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Review
. 2025 Jul 8:66:335-345.
doi: 10.1016/j.jor.2025.07.005. eCollection 2025 Aug.

Augmented reality navigation systems vs. conventional techniques in acetabular cup positioning: a systematic review and meta-analysis

Dimitrios Mouselimis  1 , Xanthippi Topalidou  2 , Konstantinos Papadopoulos  1 , Martin Brucker  1 , Gábor Molnár  1 , André R Zahedi  1 , Christian Lüring  1
Affiliations
Review

Augmented reality navigation systems vs. conventional techniques in acetabular cup positioning: a systematic review and meta-analysis

Dimitrios Mouselimis et al. J Orthop. .

Abstract

Purpose: The aim of this systematic review and meta-analysis was to evaluate the effectiveness of augmented reality (AR) techniques in acetabular cup positioning during total hip arthroplasty (THA).

Methods: The Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE databases were systematically searched until December 12, 2024 according to the PRISMA 2020 guidelines for prospective and retrospective studies comparing AR techniques to conventional ones regarding acetabular cup positioning. Anteversion, inclination angles, blood loss, operation time and postoperative complications comprised the outcomes. Bias assessment was performed with the RoB 2 tool for prospective studies and ROBINS-I for retrospective ones.

Results: In total, 9 studies were included in the systematic review and 8 in the meta-analysis. The target error according to postoperative radiographs or computer scan for both anteversion and inclination angles was significantly more precise in the 346 THAs of the AR group (Zinclination = 3.10, P inclination = 0.002, Std. mean difference = -0.52 [95 % CI: 0.85 to -0.19] and Zanteversion = 2.44, P anteversion = 0.01, Std. mean difference = -0.57 [95 % CI: 1.03 to -0.11]) with a significant substantial heterogeneity (I2 inclination = 79 %, Pinclination<0.0001 and I2 anteversion = 89 %, P anteversion < 0.00001), when compared to the 395 THAs of the conventional group. Regarding blood loss, operation time and postoperative complications, no significant differences were observed. The risk of bias was high among the retrospective studies.

Conclusion: The different types of studies, as well as their individual way of assessing the acetabular cup angles are the main limitations of the meta-analysis. The results provide a strong sign of improved acetabular cup positioning with the help of AR systems, while maintaining a favorable safety profile.

Prospero registration number: CRD42024609350.

Keywords: AR; Acetabular cup; Augmented reality; Complications; THA; Total hip arthroplasty.

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Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
The PRISMA 2020 Flowchart.
Fig. 2
Fig. 2
Forest and funnel plots of inclination and anteversion angles A. Standardized mean difference of target error in inclination angle B. Standardized mean difference of navigation error inclination angle C. Standardized mean difference of target error in anteversion angle D. Standardized mean difference of navigation error in anteversion angle.
Fig. 3
Fig. 3
Forest and funnel plots regarding blood loss (A), operation time (B) and postoperative complications (C).
Fig. 4
Fig. 4
Risk of Bias in the included studies.
See this image and copyright information in PMC

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