Table Of ContentJames B. Stiehl
Werner H. Konermann
Rolf G. Haaker
Navigation and Robotics in Total Joint and Spine Surgery
Springer
Berlin
Heidelberg
New York
Hongkong
London
Milano
Paris
Tokyo
James B. Stiehl
Werner H. Konermann
Rolf G. Haaker
Navigation and
Robotics in
Total Joint and
Spine Surgery
With 460 Figures, 355 in Colors
and 31 Tables
, Springer
Stiehl, James B., Associate Professor, M.D.
Orthopaedic Hospital of Wisconsin
575 West Riverwood, Parkway, Suite 204
Milwaukee 53212, USA
Konermann, Werner H., Professor, M.D.
Orthopaedic Hospital
Am Muhlenberg, 37235 Hessisch-Lichtenau,
Germany
Haaker, Rolf G., Associate Professor, M.D.
Orthopaedic Hospital, st. Vincenz-Hospital
Danziger StraBe 17,33034 Brakel,
Germany
ISBN-13:978-3-642-63922-7 e-ISBN-13:978-3-642-59290-4
001: 10.10071978-3-642-59290-4
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v
Foreword
Orthopaedic surgery is currently just a few moments past the sunrise of computer implementation for the per
formance of surgery itself. OUT specialty has always seemed to have a nearly unique. over arching characteristic - it
deals almost exclusively with alteration, typically rebuilding or reconstituting. structure. What we do has more of a
structural impact than a physiologic one, even when compared to the structural alterations introduced by vascular
and cardiac surgery_ This structural reconstitution contrasts strongly with the largely excisional characteristic of
most other surgical fields.
The relevance of Ihis feature is thai OUf specialty, as much as any, and more than most, needs precision of cuning,
alignment, and replacemenl.As we contrast the rudimentary tools, we use in our operating rooms with the sophis
ticated robotic, computerized, and more extensively mechanized equipment of industry, we seem very far behind.
We are almost ancient considering the pace of development and change over the last fifty years.
Many question the need, practicality, expense and therefore ultimate acceptance of these methods into ortho
paedics. However, the quality I mention above, leads me to believe that eventually, hi-tech involving computer assis
tance and including robotic tools, will almost take over. The current era is and will be appreciated as a beginning
a time when new equipment and techniques are introduced, bugs worked out, and valuable tools refined. nearly
perfected, with costs lowered.
Today every country feels the constraint of cost containment in health care. The social, economic environment
seems, in the minds of many, to prohibit substantial incorporation of this methodology. This writer has confidence
Ihat real improvements from the incorporation of hi-technology will be recognized. And, considering the impor
lance to each individual patient of the life-event that is his or her orthopaedic surgery, demand for best practice not
cheapest will sustain. Along with social order there is perhaps nothing more important to an individual than health
and therefore, healthcare. The dollars will be found. The choices made.
In this marvelous volume compiled by Doctors Stiehl, Konermann, and Haaker we are treated to the early
logbook for a worldwide advance into this new age of high technology orthopaedics. The field is covered both
widely and in depth. Contributions are from the pioneers and developers of these methods.
Kenneth A. Krackow
Buffalo, New York, USA
October 1003
VII
Short Biography of the Editors
Stiehl, James e., Associate Professor, M.D.
Orthopaedic Hospital of Wisconsin
575 West Riverwood Parkway, Suite 204
Milwaukee 53211, USA
Aboul the Editor:
Born in 1949,Adult Reconstructive Orthopaedic Surgeon. Residency at the Universi
ty of Texas Health Science Center in San Antonio Texas under Drs. Charles Rock
wood and David Green, and Fellowships at the Princess Margaret Rose Hospital,
Edinburgh and Swiss AQ Fellowship,Zurich. He is in private practice at Columbia 51
Mary's Hospital in Milwaukee, Wisconsin, USA. His main interests are in tOlal joint
arthroplasty and adult reconstructive surgery and he has a longstanding interest in
biomechanical research in orthopaedics.
Konermann, Werner H., Professor, M.D.
Hospital of Orthopaedics and Traumatology
Am MUhlenberg 3, 0-37135 Hessisch·Uchtenau, Germany
About the Editor:
Born in 1959, Specialist Orthopaedic Surgeon and Rheumatologist. Residencies in
three German Universities at TIlbingen,Milnster and Mannheim. His thesis was done
in biomechanics of the lumbar spine. He is now a Consultant Orthopaedic
Surgeon for orthopaedics and traumatology in Hessisch Lichtenau, Germany. His
main interest is in knee and hip arthroplasty and computer-assisted surgery.
Haaker, Rolf G., Associate Professor, M.D.
Hospital for Orthopaedics and Rheumatology
St. Vincen1-Hospital, Danziger Str. 17,33034 Brake!, Germany
About the Editor:
Born in 1959,Specialist Orthopaedic Surgeon and Rheumatologist. Residencies at the
Sportsmedical Devision, Military Hospital in Warendorf and Koblenz followed by a
recidency at the University in Bochum, Germany. His thesis was done in biomecha
nics of the multilevel lumbar spinal fusion. He is now a Chief Consultant Orthopa
edic Surgeon in Bad Driburg-Brakel. Germany. He has a main interests in revision
surgery of hip and knee arthroplasty, spine surgery and computer assisted surgery.
