Feasibility of image-based augmented reality guidance of total shoulder arthroplasty using microsoft HoloLens 1

ABSTRACT

Total Shoulder Arthroplasty (TSA) is a shoulder replacement procedure to treat severe rotator cuff deficiency, primarily caused by osteoarthritis in elderly patients. One of the critical factors in reducing postoperative complications is accurate drilling of a centring hole on the glenoid surface at a precise position and orientation. While the drilling path is planned pre-operatively on 3D diagnostic images, the absence of visual guidance during surgery can lead to low reproducibility. In this paper, we present the design and feasibility analysis of a marker-less image-based registration pipeline using the Microsoft HoloLens 1 and its built-in sensors to guide glenoid drilling during TSA. Our solution intra-operatively registers the pre-operative 3D scan to the exposed glenoid surface both with and without occlusion. Our results provide a breakdown of the sources contributing to registration error. In addition to the commonly discussed errors (SLAM-based head tracking, partial overlap etc.), we find that the poor performance of the depth sensing camera becomes a major source of error. We further find that partial overlap between the source and target remains a large concern for registration in high occlusion scenarios. This work begins to characterise the depth sensor error and suggests future work towards image-based augmented reality guidance.

KEYWORDS:

• Mixed reality
• joint replacement
• registration
• surgical navigation

Acknowledgments

We gratefully acknowledge the collaborative support of Lawrence Higgins, MD, MBA, Ricardo Albertorio, BS, and Coen Wijdicks, PhD, from Arthrex Inc., and Gerhard Kleinzig and Sebastian Vogt from SIEMENS Healthineers for making an ARCADIS Orbic 3D available.

Disclosure statement

This work was performed under a sponsored research agreement between Johns Hopkins University and Arthrex Inc.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

The funding agreement is signed between Johns Hopkins University and Arthrex Inc.

Notes on contributors

Wenhao Gu

Wenhao Gu is a PhD student in the Department of Computer Science at Johns Hopkins University with research focus in Augmented Reality in operating room.

Kinjal Shah

Kinjal Shah is a graduate student studying Robotics in the Laboratory of Computational Sensing and Robotics at Johns Hopkins University. Her research focuses on human-computer interaction and developing technologies that improve accessibility.

Jonathan Knopf

Jonathan Knopf is a Principal Designer in Arthrex Inc. working on next generation products/services to help surgeons treat their patients better.

Nassir Navab

Nassir Navab is the Director of the Computer Aided Medical Procedures (CAMP) research team at both Technical University of Munich and Johns Hopkins University. He has also secondary faculty appointments at both affiliated Medical Schools.

Mathias Unberath

Mathias Unberath is an Assistant Professor in the Department of Computer Science at Johns Hopkins University with affiliations to the Laboratory for Computational Sensing and Robotics and the Malone Center for Engineering in Healthcare.