ABSTRACT
Objective Surgery simulators have gained popularity in medical education during recent decades especially following COVID-19 pandemics. This study was designed to find the most effective and applicable model for development of total knee arthroplasty surgery simulator.Method The protocol of this study is evaluated and confirmed by Tehran university of Medical Sciences research committee (No: 52841-101-1-1400) in March 2021. This is a qualitative study using focus group discussion (FGD) for data gathering. Three FGDs were performed through online platform. Eligible five orthopedics residents, four fellowship trainees, and seven university professors from 3 different university hospitals were interviewed.Results The main domains of discussion were the necessity of a TKA simulator, virtual vs. physical model, bone and soft tissue characteristics, and the feedback system. 12% of participants (2 senior residents) said a virtual model has more advantages than a physical one while the other two thought physical model is more applicable. 12% of them (One senior resident and a fellowship trainee) suggested a mixed model would be more useful. The essential parts of the TKA simulator were mainly addressed by fellowship trainees focusing on presence of foot, ankle and hip in the model and inclusion of vital soft tissue elements and ligaments and tendons (especially collateral ligaments). Gap balancing was noticed as a crucial part by 40% of participants (senior residents and fellowships). To improve the simulator, participants suggested that it should have a modular design with sensors to alarm any damage to vital elements and feedbacks given during the procedures.Conclusion Through this study, the participants highlighted the most important parts of hard and soft tissues in the model, as well as the fundamental points in designing the TKA simulator.
Subject(s)
COVID-19ABSTRACT
Purpose: COVID-19 pandemic makes outdoors rehabilitation a potential hazard. Patient education to perform simple home-based exercises seems to be an interesting and sometimes a mandatory option. This study provides a comparison between the conventional and home-based virtual rehabilitation after surgical repair of medial meniscus root tears. Methods: : All patients who underwent MPRT repair with a modified trans-tibial pull-out technique from March 2019 to March 2021 were evaluated. Those who underwent surgery after December 2019 were trained to perform self-rehabilitation. The rest had undergone outdoors specialized rehabilitation according to a unified protocol and these were used as a historical control group. All patients were followed up for a minimum of 2 year after surgery. Final Lysholm scores were utilized to compare functional outcomes. Results: : Forty-three consecutive patients with medial meniscal root tears were studied. Thirty-nine (90.7%) were women and 4 (9.3%) were men. The mean age of participants was 53.2 ±8.1 years. The total Lysholm knee score, and all its items were significantly improved in both groups at a two-year follow-up (p<0.05), except the “Using cane or crutches” item (p=0.065). Nevertheless, the final Lysholm knee score improvement was higher in patients who performed outdoors specialized rehabilitation and in patients with shorter time-to-surgery. Conclusion: Regardless of age and gender, home-based rehabilitation after meniscal root repair with the modified trans-tibial pull-out technique improved the patients’ function at a two-year follow-up. Nonetheless, this effect was still significantly lower than that of the outdoors specialized rehabilitation. Future work is required to clarify basic protocols for home-based tele-rehabilitation programs and determine clinical, radiological and functional results. Level of evidence: Level IV, therapeutic, historically controlled study