• Daniel Suter, Sandro Hodel, Florentin Liebmann, Philipp Fürnstahl, and Mazda Farshad.
• Research in Orthopedic Computer Science, University Hospital Balgrist, University of Zurich, Balgrist Campus, Lengghalde 5, 8008, Zurich, Switzerland. dapesu@bluewin.ch.
• Eur Spine J. 2023 Oct 1; 32 (10): 342534333425-3433.

PurposeOver the last years, interest and efforts to implement augmented reality (AR) in orthopedic surgery through head-mounted devices (HMD) have increased. However, the majority of experiments were preclinical and within a controlled laboratory environment. The operating room (OR) is a more challenging environment with various confounding factors potentially affecting the performance of an AR-HMD. The aim of this study was to assess the performance of an AR-HMD in a real-life OR setting.MethodsAn established AR application using the HoloLens 2 HMD was tested in an OR and in a laboratory by two users. The accuracy of the hologram overlay, the time to complete the trial, the number of rejected registration attempts, the delay in live overlay of the hologram, and the number of completely failed runs were recorded. Further, different OR setting parameters (light condition, setting up partitions, movement of personnel, and anchor placement) were modified and compared.ResultsTime for full registration was higher with 48 s (IQR 24 s) in the OR versus 33 s (IQR 10 s) in the laboratory setting (p < 0.001). The other investigated parameters didn't differ significantly if an optimal OR setting was used. Within the OR, the strongest influence on performance of the AR-HMD was different light conditions with direct light illumination on the situs being the least favorable.ConclusionAR-HMDs are affected by different OR setups. Standardization measures for better AR-HMD performance include avoiding direct light illumination on the situs, setting up partitions, and minimizing the movement of personnel.© 2023. The Author(s).

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