The Use of Mixed Reality in Custom-Made Revision Hip Arthroplasty: A First Case Report

A complex revision hip arthroplasty was performed using a custom-made implant and mixed reality technology. According to the authors' knowledge, this is the first report of such procedure described in the literature.

This technique involves the integration of mixed reality technology and custom made implant which allows for exiting the precise menting of Endotipsitis best increasing your chance of successful treatment. The main advantage of the method used is the great precision in implantation of the endo prosthesis. Proper visualization gives the surgeon a better chance of successful surgery.

The integration of mixed reality technology and custom made implants can prove useful in endoplastic traumatology of the musculoskeletal system oncological surgery, etcetera. In areas where the best possible visualization of the operated structures is important The method can be improved and developed in the field of operational activities and various fields of orthopedics andrology of the musculoskeletal system. With the support of the engineers the use of technology is not demanding and it can affect the success of the therapy.

It is worth taking care of the team because this type of action requires the cooperation of several people. To begin, take a pelvic CT scan and acquire DICOM files as described in the text protocol. To process the pelvic CT DICOM file into a holographic representation open the holographic DICOM viewer.

Then, select the folder containing CT DICOM files. Check the IP that is displayed when the mixed reality headset is switched on and enter it into the holographic DICOM viewer. Click on the connect button to see the visualization in the mixed reality headset.

To segment the pelvis bone tissue structures, manually enable the scissors option. Click on the left mouse button and move the mouse around to remove the structures that are selected with this tool. End the selection with another click of the left mouse button.

Confirm that the selected structures are cut out from the selection. From the list of available functions, choose the predefined transfer function CT bone endo prosthesis, which contains color visualization parameters dedicated to orthopedic procedures. Adjust the visualization by changing the window and level using the right mouse button connected with mouse movement in the 3D visualization window.

Adjust the image using voice commands such as rotate, zoom, cut smart, and hand gestures. Use the cut smart command to adjust a cutting plane that is perpendicular to the line of sight of the user. Observe, that the plane goes deeper as the user moves the head closer into the hologram.

Perform these movements to see the inner parts of the visualization. First, use the hardinge access to release the connective tissue adhesions to the hip joint and remove the loose implant. Then, use a wider access to perform the operation in the same way as other revision procedures of the hip joint.

Remove all soft tissues from the surface of the acetabulum so that the shape exactly matches the model provided. Ensure that the implant model perfectly adheres to the surface of the acetabular bone. Fix the new, uncemented implant using specially designed screws that stabilize the implant.

Perform a femoral nerve block after surgery. Next, load the visualization of the DICOM CT scan prepared in the previous section to the mixed reality application. Connect the mixed reality headset to the mixed reality application to see the prepared visualization in the 3D holographic space.

Use intraoperative holographic visualization of the processed images to achieve adequate and precise pelvic bone surface preparation, as well as to remove the excess of connective tissue that developed as a response to loosening of the acetabular component. Ensure that the operator looks at the holographic visualization as a reference image. Use a scalpel, an electrosurgical knife with a coagulator, a lure tool and cutters for the operation.

For postoperative care, make the patient undergo a standard rehabilitation and recovery protocol, including rehabilitation and mobilization on the first day after surgery. Using this protocol, an interactive visualization was generated that displayed tissues and potential fixation of the implant in the pre-operative planning process. The blue color in the visualization showed the border of the implant.

On the basis of the CT, the position of the screws was planned such that it avoided the contact of the screws with the vascular nerve structures and their damage. Colors were used to distinguish bolts having different parameters, such as length and cross section. Before the surgery, CT 3D reconstruction showed visible degeneration and destruction of bone structures and pelvic asymmetry.

X-ray conducted six weeks after the surgery showed that the implant was fitted correctly, confirming the success of the surgery. The mixed reality technology allowed a safe and non-invasive way to accurately visualize the pelvis, bones, and soft tissues, increasing the chances of good implant placement. By manipulating the image, such as by zooming in the selected fragments of the complex anatomical structures, one can exclude the imperfections of the surgeon's eye.

The procedure of auto plaster is carried out in accordance with generally accepted standards. Each element of preparation of surgery, including cooperation with engineers, implant preparation, patient preparation, and subsequent step by step surgical procedures are very important. The integration of mixed reality and custom made implants may open a new chapter in orthopedics andrology of the musculoskeletal system.

Where appropriate visualization and precision of implant replacement are very important.