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What does the future hold for CAOS?
Bone-mounted robots and electronic trackers may become surgical staples within five years.
Computer-assisted orthopedic surgery marks a new phase in orthopedics. New tools may aid in this transition, but soft tissue registration will most likely remain a problem.
According to Jean-Louis Briard, MD, an orthopedic surgeon at the Clinique de Cèdre in Bois-Guillaume, France, the future of navigated knee surgery will include advances in registration, tracking and visualization.
“Visualization will prosper [and] maybe with real-time animation,” Briard said during his presentation at the 7th European Federation of National Associations of Orthopaedics and Traumatology Congress. “And we will have new tools to assist us in the cutting, and maybe tiny robots,” he said. Briard also predicted that these innovations could become a reality within five years.
Soft tissue challenges
Soft tissue registration may present the greatest hurdle in fostering more widespread use of computer-assisted orthopedic surgery (CAOS) instruments. Developing the ideal soft tissue tension without inducing varus or valgus will require new tools, he said. In addition, surgeons will still need to identify soft tissue pathology.
Improvements in registration could result in individualized procedures.
“We should be able to produce a custom-made operation close to derived mechanics or biomechanics for each patient,” he said. “During surgery, once registration is achieved, we should be able to simulate and choose the best position for the implant for the better mechanics.”
Virtual surgery
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Knowing the exact physiology of each patient can help researchers create computerized surgical scenarios. Surgeons could first run through virtual procedures and then later perform the actual surgery, he said. Preoperative mapping of limbs may also improve post-surgical outcomes. “Through gait studies, we would be able to generate animated 3-D models, which then will be adjusted to the actual patient’s knee during surgery,” Briard said.
During operation, orthopedists may use electromagnetic trackers like the EMAT from DePuy, a Johnson & Johnson company. Using these trackers could decrease operating time and prove beneficial for minimal procedures, he said. These implanted devices track the bones and the implants registered during surgery and will allow further measurements later on with the patients walking, including assessments of gait mechanics and wear.
Better views, robots
As the push for non-invasive surgery continues, researchers will develop new visualization methods. Future breakthroughs may include flat screens placed on top of patients. The monitors would show cutting guide coordinates while detailing alignment, Briard said.
Surgeons may also wear helmets with a “semi-transparent mirror” to view structures, he said. The application of robots mounted on bone, such as the Praxiteles, may also increase during surgery, Briard said.
Tomorrow’s innovations
Even though surgeons and product developers have made many refinements in CAOS instruments over the past few years, there has also been greater disruption and disagreement about CAOS techniques, Briard said. But the data collected from navigated operations provide the groundwork for future standardized treatments.
“Our surgery should be more precise [and] more reproducible,” he said. “There should be no more good and bad days for the same surgeon … [and] no more learning curve with our surgery.”
Briard added: “I think we are entering a new renaissance in orthopedic surgery [with CAOS]. I think we are moving from the craftsman’s age to a high-tech time because we can measure [and] make calculations with the computers.”
Dr. Briard is a paid consultant for Johnson & Johnson.
For more information:
- Briard, JL. Future developments and applications. Symposium #23: Navigation in future orthopaedics. Presented at the 7th European Federation of National Associations of Orthopaedics and Traumatology Congress. June 4-7, 2005. Lisbon, Portugal.