Experimental Study Of Augmented Reality Technology In Simulated Total Hip Arthroplasty

Objective:This in vitro study aimed to compare the effects of two different approaches under augmented reality(AR)technology-based guidance and traditional freehand techniques on acetabular component position during artificial total hip arthroplasty simulating a posterolateral approach.Methods:An AR environment was created using a radiopaque foamy pelvis(sawbones,USA)model,combined with Holo Lens 2(Microsoft,USA),which was used to simulate acetabular cup prosthesis placement.24 orthopedic residents completed acetabular cup prosthesis placement using two methods based on AR guided technique and traditional freehand technique.Participants were randomized into two groups,one receiving the AR guided technique and the other guided by the traditional freehand technique in a randomized controlled trial.Demographic data on participants who underwent acetabular component placement were collected before performing proceeding with the trial.Both groups were measured the precision and accuracy of the acetabular cup prosthesis placement position angle(anteversion,abduction angle)with respect to the target value,execution time,fluoroscopic radiation dose and usability(system usability scale(SUS),surgical task load index(STLI)).Data from each group were analyzed for differences using IBM spss25.0.Acetabular component placement accuracy was compared using paired t tests.Precision was tested using the variance ratio.A paired t-test was used to compare execution time,fluoroscopic radiation dose,STLI value,and SUS score.P values < 0.05 were considered significant.Participants who had undergone placement of the acetabular component with the AR guided technique also completed a questionnaire that assessed how they felt.Result:(1)In terms of acetabular component placement accuracy,the AR technique guided acetabular component abduction angle and anteversion to target differences were 2.58 ± 1.18 degrees and 1.79 ± 0.75 degrees,respectively,in the AR technique guided group,and the traditional freehand technique guided acetabulum was abduction angle and anteversion to target differences were 7.17± 1.64 degrees and 7.67 ± 1.72 degrees,respectively,with statistically significant differences(P < 0.05)in the accuracy of acetabular component abduction angle and anteversion between the two groups,The results showed that the acetabular component abduction angle and anteversion angle were more accurate in the group guided by the AR technique;In terms of acetabular component placement precision,the F-statistics in terms of acetabular component abduction angle and anteversion in the AR technique guided group and the traditional freehand technique group were 61.5 and 117.1,respectively.There was a statistically significant difference in the precision of acetabular abduction angle and anteversion between the two groups(P < 0.05),and the results showed that the precision of acetabular abduction angle and anteversion placement was more accurate in the group guided by the AR technique.(2)Execution time the execution time was 42.2 ± 6.91 seconds in the AR technique guided group and 92.5 ± 13.3 seconds in the traditional freehand technique group,which was statistically different(P < 0.05)between the two groups,and the execution time was more rapid in the group guided by the AR technique.(3)The fluoroscopic radiation dose between the two groups with AR technique guided and conventional freehand technique was 1.17 ± 0.14 cgycm2 and 1.21 ± 0.66 cgycm2,respectively.There was no statistically significant difference between the two groups(P = 0.120),indicating no significant difference in fluoroscopic radiation dose.(4)The mean score of STLI guided by AR technique was 27.58 ± 6.28 compared with 55.91 ± 6.63 in the traditional freehand technique group,which was statistically different between the two groups(P < 0.05).The mean SUS score guided by the AR technique was 76.58 ± 10.8,compared with 53.08 ± 8.10 in the conventional free hand technique group,which was statistically different(P < 0.05)(5)In the online questionnaire,the mean score for participants to understand the orientation,indications,and biomechanical factors involved in was 7 and 8points,respectively.The mean score of the hip model and angle positioning in terms of orientation task items was 8 points,the AR Holo Lens 2 guided technique platform pleasant learning method,and the mean score that helped to improve their understanding of hip arthroplasty with both comfort and effectiveness was7 points.It is valuable to visualize anatomical concepts and formulate individualized surgery on this platform with a mean score of 8 points.The mean score for developing a simulation program that was also a prevalent ideal situation for participants was 7 points.Nine of the 12 subjects expressed a preference for the AR guided technology platform for learning hip implant positioning,and another 7 preferred training and learning with the AR guided technology platform for hip implant positioning.Conclusion:(1)The AR technique based guidance demonstrated more accurate and precise anteversion and abduction angle placement in simulating acetabular cup prosthesis placement,resulting in more execution time savings and easier acetabular cup prosthesis placement than the traditional freehand technique.(2)AR technique guidance can be considered a feasible and valuable tool for acetabular cup prosthesis placement and,in the future,could be used as an adjunct to preoperative training and intraoperative guidance for surgeons in surgical procedures.