Brainlab Dash®: iPod®-Based Navigation System in Total Knee and Hip Replacements

Abstract

Computer-assisted techniques in total joint replacement procedures have been used for more than 10 years, with numerous studies demonstrating superior results regarding implant position and correction of leg deformities compared to conventional techniques. This has been shown both in randomized trials and in large-scale retrospective cohort analyses. Nevertheless, the technique has not become the standard of care in most hospitals around the world. There are several reasons why the navigation technique is still not used regularly despite its valuable advantages. The main obstacles in implementing the technique are undoubtedly the additional costs for the patient, the surgeon, the hospital, or – in view of medical reimbursement systems – even the community. The costs can be divided into direct costs for investment and costs per case or indirect costs such as the additional time required for the surgical procedure. Moreover, the computer-assisted technique is still perceived as a demanding procedure; surgeons require training and need to complete their own learning curve before becoming familiar with the technique compared to the conventional technique that they are already trained in. Based on these conditions, Brainlab AG started a development project in 2007 to tackle some of these obstacles so as to increase general acceptance of the navigation technique in joint replacement surgeries. The main aspects of the development agenda were to create simplified user-friendly software algorithms, intuitive handling, a system with lower investment costs, and an optimized time frame for setting up the system as well as for the surgery itself. Our hospital department joined a development cooperation and we were involved in multiple design reviews, cadaver workshops, and a clinical prototype study on total hip and knee replacement, until the final release of the system.