Work

Mixed reality guidance improves humeral head cut accuracy

Year: 2026

Type: article

Abstract: Background: The humeral head osteotomy is a critical step in both anatomic and reverse shoulder arthroplasty because it determines humeral component alignment, including neck-shaft angle (NSA), retroversion, and component height. Inaccurate osteotomy may adversely affect implant positioning, soft tissue tensioning, joint biomechanics, and long-term clinical outcomes. Mixed reality (MR) technology has demonstrated potential to improve intraoperative visualization and surgical accuracy in shoulder arthroplasty; however, its role in improving humeral head osteotomy accuracy remains largely unexplored. The purpose of this study was to determine whether MR guidance improves the accuracy of humeral head osteotomy compared with freehand and extramedullary guide (EG) techniques. Methods: Forty-five identical 3-dimensional printed arthritic proximal humerus models were created and mounted in standardized orientation. Nine orthopedic surgery residents were stratified by postgraduate year and randomly assigned within each stratum to one of 3 groups performing humeral head osteotomies using one of 3 techniques: freehand, EG, or MR holographic guidance using a Microsoft HoloLens 2. Each participant performed 5 osteotomies targeting a 135° NSA and 30° of retroversion. Following osteotomy, specimens were digitized using 3-dimensional scanning and compared with a predefined reference osteotomy plane using iterative closest point analysis in Blender software. Primary outcomes included absolute deviation from planned NSA, retroversion, and cut height. Results: = .70). Conclusion: MR holographic guidance improved the accuracy and reproducibility of humeral head osteotomy, particularly with respect to NSA and cut height, compared with freehand and EG techniques. These improvements were achieved using passive holographic guidance without formal navigation, optical tracking, or hologram registration, suggesting that 3-dimensional visualization alone may improve osteotomy reproducibility during shoulder arthroplasty. Further investigation is warranted in cadaveric and clinical settings.

Source: Journal of Shoulder and Elbow Arthroplasty

DOI: 10.1016/j.jsea.2026.100105

Authors: Daniel B. Calem, Lorik Berisha, Tej Joshi, Akhil Katakam, John Erickson

Institutions: Rutgers New Jersey Medical School, New York University, Overlook Medical Center

Language: English

Topic: Augmented Reality Applications

Subfield: Computer Vision and Pattern Recognition

Field: Computer Science

Domain: Physical Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,000