Implementation of an Intraoperative Augmented Reality Environment for Custom-Made Partial Pelvis Replacements—A Proof of Concept and Initial Results

TL;DR

This study shows that using augmented reality during surgery for custom-made pelvis replacements can improve accuracy, though it increases stress for the surgical team.

Contribution

The first intraoperative use of AR for custom partial pelvis replacements in revision arthroplasty is demonstrated.

Findings

AR enabled implantation in all 11 cases with a mean COR deviation of 4.2 mm.

The cup plane deviation angle averaged 4.4°, and the implant superimposition scored 0.69 (Dice-Score).

AR improved intraoperative feedback but increased stress for the surgical team.

Abstract

Background: The use of augmented reality (AR) in orthopaedics is growing rapidly but is mainly limited to pre-operative planning and teaching. This study is one of the first to describe the intraoperative application within revision arthroplasty for the positioning of customised partial pelvic replacements. Methods: In a proof-of-concept study an AR environment was used during surgery in 11 cases to enhance implant positioning. Postoperatively, a voxel-based CT deviation analysis was carried out to determine the COR deviation and the cup plane deviation angle. Additionally, digital implant superimposition was conducted. Results: Implantation was possible in all cases with a mean COR deviation vector of 4.2 (SD 2.5; 1.2–9.3) mm and a cup plane deviation angle of 4.4 (SD 2.5; 0.7–8.1)°. The implant analysis showed a superimposition of 0.69 (SD 0.15; 0.38–0.88) (Dice-Score calculation). Conclusions: This study is able to report promising results for AR in orthopaedic surgery, showing improved intraoperative feedback in complex operations, resulting in increased accuracy. However, the integration of AR poses a new challenge to the surgical team, especially because the AR users are facing a significantly increased level of intraoperative stress. Further development of this auspicious tool, as well as a conceivable combination with navigation, is necessary to facilitate broader usage.

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