Accurate implant orientation is associated with improved outcomes after artificial joint replacement. We investigated if a novel augmented-reality (AR) platform (with live feedback) could train novice surgeons to orientate an acetabular implant as effectively as conventional training (CT). Twenty-four novice surgeons (pre-registration level medical students) voluntarily participated in this trial. Baseline demographics, data on exposure to hip arthroplasty, and baseline performance in orientating an acetabular implant to six patient-specific values on a phantom pelvis, were collected prior to training. Participants were randomised to a training session either using a novel AR headset platform or receiving one-on-one tuition from a hip surgeon (CT). After training, they were asked to perform the six orientation tasks again. The solid-angle error in degrees between the planned and achieved orientations was measured using a head-mounted navigation system.Background
Methods
Complications such as dislocations, impingement and early wear following total hip arthroplasty (THA) increase with acetabular cup implant malorientation. These errors are more common with low-volume centres or in novice hands. Currently, this skill is most commonly taught during real surgery with an expert trainer, but simulated training may offer a safer and more accessible solution. This study investigated if a novel MicronTracker® enhanced Microsoft HoloLens® augmented reality (EAR) headset was as effective as one-on-one expert surgeon (ES) training for teaching novice surgeons hip cup orientation skill. Twenty-four medical students were randomly assigned to EAR or ES training groups. Participants used a modified sawbone/foam pelvis model for hip cup orientation simulation. A validated EAR headset measured the orientation of acetabular cup implants and displayed this in the participant”s field of view. The system calculated the difference between planned and achieved orientation as a solid-angle error. Six different inclination and anteversion combinations, related to hypothetical patient-specific anatomy, were used as target orientations. Learning curves were measured over four sessions, each one week apart. Error in orientations of non-taught angles and during a concealed pelvic tilt were measured to assess translation of skills. A post-test questionnaire was used for qualitative analysis of procedure understanding and participant experience.Background
Methods
Trust in the validity of a measurement tool is critical to its function in both clinical and educational settings. Acetabular cup malposition within total hip arthroplasty (THA) can lead to increased dislocation rates, impingement and increased wear as a result of edge loading. We have developed a THA simulator incorporating a foam/Sawbone pelvis model with a modified Microsoft HoloLens® augmented reality (AR) headset. We aimed to measure the trueness, precision, reliability and reproducibility of this platform for translating spatial measurements of acetabular cup orientation to angular values before developing it as a training tool. A MicronTracker® stereoscopic camera was integrated onto a HoloLens® AR system. Trueness and precision values were obtained through comparison of the AR system measurements to a gold-standard motion capture system”s (OptiTrack®) measurements for acetabular cup orientation on a benchtop trainer, in six clinically relevant pairs of anteversion and inclination angles. Four surgeons performed these six orientations, and repeated each orientation twice. Pearson”s coefficients and Bland-Altman plots were computed to assess correlation and agreement between the AR and Motion Capture systems. Intraclass correlation coefficients (ICC) were calculated to evaluate the degree of repeatability and reproducibility of the AR system by comparing repeated tasks and between surgeons, respectively.Background
Methods
