A review of the evolution of robotic-assisted total hip arthroplasty.

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

Registration techniques for computer assisted orthopaedic surgery

The registration of 3D preoperative medical data to patients is a key task in developing computer assisted surgery systems. In computer assisted surgery, the patient in the operation theatre must be aligned with the coordinate system in which the preoperative data has been acquired, so that the planned surgery based on the preoperative data can be carried out under the guidance of the computer assisted surgery system.The aim of this research is to investigate registration algorithms for developing computer assisted bone surgery systems. We start with reference mark registration. New interpretations are given to the development of well knowm algorithms based on singular value decomposition, polar decomposition techniques and the unit quaternion representation of the rotation matrix. In addition, a new algorithm is developed based on the estimate of the rotation axis. For non-land mark registration, we first develop iterative closest line segment and iterative closest triangle patch registrations, similar to the well known iterative closest point registration, when the preoperative data are dense enough. We then move to the situation where the preoperative data are not dense enough. Implicit fitting is considered to interpolate the gaps between the data . A new ellipsoid fitting algorithm and a new constructive implicit fitting strategy are developed. Finally, a region to region matching procedure is proposed based on our novel constructive implicit fitting technique. Experiments demonstrate that the new algorithm is very stable and very efficient

Augmented reality for computer assisted orthopaedic surgery

In recent years, computer-assistance and robotics have established their presence in operating theatres and found success in orthopaedic procedures. Benefits of computer assisted orthopaedic surgery (CAOS) have been thoroughly explored in research, finding improvements in clinical outcomes, through increased control and precision over surgical actions. However, human-computer interaction in CAOS remains an evolving field, through emerging display technologies including augmented reality (AR) – a fused view of the real environment with virtual, computer-generated holograms. Interactions between clinicians and patient-specific data generated during CAOS are limited to basic 2D interactions on touchscreen monitors, potentially creating clutter and cognitive challenges in surgery. Work described in this thesis sought to explore the benefits of AR in CAOS through: an integration between commercially available AR and CAOS systems, creating a novel AR-centric surgical workflow to support various tasks of computer-assisted knee arthroplasty, and three pre–clinical studies exploring the impact of the new AR workflow on both existing and newly proposed quantitative and qualitative performance metrics. Early research focused on cloning the (2D) user-interface of an existing CAOS system onto a virtual AR screen and investigating any resulting impacts on usability and performance. An infrared-based registration system is also presented, describing a protocol for calibrating commercial AR headsets with optical trackers, calculating a spatial transformation between surgical and holographic coordinate frames. The main contribution of this thesis is a novel AR workflow designed to support computer-assisted patellofemoral arthroplasty. The reported workflow provided 3D in-situ holographic guidance for CAOS tasks including patient registration, pre-operative planning, and assisted-cutting. Pre-clinical experimental validation on a commercial system (NAVIO®, Smith & Nephew) for these contributions demonstrates encouraging early-stage results showing successful deployment of AR to CAOS systems, and promising indications that AR can enhance the clinician’s interactions in the future. The thesis concludes with a summary of achievements, corresponding limitations and future research opportunities.Open Acces

Technology applications in shoulder replacement

The advancement of technologies in orthopaedic surgery should provide the surgeon with precise and trustworthy support for pre-operative planning, intra-operative guidance and post-operative follow-up. The request for greater accuracy, predictable results and fewer complications, is the engine of digital evolution in pre-operative planning and computer-assisted surgery (CAS). It is an evolution rather than a revolution, and in the last few years these developments have begun to involve shoulder replacement surgery, too

3D/4D ultrasound registration of bone

This paper presents a method to reduce the invasiveness of Computer Assisted Orthopaedic Surgery (CAOS) using ultrasound. In this goal, we need to develop a method for 3D/4D ultrasound registration. The premilinary results of this study suggest that the development of a robust and ``realtime'' 3D/4D ultrasound registration is feasible

Computer and robotic assisted orthopaedic knee arthroplasty surgery who drives innovations?

Computer assisted and Robotic technology in orthopaedic surgery is still not commonplace compared to un-assisted, conventional orthopaedic surgery. It may be considered somewhat surprising therefore, at a time of incredible technological progress that the computer still struggles nowadays to make its way in all orthopaedic theatres of the world.[1, 2] In June 2016, Dalton et al.[3] reviewed all patents and papers published between 1980 and 2014 related to knee surgery and sorted them into four clusters of innovations, which could be used to link patents and publications: Unicompartmental Knee Arthroplasty (UKA), Patient Specific Instrumentation (PSI), Navigation and Robotics. Three of these are part of the CAOS technology “family”. Since 2004, the ratio between patents and publications increased from approximately 1: 10 in 2004 to almost 1: 3 in 2014 showing industry-driven innovation on technology introduction in the field of knee arthroplasty

