Computer-Assisted Orthopaedic Surgery and Robotic Surgery in Total Hip Arthroplasty

Abstract

Various systems of computer-assisted orthopaedic surgery (CAOS) in total hip arthroplasty (THA) were reviewed. The first clinically applied system was an active robotic system (ROBODOC), which performed femoral implant cavity preparation as programmed preoperatively. Several reports on cementless THA with ROBODOC showed better stem alignment and less variance in limb-length inequality on radiographic evaluation, less incidence of pulmonary embolic events on transesophageal cardioechogram, and less stress shielding on the dual energy X-ray absorptiometry analysis than conventional manual methods. On the other hand, some studies raise issues with active systems, including a steep learning curve, muscle and nerve damage, and technical complications, such as a procedure stop due to a bone motion during cutting, requiring re-registration and registration failure. Semi-active robotic systems, such as Acrobot and Rio, were developed for ease of surgeon acceptance. The drill bit at the tip of the robotic arm is moved by a surgeon's hand, but it does not move outside of a milling path boundary, which is defined according to three-dimensional (3D) image-based preoperative planning. However, there are still few reports on THA with these semi-active systems. Thanks to the advancements in 3D sensor technology, navigation systems were developed. Navigation is a passive system, which does not perform any actions on patients. It only provides information and guidance to the surgeon who still uses conventional tools to perform the surgery. There are three types of navigation: computed tomography (CT)-based navigation, imageless navigation, and fluoro-navigation. CT-based navigation is the most accurate, but the preoperative planning on CT images takes time that increases cost and radiation exposure. Imageless navigation does not use CT images, but its accuracy depends on the technique of landmark pointing, and it does not take into account the individual uniqueness of the anatomy. Fluoroscopic navigation is good for trauma and spine surgeries, but its benefits are limited in the hip and knee reconstruction surgeries. Several studies have shown that the cup alignment with navigation is more precise than that of the conventional mechanical instruments, and that it is useful for optimizing limb length, range of motion, and stability. Recently, patient specific templates, based on CT images, have attracted attention and some early reports on cup placement, and resurfacing showed improved accuracy of the procedures. These various CAOS systems have pros and cons. Nonetheless, CAOS is a useful tool to help surgeons perform accurately what surgeons want to do in order to better achieve their clinical objectives. Thus, it is important that the surgeon fully understands what he or she should be trying to achieve in THA for each patient.

Custom acetabular prosthesis for total hip replacement: A case report in a dog with acetabular bone loss after femoral head and neck ostectomy

“…Sakai et al reported that PSG tend not to maintain an accurate position during cup impaction and may not be clinically useful for cup implantation. In addition, an exact fit of a PSG to the target bone area may require a wider exposure through a larger skin incision and soft tissue dissection for PSG fitting, increasing the risk of neurovascular damage . Furthermore, alignment of the implants can be affected by local soft tissue or bony impedance.…”

“…In addition, an exact fit of a PSG to the target bone area may require a wider exposure through a larger skin incision and soft tissue dissection for PSG fitting, increasing the risk of neurovascular damage. 25 Furthermore, alignment of the implants can be affected by local soft tissue or bony impedance. In this case we did not use PSG, but future studies may determine whether the application of PSG can increase the accuracy of implant alignment in dogs undergoing THR.…”

Computer-Assisted Virtual Autopsy Using Surgical Navigation Techniques

“…Second, navigation software performs the reg- Hardware includes the following: CT scanner (a); retroreflective markers (b), which are shown in Figure 4; surgical pointer with integrated laser (c), which is shown in Figure 3; optical tracker (d); wallmounted screen (e); and foot switch (f). Software consists of tool server (1) and navigation software (2). Tool server application reads camera images and calculates position of retroreflective markers in space.…”

“…They assist surgeons in preoperative planning and in the implementation of interventions in neurosurgery, orthopedic surgery, radiosurgery, and other subspecialties [1][2][3].…”

Effects of coordinate-system construction methods on postoperative computed tomography evaluation of implant orientation after total hip arthroplasty

“…[1][2][3][4][5][6] Therefore, it is recommended that in modern THA with a conventional femoral head size, [7] surgeons use an inclination of [40][41][42][43][44][45] and anteversion based on combined anteversion theory for acetabular cup orientation, and indeed it has recently been reported that precise implantation prevents such complications. [8,9] Although many helpful techniques have been developed to achieve accurate implantation, [8][9][10][11][12][13][14] such as computed tomographybased (CT-based) navigation, imageless navigation, and patient-specific surgical guides, it is also important to assess postoperative implant orientation and the accuracy of these estimation modalities. The CT-based threedimensional (3D) templating method using 3D preoperative planning software is generally recommended for evaluation of postoperative implant orientation from the point of view of reproducibility.…”