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I am Chair of Orthopaedics at Imperial College in London and have a research team working on nothing but hip resurfacing. Our particular interest is in doing the operation exactly right: we plan each operation with a CT scan, which enables us to plan precisely. We then navigate in surgery to achieve that plan. I append a couple of pics of a plan and a post op xray to show you the idea.

I appreciate that this is a patient driven site, but thought you might be interested..

Justin Cobb

 

I was at the Annapolis conference last week and listened with great interest to the discussions on this topic. As you can well imagine the navigation companies have been trying very hard to sell their equipment to the hospitals. I have resisted thus far because I never felt the cost was justified in either total knees or primary stemmed hips because the anatomy is easily directly visualized and my accuracy was already excellent in placing the components with the available instruments.

For resurfacing the anatomy is not so easily visualized because the pin is placed in the center of the femoral neck and can't be directly visualized. Additionally the neck is not fully visualized because the capsular attachments are preserved to maintain blood supply to the femoral head.

I went back this week and reassessed my pin placements on my first 50
resurfs and found that my pin placement was very accurate and that all the pins that were more then 2 degrees off ideal (total of 2) were in the first 10 cases. That said there have been a few times where although the pins were placed accurately I was a little unsure until the post op x-ray confirmed things. There are a number of ways to check placement with the neck feeler gauges prior to reaming over the pin and once one learns how to do this it works well. As I have done more I now rarely have those feelings of uncertainty and would agree that computer navigation might not offer much at this stage.

The role I see for navigation is in a surgeons early cases not to be the only way to place the pin but rather as a way to check placement of a conventionally placed pin to confirm proper position and allow repositioning if needed. That would prevent misplacement in the early cases while allowing a surgeon to gain experience and confidence in conventional pin placement.

Although I am now confident in my pin placements I am going to try a navigation system once or twice just to see. After that the hospital would need to buy the system and for now I don't think the cost will be justified. I will keep everyone informed of my opinions after I give it a try.

Scott Rubinstein M.D.
Illinois Bone and Joint Institute
Chicago, Illinois
 

Dr. Bose

I was one of the first to try out computer aided surgery for resurfacing. This has no advantage except in patient who have had previous surgery like a osteotomy . It has a very important disadvantage of removing all the capsule and soft tissues on the neck of the femur ( to take a computer reading known as bone morphing). This will compromise blood supply. I have to say that currently for resurfacing computer aided navigation is only a marketing tool for surgeons/ companies. Computer aided navigation is very beneficial in knee replacements where one has to align the knee components to the hip and ankle and I use it routinely for knee replacements.

Wishing you the very best

With best regards
Vijay bose
chennai
 

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