Computer-assisted orthopedic surgery

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Computer-assisted orthopedic surgery
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Radiographic imaging is combined with computer technology to reduce a distal femoral fracture by aligning the red and green lines.
Other namesCAOS
Specialty orthopedic

Computer-assisted orthopedic surgery or computer-assisted orthopaedic surgery (sometimes abbreviated as CAOS [1] ) is a discipline where computer technology is applied pre-, intra- and/or post-operatively to improve the outcome of orthopedic surgical procedures. [2] [3] Although records show that it has been implemented since the 1990s, [4] CAOS is still an active research discipline which brings together orthopedic practitioners with traditionally technical disciplines, such as engineering, computer science and robotics.

Contents

Goals and Targeted Outcomes

The principal idea behind CAOS is that operative outcomes will be improved through the use of computer technology. Taking the example of joint replacement, the task of the surgeon is to integrate the new joint components into the patient's existing anatomy; CAOS technologies allow the surgeon to: [2] [4]

Procedural Approaches

CAOS does not substantially deviate from traditional surgical procedures, because the intended goal is to improve the overall operative outcome of the surgery. In image-based procedures, the patient still undergoes similar pre-operative screenings (consultations, scans, etc.). [2] However, CAOS allows the surgeon to also create a "patient jig", [4] which is a 3-D printed model of the skeletal structure of interest that aids the surgeon in the pre-operative planning stage. There are a variety of CAOS procedures depending on the system and navigation preferences. CAOS is initially divided into two categories: [2] an active system, in which the entire procedure can be completed by a robot with little or no help necessary from the surgeon; and a passive system, in which a robot or computerized program aids the surgeon in completing the procedure. Regardless of a passive or active system, CAOS requires a mode of navigation to accurately carry out procedures. There are three methods of navigation used to carry out the surgery. [2] [4]

*The 3-D images are created when the computer interacts with body parts via infrared lights and gate detectors. [4]

With CAOS, the surgeon can more accurately pinpoint anatomical landmarks that might be hard to see in a small incision. A chosen navigation system then guides the surgeon through different bone cuts and finally to implantation.

Shortcomings

Although CAOS has advantages in both the accuracy and precision of the procedure at hand, it is still not widely accepted within the orthopedic community for various reasons. One such reason is the increased medical costs to the patient. [5] [3] Regardless of the navigation preference, the inclusion of computer technology results in increased hospital expenditures, which are then billed to the patient. Since CAOS is still an area of active research, insurance plans are also unlikely to cover the cost of the procedures. [3] Some studies suggest CAOS can be cost-effective for the hospital under the circumstance that a large volume of procedures are conducted on geriatric patients. [5] Other than costs, each of the navigation methods has a shortcoming: CT-based navigation systems increase radiation exposure to the patient; [2] fluoroscopy-based navigation increases the duration of the procedure due to the surgeon pausing to take images for an appropriate template; [2] and imageless navigation relies heavily upon the skill of the surgeon to input accurate values derived from Orthopedic tests. [2]

Current Development Status

There is evidence that implants and procedures undertaken with computer-assisted orthopedic surgery have significantly higher levels of accuracy and precision [6] [7] [8] [9] However, it is not conclusive that CAOS technologies result in a significant long-term improvement in operative outcome, studies suggest that CAOS may lower revision rates. [10] Further, because of the functional adaptability of bone, errors in component placement may become unimportant in the long term. [3] [11] Due to the relatively short time period over which CAOS has developed, long-term follow-up studies have not yet been possible. [11] Whilst the surgeon (or even medical students in laboratory studies [12] [13] ) can achieve better results in terms of planned vs. achieved placement of components, it is not clear whether the plan has been constructed optimally.

Currently, computer-assisted orthopedic surgery is mostly used in knee implant surgery because of the precision the surgeon get with femoral and tibial bone cuts. [3] [4] It is also used to navigate acetabular components placement where correct cup inclination is crucial. [2] [3] [4] Although CAOS is still not widely accepted by many orthopedic surgeons, it is shown to be an incredibly useful tool in facilitating the training of new surgeons due to the creation of images to help visualize anatomical landmarks for procedures. [12] [13] More developments are being made to reduce both costs, and radiation exposure while providing accurate guidance to the surgeon via ultrasound imaging. [14] This navigation method is still currently being tested, and is not readily available for clinical use. [3]

Related Research Articles

<span class="mw-page-title-main">Orthopedic surgery</span> Branch of surgery concerned with the musculoskeletal and bones system

Orthopedic surgery or orthopedics is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors, and congenital disorders.

