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DEAR PAT
WHAT ABOUT NAVIGATION
Today navigation is still a tool that is not easy to use and
that needs a certain learning curve as resurfacing itself
also has.
So it is not a useful tool today for resurfacing beginners,
where it should be! It would be nice if it would be a help
at the start of the learning curve.
So can somebody with experience use it or should they use
it?
It is like doing a certain approach and having experience
with it, so it feels better and confident.
Most of the experienced surgeons do feel they do not need
it. MAYBE it could help.
BUT there are some things that have to be cleared out still
today:
- there is no correlation in most of the systems between
head and cup.
- Most of the systems only look to the
head, and nobody can tell us today what is now the best
place to put the implant
- It would be the best to use it for the cup because
there we have the most failures!
BUT AGAIN the most problems will be with females, that
easily have twisted pelvis on the table and smaller sizes,
and it is not sure it will have a big influence here.
If it is a system with preop CT of the pelvis to do the
acetabulum, the pictures are taken in SUPINE (lying down
position!). The patients walk and run on their hips, they do
not lie on them, and that can make a complete difference!
So we are not there yet, if something could help me to do
better surgery it would be navigation, but as it is today,
it is not a 100% proven project. I have today so designed
instruments that I call it navigation without navigation; of
course in other sites navigation really could help!
I do not know if the 7 malpositioned cups in my series of
3000 would have benefited with navigation, possibly yes, but
maybe would have had others where then the placement was
worse?
It is the future?, maybe, but not there yet at present for
everybody. That is why not everybody is using it, not just
because we would be to lazy, to old, to stubborn or
whatever.
If it would be used tomorrow in all cases from the start,
the worry is also there, that if the navigation fails we do
not know anymore what to do. All these facts should not be
used for marketing or publicity issues but left to the
orthopaedic community to make it better, try it and try to
succeed better, what prof. Cobb, myself and all others I
think try to do.
KOEN
koen de smet
hipsurgeon amc gent krijgslaan 181 9000 GENT BELGIUM
+3292525903 www.heup.be
anca clinic roma valle giulia ROMA ITALY
www.ancaclinic.it
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