IX
.. Thecurrenl discoveries ltach U5t hat whatever we thought is true ae
lually was wrong. II appears \0 me thallhc only knowledge we can still
trust is the faeltha! light speed is the fastesllhing on earth. POSSibly .•
EDWARD TEll..ER
Preface
With the advance of the technology age, the known body of knowledge composing medical science has tripled since
1960. Many important new treatments and methods have envolved during this period. For example. tolal joint
arthroplasty, a recent innovation, has benefited millions of patients and is now one of the most common surgical
procedures in medical practice. Yel, despite this success, basic issues such as component alignment and positioning
are not always ideal, and may lead 10 unsatisfactory clinical results with early loosening or failure of the implants.
Computer navigation and robotics are considered to be controversial tools, but recent experience has revealed
promising applications in hip and knee arthroplasty, spine surgery, ACLr econstruction and other operations.
At the first symposium for computer navigation and robotics in Bochum, Germany.an international faculty con
sisting of orthopaedic,trauma, and neurosurgeons as well as engineers, reported a wide range of applications for
this technology and its current practical use. A state of the art publication resulted which also includ~ the current
technology development of several commercial interests. This groundwork leads to an overview of the current prac
tical use of navigation and robotics.
In this book, an important premise was that the contributing authors reported honestly on their personal ex
periences, including both success and failures. Because the basic technologies of computer navigation and robotics
have many applications. we felt compelled to combine the experiences in many surgical disciplines. Finally, we re
cognize the swift evolution of computer software and technology in this field. and we have attempted to highlight
the evolutionary improvements to time-tested surgical methods as well as to offer new vistas in advanced surgical
technique.
We are al the b~inning of a new and revolutionary development in medicine, which will not replace the surgeon,
but will help to improve accuracy and consistency of high precision in standard operations. In America, great
enthusiasm has arisen for minimally invasive techniques especially in total joint replacement. Many opinions find
navigation a critical element to the efficacy of the approach which can be found in this book. We consider this book
a guideline and reference for navigational and robotic surgical tools as well as help for medicolegal concerns re
garding minimizing risks, quality control and documentation.
We would like to express our sincere thanks to all authors who have generously contributed to this project. It is
only through their efforts and dedication to advancing medical science that this book is possible.
We would like to thank our colleague Jens Boldt, St.-Vincent Hospital, Dusseldorf, for his tireless effort in trans
lating many of the enclosed chapters from the original book published in the German language.
We are also very grateful to the publisher Springer-Verlag, Heidelberg, Germany, with special thanks to the editor,
Thomas GOnther, for expediting the production of this book.
James B. Stiehl Werner H. Konermann Rolf G. Haaker
October lOO)
XIII
Contents
I.
Computer.Assisted Planning and
Computer-Assisted Navigation oflotal Hip Arthroplasty
Ortho~edlc 5u~.1')' USing the Navitrack and mediCAD System .. 82
j. Babisch, F. Layher, R.A. Venbrocks
11 Hip Cup Implantation Using the
9.
Basics of Computer-Assisted Orthopaedic SurgiGATESystem ....................
Surgery (CAOS) .......................... 3 M. Srockheim, J. Kramer
L.-P. No/re, F. Lang/olz 12 Hip Navigation Using the SurgiGATESystem
9.
2 CT -Based Navigation Systems. _. . _. . . . . . . . , 0 in Dysplastic and Revision Cases ..........
B. jaramaz, A.M. DiGioia Iff R.G. Haaker
3 ( -Arm-Based Navigation ..... _. . _ ..... _. _ 17 13 Femoral Stem Navigation with the
A. Hebecker SurgiGATE System .................. ,.2
4 CT-Free-Based·Navigation Systems ... _. . _.2 4 I. F. Langlorz, A. Marx. M. Kubiak·Langer,
S.D. Stu/berg G. Zheng. U. Langlotz
S Bone Morphlng:3D Reconstruction Minimally Invasive Hip Surgery with
Without Pre-or Intraoperative Imaging Imageless Navigation ................... 11.
Concept and Applications .... _. . _. . _. . _. . 39 M. Nogler, M. Kr;smer, F. Rachbauer, J. Sledge
E. Stindel,/.-L. Briard, S. Laval/ee, F. Dubrana,
S. Piaweski, P. Mer/oz, C. Leftvre, J. Troccaz
1 S Robotic Hip Surgery and Current
Development with the ROSODOC System .. 119
tv.
