Scripps First to Use 3D Hologram Technology in Shoulder Replacement

Mixed reality opens the door for greater surgical precision

Mixed reality surgeon performing the new mixed reality shoulder surgery.

Mixed reality opens the door for greater surgical precision

Scripps Clinic recently became the first health care provider in Southern California to use an innovative mixed reality headset technology that offers surgeons a 3D holographic view of a patient’s preoperative surgical plan during shoulder replacement procedures.

The new system allows surgeons to use hand gestures and voice commands to view and manipulate a hologram of the patient’s preoperative plan from inside the headset lens, while simultaneously maintaining a direct view of the open surgical site. The technology lets doctors superimpose the 3D surgery plan over the patient’s anatomy on the operating table, providing an intricate, personalized level of prosthetic placement.

“Being able to view the entire surgical plan during the operation is a big advantage for patients, because it can help surgeons replicate the pre-op plan with precision,” said Brian Rebolledo, MD, who is the first Scripps Clinic orthopedic surgeon to use the new system. “Having a detailed 3D model of the patient’s surgical plan directly in our sights in real-time opens up a new window to help further enhance the procedure.”

The surgeon can rotate and zoom in or out of the hologram model, while comparing it in real-time to the patient’s anatomy. The holograms are generated by the system’s software through preoperative CT scans.

Scripps Clinic is one of 33 health care providers in the United States currently using this mixed reality technology for shoulder replacement surgery. The first such surgery using this system was performed in Minnesota in July 2020.

Alan Benedict of Valley Center is one of the first local residents to have his shoulder replaced using the new technology. Now retired, the longtime Sony engineering executive has kept active with pickleball, disc golf and mountain biking. But in recent years, the rigors of time have caught up with his right shoulder, severely limiting his range of motion and causing significant pain.

“I’ve seen a lot of pretty amazing technological advances during my 25 years in the consumer electronics industry,” Benedict said. “So I really like the idea of having doctors bring innovative technology into the OR to help them with something that requires such a high level of precision.” 

For many years, Scripps Clinic surgeons have used 3D computer modeling software to plan shoulder replacement procedures, and to perform “virtual dry-run surgeries” via laptops before entering the operating room. Under the leadership of orthopedic surgeon Heinz Hoenecke, M.D., Scripps Clinic in 2015 began using preoperative planning software to create customized 3D-printed drill guides to help position the implant and screws at the optimal position and angles. Mixed reality is the latest advancement, enabling surgeons to refer to and interact with the 3D surgical plan while at the operating table and digitally overlay it onto the patient.

While virtual reality immerses the viewer into a completely virtual environment, mixed reality allows the viewer to see the real world along with an overlay of 3D holographic images, providing a supplement to reality. The popular mobile game Pokémon GO uses a mixed reality platform that combines real-world scenarios with computer-made overlay.

Approximately 53,000 people in the U.S. undergo shoulder replacement surgery each year, according to the Agency for Healthcare Research and Qualify, the lead federal agency charged with improving the safety and quality of health care in America.

The new mixed reality technology is currently available to patients planning a shoulder replacement surgery at Scripps Green Hospital. Procedures using the technology are often covered by many insurance carriers. More information is available by calling 800-727-4777.

Learn more about Scripps Health, a nonprofit integrated health system in San Diego, Calif.

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Keith Darce