Validation of Mixed Reality Surgical Navigation for Glenoid Axis Pin Placement in Shoulder Arthroplasty Using a Cadaveric Model.

Abstract

Mixed reality may offer an alternative for computer-assisted navigation in shoulder arthroplasty. The purpose of this study was to determine the accuracy and precision of mixed reality guidance for placement of the glenoid axis pin in cadaver specimens. This step is essential for accurate glenoid placement in total shoulder arthroplasty.Fourteen cadaveric shoulders underwent simulated shoulder replacement surgery by seven experienced shoulder surgeons. The surgeons exposed the cadavers through a deltopectoral approach, and then used mixed reality surgical navigation to insert a guide pin in a pre-planned position and trajectory in the glenoid. The mixed reality system utilized Microsoft Hololens 2 headset, navigation software, dedicated instruments with fiducial marker cubes, and a securing pin. CT scans obtained before and after the procedure were used to plan the surgeries and to determine the difference between the planned and the executed values for the entry point, version, and inclination. One specimen had to be discarded from the analysis because the guide pin was removed accidentally prior to obtaining the post-procedure CT scan.Regarding the navigated entry point on the glenoid, the mean difference between planned and executed values was 1.7±0.8 mm; this difference was 1.2 ± 0.6 mm in the superior-inferior direction and 0.9 ± 0.8 mm in the anterior-posterior direction. The maximum deviation from the entry point for all 13 specimens analyzed was 3.1 mm. Regarding version, the mean difference between planned and executed version values was 1.6±1.2 degrees, with a maximum deviation in version for all 13 specimens of 4.1 degrees. Regarding inclination, the mean angular difference was 1.7 ± 1.5 degrees, with a maximum deviation in inclination of 5 degrees.The mixed reality navigation system utilized in this study allowed surgeons to insert the glenoid guide pin on average within 2 mm from the planned entry point and within 2 degrees of version and inclination. The navigated values did not exceed 3 mm or 5 degrees respectively for any of the specimens analyzed. This approach may help surgeons more accurately place the definitive glenoid component.

View details for DOI 10.1016/j.jse.2023.09.027

View details for PubMedID 37890765