Saturday, February 26, 2005
CAOS improves patient care and surgeon accuracyThe use of computer-assisted orthopaedic surgery (CAOS), anticipated improvements and its potential to improve patient care were discussed yesterday at a media briefing panel. Panelists included: Richard A. Berger, MD, assistant professor of orthopaedic surgery at Rush Presbyterian-St. Luke's Medical Center, Chicago; S. David Stulberg, MD, professor of clinical orthopaedics and director of the Joint Reconstruction and Implant Surgery at Northwestern Memorial Hospital, Chicago; Anthony M. DiGioia, III, MD, director of the Institute for Computer Assisted Orthopaedic Surgery at The Western Pennsylvania Hospital, Pittsburgh; and William J. Hozack, MD, professor of orthopaedic surgery at Thomas Jefferson Medical School, Rothman Institute of Orthopedics, Philadelphia.
CAOS augments current joint replacement procedures and provides surgeons with instant information and feedback. This enables more accurate decision-making and surgical procedures with potentially fewer complications for patients.
An evolving technology, CAOS not only provides orthopaedic surgeons with better accuracy in regard to the position and orientation of prosthetic components, but also enables surgeons to make more informed decisions during the operation. According to Dr. Berger, the use of CAOS in orthopaedics is still considered somewhat 'under the radar.'
"As CAOS technology becomes easier to use and receives greater recognition in terms of how it enhances surgical procedures, it will be more widely adopted by the orthopaedic community," he said.
Dr. Stulberg said that CAOS is an extremely reliable tool for assisting the surgeon in increasing not only the accuracy, but also the reproducibility of a procedure. "The most important advantage CAOS offers surgeons is the ability to determine how well we are implanting knee and hip replacements. This understanding allows us to relate the results to clinical outcomes, and to develop a clearer understanding of the longevity of the devices we use in orthopaedic surgical procedures."
In addition to enhancing patient safety and favorable outcomes post-surgery, CAOS is also a potentially powerful tool for education. It also allows surgeons to access the accuracy of cuts that are made during surgery and can actually assist surgeons in improving their sawing techniques, which can be very helpful.
Currently, CAOS systems cost up to $250,000, which can pose a possible drawback for some medical institutions and smaller hospitals. Also, because computers are in their infancy and improvements are still in the pipeline, setting up these systems can actually add operative time, which is a consideration. The longer surgery takes, the more blood lost and the greater the risk of infection. Some component parts are bulky, too, although smaller parts are expected within one to two years.
Dr. DiGioia, who is considered one of the pioneers of CAOS, views CAOS and other navigational tools as an effective means for surgeons to measure and document what they do during surgery, and to examine the effects of the surgery on the patient postoperatively. In his hospital, this data is then fed into the Total Joint Registry-a database of more than 1,940 patients who have been enrolled in this program. "This information can ultimately be used to directly relate whatever surgical technique has been performed to the outcome of an individual patient," he said. "By 'closing the loop,' we can determine the best treatment for the next patient."
Newer CAOS-based tools, including ultrasonic technologies and electromagnetic tracking systems, are already in the developing stages. "We are just scratching the surface, as my prediction is that minimally invasive procedures, with CAOS, will be combined with tissue engineering within about 10 years or less," said Dr. DiGioia. "This would enable surgeons to perform biologic resurfacing of patients' joints using their own bone and cartilage as implants instead of the metal, ceramic or plastic versions in use today."
"The only negative I see is when a surgeon thinks a computer is going to perform the operation, forgetting that surgery truly is an art. Surgeons still need to make decisions for themselves," added Dr. Hozack. He sees CAOS technologies as a possible catalyst for improving chances of best results of joint replacement procedures for his patients. "If I had a choice between two surgeons who I respected equally, and only one used CAOS, I would choose the surgeon who used CAOS. But it's the surgeon who makes the biggest difference."