Title : Use of extended reality, virtual reality, augmented reality and mixed reality in clinical practice, education and research in knee arthroplasty - A scoping review
Abstract:
Objective: This scoping review was designed to map out the literature on the emerging topic of using Extended Reality (XR), Virtual Reality (VR), Augmented Reality (AR), and Mixed Reality (MR) in knee arthroplasty and to identify gaps to guide future research in this field.
Introduction: The use of XR technology in knee arthroplasty is greatly diversified and extensive. Due to the high prevalence of knee osteoarthritis and the high frequency of knee arthroplasty performed annually, there is a need to determine the evidence regarding the literature surrounding the use of XR technology in knee arthroplasty with the aim of improving patient outcomes.
Inclusion Criteria: Articles were included in the scoping review if they included using XR/VR/AR and MR in knee arthroplasty. Studies before 2004 were excluded. Editorial articles, case reports, and studies that did not evaluate the knee joint were excluded.
Methods: A literature review was performed on 4 databases – PubMed, Cochrane Central Register for Controlled Trials, National University of Singapore (NUS) Libraries, and Google Scholar. This was conducted in December 2023 and updated in April 2024. Only articles that were reported in English were included. Relevant articles were categorized into themes (and subthemes) of clinical practice (rehabilitation, surgery, and anaesthesia), education (surgeon and nurses), and research (Artificial Intelligence (AI) and robotic-assisted surgery). Data from each article is summarised in a table with relevant information from each article.
Results: 236 papers were identified from the electronic databases, with 5 additional articles identified from a reference list of eventually included articles. 54 articles were identified to be included in the scoping review. Most of the articles were written about the use of VR (n=42). The remaining articles were written about AR (n=21), MR (n=5), and XR (n=2), with some articles written about more than 1 type of technology in the same article (n=9). The articles were categorised into themes of ‘clinical practice’ (n=45), ‘education’ (n=9) and ‘research’ (n=2) with two articles classified under more than 1 theme.
Conclusions: Currently, XR technology in knee arthroplasty serves multiple purposes, ranging from preoperative training for medical students, operating theatre staff, and surgical registrars to intraoperative surgical guidance systems and anaesthesia and post-operative rehabilitation. Articles under the subtheme of ‘rehabilitation’ demonstrated the most ambivalence in terms of the effect of XR technology post-knee arthroplasty, while most articles under the remaining subthemes of ‘surgery’, ‘anaesthesia’, education for ‘surgeons’, ‘nurses’ and future ‘research’ generally demonstrates practical usage of XR technology and paints a promising future for XR technology in knee arthroplasty. There is much room for future research in all subthemes identified.
