Augmented-Reality-Assisted K-Wire Placement for Glenoid Component Positioning in Reversed Shoulder Arthroplasty: A Proof-of-Concept Study

Abstract

The accuracy of the implant’s post-operative position and orientation in reverse shoulder arthroplasty is known to play a significant role in both clinical and functional outcomes. Whilst technologies such as navigation and robotics have demonstrated superior radiological outcomes in many fields of surgery, the impact of augmented reality (AR) assistance in the operating room is still unknown. Malposition of the glenoid component in shoulder arthroplasty is known to result in implant failure and early revision surgery. The use of AR has many promising advantages, including allowing the detailed study of patient-specific anatomy without the need for invasive procedures such as arthroscopy to interrogate the joint’s articular surface. In addition, this technology has the potential to assist surgeons intraoperatively in aiding the guidance of surgical tools. It offers the prospect of increased component placement accuracy, reduced surgical procedure time, and improved radiological and functional outcomes, without recourse to the use of large navigation or robotic instruments, with their associated high overhead costs. This feasibility study describes the surgical workflow from a standardised CT protocol, via 3D reconstruction, 3D planning, and use of a commercial AR headset, to AR-assisted k-wire placement. Post-operative outcome was measured using a high-resolution laser scanner on the patient-specific 3D printed bone. In this proof-of-concept study, the discrepancy between the planned and the achieved glenoid entry point and guide-wire orientation was approximately 3 mm with a mean angulation error of 5°.

Augmenting Performance: A Systematic Review of Optical See-Through Head-Mounted Displays in Surgery

“…In Figure 8 , a breakdown of the 57 papers included in our survey is depicted based on their general surgical speciality. The majority of papers ( ) focused on orthopedic applications, such as osteotomy [ 45 , 46 , 47 , 48 , 49 ] and K-wire placement [ 50 , 51 ], with the second largest ( ) involving maxillofacial surgery procedures, such as tumor resection [ 52 ] and craniofacial fibrous dysplasia [ 53 , 54 ]. The prevalence of OST-HMD investigation in orthopedic and maxillofacial surgeries is likely due to the rigid nature of the relevant anatomy, the availability of consistent landmarks for registration and tracking, and the prevalence of commercially available surgical navigation suites.…”

“…Several groups reported the use of volume-rendered models for display on an OST-HMD during guidance for use in maxillofacial tumor resection [ 52 ] and neurosurgery [ 64 ]. Some groups mentioned the use of 3D printed models created from segmented surface models of preoperative patient anatomy for enhanced visualization and assessment alongside the virtual model display [ 51 ].…”

Glenoid Component Placement Assisted by Augmented Reality Through a Head-Mounted Display During Reverse Shoulder Arthroplasty

“…The use of navigated AR system through HMD in shoulder arthroplasty has recently been published in an in vitro setting. 15 , 16 , 17 Kriechling et al. 15 described a feasibility study of a navigated AR system through HMD in 3D-printed scapula models showing a mean deviation of 2.3 mm and 2.7°.…”

“… 13 This information may be presented through a head-mounted display (HMD), which enables the user to visualize essential information directly overlaid onto the surgical field. A type of navigated AR through HMD was recently validated for glenoid K-wire placement in 3D-printed scapula models 15 , 16 and cadavers. 17 To the best of our knowledge, no technical description of in vivo glenoid component placement with navigated AR system through a HMD has been published.…”

Taking the Next Step in Personalised Orthopaedic Implantation

“…Ultimately, however, this information only helps us if we can put it into practice on the patient. Augmented reality and robotic systems will help us to translate the planning [ 23 ]. Personally, I strongly believe that these new technologies will bring us further in successful and, above all, adapted therapy for our patients.…”