1
|
Nees TA, Mueller CT, Innmann MM, Spranz DM, Westhauser F, Renkawitz T, Reiner T, Walker T. Assessment Accuracy of 2D vs. 3D Imaging for Custom-Made Acetabular Implants in Revision Hip Arthroplasty. J Pers Med 2024; 14:808. [PMID: 39202000 PMCID: PMC11355157 DOI: 10.3390/jpm14080808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Revised: 07/26/2024] [Accepted: 07/27/2024] [Indexed: 09/03/2024] Open
Abstract
Revision total hip arthroplasty (rTHA) presents significant challenges, particularly in patients with severe acetabular bone defects. Traditional treatment options often fall short, leading to the emergence of custom-made 3D-printed acetabular implants. Accurate assessment of implant positioning is crucial for ensuring optimal postoperative outcomes and for providing feedback to the surgical team. This single-center, retrospective cohort study evaluates the accuracy of standard 2D radiographs versus 3D CT scans in assessing the positioning of these implants, aiming to determine if 2D imaging could serve as a viable alternative for the postoperative evaluation. We analyzed the implant positions of seven rTHA patients with severe acetabular defects (Paprosky ≥ Type IIIA) using an alignment technique that integrates postoperative 2D radiographs with preoperative CT plans. Two independent investigators, one inexperienced and one experienced, measured the positioning accuracy with both imaging modalities. Measurements included translational shifts from the preoperatively templated implant position in the craniocaudal (CC), lateromedial (LM), and ventrodorsal (VD) directions, as well as rotational differences in anteversion (AV) and inclination (INCL). The study demonstrated that 2D radiographs, when aligned with preoperative CT data, could accurately assess implant positions with precision nearly comparable to that of 3D CT scans. Observed deviations were 1.4 mm and 2.7 mm in CC and LM directions, respectively, and 3.6° in AV and 0.7° in INCL using 2D imaging, all within clinically acceptable ranges. For 3D CT assessments, mean interobserver variability was up to 0.9 mm for translational shifts and 1.4° for rotation, while for 2D alignment, observer differences were 1.4 mm and 3.2° for translation and rotation, respectively. Comparative analysis of mean results from both investigators, across all dimensions (CC, LM, AV, and INCL) for 2D and 3D matching, showed no significant differences. In conclusion, conventional anteroposterior 2D radiographs of the pelvis can sufficiently determine the positioning of custom-made acetabular implants in rTHA. This suggests that 2D radiography is a viable alternative to 3D CT scans, potentially enhancing the implementation and quality control of advanced implant technologies.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Tilman Walker
- Department of Orthopaedics, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany
| |
Collapse
|
2
|
Kim K, Kwon S, Kwon J, Hwang J. A review of robotic-assisted total hip arthroplasty. Biomed Eng Lett 2023; 13:523-535. [PMID: 37872985 PMCID: PMC10590363 DOI: 10.1007/s13534-023-00312-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/02/2023] [Accepted: 08/11/2023] [Indexed: 10/25/2023] Open
Abstract
Total hip arthroplasty (THA) is a successful surgical method for hip replacement but still poses challenges and risks. Robotic-assisted THA (rTHA) using new generation robotic systems has emerged to improve surgical precision and outcomes. The purpose of this paper is to review the literature on rTHA, with a focus on its advantages, such as individualized preoperative planning, intraoperative assistance, and improved accuracy in implantation, especially in complex cases. Additionally, it aims to explore the disadvantages associated with the use of rTHA, including high costs, the learning curve, and prolonged operation time compared to manual THA (mTHA), which are critical drawbacks that require careful consideration and efforts for minimization. Some financial analyses suggest that rTHA may offer cost-effectiveness and reduced postoperative costs compared to mTHA. While technological advancements are expected to reduce technical complications, there are still debates surrounding long-term outcomes. Practical limitations, such as limited availability and accessibility, also warrant attention. Although the development of rTHA shows promise, it is still in its early stages, necessitating critical evaluation and further research to ensure optimal patient benefits.
