Skip to main content
SpringerLink
Log in

Hip Arthroscopy: The Use of Computer Assistance

  • Review Article
  • Published:
HSS Journal ®

Abstract

Background:

Hip arthroscopy is rapidly becoming the mainstay of treatment for femoroacetabular impingement (FAI), but remains technically demanding and has its limitations. The failures of arthroscopic FAI surgery due to inaccurate and inadequate resection are reported to be increasing. Computer-assisted surgery (CAS) can theoretically improve the accuracy and precision of the osseous resections required to treat FAI. It does so by providing a preoperative assessment tool, an intraoperative tracking device, and a robotic-assisted cutting instrument.

Questions/Purposes:

The purpose of this review is to discuss the evolution of CAS to address the current limitations of arthroscopic FAI surgery and propose the features required of the ideal CAS solution for FAI.

Methods:

A computerized keyword search of MEDLINE was performed for studies that investigated the use of computer assistance in FAI surgery. Data was collected on preoperative assessment tools, intraoperative navigation programs, and robotic-assisted execution of FAI surgery.

Results:

Sixty-one articles were identified after the keyword search. Nineteen studies met our inclusion criteria. Thirteen studies were selected to address our study questions: three studies were analyzed for preoperative planning, six for navigated osseous resection, and four for robotic-assisted execution.

Conclusion:

Navigation and robotic-assisted surgery can preoperatively plan and execute osseous resection with greater accuracy compared to freehand techniques, although the clinical success and cost-effectiveness has yet to be demonstrated. The ideal CAS solution must be able to virtually plan a resection, guide the surgeon towards accurate execution of the plan, and facilitate post-resection assessment of the adequacy of resection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Advincula AP. Surgical Techniques: Robot-Assisted Laparoscopic Hysterectomy with the da Vinci Surgical System. International Journal of Medical Robotics and Computer Assisted Surgery. 2006;2: 305–311.

    Article  PubMed  CAS  Google Scholar 

  2. Almoussa S, Barton C, Speirs AD, Gofton W, Beaule PE. Computer-assisted correction of cam-type femoracetabular impingement. A sawbones study. J Bone Jt Surg Am. 2011;93(Suppl 2):70–75.

    Article  Google Scholar 

  3. Beaule PE, Le Duff MJ, Zaragoza E. Quality of life following femoral head-neck osteochondroplasty for femoroacetabular impingement. J Bone Joint Surg Am. 2007;89:773–9.

    Article  PubMed  Google Scholar 

  4. Bedi A, Chen N, Robertson W, Kelly BT. The management of labral tears and femoroacetabular impingement of the hip in the young, active patient. Arthroscopy 2008;24:1135–45.

    Article  PubMed  Google Scholar 

  5. Bedi A, Zaltz I, De La Torre K, Kelly BT. Radiographic comparison of surgical hip dislocation and hip arthroscopy for treatment of cam deformity in femoroacetabular impingement. Am J Sports Med. 2011;39(Suppl):20–28.

    Article  Google Scholar 

  6. Botser IB, Smith TW Jr, Nasser R, Domb BG. Open Surgical Dislocation Versus Arthroscopy for Femoroacetabular Impingement: A Comparison of Clinical Outcomes. Arthroscopy. 2011;27(2):270–278.

    Article  PubMed  Google Scholar 

  7. Brunner A, Horisberger M, Herzog RF. Evaluation of a Computed Tomography-Based Navigation System Prototype for Hip Arthroscopy in the Treatment of Femoroacetabular Cam Impingement. Journal of Arthroscopy. 2009;25(4):382–391.

    Article  Google Scholar 

  8. Cartiaux O, Paul L, Docquier P, Raucent B, Dombre E, Banse X. Computer-Assisted and Robot-Assisted Technologies to Improve Bone-Cutting Accuracy when Integrated with a Freehand Process Using an Oscillating Saw. J Bone Joint Surg Am. 2010;92:2076–82.

