Research Article| Volume 28, SUPPLEMENT 2, 12-30, 1997

Morphological 3-dimensional assessment, pre-operative simulation and rationale of intra-operative navigation in orthopaedic surgery: Practical application for re-orienting osteotomies of the hip joint

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      A few events represent progress in the development of orthopaedic surgery. Imagery, and especially imagery by Roentgen rays, brought up modern orthopaedic surgery about one hundred years ago. So-called conventional radiography also brought with it disadvantages and pitfalls and misinterpretations mostly due to the ‘shadow’ technique of imaging by planar projection of three-dimensional structures. Surgical handling of the locomotor system is basically subject to the physical rules of statics and dynamics. Such handling may (and should today) be preceded by preoperative evaluation and planning using technology which operates within three-dimensional space. Such technologies have been developed recently in the form of computerized radiographic tomography (CT) and computerized nuclear magnetic imaging (MRI). The path to the practical application of these techniques in orthopaedic surgery requires specialized software, the use of which is described here. Such software introduces virtual reality in the interpretation of pathology and simulation of corrective means by osteotomy. Surgical handling in orthopaedic surgery, similar to aircraft navigation, thus gains in reliability and precision and loses some of its adventurous aspect. Using virtual reality in simulating re-orientating osteotomies can also lead to misinterpretation, for example, due to underestimating the role of the soft tissues. Soft tissues can be represented in static views but must be excluded when using intra-operative navigation. The rationale of using three-dimensional imagery has clear limits which have to be respected. Direct visualization of the hard tissue (bone) is mandatory in correction osteotomies even when using interactive image control because of the unknown behaviour of soft tissue under strain. Endoscopic techniques are useful tools, complementing 3-D imaging and image interaction.


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