April 2003
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Computer surgery maps 'route' to perfect knee replacement
By Carol Wittman
Just as global positioning systems (GPS) help drivers arrive at exact destinations in the world, a similar computerized system is helping an orthopedic surgeon pinpoint the perfect alignment for new knee prostheses.
David Lionberger, MD, an associate professor of orthopedics at Baylor College of Medicine and an orthopedic surgeon at The Methodist Hospital in Houston, is one of 11 surgeons in the country who uses a new computer-assisted orientation system to guide his progress in knee replacement surgery. Lionberger, who performs 25 to 30 surgeries a month using this technique, will soon offer training at Baylor for orthopedic surgeons in the southwestern United States.
“It’s
making a dramatic change in the way we perform surgery now,” said
Lionberger. “Not since the advent of X-ray have we seen such an
advance in orthopedic surgery. With this computerized system, we can position
new knees with greater accuracy than ever. When patients have perfect
knee alignment, they have improved range of motion and shorter rehabilitation
times.”
In the operating room, Lionberger connects three trackers with attached
cameras to the patient’s pelvis, femur and tibia (two bones in the
leg). As he moves the femur, a three-dimensional image appears on a computer
screen that plots the perfect coordinates where the new knee will go.
At the close of surgery, the system produces a printout showing the patient’s
range of motion prior to surgery and following surgery.
When Sharon Gouger came to Lionberger for her first knee replacement surgery
in 2001, she had lost the cartilage that cushioned her knees. She literally
was grinding bone-on-bone and was taking painkillers to ease her constant
pain. At that time, Lionberger performed her surgery by using conventional
measurement tools to align the new knee properly.
“He did a good job with the surgery, but rehabilitation seemed to take a long time,” said Gouger. “I had some outside rehab, and I also worked with a therapist at home. Even though I needed my other knee replaced, it took about a year and a half before I could face another surgery.”
By the time Lionberger performed Gouger’s second knee replacement
surgery, he had adopted the new computer-assisted method.
“Everything seemed to go faster this time around. It seemed that
the actual surgery took less time. And, my rehab is progressing at a better
pace than the first time. Now at four months after the second surgery,
I’m much farther along in my rehabilitation than I was after six
months the first time,” said Gouger.
“With traditional knee replacement techniques, surgeons have difficulty
finding the correct knee orientation,” said Lionberger. “Working
in the knee tissue is like a pilot flying in clouds without instruments
to tell him where to land. The computer system eliminates human error
and selects the correct knee orientation regardless of the amount of tissue.”
As knowledge increases, Lionberger predicts the system will be used in all major metropolitan cities. And, not far into the future, it could be standard equipment for most knee surgeons.
“We’re only using it for knees now, but it has great possibilities
for total hip replacement, trauma and minimally invasive surgeries with
small incisions,” he said.
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