The Evolution of Computer-Assisted Total Hip Arthroplasty and Relevant Applications

Abstract

In total hip arthroplasty (THA), the accurate positioning of implants is the key to achieve a good clinical outcome. Computer-assisted orthopaedic surgery (CAOS) has been developed for more accurate positioning of implants during the THA. There are passive, semi-active, and active systems in CAOS for THA. Navigation is a passive system that only provides information and guidance to the surgeon. There are 3 types of navigation: imageless navigation, computed tomography (CT)-based navigation, and fluoroscopy-based navigation. In imageless navigation system, a new method of registration without the need to register the anterior pelvic plane was introduced. CT-based navigation can be efficiently used for pelvic plane reference, the functional pelvic plane in supine which adjusts anterior pelvic plane sagittal tilt for targeting the cup orientation. Robot-assisted system can be either active or semi-active. The active robotic system performs the preparation for implant positioning as programmed preoperatively. It has been used for only femoral implant cavity preparation. Recently, program for cup positioning was additionally developed. Alternatively, for ease of surgeon acceptance, semi-active robot systems are developed. It was initially applied only for cup positioning. However, with the development of enhanced femoral workflows, this system can now be used to position both cup and stem. Though there have been substantial advancements in computer-assisted THA, its use can still be controversial at present due to the steep learning curve, intraoperative technical issues, high cost and etc. However, in the future, CAOS will certainly enable the surgeon to operate more accurately and lead to improved outcomes in THA as the technology continues to evolve rapidly.

Common Post Lower Limb Arthroplasty Complications, Management Approaches and How to Minimize the Risks

“…32 However, longer learning curve, increased cost, prolonged operation time with increased risk of complications are their disadvantages. 31,33,34 Besides, there should be a balance between the benefit and disadvantages of new approaches. Additionally, studies so far did not show any significant differences of clinical function, position, and survivorship of the components between conventional approach and computer assisted systems in long-term follow-up over 12 years for knee replacement.…”

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

“…It then recognises the position of these fiducials and places them in context of the patients bony anatomy. 12 Due to the drawbacks, in 1999 ROBODOC introduced surface marking calibration techniques using optical sensors placed in the operating room and probes placed on bony landmarks on the patient known as the DigiMatch Technique. This eliminated the need for the surgical pins.…”

“…It then recognises the position of these fiducials and places them in context of the patients bony anatomy. 12…”

Mixed Reality-Based Simulator for Training on Imageless Navigation Skills in Total Hip Replacement Procedures

“…Finally, the app provides the users an interface of the tools orientation measured on the two anatomic planes calculated from their landmark registration, namely the coronal 1 and sagittal 2 plane. Additionally, a dynamically coloured line is casted from the tip of the reaming tool in the direction D tool , changing its colour according to how close the trainee is to an orientation inside a "safe zone" [4].…”

“…Total hip replacement is one of the most successful and cost-effective surgeries in the orthopaedic field with over 66,000 procedures performed each year in England [3]. Imageless navigation systems (INS) provide an alternative to conventional methods in achieving a more accurate position of the implants [4] [5] minimizing the amount of radiation the patient is exposed to, as well as the risks of leg length discrepancies, dislocation, a higher wear rate and other clinical complications [6].…”