Collapse
Affiliation(s)
- Kwangkyoun Kim
- Department of Orthopaedic Surgery, Gangnam Sacred Heart Hospital, Hallym University School of Medicine, Seoul, South Korea
- Department of Orthopaedic Surgery, Konyang University School of Medicine, Daejeon, South Korea
| | - Seungcheol Kwon
- Department of Orthopaedic Surgery, Gangnam Sacred Heart Hospital, Hallym University School of Medicine, Seoul, South Korea
- Department of Orthopaedic Surgery, Konyang University School of Medicine, Daejeon, South Korea
| | - Junhyuk Kwon
- Department of Orthopaedic Surgery, Gangnam Sacred Heart Hospital, Hallym University School of Medicine, Seoul, South Korea
- Department of Orthopaedic Surgery, Konyang University School of Medicine, Daejeon, South Korea
| | - Jihyo Hwang
- Department of Orthopaedic Surgery, Gangnam Sacred Heart Hospital, Hallym University School of Medicine, Seoul, South Korea
- Department of Orthopaedic Surgery, Konyang University School of Medicine, Daejeon, South Korea
| |
Collapse
|
3
|
Kort N, Stirling P, Pilot P, Müller JH. Clinical and surgical outcomes of robot-assisted versus conventional total hip arthroplasty: a systematic overview of meta-analyses. EFORT Open Rev 2021; 6:1157-1165. [PMID: 35839094 PMCID: PMC8693228 DOI: 10.1302/2058-5241.6.200121] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Robot-assisted total hip arthroplasty (THA), in comparison to conventional THA, improves radiographic outcomes, but it remains unclear whether it alters complication rates, clinical and functional outcomes, and implant survival. The purpose of this systematic overview was to summarize the findings of the most recent meta-analyses that compare clinical and surgical outcomes of robot-assisted versus conventional THA. Two readers independently conducted an electronic literature search, screening and data extraction from five electronic databases. Inclusion criteria were: meta-analyses evaluating robot-assisted versus conventional THA in terms of radiographic outcomes, clinical and functional scores, and complications and revision rates. The literature search returned 67 records, of which 14 were duplicates and 49 were excluded, leaving three meta-analyses published within the past two years for data extraction and analysis. The present overview of meta-analyses suggests that, compared to conventional THA (n = 3011), robot-assisted THA (n = 1813) improves component placement and reduces intraoperative complications. The overview also affirms that robot-assisted THA could extend surgery by 20 minutes, and increases risks of postoperative heterotopic ossification, dislocation, and revision. None of the meta-analyses found significant differences in clinical or functional scores between robot-assisted and conventional THA. Future studies and reviews should make a clear distinction between active and semi-active robotic assistance, address technology matureness, and describe the experience of surgeons with robotic assistance.
Cite this article: EFORT Open Rev 2021;6:1157-1165. DOI: 10.1302/2058-5241.6.200121
Collapse
|
4
|
Remily EA, Nabet A, Sax OC, Douglas SJ, Pervaiz SS, Delanois RE. Impact of Robotic Assisted Surgery on Outcomes in Total Hip Arthroplasty. Arthroplast Today 2021; 9:46-49. [PMID: 33997208 PMCID: PMC8105177 DOI: 10.1016/j.artd.2021.04.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/24/2021] [Accepted: 04/04/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The introduction of robotic technologies into the field of arthroplasty ushered in promises of increased precision and superior outcomes over conventional methods. However, the effect on outcomes in total hip arthroplasty (THA) remains debatable, particularly when considering the additional financial burden created by the addition of robotics. The purpose of this study is to examine total cost of care, length of stay (LOS), and postoperative complications in robotic-assisted vs conventional THA recipients. MATERIALS AND METHODS A retrospective review of the Mariner database was performed within PearlDiver Technologies for patients undergoing THA from 2010 to 2018 (n = 714,859). Patients with robotic-assisted procedures were matched with patients undergoing conventional THA at a 1:1 ratio based on age, sex, Charlson Comorbidity Index, smoking, and obesity status (n = 4630). LOS, total cost of care, readmission rates, and medical and surgical outcomes were examined. RESULTS Robotic-assisted patients had shorter average LOS (3.4 vs 3.7 days, P = .001). The mean cost for robotic-assisted patients was $1684 and $1759 less at 90 days and 1 year, respectively (both P = .001). Readmission rates were higher for robotic-assisted patients at 1 year (7.8 vs 6.6%; P = .001), while surgical outcomes were not significantly different at all timepoints (all P > .498). Robotic-assisted patients demonstrated significantly higher blood transfusion rates (4.4 vs 3.2%; P = .001). CONCLUSIONS Robotic-assisted THA was associated with minimal decreases in LOS and costs as compared to conventional methods. However, robotics was associated with slightly higher readmissions and blood transfusions.
