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

## TL;DR

Virtual reality training improves orthopedic residents' performance in knee replacement surgery, with measurable improvements in steps completed, time efficiency, and focus.

## Contribution

This study demonstrates that VR-based training significantly enhances surgical performance metrics in total knee arthroplasty training.

## Key findings

- VR training significantly increased the number of surgical steps completed successfully.
- Residents showed a significant decrease in time per step after VR training.
- Improvement in surgical site gaze was observed with VR training.

## 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%, p = 0.005; partial eta squared = 0.509; Cohen's d = 1.11) by simulator training. The time per step decreased (mean diff. ± SD: −22.73 ± 11.8 s; p = 0.000; partial eta squared = 0.807; Cohen's d = 1.63) and an improvement in surgical site gaze (SSG) (mean diff. ± SD: 9.65% ± 4.18%; p = 0.000; partial eta squared = 0.874; Cohen's d = 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.