James B. Stiehl Werner H. Konermann Rolf G. Haaker Anthony M. DiGioia III Navigation and MIS in Orthopedic Surgery James B. Stiehl Werner H. Konermann Rolf G. Haaker Anthony M. DiGioia III

Navigation and MIS in Orthopedic Surgery

With 515 Figures and 56 Tables

123 Stiehl, James B., Associate Professor, M.D. Haaker, Rolf G., Associate Professor, M.D. Columbia St Mary’s Hospital, Orthopedic Clinic, St. Vincenz-Hospital, 575 W River Woods Parkway, Milwaukee, Danziger Str. 17, D-33034 Brakel, Germany Wisconsin 53211, USA DiGioia, Anthony M. III, Clinical Associate Professor Konermann, Werner H., Professor, M.D. of Orthopaedic Surgery, M.D. Orthopaedic Hospital, University of Pittsburgh School of Medicine and Am Mühlenberg 3, Renaissance Orthopaedics, P.C. 300 Halket Street 37235 Hessisch-Lichtenau, Germany Pittsburgh, PA 15213, USA

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Foreword

The reader is enthusiastically encouraged to tackle this second edition text in two ways. The first is simply to scan chapters with their introductions, summaries and conclusion points. Second, is to delve into those sections of seeming greater interest depending upon one’s spe- cialty and role. The expansion and quality of this material speak to the success of the first edition by these editors and many similar authors. In addition, the continued and enlarged interest in computer assisted Orthopedic surgery indicates the relevance and enduring importance of this advance in our field of musculoskeletal surgery. I suggest that no other discipline in surgery is so appropriately suited to computer assistance including robotic performance. Orthopedics has always seemed unique to this author in that it focuses more than any other medical field on gross physical, mechanical structure. We deal nearly exclusively in physical repair of broken elements, rearrangement of deformed ones, and resurfacing or refurbishing those that are diseased in a way that has altered their mechanical integrity, shapes, and other structural aspects. Certainly there are biochemical, physiologic, cell biologic, and immunologic even infectious and neoplastic issues involved to major degrees in the injuries, treatments and basic pathology of all that we treat. Our methods attempt to take advantage of these aspects of the biology and structure involved. Nonetheless, what we actually do in the operating room, what we spend so many years learning to do safely, correctly and accurately is to rebuild and repair the physical structures which are the musculoskeletal system. It is my belief that this rather gross structural character of Orthopedic surgery is what makes so ready-made for computer assistance, even robotic preparation and interaction. The anatomic and physiologic nature of the human body makes physical intervention much more variable and complex than tasks done on inanimate objects in factories. These factors also present more difficulty than addressing many problems and studies in physical and biological science. It was only natural that computer assistance in general and the employment of robots in particular factory processes were first seen in those applications. However, the need for precision is as great and in many ways greater when we commence treatment of the deranged or diseased human structure. Clearly there is resistance to the introduction of these hi-tech changes into our field. We first fear their cost, second their complexity as it relates to the uninitiated user, and also the sense of losing control of our surgical processes. Nonetheless, the need is there – the need to maximize the accuracy, consistency, and safety of our surgical procedures. It is this writer’s prediction that our future, within the next 10 to 15 years will see an evolu- tion in computer applications and mechanical, plus robotic methods that will revolutionize the way our surgeries are performed. It will be routine practice that our procedures are done thru incisions that are only as large as necessary to either introduce or remove the material which is involved in an operation. And, this surgery will be done with maximal computer assistance in the form of navigation and other aspects. Furthermore, retraction, tissue cutting and reforma- tion, as well as implant placement, will be done by robots. Like it or not today, the importance of accuracy and consistency, together with technologic changes and software development will allow and drive this revolution. That said, it is time for all of us to understand the bases of these techniques and appreciate the applications and success of the methods developed so far.

Kenneth A. Krackow, MD In memoriam Thomas Günther from Springer, who unexpectedly died during this book project.

He will be greatly missed. VII VII

Short Biography of the Editors

Stiehl, James B., Associate Professor, M.D. Orthopaedic Hospital of Wisconsin 575 West Riverwood Parkway, Suite 204 Milwaukee 53212, USA Born in 1949, Adult Reconstructive Orthopaedic Surgeon. Residency at the University of Texas Health Science Center in San Antonio Texas under Drs. Charles Rockwood and David Green, and Fellowships at the Princess Margaret Rose Hospital, Edinburgh and Swiss AO Fellowship, Zurich. He is in private practice at Columbia St Mary’s Hospital in Milwaukee, Wisconsin, USA. His main interests are in total joint arthroplasty and adult reconstructive surgery and he has a longstanding interest in biomechanical research in orthopaedics.

Konermann, Werner H., Professor, M.D. Hospital of Orthopaedics and Traumatology Am Mühlenberg 3, D-37235 Hessisch-Lichtenau, Germany Born in 1959, Specialist Orthopaedic Surgeon and Rheumatologist. Residencies in three German Universities at Tübingen, Münster and Mannheim. His thesis was done in biome- chanics of the lumbar spine. He is now a Consultant Orthopaedic Surgeon for orthopaedics and traumatology in Hessisch Lichtenau, Germany. His main interests are in total joint arthroplasty, adult reconstructive surgery and computer assisted surgery.

Haaker, Rolf G., Associate Professor, M.D. Hospital for Orthopaedics and Rheumatology St. Vincenz-Hospital, Danziger Str. 17, 33034 Brakel, Germany Born in 1959, Specialist Orthopaedic Surgeon and Rheumatologist. Residencies at the Sportsmedical Devision, Military Hospital in Warendorf and Koblenz followed by a reci- dency at the University in Bochum, Germany. His thesis was done in biomechanics of the multilevel lumbar spinal fusion. He is now a Chief Consultant Orthopaedic Surgeon in Bad Driburg-Brakel, Germany. He has a main interests in revision surgery of hip and knee arthroplasty, spine surgery and computer assisted surgery.

