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. 2021 Feb 18:16:249-256.
doi: 10.1016/j.jcot.2021.02.014. eCollection 2021 May.

Active vs passive haptic feedback technology in virtual reality arthroscopy simulation: Which is most realistic?

Kalpesh R Vaghela  1 , Amaury Trockels  2 , Marco Carobene  3
Affiliations

Active vs passive haptic feedback technology in virtual reality arthroscopy simulation: Which is most realistic?

Kalpesh R Vaghela et al. J Clin Orthop Trauma. .

Erratum in

  • Erratum regarding previously published articles.
    [No authors listed] [No authors listed] J Clin Orthop Trauma. 2021 Jul 30;20:101539. doi: 10.1016/j.jcot.2021.101539. eCollection 2021 Sep. J Clin Orthop Trauma. 2021. PMID: 34405084 Free PMC article.

Abstract

Background: Virtual Reality (VR) simulators are playing an increasingly prominent role in orthopaedic training and education. Face-validity - the degree to which reality is accurately represented - underpins the value of a VR simulator as a learning tool for trainees. Despite the importance of tactile feedback in arthroscopy, there is a paucity for evidence regarding the role of haptics in VR arthroscopy simulator realism.

Purpose: To assess the difference in face validity between two high fidelity VR simulators employing passive and active haptic feedback technology respectively.

Method: 38 participants were recruited and divided into intermediate and expert groups based on orthopaedic training grade. Each participant completed a 12-point diagnostic knee arthroscopy VR module using the active haptic Simbionix ARTHRO Mentor and passive haptic VirtaMed ArthroS simulators. Subsequently, each participant completed a validated simulator face validity questionnaire.

Results: The ARTHRO Mentor active haptic system failed to achieve face validity with mean scores for external appearance (6.61), intra-articular appearance (4.78) and instrumentation (4.36) falling below the acceptable threshold (≥7.0). The ArthroS passive haptic simulator demonstrated satisfactory scores in all domains: external appearance (8.42), intra-articular appearance (7.65), instrumentation (7.21) and was significantly (p < 0.001) more realistic than ARTHRO Mentor for all metrics. 61% of participants gave scores ≥7.0 for questions pertaining to haptic feedback realism from intra-articular structures such as menisci and ACL/PCL for the ArthroS vs. 12% for ARTHRO Mentor. There was no difference in face-validity perception between intermediate and expert groups for either simulator (p > 0.05).

Conclusion: Current active haptic technology which employs motors to simulate tactile feedback fails to demonstrate sufficient face-validity or match the sophistication of passive haptic systems in high fidelity arthroscopy simulators. Textured rubber phantoms that mirror the anatomy and haptic properties of the knee joint provide a significantly more realistic training experience for both intermediate and expert arthroscopists.

Keywords: Arthroscopy; Simulation; Training; Virtual reality.

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Figures

Fig. 1
Fig. 1
VirtaMed ArthroS™ arthroscopy simulator (https://www.virtamed.com/en/aoa/).
Fig. 2
Fig. 2
3D systems arthro Mentor™ arthroscopy simulator (https://www.3dsystems.com/medical-simulators/simbionix-arthro-mentor).
Fig. 3
Fig. 3
Comparative mean results of the passive and active arthroscopy simulator questionnaire scores. Error bars denote standard deviation. All pairwise comparisons shown below are significantly different (p < 0.001).
Fig. 4
Fig. 4
Comparative mean scores of the active haptic arthroscopy simulator questionnaire for intermediates and experts. Error bars denote standard deviation. None of the pairwise comparisons below were significantly different (p > 0.05).
Fig. 5
Fig. 5
Comparative mean scores of the passive haptic arthroscopy simulator questionnaire for intermediates and experts. Error bars denote standard deviation. None of the pairwise comparisons below were significantly different (p > 0.05).
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