Augmented Reality in Orthopedic Surgery Is Emerging from Proof of Concept Towards Clinical Studies: a Literature Review Explaining the Technology and Current State of the Art

Casari, Fabio A.; Navab, Nassir; Hruby, Laura A.; Kriechling, Philipp; Nakamura, Ricardo; Tori, Romero; Nunes, Fátima L. S.; Queiroz, Marcelo Cavalheiro de; Fürnstahl, Philipp; Farshad, Mazda

doi:10.1007/s12178-021-09699-3

Cited by 61 publications

(31 citation statements)

References 67 publications

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“…In a recent article, Hintringer et al highlighted the relevance of considering the traumamechanism to determine the surgical approach, which can be in conflict with the standardized palmar acess for PSI use [28]. Regarding the rapid development of surgical navigation technology, an augmented reality-based application might advance the here presented approach allowing a traumamechanism-based surgical access [29,30].…”

Section: Discussionmentioning

confidence: 99%

Computer-assisted open reduction internal fixation of intraarticular radius fractures navigated with patient-specific instrumentation, a prospective case series

Casari

Roner

Fürnstahl

et al. 2021

Arch Orthop Trauma Surg

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Background Intra-articular fractures are associated with posttraumatic arthritis if inappropriately treated. Exact reduction of the joint congruency is the main factor to avoid the development of arthrosis. Aim of this study was to evaluate feasibility of computer-assisted surgical planning and 3D-printed patient-specific instrumentation (PSI) for treatment of distal intraarticular radius fractures. Method 7 Patients who suffered a distal intraarticular radius fracture were enrolled in this prospective case series. Preoperative CT-scan was recorded, whereupon a 3D model was computed for surgical planning and design of PSI for surgical navigation. Postoperative accuracy and joint congruency were assessed. Patients were followed-up 3, 6 and 12 months postoperatively. Results Mean follow-up was 16 months. Over all range of motion was restored and flexion, extension and pronation showed significant recovery, p < 0.05. Biggest intraarticular joint step-off and gap reduced from average 2.49 (± 1.04) to 0.8 mm (± 0.44), p < 0.05 and 6.12 mm (± 1.04) to 2.21 mm (± 1.16), p < 0.05. Average grip strength restored (3–16 months) from 20.33 kg (± 7.12) to 39.3 kg (± 19.55) p < 0.05, 100% of the healthy contralateral side. 3D-accuracy for guided fragments was 2.07 mm (± 0.64) and 8.59° (± 2.9) and 2.33 mm (± 0.69) and 12.86° (± 7.13), p > 0.05 for fragments reduced with ligamentotaxis. Conclusion Computer-assisted and PSI navigated intraarticular radius fracture treatment is feasible, safe and accurate. The benefits of this method, however, do not outstand the additional effort. Level of evidence IV.

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Section: Discussionmentioning

confidence: 99%

Computer-assisted open reduction internal fixation of intraarticular radius fractures navigated with patient-specific instrumentation, a prospective case series

Casari

Roner

Fürnstahl

et al. 2021

Arch Orthop Trauma Surg

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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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“…Medicine is another scenario deeply described by the literature to test and apply AR. For training surgeons, the precise positioning of needles and medical devices during surgery, enhanced view, alignment between Computer Tomography (CT) images and the real patient is a not an inclusive list of proposed tasks to be carried out with AR support [30]. In this case, the precision which can be obtained through AR in the alignment of the virtual model with the real patient, and the need for augmentation systems able to continue tracking, even when a medical operator covers the field of view of cameras or markers, are the main limits of the current technology.…”

Section: Applications Proposed By Literaturementioning

confidence: 99%

Augmented Reality in Industry 4.0 and Future Innovation Programs

et al. 2021

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Augmented Reality (AR) is worldwide recognized as one of the leading technologies of the 21st century and one of the pillars of the new industrial revolution envisaged by the Industry 4.0 international program. Several papers describe, in detail, specific applications of Augmented Reality developed to test its potentiality in a variety of fields. However, there is a lack of sources detailing the current limits of this technology in the event of its introduction in a real working environment where everyday tasks could be carried out by operators using an AR-based approach. A literature analysis to detect AR strength and weakness has been carried out, and a set of case studies has been implemented by authors to find the limits of current AR technologies in industrial applications outside the laboratory-protected environment. The outcome of this paper is that, even though Augmented Reality is a well-consolidated computer graphic technique in research applications, several improvements both from a software and hardware point of view should be introduced before its introduction in industrial operations. The originality of this paper lies in the detection of guidelines to improve the Augmented Reality potentialities in factories and industries.

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Augmented Reality in Orthopedic Surgery Is Emerging from Proof of Concept Towards Clinical Studies: a Literature Review Explaining the Technology and Current State of the Art

Cited by 61 publications

References 67 publications

Computer-assisted open reduction internal fixation of intraarticular radius fractures navigated with patient-specific instrumentation, a prospective case series

Computer-assisted open reduction internal fixation of intraarticular radius fractures navigated with patient-specific instrumentation, a prospective case series

Augmented Reality-Assisted Femoral Bone Resection in Total Knee Arthroplasty

Augmented Reality in Industry 4.0 and Future Innovation Programs

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