The Integration of Extended Reality in Arthroplasty: Reviewing Technological Progress and Clinical Benefits

Abstract

Background: Extended reality (XR) has shown promise in the operating room for enhancing surgical precision and improving patient outcomes. With the evolution of individualized planning in orthopedic surgery, precise implant alignment is integral to improving pain and function. XR encompasses augmented reality (AR), virtual reality (VR), and mixed reality (MR). Both AR and MR have been adapted for operating room use, while VR has been adapted for surgical planning and educational training.

Methods: A literature search identified studies evaluating XR in arthroplasty and XR systems approved by the US Food and Drug Administration. This narrative report highlights the integration of XR in arthroplasty.

Results: In total hip arthroplasty (THA), XR is most effective for maximizing alignment of the acetabular cup. Traditional techniques make ideal anteversion and inclination angles difficult to achieve, values critical for implant stability and the prevention of impingement and precocious wear. XR systems have been shown to improve the accuracy of inclination compared with traditional techniques in THA. For total knee arthroplasty (TKA), XR proves most useful in ensuring accurate alignment and resection for the tibial and femoral components. XR systems for TKA have been shown to increase the accuracy of distal femoral resection with a limited increase in surgery duration. Conventional techniques for total shoulder arthroplasty (TSA) are complicated by the difficulty faced in accessing and visualizing key structures with the shoulder, particularly with the recent trend towards minimally invasive techniques. Issues with implant positioning are more common in TSA than other joint arthroplasties, making XR particularly promising in this setting.

Conclusions: XR technologies have shown significant potential in enhancing precision and patient outcomes in arthroplasty. There are some disadvantages to its use, however, including high cost and increased operative time. Integrating XR into surgical practice can improve implant alignment and accuracy, addressing challenges faced with conventional techniques.