There are many indications that computer aided surgery has a major role to play in improving results in orthopaedic surgery, says Dr. Stefano Zaffagnini, who has played a pioneering role in the use of this technology and who moderates a symposium on this theme at the Congress of the European Federation of National Associations of Orthopaedics and Traumatology (EFORT), taking place from June 3 to 6 in Vienna, with more than 8,000 participants from around the world. This technology should allow total knee prosthesis using minimally invasive surgery to become a standard procedure within a decade. Osteotomy and hip operations are only two of the many other fields where computer aided surgery can also markedly improve results for patients, experts state at the EFFORT Congress in Vienna.

A computer record: better training

Another important aspect of computer aided surgery is that it provides an immediate record of the surgeon's work, thus allowing better reproducibility of results. With this technology, surgeons in future will be better able to document and describe procedures undertaken. "The advantages in teaching other doctors are clearly evident," says Dr. Zaffagnini. A semi-automatic device has been developed that simulates surgical procedures. This allows objective evaluation of a doctor's skills. It should also allow trainee doctors to be thoroughly examined before they are licensed as surgeons.

High costs are an obstacle; research potential is important

Experts at the EFORT Congress also discuss problems facing doctors in many European countries: A major obstacle to the wider use of this important new technology is its cost, at between 50,000 and 80,000 USD per machine. It is mainly in use in university hospitals and teaching centres. However, since its availability is at the moment limited, it is important that it is located in these institutions, as computer aided surgery also has a significant role to play in research, Dr. Zaffagnini stresses. Its potential is being tapped in developing less invasive surgical techniques in many areas, and it can be hoped that as these spread and the technology becomes more surgeon-friendly, the cost of the technology may come down. Computer aided surgery, says Dr. Zaffagnini, is "like augmented reality" allowing the surgeon to "see" better what he is doing during an operation. "Outcomes, for instance in knee arthroscopy, are significantly improved, and it is fair to say that computer aided surgery in general promises much higher quality of results."

An example discussed at the EFORT Congress in Vienna is total knee arthoplasty, in which optimal mechanical alignment with the leg is crucial. A more than 3% lack of alignment contributes to failure of the prosthesis. "With computer aided surgery, the alignment is checked by the computer," says Dr. Zaffagnini, "giving optimal results." This translates directly into better movement for patients and reduced failure rates.

Ligaments and laxity: each knee is different

In treatment of ligaments, computer aided surgery helps a greater understanding of the instability in the case of each patient. "Every knee is different," says Dr. Zaffagnini, "and if the doctor can characterise the degree of laxity before surgery, that information can decide how he or she proceeds. This in effect means customized surgery for each patient."

Improvements in the technology are desirable

At the moment, though computer aided surgery already clearly offers great potential, there is also room for improvement in the technology involved, as experts discuss at the EFFORT Congress. "The system needs to become more elastic," says Dr. Zaffagnini, "with greater surgeon input." At the moment programs offer a wealth of imagery, in some cases too much, and not necessarily what the surgeon needs. There is a need for some simplification in the volume of imagery the technology delivers to the surgeon.

Source
EFORT