DiGioia, Anthony M. III, MD Magee-Womens Hospital of the University of Pittsburgh Medical Center and Renaissance Orthopaedics, P.C. Adult Reconstructive Orthopaedic Surgeon and Clinical Researcher. Undergraduate and Masters degrees in engineering from Carnegie Mellon University. Medical degree from Harvard University School. Residency in Orthopaedic Surgery at the University of Pitts- burg Medical Center. Fellowship in Adult Reconstructive Surgery at the University of Pitts- burgh Medical Center. He is in private practice at Magee-Womens Hospital in Pittsburgh, PA. He was a founder of the Innovation Center at the UPMC Health System in Pittsburgh. His main interest is in applied research and development of new technologies for training simulations, process re-engineering and programs in Patient Focused Care. IX IX

Preface

Computer assisted Orthopedic surgery has made significant advances since our first textbook was completed in 2003, not only in refinement of existing methods but in newer ideas such as early robotic applications and validation con- cepts. The basic platforms from which we work have been long established fixtures in the computer and technology world. One might conclude that the medical profession has been late to get into this game. Machines aren’t necessarily better than humans when it comes to artistic creations, but they can certainly have become more reproducible and precise. Any surgeon who dismisses this concept faces the likely hood of becoming a surgical anachronism. Surgical navigation is an enabling technology that has limited side effects and promises to advance the art of Orthopedic surgery in ways not imagined. This contrasts with Minimally Invasive Surgery which is a new and different surgical technique done through less intrusive methods that enhance postoperative recovery and minimize tissue damage. Many surgeons have learned that MIS techniques can be difficult and may add significant complications to previously straight forward operations. This textbook importantly discusses the marriage of surgical navigation with minimally invasive surgery as we believe »virtual reality« in surgery makes MIS a safer venture. The other important point we would like to make about these technologies, is that they are fickle mistresses and takes no hostages. Scientific advancement celebrates only the innovators and practioners of today and tomorrow, not of yesterday. There are no ‘giants’ in this field comparable to the days of Mueller, Charnley and Insall who literally held court throughout their lifetimes following the hegemony of their primary innovations. In contrast, going to the ‘com- puter store’ to buy your first new personal computer will quickly put you on equal footing with the guy who has been doing it for ten years. This simple collaborative fact makes computer assisted surgery extremely attractive to the future generation of »millenial« Orthopedic surgeons, who thrive on teamwork and system consensus. This is how they have been raised. The editors celebrate our friendship with all the world-wide group of contributors to this current volume and offer our gratitude for their participation in this exciting field.

October 2006 The Editors James B. Stiehl, Werner H. Konermann, Rolf G. Haaker (Senior Editors), Anthony M. DiGioia III Sections

Part I Computer Assited Orthopaedic Surgery – 1

Part II Total Knee Arthroplasty – 79

Part II A Navigation: Total Knee Arthroplasty – 79 Part II B Minimally Invasive Surgery: Total Knee Arthroplasty – 189 Part II C Minimally Invasive Surgery and Navigation: Total Knee Arthroplasty – 239 Part II D Navigation and Minimally Invasive Surgery in Unicompartmental Knee Arthroplasty (UKA) – 269 Part III Anterior-Cruciate Ligament Reconstruction – 305

Part IV Total Hip Arthroplasty – 333

Part IV A Navigation: Total Hip Arthroplasty – 333 Part IV B Minimally Invasive Surgery: Total Hip Arthroplasty – 385 Part IV C Navigation and Minimally Invasive Surgery: Total Hip Arthroplasty – 421

Part V Reconstruction and Trauma Surgery – 467

Part VI Spinal Surgery – 535

Part VII Future Perspectives in CAOS – 573 XIII XIII

Contents

Part I Computer Assited Part II Total Knee Arthroplasty Orthopaedic Surgery

Part II A Navigation: 1 Basics of Computer-Assisted Orthopaedic Total Knee Arthroplasty Surgery ...... 2 J. Kowal, F. Langlotz, L.-P. Nolte 10 Postoperative Alignment of Conventional 2 CT-Based Navigation Systems ...... 9 and Navigated Total Knee Arthroplasty ...... 81 B. Jaramaz, A.M. DiGioia III W.H. Konermann, M.A. Saur

3 C-Arm-Based Navigation ...... 15 11 Computer-Assisted Implantation of a A. Hebecker Total Knee Prosthesis without Pre-Operative Imaging: The Kinematic Model ...... 88 4 CT-Free-Based Total Knee Arthroplasty D. Saragaglia Navigation with a Minimally Invasive Surgical Technique ...... 21 12 CAOS in Mobile Bearing »Tibia Cut First« S.D. Stulberg Total Knee Arthroplasty ...... 95 J.B. Stiehl 5 Bone Morphing: 3D Reconstruction without Pre- or Intra-Operative Imaging ...... 36 13 Total Knee Arthroplasty using the Stryker E. Stindel, N. Perrin, J.L. Briard, S. Lavallée, Knee Trac System ...... 100 C. Lefevre, J. Troccaz K.A. Krackow

6 The Attraction of Electromagnetic 14 Navigated Total Knee Arthroplasty Computer-Assisted Navigation and the OrthoPilot System ...... 106 in Orthopaedic Surgery ...... 44 R.G. Haaker, M. Senkal, A. Ottersbach, R. Willburger D.R. Lionberger 15 CT-free Navigation including Soft-Tissue 7 CAOS for Technical Skills Training Balancing: LCS Total Knee Arthroplasty in Orthopaedic Surgery ...... 54 and VectorVision System ...... 112 P.C. Noble, M.A. Conditt, M.T. Thompson, W.H. Konermann, S. Kistner S.K. Ismaily, K.B. Mathis 16 Navigated Total Knee Arthroplasty 8 Cost Analysis of Navigation ...... 61 and the Surgetics Bone-Morphing System . . . . 123 C. Lavernia, V.H. Hernández, J.P. Hommen E. Stindel, J.L. Briard, C. Plaskos, J. Troccaz

9 Validation and Metrology in CAOS ...... 68 17 Modern Navigated Ligament Balancing J.B. Stiehl, J. Bach, D.A. Heck in Total Knee Arthroplasty with the PiGalileo System ...... 135 P. Ritschl, F. Machacek, R. Fuiko

18 Navigated Total Knee Arthroplasty with the Navitrack® System ...... 141 T. Mattes, R. Decking, H. Reichel XIV Contents

