Purpose: Computer-aided navigation and patient-specific 3D printed guides have demonstrated superior outcomes in total shoulder arthroplasty (TSA). Nevertheless, few TSAs are inserted using these technologies. Head-worn augmented reality (AR) devices can provide intuitive 3D computer navigation to the surgeon. This study investigates AR navigation in conjunction with adaptive spatial drift correction toward TSA.

Methods: A phantom study was performed to assess the performance of AR navigated pin placement in TSA. Two medical experts performed a total of 12 pin placements into phantom scapula; six were placed using an end-to-end AR-navigated technique, and six using a common freehand technique. Inside-out infrared (IR) tracking was designed and integrated into the AR headset to correct for device drift and provide tool tracking. Additionally, the impact of IR tool tracking, registration, and superposed/juxtaposed visualization techniques was investigated.

Results: The AR-navigated pin placement resulted in a mean entry point error of 1.06 mm ± 0.64 mm and directional error of $1.{66}^{\circ }\pm 0.{65}^{\circ }$ . Compared with the freehand technique, AR navigation resulted in improved directional outcomes ( $p=0.03$ ), while entry point accuracy was not significantly different ( $p=0.44$ ). IR tool tracking error was 1.47 mm ± 0.69 mm and $0.{92}^{\circ }\pm 0.{50}^{\circ }$ , and registration error was 4.32 mm ± 1.75 mm and $2.{56}^{\circ }\pm 0.{82}^{\circ }$ . No statistical difference between AR visualization techniques was found in entry point ( $p=0.22$ ) or directional ( $p=0.31$ ) errors.

Conclusion: AR navigation allowed for comparable pin placement outcomes with those reported in the literature for patient-specific 3D printed guides; moreover, it complements the patient-specific planning without the need for the guides themselves.

Keywords: Augmented reality; Computer-aided navigation; Glenoid pin placement; Shoulder arthroplasty.

© 2025. The Author(s).

目的： 计算机辅助导航和患者特异性3D打印导向在全肩关节置换术（TSA）中已显示出优越的疗效。然而，使用这些技术进行的TSA手术仍然很少见。头戴式增强现实（AR）设备可以为外科医生提供直观的三维计算机导航。本研究探讨了结合自适应空间漂移校正的AR导航在TSA中的应用。

方法： 为了评估AR导航导针放置在TSA中的表现，进行了一项模拟研究。两名医学专家总共进行了12次导针放置到模拟肩胛骨上；其中6次使用端对端的AR导航技术完成，另外6次则采用传统的徒手技术完成。设计并整合到了AR头戴设备中的一种内向外红外（IR）跟踪系统用于校正设备漂移，并提供工具跟踪功能。此外，还研究了红外工具跟踪、注册以及重叠/并排可视化技术的影响。

结果： 使用AR导航进行的导针放置平均入口点误差为1.06毫米±0.64毫米和方向误差为$1\; .\; \{66\}^\{circ\}\; pm\; 0\; .\; \{65\}^\{circ\}$。与徒手技术相比，AR导航在方向结果方面得到了改善（$p\; =\; 0.03$），而入口点准确性没有显著差异（$p\; =\; 0.44$）。红外工具跟踪误差为1.47毫米±0.69毫米和$0\; .\; \{92\}^\{circ\}\; pm\; 0\; .\; \{50\}^\{circ\}$，注册误差为4.32毫米±1.75毫米和$2\; .\; \{56\}^\{circ\}\; pm\; 0\; .\; \{82\}^\{circ\}$。在入口点（$p\; =\; 0.22$）或方向误差（$p\; =\; 0.31$）方面，没有发现AR可视化技术之间的统计学差异。

结论： AR导航实现了与文献报道的患者特异性3D打印导向导针放置结果相当的效果；此外，它还可以在无需实际导向的情况下补充患者的个性化计划。

关键词： 增强现实；计算机辅助导航；盂唇钉置入术；肩关节置换术。