{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T17:18:45Z","timestamp":1793726325765,"version":"4.6.1"},"reference-count":16,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2021,7,21]],"date-time":"2021-07-21T00:00:00Z","timestamp":1626825600000},"content-version":"vor","delay-in-days":201,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2021,1,1]],"date-time":"2021-01-01T00:00:00Z","timestamp":1609459200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,7,21]],"date-time":"2021-07-21T00:00:00Z","timestamp":1626825600000},"content-version":"vor","delay-in-days":201,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J. exp. orthop."],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>A systematic review of the literature has been carried out to assess the actual evidence of the use of augmented reality in total knee arthroplasty (TKA). We then conducted a pilot clinical study to examine the accuracy of the Knee\u2009+\u2009augmented reality navigation in performing TKA. The present augmented reality (AR) system allows the surgeon to view the tibial and femur axis superimposed on the surgical field through the smart glasses. It provides real\u2010time information during surgery and intraoperative feedback.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A systematic review of the PubMed, MEDLINE, and Embase databases up to May 2021 using the keywords \u201caugmented reality\u201d, \u201cknee arthroplasty\u201d, \u201ccomputer assisted surgery\u201d, \u201cnavigation knee arthroplasty\u201d was performed by two independent reviewers. We performed five TKAs using the Knee\u2009+\u2009system. Patients were 4 females, with mean age of 76.4 years old (range 73\u201379) and mean Body Max Index (BMI) of 31.9\u00a0kg\/m<jats:sup>2<\/jats:sup> (range 27\u201335). The axial alignment of the limb and the orientation of the components were evaluated on standardized pre and postoperative full leg length weight\u2010bearing radiographs, anteroposterior radiographs, and lateral radiographs of the knee. The time of tourniquet was recorded. The perception of motion sickness was assessed by Virtual Reality Sickness Questionnaire (VRSQ) subjected to surgeon immediately after surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>After duplicate removal, a total of 31 abstracts were found. However, only two studies concerned knee arthroplasty. Unfortunately, both were preclinical studies. Knee\u2009+\u2009system is able to perform a cutting error of less than 1\u00b0 of difference about coronal alignment of femur and tibia and less than 2\u00b0 about flexion\/extension of femur and posterior tibial slope. The absolute differences between the values obtained during surgery and the measurement of varus femur, varus tibia, posterior slope, and femur flexion angle on post\u2010operative radiographs were 0.6\u00b0\u2009\u00b1\u20091.34\u00b0, 0.8\u00b0\u2009\u00b1\u20090.84\u00b0, 0.8\u00b0\u2009\u00b1\u20091.79\u00b0, and 0.4\u00a0mm\u2009\u00b1\u20090.55\u00a0mm, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>On light of our preliminary results, the Knee\u2009+\u2009system is accurate and effective to perform TKA. The translation from pilot study to high\u2010level prospective studies is warranted to assess accuracy and cost\u2010effective analysis compared to conventional techniques.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>IV<\/jats:p><\/jats:sec>","DOI":"10.1186\/s40634-021-00374-7","type":"journal-article","created":{"date-parts":[[2021,7,21]],"date-time":"2021-07-21T10:03:18Z","timestamp":1626861798000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":33,"title":["The use of augmented reality for limb and component alignment in total knee arthroplasty: systematic review of the literature and clinical pilot study"],"prefix":"10.1002","volume":"8","author":[{"given":"V.","family":"Iacono","sequence":"first","affiliation":[{"name":"Department of Orthopaedics IRCCS Ospedale Sacro Cuore Don Calabria Negrar di Valpolicella Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Farinelli","sequence":"additional","affiliation":[{"name":"Clinical Ortopaedics Department of Clinical and Molecular Sciences Universit\u00e0 Politecnica Delle Marche Ancona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Natali","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics IRCCS Ospedale Sacro Cuore Don Calabria Negrar di Valpolicella Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"Piovan","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics IRCCS Ospedale Sacro Cuore Don Calabria Negrar di Valpolicella Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Screpis","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics IRCCS Ospedale Sacro Cuore Don Calabria Negrar di Valpolicella Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Gigante","sequence":"additional","affiliation":[{"name":"Clinical Ortopaedics Department of Clinical and Molecular Sciences Universit\u00e0 Politecnica Delle Marche Ancona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Zorzi","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics IRCCS Ospedale Sacro Cuore Don Calabria Negrar di Valpolicella Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,7,21]]},"reference":[{"key":"e_1_2_9_2_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.I.01398"},{"key":"e_1_2_9_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2018.01.027"},{"key":"e_1_2_9_4_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.M.01496"},{"key":"e_1_2_9_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2018.01.067"},{"key":"e_1_2_9_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12178\u2010021\u201009699\u20103"},{"key":"e_1_2_9_7_2","first-page":"11","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page MJ","year":"2021","journal-title":"BMJ"},{"key":"e_1_2_9_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.apergo.2017.12.016"},{"key":"e_1_2_9_9_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11999\u2010011\u20101936\u20105"},{"key":"e_1_2_9_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2015.05.049"},{"key":"e_1_2_9_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11548\u2010016\u20101426\u2010z"},{"key":"e_1_2_9_12_2","doi-asserted-by":"publisher","DOI":"10.1186\/s40634\u2010019\u20100212\u20106"},{"key":"e_1_2_9_13_2","doi-asserted-by":"publisher","DOI":"10.1055\/s\u20100037\u20101604149"},{"key":"e_1_2_9_14_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00264\u2010012\u20101688\u20101"},{"key":"e_1_2_9_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.knee.2009.06.004"},{"key":"e_1_2_9_16_2","doi-asserted-by":"publisher","DOI":"10.1054\/arth.2002.33564"},{"key":"e_1_2_9_17_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.18.01205"}],"container-title":["Journal of Experimental Orthopaedics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40634-021-00374-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s40634-021-00374-7\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40634-021-00374-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"},{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1186\/s40634-021-00374-7","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T18:02:09Z","timestamp":1760637729000},"score":1,"resource":{"primary":{"URL":"https:\/\/esskajournals.onlinelibrary.wiley.com\/doi\/10.1186\/s40634-021-00374-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1]]},"references-count":16,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,1]]}},"alternative-id":["10.1186\/s40634-021-00374-7"],"URL":"https:\/\/doi.org\/10.1186\/s40634-021-00374-7","archive":["Portico"],"relation":{},"ISSN":["2197-1153","2197-1153"],"issn-type":[{"value":"2197-1153","type":"print"},{"value":"2197-1153","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1]]},"assertion":[{"value":"11 June 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 July 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 July 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The present study was approved by the Ethics Committee of Verona and Rovigo \u2013 Italy. Each patient signed informed consent.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent\/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"52"}}