Introduction 

    In Augmented Reality (AR overlays digital elements onto the real world, enhancing the physical  environment with additional information, graphics, or interactions. It does not replace the real world but adds layers of digital content. AR is used for navigation, real-time translations, interactive guides, or enhancing retail experiences AR can often be experienced through everyday devices like smartphones or tablets where we have developed many medical software 
An immersive space refers to any environment, virtual or physical, that surrounds a person and engages multiple senses to create a sense of "being there" within a different reality. This could be a fully digital environment or a physical space enhanced by digital elements. Apple vision pro offers this  immersive space in surgeons every day  environment

Description: What is it?

 

A hip joint replacement surgery navigation app designed for the Apple Vision Pro is an advanced mixed reality  combining also previous augmented reality (AR) tools aimed at assisting orthopedic surgeons during hip replacement procedures. This app utilizes the cutting-edge capabilities of Apple Vision Pro, such as 3D visualization, real-time image processing, and precise spatial tracking, to enhance surgical accuracy and improve patient outcomes in immersive space.
Apple Vision Pro's object tracking is highly accurate due to its combination of advanced sensors (High-Resolution Cameras,LiDAR Sensors, Internal Measurement Units -gyroscopes and accelerometers), machine learning, and robust software tools. Real-time  navigation guidance on instrument positioning, alignment, and implant placement are capable by Hand  and instrument tracking in immersive space by taking leverage Apple vision pro  capability.  

Orthopractis ® navigation system workflow 

    Based on the Orthopractis navigational system which is based on spatial informations taken of  a reference cube placed on the patient during preoperative CT imaging. Generated images after being processed and segmented are  exported in Apple vision Pro allowing in immersive space  3D Visualization of the patient's anatomy (e.g., pelvis, femur) overlaid on the real-world view during surgery.
The workflow starts with patient imaging (CT and / or  MRI) whith   orthopractis reference cube during patient imaging All  data are collected and stored in Apples cloud. Preoperatively, the registration of anatomicals points needed for intraoperative navigation are preregistered and positioned over the 3D patient model. Once patient are processes and calibrated accordingly surgeon can download these data directly to device and can overlaid  over patients body through Apple vision Pro during surgery in immersive environment . 

Hand tracking 

    App is taken leverage or Apples machine learning  algorithms in visionOS Entire hand joints and fingers are in real time accurately detected and precisely track  enabling interactions in immersive space by offering advanced auto calibration algorithms developed by our team allows accurate virtual  precise attachment of surgical tools that are previously recognised as objects with neural engines. This makes  common surgeon task  precise and accurate i.e. of screws placement or ablation needles for biopsy.

Instruments tracking 

        Instruments are trained before with Create ML and registered in App giving continuously spatial information. Position and orientation of instruments  in a three-dimensional space are precisely traced in immersive environment of apple vision pro by leveraging  advanced spatial object recognition  Apples visionOS  machine learning capabilities.
   Instruments  can be tracked  objects from various angles and under different conditions offering, tracking accuracy. We designed also guides over surgical instruments  in case where the whole instrument is not appropriate for recognition due  to physical hurdles. Once are spatial recognized we  integrated them in  real-time feedback association with the main app by  visualising  measurements needed during specific surgery By adding also  physical properties allowing to take advantage of  power of interactive  immersion environment like  haptic or visual feedback for warnings (e.g., when a surgical tool is too close to vital structures
Real-time image processing and rendering to handle the complex requirements of surgery.We developed a prototyped based over previous knowledge in augmented reality for hip surgeries 

What problem is this solving? 

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Marker-less surgical registration

The registration procedure during robotic-assisted total hip replacement surgery involves mapping the patient’s anatomical landmarks can present challenges the most critical and sometimes problematic steps in robotic-assisted total hip replacement. 
   Traditionally, Marker-based registration methods identify the marker points then register them with the corresponding marker points on the intraoperative anatomical structure of patient. Traditional registration can be a time-consuming process, especially if difficulties arise or recalibration is needed. due to accuracy of capturing anatomical landmarks when are obscured by surgical instruments, soft tissue, or blood.
Patient Intraoperative Movement by surgeon manipulation altering the orientation of bony landmarks. Patient-Specific Anatomy the identification of accurate anatomical landmarks during registration, making it difficult to create an accurate match between the model and the actual anatomy.Obesity or MuscularityRobotic systems rely on precise calibration and real-time tracking of instruments. If the tracking system fails or loses sight of a reference marker or target, the registration may be thrown off, necessitating recalibration or re-registration.

