Impact of augmented reality assisted navigation on early outcomes in reverse shoulder arthroplasty: a retrospective cohort study

Augmented reality–assisted intraoperative navigation (ARIN) has recently emerged as a novel technology intended to improve intraoperative accuracy and workflow in reverse shoulder arthroplasty (RSA). This study evaluated the impact of ARIN on early complications and revisions, glenoid baseplate inclination and fixation, fluoroscopy time, and surgical duration.

Two hundred three primary RSAs were retrospectively analyzed: 72 performed with ARIN and 131 freehand. The primary outcome was 90-day complications and revisions. Secondary outcomes were baseplate inclination (RSA angle on true AP radiographs), number and length of peripheral screws, fluoroscopy time, and surgical duration.

No statistically significant differences were observed between the ARIN and freehand groups regarding complications (3% vs. 9.4%, p = .139), revisions (3% vs. 8.5%, p = .216), or dislocations (1.5% vs. 3.4%, p = .655). Baseplate inclination was significantly closer to neutral in the ARIN group (4.6° ± 7° vs. 11.6° ± 8.1°, p < .001), and superior inclination > 10° was significantly less frequent (18.8% vs. 55.6%, p < .001). Significantly fewer screws were used for baseplate fixation (2.1 ± 0.4 vs. 3.2 ± 0.9, p < .001), which were significantly longer (33.7 ± 6.3 mm vs. 25.6 ± 7.8 mm, p < .001). Fluoroscopy time (19.7 ± 15.4 s vs. 45.9 ± 37.1 s, p < .001) and operative duration (104.1 ± 27.3 min vs. 113.4 ± 35.3 min, p = .038) were also significantly shorter with ARIN.

ARIN in RSA was associated with improvements in glenoid baseplate inclination, screw placement, intraoperative fluoroscopy time, and surgical duration, while no statistically significant differences in early complication, dislocation, or revision rates were observed compared with the conventional freehand technique. Larger studies with greater statistical power and longer follow-up are warranted to determine potential long-term clinical benefits.

Level of evidence III; retrospective comparative study.