What is HipInsight System?
The HipInsight System is the first FDA-cleared augmented reality (AR) guidance platform for hip replacement surgery.
Hip replacement, also referred to as total hip replacement or total hip arthroplasty, is a surgical procedure in which the worn-out or damaged parts of the hip joint are removed and replaced with artificial hip components called prostheses or implants made of metal, ceramic, or plastic. It is among the most common and highest total spend on elective surgery in the United States. However, up to 7 percent of patients have 90-day complications after the operation, most commonly joint dislocation that is connected to poor acetabular component positioning. These complications result in patient mortality and morbidity, as well as considerable costs to the health system. As such, surgeons and hospitals value navigation technology, but existing solutions including optical navigation and robotics are expensive, time-consuming, and difficult to learn, leading to limited uptake globally.
HipInsight system’s augmented reality represents a navigation solution that is easy to learn, highly advanced, and accurate, and does not require large and expensive equipment in the operating room. It is the first FDA-cleared surgical guidance platform to be contained completely within a head-mounted device, the industry-leading Microsoft HoloLens 2. Combining cloud-based preoperative planning and virtual interoperative guidance, the platform allows surgeons to be more accurate in the most critical aspects of the surgery, which can increase the possibility of successful results. The HipInsight system also offers a more intuitive and seamless solution compared to complex and costly traditional robotic and navigation systems.
Traditional navigation systems, robotics, and intraoperative imaging provide information on flat screens outside the surgeon's view of the patient, leaving the process awkward and disjointed. The HipInsight system allows surgeons to stay focused on the patient, projecting holograms on AR glasses that effectively give them “x-ray vision” so that surgeons can view what they need to view, when they need to view it, right within the patient's body.
Anatomy of the Hip
The hip joint is one of the body's largest weight-bearing joints and is the point where the thighbone (femur) and pelvis (acetabulum) join. It is a ball-and-socket joint in which the head of the femur forms the ball, and the pelvic acetabulum forms the socket. The joint surface is covered by smooth articular cartilage that cushions and enables frictionless movement of the joint. The bones are held together by bands of tissue called ligaments that provide stability to the joint.
Indications for HipInsight System
HipInsight system is usually indicated for individuals with osteoarthritis of the hip joint that is not responsive to conservative treatment. Osteoarthritis is a degenerative joint disease that causes breakdown and eventual loss of cartilage in the joint, causing a painful rubbing of bone surfaces with movement. Other hip conditions that your surgeon may recommend HipInsight System for hip arthroplasty include severe hip joint fracture or trauma and failed/revision hip replacement.
How Does HipInsight System Work?
HipInsight is an augmented reality solution for navigation of the acetabular component in total hip replacement. It includes preoperative, cloud-based surgical planning based on patient imaging and surgeon preference for implants as well as intraoperative guidance for placement of the acetabular component. Once the patient-specific surgical plan is generated on the cloud-based planning system, holograms showing the optimal planned position of the acetabular component are exported in holographic format to a Microsoft HoloLens 2, which the surgeon wears during the placement of the acetabular component in hip replacement. The pelvis is registered using the HipXpert mechanical registration device, which takes 2 to 3 minutes to dock in the operating room. The surgeon then is able to view the patient's anatomy and optimal positioning of the acetabular component underneath the skin in augmented reality. The surgeon then aligns the real cup impactor with the augmented reality projection of the cup impactor resulting in the precise placement of the cup.
Preparation for HipInsight System
The preoperative preparation is similar to most hip joint replacement procedures. But contrary to traditional techniques, the HipInsight system provides a detailed, Computed Tomography (CT)-based, 3D surgical plan that includes information important for accurate and efficient implant positioning, including planned component size, pelvic tilt, leg length, and offset change to enable the surgeon to design a personalized plan tailored to an individual before performing the surgery.
In addition, preparation for HipInsight system-based total hip replacement may involve the following steps:
- A review of your medical history and a physical examination by your doctor to check for any medical issues that need to be addressed prior to surgery.
- Diagnostic tests such as blood work and imaging to help detect any abnormalities that could compromise the safety of the procedure.
- You will be asked if you have allergies to medications, anesthesia, or latex.
- You should inform your doctor of any medications or supplements that you are taking or any conditions you have such as heart or lung disease.
- You may be asked to avoid medications such as blood thinners or anti-inflammatories for a specific period prior to surgery.
- You should refrain from alcohol or tobacco at least a few days prior to the surgery and several days after as they can hinder the healing process.
- You should not consume solids or liquids at least 8 hours prior to surgery.
- You should arrange for someone to drive you home after surgery.
- A signed informed consent will be obtained from you after the pros and cons of the surgery have been explained.
Procedure for HipInsight System
HipInsight System based augmented reality navigation total hip replacement surgery is performed under general anesthesia with you appropriately positioned on the operating table. A surgical cut is made over the hip to expose the hip joint, and the femur is dislocated from the acetabulum. The surface of the socket is cleaned and the damaged or arthritic bone is removed using a reamer. During the surgery, the HipInsight system uses mixed-reality glasses and the position of a smart registration tool to overlay holograms in real-time on the patient's anatomy so that the surgeon can proceed with the surgical plan in direct view. The system effectively gives the surgeon “x-ray vision” to see anatomy, instruments, and implants inside the patient’s body in real-time. Using this, the surgeon analyzes the patient's unique hip anatomy to precisely resurface and cut the bones of the hip joint and fix the implant accurately according to the HipInsight system’s preoperative surgical plan. Once the surgery is completed, the incision is closed with sutures and covered with a sterile dressing.
Postoperative Care and Recovery
In general, postoperative care and recovery after the HipInsight system’s AR-based hip replacement surgery involves the following:
- You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs.
- Most patients may need to stay in the hospital for a day or two before discharge to home.
- You may experience pain, swelling, and discomfort in the hip area. Pain and anti-inflammatory medications are provided as needed for comfort.
- Antibiotics are also prescribed to address the risk of surgery-related infection.
- You will be placed on assistive devices such as crutches with instructions on restricted weight-bearing for a specified period of time. You are encouraged to walk with assistance as frequently as possible to prevent blood clots.
- Instructions on surgical site care and bathing will be provided to keep the wound clean and dry.
- Refrain from strenuous activities for the first few months and lifting heavy weights for at least 6 months. A gradual increase in activities over a period of time is recommended.
- An individualized physical therapy regimen will be designed to help strengthen hip muscles and optimize hip function once you are off crutches.
- Most patients are able to resume their normal activities in 3 to 4 weeks after surgery; however, a return to sports or high-intensity activities may take 6 months or longer.
- You should refrain from driving until you are fully fit and receive your doctor’s consent.
- A periodic follow-up appointment will be scheduled to monitor your progress.
Risks and Complications
Augmented reality navigation total hip replacement surgery is a relatively safe procedure; however, as with any surgery, there are risks and complications that can occur, such as:
- Hemarthrosis- excess bleeding into the joint after the surgery
- Infection at the incision site or in the joint space
- Postoperative pain
- Damage to surrounding soft tissues
- Adverse reactions to anesthesia
- Blood clots or deep vein thrombosis (DVT)
- Leg-length inequality