# Augmented reality navigation systems vs. conventional techniques in acetabular cup positioning: a systematic review and meta-analysis

## TL;DR

This study compares AR navigation systems to traditional methods for positioning hip implants and finds AR improves accuracy without increasing risks.

## Contribution

The study provides a meta-analysis showing AR improves acetabular cup positioning accuracy in hip surgery.

## Key findings

- AR systems significantly improved acetabular cup inclination and anteversion accuracy compared to conventional methods.
- No significant differences were found in blood loss, operation time, or postoperative complications between AR and conventional groups.
- High heterogeneity and risk of bias in retrospective studies limit the meta-analysis conclusions.

## Abstract

The aim of this systematic review and meta-analysis was to evaluate the effectiveness of augmented reality (AR) techniques in acetabular cup positioning during total hip arthroplasty (THA).

The Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE databases were systematically searched until December 12, 2024 according to the PRISMA 2020 guidelines for prospective and retrospective studies comparing AR techniques to conventional ones regarding acetabular cup positioning. Anteversion, inclination angles, blood loss, operation time and postoperative complications comprised the outcomes. Bias assessment was performed with the RoB 2 tool for prospective studies and ROBINS-I for retrospective ones.

In total, 9 studies were included in the systematic review and 8 in the meta-analysis. The target error according to postoperative radiographs or computer scan for both anteversion and inclination angles was significantly more precise in the 346 THAs of the AR group (Zinclination = 3.10, Pinclination = 0.002, Std. mean difference = −0.52 [95 % CI: 0.85 to −0.19] and Zanteversion = 2.44, Panteversion = 0.01, Std. mean difference = −0.57 [95 % CI: 1.03 to −0.11]) with a significant substantial heterogeneity (I2inclination = 79 %, Pinclination<0.0001 and I2anteversion = 89 %, Panteversion < 0.00001), when compared to the 395 THAs of the conventional group. Regarding blood loss, operation time and postoperative complications, no significant differences were observed. The risk of bias was high among the retrospective studies.

The different types of studies, as well as their individual way of assessing the acetabular cup angles are the main limitations of the meta-analysis. The results provide a strong sign of improved acetabular cup positioning with the help of AR systems, while maintaining a favorable safety profile.

CRD42024609350.