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Utility of extended reality in shoulder arthroplasty: a meta-analysis of training efficiency and glenoid guidewire
Max L Ruiz1, Geoffrey D Abrams1, Michael T Freehill1
1Department of Orthopaedic Surgery Stanford Hospitals and Clinics, Stanford, CA, USA.
Background:
Extended reality (XR) has seen increased usage in shoulder arthroplasty for both intraoperative guidance and surgical training, but its impact on technical accuracy and performance has not been quantified across studies. The objective of this analysis was to determine the impact of XR on educational efficiency and glenoid guidewire placement error. Two separate meta-analyses of randomized or quasi-experimental studies were performed.
Methods:
Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses search guidelines, 24 studies were identified in XR-based shoulder surgery education. After applying inclusion, 3 studies involving 55 participants were meta-analyzed. Using the same Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 35 studies were identified in XR-guided shoulder arthroplasty. After applying inclusion criteria, 7 studies involving 349 guidewire placements were meta-analyzed.
Results:
In the surgical education studies, XR-trained participants completed procedures faster than controls, but OSAT (Objective Structured Assessment of Technical Skills) scores did not significantly differ. Across the glenoid guidewire studies, XR guidance reduced version error and inclination error versus freehand, but entry point error was not significantly different between XR-guided procedures and freehand.
Conclusion:
XR-based tools appear to offer meaningful benefits for shoulder arthroplasty, but their impact may be domain-specific. XR education may substantially improve operative efficiency, while XR guidance may enhance the angular accuracy of glenoid guidewire placement without clearly changing entry point error.
