Hip & pelvis

The Korean Hip Society (대한고관절학회)
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Computer-Assisted Total Hip Arthroplasty

컴퓨터 시스템을 이용한 고관절 치환술

  • Kim, Kang-Il (Department of Orthopaedic Surgery, Kyung Hee University School of Medicine) ;
  • Rhyu, Kee-Hyung (Department of Orthopaedic Surgery, Kyung Hee University School of Medicine) ;
  • Cho, Kye-Youl (Department of Orthopaedic Surgery, Kyung Hee University School of Medicine) ;
  • Huh, Dae-Seok (Department of Orthopaedic Surgery, Kyung Hee University School of Medicine)
  • 김강일 (경희대학교 의학전문대학원 정형외과학교실) ;
  • 유기형 (경희대학교 의학전문대학원 정형외과학교실) ;
  • 조계열 (경희대학교 의학전문대학원 정형외과학교실) ;
  • 허대석 (경희대학교 의학전문대학원 정형외과학교실)
  • Published : 2011.12.31
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Abstract

Despite the overall satisfactory results of total hip arthroplasty, post-operative complications continue to occur. To minimize these problems, computer-assisted total hip arthroplasty using navigation or robot-assisted systems is being developed. A navigation system is defined as a system that locates a position in three-dimensional space and traces the target spot, and a robot-assisted system is defined as a system that performs operations automatically with mechanical robot arms based on prior preoperative planning. Computer-assisted surgeries have shown superior results to conventional methods in implant positioning, fixation, and accurate lower extremity alignment in the limited reports available. However, computer-assisted surgeries take longer compared to conventional methods. Due to the extra time needed, the risk of postoperative infection and blood loss is considered to be higher. Nevertheless, robot-assisted system is being developed for the field of hip arthroplasty, and thus its efficacy and accuracy needs to be further investigated. Since these methods have other advantages compared to conventional methods, they are the focus of much interest.

인공 고관절 수술의 우수한 결과에도 불구하고 수술 후 합병증이 여전히 발생하고 있어 그러한 문제점들을 최소화하기 위해 컴퓨터를 이용한 정형외과 수술인 네비게이션 이용 수술 및 로봇 보조수술이 개발되었다. "네비게이션"이란 삼차원적인 공간에서 위치를 찾고 목표 지점을 추적하는 시스템이며 "로봇"은 사전에 저장한 명령에 기초하여 기계적인 로봇팔이 자동적으로 작업을 수행하는 것을 말한다. 컴퓨터 응용 수술은 이미 일부 보고에 의하면 고식적인 인공 고관절 수술과 비교할 때 더 우수한 인공 관절의 고정, 위치 및 하지정렬을 얻을 수 있다고 하지만, 고식적인 인공관절 수술보다는 추가 시간이 소요되므로 술 후 감염 및 실혈의 위험성을 고려해야만 한다. 로봇 보조 수술은 고관절 영역에서는 아직 시작 단계로 앞으로 효용가치와 정확성 여부가 연구되어야 할 것이다. 컴퓨터 응용 수술은 고식적인 수술에 비해 얻을 수 있는 장점도 있기 때문에 점점 관심이 증가하고 있는 분야이다.

