UT Southwestern orthopedic specialist performs first AR shoulder replacement surgery in Texas

UT Southwestern Medical Center is one of just 15 surgical centers in the world using next-generation augmented reality (AR) in the operating room for shoulder arthroplasty. Shoulder specialist Michael Khazzam M.D., Associate Professor of Orthopaedic Surgery, became the first orthopedic surgeon in Texas to use the Food and Drug Administration-approved technique while operating to restore shoulder function.

“Essentially, we can perform the entire surgery and estimate post-surgical mobility and function in virtual reality before we even touch the patient in the OR,” said Dr. Khazzam, who specializes in reparative and complex shoulder reconstruction surgery. “I can show patients what we’ll do prior to surgery, which helps them feel more informed and engaged in their care.”

By the time Monte Perkins arrived at UT Southwestern, the pain in his right shoulder was so intense that it was “driving him into the ground,” he said. The 74-year-old Dallas resident had fallen in his front yard and torn two tendons, and over the next few months he and his wife, Lynda, visited several doctors in search of relief.

Mr. Perkins is one of the first patients in Texas to undergo AR shoulder replacement surgery. “It’s almost like a ‘Star Wars’-type thing,” said Mr. Perkins, a third-generation jeweler. “Dr. Khazzam was able to layer everything together and make sure it all fit perfectly – just like a puzzle.”

For years, AR has been used before surgery to develop a 3D model of the procedure, making it possible to preserve more of the patient’s natural anatomy. This latest development allows surgeons to use AR techniques in real time by virtually overlaying the 3D surgical plan directly over the patient’s anatomy, providing an intricately personalized procedure with the highest level of precision, said Dr. Khazzam, a member of the UTSW Sports Medicine and Shoulder Service team. Dr. Khazzam has completed roughly 30 augmented reality shoulder replacements since April – among nearly 6,000 hip, knee, and joint replacements completed at UTSW in the past year.

The preoperative shoulder CT scan is entered into special software, which then generates a 3D model of the patient's anatomy. Physicians use the model to examine the patient's anatomy, plan incision points, mark the points for the anchor pins, and adjust the prosthetic device.

We can conduct a virtual 'dry run,' implanting the shoulder in the software environment so we can determine what works best for that patient's anatomy and pathology. Ultimately, this 'dry run' becomes our surgical plan."

Dr Michael Khazzam, Associate Professor, Orthopaedic Surgery, UT Southwestern Medical Center

Wearing Microsoft HoloLens AR glasses during surgery makes it possible to see, navigate, and manipulate the entire surgical plan during the procedure. The surgeon can scroll through it and zoom while comparing the plan in real time to the patient's anatomy. The ability to reference the plan during the operation adds another layer of checks and balances to the already highly precise shoulder replacement process.

"Research shows that 3D modeling can result in a highly accurate restoration of the patient's anatomy and precise positioning of the implant," said Dr. Khazzam. "AR certainly seems like a game-changing advancement for shoulder repair and replacement surgery."

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