This is a relatively new technique that uses computer modeling to help facilitate accuracy in joint replacement surgery.
Alignment in total knee replacement is critical to the function and long term durability of total knee replacement. Traditional techniques have relied on a combination of surgical "eyeballing" and indirect methods to guide the cuts in the bone which determine the position/alignment of the prosthesis.
Computer navigation reduces the number of prosthesis that is inserted in less than ideal alignment. Mal alignment can result in an "unbalanced" knee, or early wear of the prosthesis.
The technique is simple, adds little time to the procedure and has other benefits in that it facilitates less invasive surgery and eliminates the need for intramedullary guides, the insertion of which cause an embolic shower of fat and marrow upon the cardiovascular system.
Whilst the vast majority of knee replacements performed using conventional techniques perform very well. It is hoped that this technology will reduce the small number that may perform poorly because of mal alignment.
Computer-assisted surgery allows surgeons to align the patient's joint replacement with a degree of accuracy not possible with the naked eye. This technology can be used with both hip replacements and knee replacements. Using an infrared camera and sensors on the instruments, the computer gives real-time feedback to the surgeon. The computer tells the surgeon how much bone is being cut to the millimeter and what angle the bone is being cut to a fraction of a degree.
The prosthesis is made of two main parts : -
- Acetabular component (socket) : - The acetabular component is made of a metal shell with a plastic inner liner that provides the bearing surface. The plastic used is so tough and slick.
- Femoral component (stem and ball) : - The femoral component replaces the femoral head. The femoral component is made of metal. Sometimes, the metal stem is attached to a ceramic ball.
HIP Navigation provide surgeons the data they need for cup and stem positioning, leg length determination, correct femoral offset and real time intra-operative assessment of stability and range of motion. It helps the surgeon align and orient the hip implant with more precision than ever before. The surgeon is able to view an interactive display of the lines, angles, and measurements needed to position your hip implant. This combination of computers with wireless cameras and infrared technology is significantly improving medical technology for orthopaedic surgery.
How does computer navigation work ?
- In the operating room infrared optics and tracking software continually monitor the position and mechanical alignment of the joint replacement components relative to your specific anatomy.
- Minimally invasive smart wireless instruments send data about to the joint movements (kinematics) to a computer.
- The computer analyzes and displays the kinematic data on the screen in the form of charts and graphs.
- These images provide your surgeon with the angles, lines, and measurement needed to best align your hip or knee implant.
What are the potential benefits ?
- It allows your surgeon to make adjustments to within a fraction of a degree, helping to ensure optimal "fit" for your joint.
- It provides your surgeon with a comprehensive view of your joint mechanics.
- It helps your surgeon correctly position your joint in situations where it is otherwise difficult to get a good view of your anatomy.
- It may lead to improved stability for your joint and optimal range of motion for you.
Computer Navigation in Hip Replacement Surgery in India
Some of the latest technology in joint replacement includes not only implant material advances, but also advances in how we place the components during the reconstructive surgery. There are different surgical approaches in hip and knee replacement that can make significant differences in early and late outcomes. Another technology that is attempting to improve early and late outcomes by making implant placement more accurate is computer aided surgery or CAS.
Currently all primary hip and knee replacements in my practice are being done utilizing computer guidance for implant placement. Nearly all patients are candidates for CAS except the very morbidly obese. The technology itself has been available in limited markets for a few years and mainly in knee replacement. Recent software developments have expanded the technology to hip replacement.
The goals for CAS are simple; to improve implant placement, ligament balance and leg length control in an effort to customize each joint replacement with the patient’s anatomy, thereby minimizing implantation related complications. The potential complications of interest are ligament imbalance, component malrotation and angular malalignment in knee replacement.
In hip replacement the potential complications of interest are angular malalignment, dislocation, leg length discrepancy Thus far CAS has been very successful in achieving the above goals. In the knee, ligament balance and overall joint motion has been significantly improved by allowing the computer to aid in component size and rotational alignment. In the hip, leg length prediction is very precise decreasing my need for x-ray during the case and avoiding any surprises post operatively.
It is important to understand that CAS is not robotic surgery. The surgeon obtains highly accurate information from the computer, but the surgeon ultimately has complete control and must apply the information correctly. The information obtained is highly precise but could be inaccurate if input information into the computer is incorrect.
There are very few downsides using CAS. Four additional 5mm wounds are made to place pins in the pelvis and femur. There has been very little pain from these wounds reported by patients In my experience, there have only been improvements using CAS. No reconstructions have been adversely affected in my hands with this technology. Again, CAS is an additional tool not the only tool used to properly reconstruct knees and hips.
At this point I have no reason to return to non-navigated replacements. Both in the knee and the hip CAS is another check in an effort to make every joint replacement as close to perfect as possible. Individual patient considerations at times force certain limitations in replacement surgery, but with proper pre-operative planning and additional intra-operative information from technologies such as CAS, surprises during and after surgery can be minimized.
So how much longer will a computer assisted hip or knee replacement last ?
Longevity of a replacement varies from individual to individual. That being said, a standard knee implant without the assistance of computer navigation typically lasts 10 to 15 years. With computer-assisted surgeries, a knee implant is more precisely aligned to minimize joint wear, potentially extending the life of the implant to up to 30 years. We can’t say that with absolute certainty yet because we don’t have enough data but we will in the years ahead.
Does computer navigation help shorten the recovery period for knee and hip surgery ?
There is no conclusive evidence that it does. However, the technology is a perfect complement to minimally invasive surgical procedures which frequently do result in an easier and faster recovery for the patient. Surgeons can operate through smaller incisions (4 to 6 inches compared to 10 to 12 in standard, open surgery) This causes less trauma to the surrounding tissue, which can lead to less post-operative pain, quicker restoration of mobility, and a shorter hospital stay.
What is the advantage of computer navigation for joint replacement surgery ?
In nearly 30 years of peer-reviewed orthopedic literature, it is clear that the single most important determinant of long-term survival of a total knee or hip implant in a patient is the alignment of the implant with respect to the whole leg. The more accurate the alignment, the longer the implant will last.
Computer navigation allows us to perform surgical procedures within the joint and to align the implant more reliably and more accurately. Based on past experience, these improvements will translate into longer lasting repairs.
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