Computer-assisted orthopedic surgery (CAOS) has recently evolved as an important technical application that has offered substantial improvements over conventional instrumented methods. The possibility of using computers in total joint replacement surgery is not a recent discovery, as Bargar and Paul introduced the first successful robotic application for total hips in 1987.1 Their system was a development effort with IBM, which had identified a considerable research program to apply robotics to medicine. Perhaps the most significant discovery at the time was to refine digital software algorithms to the level of “pixel accuracy” (20–30 μm). This was required for the machining of custom total hip femoral implants that were implanted at that time. The next years of evolution occurred in Europe, where computer algorithms were advanced to allow intraoperative registration, removing the need for preoperative fiducial placement. DiGioia and Jaramaz developed the first computed tomography (CT) system that could be applied for navigation of the acetabular component.2 Actually, this approach was a step backward because the complex robot was not needed. Imageless total knee applications were an even simpler method because preoperative images were no longer needed.
From a purely scientific point of view, the proof of these systems for increasing surgical precision and presumed benefit has been straightforward. The literature that I will outline clearly indicates the benefit of computer-assisted techniques over conventional instrumentation. Even in imageless total hip applications with lesser accuracy, computer-assisted surgery (CAS) provides a statistical improvement over conventional techniques from most studies. In this chapter, I offer a broad overview of the current state of the art. As with minimally invasive surgery (MIS), there are a group of early advocates who may offer a more enthusiastic viewpoint. As demonstrated, I will describe my current experience and research, which would question some of the claims regarding electromagnetic applications and imageless total hip applications, for example. However, this technology is a moving target, and improvements are being developed as we speak.
Total Knee Arthroplasty Minimally Invasive Surgery Acetabular Component Mechanical Axis Computer Navigation
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in to check access.
Bargar WL, Bauer A, Boerner M. (1998) Primary and revision total hip replacement using ROBODOC. Clin Orthop Relat Res Sep;(354):82–91CrossRefGoogle Scholar
Jaramaz B, DiGioia AM III, Blackwell M, Nikou C. (1998) Computer assisted measurement of cup placement in total hip replacement. Clin Orthop Relat Res Sep;(354):70–81CrossRefGoogle Scholar
Petersen T, Engh G. (1988) Radiographic assessment of knee alignment after total knee arthroplasty. J Arthroplasty 3:67–72CrossRefPubMedGoogle Scholar
Berend M, Ritter M, Meding J, et al. (2004) Tibial component failure mechanisms in total knee arthroplasty. Clin Orthop Relat Res Nov;(428):26–34CrossRefGoogle Scholar
Yau WP, Leung A, Chiu KY, Tang WM, Ng TP. (2005) Intraobserver errors in obtaining visually selected anatomic landmarks during registration process in nonimage based navigation-assisted total knee arthroplasty. J Arthroplasty 20:591–599CrossRefPubMedGoogle Scholar
Bathis H, Perlick L, Tingart M, et al. (2004) Alignment in total knee arthroplasty. J Bone Joint Surg Br 86:682–687CrossRefPubMedGoogle Scholar
Sparmann M, Wolke B, Czupalla H, et al. (2003) Positioning of total knee arthroplasty with and without navigation support. J Bone Joint Surg Br 85:830–835PubMedGoogle Scholar
Bathis H, Perlick L, Tingart M, et al. (2004) Radiological results of image-based and non-image-based computer-assisted total knee arthroplasty. Int Orthop 28:87–90CrossRefPubMedGoogle Scholar
Victor J, Hoste D. (2004) Image-based computer-assisted total knee arthroplasty leads to lower variability in coronal alignment. Clin Orthop Relat Res Nov;(428):131–139CrossRefGoogle Scholar
Lionberger, DR. (2006) The attraction of electromagnetic computer navigation in orthopaedic surgery. In Navigation and Minimally Invasive Surgery, JB Stiehl, A Digioia, W Konermann, R Haaker (eds). Springer, HeidelbergGoogle Scholar
Kalairajah Y, Simpson P, Cossey AJ, Verrall GM, Spriggins AJ. (2005) Blood loss after total knee arthroplasty, effects of computer assisted surgery. J Bone Joint Surg Br 87:1480–1482CrossRefGoogle Scholar
Kalairajah Y, Cossey AJ, Verall GM, Ludbrook G, Spriggins AJ. (2005) Are systemic emboli reduced in computer assisted surgery. J Bone Joint Surg Br 88:198–202Google Scholar
Cobb J, Henckel J, Gomes P, et al. (2006) Hands on robotic unicompartmental knee replacement. J Bone Joint Surg Br 88:188–197Google Scholar
Cossey AJ, Spriggins AJ. (2005) The use of computer-assisted surgical navigation to prevent malalignment in unicompartmental knee arthroplasty. J Arthroplasty 20:29–33CrossRefPubMedGoogle Scholar
Keene G, Simpson D, Kalairag Y. (2006) Limb alignment in computer assisted minimally-invasive unicompartmental knee replacement. J Bone Joint Surg Br 88:44–48CrossRefGoogle Scholar
DiGioia AM, Jaramaz B, Plakseychuk AY, et al. (2002) Comparison of a mechanical acetabular alignment guide with computer placement of the socket. J Arthroplasty 17:359–364CrossRefPubMedGoogle Scholar
Haaker R, Tiedjen K, Ottersbach A, Stiehl JB, Rubenthaler F, Shockheim M. (2007) Comparison of freehand versus computer assisted acetabular cup implantation. J Arthroplasty 22(2): 151–159CrossRefPubMedGoogle Scholar
Kalteis T, Handel M, Bathis H, Perlick L, Tingart M, Grifka J. (2006) Imageless navigation for insertion of the acetabular component in total hip arthroplasty. J Bone Joint Surg Br 88:163–167CrossRefGoogle Scholar
Lewinnek GE, Lewis JL, Tarr R, et al. (1978) Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg Am 60:217–220PubMedGoogle Scholar
Nogler M, Kessler O, Prassl A, et al. (2004) Reduced variability of acetabular cup positioning with use of an imageless navigation system. Clin Orthop Relat Res Sep(426):159–163CrossRefGoogle Scholar
Stiehl JB, Heck DA. (2006) Validation of imageless total hip navigation. In Navigation and Minimally Invasive Surgery in Orthopaedics, JB Stiehl, A Digioia, W Konermann, R Haacker. (eds). Springer, HeidelbergGoogle Scholar
Stiehl JB, Heck DA, Jarmaz B, Amiot L-P. Comparison of fluoroscopic and imageless referencing in navigation of total hip arthroplasty. J Comput Assist Surg in pressGoogle Scholar
Grutzner PA, Zheng G, Langlotz U, et al. (2004) C-arm based navigation in total hip arthroplasty - background and clinical experience. Injury 35(Suppl 1):A90CrossRefGoogle Scholar