Use of extended reality, virtual reality, augmented reality and mixed reality in clinical practice, education and research in knee arthroplasty: A scoping review.

Abstract

This scoping review aims to map and evaluate the current body of literature on the use of extended reality (XR), including virtual reality (VR), augmented reality (AR) and mixed reality (MR), in the field of knee arthroplasty. There is a high global prevalence of knee osteoarthritis, and the frequency of knee replacement surgeries is increasing. The integration of XR technologies with surgery has the potential to improve patient care, surgical precision and medical education. This review seeks to understand the current landscape of XR applications in knee arthroplasty and identify gaps in knowledge to guide future research and clinical innovation. A systematic search of four databases-PubMed, Cochrane Central Register for Controlled Trials, National University of Singapore Libraries and Google Scholar-was conducted in December 2023 and updated in April 2024. Only English-language articles published from 2004 onwards were included. Editorials, case reports and articles not related to the knee joint were excluded. Eligible studies involved the use of XR/VR/AR/MR technologies specifically in the context of knee arthroplasty. Included articles were categorised under three major themes: (1) Clinical Practice (encompassing surgery, anaesthesia and rehabilitation), (2) Education (targeting both surgeons and nursing staff) and (3) Research (including applications in artificial intelligence and robotic-assisted surgery). Data from each study were extracted and summarised in a thematic table. Out of 236 articles retrieved from databases and 5 identified through reference screening, 54 articles met the inclusion criteria. VR was the most commonly studied modality (<i>n </i>= 42), followed by AR (<i>n </i>= 21), MR (<i>n </i>= 5), and XR (<i>n </i>= 2), with some overlap (<i>n </i>= 9) across technologies. Most articles focused on clinical practice (<i>n </i>= 45), while fewer addressed educational uses (<i>n </i>= 9) and research applications (<i>n </i>= 2). Two studies were classified under multiple themes. XR technologies were applied across preoperative training, intraoperative surgical navigation, anaesthesia techniques and postoperative rehabilitation. XR technologies in knee arthroplasty are diverse and show promising applications across clinical, education and research domains. While surgery, anaesthesia and education-related applications appear practical and beneficial, rehabilitation-related studies report mixed outcomes. Further high-quality research is needed to evaluate effectiveness and support broader clinical implementation across all identified subthemes. Level V.