• Sandro F Fucentese and Peter P Koch.
• University Hospital Balgrist, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland. Sandro.fucentese@balgrist.ch.
• Arch Orthop Trauma Surg. 2021 Dec 1; 141 (12): 2227-2233.

IntroductionMany of the functional complications that arise after total knee arthroplasty (TKA) are caused by a non-optimal balance of the knee after surgery. Over the past 20 years, technology has been used in the Operating Room (OR) to help improve precision and balance. The results of Computer-Assisted Surgery (CAS) and robotic systems show improved accuracy regarding implant positioning but a relatively small improvement in patient-reported outcomes and implant survival compared to conventional TKA. Recently, Augmented Reality (AR) has been proposed as a technology that could improve accuracy in orthopaedic surgery, providing a more efficient and cost-effective solution.Materials And MethodsThis article describes a novel AR-based surgical guidance system that measures intra-operatively the effect of prosthesis alignment and positioning on soft tissue balance. The system is integrated in a pair of smart glasses and two small sensors and displays surgical targets directly in the field of view of the surgeon.ResultsThe system has been used in a limited number of cases. While the preliminary experience has been positive, clinical research is ongoing to confirm to confirm the performance of the system and the impact on clinical outcomes.ConclusionAugmented Reality can be a valuable tool to improve accuracy in TKA. The use of smart glasses and integrated sensors improves the efficiency of the procedure, particularly when coupled with single-use instrumentation. A novel protocol for soft tissue assessment allows for a 3-dimensional evaluation of the ligaments and a better measurement of the effect of tibial rotation.© 2021. The Author(s).

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