Hip Arthroscopy Simulator Training with Immersive Virtual Reality has Similar Effectiveness to Non-Immersive Virtual Reality

Purpose The purpose of this study was to (1) compare the efficacy of immersive virtual reality (iVR) to non-immersive virtual reality (non-iVR) training in hip arthroscopy on procedural and knowledge-based skills acquisition and (2) evaluate the relative cost of each platform. Methods Fourteen orthopaedic surgery residents were randomized to simulation training utilizing an iVR Hip Arthroscopy Simulator (n=7; PrecisionOS, Vancouver, Canada) or non-iVR simulator (n=7; ArthroS Hip VR; VirtaMed, Zurich, Switzerland). After training, performance was assessed on a cadaver by four expert hip arthroscopists through arthroscopic video review of a diagnostic hip arthroscopy. Performance was assessed using the Objective Structured Assessment of Technical Skills (OSATS) and Arthroscopic Surgery Skill Evaluation Tool (ASSET) scores. A cost analysis was performed using the transfer effectiveness ratio (TER) and a direct cost comparison of iVR to non-iVR. Results Demographic characteristics did not differ between treatment arms, by training level, hip arthroscopy experience, or prior simulator use. No significant differences were observed in OSATS and ASSET scores between iVR and non-iVR cohorts (OSATS: iVR 19.6±4.4, non-iVR 21.0±4.1, p=0.55; ASSET: iVR 23.7±4.5, non-iVR 25.8±4.8, p=0.43). The absolute TER was 0.06 and there was a 132-fold cost difference of iVR to non-iVR. Conclusions Hip arthroscopy simulator training with iVR had similar performance results to non-iVR for technical skill and procedural knowledge acquisition after expert arthroscopic video assessment. The iVR platform had similar effectiveness in transfer-of-skill compared to non-iVR with a 132-times cost differential.