Glenoid Component Placement Assisted by Augmented Reality Through a Head-Mounted Display During Reverse Shoulder Arthroplasty

These authors assert that, "using a navigated augmented reality system through a head-mounted display for placement of the glenoid component in RSA is viable in an in vivo setting".

Navigated augmented reality (AR) refers to the real world augmented with virtual real-time information about the position and orientation of instruments and components. This information can be presented through a head-mounted display (HMD), which enables the user to visualize the virtual information directly overlaid onto the real world.

They present a case of reverse total shoulder arthroplasty performed using augmented reality for a shoulder with simple preoperative anatomy.

The result is shown below with a bone graft beneath the baseplate and substantial lengthening of the arm (see this link).

The authors do not present the cost of the augmented reality system, the time to learn and the time to apply this technology in each case, the indications for its use, or the ability of the system to be implemented with more complex anatomy, such as a substantially retroverted glenoid which makes exposure of the glenoid more difficult.

They do point out:

the need for a wide exposure to accommodate the instrumentation,

the need for a K-wire in the base of the coracoid with risks if the pin is placed too medial or too lateral

the risk of coracoid fracture

and the risk of loosening of the tracker leading to wrong information regarding instrument position.

Comment: Most reverse total shoulders can be performed using the technique shown in this link, which does not require the use of preoperative CT scans, 3D planning, patient specific instrumentation, or augmented reality as shown in the example below.

Extensive clinical research will be needed to define the value to the patient of augmented reality through a head-mounted display (i.e. do surgeries with this technology yield better clinical outcomes?). As we approach 100,000 reverse total shoulders per year in the United States, which of these patients and which surgeons might benefit from this innovation?

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