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BMJ  2004;328:426 (21 February), doi:10.1136/bmj.328.7437.426-e
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Orthopaedic and Trauma Surgery

News extra

Surgeons introduce computer assisted, minimally invasive surgery for hip replacement

Jerusalem Judy Siegel-Itzkovich

A team of surgeons in Jerusalem have introduced the use of computer assisted, minimally invasive surgery for hip replacement—a technology that eliminates the need to cut muscles and tendons and results in optimally accurate preparation and insertion, less pain, quicker recovery, and shorter hospitalisation. Until now, computer navigation has been used only partially for knee joints and dealing with trauma to other limbs, but not for total hip replacement.

Orthopaedic surgeons at Hadassah University Medical Centre were invited by Zimmer and Medtronics, a US company that makes artificial hip and computer navigation equipment, to be the first people to use the hardware and software for hip surgery. They have now used it on four patients.

"We have a great deal of experience using computer navigation for helping us perform surgery on terror attack and other trauma victims," explained Professor Meir Liebergall, head of the orthopaedics departments at Hadassah’s two Jerusalem campuses, who, along with Dr Yoav Matan, head of the joint replacement unit at the Mount Scopus Hospital, led the Israeli team.

"Ours became one of the world’s most experienced [departments] in the use of fluoroscope x rays combined with computer assisted surgery for trauma."

The Hadassah team used the benefits of the immediate fluoroscopic images from different angles to make a three dimensional configuration for hip surgery. "We wanted the computer hardware and software so we could make a pair of small incisions, each three to five centimetres long—one for the metallic acetabulum and the other for the stem going into the femur. Because the incision is so small, surgeons can’t see into the patient’s body to drill a round hole to fit the acetabulum and another for the stem, thus computer navigation is essential." The skin is elastic enough to let the artificial hip, about 6 cm at its widest, pass through.

An accurate, three dimensional virtual picture of the area of the body to be operated on appears on a computer screen in front of the surgeons from the beginning of the operation to the end. This is made possible by special infrared bone tracking sensors attached to the body that transmit data on the location of the hip joint and a fluoroscope that provides the basis of the virtual picture by transmitting an x ray image of the hip. These guide the surgeons in positioning the metallic artificial hip joint with a display of the exact coordinates of the surgical angle and location at which the implant should be placed. The exactitude minimises or even eliminates the risks of dislocation, loosening, and leg length discrepancies.

"The technology does not perform the surgery like a robot; we do the work, but it is an excellent tool to perform the operation most accurately," Dr Matan added. "It will also help us teach less experienced orthopaedic surgeons much more quickly how to perform the surgery without having to rely only on their judgment."
 

Rapid Responses:

Read all Rapid Responses

Minimally invasive total hip replacement-Ideal in selected cases but Neither applicable nor feasible in majority of instances.
Sashi Kommu
bmj.com, 25 Feb 2004 [Full text]
Minimally invasive total hip replacement-Ideal in selected cases but Neither applicable nor feasible in majority of instances.
Sashi Kommu
bmj.com, 28 Feb 2004 [Full text]


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Orthopaedic and Trauma Surgery


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