Virtual Reality in Orthopedic Surgery Training

Figures & data

Table 1 Summary of Referenced Primary Studies Evaluating the Use of Virtual Reality Simulation in Orthopaedic Surgery Training Published Within Five Years

Study	Population	Methods	Outcomes
Logishetty et al, 2019^Citation8	24 surgical trainees naïve to anterior approach total hip arthroplasty	1:1 randomization with 12 trainees completing conventional preparation and 12 trainees completing a six-week immersive VR training using headsets and a VR-enabled operating room	VR trainees outperformed conventional trainees requiring less guidance and instructor intervention, completing more key steps, more accurately handling instruments, and finishing in less overall time in a procedure-based assessment
Walbron et al, 2020^Citation22	107 first-year residents learning arthroscopy	Non-random assignment to one of three groups: conventional training only (Group A, 76 residents); conventional training with a single, non-VR supplemental session (Group B, 17 residents); conventional training with 10 hours of VR training (Group C, 14 residents)	VR-trained residents (Group C) outperformed both other groups in procedure time and measures of accuracy and instrument handling in two procedure-based assessments
Khanduja et al, 2017^Citation23	10 residents who had completed <250 hip arthroscopies each and 9 faculty who had completed >250 hip arthroscopies each	All participants completed a procedure-based assessment that measured procedure time, soft tissue and bone collisions, and instrument handling	Faculty outperformed residents showing a correlation between experience in hip arthroscopy and performance in the simulator supporting the construct validity of the simulator and its potential to assist in the development of basic arthroscopic skills
Hooper et al, 2019^Citation34	14 first-year residents who had completed one cadaver total hip arthroplasty	1:1 randomization with 7 trainees completing conventional preparation and 7 trainees completing conventional preparation and two virtual total hip arthroplasties before completing their second cadaver total hip arthroplasty	VR-trained residents outperformed the conventionally trained residents in all steps of the Ottawa Surgical Competency Operating Room Evaluation in the second cadaver total hip arthroplasty
Lohre et al, 2020^Citation36	16 senior residents and 7 faculty	1:1 randomization with 8 residents and 3 faculty completing conventional preparation and 8 residents and 4 faculty completing a single immersive VR training using headsets and a VR-enabled operating room	VR-trained participants outperformed the conventionally trained participants in mean time and instrument handling while within groups experience correlated to greater simulator performance supporting the construct validity of the simulator and its potential to assist in the development of basic arthroscopic skills

Table 2 Advantages and Disadvantages of Virtual Reality in Teaching Orthopaedic Procedures

Advantages	Disadvantages
Potential benefit to patient safety and ethical acceptability	Nascent technology with imperfect fidelity
Opportunity to assess trainee competence in a consistent and reproducible manner	Expensive to implement
Low-risk environment in which trainees can practice at any time	Limited evidence regarding optimal implementation within residency training
Predictable availability regardless of external factors	Limited to certain procedures
Emerging evidence of construct validity and transferability of simulator skills	Current simulators only focus on developing technical skill and do not incorporate interaction with the rest of the intraoperative team

Logishetty K, Rudran B, Cobb JP. Virtual reality training improves trainee performance in total hip arthroplasty: a randomized controlled trial. Bone Joint J. 2019;101-b(12):1585–1592. doi:10.1302/0301-620x.101b12.Bjj-2019-0643.R1

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Walbron P, Common H, Thomazeau H, et al. Virtual reality simulator improves the acquisition of basic arthroscopy skills in first-year orthopedic surgery residents. Orthop Traumatol Surg Res. 2020;106(4):717–724. doi:10.1016/j.otsr.2020.03.009

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Khanduja V, Lawrence JE, Audenaert E. Testing the construct validity of a virtual reality hip arthroscopy simulator. Arthroscopy. 2017;33(3):566–571. doi:10.1016/j.arthro.2016.09.028

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Hooper J, Tsiridis E, Feng JE, et al. Virtual reality simulation facilitates resident training in total hip arthroplasty: a randomized controlled trial. J Arthroplasty. 2019;34(10):2278–2283. doi:10.1016/j.arth.2019.04.002

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Lohre R, Bois AJ, Athwal GS, Goel DP. Improved complex skill acquisition by immersive virtual reality training: a randomized controlled trial. J Bone Joint Surg Am. 2020;102(6):e26. doi:10.2106/jbjs.19.00982

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