Surgical navigation in adult reconstruction surgery: techniques and clinical experience

A surgeon's first response to the concept of computer-assisted orthopaedic surgery may be a sense of lost autonomy. However, a system need not and should not be designed to this end. Using the computational ability of the computer system to see beyond the human eye to view the knee with full kinematic dimensions, surgeons have recently made progress in the areas of computer-assisted ligament balancing and in using smart tools for minimally invasive surgery. Full comprehension of the use of any navigational system must begin with the understanding that the system can provide feedback that is based on only specifically programmed computer code. In referring to or locating a point or axis, the computer programmer must create an absolutely reliable methodology for determining that point or axis. Expecting the computer to achieve certain functionalities when physicians have no ironclad method to achieve such functionalities exposes the true limitations of any computer-assisted process. Although the computer generates a methodology, the process of computer-assisted surgery requires that the surgeon be constantly vigilant in analyzing the feasibility of these responses. Those instrumental in the development and implementation of computer-assisted surgical techniques must ensure that measurements are valid, precise, and reproducible across subjects and users. Prospective users of computer-assisted techniques must ensure that each of these issues has been addressed before agreeing to use the system in standard practice. Once due consideration has been given to all aspects of use, and the limitations of the system are known, the benefits of computer assistance are easily understood.