AAOS Now

Published 8/1/2008
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Annie Hayashi

Research symposium integrates diverse technologies

Examines advanced imaging and computer-assisted surgery of the knee and hip

“This was a real experiment,” said Martha Gray, PhD, co-chair of the AAOS/Orthopaedic Research Society Advanced Imaging and Computer-Assisted Surgery of the Knee and Hip (AICKH) research symposium. “It started a critically important conversation that I believe will catalyze new approaches to patient care.”

The symposium brought together orthopaedic clinicians and researchers, radiologists, engineers, and representatives from government agencies and industry manufacturers “to see how we could collectively move these fields forward,” according to Dr. Gray.

“Although the fields of computer-assisted surgery (CAS), musculoskeletal imaging, and advanced imaging would seem quite similar, many participants had never met one another, which is unusual for these types of research meetings,” she commented.

The mission of AICKH
“We brought these diverse disciplines together for a reason: to assess what imaging has taught us about disease etiology and therapeutic delivery and how it applies to CAS and minimally invasive surgical (MIS) procedures in the hip and knee,” said Dr. Gray. The forum was also designed to foster technology integration among advanced imaging, CAS, and MIS.

Another important question confronting attendees was, “How is this going to make a difference to patient care?”

Both Dr. Gray and co-chair Andrew D. Pearle, MD, wanted to keep the focus on improving clinical outcomes for patients and force some difficult questions. As a result, the symposium included sessions ranging from basic science issues to the role of navigation in total hip arthroplasty.

Seeking integrated solutions
“Breakout sessions were used to develop a consensus on future areas of research and address strategies for the quick translation of basic research to patient care,” she explained.

For example, the group charged with examining the future of computer-assisted orthopaedic surgery in 2015 recommended that CAS should be used when training orthopaedic surgeons because it can improve various aspects of surgical techniques.

It also acknowledged, however, that practical improvements must be made to the current technology to enable “better integration of preoperative imaging using dynamic and kinematic imaging tools,” reported Christian Lattermann, MD.

Another group discussed whether knee joint kinematics were esoteric basic science or the next generation of advanced diagnostics and therapeutics. When assessing current technologies that measure joint kinematics, the group believed it was important to balance the “accuracy of measurement” and the “accuracy of reproduction of natural activity.” Fluoroscopy, for example, can provide some measurements with submillimeter accuracy, but cannot measure unrestricted motion with that same degree of accuracy. Similarly, almost all daily activities can be assessed using gait laboratory technology, though not with a high degree of accuracy.

The issue of whether the knee joint can tolerate kinematic change without development of degenerative diseases was also considered. The group advised caution when applying information contained in kinematic studies to clinical practices.

Grant support for the Advanced Imaging and Computer-Assisted Surgery of the Knee and Hip research symposium was received from the Orthopaedic Research and Educational Foundation and the National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health; Conformis and MAKO were industry “gold” sponsors of the event, and additional funding was provided by the Genzyme Corporation.

A supplement to the Journal of Bone and Joint Surgery (JBJS) will be published later this year with the results of the AICKH symposium.

Annie Hayashi is the senior science writer for AAOS Now. She can be reached at hayashi@aaos.org