Kayaalp Mahmut Enes, Konstantinou Efstathios, Karaismailoglu Bedri, Lucidi Gian Andrea, Kaymakoglu Mehmet, Vieider Romed, Giusto Joseph D, Inoue Jumpei, Hirschmann Michael T
Department of Orthopaedics and Traumatology, Istanbul Fatih Sultan Mehmet Training and Research Hospital, University of Health Sciences, Istanbul, Türkiye.
Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Germany.
Knee Surg Sports Traumatol Arthrosc. 2025 Jul 7. doi: 10.1002/ksa.12723.
PURPOSE: The metaverse and extended reality (XR), which includes augmented reality (AR), virtual reality (VR) and mixed reality (MR), are transforming orthopaedic surgery by enhancing training, procedural accuracy and rehabilitation. However, a literature review of these new virtual tools is lacking. The purpose of this narrative review is to summarise available evidence about the metaverse and discuss current and future clinical applications. METHODS: A narrative review of the current literature was performed for studies evaluating XR tools and their respective clinical and educational utility. Studies from all orthopaedic subspecialties were eligible for inclusion. The XR tools evaluated in each study were categorised according to the reality spectrum and future research or clinical applications were discussed. RESULTS: XR is a technological spectrum that includes AR, VR and MR to create immersive and interactive surgical training environments. VR-based simulators may improve surgical education by allowing trainees to refine their skills in a risk-free setting. AR may enhance intraoperative guidance and has been studied within orthopaedics to improve implant positioning accuracy and reduce complications in procedures including arthroscopy and total joint arthroplasty. In rehabilitation, AR and VR have been implemented to facilitate patient engagement and adherence, promoting functional recovery through gamified therapy and remote telerehabilitation. CONCLUSIONS: There has been a paradigm shift in orthopaedic care in which digital tools are integrated with patient care to optimise patient outcomes. However, challenges to the widespread implementation of promising XR technology include high costs, steep learning curves and limited clinical validation. Ethical concerns, including data security and patient privacy, further complicate its use in clinical settings. Future research must focus on cost-effectiveness, standardisation and improving accessibility to ensure seamless integration into clinical practice. LEVEL OF EVIDENCE: Level V.
目的：元宇宙和扩展现实（XR），包括增强现实（AR）、虚拟现实（VR）和混合现实（MR），正在通过加强培训、手术准确性和康复来改变骨科手术。然而，目前缺乏对这些新型虚拟工具的文献综述。本叙述性综述的目的是总结关于元宇宙的现有证据，并讨论其当前和未来的临床应用。 方法：对当前文献进行叙述性综述，以评估XR工具及其各自的临床和教育效用的研究。所有骨科亚专业的研究均符合纳入标准。根据现实频谱对每项研究中评估的XR工具进行分类，并讨论未来的研究或临床应用。 结果：XR是一个技术频谱，包括AR、VR和MR，以创建沉浸式和交互式手术培训环境。基于VR的模拟器可以通过让受训者在无风险的环境中磨练技能来改善手术教育。AR可以增强术中指导，并且在骨科领域已经进行了相关研究，以提高植入物定位的准确性，并减少包括关节镜检查和全关节置换术在内的手术中的并发症。在康复方面，AR和VR已被用于促进患者参与和依从性，通过游戏化治疗和远程远程康复促进功能恢复。 结论：骨科护理发生了范式转变，数字工具与患者护理相结合以优化患者预后。然而，有前景的XR技术广泛应用面临的挑战包括成本高、学习曲线陡峭和临床验证有限。包括数据安全和患者隐私在内的伦理问题，使其在临床环境中的使用更加复杂。未来的研究必须专注于成本效益、标准化和提高可及性，以确保无缝融入临床实践。 证据级别：V级。
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