<span class="mw-page-title-main">Hip replacement</span> Surgery replacing hip joint with prosthetic implant

Hip replacement is a surgical procedure in which the hip joint is replaced by a prosthetic implant, that is, a hip prosthesis. Hip replacement surgery can be performed as a total replacement or a hemi/semi(half) replacement. Such joint replacement orthopaedic surgery is generally conducted to relieve arthritis pain or in some hip fractures. A total hip replacement consists of replacing both the acetabulum and the femoral head while hemiarthroplasty generally only replaces the femoral head. Hip replacement is one of the most common orthopaedic operations, though patient satisfaction varies widely. Approximately 58% of total hip replacements are estimated to last 25 years. The average cost of a total hip replacement in 2012 was $40,364 in the United States, and about $7,700 to $12,000 in most European countries.

Image-guided surgery (IGS) is any surgical procedure where the surgeon uses tracked surgical instruments in conjunction with preoperative or intraoperative images in order to directly or indirectly guide the procedure. Image guided surgery systems use cameras, ultrasonic, electromagnetic or a combination of fields to capture and relay the patient's anatomy and the surgeon's precise movements in relation to the patient, to computer monitors in the operating room or to augmented reality headsets. This is generally performed in real-time though there may be delays of seconds or minutes depending on the modality and application.

<span class="mw-page-title-main">Robot-assisted surgery</span> Surgical procedure

Robot-assisted surgery or robotic surgery are any types of surgical procedures that are performed using robotic systems. Robotically assisted surgery was developed to try to overcome the limitations of pre-existing minimally-invasive surgical procedures and to enhance the capabilities of surgeons performing open surgery.

<span class="mw-page-title-main">Knee replacement</span> Surgical procedure

Knee replacement, also known as knee arthroplasty, is a surgical procedure to replace the weight-bearing surfaces of the knee joint to relieve pain and disability, most commonly offered when joint pain is not diminished by conservative sources. It may also be performed for other knee diseases, such as rheumatoid arthritis. In patients with severe deformity from advanced rheumatoid arthritis, trauma, or long-standing osteoarthritis, the surgery may be more complicated and carry higher risk. Osteoporosis does not typically cause knee pain, deformity, or inflammation, and is not a reason to perform knee replacement.

<span class="mw-page-title-main">Joint replacement</span> Orthopedic surgery to replace a joint

Joint replacement is a procedure of orthopedic surgery known also as arthroplasty, in which an arthritic or dysfunctional joint surface is replaced with an orthopedic prosthesis. Joint replacement is considered as a treatment when severe joint pain or dysfunction is not alleviated by less-invasive therapies. Joint replacement surgery is often indicated from various joint diseases, including osteoarthritis and rheumatoid arthritis.

<span class="mw-page-title-main">Spinal fusion</span> Immobilization or ankylosis of two or more vertebrae by fusion of the vertebral bodies

Spinal fusion, also called spondylodesis or spondylosyndesis, is a surgery performed by orthopaedic surgeons or neurosurgeons that joins two or more vertebrae. This procedure can be performed at any level in the spine and prevents any movement between the fused vertebrae. There are many types of spinal fusion and each technique involves using bone grafting—either from the patient (autograft), donor (allograft), or artificial bone substitutes—to help the bones heal together. Additional hardware is often used to hold the bones in place while the graft fuses the two vertebrae together. The placement of hardware can be guided by fluoroscopy, navigation systems, or robotics.

<span class="mw-page-title-main">Shoulder replacement</span>

Shoulder replacement is a surgical procedure in which all or part of the glenohumeral joint is replaced by a prosthetic implant. Such joint replacement surgery generally is conducted to relieve arthritis pain or fix severe physical joint damage.

Computer-assisted surgery (CAS) represents a surgical concept and set of methods, that use computer technology for surgical planning, and for guiding or performing surgical interventions. CAS is also known as computer-aided surgery, computer-assisted intervention, image-guided surgery, digital surgery and surgical navigation, but these are terms that are more or less synonymous with CAS. CAS has been a leading factor in the development of robotic surgery.

Evan Flatow is an American orthopaedic surgeon-scientist. As of 2023, he is President of Mount Sinai West, part of the Mount Sinai Health System. He published more than 400 book chapters and peer-reviewed articles. Flatow is indicated as principal or co-principal investigator for nine research grants and listed on six patents for influential shoulder implant systems.

