Computer-integrated revision total hip replacement surgery: Concept and preliminary results

Russell H. Taylor, Leo Joskowicz, Bill Williamson, André Guéiec, Alan Kalvin, Peter Kazanzides, Robert Van Vorhis, Jianhua Yao, Rajesh Kumar, Andrew Bzostek, Alind Sahay, Martin Börner, Armin Lahmer

Research output: Contribution to journalArticlepeer-review

77 Scopus citations


This paper describes an ongoing project to develop a computer-integrated system to assist surgeons in revision total hip replacement (RTHR) surgery. In RTHR surgery, a failing orthopedic hip implant, typically cemented, is replaced with a new one by removing the old implant, removing the cement and fitting a new implant into an enlarged canal broached in the femur. RTHR surgery is a difficult procedure fraught with technical challenges and a high incidence of complications. The goals of the computer-based system are the significant reduction of cement removal labor and time, the elimination of cortical wall penetration and femur fracture, the improved positioning and lit of the new implant resulting from precise, high-quality canal milling and the reduction of bone sacrificed to lit the new implant. Our starting points are the ROBODOC(R) system for primary hip replacement surgery and the manual RTHR surgical protocol. We first discuss the main difficulties of computer-integrated RTHR surgery and identify key issues and possible solutions. We then describe possible system architectures and protocols for preoperative planning and intraoperative execution. We present a summary of methods and preliminary results in CT image metal artifact removal, interactive cement cut-volume definition and cement machining, anatomy-based registration using fluoroscopic X-ray images and clinical trials using an extended RTHR version of ROBODOC. We conclude with a summary of lessons learned and a discussion of current and future work.

Original languageEnglish (US)
Pages (from-to)301-319
Number of pages19
JournalMedical image analysis
Issue number3
StatePublished - 1999


  • Computer-assisted surgery
  • Image-based registration
  • Orthopedics, revision total hip replacement
  • ROBODOC and ORTHODOC systems

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging
  • Computer Vision and Pattern Recognition
  • Health Informatics
  • Computer Graphics and Computer-Aided Design


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