Computer and Template Assisted Orthopedic Surgery

172 Pages·2013·7.704 MB·English

by  Prof. Dr. Rolf Haaker (auth.), Prof. Dr. med. Rolf Haaker, Prof. Dr. med. Werner Konermann (eds.)

Haaker
Konermann
Computer and
Template Assisted
Orthopedic
Surgery
Computer and Template Assisted Orthopedic Surgery
Rolf Haaker
Werner Konerman (Eds.)
Computer
and Template Assisted
Orthopedic
Surgery
With 210 images
123
Editors:
Haaker, Rolf, Prof. Dr. med.
St. Vincent Hospital
Danziger Str. 17
33034 Brakel
Konermann, Werner, Prof. Dr. med.
Kassel Red Cross Hospital
Hansteinstr. 29
34121 Kassel
ISBN-13 978-3-642-29727-4 ISBN 978-3-642-29728-1 (eBook)
DOI 10.1007/978-3-642-29728-1
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V
Preface
The continued and growing interest in computer-assisted orthopedic surgery (CAOS)
prompted us to add a new edition to the two previous volumes on this subject last edited in
2007 by J.B. Stiehl, A.M. DiGioia, and us both.
Moreover, additional developments in the field of CAOS have closed the circle from the
methods presented in our first edition in 2001 to the presently available techniques of leg axis
restoration and implant positioning by individual cutting devices, as described initially by
Portheine and coworkers in the first edition, giving us another reason to do so.
This volume is a combination of the two previous editions. On the one hand, it describes
the techniques and initial results of the new methods, which are based on CT or MRI scans of
knee joints to prepare patient-individual cutting blocs in external laboratories using the rapid
recovery protocol as well as individual implants. On the other hand, this edition illustrates the
advances in navigation systems as they »come of age« and become more precise and easier
to use.
Last but not least, we give an overview of the use of three-dimensional fluoroscopic de-
vices in the operating theater for the treatment of trauma cases – individually as well as in
combination. One chapter in the volume deals with the opportunities of modern robotics in
orthopedic surgery.
The last four chapters in particular demonstrate the evolution of computer applications,
which will revolutionize the way we perform our surgeries for the next few decades. All the
strategies demonstrated here have the same goal: to improve implant positioning along with
preservation of soft tissues so as to get better clinical results and increased implant longevity.
We hope you enjoy reading about the bases of these techniques and their current applications.
The Editors
Prof. Dr. Rolf G. Haaker
Prof. Dr. Werner Konermann
April 2013
Contents
I Introduction
1 History of Computer-Assisted Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Rolf Haaker
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
2 Renaissance of Computer-Assisted Orthopedic Surgery with
Individual Templates: Evolution or Revolution?. . . . . . . . . . . . . . . . . . . . . 11
Klaus Radermacher
2.1 Historical Background and Evolution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
2.2 From Concept to Broad Clinical Acceptance: Evolution or Revolution? . . . . . . . . . 17
2.3 Conclusion and Outlook . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
2.4 Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
II Individual Templates in Total Knee Arthroplasty
3 Patient-Specific Instruments for Total Knee Replacement:
Based on MRI and Whole-Leg Radiograms (VISIONAIRETM) . . . . . . . . . . . . 25
Carsten O. Tibesku
3.1 Description of VISIONAIRETM Technology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
3.2 Intraoperative Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
3.3 Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
3.4 Early Experience and First Published Results . . . . . . . . . . . . . . . . . . . . . . . . . . 29
3.5 Clinical Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
3.6 Rotational Alignment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
3.7 Cost-Effectiveness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
3.8 Future Outlook . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
4 MyKnee(cid:163): Patient-Matched Instruments . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Stefan Dittrich, Werner Anderl
4.1 What Is MyKnee(cid:163)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
4.2 Operative Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
4.3 The Advantages of MyKnee(cid:163) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
4.4 The Disadvantages of MyKnee(cid:163) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
4.5 Initial Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
4.6 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
VII
Contents
5 Zimmer(cid:163) Patient-Specific Instruments for Total
and Unicompartmental Knee Replacement . . . . . . . . . . . . . . . . . . . . . . . 39
Georg Köster
5.1 Principle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
5.2 Indications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
5.3 Contraindications/Constraints . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
5.4 Preoperative Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
5.5 Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
5.6 Surgical Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
5.7 Initial Experience . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
5.8 Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
6 The Individual-Template System Combined with Individual Endoprosthesis:
ConforMISTM iUni G2, iDuo G2, and iTotal G2 . . . . . . . . . . . . . . . . . . . . . . 53
Andre F. Steinert, Ulrich Nöth, Maximilian Rudert
6.1 Introduction to Individualized Knee Arthroplasty . . . . . . . . . . . . . . . . . . . . . . . 54
6.2 Indications and Contraindications: Which Knee Implant for Which Patient? . . . . . . 55
6.3 Preoperative Planning and iView(cid:163) Technology . . . . . . . . . . . . . . . . . . . . . . . . . 55
6.4 Individual Unicompartmental Knee Arthroplasty: iUni(cid:163) G2 . . . . . . . . . . . . . . . . . 56
6.5 Individual Bicompartmental Knee Arthroplasty: iDuo(cid:163) G2 . . . . . . . . . . . . . . . . . 59
6.6 Individual Tricompartmental Knee Arthroplasty: iTotal(cid:163) G2 . . . . . . . . . . . . . . . . 60
6.7 Summary and Perspectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
7 Kinematic Alignment in Total Knee Arthroplasty with
Stryker ShapeMatch(cid:163) Technology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Tilman Calliess, Henning Windhagen
