Accuracy of Implant Placement Using Augmented Reality-assisted Technique in Total Wrist Arthroplasty

The study aimed to evaluate the accuracy of augmented reality-assisted total wrist arthroplasty (AR-TWA) in a cadaveric model using a three-point registration method. The hypothesis is that AR-assisted surgery can enable surgeons to achieve accurate implant placement comparable with surgeries performed under specialist guidance.

Fourteen fresh-frozen upper extremities from seven cadavers were used for TWA. Computed tomography data were imported into three-dimensional image analysis software for surgical planning. On one side, AR-TWA was performed by a board-certified orthpaedic surgeon with no clinical experience in TWA, and on the contralateral side, non-AR-TWA was performed by the same surgeon under the guidance of an experienced hand surgeon. The accuracy of implant placement was assessed by comparing preoperative and postoperative computed tomography scans and measuring deviations and angular errors between the planned and actual component positions.

For both the radial and carpal components, four of six parameters demonstrated smaller errors in the AR-TWA. Although certain parameters favored the non-AR-TWA, overall variability was lower with AR. When classified as acceptable or outlier, all seven radial cases in the AR-TWA were acceptable for deviation, and six were acceptable for angular error, indicating better consistency than the non-AR-TWA. On the carpal side, AR-TWA demonstrated higher accuracy than non-AR-TWA, but more outliers were observed, suggesting relatively greater variability in this region.

Augmented reality-assisted TWA using a three-point registration method improved the accuracy of implant placement, even when performed by a less experienced surgeon.

Augmented reality technology may assist less experienced surgeons in performing technically demanding procedures, such as TWA, with improved accuracy.