Augmented reality-assisted total elbow arthroplasty following tumor resection of the distal humerus: A case report

Total elbow arthroplasty is a viable option for metastatic tumors of the distal humerus, but accurate implant placement —particularly proper rotational alignment—is challenging after wide bone resection due to the loss of anatomical landmarks. This case report aims to demonstrate the utility of augmented reality (AR) technology in ensuring the intraoperative reproducibility of a three-dimensional (3D) preoperative plan in a complex oncologic reconstruction. A 63-year-old woman sustained a pathological distal humeral fracture from metastatic renal cell carcinoma. She underwent tumor resection and total elbow arthroplasty. As the extensive resection removed anatomical landmarks, obtaining correct rotational alignment was difficult. We employed AR technology to visualize the native bone morphology and the planned implant position intraoperatively on a smartphone screen. Postoperative computed tomography confirmed that the implant was placed accurately, with a rotational error of less than 3° relative to the preoperative plan. Although long-term follow-up was limited to four weeks due to the patient's transfer for systemic treatment, she achieved early functional recovery with a range of motion from -45° to 100°. AR guidance, combined with three-dimensional planning, enabled high surgical precision and excellent reproducibility of implant positioning following wide resection. This technology offers an effective solution for maintaining surgical accuracy in complex oncologic elbow reconstructions where anatomical references are compromised.