Keywords

References

  1. Parvizi J, Kim KI, Goldberg G, Mallo G, Hozack WJ. Recurrent instability after total hip arthroplasty: beware of subtle component malpositioning. Clin Orthop Relat Res. 2006;447:60-5.
  2. Bonutti PM, Zywiel MG, Seyler TM, et al. Minimally invasive total knee arthroplasty using the contralateral knee as a control group: a case-control study. Int Orthop. 2010;34:491-5. https://doi.org/10.1007/s00264-009-0775-4
  3. Bargar WL, Bauer A, Borner M. Primary and revision total hip replacement using the Robodoc system. Clin Orthop Relat Res. 1998;354:82-91.
  4. Paul HA, Bargar WL, Mittlestadt B, et al. Development of a surgical robot for cementless total hip arthroplasty. Clin Orthop Relat Res. 1992;285:57-66.
  5. Stulberg SD, Loan P, Sarin V. Computer-assisted navigation in total knee replacement: results of an initial experience in thirty-five patients. J Bone Joint Surg Am. 2002;84-A Suppl 2:90-8.
  6. Dalury DF, Dennis DA. Mini-incision total knee arthroplasty can increase risk of component malalignment. Clin Orthop Relat Res. 2005;440:77-81. https://doi.org/10.1097/01.blo.0000185757.17401.7b
  7. Saxler G, Marx A, Vandevelde D, et al. The accuracy of free-hand cup positioning--a CT based measurement of cup placement in 105 total hip arthroplasties. Int Orthop. 2004;28:198-201.
  8. Kalteis T, Handel M, B?this H, Perlick L, Tingart M, Grifka J. Imageless navigation for insertion of the acetabular component in total hip arthroplasty: is it as accurate as CT-based navigation? J Bone Joint Surg Br. 2006;88:163-7. https://doi.org/10.1302/0301-620X.88B2.17163
  9. Leenders T, Vandevelde D, Mahieu G, Nuyts R. Reduction in variability of acetabular cup abduction using computer assisted surgery: a prospective and randomized study. Comput Aided Surg. 2002;7:99-106. https://doi.org/10.3109/10929080209146021
  10. Honl M, Dierk O, Gauck C, et al. Comparison of roboticassisted and manual implantation of a primary total hip replacement. A prospective study. J Bone Joint Surg Am. 2003;85-A:1470-8.
  11. Kwoh YS, Hou J, Jonckheere EA, Hayati S. A robot with improved absolute positioning accuracy for CT guided stereotactic brain surgery. IEEE Trans Biomed Eng. 1988;35:153-60. https://doi.org/10.1109/10.1354
  12. Nishihara S, Sugano N, Nishii T, et al. Clinical accuracy evaluation of femoral canal preparation using the ROBODOC system. J Orthop Sci. 2004;9:452-61.
  13. Jakopec M, Harris SJ, Rodriguez y Baena F, Gomes P, Cobb J, Davies BL. The first clinical application of a "hands-on" robotic knee surgery system. Comput Aided Surg. 2001;6:329-39.
  14. Nolte LP, Zamorano L, Visarius H, et al. Clinical evaluation of a system for precision enhancement in spine surgery. Clin Biomech. 1995;10:293-303. https://doi.org/10.1016/0268-0033(95)00004-5
  15. Langlots U, Lawrens J, Hu Q, Langlotz F, Lolte LP. Image guided cup placement. In: Lemke HU, Vannier MW, Inamura K, Farman AG ed. Computer Assisted Radiology and Surgery. Amsterdam: Elsevier; 1999. 717-21.
  16. Digioia AM, Jaramaz B, Blackwell M, et al. The Otto Aufranc Award. Image guided navigation system to measure intraoperatively acetabular implant alignment. Clin Orthop Relat Res. 1998;355:8-22.
  17. Hananouchi T, Sugano N, Nakamura N, et al. Preoperative templating of femoral components on plain X-rays. Rotational evaluation with synthetic X-rays on ORTHODOC. Arch Orthop Trauma Surg. 2007;127:381-5. https://doi.org/10.1007/s00402-007-0349-0
  18. Dorr LD, Malik A, Wan Z, Long WT, Harris M. Precision and bias of imageless computer navigation and surgeon estimates for acetabular component position. Clin Orthop Relat Res. 2007;465:92-99.
  19. Ryan JA, Jamali AA, Bargar WL. Accuracy of computer navigation for acetabular component placement in THA. Clin Orthop Relat Res. 2010;468:169-77. https://doi.org/10.1007/s11999-009-1003-7
  20. Nishihara S, Sugano N, Nishii T, Miki H, Nakamura N, Yoshikawa H. Comparison between hand rasping and robotic milling for stem implantation in cementless total hip arthroplasty. J Arthroplasty. 2006;21:957-66. https://doi.org/10.1016/j.arth.2006.01.001
  21. Nakamura N, Sugano N, Nishii T, Kakimoto A, Miki H. A comparison between robotic-assisted and manual implantation of cementless total hip arthroplasty. Clin Orthop Relat Res. 2010;468:1072-81. https://doi.org/10.1007/s11999-009-1158-2
  22. Prymka M, Wu L, Hahne HJ, Koebke J, Hassenpflug J. The dimensional accuracy for preparation of the femoral cavity in HIP arthroplasty. A comparison between manual- and robot-assisted implantation of hip endoprosthesis stems in cadaver femurs. Arch Orthop Trauma Surg. 2006;126:36-44. https://doi.org/10.1007/s00402-005-0080-7
  23. Kelley TC, Swank ML. Role of navigation in total hip arthroplasty. J Bone Joint Surg Am. 2009;91 Suppl 1:153-8.
  24. Parratte S, Argenson JN. Validation and usefulness of a computer-assisted cup-positioning system in total hip arthroplasty. A prospective, randomized, controlled study. J Bone Joint Surg Am. 2007;89:494-9. https://doi.org/10.2106/JBJS.F.00529
  25. Beckmann J, Stengel D, Tingart M, Gotz J, Grifka J, Luring C. Navigated cup implantation in hip arthroplasty. Acta Orthop. 2009;80:538-44. https://doi.org/10.3109/17453670903350073