A new augmented reality (AR)-guided platform now being used clinically at Duke has the potential to increase surgical efficiency and accuracy in total hip arthroplasty. With this technology, the surgeon can intraoperatively view 3D models of the patient’s anatomy, implants, and instruments inside the body in real time.

Samuel S. Wellman, MD, a Duke joint replacement surgeon, was the first surgeon to perform an AR-guided total hip replacement using the HipInsight System (Surgical Planning Associates, Inc., Boston, MA) outside of the institution where it was originally designed. The first-ever total hip replacement using this technology following FDA clearance took place in February 2021 at North Atlantic Surgical Suites in Salem, New Hampshire, by a team of surgeons who practice at New England Baptist Hospital (NEBH) in Boston, MA.

Wellman has used an earlier prototype of the AR technology more than 700 times since his Adult Reconstruction Fellowship under NEBH’s Stephen B. Murphy, MD, an orthopaedic surgeon who conceived of and developed the AR system. This new platform is the first FDA-cleared AR system to be contained entirely within a head-mounted device.

Unlike robotic and traditional navigation systems, this AR-based digital surgery platform doesn't require large, bulky external workstations, cameras, or screens. The small footprint of the AR system means it can be easily deployed across operating rooms, promoting greater surgical team efficiency and cost savings.

Minimally invasive surgical approaches have improved patient outcomes and reduced the length of hospital stays. However, the smaller incisions associated with these approaches have made it more difficult for the entire surgical team to see inside the exposure.

Projecting the critical bone, implant, and instrument models inside the patient’s body effectively gives the surgeon “x-ray vision” to see beyond what can be seen through the incision and enables the surgeon to confirm accurate achievement of the goals of surgery in a seamless, intuitive way, Wellman notes. “Where robots often replace some of the surgeon’s functions, the AR system enhances the surgeon’s ability,” he adds.

“Being able to actually see the bones of the pelvis in real-time without having to look back and forth between the screen and patient is potentially going to be a big leap forward in repeatability and efficiency in hip replacements,” says Wellman, who has performed close to 2,500 hip replacements in his career. “This AR-guided technology simplifies a very complex procedure and addresses the most critical problems that we’ve needed to solve.”