Augmented Reality–Assisted vs Manual Total Knee Arthroplasty: Clinical and Perioperative Outcomes in a Consecutive Single-Surgeon Cohort

Background Augmented reality–assisted navigation (ARAN) has emerged as an alternative enabling technology for total knee arthroplasty (TKA), providing real-time intraoperative alignment guidance without the capital investment or workflow demands of robotic platforms. Evidence directly comparing ARAN with conventional manual instrumentation on clinical outcomes remains limited. Methods We performed a retrospective cohort study of 586 consecutive primary TKAs by a single surgeon between 2022 and 2023. Manual instrumentation (M-TKA) was used in 2022 and ARAN-TKA in 2023. The final cohort included 570 patients. The primary outcome was operative time. Secondary outcomes included 30-day readmissions, opioid utilization in morphine milligram equivalents, and Knee Injury and Osteoarthritis Outcome Score Jr. Results Groups were well-matched at baseline. ARAN-TKA was associated with a modest operative time increase (mean difference 3.54 minutes, P < .001). Readmissions occurred in 8 M-TKA patients and 4 ARAN-TKA patients, a nonsignificant difference ( P = .156). Age was the only significant independent predictor of readmission (adjusted odd ratio: 1.12 per year, P = .028). Initial opioid prescriptions were lower in the ARAN group ( P < .001), but 90-day utilization did not differ significantly ( P = .436). Knee Injury and Osteoarthritis Outcome Score Jr improvements were comparable at 1 year. Conclusions ARAN-TKA demonstrated noninferior clinical outcomes and comparable patient-reported improvements vs conventional manual instrumentation. ARAN-TKA was associated with a modest operative time increase, lower initial opioid prescribing not sustained at 90 days, and no significant difference in readmission rates. These findings support the feasibility of integrating ARAN into standard TKA workflows without compromising outcomes. Larger multicenter studies are needed to explore the clinical impact of ARAN-TKA.