19 Experience with Navigated Total Knee 29 MIS Total Knee Arthroplasty Replacements with CT-Free and CT-Based with a Subvastus Approach ...... 223 VectorVision® BrainLAB Navigation System . . . 147 M.W. Pagnano C. Lüring, H. Bäthis, M. Tingart, J. Grifka, L. Perlick 30 Minimally Invasive Total Knee 20 Navigated Revision Total Knee Replacement in Tibia First Technique Arthroplasty, CT-Free Navigation with the INNEX® Knee System ...... 228 with VectorVision System ...... 155 A.M. Halder, S. Köhler, G. Pap, W. Neumann L. Perlick, C. Lüring, M. Tingart, J. Grifka, H. Bäthis

21 Navigated Total Knee Arthroplasty Part II C Minimally Invasive Surgery and the ORTHOsoft Navitrack System ...... 162 and Navigation: Total Knee M. Bolognesi Arthroplasty 22 Navigated Total Knee Arthroplasty with the Fluoroscopic Medtronic System ...... 167 31 Valgus Approach to Total Knee Arthroplasty . . 240 J. Victor T.M. Seyler, M.A. Mont, J.F. Plate, P.M. Bonutti

23 Computer-Assisted Ligament Balancing of the 32 Implications of Minimally Invasive Surgery Femoral Tibial Joint Using Pressure Sensors . . . 175 and CAOS to TKR Design ...... 247 R.C. Wasielewski, R.D. Komistek P.S. Walker, G. Yildirim, J. Sussman-Fort

24 Computer-Assisted Total Knee Arthroplasty 33 Fluoroscopy-Based Navigation in Genesis II Using Patient-Specific Templates: Total Knee Arthroplasty with the Medtronic the Custom-made Cutting Guides ...... 182 »Viking« System ...... 255 M.A. Hafez, K.L. Chelule, B.B. Seedhom, K.P. Sherman F.-W. Hagena, M. Kettrukat, R.M. Christ, M. Hackbart

34 Minimally Invasive-Navigated Part II B Minimally Invasive Surgery: Extra-Medullary Preparation in Total Knee Total Knee Arthroplasty Arthroplasty with the »Stryker« System ...... 261 R.L. Wixson, M. MacDonald 25 Principles of MIS in Total Knee Arthroplasty . . . 190 F. Benazzo, S. Stroppa, S. Cazzamali, L. Piovani, M. Mosconi Part II D Navigation and Minimally Invasive Surgery in 26 MIS Total Knee Arthroplasty with the Unicompartmental Knee Limited Quadriceps Splitting Approach ...... 194 Arthroplasty (UKA) J.L. Cook, G.R. Scuderi

27 Total Knee Replacement through 35 Navigated Minimally Invasive Surgery a Mini-Mid-Vastus Approach ...... 204 Unicompartmental Knee Replacement ...... 270 R.S. Laskin J.-Y. Jenny

28 Quadriceps Sparing Total Knee 36 Minimal Invasive Navigated Arthroplasty in Association with Unicondylar Knee Replacement Electromagnetic Navigation ...... 211 with the DePuy Ci-System ...... 277 R.K. Alan, A.J. Tria H. Bäthis, L. Perlick, C. Lüring, M. Tingart, J. Grifka XV XV Contents

37 Hands-on Robotic Unicompartmental 45 Navigation of Computer-Assisted Knee Replacement ...... 284 Designed Hip Arthroplasty ...... 352 J. Cobb J.-N. Argenson, S. Parratte, X. Flecher, J.-M. Aubaniac 38 Navigated Unicompartmental Knee-Replacement – 46 Computer-assisted Hip Resurfacing ...... 359 Genesis-Accuris-System ...... 297 H. Bäthis, L. Perlick, M. Tingart, T. Kalteis, K. Buckup, L.-Chr. Linke J. Grifka

47 Navigation for Hip Resurfacing ...... 365 T. Hess Part III Anterior-Cruciate Ligament Reconstruction 48 Cup and Stem Navigation with the OrthoPilot System ...... 372 39 Image-Free Navigation D. Lazovic in ACL Replacement with the OrthoPilot System ...... 306 49 Cup and Stem Navigation H.-J. Eichhorn with the VectorVision System ...... 378 L. Perlick, T. Kalteis, M. Tingart, H. Bäthis, 40 PRAXIM ACL Navigation System C. Lüring using Bone Morphing ...... 315 S. Plaweski, A. Pearle, C. Granchi, R. Julliard Part IV B Minimally Invasive Surgery: 41 Fluoroscopic-based ACL Navigation ...... 324 Total Hip Arthroplasty S. Shafizadeh, Th. Paffrath, S. Grote, J. Hoeher, Th. Tiling, B. Bouillon 50 Total Hip Arthroplasty with the Minimally-Invasive Two-Incisions Approach . . . 386 R. Berger Part IV Total Hip Arthroplasty 51 Direct Lateral Approach in Minimally Part IV A Navigation: Total Hip Invasive Surgery Total Hip Arthroplasty ...... 393 Arthroplasty A.V. Lombardi Jr., K.R. Berend

52 Minimally Invasive Surgery Anterolateral 42 Validation of Imageless Approach in Total Hip Arthroplasty ...... 398 Total Hip Navigation ...... 334 D.S. Garbuz, C.P. Duncan J.B. Stiehl, D.A. Heck 53 Posterior Minimally Invasive Surgery 43 Cup and Stem Navigation Approach for Total Hip Arthroplasty ...... 405 with the Orthopilot System ...... 339 T.P. Vail H. Kiefer, A. Othman 54 The Medial Approach to the Hip Joint 44 Imageless Cup and Stem Navigation for Implantation of Prostheses ...... 412 in Dysplastic Hips with the Navitrack W. Thomas, L. Lucente, P. Benecke, C.L. Busch, and Vector Vision Systems ...... 344 H. Grundei J. Babisch, F. Layher, K. Sander XVI Contents

64 New CAS Techniques in Trauma Surgery ...... 496 Part IV C Navigation and Minimally G. Zheng, X. Zhang, X. Dong, S. Sagbo, Invasive Surgery: P.A. Grützner, F. Langlotz Total Hip Arthroplasty 65 Navigated High Tibial Osteotomy 55 Cup and Offset Navigation with Vector Vision System ...... 501 with OrthoPilot System ...... 422 K.-W. Cheung, W.-P. Yau, K.-H. Chiu, K.-Y. Chiu R.G. Haaker, G. Trottenberg, A. Gleichmann 66 Navigated Correction Operation of the Pelvis . . . 508 56 Minimally Invasive Navigation-Guided T. Hüfner, J. Geerling, D. Kendoff, M. Citak, Total Hip Arthroplasty in Practice ...... 429 T. Pohlemann, T. Gösling, C. Krettek J.E. Brandenberg, C. De Simoni 67 Computer-Assisted Osteosynthesis 57 Optimization of Cup Positioning in Total Hip of Long Bone Fractures ...... 513 Arthroplasty ...... 435 P.A. Grützner, G. Zheng, C. Keil, L.P. Nolte, A. Ottersbach, R.G. Haaker A. Wentzensen, J. von Recum, F. Langlotz, N. Suhm

