Does augmented reality improve clinical outcome in TKA? A prospective observational report.

AIMS: The Pixee Knee+ system offers intraoperative assistance through augmented reality glasses. This allows the surgeon to see the tibial and femoral axis depicted on the surgical field, providing real-time information during surgery.METHODS: 122 patients received TKA surgery with the Pixee Knee+ system, and were matched based on gender and age to 122 patients who received conventional surgery. PROMs (Oxford knee Score, KOOS, and Forgotten Joint score) were collected preoperatively, at 6 weeks and 3 months. The difference between the scores at 6 weeks versus preoperative (Delta) was analyzed over time of surgery, in order to evaluate any possible surgeon learning curve.RESULTS: Pixee patients scored significantly lower on the symptoms sub-scale of the KOOS score at 6 weeks. Similarly, at 3 months, the Quality of life sub-score, Forgotten Joint score and Oxford Knee Score were all significantly worse for the Pixee group. When analyzing the Delta KOOS over time, a clear increase in the linear model could be established for the Pixee group, whereas the Delta KOOS outcomes in the conventional group remained at a plateau.CONCLUSION: The use of the Pixee Knee+ system results in an initial inferior clinical outcome when comparing the average of the two groups. This is likely explained by a learning curve, which shows an increase over time of the Delta KOOS at 6 weeks in the Pixee group. To what extent this increase over time will persist remains to be investigated