Computer Assisted Knee Replacement Surgery: Is the Movement Mainstream?
Open accessAbstract
The first computer-assisted Total Knee Arthroplasty (TKA) was performed in 1997. The FDA approved computer assisted knee arthroplasty systems used in the early 2000s. Since then, surgeons and institutions all over the world have gradually adopted the technology. While the computer holds an importance place in the majority of workspaces across all industries, computer-assisted surgical technique has yet to become the preferred tool of the orthopaedic surgeon. Why has "e-instrumentation" not yet substituted conventional instrumentation in TKA orthopaedic surgery? In this article, we argue that main reasons which oppose the use of this technology are based on inaccurate or misleading observations. We isolated the factors likely to explain such opposition to this innovation: current results of total knee replacement, surgeon age, operative time, system ergonomics, cost for users, and cost for suppliers and "disruptive" innovations. Other factors such as surgeon habits, hospital environment and available assistance for support, although relevant, are not discussed. We assessed the advantages and drawbacks, costs and benefits of this technology to assess whether or not this opposition is justified. Finally, we explored the reasons why such a technology may impel surgeons to use this technique or any "related technologies" in the future. The main factors limiting TKA navigation spreading amongst orthopaedic surgeons are ergonomics and economics. Other factors, such as current TKA outcomes and surgeon's age are fallacious arguments in the rebuttal of CAS system use. Computer assisted knee arthroplasty surgery is not yet mainstream, but TKA will not escape technological progress.
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Navigation systems are not widely adopted due to high purchase price despite limited versatility, increased procedural time and cost, and potential for disruptions to surgical workflows due to line-of-sight occlusions or other system complications.
“Unfortunately, navigation systems are not widely adopted due to, among other things, high purchase price despite limited versatility, increased procedural time and cost, and potential for disruptions to surgical workflows due to line-of-sight occlusions or other system complications (Picard et al., 2014; Joskowicz and Hazan, 2016).”
From The Impact of Machine Learning on 2D/3D Registration for Image-Guided Interventions: A Systematic Review and Perspective (2021) · cites this paper as Picard et al., 2014
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Research works printed but not linked: 12
- Lavernia c, Hernandez VH, Hommen JP (2007) Cost Analysis of navigation in JB Stiehl, DiGioia, Anthony M., Rolf G. Haaker, and Werner H. Konermann, eds. Navigation and MIS in orthopedic surgery. Springer.
- Desai, Aravind S, Asterios Dramis, Daniel Kendoff, and Tim N (2011) "Critical review of the current practice for computer-assisted navigation in total knee replacement surgery: cost-effectiveness and clinical outcome." Current reviews in musculoskeletal medicine 4: 11-15.
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- Choong, Peter F, Michelle M Dowsey, and James D. Stoney (2009) "Does accurate anatomical alignment result in better function and quality of life? Comparing conventional and computer-assisted total knee arthroplasty." The Journal of arthroplasty 24: 560-569.
- Parratte, Sebastien, Mark W. Pagnano, Robert T. Trousdale, and Daniel J. Berry (2010) "Effect of postoperative mechanical axis alignment on the fifteen-year survival of modern, cemented total knee replacements." The Journal of Bone & Joint Surgery 92: 2143-2149.
- Bonner TJ, Eardley WG, Patterson P, Gregg PJ (2011) The effect of post- operative mechanical axis alignment on the survival of primary total knee replacements after a follow-up of 15 years. J Bone Joint Surg Br 93: 1217-1222. Citation: Picard F, Clarke J, Deep K, Gregori A (2014) Computer Assisted Knee Replacement Surgery: Is the Movement Mainstream?. Orthopedic Muscul Syst 3: 153. doi:10.4172/2161-0533-3-1000153 Orthopedic Muscul Syst ISSN:2161-0533 OMCR, an open access journal Volume 3 • Issue 2 • 1000153 · DOI
- Bäthis H, Perlick L, Tingart M, Lüring C, Zurakowski D, et al. (2004) "Alignment in total knee arthroplasty A comparison of computer-assisted surgery with the conventional technique." Journal of Bone & Joint Surgery, British Volume 86: 682-687.
- Kalairajah Y, Simpson D, Cossey AJ, Verrall GM, Spriggins AJ (2005) "Blood loss after total knee replacement effects of computer-assisted surgery." Journal of Bone & Joint Surgery, British Volume 87: 1480-1482.
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- Katz, Jeffrey N, Elena Losina, Jane Barrett, Charlotte B Phillips, et al. (2001) "Association between hospital and surgeon procedure volume and outcomes of total hip replacement in the united states medicare population*." The Journal of Bone & Joint Surgery 83: 1622-1629.
- Christensen, Clayton M, Michael E Raynor (2003) The innovator's solution: Creating and sustaining successful growth. Harvard Business Press.
- Laude F, Moreau P, Vie P (2008) "Arthroplastie totale de hanche par voie antérieure de Hueter mini-invasive." Maitrise orthop 178. Citation: Picard F, Clarke J, Deep K, Gregori A (2014) Computer Assisted Knee Replacement Surgery: Is the Movement Mainstream?. Orthopedic Muscul Syst 3: 153. doi:10.4172/2161-0533-3-1000153 · DOI
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Unberath, M., Gao, C., Hu, Y., Judish, M., Taylor, R. H., Armand, M., & Grupp, R. (2021) · Frontiers in Robotics and AI · doi:10.3389/frobt.2021.716007 · Cited by 102 · see citing works
“Unfortunately, navigation systems are not widely adopted due to, among other things, high purchase price despite limited versatility, increased procedural time and cost, and potential for disruptions to surgical workflows due to line-of-sight occlusions or other system complications [8, 9].”
Background
- Authors
- Picard, F.
- Affiliations
- National Health Service (GB)
- Corresponding author
- Picard, Frederic
- ORCID
- Picard, Frederic
- Venue
- Orthopedic & Muscular System
- Publisher
- OMICS Publishing Group
- Published
- 2014
- Volume
- 03
- Issue
- 02
- ISSN
- 2161-0533 (ISSN-L)
- OpenAlex
- W2110246586
- Cited by
- 23
- References
- 0
- Citations by year
- 2025: 2 · 2023: 3 · 2022: 5 · 2021: 4 · 2019: 3 · 2018: 3 · 2017: 1 · 2016: 2
- FWCI
- 0.99
- Type
- journal article
- Language
- en
- Open access
- Licence
- other-oa
- Locations
- Orthopedic & Muscular System (publishedVersion)
- Strathprints: The University of Strathclyde institutional repository (University of Strathclyde) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Surgery › Total Knee Arthroplasty Outcomes
- Health Sciences › Medicine › Surgery › Orthopaedic implants and arthroplasty
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Technology and Human Factors in Education and Health
- Keywords
- computer-assisted surgery, total knee arthroplasty, surgical navigation systems, barriers to adoption, surgeon age, operative time, cost analysis, disruptive innovation
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