Orthopaedic surgeons' perception and acceptance of augmented reality for PSI placement and implant positioning: A user-based evaluation

Author(s): Borja Lara-Galdón, Tanya Fernández- Fernández, Javier Orozco-Martínez, Elena Aguilera- Jimenez, Carla de Gregorio-Bermejo, Amaia Iribar- Zabala, Lydia Mediavilla-Santos, Mónica García- Sevilla, Rubén Pérez-Mañanes, Javier Pascau, José Antonio Calvo-Haro

Background: Augmented reality (AR) has emerged as a promising tool to enhance precision and workflow in orthopaedic surgery. Its application in patient-specific instruments (PSI) placement and implant positioning is particularly relevant for improving spatial understanding and decisionmaking.

Methods: This cross-sectional, mixed-methods study evaluated the perception and acceptance of AR among 45 orthopaedic surgeons with varying experience levels. Participants used Microsoft HoloLens 2 to perform PSI placement and implant alignment tasks on a 3D-printed pelvic phantom. Performance metrics, structured Likert-scale questionnaires, and open-ended feedback were collected and analyzed.

Results: Participants reported high confidence levels in anatomical visualization and precision of PSI placement using AR. Significant differences in perceived usability and task completion time were observed between experienced and naïve users (p<0.05). Most participants highlighted the immersive interface, real-time guidance and personalization features as key advantages, while headset weight and visual lag were noted as areas for improvement.

Conclusions: AR was perceived as an intuitive and effective PSI placement and implant alignment tool. Its ability to integrate surgical planning directly into the operative field without external monitors offers a valuable alternative to conventional navigation systems. These findings support AR’s clinical applicability and suggest strong translational potential for routine use in orthopaedic workflows.