Augmented Reality-Assisted Implant Positioning: A Novel Method for Real- Time Precision Placement

Author(s): Javier Orozco Martínez, Tanya Fernández-Fernández, Amaia Iribar-Zabala, Elena Aguilera-Jiménez, Carla de Gregorio-Bermejo, Alicia Pose-Díez-de-la-Lastra, Susana Gómez de los Infantes Peña, Borja Lara Galdón, Javier Pascau, Mónica García-Sevilla, José Calvo-Haro, Rubén Pérez Mañanes.

Introduction: Accurate positioning of custom-made prostheses is critical for ensuring stability, functionality, and longevity. Conventional manual placement has limitations in precision and intraoperative flexibility. This study explores a novel augmented reality (AR)- based method that provides real-time feedback to enhance acetabular implant placement accuracy.

Materials and Methods: Custom-made prostheses were designed for ten cadaveric hemipelvis using 3D printing technologies. An AR-based navigation system, developed for the HoloLens 2, provided real-time visual feedback, integrating holographic target position projections and color-coded alignment feedback. Accuracy in prosthesis placement (angular and distance errors), AR marker-associated errors, and procedural time were evaluated.

Results: The mean angular error for prosthesis placement was 1.70° (95% CI: 0.99°–2.41°), ranging from 0.24° to 3.60°. The mean distance error was 1.75 mm (95% CI: 1.18–2.32 mm). AR marker-associated errors included a mean translational error of 1.07 mm and a rotational error of 0.86°. The AR-guided placement process had an average execution time of 56 seconds.

Conclusions: This study presents a novel AR-assisted guidance method that enables high-precision prosthesis placement. The results highlight its potential to enhance accuracy and efficiency in complex surgical workflows, supporting its integration into future orthopaedic procedures.