Nail it! vision-based drift correction for accurate mixed reality surgical guidance.

PURPOSE: Mixed reality-guided surgery through head-mounted displays (HMDs) is gaining interest among surgeons. However, precise tracking of HMDs relative to the surgical environment is crucial for successful outcomes. Without fiducial markers, spatial tracking of the HMD suffers from millimeter- to centimeter-scale drift, resulting in misaligned visualization of registered overlays. Methods and workflows capable of automatically correcting for drift after patient registration are essential to assuring accurate execution of surgical plans. METHODS: We present a mixed reality surgical navigation workflow that continuously corrects for drift after patient registration using only image-based methods. We demonstrate its feasibility and capabilities using the Microsoft HoloLens on glenoid pin placement in total shoulder arthroplasty. A phantom study was conducted involving five users with each user placing pins on six glenoids of different deformity, followed by a cadaver study by an attending surgeon. RESULTS: In both studies, all users were satisfied with the registration overlay before drilling the pin. Postoperative CT scans showed 1.5 mm error in entry point deviation and 2.4[Formula: see text] error in pin orientation on average in the phantom study and 2.5 mm and 1.5[Formula: see text] in the cadaver study. A trained user takes around 90 s to complete the workflow. Our method also outperformed HoloLens native tracking in drift correction. CONCLUSION: Our findings suggest that image-based drift correction can provide mixed reality environments precisely aligned with patient anatomy, enabling pin placement with consistently high accuracy. These techniques constitute a next step toward purely image-based mixed reality surgical guidance, without requiring patient markers or external tracking hardware.