Challenges of Technology Integration and Computer-Assisted Surgery

The rapid progress of modern computerized capabilities has not been paralleled by a similar progress in the operating room setting and in operating techniques. The major advance in orthopaedic surgery during the past fifty years has been the introduction of intraoperative fluoroscopic imaging, while surgical techniques have remained mostly unchanged. Orthopaedic procedures dealing with bones-a nondeformable tissue-are suitable for computerized guidance based on preoperatively and intraoperatively obtained images. Computer-assisted surgery progressed from the first-generation systems of the 1990s to the present third-generation systems, enabling surgeons to implant a knee or hip prosthesis with high precision. However, most orthopaedic surgeons avoid using computer-navigation surgical techniques. Why has the implementation of computer-assisted surgery procedures met so many hurdles and obstacles? The factors that make up the answer to this question can be grouped into three categories: human, technological, and financial. Computer-assisted surgery has the potential to revolutionize orthopaedic surgery just as fluoroscopy did a few decades ago; however, its widespread use has been hampered by a lack of sufficient clinical data on the one hand and by a reluctance to use the technique and thereby collect and share data on the other. The challenge is to overcome the human, technological, and financial hurdles. Once these obstacles are addressed, we believe that computer-assisted surgery will set a new standard of care. Until that time, some will be willing to lead the revolution and pay the price of progress, and others will be reluctant to take part in this endeavor.