Computer-assisted Navigation in Orthopedic Surgery

Mavrogenis, Andreas F.; Savvidou, Olga D.; Mimidis, George; Papanastasiou, John; Koulalis, Dimitrios; Demertzis, Nikolaos; Papagelopoulos, Panayiotis J.

doi:10.3928/01477447-20130724-10

Cited by 64 publications

(44 citation statements)

References 123 publications

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“…Clinical studies that have compared the surgical duration of conventional and navigation-assisted orthopaedic procedures show increased operating time [3,7,11,18]. The mean time for navigation procedures including bone resection and allograft reconstruction during surgery was 35 minutes in our series.…”

Section: Discussionmentioning

confidence: 80%

“…Although there are potential advantages of computerassisted surgery, in conventional orthopaedic surgery (such as trauma and arthroplasty), the use of this technology is at times associated with technical problems [3,11], increased surgical time of the procedures [7,19], and no clear improvement in clinical outcome regarding conventional surgeries [3,11]. In orthopaedic oncology, this technology is reported to aid in achieving adequate margins [8,20] and improve the accuracy of bone cuts [10,14,21].…”

Section: Introductionmentioning

confidence: 99%

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Does Intraoperative Navigation Assistance Improve Bone Tumor Resection and Allograft Reconstruction Results?

Aponte-Tinao

Ritacco

Ayerza

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Bone tumor resections for limb salvage have become standard treatment. Recently, computer-assisted navigation has been introduced to improve the accuracy of joint arthroplasty and possible tumor resection surgery; however, like with any new technology, its benefits and limitations need to be characterized for surgeons to make informed decisions about whether to use it. Questions/purposes We wanted to (1) assess the technical problems associated with computer-assisted navigation; (2) assess the accuracy of the registration technique; (3) define the time required to perform a navigated resection in orthopedic oncology; and (4) the frequency of complications such as local recurrence, infection, nonunion, fracture, and articular collapse after tumor resection and bone reconstruction with allografts using intraoperative navigation assistance. Methods We analyzed 69 consecutive patients with bone tumors of the extremities that were reconstructed with massive bone allografts using intraoperative navigation assistance with a minimum followup of 12 months (mean, 29 months; range, 12-43 months). All patients had their tumors reconstructed in three-dimensional format in a virtual platform and planning was performed to determine the osteotomy position according to oncology margins in a CT-MRI image fusion. Tumor resections and allograft reconstructions were performed using a computer navigation system according to the previously planned cuts. We analyzed intraoperative data such as technical problems related to the navigation procedure, registration technique error, length of time for the navigation procedure, and postoperative complications such as local recurrence, infection, nonunion, fracture, and articular collapse. Results In three patients (4%), the navigation was not carried out as a result of technical problems. Of the 66 cases in which navigation was performed, the mean registration error was 0.65 mm (range, 0.3-1.2 mm). The mean required time for navigation procedures, including bone resection and allograft reconstruction during surgery, was 35 minutes (range, 18-65 minutes). Complications that required a second surgical procedure were recorded for nine patients including one local recurrence, one infection, two fractures, one articular collapse, and four nonunions. In two of these nine patients, the allograft needed to be removed. At latest followup, three patients died of their original disease. Conclusions The navigation procedure could not be performed for technical reasons in 4% of the series. The mean registration error was 0.65 mm in this series and the navigation procedure itself adds a mean of 35 minutes during

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Section: Discussionmentioning

confidence: 80%

Section: Introductionmentioning

confidence: 99%

Does Intraoperative Navigation Assistance Improve Bone Tumor Resection and Allograft Reconstruction Results?

Aponte-Tinao

Ritacco

Ayerza

et al. 2015

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

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“…This surgical assistance is becoming more frequently used in limb salvage surgery to preserve as much host tissue as possible without compromising tumor margins and may help surgeons perform more accurate resections [11,15,16,18]. However, previous reports about navigation in trauma and arthroplasty have suggested that computer assistance techniques do not improve patient-reported outcomes and that these techniques add surgical time [6,8,13,20]. Intraoperative problems and increased surgical time might be expected with the adoption of new technology, and a learning curve may apply to surgeons who attempt new methods like navigation [1,12,17].…”

Section: Introductionmentioning

confidence: 99%

What Is the Expected Learning Curve in Computer-assisted Navigation for Bone Tumor Resection?

