Methods involved will require medical image manipulation and analysis (3D and 2D), and 3D-to-2D projection to simulate radiographs by extending existing tools developed through previous projects.
2. Develop a tool to correct offset measurements for non-neutral femur orientation in AP X-rays using statistical shape modelling techniques in conjunction with methods developed in Study 1.
3. Estimate the deviation between restored and natural FHC in two cohorts of hip replacement patients (radiograph-based vs reality-based planning), using the tools developed in Studies 1 and 2.
4. Establish whether deviation between restored and natural femoral head centre has any measurable impact on either biomechanical or clinical outcomes using musculoskeletal biomechanics simulation.

Collaboration
There will be opportunities to collaborate with the industrial partner (DePuy Synthes, part of the Johnson & Johnson family of companies) and undertake secondments with the clinical supervisor in Musgrave Park Hospital.

Key skills required for the post:
• A minimum degree of 2:1 (or equivalent) in mechanical engineering, biomedical engineering, or another relevant discipline.
• This challenging and interesting project requires computational, scientific, and interdisciplinary communication skills. Applicants should have a keen interest to develop skills in medical image analysis, 3D modelling, and numerical modelling applied to biomechanics.

Key transferable skills that will be developed during the PhD:
Transferable skills that will be developed during the PhD are i) scientific computing, ii) data science, iii) communicating to a multidisciplinary audience, iv) time management, and v) leadership skills.

Funding Notes

Full Award Eligibility:
Be a citizen of Northern Ireland, Great Britain, or the European Union.

Fees are NOT available for international applicants

Funding Notes:
The studentship covers fees (approx. £4,400/year for UK/EU students only) and includes a tax-free income of £15,000 /year. Additionally, PhD students in the School have the opportunity to apply to be demonstrators on undergraduate modules. Compensation for this can amount to in excess of £2,400 per year.

References

1. Effect of combined flexion and external rotation on measurements of the proximal femur from anteroposterior pelvic radiographs. O'Connor JD, Rutherford M, Hill JC, Beverland DE, Dunne NJ, Lennon AB. Orthop Traumatol Surg Res. 2018 Jun;104(4):449-454.

How good is research at Queen’s University Belfast in Aeronautical, Mechanical, Chemical and Manufacturing Engineering?

FTE Category A staff submitted: 49.50

Research output data provided by the Research Excellence Framework (REF)

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