Joint Replacement Surgery Gets ‘Smarter’

Technology helps surgeons position artificial joints
image of body

Traditionally, surgeons performing joint replacement surgery determine the placement of a new hip, shoulder or knee joint based on two-dimensional imaging, such as X-rays and CT scans.

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But Wael Barsoum, MD, Vice Chairman, Department of Orthopaedic Surgery at Cleveland Clinic, and Joseph Iannotti, MD, PhD, Chairman of Cleveland Clinic’s Orthopaedic & Rheumatologic Institute, are working on an innovative software program. Using three-dimensional printers, they create customized models — called SmartBones— of a patient’s specific anatomy before and after implant placement.

An ‘exact replica’ of a patient’s bone

“We now can virtually recreate the joint anatomy with standard CT scans, plan the surgery in three dimensions with the software, and generate an exact replica of the patient’s bone with the planned implant position,” Dr. Barsoum says. “This then helps us recreate that plan in the operating room by using the patient-specific bone model as a reference guide.”

This computer modeling technology uses landmarks to correctly align trajectories and replicate the surgical experience.

For patients with bone loss, the software also can create a guide to show surgeons where to place the augmentation or artificial bone, and the safest place to position screws and other hardware.

Artificial joint placement is big challenge

Correct placement of new artificial joint implants is one of the biggest challenges in joint replacement surgery, says Dr. Barsoum.

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“The hip and shoulder can be visualized as ball-and-socket joints,” he says. “In these surgeries, the new socket must be correctly positioned so the ball can move freely.

“If the artificial joint is not positioned in the correct orientation, the ball may pop out or the patient’s new joint may feel unstable. These are common causes of early revision hip and shoulder replacements.”

More than 400,000 hip and shoulder replacements are performed in the United States every year.

While most are successful, approximately 10 percent will need to be revised eventually. An estimated 9,000 revisions are related to the incorrect placement of the prosthetic joint during the original surgery.

New technology sharpens placement accuracy

Dr. Barsoum notes that several studies have shown that a surgeon’s accuracy in positioning implants is greatly improved when using this preoperative software and SmartBone technology instead of X-rays and standard techniques.

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The studies included surgeons of varying skills: medical students, residents, fellows, and highly trained, experienced orthopaedic surgeons. Every group improved dramatically with the aid of this technology.

In addition to directly benefiting patients’ surgical outcomes, this technology will lower readmission rates and save money by preventing the incidence of dislocations.

The project is funded through grants from the state of Ohio and various biomedical research and program grants.

“However, our research coordinators, fellows and students who work on these studies are funded by the generosity of Cleveland Clinic supporters,” Dr. Barsoum says. “We can’t raise enough money through industry and program grants, and we’re incredibly grateful to those who believe in and support our research.”

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