Bargar
•
BasJes ofTotal Hlp Replacement Surgery .. _ 49 16 Robotically Milled Bone Cavities
B.J. Thomas, f.B. Stiehl in Comparison with Hand·Broaching in
Total Hip Replacement .................. 123
M. Thomsen
17 An Anatomically Shaped Prosthesis Stem 132
K. Knabe. C. Hurschler,
C. Stukenborg·Colsman, F. Gosse
18 Clinical Experiences with ROBODOC
7 Mini-Incision Techniques and Navigation in Total Hip Arthroplasty , ............... 140
M. BlJrner, U. Wiesel
forTotalHip •...••...•................... 61
A.M. DiGioia III, A. Y. Plakseychuk, B. Jaramaz 19 Minimally Invasive Total Hip Replacement
8 Acetabular Cup Navigation with the Application of Intraoperative Navigation
OrthoPilot System ........................ 70 and Robotics ........................... 14S
H. Kiefer F. Kerschbaumer, S. Kuenzler, J. Wa},rbllrg
9 AcetabularCup Navigation with the 20 Cement Removal with the ROBODOC System
Vector Vision System ...................... 76 in Total Hip Arthroplasty Stem - Revision . 1S1
WH. Kluge. I. Babisch, R.A. Venhrocks M. Nogfer, M. Krismer
XIV COnll!nlS
21 Advantages of Custom-Made Stems 33 Computer-Assisted Navigation
Using Adaptiva Components ........... . 155 with the OrthoPiiot System Using the
G. Grubu Search Evolution TKA Prosthesis ......... 234
" Computer-Assisted Designed Hip U. Clemens, lV, H. Konermann, S. Kohler,
Arthroplasty ...•.................... '.0 H. Kiefer, I. Y. lerllly, R.K. Miehlke
I.-N. Argenson, X. Fleeher, j.-f.1. Aubaniae 34 The OrrhoPilot Navigation System
23 Navigation and Robotics in Joint and ,., in Total Knee Arthroplasty:Version 4.0 ... 242
Spine Surgery ......................... . R.K. Miehlke, R. G. Haaker, ~v: H. Konermann
I. Hassenpjlug, M. Prymka 35 Navigated Implantation ofthe Columbus
Total Knee Arthroplasty with the OrthoPilot
System: Version 4.0 ................•.... 248
F. Lampe, E. Hille
III Toul Kn .. Arthroplnty 3.
CT-Free Navigation Including Soft-Tissue
Balancing: lCS·TKA and VecrorVision
Systems •••............................ 254
24 Total Knee Arthroplasty ................ . 175 ~v: H. KOllerman", S. Kistner
F.F. Bueellel, I.B. Stiehl
37 Navigation and Soft-Tissue Balancing of
25 Why the Tibia Cut First in Mobile Bearing
lCS Total Knee Arthroplasty ............. 266
TKA Technique? ....................... . 180 I.M. Strauss, W. RUther
'.B.
Stiehl
38 CT-Free Navigation with the LCS Surgeries
2.
Femur First Approach in TKA-
Station: A New Way of Balancing the Soft
Surgical Techniques ................... . 185
TIssues in TKA Based on Bone Morphing .. 274
K.A. Krackow
I.L. Briard, E. Slinde/, S. Ploweski, F. Dubrana,
27 Femoral Component Alignment in TKA ... 189 P. Mer/oz, C. Lefevre,}. Troccaz, F. Bertrand,
I.G. Boldt
N. Begoe, P. Solodky, M. Breysse
28 Computer-Assisted ligament Balancing
39 The Galileo System for Implantation
of thl! Femoral Tibial Joint Using Pressures
ofTotal Knee Arthroplasty .............. 281
Sensors. . . . . . .. . . . .. . .. . .. . . . .. .. . . .. .. 197 P. Rirschl, F. Machacek jun., R. Fuiko, R. Zettf.
R.c. Wasielewski, D.O. Galat, R.D. Komistek
B. Kotten
29 Computer-Assisted Pressure Measurement
40 Clinical Experiences with the
in the Patellofemoral Joint with Surgeties System in TKA .........•....... 287
Ell!ctronic Pressure Sensors ............. 204 U 8Mling, J. Scholz, R. Nassutt, H. Grundei
I. Mortier, L. Ziehrler
41 Navigation in TKA with the
30 Patellofemoral Arthroplasty ............. 209 Nail/frock System ....................... 293
I.-N. Argenson, X. Flecher, H. Vinel T. Mattes, W. Puhl
42 Clinical Experience with the CT -Based
VectorVlson System ..................... 301
III A NovIgatton:T.tol KnH Arthroplasty M. Wiese, K. Schmidt, R.E. Willburger
43 CT ·Based and CT-Free Navigation with the
BrainLAB VectorVision System in Total Knee
31 Postoperative Alignment of Conventional Arthroplasty ........................... 304
and Navigated Total Knee Arthroplasty. .. 219 L. Perlick, H. BiHllis, C LUring, M. Tingart,
W.H. Konermann, M.A. Sailor }. Grifka
32 Computer-Assisted Implantation of Total 44 Extra-Medullary Computer-Assisted Total
Knee Endoprosthesis with no Preoperative Knee Replacement:
Imaging: the Kinematic Model. . . .•. . . . .. 226 Towards lesser Invasive Surgery .. . . . . .. . 311
D. S4ragagfia, F. Picard R.L Wixson
