The Practice of Computer-Assisted Planning and Navigation for Hip Arthroscopy

Despite significant developments in hip arthroscopic surgery in recent years, precise preoperative planning and accurate performance remain challenging. Preoperative planning is particularly important in cases of osteochondroplasty for cam-type femoroacetabular impingement (FAI), and can be aided by several computer-assisted tools, including three-dimensional imaging analysis or kinematic analysis. Initially, the exact point of the bony impingement is identified using simulation analysis; then, virtual osteochondroplasty is performed. Improvements in the range of motion can then be evaluated using computer simulation again. In this way, the required area and depth of bone resection can be assessed preoperatively. In addition, computed tomography-based navigation assistance can be used to complete the osteochondroplasty in accordance with the preoperative planning. After surgery, postoperative evaluation provides valuable feedback to improve future planning and procedures. In this chapter, we describe the practice of computer-assisted planning and navigation for hip arthroscopy

Halicin remains active against Staphylococcus aureus in biofilms grown on orthopaedically relevant substrates

Aims: Biofilm infections are among the most challenging complications in orthopaedics, as bacteria within the biofilms are protected from the host immune system and many antibiotics. Halicin exhibits broad-spectrum activity against many planktonic bacteria, and previous studies have demonstrated that halicin is also effective against Staphylococcus aureus biofilms grown on polystyrene or polypropylene substrates. However, the effectiveness of many antibiotics can be substantially altered depending on which orthopaedically relevant substrates the biofilms grow. This study, therefore, evaluated the activity of halicin against less mature and more mature S. aureus biofilms grown on titanium alloy, cobalt-chrome, ultra-high molecular weight polyethylene (UHMWPE), devitalized muscle, or devitalized bone. Methods: S. aureus-Xen36 biofilms were grown on the various substrates for 24 hours or seven days. Biofilms were incubated with various concentrations of halicin or vancomycin and then allowed to recover without antibiotics. Minimal biofilm eradication concentrations (MBECs) were defined by CFU counting and resazurin reduction assays, and were compared with the planktonic minimal inhibitory concentrations (MICs). Results: Halicin continued to exert significantly (p < 0.01) more antibacterial activity against biofilms grown on all tested orthopaedically relevant substrates than vancomycin, an antibiotic known to be affected by biofilm maturity. For example, halicin MBECs against both less mature and more mature biofilms were ten-fold to 40-fold higher than its MIC. In contrast, vancomycin MBECs against the less mature biofilms were 50-fold to 200-fold higher than its MIC, and 100-fold to 400-fold higher against the more mature biofilms. Conclusion: Halicin is a promising antibiotic that should be tested in animal models of orthopaedic infection. Cite this article: Bone Joint Res 2024;13(3):102–110

Computer-Assisted Hip Arthroscopic Surgery for Femoroacetabular Impingement

Precise osteochondroplasty is key for success in hip arthroscopic surgery, especially for femoroacetabular impingement (FAI) caused by cam or pincer morphology. In this Technical Note, we present computer-assisted hip arthroscopic surgery for FAI, including preoperative planning by virtual osteochondroplasty and intraoperative computer navigation assistance. The important concept of this technique is that navigation assistance for osteochondroplasty is based on planning made by computer simulation analysis. The navigation assistance allows us to perform neither too much nor too little osteochondroplasty. Specifically, computer simulation was used to identify the impingement point. Virtual osteochondroplasty was then performed to determine the maneuvers that would improve range of motion. Thereafter, the planning data were transported to a computed tomography-based computer navigation system that directly provided intraoperative assistance. Thus, computer-assisted technology including preoperative simulation, virtual osteochondroplasty planning, and intraoperative navigation assistance may promote precise hip arthroscopic surgery for FAI