"Professor" Derek McMinn is a British orthopaedic surgeon and inventor who practised in Birmingham, United Kingdom at the BMI Edgbaston Hospital until his suspension in 2020. McMinn is currently under police investigation for allegedly keeping the body parts of thousands of patients over a 25-year period.

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<span class="mw-page-title-main">Hybrid operating room</span> Type of surgical theatre

A hybrid operating room is a surgical theatre that is equipped with advanced medical imaging devices such as fixed C-Arms, X-ray computed tomography (CT) scanners or magnetic resonance imaging (MRI) scanners. These imaging devices enable minimally-invasive surgery. Minimally-invasive surgery is intended to be less traumatic for the patient and minimize incisions on the patient and perform surgery procedure through one or several small cuts.

Orthopedic templating is a process wherein surgeons use either acetate templates or digital templates to estimate the correct size of the prosthesis to be used in surgery. The biggest educator on the subject has been AO/ASIF. In a study published in the Injury journal published in 1998, 94% of consultants and 100% of trainees felt that planning was important but half, respectively, routinely planned fracture treatment.

The Mumford procedure, also known as distal clavicle excision or distal clavicle resection, is an orthopedic procedure performed to ameliorate shoulder pain and discomfort by excising the distal (lateral) end of the clavicle. Those suffering from osteoarthritis in the acromioclavicular joint can opt for this procedure when non-surgical alternatives are unsuccessful. The surgery can be performed through an open or arthroscopic procedure. A regimen of physical therapy following surgery is prescribed and most patients experience full recovery within 8 to 10 weeks post-surgery. The procedure was created by, and named for, orthopedic surgeon Eugene Bishop Mumford in 1941.

The following outline is provided as an overview of and topical guide to trauma and orthopaedics:

Augmented reality-assisted surgery (ARAS) is a surgical tool utilizing technology that superimposes a computer-generated image on a surgeon's view of the operative field, thus providing a composite view for the surgeon of the patient with a computer generated overlay enhancing the operative experience. It can be used for training, preparation for an operation, or performance of an operation. ARAS can be performed using a wide array of technology, including an optical head-mounted display (OHMD)—such as the Google Glass XE 22.1 or Vuzix STAR 1200 XL—and a digital overlay from robotic and laparoscopic surgery feeds. The technique has been primarily been tested in the urological and cardiovascular domains.

<span class="mw-page-title-main">Reverse shoulder replacement</span>

Reverse shoulder replacement is a type of shoulder replacement in which the normal ball and socket relationship of glenohumeral joint is reversed, creating a more stable joint with a fixed fulcrum. This form of shoulder replacement is utilized in situations in which conventional shoulder replacement surgery would lead to poor outcomes and high failure rates.

Dr. Javad Parvizi is an American Board Certified Orthopaedic Surgeon and the director of clinical research at the Rothman Orthopaedic Institute, Philadelphia. He holds the James Edwards Professor Chair of Orthopaedics at Thomas Jefferson University. He is the co-founder of the International Consensus Meeting and President of the Musculoskeletal Infection Society (MSIS).

Justin Peter Cobb is a British professor of orthopaedic surgery at Imperial College London, known for introducing medical robotics into orthopaedic surgery. He is a member of the Royal Medical Household and was royal orthopaedic surgeon to the Queen. He is on the staff at King Edward VII's Hospital (KEVII) and is civilian advisor in orthopaedics to the Royal Air Force (RAF). His research has also included themes relating to designing new devices such as for ceramic hip resurfacing, 3D printing in orthopaedics, and training in surgical skills. He is a director of the MSk laboratory based in the Sir Michael Uren Hub.

