Abstract
BackgroundComputer-assisted solutions are changing surgical practice continuously. One of the most disruptive technologies among the computer-integrated surgical techniques is Augmented Reality (AR). While Augmented Reality is increasingly used in several medical specialties, its potential benefit in orthopedic surgery is not yet clear. The purpose of this article is to provide a systematic review of the current state of knowledge and the applicability of AR in orthopedic surgery.MethodsA systematic review of the current literature was performed to find the state of knowledge and applicability of AR in Orthopedic surgery. A systematic search of the following three databases was performed: “PubMed”, “Cochrane Library” and “Web of Science”. The systematic review followed the Preferred Reporting Items on Systematic Reviews and Meta-analysis (PRISMA) guidelines and it has been published and registered in the international prospective register of systematic reviews (PROSPERO).Results31 studies and reports are included and classified into the following categories: Instrument / Implant Placement, Osteotomies, Tumor Surgery, Trauma, and Surgical Training and Education. Quality assessment could be performed in 18 studies. Among the clinical studies, there were six case series with an average score of 90% and one case report, which scored 81% according to the Joanna Briggs Institute Critical Appraisal Checklist (JBI CAC). The 11 cadaveric studies scored 81% according to the QUACS scale (Quality Appraisal for Cadaveric Studies).ConclusionThis manuscript provides 1) a summary of the current state of knowledge and research of Augmented Reality in orthopedic surgery presented in the literature, and 2) a discussion by the authors presenting the key remarks required for seamless integration of Augmented Reality in the future surgical practice.Trial registrationPROSPERO registration number: CRD42019128569.
Highlights
Computer-assisted solutions are changing surgical practice continuously
Systematic search Based on the above-mentioned predefined search terms and exclusion criteria, 31 studies were selected for final analysis (Fig. 1)
The main finding of this systematic review is that Augmented Reality (AR) has the potential to be a timesaving, risk and radiation reducing, and accuracy enhancing technology in orthopedic surgery
Summary
Computer-assisted solutions are changing surgical practice continuously. One of the most disruptive technologies among the computer-integrated surgical techniques is Augmented Reality (AR). Surgical planning was routinely done manually on fluoroscopy images. Today, this is replaced by advanced planning software incorporating multi-modal and patient-specific medical data. Robot solutions are proposed to reduce human error, increase precision, and ensure reproducibility [7,8,9,10]. They are not yet clinically adopted widely across different disciplines. Current drawbacks of robotic solutions in surgery include their minimal adaptive intellectual and haptic behavior, limitations in integrative interpretation and action in complex situations, ill-posed registration to the patient, complex setup, invasive fiducial implantation, and workflow disruption [9]
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