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Computer-Guided Total Hip Arthroplasty

  • James B. Stiehl
Chapter

Abstract

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

Keywords

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.

References

  1. 1.
    Knolte LP, Langlotz F. (2003) Basics of computer-assisted orthopaedic surgery (CAOS). In Stiehl JB, Konermann WH, Haaker RG, (eds) Navigations and Robotics in Total Joint and Spinal Surgery, Springer, Berlin Heidelberg New York TokyoGoogle Scholar
  2. 2.
    Bargar WL, Bauer A, Bomer M. (1998) Primary and revision total hip replacement using ROBODOC. Clin Orthop Relat Res Sep;(354):82–91CrossRefGoogle Scholar
  3. 3.
    Bargar WL. (2003) Robotic surgery and current development with the ROBODOC system. In Stiehl JB, Konermann WH, Haaker RG, (eds) Navigations and Robotics in Total Joint and Spinal Surgery, Springer, Berlin Heidelberg New York TokyoGoogle Scholar
  4. 4.
    Weise M, Schmidt K, Willburger RE. (2003) Clinical experience with CT-based Vectorvision system. In Stiehl JB, Konermann WH, Haaker RG, (eds) Navigations and Robotics in Total Joint and Spinal Surgery, Springer, Berlin Heidelberg New York TokyoGoogle Scholar
  5. 5.
    Hagena FW, Kettrukat M, Christ RM, Hackbart M. (2003) Fluoroscopy-based navigation in Genesis II total knee arthroplasty with the Medtronic “Viking” system. In Stiehl JB, Konermann WH, Haaker RG, (eds) Navigations and Robotics in Total Joint and Spinal Surgery, Springer, Berlin Heidelberg New York TokyoGoogle Scholar
  6. 6.
    Giurea A, Zehetgruber H, Funovics P, Grampp S, Karamat L, Gottsauner-Wolf F. (2001) Risk factors for dislocation in cementless hip arthroplasty - a statistical analysis. Z Orthop Ihre Grenzgeb 139:194–199CrossRefPubMedGoogle Scholar
  7. 7.
    Kennedy JG, Rogers WB, Soffe KE, Sullivan RJ, Griffen DG, Sheehan LJ. (1998) Effect of acetabular component orientation on recurrent dislocation, pelvic osteolysis, polyethylene wear and component migration. J Arthroplasty 13:530–534CrossRefPubMedGoogle Scholar
  8. 8.
    Bader RJ, Steinhauser E, Willmann G, Gradinger R. (2001) The effects of implant position, design, and wear on the range of motion after total hip arthroplasty. Hip Int 11:80–90Google Scholar
  9. 9.
    Lewinnek GE, Lewis JL, Tarr R, Compere CL, Zimmermann JR. (1978) Dislocations after total hip replacement arthroplasties. J Bone Joint Surg Am 60:217–221PubMedGoogle Scholar
  10. 10.
    Barrack RL, Lavernia C, Ries M, Thornberry R, Tozakoglou E. (2001) Virtual reality computer animation of the effect of component position and design on stability after total hip arthroplasty. Orthop Clin North Am 32:569–577CrossRefPubMedGoogle Scholar
  11. 11.
    Seki M, Yuasa N, Ohkuni K. (1998) Analysis of optimal range of socket orientations in total hip arthroplasty with use of computer-aided design simulation. J Orthop Res 16:513–517CrossRefPubMedGoogle Scholar
  12. 12.
    McCollum DE, Gray WJ. (1990) Dislocation after total hip replacement. Clin Orthop Relat Res Dec;(261):159–170Google Scholar
  13. 13.
    DiGioia AM, Jamaraz B, Blackwell M, Simon DA, Morgan F, Moody JE, Nikou C, Colgan BD, Aston CA, LaBarca RS, Kischell E, Kanade T. (1998) Image guided navigation system to measure intraoperatively acetabular implant alignment. Clin Orthop Relat Res Oct;(355):8–22Google Scholar
  14. 14.
    Di Gioia AM, Jamaraz B, Nikou C, LaBarca RS, Moody JE, Colgan S. (2000) Surgical navigation for total hip replacement with the use of HipNav. Oper Tech Orthop 10:3–8CrossRefGoogle Scholar
