Augmented reality in total knee arthroplasty: Balancing precision, promise, and challenges in surgical innovation

Table 1 The comparison between commonly used techniques in joint replacement

	Augmented reality	Surgical robot	Traditional navigation
Accuracy	High precision, real-time visualization, close to robotic levels	Extremely high precision, relies on robotic arm and algorithms	Moderate precision, heavily dependent on surgeon experience
Cost-effectiveness	Lower cost, affordable equipment, faster recovery	High cost, expensive maintenance, suitable for high-budget centers	Moderate cost, longer surgery and recovery times
Learning curve	Steep but easier than robotic systems	Very steep, requires mastering complex operations	Low difficulty, mature and easy to learn
Clinical adoption	Gradually increasing, limited by device performance and acceptance	Low adoption, mainly in large hospitals and complex cases	Widely adopted, but limited in precision and efficiency
Surgery time	Shorter, with real-time guidance improving efficiency	Longer, due to robotic setup and calibration	Moderate, requiring intraoperative adjustments
Postoperative recovery	Faster recovery, less trauma, higher satisfaction	Faster recovery, but higher financial burden	Slower recovery, more trauma
Technical limitations	Limited battery life, potential neck fatigue, lack of long-term data	High cost, complex maintenance, limited flexibility	Depends on preoperative imaging, limited real-time adjustment
Future potential	High, with artificial intelligence, 5G, and augmented reality integration, broad applications	Significant for complex surgeries, but limited by cost	Limited, likely to be replaced by augmented reality and robotics

Table 2 Summary of key studies on augmented reality-assisted total knee arthroplasty

Ref.	Study design	Sample size	AR system	Key focus	Main findings
Tsukada et al[7], 2019	Single-center pilot study	10	AR-KNEE	Tibial resection accuracy	AR provided reliable accuracy in coronal, sagittal, and rotational alignment
Tsukada et al[8], 2021	Prospective controlled trial	74	AR-KNEE	Distal femoral osteotomy accuracy	AR enabled more accurate osteotomy compared to conventional intramedullary guides
Bennett et al[9], 2023	Prospective study	20	AR-AN	Coronal component alignment	Low rate of component malposition in the coronal plane
Su et al[19], 2023	A systematic review and meta-analysis	-	AR-based rehabilitation vs conventional	Pain, function and anxiety	AR-based rehabilitation improved early pain, function, and anxiety
Shim et al[6], 2023	Randomized controlled trial	56	AR-based rehabilitation vs conventional	Function	AR-based rehabilitation may be useful treatment as an alternative to conventional rehabilitation

AR: Augmented reality.