Evaluation of a Slipped Capital Femoral Epiphysis Virtual Reality Surgical Simulation for the Orthopaedic Trainee

Abstract

Objective: The purpose of this study was to compare outcomes between orthopaedic trainees using various preoperative training platforms (physical simulation [PS], virtual reality [VR], and reading/videos) in a slipped capital femoral epiphysis model.

Methods: Participants were randomly assigned to one of the three groups: (1) reading/video control group (n = 7), (2) VR group (n = 7), or (3) PS group (n = 7). Participants in the VR group completed a VR slipped capital femoral epiphysis module while participants in the PS group practiced the placement of a screw in the physical module before evaluation of percutaneous screw placement in the PS model. Outcomes evaluated included overall surgical time, amount of fluoroscopy, Global Rating Scale score, radiographic screw position, physical screw accuracy, presence of breeching of the articular surface or femoral neck, and overall platform rating (0 to 10).

Results: No difference was observed in surgical time, Global Rating Scale score, radiographic or physical accuracy of screw position, or articular surface breaching between the groups. Subjectively, there was a difference in utility of platform rating between the groups (PS: 10 ± 0, VR: 7 ± 2, and control: 6 ± 1, P = 0.001).

Conclusion: Training with VR was subjectively rated higher in value compared with reading/video methods and had similar performance outcomes compared with training with PS.

Figure 1

Photograph showing a customized phantom limb model (Sawbones) encasing a slipped capital femoral epiphysis Sawbones femur used to simulate a pediatric patient.

Figure 2

A, Photographs showing simulated operating room with C-arm, draping, and a slipped capital femoral epiphysis phantom model. B, Instrumentation setup.

Figure 3

Radiographs showing surgical preoperative planning: participants were allowed to use preoperative planning software (Surgimap; Nemaris) to map out any planned screw trajectories on (A) AP and (B) lateral radiographs immediately before evaluation.

Figure 4

Photographs showing participants being randomized into three groups. A, Group 1: standardized reading or video material. B, Group 2: physical simulation with slipped capital femoral epiphysis model. C, Group 3: virtual reality simulation. D, Participant using virtual reality (VR) headset and hand controllers.

Figure 5

Photograph showing Kirschner wire in relation to the center of the femoral head. Physical accuracy was measured as the distance from the center of the hash mark to the Kirschner wire (dashed line).

Figure 6

Illustration showing (A–C) grading system template of radiographic screw position as previously described by Pring et al. A, Radiograph template used to evaluate radiographic accuracy. B, AP view: example of a “grade A” screw. C, Lateral view: example of a “grade A” screw. D, AP view: example of a “grade C” screw. E, Lateral view: example of “grade C” screw.

Figure 7

Photograph showing an arrow denoting femoral neck breeching posteriorly.

Figure 8

Graph showing radiographic grades in AP and lateral views across all three virtual reality platforms. As shown, physical simulation had the greatest number of grade A scores in both views. Virtual reality had more grade A scores than control only in the AP view.