  15. 15.
    Haaker R, Tiedjen K, Ottersbach A, Stiehl JB, Rubenthaler F, Shock-heim M. (2004) Comparison of freehand versus computer assisted acetabular cup implantation. J Bone Joint Surg Br [Submitted]Google Scholar
  16. 16.
    Hofstetter R, Slomczykowski M, Bourquin Y, Nolte LP. (1997) Fluoroscopy based surgical navigation. In Lemke HU, Vannier MW, Inamura K, (eds) Computer Asssited Radiology and Surgery, Elsevier Science B.V., Amsterdam, pp 956–960Google Scholar
  17. 17.
    Hofstetter R, Slomczykowski M, Sati M, Nolte LP. (1999) Fluoroscopy as an imaging means for computer-assisted surgical navigation. Comput Aided Surg 4:65–76CrossRefPubMedGoogle Scholar
  18. 18.
    Hassan DM, Johnston GHF, Dust WNC, Watson G, Dolovich AT. (1998) Accuracy of intraoperative assessment of acetabular prosthesis placement. J Arthroplasty 13:80–84CrossRefPubMedGoogle Scholar
  19. 19.
    Bernsmann K, Langlotz U, Ansari B, Wiese M. (2000) Computer-assistierte navigierte Pfannenplatzierung in der Hüftendoprothetik - Anwenderstudie im klinischen Routinealltag. Z Orthop Ihre Grenzgeb 138:515–521CrossRefPubMedGoogle Scholar
  20. 20.
    Bernsmann K, Langlotz U, Ansari B, Wiese M. (2001) Compu-terassistierte navigierte Platzierung von verschiedenen Pfannentypen in der Hüftendoprothetik - eine randomisierte kontrollierte Studie. Z Orthop Ihre Grenzgeb 139:512–517CrossRefPubMedGoogle Scholar
  21. 21.
    Jarmaz B, DiGioa AM, Blackwell M, Nikou C. (1998) Computer assisted measurement of cup placement in total hip replacement. Clin Orthop Relat Res Sep;(354):70–81CrossRefGoogle Scholar
  22. 22.
    Jolles BM, Genoud P. (2001) Accuracy of computer-assisted placement in total hip arthroplasty. Int Congr Ser 1230:314–318CrossRefGoogle Scholar
  23. 23.
    Leenders T, Vandervelde D, Nahiew G, Nuyts R. (2002) Reduction in variability of acetabular cup abduction using computed assisted surgery: prospective and randomized study. Comput Aided Surg 7:99–106CrossRefPubMedGoogle Scholar
  24. 24.
    Mian SW, Truchly G, Pflum FA. (1992) Computed tomography measurement of acetabular cup anteversion and retroversion in total hip arthroplasty. Clin Orthop Relat Res Mar;(276):206–209Google Scholar
  25. 25.
    Murray DW. (1993) The definition and measurement of acetabular orientation. J Bone Joint Surg Br 75:228–232PubMedGoogle Scholar
  26. 26.
    Ackland MK, Bourne WB, Uhthoff HK. (1986) Anteversion of the acetabular cup. J Bone Joint Surg Br 68:409–413Google Scholar
  27. 27.
    Thoren B, Sahlstedt. (1990) Influence of pelvic position on radiographic measurements of the prosthetic acetabular component. Acta Radiol 31:133–136CrossRefPubMedGoogle Scholar
  28. 28.
    Herrlin K, Pettersson H, Selvik G. (1998) Comparison of two- and three-dimensional methods for assessment of orientation of the total hip prosthesis. Acta Radiol 29:357–361Google Scholar
  29. 29.
    Fontes D, Benoit J, Lortat-Jacob A, Didry R. (1991) Luxation of total hip endoprosthesis. Statistical validation of a modelization of 52 cases. Rev Chir Orthop Reparatrice Appar Mot 77:163–170PubMedGoogle Scholar
  30. 30.
    DiGioa AM, Jaramaz B, Plakseychuk AY, Moody JE, Nikou C, LaBarca RS, Levison TJ, Picard F. (2002) Comparison of a mechanical acetabular alignment guide with computer placement of the socket. J Arthroplasty 17:359–364CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryMedical College of WisconsinMilwaukeeUSA

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