    Article  PubMed  Google Scholar 

  9. Clohisy JC, Nunley RM, Otto RJ, Schoenecker PL. The frog-leg lateral radiograph accurately visualized hip cam impingement abnormalities. Clin Orthop Relat Res. 2007;462:115–121.

    Article  PubMed  Google Scholar 

  10. Cobb J, Henckel J, Gomes P, et al. Handson robotic unicompartmental knee replacement: a prospective, randomized controlled study of the acrobat system. J Bone Joint Surg Br 2006;88:188–197.

    PubMed  CAS  Google Scholar 

  11. Dolan MM, Heyworth BE, Bedi A, Duke G, Kelly BT. CT reveals a high incidence of osseous abnormalities in hips with labral tears. Clin Orthop Relat Res. 2011;469(3):831–8.

    Article  PubMed  Google Scholar 

  12. Ecker TM, Puls M, Steppacher SD, Bastian JD, Keel MJB, Siebenrock KA, Tannast M. Computer Assisted Femoral Head-Neck Osteochondroplasty Using a Surgical Milling Device. The Journal of Arthroplasty. 2012;27(2):310–316.

    Google Scholar 

  13. Haaker RGA, Tiedjen K, Ottersbach A, Rubenthaler F, Stockheim M, Stiehl J. Comparison of Conventional versus Computer-Navigated Acetabular Component Insertion. Journal of Arthroplasty. 2007;22(2):151–159.

    Article  PubMed  Google Scholar 

  14. Heyworth BE, Shindle MK, Voos JE, Rudzki JR, Kelly BT. Radiologic and Intraoperative Findings in Revision Hip Arthroscopy. Arthroscopy. 2007;23:1295–1302.

    Article  PubMed  Google Scholar 

  15. Kather J, Hagen ME, Morel P, Fasel J, Markar S, Schueler M. Robotic Hip Arthroscopy in Human Anatomy. International Journal of Medical Robotics and Computer Assisted Surgery. 2010;6:301–305.

    Article  PubMed  Google Scholar 

  16. Konan S, Rhee SJ, Haddad FS. Hip arthroscopy: analysis of a single surgeon's learning experience. J Bone Joint Surg Am. 2011;93(Suppl 2):52–6.

    Article  PubMed  Google Scholar 

  17. Kubiak-Langer M, Tannast M, Murphy SB, Siebenrock KA, Langlotz F. Range of motion in anterior femoroacetabular impingement. Clin Orthop Relat Res. 2007;458:117–124.

    PubMed  CAS  Google Scholar 

  18. Larson CM, Giveans MR. Arthroscopic management of femoroacetabular impingement: early outcome measures. Arthroscopy 2008;24:540–546.

    Article  PubMed  Google Scholar 

  19. Mardones RM, Gonzalez C, Chen Q, Zobitz M, Kaufman KR, Trousdale RT. Surgical Treatment of Femoroacetabular Impingement: Evaluation of the Effect of the Size of the Resection. Journal of Bone and Joint Surgery Am. 2006;87(2):273–279.

    Article  Google Scholar 

  20. Matsuda DK. Acute iatrogenic dislocation following hip impingement arthroscopic surgery. Arthroscopy 2009;25:400–404.

    Article  PubMed  Google Scholar 

  21. Monahan E, Shimada K. Computer-aided navigation for arthroscopic hip surgery using encoder linkages for position tracking. Int J Med Robot 2006;2:271–278.

    Article  PubMed  Google Scholar 

  22. Monahan E, Shimada K. Verifying the effectiveness of a computer-aided navigation system for arthroscopic hip surgery. Stud Health Technol Inform. 2008;132:302–307.

    PubMed  Google Scholar 

  23. Nötzli HP, Wyss TF, Stoecklin CH, Schmid MR, Treiber K, Hodler J. The Contour of the Femoral Head-Neck Junction as a Predictor for the Risk of Anterior Impingement. Journal of Bone and Joint Surgery Br. 2002;84-B(4): 556–560.

