Applicability of augmented reality in orthopedic surgery – A systematic review

Abstract

Background: Computer-assisted solutions are changing surgical practice continuously. One of the most disruptive technologies among the computer-integrated surgical techniques is Augmented Reality (AR). While Augmented Reality is increasingly used in several medical specialties, its potential benefit in orthopedic surgery is not yet clear. The purpose of this article is to provide a systematic review of the current state of knowledge and the applicability of AR in orthopedic surgery. Methods: A systematic review of the current literature was performed to find the state of knowledge and applicability of AR in Orthopedic surgery. A systematic search of the following three databases was performed: "PubMed", "Cochrane Library" and "Web of Science". The systematic review followed the Preferred Reporting Items on Systematic Reviews and Meta-analysis (PRISMA) guidelines and it has been published and registered in the international prospective register of systematic reviews (PROSPERO). Results: 31 studies and reports are included and classified into the following categories: Instrument / Implant Placement, Osteotomies, Tumor Surgery, Trauma, and Surgical Training and Education. Quality assessment could be performed in 18 studies. Among the clinical studies, there were six case series with an average score of 90% and one case report, which scored 81% according to the Joanna Briggs Institute Critical Appraisal Checklist (JBI CAC). The 11 cadaveric studies scored 81% according to the QUACS scale (Quality Appraisal for Cadaveric Studies). Conclusion: This manuscript provides 1) a summary of the current state of knowledge and research of Augmented Reality in orthopedic surgery presented in the literature, and 2) a discussion by the authors presenting the key remarks required for seamless integration of Augmented Reality in the future surgical practice. Trial registration: PROSPERO registration number: CRD42019128569.

PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews

“…Example of item 24a of PRISMA 2020 checklist "…this systematic review has been registered in the international prospective register of systematic reviews (PROSPERO) under the registration number: CRD42019128569" 201 Example of item 24b of PRISMA 2020 checklist likely to lessen unnecessary changes after protocol development. 22 However, it is difficult to anticipate all scenarios that will arise, necessitating some clarifications, modifications, and changes to the protocol (such as data available may not be amenable to the planned meta-analysis).…”

Current Perspectives on Augmented Reality in Medical Education: Applications, Affordances and Limitations

“… 12 A further review of research into AR in orthopedic surgery also included some examples of education and training. 13 There have also been some more general analyses of the literature pertaining to AR in medical education, for example a review of articles relating to AR for healthcare education in areas other than surgery, 14 while Barsom et al and Tang et al have produced systematic reviews of augmented reality across all aspects of medical education. 15 , 16 Both these studies focused specifically on the different types of AR applications (ARAs) adopted in medical education.…”

Augmenting Surgery: Medical Students’ Assessment and Ergonomics of 3D Holograms vs. CT Scans for Pre-Operative Planning

“…In surgery, MR display technologies could be used both intra-operatively and pre-operatively. In the first scenario, the surgeon performs the intervention while a display superimposed on the patient's body shows relevant, but normally invisible medical information that helps to improve accuracy [9,10]. In the heart surgery branch, for example, the three-dimensional image data have potential benefits of high mobility, gesture control, and angle independency of users [11].…”