Thank you, Al. Next up is Dr. Shea Ngo from Chicago, Rush. Thanks, guys. Okay, so I'll be talking on preoperative planning and intraoperative guidance for bony resection for the treatment of femoral acetabular impingement syndrome. My name is Shea Ngo. I'm at Rush University Medical Center in Chicago. These are my disclosures that can be found on the Academy website. So we all know that the hallmark of femoral acetabular impingement is a mispatch between the shape of the proximal femur and the acetabulum, and this conflict is what creates labral tears, chondrolabral injury, and subsequently pain and loss of function. We also know that residual impingement is the most common reason for failed hip arthroscopy, and while the under a section can lead to recurrent pain and symptoms, we know that there is no way to correct over resection, and our goal should be achieve complete cam resection, and this will decrease contact pressure as well as improve patient function. So currently as it exists today, if we have a situation on our left where we're doing a scope, we've got at our disposal visualization arthroscopically, fluoroscopically, dynamic assessment, but is there any newer tools, software, any programs that we can use to help us create a more spherical cam? And in fact there is. There's intraoperative guidance through a technology called computer vision that's available. We could use that without any preoperative imaging. There's no planning required, and each image is then transferred from the fluoro to the software program that can automatically draw alpha angles kind of real-time. So one of the things that I was curious about is does this actually help in terms of decreasing our learning curve and basically allowing us to do a more perfect cam resection. So this was a cadaveric study that we had done in our lab. This is what it looked like using fluoro and then applying the software. It automatically draws an alpha angle for us. We'll go ahead and do our camera section on these cadaver hips and then use the computer vision software program to then calculate alpha angle. You can see on the left we've got the pre-op and post resection on the right, and you can see how this shows us that we've gotten a good resection. So this was a cadaveric study that we did with 28 hips. We had a novice surgeon that was defined by someone who just recently finished their fellowship compared to me, experienced surgeon, and basically the control was either the fluoro alone or fluoro plus this computer vision interface. And what we found with the experienced surgeon that there was really no difference when using fluoro plus the computer vision interface. But when you look at the novice surgeon, this is where the real power of this was that when you had fluoro alone, they had a range of about 12 degrees in terms of the alpha angle, whereas with computer vision they narrowed it down pretty close to that of an experienced surgeon. So this is a graph showing the learning curve of novice surgeon. Blue is computer vision interface, and you can see the range is pretty tight, hovering around 42 degrees. Again, that three degree difference. But when you look at the fluoroscopic group, you can see that there's a much wider range, and again at the high end you had about a 12 degree difference as far as the alpha angle. This is a case presentation of how we apply this. 18 year old high-level hockey player, two years of hip pain. The patient has plain x-rays, which shows well-preserved joint space, no dysplasia, loss of head neck offset, pretty decent cam deformity. MRI shows a labral tear, preservation of the cartilage, and again kind of reiterating that large cam deformity. So when you see something this large, I have a low threshold of getting a CT scan. CT scan can then be sent out for processing. The image processing can then kind of highlight where the areas of most bony prominence is, and it'll give you this the length, width, depth, height of the cam deformity. But the models also allow you to manipulate the images so that you can correlate what you're seeing arthroscopically with the model at hand. That way you'll get a real good comprehensive look at the entire proximal femur. And this is kind of how it fits in the OR. A is the arthroscopic camera. D is the fluoroscopic screen, and B is that little tablet that kind of fits right inside. So rather than looking left to the scope and right to the fluoro, you can keep all your viewing to the left so that the tablet kind of fits nicely just kind of underneath your arthroscopic screen. So it kind of helps ergonomically. And it's really easy to use. It then synchronizes with your fluoro. You can just mark the center of the femoral head, the center of the femoral neck, and it'll automatically draw a Mohs circle. And then the alpha angle, this will do kind of pre-resection, and we'll do it based on six different positions from 1145 to 245. And not only will it show you the numeric value in terms of what the alpha angle is, but it's color-coded. So if it's yellow or orange, you know that it's a high CAM lesion. And if it's green, you know that there's no evidence of a CAM in that particular location. So this is what it looked like arthroscopically. So step one, what I want to do is I want to mark the proximal extent. I'll do that with a radiofrequency device, and then I'll create a trough, which is about a burr width and a half from that proximal extent. And this will kind of mark my depth of the CAM resection. And then once I've created this trough, then the next step is then to contour the distal neck. So I want to use that trough as the depth, again using that template, and then going down to the neck to kind of create that distal extent, that distal contour. And then finally, we'll kind of finish with the proximal contour so that we can create a nice sphericity. And this will then allow for a nice resection of the CAM. We'll go ahead and do our dynamic assessment and confirm that we have impingement-free motion. Then we'll do our post-resection check. Again, same positions, the same six positions. We'll start extension and inter-rotation to get 1145, and then we'll go all the way to 245, which will be flexion and extra rotation. And then we'll go ahead and have the fluoro take the image, and it'll draw these kind of alpha angles real-time. And then we get a nice display in terms of what the final resection looks like, both from 1145 to 245. Again, you get your numeric values, but then you also get the color coding. So if it's green, you know, you can tell that you've got a nice CAM resection. In addition to that, the tablet will also kind of give you the pre- and the post-comparison. So this is just an example, 1145, pre-resection, we're at 79-degree alpha angle, and it's orange. And then post-resection, we're 46 degrees, and it's green. So this kind of confirms that we're complete. So in summary, CAM correction is difficult to perform. CAM correction is difficult to perfect. We definitely should take advantage of 2D, 3D images, bone models. Those are all available for use. Computer vision integration, I think, is something easy to implement into your OR. It actually takes very minimal time to use. It actually saves you in terms of OR time. It decreases your learning curve. And I think you'll leave the OR confident with your CAM resection every time. Thank you. Applause

femoral acetabular impingement syndrome

computer vision

cam resection

intraoperative guidance

surgery outcomes