Collapse
Affiliation(s)
- Ethan A. Remily
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Austin Nabet
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Oliver C. Sax
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Scott J. Douglas
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Sahir S. Pervaiz
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Ronald E. Delanois
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, MD, USA
| |
Collapse
|
5
|
Subramanian P, Wainwright TW, Bahadori S, Middleton RG. A review of the evolution of robotic-assisted total hip arthroplasty. Hip Int 2019; 29:232-238. [PMID: 30963802 DOI: 10.1177/1120700019828286] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Total hip arthroplasty (THA) is currently a very successful operation but continues to evolve as we try to perfect techniques and improve outcomes for our patients. Robotic hip surgery (RHS) began with the 'active' ROBODOC system in the 1980s. There were drawbacks associated with the original ROBODOC and most recently, the MAKO robot was introduced with early promising results. AIM The aim of this paper is to provide an up-to-date review surrounding this area and discuss the pros and cons of this technique. METHODS A literature review searching Medline, Embase, Ovidsp, Cochrane library, pubmed database and google scholar was performed searching keywords including: 'Robotic hip surgery', 'Robotic orthopaedic surgery', 'Computer assisted hip surgery', 'robotic arthroplasty', and 'computer assisted orthopaedic surgery'. CONCLUSION Robotic hip surgery aims to tackle the limitations of the human factor in surgery by promising reproducible and reliable methods of component positioning in arthroplasty surgery. However, as orthopaedic surgeons, we must critically appraise all new technology and support the use providing there is sound robust evidence backing it.
Collapse
Affiliation(s)
| | - Tom W Wainwright
- 2 Trauma and Orthopaedics, Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, UK.,3 Orthopaedic Research Institute Bournemouth University, Bournemouth, UK
| | - Shayan Bahadori
- 3 Orthopaedic Research Institute Bournemouth University, Bournemouth, UK
| | - Robert G Middleton
- 2 Trauma and Orthopaedics, Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, UK.,3 Orthopaedic Research Institute Bournemouth University, Bournemouth, UK
| |
Collapse
|
6
|
Han PF, Chen CL, Zhang ZL, Han YC, Wei L, Li PC, Wei XC. Robotics-assisted versus conventional manual approaches for total hip arthroplasty: A systematic review and meta-analysis of comparative studies. Int J Med Robot 2019; 15:e1990. [PMID: 30746868 PMCID: PMC6594016 DOI: 10.1002/rcs.1990] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 02/02/2019] [Accepted: 02/07/2019] [Indexed: 12/13/2022]
Abstract
Background Several studies have compared robotics‐assisted (RA) and conventional manual (CM) approaches for total hip arthroplasty (THA), but their results are controversial. Methods A literature search was conducted for controlled clinical trials (CCTs) comparing the clinical efficacy of the RA and CM approaches for THA and published between August 1998 and August 2018. The obtained data were analyzed using the statistical software Review Manager 5.3. Results Fourteen articles were included in the meta‐analysis, which revealed that the RA group had less intraoperative complications, better cup angle, and more cases of cup placement in the safe zone than the CM group. However, the operation time required for the CM group was less than that required for the RA group. Moreover, postoperative complications (eg, dislocation and revision surgery) were less frequent in the CM group than in the RA group. However, the two groups had similar functional scores, total number of complications, and rate of occurrence of limb length discrepancy. Conclusion Compared with the CM approach, the RA approach yields better radiological outcomes and fewer intraoperative complications in THA, but similar functional scores.
