What is Virtual Reality-Assisted Shoulder Replacement?
Virtual reality-assisted shoulder replacement is an innovative virtual reality (VR)-based navigation system that uses a combination of equipment including a 3-dimensional (3D) rendering capable computer, head-mounted display (HMD), and controllers with position trackers to perform shoulder replacement surgery.
The shoulder is a highly movable body joint that allows various movements of the arm. It is a ball-and-socket joint, where the head of the humerus (upper arm bone) articulates with the socket of the scapula (shoulder blade) called the glenoid. The two articulating surfaces of the bones are covered with cartilage, which prevents friction between the moving bones. The cartilage is lubricated by synovial fluid. Tendons and ligaments around the shoulder joint provide strength and stability to the joint. When the cartilage is damaged, the two bones rub against each other resulting in pain, swelling, and stiffness of the joint (osteoarthritis). Shoulder replacement surgery is performed to relieve these symptoms. In this surgery, the damaged articulating parts of the shoulder joint are removed and replaced with artificial prostheses.
Surgeons use virtual reality for areas of preoperative planning, intraoperative adjuncts, as well as surgical simulation for education purposes. Computer-assisted navigation provides surgeons with clinical information generated from the patient’s preoperative CT scans, but the information is displayed on monitors placed outside of the operative field. With VR, surgeons have access to the same information in their VR headset without needing to avert their eyes from the patient. The technology helps your surgeon to make more precise and accurate bony cuts intraoperatively for improved implant placement and joint alignment. It also enables your surgeon to reduce outliers and perform more efficient and precise shoulder replacement surgery.
Indications for Virtual Reality-Assisted Shoulder Replacement
Virtual reality-assisted shoulder replacement surgery is indicated for conditions such as osteoarthritis or rheumatoid arthritis of the shoulder joint when medication, injections, physical therapy, and activity changes have not helped to relieve the pain. Your doctor recommends surgery when you have the following symptoms:
- Severe shoulder pain that restricts daily activities
- Moderate-to-severe pain during rest
- Weakness and/or loss of motion
Preparation for Virtual Reality-Assisted Shoulder Replacement
The preoperative preparation is similar to most shoulder replacement procedures. But contrary to traditional techniques, virtual reality-assisted shoulder replacement involves careful planning and utilizes a series of CT scans to generate 3D images of an individual’s unique shoulder joint anatomy. These images enable the surgeon to design a personalized plan tailored to an individual and help to determine the precise implant size, level of the bone cut, and other requirements prior to performing the surgery.
In addition, preparation for the virtual reality-assisted shoulder replacement may involve the following steps:
- A review of your medical history and a physical examination by your doctor to check for any medical issues that need to be addressed prior to surgery.
- Diagnostic tests such as blood work and imaging to help detect any abnormalities that could compromise the safety of the procedure.
- You will be asked if you have allergies to medications, anesthesia, or latex.
- You should inform your doctor of any medications or supplements that you are taking or any conditions you have such as heart or lung disease.
- You may be asked to avoid medications such as blood thinners or anti-inflammatories for a specific period prior to surgery.
- You should refrain from alcohol or tobacco at least a few days prior to the surgery and several days after as they can hinder the healing process.
- You should not consume solids or liquids at least 8 hours prior to surgery.
- You should arrange for someone to drive you home after surgery.
- A signed informed consent form will be obtained from you after the pros and cons of the surgery have been explained.
Procedure for Virtual Reality-Assisted Shoulder Replacement
Virtual reality-assisted shoulder replacement is usually performed under general anesthesia. A surgical cut is made over the shoulder to expose the shoulder joint, and the upper arm bone is dislocated from the shoulder socket. The surface of the socket is cleaned and the damaged or arthritic bone is removed using a reamer. Virtual reality navigation provides your surgeon with real-time 3-D images of your mapped shoulder and the surgical instruments during surgery. The data for the images is provided by the tracking device fixed to the bones of the joint and the surgical instruments. When the VR lenses pair with the tracker, the patient’s anatomical information is projected inside the body. The surgeon analyzes the patient's unique shoulder anatomy to precisely resurface and cut the bones of the shoulder joint and fix the implant accurately according to the pre-operative surgical plan. Once the surgery is completed, the incision is closed with sutures and covered with a sterile dressing.
Postoperative Care and Instructions
In general, postoperative care instructions and recovery after virtual reality-assisted shoulder replacement will involve the following steps:
- You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs as you recover.
- You may need to stay in the hospital for at least 2 to 3 days before discharge to home.
- You are likely to experience pain, swelling, and discomfort in the shoulder area. Pain and anti-inflammatory medications are provided as needed to address these.
- Your arm will be secured with an immobilizer or assistive device such as a sling for the first few weeks to facilitate healing and protect the repair.
- Instructions on surgical site care and bathing will be provided to keep the surgical site clean and dry.
- Refrain from overhead activities and lifting heavy weights for the first couple of months. A gradual increase in activities over a period of time is recommended.
- You will need to take off work for at least a week to rest and promote healing.
- You will not be able to drive until you are fully fit and able to hold the steering wheel comfortably in both arms.
- An individualized physical therapy protocol will be designed to help strengthen shoulder muscles and optimize shoulder function.
- Most patients are able to resume their normal activities in a month or two after surgery; however, returning to sports may take at least 6 months or longer.
- Refrain from driving until you are fully fit and receive your doctor’s consent.
- A periodic follow-up appointment will be scheduled to monitor your progress.
Risks and Complications
Virtual reality-assisted shoulder replacement is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as:
- Infection
- Blood clots
- Injury to nerves and vessels
- Bleeding
- Instability
- Stiffness
- Swelling and pain
- Anesthetic/allergic reaction
