Aims: Aim of this study is to review the role of biomechanical modelling in computer aided orthopaedic surgery (CAOS), and to identify the issues that prevent a wider adoption of biomechanical modelling in the clinical practice.

Methods: we reviewed the experience we cumulated over the years in the use of biomechanical models to answer clinically relevant questions in the domains of joint prosthetics design and of skeletal strength under pathological conditions. also summarised the studies done in the past few years on the use of computer aided systems in the pre-operative planning, with particular reference to the Hip-OpA9 surgical planner for total hip replacement. Last, we analyse the improvements that the introduction of new technologies such as the Multimod Application Framework is likely to allow in a near future. All this information was combined in order to establish two possible scenarios for the next generation of computer aided orthopaedic surgery solutions: the use of biomechanics models as pre-operative and intra-operative decision-support instruments, and the role of multisensorial interfaces in CAOS applications.

Results: With this review we found that various technology limitation still limit a wider introduction of biomechanics modelling in CAOS. Specific research activities must be focused on the generation of patient-specific models of the musculo-skeletal apparatus that are not only anatomically but also functionally correct and accurate.

Conclusions: While multimodal imaging (CT+MRI+ SPECT) may provide the best results, solutions are being developed which are compatible with the logistics of the clinical practice.