Mixed reality as a novel tool for diagnostic and surgical navigation in orthopaedics

Abstract

Purpose This study presents a novel surgical navigation tool developed in mixed reality environment for orthopaedic surgery. Joint and skeletal deformities affect all age groups and greatly reduce the range of motion of the joints. These deformities are notoriously difficult to diagnose and to correct through surgery. Method We have developed a surgical tool which integrates surgical instrument tracking and augmented reality through a head mounted display. This allows the surgeon to visualise bones with the illusion of possessing “X-ray” vision. The studies presented below aim to assess the accuracy of the surgical navigation tool in tracking a location at the tip of the surgical instrument in holographic space. Results Results show that the average accuracy provided by the navigation tool is around 8 mm, and qualitative assessment by the orthopaedic surgeons provided positive feedback in terms of the capabilities for diagnostic use. Conclusions More improvements are necessary for the navigation tool to be accurate enough for surgical applications, however, this new tool has the potential to improve diagnostic accuracy and allow for safer and more precise surgeries, as well as provide for better learning conditions for orthopaedic surgeons in training.

Augmented Reality, Virtual Reality and Artificial Intelligence in Orthopedic Surgery: A Systematic Review

“…The selected articles included three RCTs [5,21,22] and 18 NRCTs [11,[23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] (five pilot, three prospective comparative, two prospective observational, two prospective cohort, two prospective case-control, two retrospective comparative, two retrospective cohort). Studies were published between 2013 [21] and 2021 [28]. VR was used for training procedures and preoperative planning [2,3,5,21,22,27,32,33,36].…”

“…VR was used for training procedures and preoperative planning [2,3,5,21,22,27,32,33,36]. AR was utilized for preoperative planning and intraoperative purposes [2,3,11,[23][24][25][26][28][29][30][31]34,35,[37][38][39]. AI was found reported only in two studies and was adopted to improve the preoperative diagnosis accuracy [27,33].…”

“…The MINORS tool was used to assess the risk of bias in NRCTs. Among these studies, fifteen studies (83.3%) [11,24,25,27,[29][30][31][32][33][34][35][36][37][38][39] had a low risk of bias, and three studies (16.7%) [23,26,28] had a high risk of bias. The Cochrane Risk of Bias Tool and MINORS were reported in Tables 1 and 2.…”

“…Fourteen studies were included (five pilot, one retrospective cohort, two retrospective comparative, two prospective comparative, one prospective case-control, two prospective cohort, one prospective observational) [11,[23][24][25][26][28][29][30][31]34,35,[37][38][39]. The authors of these studies reported that AR efficiently aided surgeons in performing surgical operations.…”

“…The hardware used in these procedures included head-mounted displays, such as HoloLens or Xvision (Augmedics). One of the articles mentioned MR [28] rather than AR. Different AR registration techniques were used in these studies.…”