What once belonged to science fiction is now reshaping modern surgery. Augmented reality is no longer just a futuristic concept. It’s a powerful tool that surgeons are using in the operating room to improve outcomes in total shoulder replacement procedures. NextAR is an augmented reality-based navigation platform that enhances traditional shoulder replacement surgery by providing real-time visual guidance through AR overlays and tracking tools. The system aligns a surgeon’s preoperative plan with what is happening inside the operating room, allowing for greater precision throughout the procedure. “Traditional shoulder replacement surgery was based on a surgeon, like myself, taking a plain radiograph in the office or using a standard X-ray to determine that a patient had advanced shoulder arthritis and was a good candidate for surgery because their arm didn’t move well and they were in constant pain,” said Dr. Carl DiLella, an orthopedic surgeon at Cleveland Clinic Indian River Hospital. “The shoulder replacement was then positioned based on the X-ray and the surgeon’s experience.” “The NextAR system goes beyond simple X-rays,” he explained. “Patients undergo a CT scan, which the system uses to build a three-dimensional model of the shoulder. Surgeons use that model to plan the optimal implant size, orientation, and placement tailored to each patient’s unique anatomy.” There are 16 different implant sizes, along with multiple options for both the humeral and glenoid (socket) components. Using the planning software, surgeons can map every possible implant onto the patient’s CT scan. On one screen, the humeral side is planned, allowing the surgeon to choose stem size, metal components and polyethylene. Another screen focuses on the glenoid side, where the surgeon selects the baseplate, screw sizes and screw orientation. A third screen brings everything together, using predictive modeling to show how the shoulder will move and what the expected outcome of the surgery will be. “I do all of that planning at my desktop prior to surgery,” Dr. DiLella said. Once finalized, the surgical plan is uploaded onto a thumb drive and transferred to a computer in the operating room. During the procedure, surgeons wear smart glasses and view a monitor that overlays the preoperative plan directly onto the surgical field. This allows them to see detailed guidance in real time without looking away from the patient. Infrared-based trackers are attached to the patient’s scapula and to handheld surgical instruments. These trackers feed real-time data into the system, ensuring the augmented reality overlays align precisely with the patient’s anatomy and the surgeon’s tools. The system continuously provides feedback on instrument orientation, bone preparation, and implant placement relative to the plan, allowing surgeons to execute each step with far greater precision than with experience and visual estimation alone. “The system takes all the CT scan imaging we’ve done and uploads it live into the operating room,” Dr. DiLella said. “It allows me to take the entire plan and execute it in the patient’s shoulder by showing me exactly where to place the pin in the socket, where to put the screws, and how to recreate the plan in real time using camera tracking.” Studies show that augmented reality guidance systems like NextAR can significantly improve the accuracy of implant positioning, particularly for challenging components such as the shoulder socket. Traditional shoulder replacement surgery can result in alignment deviations of 10 to 11 degrees, but AR-guided placement can reduce that margin to fractions of a degree (approximately 0.6 degrees). “It’s really all about accuracy,” he continued. “The more accurately the implant is aligned, the better the joint function will be. Improved mobility also translates to longer-lasting implants. When positioned properly, these implants are expected to last 15 to 20 years.” Dr. DiLella performed Florida’s first NextAR-assisted shoulder replacement surgery in 2020. At that time, CT scans were sent to a team of engineers in Switzerland, where the company was originally based. The engineers processed the images and returned a surgical plan, which the surgeon could then modify and resend, a process that often took weeks. Today, the system has evolved into a standalone planner. Surgeons can upload CT images directly to their own computers and make immediate adjustments. With the latest version of the technology, Dr. Delilia can now have a patient undergo a CT scan, complete surgical planning, and perform the operation within 48 hours. “NextAR is the only augmented reality system that allows surgeons to make intraoperative changes,” he said. “Sometimes, despite all the planning, something doesn’t add up once you’re in the operating room. The freedom to adjust screw placement is one of the system’s biggest advantages. The tracker shows me not only where the screw is going, but also how long it should be. It takes the guesswork out of the process.” NextAR is part of a broader shift toward computer-assisted, patient-specific surgical planning in orthopedics. Unlike robotic systems, it uses augmented reality and tracking technology rather than large robotic arms or complex consoles. Surgeons retain full control of the procedure while benefiting from continuous, data-rich guidance. As augmented reality continues to move from concept to clinical standard, technologies like NextAR are redefining what precision looks like in orthopedic surgery and bringing surgeons closer than ever to a perfectly planned and executed operation. Carl P. DiLella, DO, is an orthopedic surgeon with Cleveland Clinic Indian River Hospital specializing in shoulder and knee reconstruction. His former practice, Orthopaedic Center of Vero Beach, recently became part of Cleveland Clinic. Dr. DiLella is a board-certified sports medicine fellowship trained orthopedic surgeon having completed his sports medicine fellowship at the Los Angeles Orthopedic Institute in Sherman Oaks, California. Dr. DiLella sees patients for consultation at 1285 36th Street, Suite 100, Vero Beach. For appointments, call 772-778-2009.