Mixed reality guidance in osteotomy provides superior precision and accuracy: validation and comparative study
- 11.06.2025
- Research
Erschienen in:
- Verfasst von
- Jakub Stefaniak
- Szymon Stupnicki
- Piotr Tuczyński
- Agata Kaczmarek
- Jan Niziński
- Justyna Rajczyk
- Bartłomiej Lubiatowski
- Przemysław Lubiatowski
- Erschienen in
- International Orthopaedics | Ausgabe 8/2025
Abstract
Purpose
Bone deformities, such as cubitus varus, can lead to abnormal joint alignment and impaired function. Corrective osteotomy aims to restore anatomical alignment, and its precision may be enhanced using various guidance methods. Emerging mixed reality systems allow for the placement and manipulation of virtual objects and may offer effective surgical navigation. This study aimed to validate the accuracy and precision of holographic guidance compared with classic visual estimation and a printed triangle gauge in a controlled laboratory setting.
Methods
Closed-wedge osteotomies at angles of 15° and 30° were performed on fresh-frozen porcine femora. Three techniques were evaluated: Group EB (eyeballing)—visual estimation; Group PW (printed wedge)—using 15° and 30° plastic templates; and Group HW (holographic wedge)—using a mixed reality system (RSQ HOLO, RSQ Technologies, Poznań, Poland, and HoloLens 2, Microsoft). In the HW group, a holographic wedge tool guided the osteotomy. The angle of the excised bone wedge and post-osteotomy alignment in the anteroposterior (AP) and lateral planes were measured physically (goniometer) and digitally (radiographs). Statistical analysis assessed accuracy (closeness to 15°/30°) and precision (standard deviation [SD], mean deviation, coefficient of variation [CV]).
Results
At 15°, the PW and HW techniques demonstrated greater accuracy and lower error compared with EB (T = 3.60; p < 0.01), with HW yielding the lowest systematic error (SE = 0.12). Alignment in the AP plane was similar across groups (T < 2.11; p > 0.05), whereas lateral alignment showed significant differences (T > 2.11; p < 0.05). At 30°, HW achieved the best alignment in both AP (T = 2.48; p = 0.01) and lateral views (T = 2.35; p = 0.02). Lateral alignment was improved by more than 5° with holographic guidance compared to other techniques (p = 0.01). The HW group exhibited the highest precision for both 15° and 30° angles (lowest SD and CV; p < 0.05).
Conclusions
Augmented reality provides accurate and precise intraoperative guidance, outperforming both visual estimation and printed wedge templates in deformity correction.
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- Titel
- Mixed reality guidance in osteotomy provides superior precision and accuracy: validation and comparative study
- Verfasst von
-
Jakub Stefaniak
Szymon Stupnicki
Piotr Tuczyński
Agata Kaczmarek
Jan Niziński
Justyna Rajczyk
Bartłomiej Lubiatowski
Przemysław Lubiatowski
- Publikationsdatum
- 11.06.2025
- Verlag
- Springer Berlin Heidelberg
- Erschienen in
-
International Orthopaedics / Ausgabe 8/2025
Print ISSN: 0341-2695
Elektronische ISSN: 1432-5195 - DOI
- https://doi.org/10.1007/s00264-025-06574-5
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