Accuracy of augmented reality with computed tomography-based navigation in total hip arthroplasty

Abstract

Background Augmented reality (AR) provides the surgeon with direct visualization of radiological images by overlaying them on the patient. This study aimed to evaluate the accuracy of cup placement using a computed tomography (CT)-based AR navigation system. Methods Sixty-five prospectively enrolled patients underwent primary cementless total hip arthroplasty (THA) in a supine position using this novel AR navigation system, and changes in pelvic flexion angle (PFA) were evaluated. Absolute navigation errors were defined as the absolute differences between angles in the intraoperative navigation record and those measured on postoperative CT. Factors affecting the absolute navigation error in cup alignment were determined. Results Mean absolute change in PFA between preoperative CT and reduction was 2.1° ± 1.6°. Mean absolute navigation errors were 2.5° ± 1.7° in radiographic inclination (RI) and 2.5° ± 2.2° in radiographic anteversion (RA). While no factors significantly affecting absolute navigation error were found for RI, absolute change in PFA between preoperative CT and reduction correlated significantly with the absolute navigation error for RA. Conclusion This CT-based navigation system with AR enabled surgeons to place the cup more accurately than was possible by freehand placement during THA in a supine position.

Comparison between accuracy of augmented reality computed tomography-based and portable augmented reality-based navigation systems for cup insertion in total hip arthroplasty

“…CT-based navigation with these AR technologies was designated AR CT-based navigation in this study. Currently, Holonavi One (Holonavi Medical Technology Inc., Ichinomiya, Japan) 8 is used AR CT-based navigation during THA. Surgeons can use AR computed tomography (CT)-based navigation systems (Holonavi One) 8 and portable AR-based navigation systems using smartphones (AR-Hip; Zimmer Biomet Japan, Tokyo, Japan) 9 , 10 .…”

“…Currently, Holonavi One (Holonavi Medical Technology Inc., Ichinomiya, Japan) 8 is used AR CT-based navigation during THA. Surgeons can use AR computed tomography (CT)-based navigation systems (Holonavi One) 8 and portable AR-based navigation systems using smartphones (AR-Hip; Zimmer Biomet Japan, Tokyo, Japan) 9 , 10 . One of the advantages of the AR CT-based navigation system is its ease of use without an AR headset, which may be difficult to use with a surgical helmet 8 .…”

“…Surgeons can use AR computed tomography (CT)-based navigation systems (Holonavi One) 8 and portable AR-based navigation systems using smartphones (AR-Hip; Zimmer Biomet Japan, Tokyo, Japan) 9 , 10 . One of the advantages of the AR CT-based navigation system is its ease of use without an AR headset, which may be difficult to use with a surgical helmet 8 . The AR CT-based navigation system enables surgeons to enhance cup placement accuracy in a supine position, compared with freehand placement 8 .…”

“…One of the advantages of the AR CT-based navigation system is its ease of use without an AR headset, which may be difficult to use with a surgical helmet 8 . The AR CT-based navigation system enables surgeons to enhance cup placement accuracy in a supine position, compared with freehand placement 8 . In addition, surgeons can confirm not only the bone but also the muscles and vessels on the monitor of the AR CT-based navigation system 8 .…”

“…The AR CT-based navigation system enables surgeons to enhance cup placement accuracy in a supine position, compared with freehand placement 8 . In addition, surgeons can confirm not only the bone but also the muscles and vessels on the monitor of the AR CT-based navigation system 8 . Both systems demonstrate accurate cup insertion 8 – 13 .…”