Computer assisted orthopaedic surgery (CAOS) is a surgical technology that assists surgeons through creation and display of images showing the replacement components in their relationships to the bones and ligaments of the joint being replaced. CAOS is also called Imaged Guided Surgery or Surgical Navigation. CAOS has two basic components:
- A special camera designed to see the surgical joint and limb and create a picture or image of the hip or knee
- Computer programs which integrate these images with surgical information and assist the surgeon during the operation
CAOS can use actual images of the joint (X-Rays/fluoroscopic, ultrasound or CT images) or can create virtual images of the damaged joint. The camera and computer are given information by the surgeon about the normal and abnormal anatomic landmarks of the joint and limb. This information can be transmitted in several ways. Some CAOS systems use special cameras to identify and record the position of photo reflective spheres or infra-red light emitting devices. Some other systems use ultrasonic devises to identify bony landmarks. The surgeon uses the computer generated information and images to accurately and reproducibly reconstruct the damaged joint and limb.
Benefits
- Potential benefits of using CAS/Robotics in joint replacement surgery include:
- Computer organized and directed surgical work flow
- Potential improved reliability of sizing and positioning of joint implants
- Documentation of limb/joint anatomy and deformity
- Data storage for research and outcome analysis
- Potential improved accuracy of reconstructed limb length
- Potential improved accuracy of prosthetic component alignment
- Potential impact on functional outcomes and implant durability
Disadvantages
- Potential disadvantages of using CAS/Robotics in joint replacement surgery include:
- Increased time required to perform the operation
- Increased hospital costs from the additional equipment, software and surgical time
- Risk of fractures or infections related to the pins and their incisions (wounds) needed to attach the reference arrays to the bones (< 1% complication rate)
- Potential need for additional imaging before surgery (such as CT scans) to provide landmarks for surgical planning
Patients
While these technologies can be used in any patient, it is especially helpful in those patients who have specific bone deformities or have hardware from previous surgeries.
CAS/Robotic surgery can help the surgeon align the patient’s bone and implants with great accuracy. Robotics are currently most commonly used for partial knee replacements, with technologies advancing for total knee and hip replacements and other applications.
Procedure
For CAS and robotic surgery, anatomic landmarks are registered on the computer and guide the surgical procedure. The same metal, plastic, and/or ceramic implants are used in surgery as replacements without CAS and robots.
Recovery
Recovery after total hip replacement, total knee replacement, and partial knee replacement after using Computer Assisted Surgery and Robotic Surgery is the same as surgical procedures where they are not used. Please refer to those sections
