Preoperative mixed reality training improves trainee performance of glenoid guidewire positioning in shoulder arthroplasty in Walch B2 glenoid model

Abstract

BackgroundVirtual reality training has demonstrated the capacity to improve resident performance with certain surgical skills. Mixed reality (MR) devices such as the Hololens 2 could theoretically be used in a similar way for medical education and skill acquisition. Our hypothesis is that a patient specific preprocedure MR training program for 10-15 minutes followed by glenoid guidewire placement with MR holographic assistance can improve guide pin placement enough to be significantly better than freehand (FH) guidewire placement. MethodsThirty glenoid models with a Walch B2 glenoid defect were 3D printed using ABS filament. Resident trainees were selected and randomized to FH guidewire placement or MR training cohorts that were matched by experience. An app was created and installed on the Hololens 2 to allow practice of glenoid guidewire placement in a pseudo-immersive environment and comparison to the desired plan. This was used for 10-15 minutes prior to definitive placement of the glenoid guidewire in the B2 models by the resident in the MR cohort and a 3D hologram was available during guidewire placement. The volunteers each placed 10 guidewires in B2 glenoid models. The models were 3D scanned back to 3D digital files. The digital models were aligned using the automated iterative closest point method. Measurements were taken in each axis to determine the deviation from the surgical plan in version and inclination in degrees and start point in mm. ResultsAverage starting point difference from the plan for the FH group was 2.52 ± 0.82 mm, and 1.49 ± 0 .71 mm for the MR group, P = .02. The absolute value average version difference from the plan for the FH group was 11.69 ± 8.02 degrees, and 5.3 ± 3.57 degrees for the MR group, P ≤ .0001. The absolute value average inclination difference from the plan for the FH group was 8.4 ± 6.68 degrees, and 7.11 ± 4.96 degrees for the MR group, P = .27. ConclusionPreprocedure MR training improves execution of the surgical plan for guidewire version and start point in a B2 glenoid model compared to FH.