    Article  Google Scholar 

  24. Pfirrmann CW, Mengiardi B, Dora C, Kalberer F, Zanetti M, Hodler J. Cam and pincer femoroacetabular impingement: Characteristic MR arthrographic findings in 50 patients. Radiology. 2006;240:778–785.

    Article  PubMed  Google Scholar 

  25. Philippon MJ, Schenker ML, Briggs KK, Kuppersmith DA, Maxwell RB, Stubbs AJ. Revision Hip Arthroscopy. Am J Sports Med. 2007;35:1918–1921.

    Article  PubMed  Google Scholar 

  26. Puls M, Ecker TM, Tannast M, Steppacher SD, Siebenrock KA, Kowal JH. The equidistant method—a novel hip joint simulation algorithm for detection of femoroacetabular impingement. Comput Aided Surg. 2010;15(4–6):75–82.

    Article  PubMed  Google Scholar 

  27. Ranawat A, Kang H, Kasodekar S, Nortman S, Jones JA, Conditt MA. Accuracy of Robotic-Assisted Femoral Osteochondroplasty for Treatment of FAI. [Accepted as podium presentation at Orthopedic Research Society 2012 Annual Conference, San Francisco, USA].

  28. Ranawat AS, McClincy M, Sekiya JK. Anterior dislocation of the hip after arthroscopy in a patient with capsular laxity of the hip. A case report. J Bone and Joint Surg Am. 2009;91:192–7.

    Article  Google Scholar 

  29. Rudolph T, Puls M. MARVIN: a Medical Research Application Framework Based on Open Source Software. Computed Methods Programs Biomed. 2008;91:165.

    Article  Google Scholar 

  30. Stahelin L, Stahelin T, Jolles BM, Herzog RF. Arthroscopic Offset Restoration in Femoroacetabular Cam Impingement: Accuracy and Early Clinical Outcome. Arthroscopy. 2008;24(1):51–57.

    PubMed  Google Scholar 

  31. Sussman PS, Ranawat AS, Lipman J, Lorich DG, Padgett DE, Kelly BT. Arthroscopic Versus Open Osteoplasty of the Head-Neck Junction: A Cadaveric Investigation. Arthroscopy. 2007;23:1257–1264.

    Article  Google Scholar 

  32. Tannast M, Kubiak-Langer M, Langlotz F, Puls M, Murphy SB, Siebenrock KA. Noninvasive Three-Dimensional Assessment of Femoroacetabular Impingement. Journal of Orthopaedic Research. 2006;25(1):122–131.

    Article  Google Scholar 

  33. Weng YJ, Hsu RW, Hsu WH. Comparison of Computer-Assisted Navigation and Conventional Instrumentation for Bilateral Total Knee Arthroplasty. J Arthroplasty. 2009;24(5):668–673.

    Article  PubMed  Google Scholar 

Download references

Conflict-of-Interest:

Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, and patent/licensing arrangements) that might pose a conflict of interest in connection with the submitted article. One or more of the authors have or may receive payments or benefits from a commercial entity that may be perceived as a potential conflict of interest.

Human/Animal Rights: N/A.

Informed Consent: N/A.

Author information

Authors and Affiliations

  1. Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Danyal H. Nawabi MD, FRCS (Orth), Denis Nam MD, Caroline Park BA & Anil S. Ranawat MD

  2. Weill Medical College of Cornell University, New York, NY, 10065, USA

    Anil S. Ranawat MD

Authors
  1. Danyal H. Nawabi MD, FRCS (Orth)
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Denis Nam MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Caroline Park BA
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anil S. Ranawat MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anil S. Ranawat MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Nawabi, D.H., Nam, D., Park, C. et al. Hip Arthroscopy: The Use of Computer Assistance. HSS Jrnl 9, 70–78 (2013). https://doi.org/10.1007/s11420-012-9313-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11420-012-9313-9

Keywords

Search

Navigation