Computer Assisted Orthopaedic and Trauma Surgery

To create an environment where surgeons receive real-time feedback about their instrument position, computer technologies were integrated in surgical procedures. This type of surgical technology is referred to as Computer Assisted Surgery (CAS). CAS offers the possibility to continuously monitor the position of surgical instruments in relation to the patients anatomy intraoperatively. Therefore, the position of surgical instruments is superimposed virtually on single shot radiographic images in real time. This feature promises enhanced accuracy and consequently less morbidity combined with a reduction in radiation exposure. The goal of this thesis was to evaluate the hypothesis of high accuracy and reproducibility of CAS in orthopaedic and trauma surgery. In Chapter 3 the accuracy of the fluoroscopy based navigation system (Medivision, Oberdorf, CH.) was evaluated in a laboratory study performed in 20 sawbones of a proximal femur. The virtual position of the reamer appeared to be reliable in 97% of cases when considering an inaccuracy of = 2mm as clinically irrelevant. Chapter 4 describes the results of a cadaver study investigating the reliability and reproducibility of femoral anteversion angles and lengths provided by the navigation system (Medivision, Oberdorf, CH.) during femoral nailing. Length measurements provided by the navigation system showed to be reproducible and accurate enough for clinical use. The rotation measurements, however, were reproducible with a difference of almost six degrees but not accurate enough to prevent malrotation. In chapter 5 virtual planning of an anterior cruciate ligament (ACL) was analysed. Notch impingement and elongation for selected graft positioning could be predicted by displaying the kinematics of a virtual ACL on a monitor. This study indicated that computer assisted planning may reduce the inter-surgical variance to 5 mm for positioning the femoral and tibial tunnels. Moreover, the experience level of the surgeon did not effect the planning process. Chapter 6 describes the feasibility and pitfalls of CAS in the treatment of femoral neck fractures with a DHS in a small patients group. This study showed that fluoroscopy based navigation in the treatment of femoral neck fractures with a DHS is feasible. However, the technique used in this study was too complicated to use in daily practice. In Chapter 7 the results of CAS iliosacral screw fixations were compared with the results of a conventionally operated prospective control group. This study showed that fluoroscopy based CAS is a save and intuitive technique for performing posterior pelvic screw fixation. The fluoroscopy time was decreased with a factor 2.5. The use of the navigation system did not lead to a longer procedure time and may in the future even accelerate the procedure. In summary fluoroscopy based CAS is accurate enough to rely on in experimental and clinical situations. This thesis proved several clinical benefits for CAS when used for navigated guidewire insertion in iliosacral screw fixation compared with the conventional technique. The CAS femoral anteversion control module must be improved before clinical use. Computer-assisted ACL grafting has to be evaluated in a controlled study. However, it is to be expected that CAS will soon evaluate into a clinically accepted and mandatory technique in some fields of orthopaedic and trauma surger

Computer-assisted orthopaedic surgery in horses

Computer-assisted surgery is a new concept used to define a preoperative surgical strategy, or to assist the surgeon during the procedure (Computer-Assisted Medical Interventions). The author describes the use of pQCT (Peripheral Quantitative Computerized Tomography) in computer-assisted orthopedic procedures in 70 horses. In standing horses, a preoperative CT scan can be used to define a surgical strategy or identify the operative site and thus improve the accuracy of the surgical procedure. In recumbent horses (general anesthesia), a CT scan may be performed before the procedure to collect more information on the lesion, or immediately after the procedure to assess the surgical outcome.La chirurgie assistée par l'ordinateur est un nouveau concept chirurgical qui utilise les capacités technologiques de l'ordinateur pour élaborer une stratégie chirurgicale préopératoire, ou pour aider ou guider le geste chirurgical durant l'intervention: on parle de Geste Médico-Chirurgical Assisté par l'Ordinateur (GMCAO). L'auteur décrit l'utilisation d'un pQCT (peripheral quantitative computerized tomography) chez le cheval pour la réalisation d'actes de chirurgie orthopédique, assistés par l'ordinateur, dans 70 cas cliniques. Chez le cheval debout, un examen préopératoire par scanner peut être réalisé dans le but d'élaborer une stratégie chirurgicale et de mettre en place des marqueurs qui permettront d'effectuer, de façon rapide et précise, la chirurgie lorsque le cheval sera anesthésié. Chez le cheval couché anesthésié, nous pouvons réaliser un examen par scanner pour mieux définir une lésion, déjà connue avant l'intervention par d'autres techniques d'imagerie, pour identifier une lésion qui n'a pas été correctement mise en évidence par ces techniques ou pour permettre d'évaluer immédiatement le résultat du geste chirurgical

Fluoroscopic freehand and electromagnetic-guided targeting system for distal locking screws of humeral intramedullary nail

Purpose The current techniques used to lock distal screws for the nailing of long bone fractures expose the surgeons, radiologists and patients to a hearty dose of ionizing radiation. The Sureshot™ Distal Targeting System is a new technique that, with the same results, allows for shorter surgery times and, consequently, less exposure to radiation. Materials and methods The study was performed on 59 patients (34 males and 25 females) with a simple humerus fracture diagnosis, type 1.2.A according to the AO classification, who were divided into two groups. Group 1 was treated with ante-grade intramedullary nailing with distal locking screws inserted with a freehand technique. Group 2 was treated with the intramedullary nail using the Sureshot™ Distal Targeting System. Two intra-operative time parameters were evaluated in both groups: the time needed for the positioning of the distal locking screws and the time of exposure to ionizing radiations during this procedure. Results Group 2 showed a lower average distal locking time compared to group 1 (645.48″ vs. 1023.57″) and also a lower average time of exposure to ionizing radiation than in group 1 (4.35″ vs. 28.96″). Conclusion The Sureshot™ Distal Targeting System has proven to be equally effective when compared to the traditional techniques, with the added benefits of a significant reduction in both surgical time and risk factors related to the exposure to ionizing radiation for all the operating room staff and the patient

Soft tissue structure modelling for use in orthopaedic applications and musculoskeletal biomechanics

We present our methodology for the three-dimensional anatomical and geometrical description of soft tissues, relevant for orthopaedic surgical applications and musculoskeletal biomechanics. The technique involves the segmentation and geometrical description of muscles and neurovascular structures from high-resolution computer tomography scanning for the reconstruction of generic anatomical models. These models can be used for quantitative interpretation of anatomical and biomechanical aspects of different soft tissue structures. This approach should allow the use of these data in other application fields, such as musculoskeletal modelling, simulations for radiation therapy, and databases for use in minimally invasive, navigated and robotic surgery