58 Computer-assisted Simulation 68 Navigated Screw Placement of Femoro-acetabular Impingement Surgery . . 440 in Sacro-Iliac Trauma ...... 520 M. Tannast, M. Kubiak-Langer, S.B. Murphy, D.M. Kahler T.M. Ecker, M. Puls, F. Langlotz, K.A. Siebenrock 69 Computer-Assisted Surgery for Correction 59 Imageless Navigated Posterior Minimally of Skeletal Deformities ...... 527 Invasive Total Hip Replacement with the M.A. Hafez, E.H. Schemitsch, M. Fadel, G. Hosny Orthosoft Navitrack System ...... 448 A. Malik, Z. Wan, L.D. Dorr Part VI Spinal Surgery 60 Navigating The Two-Incision Total Hip Arthroplasty ...... 458 M.A. Hartzband, G.R. Klein 70 Navigation in Cervical Spine Surgery ...... 536 A. Weidner

71 Navigated Pedicle Screw Placement Part V Reconstruction and Trauma in Lumbar Spine Fusion Surgery ...... 540 Surgery J. Geerling, D. Kendoff, M. Citak, A. Gösling, T. Gösling, C. Krettek, T. Hüfner 61 High Tibial Osteotomy with a Kinematic Navigation System ...... 468 72 Navigation in Spinal Surgery M. Prymka, J. Hassenpflug using Fluoroscopy ...... 547 E.W. Fritsch 62 Principles of Computer-Aided Surgery in Trauma Surgery ...... 476 73 Navigation on the Thoracic and Lumbar Spine . . 555 Y. Weil, R. Mosheiff, L. Joskowicz, M. Liebergall P.A. Grützner, K. Wendl, J. von Recum, A. Wentzensen, L.-P. Nolte 63 Integration of Computer-Based Systems in Foot and Ankle Surgery ...... 486 74 Navigation of Tumor and Metastatic Lesions M. Richter, J. Geerling, S. Zech, T. Hüfner, M. Citak in the Thoracolumbar Spine ...... 565 F. Gebhard, M. Arand XVIIXVII Contents

Part VII Future Perspectives in CAOS

75 Alternatives to Navigation ...... 574 M.A. Hafez, B. Jaramaz, A.M. DiGioia III

76 Advanced Technologies in Navigation ...... 582 F. Langlotz, G. Zheng, L.-P. Nolte

77 Measuring Cup alignment from Radiographs after THR ...... 586 B. Jaramaz, K. Eckman

78 Application of Instrumented Linkage for TKR Surgery ...... 592 R.E Forman, M.A. Balicki, P.S Walker, C.-S. Wei, G.R. Klein

Subject Index ...... 599 XIX

Editors

Stiehl, James B., Haaker, Rolf G., DiGioia, Anthony M., III Associate Professor, M.D. Associate Professor, M.D. Clinical Associate Professor Columbia St Mary’s Hospital, Orthopedic Clinic, St. Vincenz-Hospital, of Orthopaedic Surgery, M.D. 575 W River Woods Parkway, Danziger Str. 17, D-33034 Brakel, University of Pittsburgh School Milwaukee, Wisconsin 53211, USA Germany of Medicine and Renaissance Orthopaedics, P.C. 300 Halket Street Konermann, Werner H., Pittsburgh, PA 15213, USA Professor, M.D. Orthopaedic Hospital, Am Mühlenberg 3, 37235 Hessisch-Lichtenau, Germany

List of Contributors

Alan, R.K. Babisch, J. Benecke, P. Institute for Advanced Department of Orthopedic Surgery, Chirurgische Abteilung, Orthopaedic Study, University of Jena, Waldkrankenhaus Kreiskrankenhaus Ratzeburg, Germany The Orthopaedic Center »Rudolf Elle«, Eisenberg, of New Jersey, USA Klosterlausnitzer Straße 81, Berend, K.R. 07607 Eisenberg, Germany Associate, Joint Implant Surgeons, Inc., Arand, M. New Albany, OH USA, Clinical Assistant Department of Orthaepedic Bach, J.M. Professor, Department of Orthopaedics, Trauma Surgery, Hand- and Colorado School of Mines, The Ohio State University, Columbus, Reconstructive Surgery, 1610 Illinois St., Golden, CO 80401, USA OH USA, Vice Chairman of the Board, University of Ulm, Steinhövelstraße 9, New Albany Surgical Hospital, 89075 Ulm, Germany Balicki, M.A. New Albany, OH USA New York University-Hospital for Joint Argenson, J.-N. Diseases Orthopaedic Program, Berger, R. The Aix-Marseille University, New York City, USA Assistant Professor of Orthopaedics, Department of Orthopaedic Surgery, Department of Orthopedic Surgery, Hopital Sainte-Marguerite, Bäthis, H. Rush-Presbyterian-St. Luke’s Medical Service de Chirurgie Orthopédique, Department of Trauma and Center, 1725 W. Harrison St., 270 Boulevard Sainte-Marguerite, Orthopaedic Surgery, University of Suite 1063, Chicago, Illinois 60612, USA 13009, Marseille, France Witten-Herdecke, Cologne-Merheim Medical Center (CMMC), Bolognesi, M.P. Aubaniac, J.-M. 51109 Cologne, Germany Assistant Professor, Duke University The Aix-Marseille University, Medical Center, Division of Orthopaedic Department of Orthopaedic Surgery, Benazzo, F. Surgery, Hospital South, Orange Zone, Hopital Sainte-Marguerite, Clinica Ortopedica e Traumatologica Room 5315, Durham, Service de Chirurgie Orthopédique, dell‘Università di Pavia – Fondazione North Carolina 27710, USA 270 Boulevard Sainte-Marguerite, IRCCS Policlinico San Matteo, 13009, Marseille, France P.le Golgi 2, 27100 Pavia, Italy XX List of Contributors