Collapse
Affiliation(s)
- Peng-Fei Han
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, China
| | - Cheng-Long Chen
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, China
| | - Zhi-Liang Zhang
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, China
| | - Yi-Chen Han
- Department of Upper School, Subsidiary High School of Taiyuan Normal University, Taiyuan, China
| | - Lei Wei
- Department of Orthopaedics, The Alpert Medical School of Brown University, Providence, Rhode Island
| | - Peng-Cui Li
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, China
| | - Xiao-Chun Wei
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, China
| |
Collapse
|
7
|
Fotouhi J, Alexander CP, Unberath M, Taylor G, Lee SC, Fuerst B, Johnson A, Osgood G, Taylor RH, Khanuja H, Armand M, Navab N. Plan in 2-D, execute in 3-D: an augmented reality solution for cup placement in total hip arthroplasty. J Med Imaging (Bellingham) 2018; 5:021205. [PMID: 29322072 DOI: 10.1117/1.jmi.5.2.021205] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 12/12/2017] [Indexed: 01/15/2023] Open
Abstract
Reproducibly achieving proper implant alignment is a critical step in total hip arthroplasty procedures that has been shown to substantially affect patient outcome. In current practice, correct alignment of the acetabular cup is verified in C-arm x-ray images that are acquired in an anterior-posterior (AP) view. Favorable surgical outcome is, therefore, heavily dependent on the surgeon's experience in understanding the 3-D orientation of a hemispheric implant from 2-D AP projection images. This work proposes an easy to use intraoperative component planning system based on two C-arm x-ray images that are combined with 3-D augmented reality (AR) visualization that simplifies impactor and cup placement according to the planning by providing a real-time RGBD data overlay. We evaluate the feasibility of our system in a user study comprising four orthopedic surgeons at the Johns Hopkins Hospital and report errors in translation, anteversion, and abduction as low as 1.98 mm, 1.10 deg, and 0.53 deg, respectively. The promising performance of this AR solution shows that deploying this system could eliminate the need for excessive radiation, simplify the intervention, and enable reproducibly accurate placement of acetabular implants.
Collapse
Affiliation(s)
- Javad Fotouhi
- Johns Hopkins University, Computer Aided Medical Procedures, Baltimore, United States
| | - Clayton P Alexander
- Johns Hopkins Hospital, Department of Orthopaedic Surgery, Baltimore, United States
| | - Mathias Unberath
- Johns Hopkins University, Computer Aided Medical Procedures, Baltimore, United States
| | - Giacomo Taylor
- Johns Hopkins University, Computer Aided Medical Procedures, Baltimore, United States
| | - Sing Chun Lee
- Johns Hopkins University, Computer Aided Medical Procedures, Baltimore, United States
| | - Bernhard Fuerst
- Johns Hopkins University, Computer Aided Medical Procedures, Baltimore, United States
| | - Alex Johnson
- Johns Hopkins Hospital, Department of Orthopaedic Surgery, Baltimore, United States
| | - Greg Osgood
- Johns Hopkins Hospital, Department of Orthopaedic Surgery, Baltimore, United States
| | - Russell H Taylor
- Johns Hopkins University, Laboratory for Computational Sensing and Robotics, Baltimore, United States
| | - Harpal Khanuja
- Johns Hopkins Hospital, Department of Orthopaedic Surgery, Baltimore, United States
| | - Mehran Armand
- Johns Hopkins University, Laboratory for Computational Sensing and Robotics, Baltimore, United States.,Johns Hopkins University, Applied Physics Laboratory, Laurel, Maryland, United States
| | - Nassir Navab
- Johns Hopkins University, Computer Aided Medical Procedures, Baltimore, United States.,Technische Universität München, Computer Aided Medical Procedures, Munich, Germany
| |
Collapse
|
8
|
Banerjee S, Cherian JJ, Elmallah RK, Pierce TP, Jauregui JJ, Mont MA. Robot-assisted total hip arthroplasty. Expert Rev Med Devices 2015; 13:47-56. [PMID: 26592900 DOI: 10.1586/17434440.2016.1124018] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Precise and accurate biomechanical reconstruction during total hip arthroplasty (THA) is essential for durable long-term survivorship. Accurate fit of cementless hip implants is also crucial to reduce micromotion between the bone-implant interfaces to allow for stable osseointegration. Robotic technology aims to minimize potential human errors and improve implant alignment and fit, and address persisting concerns with modern-day cementless THA. Although robotic THA dates back to the early 1990s, concerns with increased operating times, costs, and complications led to its withdrawal. However, semi-active systems have renewed interest in robot-assisted joint arthroplasty. We reviewed the current technology, its potential benefits, and the reported clinical and radiographic outcomes. Early evidence suggests that robotic use may lead to more accurate reconstruction of radiographic parameters, such as implant positioning, fit, center-of-rotation, and leg-length discrepancy. Further research is needed to determine if these will translate into better outcomes and improved implant longevity to justify increased costs.
