Directions for Future Research

Abstract

The 2008 AAOS/ORS Advanced Imaging and Computer-Assisted Surgery of the Knee and Hip (AICKH) Research Symposium explored avenues for technology integration between advanced imaging and computer-assisted surgery, and it assessed the value of imaging in evaluating the progression of joint disease and the efficacy of therapeutic interventions. The four overarching themes that were explored during the symposium and the consensus statements for future research are detailed below. The concept of technical specifications and standards for computer-assisted surgery procedures and imaging protocols was highlighted. For example, most computer-assisted surgery procedures rely on the use of quantitative data rather than surgeon feel and intuition to inform clinical decision-making. As this quantitative feedback becomes more important in surgical decision-making, we must establish appropriate specifications for various operations. These specifications must be clinically relevant and must have known target values and tolerances. In addition, we must understand the reliability of our computer-assisted tools in achieving the desired specifications. Navigated total knee replacement is an excellent example of the use of quantitative data to affect surgical technique. The first-generation navigated total knee replacement protocols focused on achieving neutral alignment in the coronal plane. The relevant specification for the navigation system is therefore coronal plane alignment. The target is well established as 0°; the tolerance has also been established as ±3°. Many authors have demonstrated the reliability of navigation in achieving neutral alignment of the lower limb within this specification. However, while navigated total knee replacement has been shown to reduce the number of outliers in terms of alignment, it has not been shown to improve short-term results. This is likely because the chosen specification (knee alignment) for this procedure …