Stellenwert der Navigation und Roboterchirurgie bei Knie-Totalendoprothesen

Abstract

Up to now robotics play a minor role in orthopedic surgery because the financing and daily costs of these devices overburden the budgets of normal hospitals. The technical demands are time consuming and pose an additional cost factor. The trauma to the patients in the opinion of some authors is considerable. Nevertheless, robotics play an important role in the further development of orthopedic surgery because improvements in technology will lead to a better operative outcome for the patients. Navigation devices have been developed in the last few years in different centers. From the medical point of view, it is important that navigation systems support surgeons in the analysis of all questions concerning alignment. This pertains not only to rotation analyses of the femur and tibia components but also to analyses of the cinematic gap in flexion and extension. The handling of soft tissues has an important influence on the postoperative function of the knee. It is also a medical issue that the navigation systems should be open, i.e., that different designs of implants could be implanted with one navigation device. There are some systems which offer this quality. Improvements in technology are necessary especially in rotation analyses of the lower limb.

Patients’ perspective on controversial issues in total knee arthroplasty

“…Application of computer assisted navigation technology to TKA has been reported to increase the surgical accuracy in terms of alignment and soft tissue balancing, which play a critical role in the function and longevity of TKA [21,22]. However, the question that the improved surgical accuracy will lead to clinically significant differences remains to be answered and controversy continues as this new technology involves additional surgical time, cost, the need of a new learning period, and new problems unique to the technology [23][24][25]. Although the application of CAS is one of the most controversial issues in the current field of TKA, the patients themselves of this study were not informed sufficiently enough to make a decision between the new and standard options.…”

Kniegelenksendoprothetik

“…Mit präoperativen Modellnavigationen unter Verwendung von geometrischen Daten und Operationssimulatoren kann der Operateur einen optimalen patientenspezifischen Plan zur Positionierung des Implantates erstellen. Eine Berücksich-tigung der daraus resultierenden Kinematik ist nicht möglich [30]. Um den Bezug der präoperativen CTAufnahmen zur Patientenanatomie wäh-rend der Operation herzustellen, wird intraoperativ ein so genanntes "surface matching" durchgeführt.…”

Das Projekt orthoMIT

“…Das Hauptanliegen des Projektes ist die Entwicklung einer integrierten Plattform für die schonende operative Therapie von Knochen-und Gelenkerkrankungen in der Orthopädie und Traumatologie mit Modulen für die Hüft-, Knie-und Wirbelsäulenchirurgie, die eine jeweils an die individuelle Situation und den Bedarf angepasste therapeutische Vorgehensweise ermöglicht, sowie der Nachweis ihrer klinischen Gebrauchstauglichkeit und Kosteneffizienz. 24 [6,7,8,9,10,11,12,13,14]. Die Entwicklung neuer Implantate und Implantatmaterialien [15,16,17,18,19,20], endoskopischer Verfahren [8,9] sowie computerunterstützter chirurgischer Techniken einschließlich Bildgebung, Bildverarbeitung, Registrierung, Planung und Navigation [8,9,10,11,12,13,14,17] sind ausschlaggebend für den Fortschritt in der modernen minimal-invasiven orthopädischen Chirurgie.…”