Can an Augmented Reality Headset Improve Accuracy of Acetabular Cup Orientation in Simulated THA? A Randomized Trial

Abstract

Background Accurate implant orientation reduces wear and increases stability in arthroplasty but is a technically demanding skill. Augmented reality (AR) headsets overlay digital information on top of the real world. We have developed an enhanced AR headset capable of tracking bony anatomy in relation to an implant, but it has not yet been assessed for its suitability as a training tool for implant orientation. Questions/purposes (1) In the setting of simulated THA performed by novices, does an AR headset improve the accuracy of acetabular component positioning compared with hands-on training by an expert surgeon? (2) What are trainees' perceptions of the AR headset in terms of realism of the task, acceptability of the technology, and its potential role for surgical training? Methods Twenty-four study participants (medical students in their final year of school, who were applying to surgery residency programs, and who had no prior arthroplasty experience) participated in a randomized simulation trial using an AR headset and a simulated THA. Participants were randomized to two groups completing four once-weekly sessions of baseline assessment, training, and reassessment. One group trained using AR (with live holographic orientation feedback) and the other received one-on-one training from a hip arthroplasty surgeon. Demographics and baseline performance in orienting an acetabular implant to six patient-specific values on the phantom pelvis were collected before training and were comparable. The orientation error in degrees between the planned and achieved orientations was measured and was not different between groups with the numbers available (surgeon group mean error 6 SD 16°6 7°versus AR 14°6 7°; p = 0.22). Participants trained by AR also completed a validated posttraining questionnaire evaluating their experiences. Results During the four training sessions, participants using AR-guidance had smaller mean (6 SD) errors in orientation than those receiving guidance from the surgeon: 1°6 1°versus AR 6°6 4°, p < 0.001. In the fourth session's assessment, participants in both groups had improved (surgeon group mean improvement 6°, 95% CI, 4-8°; p < 0.001 versus AR group 9°, 95% CI 7-10°; p < 0.001). There was no difference between participants in the surgeon-trained and AR-trained group: mean difference 1.2°, 95% CI,-1.8 to 4.2°; p = 0.281. In posttraining evaluation, 11 of 12 participants would use the AR One of the authors (FI) received funding from Orthopaedic Research UK (31434). One of the authors (KL) received funding from the Royal College of Surgeons of England (P67699). Clinical Orthopaedics and Related Research® neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDAapproval status, of any drug or device prior to clinical use. Each author certifies that his institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research. Al...

Virtual, augmented, and mixed reality applications in orthopedic surgery

“…42 The Although there were no differences in the final assessment between the AR-trained group and the surgeon-trained group, the AR guidance system may be useful in the education setting because it can provide feedback for motor skills required for arthroplasty without the need for attending surgeon oversight. 50 A related study by Cho et al 46 (Table 3). 6…”

“…In the fourth and final assessment, participants in both groups had improved to a comparable level (mean difference in accuracy between the two groups was 1.2°, 95% CI, −1.8° to 4.2°, P = .281). Although there were no differences in the final assessment between the AR‐trained group and the surgeon‐trained group, the AR guidance system may be useful in the education setting because it can provide feedback for motor skills required for arthroplasty without the need for attending surgeon oversight . A related study by Cho et al constructed a novel AR navigation system run on a tablet PC to aid in bone tumor resection.…”

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“…28,29 Other new teaching methods Besides simulation training, other techniques exist to help in training of residents. Loghishetty et al 30 describe an augmented reality (AR) headset that can be used during total hip arthroplasty to improve accuracy of acetabular cup orientation. This study proved that the residents trained by AR were equally accurate compared to residents trained by a surgeon.…”

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“…In terms of total knee arthroplasty (TKA), Pokhrel et al (28) proposed an AR-based system which might improve the accuracy of osteotomies, so that it might potentially improve the long-term outcomes of TKA. Logishetty et al (29) evaluated the use of AR for training medical students in acetabular cup placement for total hip arthroplasty, in a phantom pelvis. The participants were found to be equally accurate when trained either by an expert surgeon or AR.…”

“…The participants were found to be equally accurate when trained either by an expert surgeon or AR. As a result, the authors concluded that the latter method could be a valuable educational tool, since it was showed that some skills for arthroplasty can be learned without supervision (29). Fotouhi et al (30) noted that AR technology could lead to limited radiation, simple and accurate placement of acetabular implant during total hip arthroplasty.…”