Hip arthroscopy: the use of computer assistance

Application of three dimensional printing in surgery for cam type of femoro-acetabular impingement

Surgical treatment of femoroacetabular impingement (FAI) focuses on improving the clearance for hip motion and alleviation of femoral abutment against the acetabular rim. Cam type of impingement is managed by performing an osteochondroplasty to remove the excess impinging bone from the head neck junction, thus improving the head neck offset. This procedure can be done by safe surgical dislocation, arthroscopy assisted mini-open method or all arthroscopy technique. Whatever be the approach, adequate excision of the Cam deformity is necessary to avoid suboptimal results. Under-excision leads to persistent symptoms and progression of disease, while over-excision can lead to weak bone vulnerable to fracture or disturb the labral seal. Various techniques utilized for intra-operative evaluation of amount of excision required described in literature are fluoroscopy, spherometer gauges, intra-operative Computed Tomography (CT) scan, navigation etc. Rapid prototyping, also called as three dimensional (3D) printing, is a technology to create dimensionally accurate model from a computer-assisted design. Accurate physical models can be designed from the medical imaging data like CT scans and 3D printed to aid in various medical applications. Its application in orthopaedic field is on a rise, recently. However, there is no report on utilization of this technique in surgeries for FAI. We have reported a case of Cam type FAI in an eighteen year old boy, which we treated surgically by performing osteochondroplasty using safe surgical dislocation. We did CT based virtual surgical planning to design femoral head and neck jigs, which were 3D printed and used intra-operatively to guide for adequate and optimum excision of bone at head neck junction. We found these customized jigs accurate and useful for the surgery. However, a comparison study with various other techniques is warranted for a detailed research on its usefulness and challenges. The main purpose of this article is to elaborate on the technical steps for designing of jigs for 3D printing to guide in osteochondroplasty surgery for FAI.

Hip arthroscopy: a focus on the future

The indications for hip arthroscopy over the last decade have increased rapidly, driven by technical and technological advances aimed at hip joint preservation. This article reviews the current indications and supporting evidence for hip arthroscopy, explores some newer techniques/technologies and discusses the future directions in this rapidly evolving and expanding field.

Open and Arthroscopic Surgical Treatment of Femoroacetabular Impingement

Femoroacetabular impingement (FAI) is a common cause of hip pain, and when indicated, can be successfully managed through open surgery or hip arthroscopy. The goal of this review is to describe the different approaches to the surgical treatment of FAI. We present the indications, surgical technique, rehabilitation, and complications associated with (1) open hip dislocation, (2) reverse periacetabular osteotomy, (3) the direct anterior “mini-open” approach, and (4) arthroscopic surgery for FAI.

Quantitative evaluation of residual bony impingement lesions after arthroscopic treatment for isolated pincer-type femoroacetabular impingement using three-dimensional CT

PURPOSE

The objective of this study is to determine the clinical characteristics of residual bony impingement lesions after arthroscopic treatment for pincer-type femoroacetabular impingement (FAI); and to determine the effects of residual bony impingement lesions on the clinical outcomes after 2 years of follow-up.

METHODS

From December 2010 to January 2012, 42 patients underwent arthroscopic surgery for symptomatic pincer-type FAI. Clinical outcomes were evaluated using the modified Harris Hip Score (mHHS) and satisfaction scores. To quantitatively evaluate the acetabular bony impingement lesions, the acetabular bony impingement angles were measured on three-dimensional CT scans. The incidence and residual rates of residual bony impingement were calculated. According to residual rates, the patients were divided into three groups: group 1, residual rate <10 %; group 2, residual rate 10-20 %; and group 3, residual rate >20 %.

RESULTS

Thirty patients met the inclusion criteria and were enrolled in this study. The mean age was 34.5 years. The mean follow-up was 26.3 months. Nineteen cases had residual bony impingement lesions after surgery. The incidence was 63.3 % (19/30). Sixteen cases (84.2 %) had residual bony impingement lesions posterior to the actual acetabular resection zones. The preoperative and postoperative bony impingement angles were 77.47° ± 21.31° and 12.94° ± 18.04°, respectively. The residual rate was 14.48 %. The overall mHHS significantly improved (P < 0.001) from 55.18 ± 7.96 preoperatively to 94.71 ± 4.39 postoperatively. The overall satisfaction rate was 76.66 %. The postoperative mHHSs of groups 1-3 were 95.86 ± 1.71, 95.23 ± 1.99, and 85.52 ± 6.41, respectively. Group 3 exhibited significantly lower postoperative mHHS compared to the other two groups (P = 0.001). The satisfaction rates in groups 1-3 were 92.86, 80, and 33.33 %, respectively. The satisfaction rate in group 3 was significantly worse than those of the other two groups (P = 0.017). There was a significant inverse linear relationship between the residual rate of bony impingement lesions and the postoperative mHHS (R (2) = 0.516, P < 0.05).

CONCLUSION

The incidence of residual impingement lesions after arthroscopic pincer-type FAI correction was 63.3 %. The residual rate was 14.48 %. The residual impingement lesions were primarily in the posterior portion of the acetabulum. The clinical outcomes were associated with the residual rate of bony impingement lesions. The patients with residual rates >20 % exhibited significantly lower clinical scores and satisfaction rates.

Computer-assisted and robotic surgery in orthopedics: where we are in 2014

Successful outcomes after orthopedic surgical procedures are believed to be highly dependent on reproducible anatomic accuracy. Immediate intraoperative feedback helps surgeons to achieve this accuracy as has been demonstrated with the use of fluoroscopy. Non-image-based computer navigation has been used in joint arthroplasty, anterior cruciate ligament reconstruction, high tibial osteotomy, and cartilage procedures along with applications in hip and shoulder arthroscopy. Most short-term studies have demonstrated superior accuracy when compared with conventional techniques; however, very few studies have shown better clinical outcomes. Robotic-assisted surgery has been most popular in total and unicompartmental arthroplasty, which again has greater accuracy but similar clinical outcomes when compared with conventional techniques. Economic analyses indicate that these high-cost technologies may only be cost-effective in high-volume centers. Other studies have shown that computer navigation improves the accuracy of lower volume surgeons to a greater degree than higher volume surgeons allowing the former to have results similar to the latter.