Surgeons have relied on marker-based navigation systems during joint replacement surgeries. This is heavy, complicated and time-consuming and  this technique is offered by all  known commercial navigational systems in order to achieve successful guidance during robotic navigational surgery in hips. However, such systems have limitations, such as the risk of marker displacement, inconvenience during surgery,potential infection risks and  are time consuming procedures. 
Apple's Vision Pro providing  immersive space  by  the app offers the capability of markerless navigation by simply overlaid the anatomical structure over raw stantomical structure and simply registration by the finger of the surgeon Reduced Invasiveness. Markerless systems eliminate the need for placing physical markers (like pins) in the patient's body, reducing invasiveness and minimizing tissue damage.Since marker-based systems require attaching and calibrating physical markers, setup time can be longer. Markerless systems streamline the setup process, leading to quicker surgeries. Without the need for markers or pins, patients experience less discomfort both during and after surgery, as no additional incisions or attachments are necessary.Marker placement can introduce the risk of infection or complications at the marker sites. By removing the need for markers, these risks are reduced in markerless systems.By eliminating the need to manage physical markers during surgery, markerless systems can reduce the technical complexity, making the surgeon’s workflow more straightforward are less intrusive and don't require constant attention to marker placement. Preoperatively, the registration of anatomicals points needed for intraoperative navigation are preregistered and positioned over the 3D patient model. Once patient data are processes and calibrated accordingly surgeon can download these data directly to device and can overlaid  over patients body through Apple vision Pro during surgery in immersive environment . 
App utilize Vision Pro's capabilities would ensure that the augmented reality overlays stay precisely aligned with the patient’s anatomy, even during movements, improving the reliability and effectiveness of the navigation system.
Our method overcomes  these issues  by simply taking  as reference  the cube and reducing these modalities to minimal point of of registration by using the hand index finger  of the surgeon avoiding cumbersome extra instrument s like pointers .

 Enhanced Immersive and interactive 3D visualization with Apple Vision Pro.

    Surgeons also should  constantly interpret and mentally map 2D imaging data CT and X-rays onto the 3D space of the patient's anatomy, which can be mentally taxing and increase the likelihood of errors, especially in long or complex surgeries.
By taking leverage of the reference cube App calculates where and position of virtual 3D patient anatomical models from CT or MRI imaging can be accurate  projected over patient body and visualised in  immersive environment Surgeon can visualize dynamically in immersive space  the overlaid CT  patients images on the real-world  over patient. Arteries veins nerves could  be loaded according surgeon preference  and  spatially presented in real time in surgeons optical field. As the real-time detection of reference cube  occurs, dynamically overlay the CT segmentation data onto the live feed or processed images, maintaining alignment between the  of overlaid images and real anatomical structure By leveraging the object detection capabilities This approach is particularly powerful in medical applications where understanding the spatial relationship between real-world images and CT scan data is critical. The combination of Core ML for real-time processing and advanced neural networks for object and segmentation detection makes this a feasible and highly impactful solution.Different levels of transparencies of virtual structures create a sense of depth and realism, he direction of virtual instrument extension. For example  the tip of  virtual instrument can be extended  and by manipulation  the direction can be adjusted easily  and visualise in augmented reality in case the tip comes  in  contact with the  virtual sensitive anatomical structure. This offer also the real time  visualisation and allows real time correction   before intervention  with the real instrument. Another  invaluable feature is a transparency  between  virtual structures in Augmented Reality feature that is offered in Apple AR. This feature offer an advance in navigation by real time  attuning the direction of insertion, helps planning the optimal direction before real attempt to find the target point of interest  and predicting the real depth  of insertion by simply visualising and simulating in augmented reality the contact with the target  point of interest. By depicting sensitive anatomical structures that can be visualised during surgery allow to avoid by surgical manipulations accidental damage giving  the surgeon the advantage to navigate or intervene between these sensitive anatomical structure. This feature allow the surgeon  searching intraoperatively the optimal way before actual intervention ensue.The app enhances precision over all by providing real-time, 3D visualization of the patient’s anatomy and surgical instruments. It guides surgeons with accurate overlays, ensuring optimal placement of implants and alignment of the hip joint. This reduces the risk of errors and improves the longevity and success of the implant.
Enhancing  Intra-Operative  surgeon Vision offers  instant flexible real time  help in critical decisions especially where surgeons view is limited and unforeseen challenges during surgery can emerge and are difficult to predict preoperative now intraoperative  adaption of  the plan  is feasible on the fly with less time and  stress.The high-resolution displays of Apple Vision Pro would enable clearer, more detailed overlays, allowing for more precise guidance during surgery
Traditional navigation systems may not offer the level of interactivity or responsiveness needed to adapt to the dynamic nature of surgery. Surgeons may lack immediate, contextual feedback during surgery, which can lead to delays in decision-making or corrective actions.
Apple Vision Pro supports advanced gesture recognition and voice commands, allowing surgeons to interact with the software hands-free during surgery. Converting Orthopractis.com’s software to utilize these features could improve the user experience by allowing surgeons to adjust views, access information, or switch modes quickly and efficiently, without needing to break the sterile field.The immersive environment provide contextual alerts, suggestions, or adjustments directly in the surgeon’s view, supporting quicker and more informed decision-making during the procedure.
Training and collaboration in surgery are often limited by physical proximity and the availability of expert consultants.
Apple Vision Pro’s capabilities could be harnessed to enable remote experts to virtually join the surgery, viewing the same AR overlays as the lead surgeon. This could facilitate real-time guidance, second opinions, and collaborative problem-solving, which is particularly valuable in complex cases. Moreover, the immersive nature of Apple Vision Pro could be used for more effective training simulations.

