Robot Surgical Application on Orthopedic Surgery

Orthopedics was one of the first areas of surgery in which robot applications were developed. Compared with soft issues, bones are relatively easy to manipulate and deform little during cutting, so image guided techniques are relatively straightforward to implement. The result is that robotic procedures can result in far better agreement with a preoperative plan than with the analogous manual procedure. Orthopedic applications that have received the greatest attention are hip and knee replacement and spinal fusion; additional work is under way in a variety of other areas, including craniofacial reconstruction and fracture treatment.

The replacement of hip joints that have failed as a result of disease or trauma has become common place. The procedure begins with disarticulation of the joint and removal of the proximal head of the femur. A metal and polymer prosthetic cup is then placed in the acetabulum.

In the current manual procedure, the surgeon cuts the cavity by forcing handheld broaches and reamers into the femur, which leaves a rough and uneven surface. The need for improved precision led to the creation of a robotic approach to forming the femoral cavity. Development of the ROBODOC system began in the mid-1980’s, and it is now commercially available in Europe and is undergoing FDA approval trial in United States.

The system provides two advantages. First clinical trials have confirmed that the femoral pocket is more accurately formed. Second, because of the need to provide precise numerical to the robot, preoperative CT images are used to plan the bone-milling procedure.

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