Collapse
Affiliation(s)
- Samik Banerjee
- a Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement , Sinai Hospital of Baltimore , Baltimore , MD , USA
| | - Jeffery J Cherian
- a Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement , Sinai Hospital of Baltimore , Baltimore , MD , USA
| | - Randa K Elmallah
- a Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement , Sinai Hospital of Baltimore , Baltimore , MD , USA
| | - Todd P Pierce
- a Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement , Sinai Hospital of Baltimore , Baltimore , MD , USA
| | - Julio J Jauregui
- a Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement , Sinai Hospital of Baltimore , Baltimore , MD , USA
| | - Michael A Mont
- a Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement , Sinai Hospital of Baltimore , Baltimore , MD , USA
| |
Collapse
|
9
|
Lim SJ, Ko KR, Park CW, Moon YW, Park YS. Robot-assisted primary cementless total hip arthroplasty with a short femoral stem: a prospective randomized short-term outcome study. ACTA ACUST UNITED AC 2015; 20:41-6. [DOI: 10.3109/10929088.2015.1076044] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
10
|
Sugano N. Computer-assisted orthopaedic surgery and robotic surgery in total hip arthroplasty. Clin Orthop Surg 2013; 5:1-9. [PMID: 23467021 PMCID: PMC3582865 DOI: 10.4055/cios.2013.5.1.1] [Citation(s) in RCA: 114] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2012] [Accepted: 07/23/2012] [Indexed: 11/30/2022] Open
Abstract
Various systems of computer-assisted orthopaedic surgery (CAOS) in total hip arthroplasty (THA) were reviewed. The first clinically applied system was an active robotic system (ROBODOC), which performed femoral implant cavity preparation as programmed preoperatively. Several reports on cementless THA with ROBODOC showed better stem alignment and less variance in limb-length inequality on radiographic evaluation, less incidence of pulmonary embolic events on transesophageal cardioechogram, and less stress shielding on the dual energy X-ray absorptiometry analysis than conventional manual methods. On the other hand, some studies raise issues with active systems, including a steep learning curve, muscle and nerve damage, and technical complications, such as a procedure stop due to a bone motion during cutting, requiring re-registration and registration failure. Semi-active robotic systems, such as Acrobot and Rio, were developed for ease of surgeon acceptance. The drill bit at the tip of the robotic arm is moved by a surgeon's hand, but it does not move outside of a milling path boundary, which is defined according to three-dimensional (3D) image-based preoperative planning. However, there are still few reports on THA with these semi-active systems. Thanks to the advancements in 3D sensor technology, navigation systems were developed. Navigation is a passive system, which does not perform any actions on patients. It only provides information and guidance to the surgeon who still uses conventional tools to perform the surgery. There are three types of navigation: computed tomography (CT)-based navigation, imageless navigation, and fluoro-navigation. CT-based navigation is the most accurate, but the preoperative planning on CT images takes time that increases cost and radiation exposure. Imageless navigation does not use CT images, but its accuracy depends on the technique of landmark pointing, and it does not take into account the individual uniqueness of the anatomy. Fluoroscopic navigation is good for trauma and spine surgeries, but its benefits are limited in the hip and knee reconstruction surgeries. Several studies have shown that the cup alignment with navigation is more precise than that of the conventional mechanical instruments, and that it is useful for optimizing limb length, range of motion, and stability. Recently, patient specific templates, based on CT images, have attracted attention and some early reports on cup placement, and resurfacing showed improved accuracy of the procedures. These various CAOS systems have pros and cons. Nonetheless, CAOS is a useful tool to help surgeons perform accurately what surgeons want to do in order to better achieve their clinical objectives. Thus, it is important that the surgeon fully understands what he or she should be trying to achieve in THA for each patient.
Collapse
Affiliation(s)
- Nobuhiko Sugano
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan.
| |
Collapse
|
11
|
Moustris GP, Hiridis SC, Deliparaschos KM, Konstantinidis KM. Evolution of autonomous and semi-autonomous robotic surgical systems: a review of the literature. Int J Med Robot 2011; 7:375-92. [DOI: 10.1002/rcs.408] [Citation(s) in RCA: 199] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2011] [Indexed: 12/25/2022]
|