AI-driven knowledge base of surgical expertise using surgeon Post operative data. Creating an AI Surgical Teacher

The integration of Apple Vision Pro from Vision Navi Hip App allows capturing surgical procedures using the Apple Vision Pro and leveraging Vision Navi Hip App to collect data from users (surgeons) in a database  can serve  as a robust foundation for building an AI-driven knowledge base and surgical expertise by collecting. Recording and Capturing Surgical data like Surgeon hand movements,Surgical tool interactions and usage,, patient anatomy visualized in 3D space (from CT,Procedural flow (steps taken, time spent on each task, deviations from standard protocols) techniques of surgical procedures, providing a comprehensive view of the surgeon's actions, the operating environment, decision-making process etch .Can serve to build a The first real time AI surgical teacher 

  - The captured data would be processed using advanced AI models, to analyze surgical techniques and procedures. AI could detect patterns and outcomes from various surgeries, cataloging them into a knowledge base that recognizes best practices, innovative techniques, and potential risks.This system could be trained with extensive surgery data, learning from a vast number of procedures and surgeons.Integrating machine learning models, it could continuously improve its recommendations by learning from new surgical data captured via Apples Vision Pro. Over time, this AI-driven system could become a reliable resource for surgeons in training, offering real-time suggestions, identifying potential errors, and suggesting improvements.
Creating an AI Surgical  consultant and Teacher 
   - The AI-driven system could function as a mentor, providing personalized guidance to surgeons, suggesting improvements based on previous experiences, and offering simulations of complex procedures. Over time, it could evolve into an AI teacher, helping surgeons refine their skills through augmented reality-guided practice, leveraging real-time feedback.

 Collecting medical data, especially during surgeries, would be comply to privacy laws (like HIPAA in the US). But Processing large volumes of real-time video and data in a surgical environment with low latency combined with  limited cloud storage capabilities are issues that can be addressed by giving cooperate usage of apple vision pro. With advancements in AI, AR, and medical data processing, the foundation for building such an AI-driven system is entirely  new concept never used before. 

In a competitive market, it can be difficult for companies to stand out with incremental improvements to existing technologies. By being one of the first to offer an Apple Vision Pro-compatible surgical navigation system, Orthopractis.com could position itself as an innovator in the field, attracting attention from leading medical institutions and surgeons interested in cutting-edge technology. This could open up new markets and opportunities for growth.

Audience: Who are we building

Orthopaedic Surgeons 
Orthopaedic Surgeons need accurate, real-time guidance during surgery with enhanced visualization of the patient’s anatomy and surgical tools  increased confidence in performing complex surgeries and Reduced risk of errors and complications and less time consuming robotic assisted surgery with easy streamline workflow 

Medical Institutions and Hospitals
Hospitals and surgical centers are to improve patient outcomes and operational efficiency by augmenting simple surgeons surgical precision and reduce the length of surgeries. Minimise cost and to  have in their armamentarium to offer  Innovative solutions like the use o apple vision pro surgeries Cost-effective tools that offer a good return on investment improved patient outcomes and satisfaction and enhanced reputation as a center for advanced surgical care.

Medical Device Companies
Companies that produce surgical instruments, implants, and other medical devices They might be interested in collaborating to ensure that their products are fully integrated with the navigation app.Seamless integration with AR-based navigation systems to enhance the usability and precision of their products.Increased demand for their devices when paired with advanced navigation technology.

Patients
End Beneficiaries are patients undergoing hip replacement surgery.
Safe, effective surgical procedures with minimal complications.Shorter recovery times and better long-term outcomes.Confidence in the use of advanced technologies that enhance surgical success.Reduced pain and faster recovery due to more precise, minimally invasive procedures.
Lower risk of complications and need for follow-up surgeries. Improved overall satisfaction with the surgical experience.

Medical Educators and Training Programs
Medical schools, residency programs, and training centers that educate future orthopedic surgeons are also an important audience.Advanced training tools that provide immersive, hands-on learning experiences.Methods to safely train surgeons on complex procedures without risking patient safety.Enhanced educational outcomes through the use of realistic, interactive simulations.
Reduced learning curve for new surgeons, leading to better preparedness and confidence in the operating room.

Healthcare Administrators and IT Departments
These professionals are responsible for the technical integration and ongoing support of new technologies within healthcare settings. Telemedicinetures could be added later as support feature tin harsh environment or making difficult operation in remote ares. Solutions that are compatible with existing healthcare IT infrastructure. Streamlined integration process with minimal disruption to current operations.

Conclusion
The hip joint replacement surgery navigation app for Apple Vision Pro is being built for a diverse audience that includes orthopedic surgeons, medical institutions, medical device companies, patients, medical educators, and healthcare administrators. Each of these groups has unique needs and stands to benefit from the precision, efficiency, and innovative capabilities that this app can bring to the field of orthopedic surgery.