Mixed reality with real-time navigation grants low deviations from planned inclination and version of the glenoid for reverse total shoulder arthroplasty

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Background Correct glenoid version and inclination can limit scapular notching, instability and glenoid loosening in reverse total shoulder arthroplasty (rTSA). Traditionally, planned trajectories were displayed on a screen close to the operating table, and reproduced freehand intra-operatively. Mixed reality planning has emerged, using superimposition of the scapular hologram on the patient's glenoid, with intended trajectories and real-time navigation to provide more accurate guidance. The purpose was to assess the implant version and inclination in reverse total shoulder arthroplasty using mixed reality with navigation. Methods The authors retrospectively assessed a series of 45 shoulders that underwent rTSA using mixed reality with navigation using a head mounted display (HMD). Computed tomography scans were acquired for each shoulder, and imported into Shoulder+ to plan the rTSA, and define the target inclination and version. The HMD was used to display an interactive hologram over the operative site to navigate the guidewire. Pre- and 6-month post-operative scans were performed, and version and inclination of the implant were measured. Results The final cohort comprised 35 shoulders, aged 75.5±7.3. Additional operative time was 10.1±2.5 minutes. The absolute deviation between post-operative and planned version was 2.8°±2.0 (p<0.001), and the absolute deviation between post-operative and intra-operative version was 2.9°±2.1 (p=0.003). The absolute deviation between post-operative and planned inclination was 4.6°±4.6 (p=0.154), and the absolute deviation between post-operative and intra-operative inclination was 4.3°±4.3 (p=0.074). Conclusion RTSA with mixed reality navigation enables accurate glenoid implant positioning, with minimal deviations from planning. However, surgeons should be aware of the additional time required. Level of Evidence Level IV; Case Series; Treatment Study

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