At its very core, performing a successful surgical procedure is about art, skills, and precision. All of which can be supported and advanced by the latest technologies. Computer-assisted surgery emerged as a novelty in the field of joint replacement surgery in the late 1990s. The first generation computer-assisted devices to allow for a more precise execution of surgery were bulky, cumbersome, time-consuming and difficult to use. Today, technology has evolved into user-friendly, powerful platforms that cover a number of aspects of joint replacement surgery, including preoperative planning, coronal and sagittal plane alignment, component rotation, quantification of soft tissue balance, and custom-made gigs and robotic surgery for precise prosthetic fit. These advanced computers and technology play an important role that increase accuracy and precision in the operating room. Here are some examples where technology is being currently used in my operating room:
- Electronic 2D preoperative planning: The anatomy of each individual patient is unique when you consider the shape, size, proportions and quality of our bones and joints. Similarly, orthopedic implants for joint replacement come indifferent shapes and sizes so that we can select implants that will best fit the patient’s unique skeletal features. For decades, we used primitive preoperative planning tools that consisted in printed x-rays and transparencies with the shape and sizes of the implants to be used. Today, we can use electronic x-rays calibrated for magnification together with powerful software that has the shape and sizes of most implants available. Precise measurements can be taken to make sure that we achieve in the OR what we planned for each patient
- Electronic 3D preoperative planning: With preoperative CT scans and MRIs, planning can be done in three dimensions (3D). Under these circumstances, the surgeons take a deeper look into the bone shape, size and quality. The images can be rotated and adjusted so that we obtain the best possible fit for the patients One of the major advantages is that we are planning surgeries days and sometimes weeks before surgery. This level of planning allows us and our team of assistants, technicians and nurses to anticipate the surgery, having implants and special equipment ready to be used. This minimizes guessing during surgery and makes surgery more expeditious.
- Computer assisted alignment tools used during hip and knee replacements: The alignment and the rotation of joint replacement components play an important role in the outcome of surgery. For example, the better the alignment and rotation of the prosthetic parts achieved during knee replacement surgery, the better the knee will function and the longer it will last. In a hip replacement, there will be lower chances of dislocation and leg length discrepancy. Today, we use computers to achieve adequate alignment and rotation of components.
- Sensor-assisted knee replacement surgery: For a knee replacement to function well, the prosthetic parts have to be properly sized and oriented so that the overall alignment of the leg is the correct one. In addition, the ligaments that “guide” the motion of the knee have to be properly balanced. We want to obtain similar tension in the internal (medial) and external (lateral) ligaments of the knee. The tools what we classically used to assess soft tissue tension were rudimentary and soft tissue balance has been considered an “art” more than a science during knee replacement surgery. Today, we can use electronic sensors during surgery that quantify the tension of the soft tissues around the knee. By making targeted releases in the soft tissues, we make sure that knees are balanced to the best of our ability.
- Robotic surgery: Guided by precise 3-D planning, robotic arms can be used to cut and burr the bone and allow precise placement of implants, restoring alignment and joint biomechanics. This technology is being predominantly used for partial knee replacement surgery.
I have witnessed and followed with interest the introduction of technology in the operating rooms with applications pertinent to hip and knee replacement surgery. When properly used and acknowledging its limitations, modern technology allows us to be more precise during surgery. Technology, however, is unlikely to replace the surgeon’s sound medical judgment, which comes from experience, careful planning, and the visual and tactile feedback obtained when surgery is meticulously performed. On the other hand, not only for the novice surgeon, but also for the seasoned one, technology has provided a number of advantages that diminish hesitation and improve precision during surgery.
As we strive to make surgeries more precise with the aid of technology, we also strive to diminish other problems of surgery unrelated to technology, like infection, bleeding and postoperative pain. I believe that technology will be used more frequently in the coming years.
Dr. Alejandro Gonzalez Della Valle has been fully devoted to orthopedic surgery since 1993. He is an expert in reconstructive surgery of the hip and knee, including joint preserving procedures, as well as hip and knee replacement surgery.