Computer assisted surgery, custom cutting guides, and other new technology: where are we headed?
As we enter into the era of health care reform with many of the aspects of the new health care legislation beginning to take effect, the introduction of new technology into orthopedic surgery will be once again reviewed. Ten years ago computer-assisted surgery became very popular in the United States. In 2004 and 2005 we performed a study evaluating computer-assisted surgery in total knee arthroplasty. In a multi-center study that we have previously presented, and is submitted for publication, we found that while surgeons improved their technique using computer-assisted surgery, it did not result in improved results or outcomes in over 300 total knee arthroplasties performed.
A meta-analysis of computer-assisted surgery published in 2007 found that alignment of knees and implant position were reliably improved; however, another study published in the Journal of Bone and Joint Surgery in September 2010, from the Mayo Clinic, found that knees with better alignment did not have improved survivorship when compared to knees with less than ideal alignment. This is obviously only one factor in the survivorship of knee replacement but points to the fact that simply putting the implants in correctly does not lead to improved results. The key to total knee arthroplasty is understanding the principles of surgery, appropriate soft tissue balancing, and pre- and postoperative treatment. While computers can be an assist, they do not substitute for knowledge of the procedure and experience.
As we move forward, there will need to be objective data to support the introduction and cost of new technology, and the era of simply buying a new device without data to support its use will probably be challenged.
William P. Barrett, MD