Next-generation 3D imaging has potential to revolutionize shoulder replacement surgery

surgical team Orthopedic Surgeon Dr. George Athwal, second from left, and his team at St. Joseph’s Health Care London

By St. Joseph’s Health Care London

Mixed reality technology in the operating room just got smarter, and surgeons even more precise.

In a Canadian first at St. Joseph’s Health Care London (St. Joseph’s), orthopedic surgeon Dr. George Athwal has introduced the ground-breaking next step in mixed reality technology that enables 3D imaging, similar to holograms, not only to act as a visual blueprint during shoulder replacement surgery but to track the surgical instruments and guide the surgeon’s hands in real time.

With this evolution of technology, a 3D representation of the patient’s anatomy and shoulder implant is overlaid on the surgical site, giving the surgeon the sci-fi superpower of X-ray vision while operating. Points of light provide vital markers for the surgeon to target. With the position of the instruments monitored by the system, Athwal has taken visionary surgery to a whole new level – literally and figuratively.

Dr. George Athwal Dr. George Athwal at St. Joseph’s Health Care London.

“Put simply, the system allows me to peer into and through the incision to the bones and other anatomical structures below. It knows exactly where my instruments are and can guide me where to make the most intricate adjustments to replicate the pre-surgical plan precisely,” said Athwal.

Athwal is a surgeon with St. Joseph’s Roth McFarlane Hand and Upper Limb Centre and an associate professor in the Department of Surgery at Schulich School of Medicine & Dentistry. He became a global pioneer in developing and using digital 3D imaging technologies as tools in shoulder replacement surgery three years ago when he performed Canada’s first – and the world’s second – shoulder replacement using Stryker’s Blueprint® Digital Platform.

The first generation of the futuristic system, which pairs stereotaxic (3D) technology with pre-operative planning software, allows a surgeon, wearing a special headset, to visualize and manipulate a digital rendering of the patient’s anatomy and the shoulder implant to plan the surgery pre-operatively. The surgeon can park this 3D map in space as an interactive reference in the operating room. It appears similar to a floating hologram.

The newest version of the technology is the Stryker Blueprint® MR Guidance solution. Using the same digital headset with specialized instrumentation, Athwal can now overlay and match the 3D representation onto the patient’s physical anatomy.

Through a front-facing camera on the headset, the position and orientation of surgical instrumentation are tracked in the physical environment so imaging and guidance widgets can be displayed on the patient and in the surgeon’s line of sight without disrupting the surgeon’s normal workflow. The feedback in the heads-up display informs Athwal of where to position and orient his surgical instruments.

Holo lens view during surgery

The latest evolution in mixed reality technology allows surgeons to overlay a 3D representation (similar to a hologram) of the patient’s anatomy and shoulder implant on the surgical site.

“What’s new and exciting is the giant leap in what we can now do with this technology to advance surgical precision,” said Athwal. “The 3D representations of the patient’s anatomy can, quite literally, point the way.”

The technology has been shown to enable surgical plan execution within two millimetres and two degrees of a preoperative plan, he said.

This latest version of the technology recently debuted with a global launch by Stryker that included St. Joseph’s and Mayo Clinic in the United States.  The two centres are the first in the world to use it in the operating room.

Athwal was part of a team that worked with Stryker, a manufacturer of shoulder implants, and Microsoft Corporation, manufacturer of the HoloLens 2 – a holographic headset – to develop the mixed reality shoulder replacement technique. He has since performed numerous surgeries using the initial version of the technology and is in demand to provide demonstrations worldwide.

Involved in the development of this software and technology for the past 10 years, the London surgeon says “it feels like you’ve been watching your child grow and become increasingly successful at every stage.” He envisions this next generation of the system being particularly instrumental for more complex shoulder replacement patients – those with the greatest amount of bone deformity and disease.

“For the most challenging cases, where implant positioning is critical to successful patient outcome, this technology is a game changer.”