Robotic Joint Replacement Surgery - Department of Computer …cis/cista/445/Lectures/Robodoc.pdf ·...

Copyright © CISST ERC, 2000, 2001NSF Engineering Research Center for Computer Integrated Surgical Systems and Technology

Robotic Joint Replacement Surgery

Russell H. TaylorDept. of Computer Science/Radiology/Mechanical EngineeringDirector, Center for Computer-Integrated Surgical Systems and

TechnologyThe Johns Hopkins University3400 N. Charles Street; Baltimore, Md. [email protected]


Computer-assisted planning

Patient-specific Model

Update Model

Computer-Assisted

Execution

Update Plan

Computer-Assisted

Assessment

Preoperative Intraoperative

Atlas

Postoperative

Patient




Update Model

Computer-Assisted

Execution

Update Plan

Computer-Assisted

Assessment


Atlas

PostoperativePatient

Surgical “CAD”

Surgical “TQM”

Surgical “CAM”




Update Model

Computer-Assisted

Execution

Update Plan

Computer-Assisted

Assessment


Atlas

Postoperative

Patient

Surgical

Assistants


Robotic Joint Replacement Surgery


Disclosures• Russell Taylor is a member of the

Scientific Advisory Board of Integrated Surgical Systems and has a (very modest) financial interest in ISS

• ISS is an Industrial Affiliate of the CISST ERC, of which Dr. Taylor is the Director, and sponsors research within the Center.

• Dr. Taylor also enjoys salt water fly fishing


Demographics

• US– Total Hip Replacement ≈ 300,000/year– Total Knee Replacement ≈ 250,000/year

• Worldwide

• NOTE: Numbers need updating


Total hip replacement

Fit?

Placement?


Robotic total hip replacement



Fit?

Placement?



Fit?

Placement?

≈≈

2 shape error25% bone-to-implant

contact

mm


Robotic Total Hip Replacement Planning





≈≥≈

0.1 shape error95% implant-bone contact1 placement accuracy

mm

mm


Leverage from Surgical CAD/CAM in Robotic THR

• Better planning

• Ability to carry out the plan– Accurate shape– Accurate placement– Limited forces– Reduced complications– Shape flexibility – Consistent execution

• Process learning



• Better planning





• Better planning




ROBODOC® (Integrated Surgical Systems)• History

– Veterinary use (IBM prototype, ’90)– Clinical use (US ’92 Europe, ’94)– Marketed in Europe, Asia– 30 systems in Europe & Japan (9/’00)– FDA approval pending

• Total Hip Replacement (THR)– First clinical case 1992– ~ 8000 primary, ~300 revisions (9/’00)– No fractures or other complications

due to robot• Total Knee Replacement (TKR)

– First clinical case March 2000– ~ 30 cases as of September 2000 – No fractures or other complications




CASPARTM System (URS)

• History– Introduced 1997– About 50 installed in Europe

• Experience– ~ 300-500? THR cases– TKR demo 4/2000– ACL tunnel drilling ?/2000– Few complications


Robodoc® Total Knee Replacement


Dr.Sugano& Prof.Borner Dr.Kakimoto performed the firstSuccessful ROBODOC TKA in Japan






Robodoc® Total Knee Replacement


Robotic THR & TKR Systems in Research Phases (Partial List)

• Parallel link approaches– Aachen (GRIGOS)– KAIST – Technion

• “Conventional” arms– Northwestern– U. Washington– Rizzoli Institute

• Cooperative Control– Imperial College (ACROBOT)– Grenoble (PaDyc)


Robotic THR & TKR Systems in Research Phases (Partial List)

• Parallel link approaches– Aachen (GRIGOS)– KAIST – Technion

• “Conventional” arms– Northwestern– U. Washington– Rizzoli Institute

• Cooperative Control– Imperial College (ACROBOT)– Grenoble (PaDyc)

Movie: Brian Davies


CAOS 2002

The AcrobotFirst Clinical Trial of a ‘hands on’ Active Constraint Robot

J. Cobb, J. Henckel, S.J. Harris, M. Jakopec, F. M. Rodriguez y Baena, M.P.S.F. Gomes, B. L. Davies


Navigation Based THR

• Emphasis on component placement

• Planning is similar to Robodoc

• Execution uses more conventional instruments

• Instruments are registered to the patient’s bone and tracked intraoperatively

• E.g., HIPNAV system (DiGioia, Jaramaz, et al.)


Related work at JHU: x-ray registration

2D-3D registration

Iterative robotic cutting

Postop CT or X-Ray

Plan• shape• place

X-ray

Follow-up

Preop CT or X-ray

Update plan

R. Taylor


X-ray based localization

R. Taylor


Iterative Cutting to Improve Accuracy

R. Taylor, R. Kumar, R. Goldberg & J. Yao


Statistical Atlases

Training Data Sets

Segmentation

Multiple resolution density models

Statistical Analysis

Average model + variation modes

Anatomical Labels

Biomechanics

General Surgical Plans

Outcome data

Electronic Anatomical

Atlas

R. Taylor & J. Yao


Statistical Atlas

“Virtual CT”

Deformable 2D-3D

Planning Updated Plans

Registered Model

Visualization & Guidance

X-raysX-rays

Rigid 2D-3D

R. Taylor & J. Yao

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