Bonutti, P.M. Chiu, K.-H. DiGioia, Anthony M., III Bonutti Clinic Department of Orthopaedics and Clinical Associate Professor 1303 West Evergreen Ave. Traumatology, Prince of Wales Hospital, of Orthopaedic Surgery, M.D. Effi ngham, IL 62401, USA Shatin, Hong Kong University of Pittsburgh School of Medicine and Renaissance Bouillon, B. Chiu, K.-Y. Orthopaedics, P.C. 300 Halket Street Department of Trauma and Department of Orthopaedics and Pittsburgh, PA 15213, USA Orthopaedic Surgery, University of Traumatology, Queen Mary Hospital, Witten/Herdecke, Cologne-Merheim Pokfulam, Hong Kong Dong, X. Medical Center (CMMC), MEM Research Center for Orthopaedic Ostmerheimer Straße 200, Christ, R.M. Surgery, Institute for Surgical 51109 Cologne, Germany Orthopaedic Hospital Auguste-Viktoria, Technology and Biomechanics, Am Kokturkanal 2, University of Bern, Bern, Switzerland Brandenberg J.E. 32545 Bad Oeynhausen, Germany OrthoZentrum St. Anna, Dorr, L.D. St. Annastrasse 32, 6006 Luzern, Citak, M. The Arthritis Institute, Switzerland Trauma Department, Hannover Medical 501 E. Hardy Street, Suite 300, School, Carl-Neuberg-Str. 1, Inglewood, CA 90301, USA Briard, J.L. 30625 Hannover, Germany Clinique du cèdre – Bois Guillaume, Duncan, C.P. 76235 Rouen-Cedex, France Cobb, J. Professor and Head Professor of Orthopaedics, Department of Orthopaedics Buckup, K. Imperial College, Charing Cross Hospital, UBC and Vancouver Acute Orthopädische Klinik des Klinikum London W4, United Kingdom 910 West 10th Avenue, Room 3114 Dortmund gGmbh, Beurhausstr. 40, Vancouver BC V5Z 4E3, Canada 44137 Dortmund, Germany Conditt, M.A. Institute of Orthopedic Research Ecker, T.M. Busch, C.L. and Education, The Methodist Hospital, Department of Orthopaedic Anatomisches Institut der and Baylor College of Medicine, Surgery, Inselspital, University of Bern, Medizinischen Universität zu Lübeck, Houston, Texas, USA Bern, Switzerland, Germany and Center for Computer Assisted and Cook, J.L. Reconstructive Surgery, New England Cazzamali, S. Florida Joint Replacement and Sports Baptist Hospital, Tufts University, Clinica Ortopedica e Traumatologica Medicine Center Harvard Medical School, Boston, MA, dell‘Università di Pavia – Fondazione 5243 Hanff Lane USA IRCCS Policlinico San Matteo, New Port Richey, FL 34652 P.le Golgi 2, 27100 Pavia, Italy Eckman, K. De Simoni C. The Robotics Institute, Carnegie Mellon Chelule, K.L. OrthoZentrum St. Anna, University, Pittsburgh, Pennsylvania, USA Research Fellow, Academic Unit of St. Annastrasse 32, 6006 Luzern, Musculoskeletal and Rehabilitation Switzerland Eichhorn, H.-J. Medicine, University of Leeds, Leeds, Orthopaedic Praxis Cooperation, United Kingdom Decking, R. Hebbelstraße 14a, 94315 Straubing, Orthopädische Abteilung des Rehabilita- Germany Cheung, K.-W. tionskrankenhauses Ulm, Orthopädische Department of Orthopaedics and Klinik mit Querschnittgelähmtenzentrum Fadel, M. Traumatology, Prince of Wales Hospital, der Universität Ulm, Oberer Eselsberg 45, Professor of Orthopaedics, El-Minia Shatin, Hong Kong 89081 Ulm, Germany University Hospital, El-Minia, Egypt XXI List of Contributors

Flecher, X. Gösling, A. Hafez, M.A. The Aix-Marseille University, Trauma Department, Adjunct Clinical Scientist, The Institute Department of Orthopaedic Surgery, Hannover Medical School, for Computer Assisted Orthopaedic Hopital Sainte-Marguerite, Carl-Neuberg-Str. 1, Surgery, Western Pennsylvania Hospital, Service de Chirurgie Orthopédique, 30625 Hannover, Germany Pittsburgh, PA, USA 270 Boulevard Sainte-Marguerite, 13009, Marseille, France Gösling, T. Hagena, F.-W. Trauma Department, Orthopaedic Hospital Auguste-Viktoria, Forman, R.A. Hannover Medical School, Am Kokturkanal 2, New York University-Hospital for Carl-Neuberg-Str. 1, 32545 Bad Oeynhausen, Germany Joint Diseases Orthopaedic Program, 30625 Hannover, Germany New York City, USA Halder, A.M. Granchi, C. Hellmuth-Ulrici-Kliniken Sommerfeld, Fritsch, E. Praxim Inc, 4, av de l‘Obliou Klinik für Endoprothetik, Orthopaedic University Hospital, 38700 La Tronche, France Fachklinik für operative Orthopädie, Homburg, Kirrberger Straße, Waldhausstraße 1, 16766 Kremmen/ 66421 Homburg/Saar, Germany Grifka, J. OT Sommerfeld, Germany Department of Orthopaedic Surgery, Fuiko, R. University of Regensburg, Hartzband, M.A. Gersthof Orthopaedic Hospital, Vienna, 93042 Regensburg, Germany Director, Total Joint Replacement Austria Service, Hackensack University Medical Grote, S. Center, Hackensack, NJ, USA Garbuz, D.S. Department of Trauma and Division of Lower Limb Reconstruction Orthopaedic Surgery, University of Hassenpfl ug, J. and Oncology, University of British Witten/Herdecke, Cologne-Merheim Department for Orthopaedic Surgery, Columbia Department of Orthopaedics, Medical Center (CMMC), University of Schleswig-Holstein, 910 West 10th Avenue, Vancouver, BC, Ostmerheimer Straße 200, Campus Kiel, Michaelisstraße 1, Canada V5Z 4E3 51109 Cologne, Germany 24105 Kiel, Germany

