Abstract
The accuracy of the implant’s post-operative position and orientation in reverse shoulder arthroplasty is known to play a significant role in both clinical and functional outcomes. Whilst technologies such as navigation and robotics have demonstrated superior radiological outcomes in many fields of surgery, the impact of augmented reality (AR) assistance in the operating room is still unknown. Malposition of the glenoid component in shoulder arthroplasty is known to result in implant failure and early revision surgery. The use of AR has many promising advantages, including allowing the detailed study of patient-specific anatomy without the need for invasive procedures such as arthroscopy to interrogate the joint’s articular surface. In addition, this technology has the potential to assist surgeons intraoperatively in aiding the guidance of surgical tools. It offers the prospect of increased component placement accuracy, reduced surgical procedure time, and improved radiological and functional outcomes, without recourse to the use of large navigation or robotic instruments, with their associated high overhead costs. This feasibility study describes the surgical workflow from a standardised CT protocol, via 3D reconstruction, 3D planning, and use of a commercial AR headset, to AR-assisted k-wire placement. Post-operative outcome was measured using a high-resolution laser scanner on the patient-specific 3D printed bone. In this proof-of-concept study, the discrepancy between the planned and the achieved glenoid entry point and guide-wire orientation was approximately 3 mm with a mean angulation error of 5°.
Highlights
This paper presents a proof-of-concept system to provide augmented reality (AR) guidance during k-wire placement for glenoid component positioning in reversed shoulder arthroplasty, using the Microsoft
To evaluate the registration error between the 3D-scanned scapulas and the reference anatomy, we measured the distance of each point in the glenoid region of the scans to the corresponding nearest neighbour on the reference anatomy
The measured errors between the planned and achieved entry point and k-wire orientation are reported in Table 1, for all the phantoms in the same order in which they were tested
Summary
Failure rates and sub-optimal performance continue to plague outcomes in reverse shoulder arthroplasty. Whilst the causes of revision surgery and poor function are multifactorial and include patient, implant factors, and surgeon, implant malposition remains a constant. Several computer-assisted strategies and tools are in use with varying outcomes. Traditional instruments remain the mainstay for the preparation of the glenoid in reverse shoulder arthroplasty, and whilst there are sophisticated 3D planning systems available on the market, delivering these virtual plans remains a challenge even for experienced surgeons [1]. Reverse total shoulder arthroplasty (RTSA) is known to be an effective surgical procedure for glenohumeral arthritis, rotator cuff arthropathy, irreparable rotator cuff tears, complex proximal humerus fractures, and failed shoulder prosthesis [3]
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