7.1 Biomechanical Rationale of Kinematic Alignment . . . . . . . . . . . . . . . . . . . . . . . 64
7.2 Stryker ShapeMatch(cid:163) Technology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
7.3 Clinical Application of Kinematically Aligned TKA . . . . . . . . . . . . . . . . . . . . . . . 66
7.4 Controversy of Mechanical Versus Kinematic Alignment . . . . . . . . . . . . . . . . . . . 69
7.5 Early Clinical Experience and Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
7.6 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
III Innovations in Navigation of TKA
8 TKA Navigation Using the Medacta System . . . . . . . . . . . . . . . . . . . . . . . 75
Gary D. Botimer
8.1 System Specifics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
8.2 Surgical Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
8.3 Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
VIII Contents
9 Total Knee Revision Supported by the OrthoPilot(cid:163) Navigation System . . . 83
Ulrich Clemens
9.1 Method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
9.2 Workflow of OrthoPilot(cid:163) TKR 1.0. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
9.3 Experience . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
9.4 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
10 Brainlab Dash(cid:163): iPod(cid:163)-Based Navigation System in Total Knee
and Hip Replacements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Holger Bäthis
10.1 Technical Aspects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90
10.2 Clinical Experience . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
10.3 Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
10.4 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
11 Benefits of Imageless Computer Navigation in Total Knee Arthroplasty. . . 97
Christoph Schnurr, Dietmar Pierre König
11.1 Influence of Imageless Computer Navigation on Implant Alignment . . . . . . . . . . . . 98
11.2 Influence of Computer Navig ation on TKA Revision Rates . . . . . . . . . . . . . . . . . . 98
11.3 Blood Loss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
IV Renaissance of Robotics in TKA
12 The Mako Robotic System for Unicompartmental Knee Arthroplasty . . . . 105
Mustafa Citak, Andrew D. Pearle, Daniel O. Kendoff
12.1 Unicompartmental Knee A rthroplasty with Haptic Robotic Systems . . . . . . . . . . . 106
12.2 Preoperative Imaging and Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
12.3 Intraoperative Set-up and Surgical Technique . . . . . . . . . . . . . . . . . . . . . . . . . 107
12.4 Outcomes of Robotic-Assisted Unicompartmental Knee Arthroplasty . . . . . . . . . . 108
12.5 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
V Innovation in the Navigation of THA
13 Hip Navigation Using the OrthoPilot(cid:163) System . . . . . . . . . . . . . . . . . . . . . 113
Thilo Floerkemeier; Henning Windhagen
13.1 Importance of Cup Positioning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
13.2 Navigation for Correct Implant Orientation . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
13.3 Evidence of Benefits Using Navigation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116
13.4 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
IX
Contents
14 Short Stem Navigation and Optimized Range of Motion . . . . . . . . . . . . . . 121
Djordje Lazovic
14.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122
14.2 Surgical Technique for Short Stem Prostheses . . . . . . . . . . . . . . . . . . . . . . . . . 122
14.3 Navigation Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
14.4 Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124
14.5 Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
15 Ultrasound-Guided Acquisition of Bony Landmarks During Navigation . . . 129
Hartmuth Kiefer
15.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130
15.2 The Technology Behind U ltrasound Navigation . . . . . . . . . . . . . . . . . . . . . . . . 131
15.3 Intraoperative Prerequisites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
15.4 Ultrasound Visualization and Transducer Guidance . . . . . . . . . . . . . . . . . . . . . . 132
15.5 Ultrasound Navigation in Total Hip Arthroplasty . . . . . . . . . . . . . . . . . . . . . . . . 134
15.6 Conclusion and Future Perspectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136
16 Process-Optimized Minimally Invasive Total Hip Replacement via a Direct
Anterior Approach with Navigation Control of Leg Length and Offset . . . . 137
Philipp Gebel , Markus Oszwald, Bernd Ishaque, Gaffar Ahmed, Recha Blessing, Fritz Thorey,
Andreas Ottersbach
16.1 Materials and Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
16.2 Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
16.3 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
VI Navigation in Trauma Surgery
17 Multidepartmental Use ofa Fixed 3D Navigation System . . . . . . . . . . . . . . 147
Florian Gebhard, Bastian Scheiderer, Peter Richter, Christoph Riepl
17.1 Materials and Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
17.2 Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
17.3 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
Reference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152
18 3D Navigation with a Mobile C-arm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153
Jochen Franke, Paul Alfred Grützner
18.1 Spine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154
18.2 Pelvis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156
18.3 Foot and Ankle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
18.4 Summary and Outlook . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
X Contents
19 Handling Modern Medical Imaging in the High-Tech O perating Theater . . 161
Nael Hawi, Musa Citak, Julia Imrecke, Ulrich Lüke, Timo Stübig, Christian Krettek, Tobias Hüfner
19.1 Surgical Set-Up . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
19.2 Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
19.3 Cost Calculation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
19.4 Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
19.5 Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164
19.6 Commercial Computer-Aided Operating Room Applications . . . . . . . . . . . . . . . . 166
19.7 Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
Subject Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169