Gebhard, F. Grundei, H. Hebecker, A. Assistant Medical Director, Fa. Eska Implants, Lübeck, Germany Siemens AG, Medical Solutions, Department of Orthaepedic Trauma Hartmannstr. 48, 91052 Erlangen, Surgery, Hand- and Reconstructive Grützner, P.A. Germany Surgery, University of Ulm, Ärztlicher Direktor, Klinik für Unfall- Steinhövelstraße 9, 89075 Ulm, und Wiederherstellungschirurgie, Heck, D.A. Germany Klinikum Stuttgart, Katharinenhospital, Baylor Health Care System, Dallas, Kriegsbergstraße 60, Texas, USA Geerling, J. 70714 Stuttgart, Germany Trauma Department, Hernández, V.H. Hannover Medical School, Haaker, R.G. 3661 South Miami Ave. Ste 610 Carl-Neuberg-Str. 1, 30625 Hannover, Orthopedic Clinic, St. Vincenz-Hospital, Miami, FL. 33133, USA Germany Danziger Str. 17, D-33034 Brakel, Germany Hess, Th. Gleichmann, A. Chefarzt der Abteilung für Orthopedic Clinic, St. Vincenz-Hospital, Hackbart, M. Orthopädie und Gelenkchirurgie Danziger Str. 17, D-33034 Brakel, Orthopaedic Hospital Auguste-Viktoria, Dreifaltigkeitshospital, Germany Am Kokturkanal 2, 59555 Lippstadt, Germany 32545 Bad Oeynhausen, Germany XXII List of Contributors

Hoeher, J. Josten, M.I.C. Klein, G.R. Department of Trauma and Universitätsklinikum Leipzig, Hackensack University Medical Center, Orthopaedic Surgery, University of Zentrum für Chirurgie, Klinik für Hackensack, NJ, USA, and New York Witten/Herdecke, Cologne-Merheim Unfall-, Wiederherstellungs- und University-Hospital for Joint Diseases Medical Center (CMMC), plastische Chirurgie, Orthopaedic Program, New York City, Ostmerheimer Straße 200, Liebigstr. 20a, 04103 Leipzig, Germany USA 51109 Cologne, Germany Julliard, R. Köhler, S. Hommen, J.P. Surgeon emeritus Hellmuth-Ulrici-Kliniken Sommerfeld, Orthopaedic Institute at Mercy, Impasse du petit Vial Klinik für Endoprothetik, 3659 S. Miami Ave Ste 4008, 38320 Herbeys, France Fachklinik für operative Orthopädie, Miami, FL 33133, USA Waldhausstraße 1, 16766 Kremmen/ Kahler, D.M. OT Sommerfeld, Germany Hosny, G. Associate Professor, University of Professor of Orthopaedics, Virginia, Department of Orthopaedic Komistek, R.D. Faculty of Medicine, Benha University, Surgery, Charlottesville, VA 22908, USA Professor of Biomedical Engineering, Benha, Egypt University of Tennessee; Center Kalteis, T. Director, Center for Musculoskeletal Hüfner, T. Department of Orthopaedic Surgery, Research Trauma Department, University of Regensburg, 93042 Hannover Medical School, Regensburg, Germany Konermann, W.H. Carl-Neuberg-Str. 1, Orthopaedic Hospital, 30625 Hannover, Germany Keil, C. Am Mühlenberg 3, Berufsgenossenschaftliche Unfallklinik 37235 Hessisch-Lichtenau, Germany Ismaily, S.K. Ludwigshafen, Klinik für Unfall- und Institute of Orthopedic Research Wiederherstellungschirurgie an der Kowal, J. and Education, The Methodist Hospital, Universität Heidelberg MEM Research Center for Orthopaedic and Baylor College of Medicine, Surgery, Institute for Surgical Houston, Texas, USA Kendoff , D. Technology and Biomechanics, Unfallchirurgische Klinik University of Bern, Bern, Switzerland Jaramaz, B. Medizinische Hochschule Institute for Computer Assisted 30625 Hannover, Germany Krackow, K.A. Orthopaedic Surgery, The Western Dept. of Orthopaedic Surgery, The Pennsylvania Hospital and Robotics Kettrukat, M. State University of New York at Buff alo, Institute, Carnegie Mellon University, Orthopaedic Hospital Auguste-Viktoria, Orthopaedic Surgery B 2, Buff alo Pittsburgh, Pennsylvania, USA Am Kokturkanal 2, General Hospital, 100 High Street, B-2, 32545 Bad Oeynhausen, Germany Buff alo, New York 14203–1126, USA Jenny, J.Y. Centre de Traumatologie et Kiefer, H. Krettek, C. d’Orthopédie, 10 avenue Baumann, Department of Orthopaedic and Medizinische Hochschule Hannover, 67400 Illkirch-Graff enstaden, France Trauma Surgery, Lukas Hospital, Zentrum Chirurgie, Unfallchirurgische Hindenburgstraße 56, Klinik, Carl-Neuberg-Str. 1, Joskowicz, L. 32257 Bünde, Germany 30625 Hannover, Germany School of Engineering and Computer Science, The Hebrew University of Kistner, S. Jerusalem, Jerusalem 91904, Israel Orthopaedic Hospital, Am Mühlenberg 3, 37235 Hessisch-Lichtenau, Germany XXIII List of Contributors

