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Präzision in der orthopädischen Computernavigation

Precision in orthopaedic computer navigation

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Zusammenfassung

Die Navigation findet vermehrt Zuspruch in der orthopädischen und unfallchirurgischen operativen Versorgung, insbesondere im Bereich der Endoprothetik. Vereinfachungen und die Nutzung bildfreier Navigationsmodule ermöglichen eine deutliche Komfortverbesserung für den Operateur. Die Präzision des Navigationssystems ermöglicht prinzipiell Korrekturen bzw. Implantatausrichtungen innerhalb eines 1°- bzw. 1-mm-Bereichs. Untersuchungen der derzeit genutzten Algorithmen zur Registrierung der mechanischen Beinachse und der Gelenkflächen zeigen reproduzierbare und valide Ergebnisse.

Mithilfe der Navigation gelingt eine exaktere Platzierung von Hüft- und Knieendoprothesen mit einer deutlichen Reduktion der Varianz gegenüber der konventionellen Technik. Ähnliches gilt für die Navigation der tibialen Umstellungsosteotomie, die Korrektur der mechanischen Beinachse wird genauer im Bezug zur präoperativen Planung und reproduzierbarer im Vergleich zur konventionellen Technik. Groß angelegte prospektive Studien im Vergleich zur konventionellen Technik liegen bisher nur für die Knie-TEP-Navigation vor. Ob tatsächlich mithilfe der verbesserten Prothesenplatzierung längere Standzeiten resultieren, werden die nächsten Jahre zeigen. Prospektiv randomisierte Studien sind hier prinzipiell für alle navigierten Operationen und Techniken notwendig.

Abstract

Navigation has become increasingly integrated into orthopaedic surgery, especially in the area of endoprosthetic procedures. Simplification of the instrumentation along with the use of imageless systems has increased the ease of use for the orthopaedic surgeon. Principle navigation systems enable an accuracy of corrections and alignments within intervals of 1 mm or 1°. Consequently, potential intra- and interobserver failures during the registration procedure typically range within a few millimetres or degrees. Analysis of the actual algorithms used for the registration process of the lower extremity mechanical axis and the articular surfaces reveal valid and reproducible results.

With the help of navigation, it is possible to achieve a higher degree of precision in total hip and knee implant placement, including a distinct reduction in variance as compared to conventional techniques. Similarly, application of navigation during a high tibial osteotomy or at the osteotomy of the distal radius also enables a more precise correction of the axis of the affected extremity, in addition to improved reproducibility. Despite these promising early results, large prospective clinical studies comparing conventional techniques versus computer assisted navigation are thus far only available for total knee arthroplasty. Whether navigated prosthesis placement can truly extend the longevity of an implant will require continued observation in the years to come. In addition, further prospective studies are required to determine the benefit of navigation in other orthopaedic procedures.

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Authors and Affiliations

  1. Unfallchirurgische Klinik, Medizinische Hochschule, Carl Neubergstraße 1, 30625, Hannover, Deutschland

    T. Hüfner,  D. Kendoff, M. Citak, J. Geerling & C. Krettek

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  1. T. Hüfner
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  2. D. Kendoff
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  3. M. Citak
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Correspondence to T. Hüfner.

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Hüfner, T., Kendoff, D., Citak, M. et al. Präzision in der orthopädischen Computernavigation. Orthopäde 35, 1043–1055 (2006). https://doi.org/10.1007/s00132-006-0995-x

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