Seeing Is Believing: Performing TKA with an Augmented Reality Platform

    Jonathan M. Vigdorchik, MD, from the Hospital for Special Surgery, has performed the first augmented reality total knee arthroplasty (TKA) in the US, using new technology designed and engineered with artificial intelligence and machine learning.

    The augmented reality knee replacement platform, known as NextAR TKA (Medacta USA; Franklin, Tennessee), received clearance from the US Food and Drug Administration in July. It utilizes a preoperative CT scan of the patient’s knee for surgical planning and augmented reality “smart” glasses during surgery.

    In augmented reality, digital information is superimposed on a user’s view of the physical environment. Thus, the smart glasses used with NextAR TKA allow the orthopaedic surgeon to visualize the structures of the knee and track progress in real time directly on the operative field, without having to look over at a computer screen.

    Jonathan M. Vigdorchik, MD, performed the first augmented reality knee replacement in the US at Hospital for Special Surgery. Photo courtesy of Hospital for Special Surgery

    “It’s like a car that has the speedometer projected on the windshield, so you don’t have to look down when you’re driving,” Dr. Vigdorchik said.

    Taking the car analogy one step further, he compared the AR knee replacement platform to GPS, noting that, “everyone knows how to drive home, but you use GPS technology to find the best and most efficient route to take.”

    Dr. Vigdorchik said that the enhanced visualization provided by the augmented reality platform allows for ultraprecise alignment and positioning of the knee implant.

    “Over the past few years, we’ve learned that optimal balancing of the knee ligaments results in a joint replacement that feels more natural and lowers the risk of instability,” he said. “Every person’s knee is different in terms of their ligaments. Some ligaments are tighter, some are looser. The platform provides direct tracking of the collateral ligaments and a 3D analysis of soft tissue throughout the whole range of motion during surgery, and this allows for optimal ligament balancing for each patient.”

    The compact, streamlined nature of the system could also provide economic benefits to the healthcare system, according to Dr. Vigdorchik. “It’s a portable system that can be used in ambulatory surgery centers in addition to hospital ORs,” he said.

    “In addition, the high level of precision of the AR platform could decrease operating time and translate into greater efficiency. This is particularly advantageous in the current health care environment, as surgeons and hospitals may still be catching up on elective knee replacements that were deferred during the pandemic lockdown.”

    Dr. Vigdorchik said that as more surgeries are performed with the AR system, he will follow patients and collect data to see how the technology compares to robotic-assisted navigation and standard knee replacement surgeries. The ultimate goal is to provide personalized care and achieve the best outcome for each individual patient.