Kubiak-Langer, M. Liebergall, M. Mathis, K.B. MEM Research Center for Department of Orthopaedic Surgery, Institute of Orthopedic Research Orthopaedic Surgery, Hadassah-Hebrew University Medical and Education, The Methodist Hospital, Institute for Surgical Technology School, Jerusalem, Hadassah Medical and Baylor College of Medicine, and Biomechanics, University of Bern, Center, POB 12000, Jerusalem 91120, Houston, Texas, USA Bern, Switzerland Israel Mattes, Th. Langlotz, F. Linke, C.L. Orthopädische Abteilung des M.E. Müller Research Center for Orthopädische Klinik des Klinikum Rehabilitationskrankenhauses Ulm, Orthopaedic Surgery, Dortmund gGmbh, Beurhausstr. 40, Orthopädische Klinik mit Institute for Surgical Technology 44137 Dortmund, Germany Querschnittgelähmtenzentrum and Biomechanics, University Bern, der Universität Ulm, Bern, Switzerland Lionberger, D.R. Oberer Eselsberg 45, 89081 Ulm, Baylor College of Medicine, Germany Laskin, R.S. 6550 Fannin St, #2625, Houston, Chief of the Arthroplasty Division, Texas 77030, USA Mont, M.A. Professor of Orthopaedic Surgery, Reubin Institute of Advanced Hospital for Special Surgery, Lombardi, A.V. Jr. Orthopaedics Weill Medical College of Clinical Assistant Professor, 2401 W. Belvedere Ave. Cornell University Department of Orthopaedics and Baltimore, MD 21215 Department of Biomedical Engineering, Lavallée, S. The Ohio State University, Columbus, Mosconi, M. PRAXIM, Grenoble, France OH USA Clinica Ortopedica e Traumatologica dell‘Università di Pavia – Fondazione Lavernia, C. Lucente, L. IRCCS Policlinico San Matteo, Orthopaedic Institute at Mercy, Clinica Quisisana, Via Gian Giacomo P.le Golgi 2, 27100 Pavia, Italy 3659 S. Miami Ave Ste 4008, Porro n. 5, OO197 Roma, Italy Miami, FL 33133, USA Mosheiff , R. Lüring, C. Department of Orthopaedic Surgery, Layher, F. Gesundheitsökonom, Orthopädische Hadassah-Hebrew University Medical Department of Orthopedic Surgery, Klinik, Universität Regensburg, School, Jerusalem, Hadassah Medical University of Jena, Waldkrankenhaus Asklepios Klinikum Bad Abbach, Center, POB 12000, Jerusalem 91120, »Rudolf Elle«, Eisenberg, Kaiser-Karl-V.-Allee 3, Israel Klosterlausnitzer Straße 81, 93077 Bad Abbach, Germany 07607 Eisenberg, Germany Murphy, S.B. MacDonald, M. Center for Computer Assisted and Lazovic, D. Northwestern Center for Orthopedics, Reconstructive Surgery, New England Clinic for Orthopedics, 676 North St. Clair, Ste. 450, Chicago, Baptist Hospital, Tufts University, Pius-Hospital, Illinois, USA Harvard Medical School, Boston, MA, Georgstraße 12, USA 26121 Oldenburg, Germany Machacek, F. Gersthof Orthopaedic Hospital, Vienna, Neumann, W. Lefevre, C. Austria Orthopädische Klinik der Otto- Centre Hospitalier et Universitaire von-Guericke Universität Magdeburg, de Brest, Hôpital de la Cavale Blanche, Malik, A. Leipzigerstr. 44, 39120 Magdeburg, Brest, France, and Laboratoire de The Arthritis Institute, 501 E. Hardy Germany Traitement de l’Information Médicale, Street, Suite 300, Inglewood, INSERM, U650, Brest, France CA 90301, USA XXIV List of Contributors

Noble, P.C. Pearle, A. Pohlemann, T. Institute of Orthopedic Research and Assistant Attending Orthopedic Medizinische Hochschule Hannover, Education, The Methodist Hospital, and Surgeon, Hospital for Special Surgery Zentrum Chirurgie, Unfallchirurgische Baylor College of Medicine, Houston, Assistant Attending Orthopedic Klinik, Carl-Neuberg-Str. 1, Texas, USA Surgeon, New York Presbyterian 30625 Hannover, Germany Hospital Nolte, L.P. Clinical Director, Hospital for Prymka, M. M.E. Müller Research Center for Special Surgery Computer Assisted Department for Orthopaedic Surgery, Orthopaedic Surgery. Institute for Surgery Center University of Schleswig-Holstein, Surgical Technology and Biomechanics, Hospital for Special Surgery Campus Kiel, Michaelisstraße 1, University Bern, Bern, Switzerland 535 East 70th Street 24105 Kiel, Germany New York, NY 10021, USA Othman, A. Puls, M. Department of Orthopaedic and Perlick, L. MEM Research Center for Orthopaedic Trauma Surgery, Lukas Hospital, Department of Orthopaedic Surgery, Surgery, Institute for Surgical Hindenburgstraße 56, 32257 Bünde, University of Regensburg, Technology and Biomechanics, Germany 93042 Regensburg, Germany University of Bern, Bern, Switzerland

Ottersbach, A. Perrin, N. Recum J. von Orthopaedic Department, Brig, Laboratoire de Traitement de Berufsgenossenschaftliche Unfallklinik Switzerland l’Information Médicale, INSERM, Ludwigshafen, Klinik für Unfall- und U650, Brest, France, and PRAXIM, Wiederherstellungschirurgie an der Paff rath, Th. Grenoble, France Universität Heidelberg Department of Trauma and Orthopaedic Surgery, University of Piovani, L. Reichel, H. Witten/Herdecke, Cologne-Merheim Clinica Ortopedica e Traumatologica Orthopädische Abteilung des Medical Center (CMMC), dell‘Università di Pavia – Fondazione Rehabilitationskrankenhauses Ulm, Ostmerheimer Straße 200, IRCCS Policlinico San Matteo, Orthopädische Klinik mit Querschnitt- 51109 Cologne, Germany P.le Golgi 2, 27100 Pavia, Italy gelähmtenzentrum der Universität Ulm, Oberer Eselsberg 45, 89081 Ulm, Pagnano, M.W. Plaskos, C. Germany Associate Professor of Orthopedic PRAXIM, Grenoble, France Surgery, Mayo Clinic College of Richter, M. Medicine, Mayo Clinic, 200 First Street Plate, J.F. Department for Trauma, Orthopaedic SW, Rochester, MN 55905, USA Reubin Institute of Advanced and Foot Surgery, Coburg Clinical Orthopaedics Center, Ketschendorfer Str. 33, 96450 Pap, G. 2401 W. Belvedere Ave. Coburg, Germany Orthopädische Klinik der Otto- Baltimore, MD 21215 von-Guericke Universität Magdeburg, Ritschl, P. Leipzigerstr. 44, 39120 Magdeburg, Plaweski, S. Gersthof Orthopaedic Hospital, Vienna, Germany Orthopedic department Austria University of Joseph Fourier Parratte, S. CHU Grenoble Sagbo, S. The Aix-Marseille University, Depart- BP 217 MEM Research Center for Orthopaedic ment of Orthopaedic Surgery, Hopital 38043 Grenoble, France Surgery, Institute for Surgical Sainte-Marguerite, Service de Chirurgie Technology and Biomechanics, Orthopédique, 270 Boulevard Sainte- University of Bern, Bern, Switzerland Marguerite, 13009, Marseille, France XXV List of Contributors

