Computer-Guided Total Hip Arthroplasty

  • James B. Stiehl


Computed-assisted orthopedic surgery (CAOS) has been recently defined as the ability to use sophisticated computer algorithms to allow the surgeon to determine three-dimensional (3D) placement of total hip implants in situ.1 A rapid ongoing evolution of technical advances has allowed the ability to move from cumbersome systems requiring a preoperative computed tomography (CT) scan of the patient’s hip joint to more elegant systems that use image-free registration or the simple use of fluoroscopy at the time of surgery. In total hip replacement, several reports have cited the accuracy with which implants can be placed using computer-aided robotic devices or surgical navigation.

From a historical perspective, ROBODOC was the first modern attempt to use computers to place implants in bones; in this example, a cementless metal femoral stem in the proximal femoral canal. The goal was to improve the precision of implant placement, and to eliminate errors from a variety of sources including inaccurate plain radiographic templating, morphological anatomical variation, and problems related to the insertion of the implants. The ROBODOC system was conceived in 1986 by Bargar and Paul, and developed over the next several years with grants from IBM. That team developed proprietary software for the CT imaging to obtain an accuracy of one pixel for the raw data, which then allowed them to create CT 3D reconstructions for choosing the implant sizes and planning the robotic surgical intervention. Originally, the fiducial markers for the robotic system were placed during a separate operative procedure and the marker was used to specifically orient the robotic tool into the inner canal of the proximal femur. This changed with the ability to register the unique anatomy of the patient intraoperatively. With improvements in software, the system could be referenced by using a digitizing probe for the key areas of the proximal femur, and small incisions were used about the midshaft of the femur for distal referencing. Currently, referencing may be done using a highly sophisticated combination of local touch point referencing and image overlay. The ROBODOC system is amenable to very small incisions that are limited in length only by the size of the implants.2,3


Acetabular Component Anterior Superior Iliac Spine Computer Navigation Pubic Tubercle Acetabular Anteversion 
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.


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Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryMedical College of WisconsinMilwaukeeUSA

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