Farfalli

Albergo

Ritacco

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Background Computer navigation during surgery can help oncologic surgeons perform more accurate resections. However, some navigation studies suggest that this tool may result in unique intraoperative problems and increased surgical time. The degree to which these problems might diminish with experience-the learning curve-has not, to our knowledge, been evaluated for navigation-assisted tumor resections. Questions/purposes (1) What intraoperative technical problems were observed during the first 2 years using navigation? (2) What was the mean time for navigation procedures and the time improvement during the learning curve? (3) Have there been any differences in the accuracy of the registration technique that occurred over time? (4) Did navigation achieve the goal of achieving a wide bone margin? Methods All patients who underwent preoperative virtual planning for tumor bone resections and operated on with navigation assistance from 2010 to 2012 were prospectively collected. Two surgeons (GLF, LAA-T) performed the intraoperative navigation assistance. Both surgeons had more than 5 years of experience in orthopaedic oncology with more than 60 oncology cases per year per surgeon. This study includes from the very first patients performed with navigation. Although they did not take any formal training in orthopaedic oncology navigation, both surgeons were trained in navigation for knee prostheses. Between 2010 and 2012, we performed 124 bone tumor resections; of these, 78 (63%) cases were resected using intraoperative navigation assistance. During this period, our general indications for use of navigation included pelvic and sacral tumors and those tumors that were reconstructed with massive bone allografts to obtain precise matching of the host and allograft osteotomies. Seventy-eight patients treated with this technology were included in the study. Technical problems (crashes) and time for the navigation procedure were reported after surgery. Accuracy of the registration technique was defined and the surgical margins of the removed specimen were determined by an experienced bone pathologist after the surgical procedure as intralesional, marginal, or wide margins. To obtain these One of the authors certifies that he (LAA-T) or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount of USD 10,000 to USD 100,000 from Stryker Americas (Miramar, FL, USA 123 Clin Orthop Relat Res (2017) 475:668-675 DOI 10.1007/s11999-016-4761-z Clinical Orthopaedics and Related Research ® A Publication of The Association of Bone and Joint Surgeons® data, we performed a chart review and review of operative notes.Results In four patients (of 78 [5%]), the navigation was not completed as a result of technical problems; all occurred during the first 20 cases of the utilization of this technology. The mean time for navigation procedures during the operation was 31 minutes (range, 11-61 minutes), and the early navigations took more time (the regression analysis shielded R 2 = 0.35 ...

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“…These devices, modified from their initial applications in neurological surgery [20-22], improve accuracy but have several drawbacks. The cumbersome and time-consuming nature of navigation systems can significantly increase surgical time [23, 24] while also increasing the risk of infection [25].…”

Section: Introductionmentioning

confidence: 99%

A Smart Tool for Intraoperative Leg Length Targeting in Total Hip Arthroplasty: A Retrospective Cohort Study

Grosso¹,

Snider²,

Muir³

2016

TOORTHJ

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Background:Leg length discrepancies following total hip arthroplasty (THA) may necessitate subsequent interventions, from heel lifts to revision surgery. Current intraoperative methods of determining leg length are either inaccurate or expensive and invasive.Objective:The objective of the current study was to investigate the ability of a novel, intraoperative smart tool (Intellijoint HIP®, Intellijoint Surgical®, Inc., Waterloo, ON) to provide accurate, real-time leg length measurements during THA.Methods:We retrospectively reviewed the medical records of 25 patients who underwent THA utilizing the Intellijoint HIP smart tool between February and August 2014. Intraoperative leg length data was compared with radiographic leg length calculations. Two observers blinded to the Intellijoint HIP findings independently assessed all post-procedure radiographs.Results:The mean difference between smart tool and radiographic measurements was 1.3 mm [CI: -0.1, 2.7]. 88% (22/25) of intraoperative measurements were within 5 mm of radiographic measurements; 100% (25/25) were within 10 mm. A Bland-Altman analysis showed excellent agreement, with 96% (24/25) of measurements within the statistical limit for acceptable agreement, and 84% (21/25) within the clinically acceptable range (± 5 mm). Removal of the first 13 procedures (surgeon training) decreased the mean difference between methods to 0.6 mm [-0.6, 1.9]. All post-training procedures were associated with a difference of <5 mm. There were no reported adverse events related to the use of the smart tool.Conclusion:The Intellijoint HIP smart tool is a safe and accurate tool for providing intraoperative measurements of leg length in real-time.

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Computer-assisted Navigation in Orthopedic Surgery

Cited by 64 publications

References 123 publications

Does Intraoperative Navigation Assistance Improve Bone Tumor Resection and Allograft Reconstruction Results?

Does Intraoperative Navigation Assistance Improve Bone Tumor Resection and Allograft Reconstruction Results?

What Is the Expected Learning Curve in Computer-assisted Navigation for Bone Tumor Resection?

A Smart Tool for Intraoperative Leg Length Targeting in Total Hip Arthroplasty: A Retrospective Cohort Study

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