Effectiveness of Virtual Reality Compared to Video Training on Acetabular Cup and Femoral Stem Implantation Accuracy in Total Hip Arthroplasty Among Medical Students: A Randomised Controlled Trial

Abstract

Purpose Virtual reality (VR) training effectiveness in improving hip arthroplasty surgical skills requires further evaluation. We hypothesised VR training could improve accuracy and the time taken by medical students compared to a control group with only video teaching.

Methods

This single-centre randomized controlled clinical trial collected data from March to June 2023. Surgically naïve volunteer undergraduate medical students performed three sessions on a VR training platform, either cup (VR-Cup=Control-Stem) or stem (VR-Stem=Control-Cup) implantation. The primary outcome was the mean difference between predefined cup inclination (60°) and stem anteversion (20°) compared to the actual implanted values in sawbones between VR and control groups. Secondary outcomes were task completion time and mistake number between the groups.

Results

A total of 101 students participated (VR-Cup 47, VR-Stem 54). Groups did not significantly differ concerning age (p = 0.879), gender (p = 0.408), study year (p = 0.938), previous VR use (p = 0.269) and baseline medical and procedural knowledge. The VR-Cup implanted the cup closer to the intended target (p < 0.001) and faster than the Control-Cup group (p = 0.113). The VR-Stem implanted the stem closer to the intended target (p = 0.008) but not faster than the Control-Cup group (p = 0.661). Stem retroversion was commoner in the Control-Stem than in the VR-Stem group (p = 0.016).

Conclusions

VR training resulted in higher rates of accurate procedure completion, reduced time and fewer errors compared to video teaching. VR training is an effective method for improving skill acquisition in THA.

Keywords

Virtual reality · VR · Hip arthroplasty · THA · Training · Randomized controlled trial

Introduction

Training medical students and junior surgeons is currently a priority in the medical field. It is widely accepted that becoming proficient in surgery requires practical experience in the operating room and a deep understanding of the theoretical aspects. The skill set requires time to develop through consistent practice, helping to develop hand-eye coordination. The continuous evolution of orthopaedic techniques poses challenges. All residents acquire new surgical skills through studying technique guides, watching procedure videos, and working with mentors. However, a significant percentage of residents learn to prepare for procedures independently, leading to varying levels of competence. Simulation methods, including sawbones use and VR technology, are evaluated as training methods with promising results but have limitations, such as availability and cost.

Materials and Methods

We designed a prospective randomized controlled trial (RCT) to measure if VR simulation helps medical students with no prior surgical experience acquire surgical technical skills in THA by performing two core steps: the acetabular cup and femoral stem implantation at specific positions. The primary outcome was the difference in the mean implanted cup inclination and femoral stem anteversion between the VR and control groups. Secondary outcomes included the time needed to complete the task and the number of mistakes.

Eligible study participants included undergraduate medical students with no previous surgical experience who agreed to participate. Exclusion criteria included postgraduate medical students and those with prior experience in THA. Informed consent was obtained from all participants. We employed the CONSORT checklist throughout the study.

Immediately after enrollment, participants completed a multiple-choice pretest assessing baseline knowledge of hip anatomy and THA. They then watched a detailed instructional video regarding the procedure and completed three VR sessions based on their assigned group. Participants were randomly assigned to one of the groups using a computerized random number generator.

Statistical Analysis

Statistical analyses included descriptive statistics and hypothesis testing for differences between groups. Tests included the Mann-Whitney U-test and chi-squared test for categorical data. A paired t-test was also conducted to compare performance outcomes between groups. SPSS software was used for all statistical analyses.

Results

One hundred and one undergraduate medical students were enrolled in the study. The demographic data and baseline assessments showed no significant differences between the groups. The analysis of performance indicated that both VR groups significantly outperformed the control groups in terms of accuracy and errors made during the implantation tasks.

Table 1: Comparative Demographic and Questionnaire Data Between Groups

Discussion

VR has shown potential for improving surgical training. Studies affirm improved accuracy and reduced task time. However, challenges remain in simulating the complete surgical experience. Current VR tools must evolve to include tactile feedback and more realistic representations of surgical environments.

Conclusion

VR can enhance surgical education by providing alternative training methods that complement traditional education. Further research is needed to optimize VR use in orthopaedic training.