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Scientific Articles   |    
Computer-Assisted and Robot-Assisted Technologies to Improve Bone-Cutting Accuracy When Integrated with a Freehand Process Using an Oscillating Saw
Olivier Cartiaux, PhD1; Laurent Paul, PhD2; Pierre-Louis Docquier, MD, PhD2; Benoît Raucent, PhD1; Etienne Dombre, PhD3; Xavier Banse, MD, PhD2
1 Centre for Research in Mechatronics, Université catholique de Louvain, Place du Levant 2, B-1348 Louvain-la-Neuve, Belgium. E-mail address for O. Cartiaux: olivier.cartiaux@uclouvain.be
2 Department of Orthopaedic Surgery, Université catholique de Louvain, Avenue Mounier 53, 1200 Bruxelles, Belgium
3 LIRMM, CNRS-Université Montpellier 2, 161 rue Ada, 34392 Montpellier CEDEX 05, France
View Disclosures and Other Information
Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from Fonds National de la Recherche Scientifique (FNRS, Télévie, Belgium) (grant 7.4570.06) and Fondation Belge contre le Cancer (grant SCIE 2006/20). Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

Investigation performed at the Centre for Research in Mechatronics and the Department of Orthopaedic Surgery, Université catholique de Louvain, Louvain-la-Neuve, Belgium

Copyright © 2010 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2010 Sep 01;92(11):2076-2082. doi: 10.2106/JBJS.I.00457
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Abstract

Background: 

In orthopaedic surgery, many interventions involve freehand bone cutting with an oscillating saw. Such freehand procedures can produce large cutting errors due to the complex hand-controlled positioning of the surgical tool. This study was performed to investigate the potential improvements in cutting accuracy when computer-assisted and robot-assisted technologies are applied to a freehand bone-cutting process when no jigs are available.

Methods: 

We designed an experiment based on a geometrical model of the cutting process with use of a simulated bone of rectangular geometry. The target planes were defined by three variables: a cut height (t) and two orientation angles (ß and ?). A series of 156 cuts were performed by six operators employing three technologically different procedures: freehand, navigated freehand, and robot-assisted cutting. After cutting, we measured the error in the height t, the absolute error in the angles ß and ?, the flatness, and the location of the cut plane with respect to the target plane.

Results: 

The location of the cut plane averaged 2.8 mm after use of the navigated freehand process compared with 5.2 mm after use of the freehand process (p < 0.0001). Further improvements were obtained with use of the robot-assisted process, which provided an average location of 1.7 mm (p < 0.0001).

Conclusions: 

Significant improvements in cutting accuracy can be achieved when a navigation system or an industrial robot is integrated into a freehand bone-cutting process when no jigs are available. The procedure for navigated hand-controlled positioning of the oscillating saw appears to be easy to learn and use.

Clinical Relevance: 

These findings support a recommendation for further study to determine if the improvements in cutting accuracy observed in vitro are possible in vivo.

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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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