Abstract

Background: Accurate acetabular component positioning is critical to the success of total hip arthroplasty (THA). Mixed reality (MR)-based simulation offers a novel approach to surgical training by providing real-time feedback within immersive learning environments. This study evaluated the impact of an MR-based simulation on technical performance, as well as its usability and user experience. Methods: A prospective pre–post pilot educational study was conducted in a controlled simulation laboratory using a physical anatomical model. Forty-six final-year medical students with no prior experience in MR technology participated. Participants performed acetabular component positioning tasks before and after MR-assisted training. Technical accuracy was assessed by measuring deviations in inclination and anteversion. Usability, workload, presence, and cybersickness were evaluated using validated questionnaires. Results: MR-assisted training significantly improved technical accuracy. Median absolute deviation in inclination decreased from 1.0° (interquartile range [IQR], 1.0–3.5) to 0.5° (IQR, 0.0–2.0) (p = 0.0008, r = 0.56), while anteversion deviation decreased from 4.5° (IQR, 2.0–7.0) to 2.0° (IQR, 1.0–4.0) (p < 0.0001, r = 0.66). User experience scores ranked the application among top-performing systems in benchmark comparisons. Participants reported high levels of presence and usability, low workload (all NASA-TLX domains <36/100), and minimal cybersickness (mean Simulator Sickness Questionnaire score = 0.26). Conclusions: MR-assisted simulation significantly improved short-term technical performance in novice trainees and was associated with high user acceptance and minimal adverse effects. These findings support the use of MR as a promising adjunct in early surgical training, enabling integration of cognitive and psychomotor skills through real-time feedback. Further studies are warranted to evaluate skill retention and transfer to clinical practice.

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