From scans to sutures: computer-assisted orthopedic surgery in the twenty-first century

Computer-assisted surgery is the process of using medical images, such as CT scans, X-ray fluoroscopy, or 3D ultrasound, to improve patient care. A typical surgical procedure begins by acquiring and processing a CT scan with specially developed image-analysis software. A surgeon then performs a "virtual surgery" on the patient to develop a preoperative plan. In the operating room the medical image is registered to the patient's anatomy by finding an optimal rigid-body transformation. This transformation allows an object or motion in one coordinate frame to be represented in the other frame, and thus a surgeon can visualize the location of an instrument deep within concealed anatomy while avoiding structures at risk. The operating surgeon can also use computer-tracked fluoroscopy or ultrasound for 3D guidance. For the past seven years, our interdisciplinary research group has been investigating fundamental problems in orthopedic surgery of bones and joints. This paper is an overview of the problems and solutions that have been tested in a set of pilot clinical trials in which we have treated more than 250 patients for early or advanced arthritis, poorly healed bone fractures, and treatment of deep bone tumors.