Overview of Methods to Quantify Invasiveness of Surgical Approaches in Orthopedic Surgery—A Scoping Review

Abstract

BackgroundThere is a trend toward minimally invasive and more automated procedures in orthopedic surgery. An important aspect in the further development of these techniques is the quantitative assessment of the surgical approach. The aim of this scoping review is to deliver a structured overview on the currently used methods for quantitative analysis of a surgical approaches' invasiveness in orthopedic procedures. The compiled metrics presented in the herein study can serve as the basis for digitization of surgery and advanced computational methods that focus on optimizing surgical procedures.MethodsWe performed a blinded literature search in November 2020. In-vivo and ex-vivo studies that quantitatively assess the invasiveness of the surgical approach were included with a special focus on radiological methods. We excluded studies using exclusively one or multiple of the following parameters: risk of reoperation, risk of dislocation, risk of infection, risk of patient-reported nerve injury, rate of thromboembolic event, function, length of stay, blood loss, pain, operation time.ResultsThe final selection included 51 articles. In the included papers, approaches to 8 different anatomical structures were investigated, the majority of which examined procedures of the hip (57%) and the spine (29%). The different modalities to measure the invasiveness were categorized into three major groups “biological” (23 papers), “radiological” (25), “measured in-situ” (14) and their use “in-vivo” or “ex-vivo” was analyzed. Additionally, we explain the basic principles of each modality and match it to the anatomical structures it has been used on.DiscussionAn ideal metric used to quantify the invasiveness of a surgical approach should be accurate, cost-effective, non-invasive, comprehensive and integratable into the clinical workflow. We find that the radiological methods best meet such criteria. However, radiological metrics can be more prone to confounders such as coexisting pathologies than in-situ measurements but are non-invasive and possible to perform in-vivo. Additionally, radiological metrics require substantial expertise and are not cost-effective. Owed to their high accuracy and low invasiveness, radiological methods are, in our opinion, the best suited for computational applications optimizing surgical procedures. The key to quantify a surgical approach's invasiveness lies in the integration of multiple metrics.

Intraoperative Assessment of Surgical Stress Response Using Nociception Monitor under General Anesthesia and Postoperative Complications: A Narrative Review

“…Intraoperative quantification of surgical severity would thus be valuable for predicting postoperative complications more accurately and for better intraoperative management to suppress postoperative complications. A method of quantitatively assessing surgical invasiveness has also been under development [ 14 ].…”

Current advancements in therapeutic approaches in orthopedic surgery: a review of recent trends

“…The length of time needed and frequency of rehabilitation will depend on the surgery performed and the severity of the condition. Total hip replacement surgery, for instance, requires rehabilitation for at least 6 months (Buis et al, 2022). Most patients who go through orthopedic surgery recover from their injuries completely.…”

The Influence of Osteon Orientation on Surface Topography Parameters after Machining of Cortical Bone Tissue

“…Orthopaedic surgeons frequently employ cortical bone tissue machining, a highly invasive technique [ 1 ]. It is primarily used for hip and knee arthroplasty, limb-fracture surgery, spine arthroplasty, and other joint-replacement procedures [ 2 , 3 ].…”