Dr. Gross Discusses Computer Navigation for Hip Resurfacing

[Pat Walter]

Dear Pat,

Thank you for the work you do, it helps so many. Computer aided navigation is an interesting concept. However, there is no evidence that it leads to better clinical outcomes and fewer failures. On the other hand, there is ample evidence that surgeon experience has a dramatic effect on outcomes and complications. 

One way to conceptulize this is that the experienced surgeon’s brain is a computer with much more sophisticated "software" than a navigation computer. When a computer is programmed, an algorithm must be created which has certain inherent limitations. Furthermore additional significant sources of errors are introduced by the registration of anatomic points for the navigation computer in surgery. 

My personal opinion is that navigation that is based on a pre-operative CT scan data, which is being pioneered by Justin Cobb, has tremendous promise in the future to improve the results. At this point, we are still in the early development phase. It will probably add several thousand dollars to the cost of each operation. 

In summary, I believe the right kind of navigation surgery based on accurate 3D CT scans holds tremendous promise for the future. It will still require an extensive amount of preliminary development work before it is ready for routine use. 

I hope this helps with this very complex issue. 

Best regards,

Thomas P. Gross, M.D.

[medgerton]

Pat,

Nice work getting the top surgeons to talk about the navigation issue. Very informative and it sure beats a bunch of us kicking around the issue.

[Pat Walter]

I am glad to be able to present the doctors' views about any subject if I can.  They are often very busy, but will normally take time to write about a subject to help people learn about different aspects of hip resurfacing.

The problem with a website like Surface Hippy and it's discussion group Hip Talk, is that a few patients think they are experts.  They have read every word on the internet about hip resurfacing and had a resurfacing surgery - therefore, in their minds, they are experts. The fact is that unless you have opened up a 1000 patients and placed a 1000 hip resurfacing devices - you are not an expert  These people have large egos and want to take over the discussion group to force their opinons on others. They feel there is no "free speech" on my website.  I will let each person state their opinon, but that is where it ends when their opinons are not in sync with the main stream thinking of hip resurfacing.  My goal is to present perspective patients with balanced information about hip resurfacing.  When a discussion gets lopsided with a lot of negative or incorrect information, I don't let it continue.  I know hip resurfaicng is not perfect and there have been some problems, I allow those to be presented and have a page about hip resurfacing problems. There are always a small number of problems with any major surgery - but on the whole, hip resurfacing is a great option. That is what I want people to read about. Not opinons of "know it alls" that have egos and opinions that won't even fit on a webpage.

So I stop discussions that are out of hand and turn to the experts - surgeons that have done thousands of hip resurfacings. Perspective patients can then make up their own minds.

Pat

[halfdone]

Thanks Pat for this and Dr. Bose's comments on computer navigation techniques in hip resurfacing. 

[obxpelican]

I had the feeling the one fellow seemed to be doing a sell job on the assisted computer surgery.

I think it's going to be hard to sell something that the experienced doctors are not sold on yet.


Chuck

[B.I.L.L.]

I had the feeling the one fellow seemed to be doing a sell job on the assisted computer surgery.

I think it's going to be hard to sell something that the experienced doctors are not sold on yet.


Chuck

I have a bhr and have read every word about hip resurfacing on the internet. In my EXPERT opinion (IMEO) ,  I would go with an older Dr who has done thousands over a newer Dr with a computer navigation system any day of the week. Due to my steep cup I spent about 14 months wondering if I was going to need an early revision or not. Would my Dr. have had a better result had he used computer navigation ?,  I would certainly hope so or whats the point.  But if I ever have to do this again I will go with a guy with years of hands on experience vs a newer surgeon with a high tech computer.   
To me it's like a carpenter vs a craftsman.  But remember I am not a Dr and this is JMEO (jusy my"expert" opinion) haha    

[Pat Walter]

Hi BILL

Your doctor would not have done better with computer navigation because it is NOT used for placing the acetabular cups.  That is where most of the problem is.  CAS is used to place the cap on the femur.  So your surgery would not have been better with CAS.

Just a note for clarity.

Pat

[JeanM]

Thanks for everything you do Pat! 

You do an amazing job with this forum.  Thank You!

[B.I.L.L.]

Hi BILL

Your doctor would not have done better with computer navigation because it is NOT used for placing the acetabular cups.  That is where most of the problem is.  CAS is used to place the cap on the femur.  So your surgery would not have been better with CAS.

Just a note for clarity.

Pat

Guess I lost my Expert status huh ?



 

[CITY2SOUTH]

I've missed u guys...

[obxpelican]

We missed ya too!




Chuck