Artificial intelligence, robotics may offer improvements to orthopedic surgery

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January 29, 2021

3 minutes to read

Source / Disclosures

Source: Benazzo FM. Robotics in TKA. Presented at: Practical Application of Artificial Intelligence EFORT Webinar. January 25, 2021 (virtual).
Grossterlinden LG. Holomedicine in traumatology. Presented at: Practical Application of Artificial Intelligence EFORT Webinar. January 25, 2021 (virtual).
Nehrer S. Applications of AI in Osteoarthritis. Presented at: Practical Application of Artificial Intelligence EFORT Webinar. January 25, 2021 (virtual).

Disclosures: Nehrer reports that he receives research support from Anika Therapeutics, Braincon and Orthosera GmbH; is a paid presenter or speaker for Arthrex Inc .; is a paid consultant for Orthosera GmbH; is a member of the board or committee of the International Cartilage Regeneration and Joint Preservation Society; and is part of the editorial board or board of directors of the Journal of Sportorthopedics and Traumatology. Benazzo and Grossterlinden do not report any relevant financial information.


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Artificial intelligence and robotics can provide precise analysis and improve surgical outcomes for patients undergoing orthopedic surgery, according to the presenters.

Without objective digital analysis system, Stephane Nehrer, MD, noted that the clinical evaluation of osteoarthritis of the knee by radiographs is subjective and has shortcomings, such as the inability to assess the progression of osteoarthritis.

“Some studies do not reach clinical evidence because our outcome parameter, the Kellgren-Lawrence score, is not objective enough to do so,” Nehrer said in his presentation to the European Federation of National Associations webinar. of orthopedics and traumatology on the practical application of the artificial. Intelligence. “When we look at joint space narrowing, which is one of the parameters we look at often, we find that it is not assessed by a numerical system but only measured manually.”

Stefan Nehrer

Stefan Nehrer

According to Nehrer, the use of artificial intelligence, such as machine learning and deep learning, can assess digitized data sets and identify patterns found in patients with osteoarthritis of the knee. He added that supporting a software system has also been shown to increase the accuracy and precision of the diagnosis of osteoarthritis of the knee, as well as the predictability of osteoarthritis of the knee.

“If you want to stop the progression of osteoarthritis, we have to get to the point of care as soon as possible,” Nehrer said. “To come from a more subjective manual [analysis] to a digitized standardized analysis, that is the objective, and artificial intelligence is promising with this and also already used routinely in some of our institutions.

Robotics in TKA

According to Francesco M. Benazzo, MD. He added that non-imaging robotics can allow surgeons to acquire bone landmarks to reconstruct knee geometry and morphology, assess ligaments and perform bone resection with the robotic arm collecting information intraoperatively.

“Thus, the responsibility of the surgeon lies in the collection of data, in the planning, in the execution with great precision of the surgical act, and we can intraoperatively and immediately postoperatively [check] the results, ”said Benazzo in his presentation.

Francesco M. Benazzo

Francesco M. Benazzo

According to Benazzo, robotic surgery can lead to fewer outliers and less damage to the soft tissue in the knee, as well as improve implant alignment, flexion-extension gap, and gap asymmetry. However, Benazzo noted that robotic PTG had its limitations, such as installation and maintenance costs, the need for additional preoperative imaging, increased operative time, and additional incisions for inserting recording pins. He added that more high-quality studies with longer-term follow-up are needed on functional results, implant survival, complications and efficacy.

“The long road must be followed before we can be sure of saying robotic surgery is better than conventional surgery,” Benazzo said.

Holomedicine in traumatology

Finally, holomedicine is a new technology that uses medical software to help doctors during surgery and helps with telehealth and education, according to Lars G. Grossterlinden, MD. With the help of artificial intelligence, Grossterlinden noted that surgeons can improve the accuracy and accessibility of surgery by merging MRI and CT images to create 3D holograms that can be controlled with gestures and voice commands. .

Grossterlinden noted that holomedicine has the advantage of viewing images of patients from all angles, which can help as a teaching tool or to educate patients about their injury and surgery. Holomedicine also allows surgeons to connect with colleagues around the world by inviting them to review a specific case, he said.

“If you need help from a colleague in Bangkok or New York, just invite them over and they might get the essential advice on how… to improve your fracture fixation,” Grossterlinden said. .

Lars G. Grossterlinden

Lars G. Grossterlinden

Despite the benefits of holomedicine, Grossterlinden noted that there may be information loss with the segmentation technique and volume rendering. Holomedicine also requires an ambitious IT department to make it easier to use, and some of the software is cloud-based, which could lead to privacy concerns, according to Grossterlinden.

“One of my dreams is to get a perfect match and fusion of the 3D data in the operating room … and then you can tone down every screw and whatever you want to do,” Grossterlinden said. “But still, it’s more or less the same in robotics.”


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