Dr. De Smet Discusses Computer Navigation for Hip Resurfacing Surgery

[Pat Walter]

DEAR PAT

WHAT ABOUT NAVIGATION

Today navigation is still a tool that is not easy to use and that needs a certain learning curve as resurfacing itself also has.

So it is not a useful tool today for resurfacing beginners, where it should be! It would be nice if it would be a help at the start of the learning curve.

So can somebody with experience use it or should they use it?

It is like doing a certain approach and having experience with it, so it feels better and confident.

Most of the experienced surgeons do feel they do not need it. MAYBE it could help.

BUT there are some things that have to be cleared out still today:

• there is no correlation in most of the systems between head and cup.
  
• Most of the systems only look to the head, and nobody can tell us today what is now the best place to put the implant
  
• It would be the best to use it for the cup because there we have the most failures!
  

     
BUT AGAIN the most problems will be with females, that easily have twisted pelvis on the table and smaller sizes, and it is not sure it will have a big influence here.

If it is a system with preop CT of the pelvis to do the acetabulum, the pictures are taken in SUPINE (lying down position!). The patients walk and run on their hips, they do not lie on them, and that can make a complete difference!

So we are not there yet, if something could help me to do better surgery it would be navigation, but as it is today, it is not a 100% proven project. I have today so designed instruments that I call it navigation without navigation; of course in other sites navigation really could help!

I do not know if the 7 malpositioned cups in my series of 3000 would have benefited with navigation, possibly yes, but maybe would have had others where then the placement was worse?

It is the future?, maybe, but not there yet at present for everybody. That is why not everybody is using it, not just because we would be to lazy, to old, to stubborn or whatever.

If it would be used tomorrow in all cases from the start, the worry is also there, that if the navigation fails we do not know anymore what to do. All these facts should not be used for marketing or publicity issues but left to the orthopaedic community to make it better, try it and try to succeed better, what prof.Cobb, myself and all others I think try to do.

KOEN 

koen de smet

hipsurgeon amc gent krijgslaan 181 9000 GENT BELGIUM +3292525903 www.heup.be

anca clinic roma valle giulia ROMA ITALY www.ancaclinic.it