Review: Current concepts in computer-assisted hip arthroscopy

Abstract

In the last 15 years, hip arthroscopy has become increasingly popular in addressing femoroacetabular impingement (FAI) because of its minimally invasive approach. However, assessing the adequacy of bone resection when correcting FAI can be difficult because visualisation and spatial awareness of the joint are poor. Recent advances in technology in the field of computer-assisted surgery and navigation and robotic surgery in orthopaedics as a resource for preoperative planning and intraoperative assistance have been widely reported. This technology is expected to upgrade surgical planning and operative techniques, decrease human error and improve patient outcomes by precisely defining the divergent anatomy and kinematics of the hip joint. This review attempts to bring the reader up-to-date with the current developments in the field of computer assisted hip arthroscopy, and discusses our experience with pre-operative planning, navigation and robotics and also provides a platform for future research in this arena.

Recent advances and future trends in hip arthroscopy

“…Computer-assisted surgery can be broadly thought of as a two-phase process, where there is computer-aided pre-operative assessment and subsequent intraoperative navigation. [39] In the field of HA, this is most applicable to the treatment of FAI. FAI presents in three forms (1) cam, where the head-neck offset is reduced, (2) pincer, where there is acetabular overcoverage, or (3) mixed type with features of both cam and pincer.…”

“…The surgeon can then develop a pre-operative plan for osteochondroplasty specific to this individual to resect only the amount of bone which would have resulted in impingement. [39] Current computer-assisted models have been shown to find higher alpha angles when compared to either XR or CT; these traditional assessment measures do not assess the cam deformity at its maximal extent which tends to be further anterosuperior. [42] Computer-aided assessment also circumvents intrinsic problems with the alpha angle metric.…”

“…[45] To achieve the benefits of pre-operative planning, navigation systems guide the surgeon to precisely reproduce these pre-operative plans intraoperatively. [39] These systems trace the surgical tool and match surgeon-guided movements to the pre-operative plan, thus tracking the intraoperative situation. This is achieved through an encoder linkage system which tracks surgical instruments during HA and was first developed by Monahan and Shimada in 2006.…”

“…[51] While robotic surgery is currently only feasible in a cadaveric model, it is assumed that this system will be amenable to HA due to the similarity of laparoscopic and arthroscopic instruments. [39]…”

History of hip arthroscopy

“…[42] This is likely due to the surgeon's assessment of the lesion using 2D modalities, including the arthroscopic appearance and fluoroscopy. [44] Navigated surgery techniques, however, are able to reduce the rate of arthroscopic underresection. [45] While there is not total agreement in the literature, hip arthroscopy has been adopted by the majority of surgeons over open arthrotomy.…”