Augmented reality in orthopaedics

Laverdière, Carl; Corban, Jason; Khoury, Jason; Ge, Susan; Schupbach, Justin; Harvey, Edward J.; Reindl, Rudy; Martineau, Paul A.

doi:10.1302/0301-620x.101b12.bjj-2019-0315.r1

Cited by 70 publications

(35 citation statements)

References 42 publications

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“…Although AR technology has been used in many orthopaedic procedures 12 , 13 , to our knowledge, there have been no clinical studies investigating the usefulness of AR technology in TKA. This is the first clinical study to investigate the accuracy of an AR-based navigation system for TKA.…”

Section: Discussionmentioning

confidence: 99%

Augmented Reality-Assisted Femoral Bone Resection in Total Knee Arthroplasty

et al. 2021

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Background: An augmented reality (AR)-based navigation system allows visualization of the center of the femoral head and femoral mechanical axis superimposed on the surgical field during total knee arthroplasty (TKA) and may help surgeons to improve the accuracy of distal femoral resection. Methods: First, we resected 10 femoral Sawbones specimens using the AR-based navigation system and performed computed tomography (CT) to measure the resection angle of the distal part of the femur. We calculated the absolute values of the differences between angles measured using CT images and angles displayed on the smartphone screen of the navigation system. Second, we measured coronal alignment using standing long-leg radiographs for 72 patients undergoing TKA and compared the error in the resection angle between TKA using the AR-based navigation system and that using a conventional intramedullary guide. Results: In the experimental study, the absolute values of the differences between angles measured on CT images and angles displayed using the AR-based navigation system were 0.8° ± 0.5° (range, 0.3° to 1.9°) in the coronal plane and 0.6° ± 0.5° (range, 0.0° to 1.4°) in the sagittal plane. In the clinical study, the mean absolute value of the error in coronal alignment was significantly smaller in the AR-based navigation group than the intramedullary-guide group (1.1° ± 1.0° [range, 0.0° to 3.2°] compared with 2.2° ± 1.6° [range, 0.0° to 5.5°], respectively; 95% confidence interval, 0.5° to 1.8°; p < 0.001). Conclusions: The AR-based navigation system may enable surgeons to perform distal femoral resection more accurately than with the conventional intramedullary guide during TKA. Clinical Relevance: This study validates the use of AR technology to enhance the precision of bone resection in TKA.

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Section: Discussionmentioning

confidence: 99%

Augmented Reality-Assisted Femoral Bone Resection in Total Knee Arthroplasty

et al. 2021

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“…7,8 Reviews by Lavadi ere and Jud et al looked at the historical advances and applicability of AR specifically in orthopaedic surgery. 9,10 Potential for direct visualisation of radiological image overlays on the patient and intraoperative overlay imaging of preoperative planning were denoted however, significant challenges were observed. The impact of COVID-19 has been farreaching but one upside has been the necessity for innovation and implementation of novel technology, especially where they can improve patient care with reduced direct contact.…”

Section: Introductionmentioning

confidence: 99%

Opportunities and challenges of using augmented reality and heads-up display in orthopaedic surgery: A narrative review

Parekh

Gamble

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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Background & aim: Utilization of augmented reality (AR) and heads-up displays (HUD) to aid orthopaedic surgery has the potential to benefit surgeons and patients alike through improved accuracy, safety, and educational benefits. With the COVID-19 pandemic, the opportunity for adoption of novel technology is more relevant. The aims are to assess the technology available, to understand the current evidence regarding the benefit and to consider challenges to implementation in clinical practice. Methods & results: PRISMA guidelines were used to filter the literature. Of 1004 articles returned the following exclusion criteria were applied: 1) reviews/commentaries 2) unrelated to orthopaedic surgery 3) use of other AR wearables beyond visual aids leaving 42 papers for review. This review illustrates benefits including enhanced accuracy and reduced time of surgery, reduced radiation exposure and educational benefits. Conclusion: Whilst there are obstacles to overcome, there are already reports of technology being used. As with all novel technologies, a greater understanding of the learning curve is crucial, in addition to shielding our patients from this learning curve. Improvements in usability and implementing surgeons' specific needs should increase uptake.

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“…Organs and systems with low mobility and deformation require low tracking and tracing power from the AR devices, whereas highly mobile organs, such as bowel, require a more complicated track and display process. Taking these factors into consideration, the specialties that have shown great favour towards adopting AR technology include Neurosurgery [16,33,36,40], Ear, Nose and Throat (ENT) surgery [34], Maxillofacial surgery [7,41], and Orthopaedic surgery [25,28,29]. The use of AR in other operative modalities, including laparoscopic surgery and robotic surgery, has been expanding rapidly.…”

Section: Discussionmentioning

confidence: 99%

“…The application of AR in trauma cases has also gained traction, with a systematic review demonstrating the advantages of using a HMD enabling direct image presentation in front of a surgeon's visual field. In 50 trauma cases, the number of times a surgeon's eyes left the surgical field of view decreased from 207 using conventional methods to 5 whilst using intra-operative AR HMD, thereby indicating an increase in the efficiency of operation [28].…”

Section: Intraoperative Ar Applicationsmentioning

confidence: 99%

“…Although AR systems have demonstrated useful applications pre-operatively, intra-operatively and in surgical teaching, there is a plethora of speciality-specific limitations that currently inhibit AR from being widely utilised in clinical practice. Surgeons using AR in orthopaedic operations often complained of an overcrowded field of view which restricted vision and hampered operation progress [28]. Furthermore, AR systems were shown to increase focus on the task at hand, albeit negatively, as surgeons occasionally became less aware of complications manifesting in the surrounding surgical field.…”

Section: Limitations Of Armentioning

confidence: 99%

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How is the Digital Surgical Environment Evolving? The Role of Augmented Reality in Surgery and Surgical Training

Georgi¹,

Patel²,

Tandon³

et al. 2021

Preprint

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Background Augmented reality (AR) in surgery can offer an enhanced view of reality through the superimposition of computer-generated digital images on the real environment. It allows surgeons to integrate image visualisation, improving operative efficiency, surgical outcomes, surgical training and patient education. This review aims to evaluate the current status of augmented reality in surgery, surgical training and potential future applications. Methods We performed a non-systematic review of available literature from January 2005 to August 2021 by searching PubMed, EMBASE and the Cochrane library using a combination of terms “augmented reality”, “virtual reality”, “surgery”, “simulation” and “training”. Articles considered for this review were identified by relevant search criteria including title, keywords, abstract, and full-text. Conclusions AR technologies present an exciting new trend with multiple potential applications in surgery. Intraoperative AR systems have shown promise in specialties involving fine movement of organs during surgical procedures, including Neurosurgery, Ears, Nose and Throat and Orthopaedic Surgery. AR has also exhibited the potential to enhance surgical training and improve knowledge acquisition; it can foster international collaborations via telesurgery and telepresence. In the near future, AR will likely work in symbiosis with surgeons, serving as a complex computer-human coalition which can improve patient outcomes, patient education and surgical training.

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Augmented reality in orthopaedics

Cited by 70 publications

References 42 publications

Augmented Reality-Assisted Femoral Bone Resection in Total Knee Arthroplasty

Augmented Reality-Assisted Femoral Bone Resection in Total Knee Arthroplasty

Opportunities and challenges of using augmented reality and heads-up display in orthopaedic surgery: A narrative review

How is the Digital Surgical Environment Evolving? The Role of Augmented Reality in Surgery and Surgical Training

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