Hip Arthroscopy: The Use of Computer Assistance

Background:

Hip arthroscopy is rapidly becoming the mainstay of treatment for femoroacetabular impingement (FAI), but remains technically demanding and has its limitations. The failures of arthroscopic FAI surgery due to inaccurate and inadequate resection are reported to be increasing. Computer-assisted surgery (CAS) can theoretically improve the accuracy and precision of the osseous resections required to treat FAI. It does so by providing a preoperative assessment tool, an intraoperative tracking device, and a robotic-assisted cutting instrument.

Questions/Purposes:

The purpose of this review is to discuss the evolution of CAS to address the current limitations of arthroscopic FAI surgery and propose the features required of the ideal CAS solution for FAI.

Methods:

A computerized keyword search of MEDLINE was performed for studies that investigated the use of computer assistance in FAI surgery. Data was collected on preoperative assessment tools, intraoperative navigation programs, and robotic-assisted execution of FAI surgery.

Results:

Sixty-one articles were identified after the keyword search. Nineteen studies met our inclusion criteria. Thirteen studies were selected to address our study questions: three studies were analyzed for preoperative planning, six for navigated osseous resection, and four for robotic-assisted execution.

Conclusion:

Navigation and robotic-assisted surgery can preoperatively plan and execute osseous resection with greater accuracy compared to freehand techniques, although the clinical success and cost-effectiveness has yet to be demonstrated. The ideal CAS solution must be able to virtually plan a resection, guide the surgeon towards accurate execution of the plan, and facilitate post-resection assessment of the adequacy of resection.