A mixed reality framework for interpretable and explainable joint replacement assessment

Objective: Joint replacement surgery, also known as arthroplasty, is a common procedure that restores mobility and relieves pain in patients with severe joint pathologies. Despite being considered routine, arthroplasties are complex interventions with potential complications and variable clinical outcomes. Accurate evaluation of replaced joint mobility to ensure implant stability within the patient’s functional range of motion (ROM) is a major challenge in postoperative care. However, the reliability of current assessment methods is limited due to their lack of standardized and quantitative tools. This study presents a patient-specific Mixed Reality (MR) framework designed to enhance postoperative evaluation in joint replacement with a focus on total hip arthroplasty (THA). Methods: The proposed system enables objective quantification and MR visualization of prosthesis biomechanics by integrating ROM simulation and 3D modeling, promoting explainability and interpretability of surgery outcomes. A retrospective analysis of 67 THAs was performed to compare simulated ROM results with clinical assessments and literature benchmarks. Additionally, surgeons evaluated the system’s clinical relevance and usability through a preliminary study, including completion of the System Usability Scale (SUS). Results: Simulated ROM measurements showed good agreement with both clinical assessments and established literature reference values across ten movements commonly examined in orthopedic practice. The MR tool demonstrated high accuracy, repeatability, and potential to support postoperative decision-making, with usability testing yielding a favorable median SUS score of 82.5, indicating strong acceptance among clinicians. Conclusion: The patient-specific MR framework provides a reliable, quantitative, and interpretable method for assessing prosthetic joint performance after replacement, supporting its integration into postoperative workflows for improved surgical outcome assessment.