Computer-Assisted Orthopedic Surgery

Computer-assisted orthopedic surgery (CAOS) is performed by digitizing the patient’s anatomy, combining the images in a computerized system, and integrating the surgical instruments into the digitized image background. CAOS is originated in framework system at early stage and has experienced an enormous and rapid development since the invention of computer and the revolutionary progresses of other related field technologies in the 1990s. According to the chosen virtual representation of the surgical object, surgical navigation systems can be classified as image-free and image-based (preoperative and intraoperative) technology. Within the latter class, in particular, CT-, 2-D fluoroscopy-, and 3-D fluoroscopy-based systems have successfully made their way into the operating room. It also can be active or passive. Active navigation systems can either perform surgical task or prohibit the surgeon from moving past a predefined zoon, such as surgical robot systems. Passive navigation systems provide intraoperative information, which is displayed on a monitor, but the surgeon is free to make any decisions he or she deems necessary, such as CT- or fluoroscopy-based systems. Currently, CAOS has gained wide acceptance among orthopedic surgeons and has become an invaluable tool for some orthopedic procedures, such as fracture treatment, TKA, THA, spine surgery, musculoskeletal tumor surgery, shoulder surgery, corrective osteotomy, and anterior cruciate ligament reconstruction. It offers surgeons real-time feedback of the surgical field and enables them to adjust the surgical technique to improve postoperative outcomes and decrease intraoperative errors. However, some factors, including a significant learning curve, increased surgical time, requirements for special setup and equipment handling in the operating room, specialized technical support, and cost, have limited this technology to be applied more extensively. Only knowing the basics and the limitations of the underlying technical principles can be the large potential that modern CAOS systems make available exploited effectively for the benefit of the patient. Finally, the clinical applications of CAOS in trauma, spine, hip, and knee arthroplasty, tumor surgery, and other fields are depicted in the last section of this chapter.