Sander, K. Seyler, T.M. Stulberg, S.D. Department of Orthopedic Surgery, Reubin Institute of Advanced Professor of Clinical Orthopaedic University of Jena, Waldkrankenhaus Orthopaedics Surgery, Northwestern University »Rudolf Elle«, Eisenberg, 2401 W. Belvedere Ave. Feinberg School of Medicine, Director, Klosterlausnitzer Straße 81, Baltimore, MD 21215 Joint Reconstruction and Implant 07607 Eisenberg, Germany Service, Northwestern Memorial Shafi zadeh, S. Hospital, 633 Clark Street, Evanston, Saragaglia, D. Department of Trauma and IL 60208, USA Service de chirurgie Orthopédique Orthopaedic Surgery, University of et de Traumatologie du Sport, CHU Witten/Herdecke, Cologne-Merheim Suhm, N. de Grenoble, Hôpital Sud, 38130, Medical Center (CMMC), Department of Surgery, University Echirolles, France Ostmerheimer Straße 200, Hospital Basel, Basel, Switzerland 51109 Cologne, Germany Saur, M.A. Sussman-Fort, J. Orthopaedic Hospital, Sherman, K.P. Department of Biomedical Engineering, Am Mühlenberg 3, Consultant Orthopaedic Surgeon, Columbia University, New York City, USA 37235 Hessisch-Lichtenau, Germany Castle Hill Hospital, Cottingham, Hull, UK Tannast, M. Schemitsch, E.H. Department of Orthopaedic Surgery, Orthopaedic Department, Siebenrock, K.A. Inselspital, University of Bern, Bern, St Michael Hospital, University of Department of Orthopaedic Surgery, Switzerland, and Center for Computer Toronto, Canada Inselspital, University of Bern, Bern, Assisted and Reconstructive Surgery, Switzerland New England Baptist Hospital, Tufts Schemitsch, E.H. University, Harvard Medical School, Professor, Division of Orthopaedics, Stiehl, J.B. Boston, MA, USA Department of Surgery, University of Columbia St Mary’s Hospital, 575 W Toronto, St. Michael’s Hospital, Suite River Woods Parkway, Milwaukee, Thomas, W. 800, 55 Queen Street East, Toronto, Wisconsin 53211, USA Clinica Quisisana, Via Gian Giacomo Ontario M5C 1R6, Canada Porro n. 5, OO197 Roma, Italy Stindel, E. Scuderi, G.R. Centre Hospitalier et Universitaire de Thompson, M.T. Insall Scott Kelly Institute Brest, Hôpital de la Cavale Blanche, Institute of Orthopedic Research and 210 East 64th St. 4th Floor Brest, France, and Laboratoire de Education, The Methodist Hospital, and New York, NY 10021 Traitement de l’Information Médicale, Baylor College of Medicine, Houston, INSERM, U650, Brest, France Texas, USA Seedhom, B.B. Reader, Academic Unit of Stroppa, S. Tiling, Th. Musculoskeletal and Rehabilitation Clinica Ortopedica e Traumatologica Department of Trauma and Medicine, University of Leeds, Leeds, dell‘Università di Pavia – Fondazione Orthopaedic Surgery, University of United Kingdom IRCCS Policlinico San Matteo, Witten/Herdecke, Cologne-Merheim P.le Golgi 2, 27100 Pavia, Italy Medical Center (CMMC), Senkal, M. Ostmerheimer Straße 200, Department for General Surgery 51109 Cologne, Germany and Orthopaedic Surgery, Ruhr University Bochum, Germany Tingart, M. Department of Orthopaedic Surgery, University of Regensburg, 93042 Regensburg, Germany XXVI List of Contributors

Tria, A.J. Jr. Weil, Y. Zhang, X. Institute for Advanced Orthopaedic Department of Orthopaedic Surgery, MEM Research Center for Orthopaedic Study, The Orthopaedic Center Hadassah-Hebrew University Medical Surgery, Institute for Surgical of New Jersey, 1527 State Highway 27, School, Jerusalem, Hadassah Medical Technology and Biomechanics, Suite 1300, Somerset, Center, POB 12000, Jerusalem 91120, University of Bern, Bern, Switzerland New Jersey 08873, USA Israel Zheng, G. Troccaz J. Wendl, K. MEM Research Center for Orthopaedic TIMC Laboratory, Grenoble University, Berufsgenossenschaftliche Unfallklinik Surgery, Institute for Surgical France Ludwigshafen, Klinik für Unfall- und Technology and Biomechanics, Wiederherstellungschirurgie an der University of Bern, Bern, Switzerland Trottenberg, G. Universität Heidelberg Orthopedic Clinic, St. Vincenz-Hospital, Danziger Str. 17, 33034 Brakel, Germany Wentzensen, A. Berufsgenossenschaftliche Unfallklinik Vail, T.P. Ludwigshafen, Klinik für Unfall- und Professor of Orthopaedic Surgery, Wiederherstellungschirurgie an der Director of Adult Reconstructive Universität Heidelberg Surgery, Duke University Medical Center, Durham, North Carolina, USA Willburger, R. Department for General Surgery and Victor, J. Orthopaedic Surgery, Ruhr University Department of Orthopaedics Bochum, Germany AZ St-Lucas, Brugge, Belgium Wixson, R.L. Walker, P.S. Professor of Clinical Orthopaedic Director, Laboratory for Minimally- Surgery, Feinberg School of Medicine, Invasive Surgery, Department of Northwestern University, Chicago, Orthopaedics, NYU Hospital for Joint Illinois, USA Diseases, New York City, USA Yau, W.-P. Wan, Z. Department of Orthopaedics and The Arthritis Institute, 501 E. Hardy Traumatology, Queen Mary Hospital, Street, Suite 300,Inglewood, CA 90301, Pokfulam, Hong Kong USA Yildirim, G. Wasielewski, R.C. Laboratory for Minimally-Invasive Adjunct Professor of Biomedical Surgery, Department of Orthopaedics, Engineering, University of Tennessee NYU Hospital for Joint Diseases, New York City, USA Wei, C.-S. Cooper Union for the Advancement of Zech, S. Science and Arts, New York City, USA Trauma Department, Hannover Medical School, Weidner, A. Carl-Neuberg-Str. 1, Spine Center 30625 Hannover, Germany Lengericher Landstr. 19b 49078 Osnabrück, Germany