References

  1. ↑ Nolte Lutz P., Beutler Thomas (2004). "Basic principles of CAOS". Injury. 35: 6–16. doi:10.1016/j.injury.2004.05.005. PMID   15183698.
  2. 1 2 3 4 5 6 7 8 9 10 11 12 Mavrogenis, Andreas F.; Savvidou, Olga D.; Mimidis, George; Papanastasiou, John; Koulalis, Dimitrios; Demertzis, Nikolaos; Papagelopoulos, Panayiotis J. (2013-08-01). "Computer-assisted Navigation in Orthopedic Surgery". Orthopedics. 36 (8): 631–642. doi:10.3928/01477447-20130724-10. ISSN   0147-7447. PMID   23937743. S2CID   15590221.
  3. 1 2 3 4 5 6 7 Joskowicz, Leo; Hazan, Eric J. (2016). "Computer Aided Orthopaedic Surgery: Incremental shift or paradigm change?". Medical Image Analysis. 33: 84–90. doi:10.1016/j.media.2016.06.036. PMID   27407004.
  4. 1 2 3 4 5 6 7 8 9 10 Zheng, Guoyan; Nolte, Lutz P. (2015). "Computer-Assisted Orthopedic Surgery: Current State and Future Perspective". Frontiers in Surgery. 2: 66. doi: 10.3389/fsurg.2015.00066 . ISSN   2296-875X. PMC   4688391 . PMID   26779486.
  5. 1 2 Gøthesen, Øystein; Slover, James; Havelin, Leif; Askildsen, Jan Erik; Malchau, Henrik; Furnes, Ove (2013-07-06). "An economic model to evaluate cost-effectiveness of computer assisted knee replacement surgery in Norway". BMC Musculoskeletal Disorders. 14 (1): 202. doi: 10.1186/1471-2474-14-202 . ISSN   1471-2474. PMC   3722089 . PMID   23829478.
  6. ↑ Sidon, Eli; Steinberg, Ely L. (2012). "Accuracy study of new computer-assisted orthopedic surgery software". European Journal of Radiology. 81 (12): 4029–4034. doi:10.1016/j.ejrad.2012.07.016. PMID   22883531.
  7. ↑ Du, Hailong; Hu, Lei; Li, Changsheng; Wang, Tianmiao; Zhao, Lu; Li, Yang; Mao, Zhi; Liu, Daohong; Zhang, Lining (2015-09-01). "Advancing computer-assisted orthopaedic surgery using a hexapod device for closed diaphyseal fracture reduction". The International Journal of Medical Robotics and Computer Assisted Surgery. 11 (3): 348–359. doi:10.1002/rcs.1614. ISSN   1478-596X. PMID   25242630. S2CID   20076831.
  8. ↑ Stiehl, James B.; Heck, David A. (2015-01-01). "How Precise Is Computer-navigated Gap Assessment in TKA?". Clinical Orthopaedics and Related Research. 473 (1): 115–118. doi:10.1007/s11999-014-3785-5. ISSN   0009-921X. PMC   4390933 . PMID   25034979.
  9. ↑ Dubois-Ferrière, Victor; Gamulin, Axel; Chowdhary, Ashwin; Fasel, Jean; Stern, Richard; Assal, Mathieu (2016). "Syndesmosis reduction by computer-assisted orthopaedic surgery with navigation: Feasibility and accuracy in a cadaveric study". Injury. 47 (12): 2694–2699. doi:10.1016/j.injury.2016.10.009. PMID   27810152.
  10. ↑ Lüring, C.; Kauper, M.; Bäthis, H.; Perlick, L.; Beckmann, J.; Grifka, J.; Tingart, M.; Rath, B. (2012-03-01). "A five to seven year follow-up comparing computer-assisted vs freehand TKR with regard to clinical parameters". International Orthopaedics. 36 (3): 553–558. doi:10.1007/s00264-011-1297-4. ISSN   0341-2695. PMC   3291781 . PMID   21674288.
  11. 1 2 Burnett, R. Stephen J.; Barrack, Robert L. (2013-01-01). "Computer-assisted Total Knee Arthroplasty Is Currently of No Proven Clinical Benefit: A Systematic Review". Clinical Orthopaedics and Related Research. 471 (1): 264–276. doi:10.1007/s11999-012-2528-8. ISSN   0009-921X. PMC   3528921 . PMID   22948522.
  12. 1 2 Cobb, J.P. et al.: Navigation Reduces the Learning Curve in Resurfacing Total Hip Arthroplasty, page 90, Clinical Orthopaedics & Related Research (463)
  13. 1 2 Picard, Frederic; Moholkar, Kirti; Gregori, Alberto; Deep, Kamal; Kinninmonth, Andrew (2014). "(vii) Role of Computer Assisted Surgery (CAS) in Training and Outcomes". Orthopaedics and Trauma. 28 (5): 322–326. doi:10.1016/j.mporth.2014.08.006.
  14. ↑ Billings, Seth; Kang, Hyun Jae; Cheng, Alexis; Boctor, Emad; Kazanzides, Peter; Taylor, Russell (2015-06-01). "Minimally invasive registration for computer-assisted orthopedic surgery: combining tracked ultrasound and bone surface points via the P-IMLOP algorithm". International Journal of Computer Assisted Radiology and Surgery. 10 (6): 761–771. doi:10.1007/s11548-015-1188-z. ISSN   1861-6410. PMID   25895079. S2CID   20127344.
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