Computer-Assisted Orthopaedic Surgery

Abstract

Summary To precisely realize a preoperative plan during an intraoperative intervention, neurosurgeons developed stereotactic approaches as early as the beginning of the last century. However, their concepts lacked accuracy as a result of the absence of appropriate imaging methods and three-dimensional tracking devices. With the availability of these technologies, computer-aided surgery was invented and eventually found its way into the orthopaedic operating rooms. This article describes this historical development and gives an overview of current applications and techniques. It lists major unsolved problems of computer-assisted orthopaedic surgery (CAOS) and discusses solutions that have been proposed. During this review, navigation systems based on preoperative computed tomography scans, intraoperative fluoroscopy images, and interactively digitized structures are presented, and their differences and commonalities are elucidated. The article explains the technical background of the different approaches as well as special elements of the pre- and intraoperative use of CAOS systems. To bridge theory and practice, examples for a variety of clinical applications are provided such as spinal stabilization, pelvic osteotomies, total hip replacement, total knee replacement, anterior cruciate ligament replacement, and fracture treatment.