Mixed Reality and Augmented Reality in Complex Revision Shoulder Arthroplasty: Head-mounted Displays for Glenoid Baseplate Positioning.
Year: 2026
Type: review
Abstract: Introduction: Revision shoulder arthroplasty, when performed in the context of severe glenoid bone loss, is one of the most technically challenging reconstructive upper-limb procedures. Version, inclination, and precision of the glenoid base plate are the main risk factors for implant survivorship in reverse total shoulder arthroplasty. The use of mixed reality (MR) and augmented reality (AR) head-mounted displays (HMDs) has become a promising solution to overcome the ergonomic and line-of-sight constraints of conventional navigation and patient-specific instrumentation (PSI), while connecting the virtual and real worlds of pre-planning and intra-operative execution. Materials and Methods: A systematic narrative literature search was performed on PubMed/MEDLINE, Embase, Cochrane Library and Scopus databases from January 2010 to September 2026, and reference-chain searches were conducted manually. Combinations of terms such as "mixed reality," "augmented reality," "head-mounted display," "HoloLens," "Magic Leap," "shoulder arthroplasty," "glenoid baseplate," "revision arthroplasty," "glenoid bone loss," "navigation," and "patient-specific instrumentation" were used as search terms. Studies were chosen based on the relevance to AR/MR technology in shoulder surgery, accuracy in glenoid positioning of the component, and revision arthroplasty outcomes. The review follows a framework developed by the Scale for the Assessment of Narrative Review Articles. Results: Eight studies were found to meet the criteria for quantitative accuracy synthesis. Version deviation was always kept within 0.9°-2.5° using AR-HMD, compared to an average of 5.1° freehand and 3.5°-8° with PSI, and an inclination deviation of 0.9°-4.1° was achieved with AR-HMD, whereas 5.1°-17° was obtained freehand and 3.5°-8° was obtained with PSI. The Pixee Medical HMD, navigated AR Shoulder (Medacta), and Stryker Blue MR Guidance were all found to have similar accuracy profiles. MR guidance was demonstrated to be effective in making the performance of experienced and junior surgeons equal in the positioning of glenoid pins. There are a few regulatory clearances for AR for shoulder arthroplasty in the market, primarily in Europe. Conclusion: AR/MR HMDs are clinically proven, ergonomic tools to assist in the positioning of the glenoid baseplate in revision shoulder arthroplasty. Initial results demonstrate that the accuracy achieved with this approach is comparable to the optical navigation method and, with respect to the freehand technique, has better accuracy, while ensuring the democratization of surgical skill, regardless of the experience of the operator. Additional randomized controlled trials with patient-reported outcomes, prospective cost-utility analyses, and regulatory expansion are needed for universal adoption.
Source: PubMed
Language: English
Subfield: Computer Vision and Pattern Recognition
Field: Computer Science
Domain: Physical Sciences
Open Access status: green
OpenAlex ID: W7225569552
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