Virtual reality simulation improves performance metrics in total knee arthroplasty training: A single-centre longitudinal study.

Abstract

Surgical training of orthopaedic residents is considered challenging. Limited knowledge is currently available regarding alternative approaches such as virtual reality (VR)-based training for total knee arthroplasty (TKA). The aim of this study was to investigate the effect of VR-based training on residents' surgical performance and the individual learning curves in VR-simulated TKA. In an educational longitudinal study of learning performance across multiple time points, five sessions were completed on a VR TKA simulator by residents at weekly intervals. The sessions included a knowledge (multiple-choice questions) and skills part, in which a VR-simulated TKA was performed using a fully immersive commercially available VR simulator (Fundamental VR Surgery HapticVR™ Simulator; FundamentalSurgery, London, GB). The results of 17 orthopaedic residents were analysed. Significant findings with strong effect sizes were observed for the primary endpoints in the surgical skill evaluation. A significantly higher number of the 16 surgical steps were successfully completed following simulator training (mean diff. ± SD: 0.11% ± 0.12%, <i>p</i> = 0.005; partial eta squared = 0.509; Cohen's <i>d</i> = 1.11) by simulator training. The time per step decreased (mean diff. ± SD: -22.73 ± 11.8 s; <i>p</i> = 0.000; partial eta squared = 0.807; Cohen's <i>d</i> = 1.63) and an improvement in surgical site gaze (SSG) (mean diff. ± SD: 9.65% ± 4.18%; <i>p</i> = 0.000; partial eta squared = 0.874; Cohen's <i>d</i> = 2.70) was observed. VR-based training for TKA was found to have a significant positive effect on the learning curve. Improvements were observed in steps completed, time required and SSG. VR-based training can therefore be considered as a safe and effective alternative in the training of orthopaedic residents. Level III.