Patient Perceptions of Emerging Technologies in Shoulder Surgery

Introduction Intraoperative navigation (NAV), augmented reality (AR), and robotics have emerged as promising new technologies in shoulder arthroplasty. Previous research in these areas has focused on the use of these technologies by surgeons, but not on understanding patient knowledge and perceptions. This study aimed to characterize patients’ baseline understanding and perceptions of new technology in shoulder arthroplasty and see if educational content in this area enhances or changes their views of these technologies. Methods A 38-question survey was administered to adult patients to assess baseline knowledge and perception of NAV, AR, and robotic surgery technologies. Subjects were recruited from local public areas (e.g., golf clubs, and grocery stores) and orthopedic clinics across Palm Beach County to provide a broad array of demographics. Baseline assessments were performed, and then educational materials were provided about each of the technologies. After learning about the different technologies, the participants repeated the survey. Bivariate analysis of categorical variables was performed. Multivariable logistic regression model evaluated factors associated with a preference for the use of technology in shoulder procedures. Results Of the 77 responders, the majority were not familiar with NAV (57.1%) or AR (70.1%). Patients were somewhat familiar with robotics (51.9%). NAV and robotic surgery were perceived to lead to better results in 51.9% and 53.2% of responders, respectively. AR was perceived to have no specific benefit (51.9%) after shoulder surgery. After reading the provided educational materials, most patients expected faster recovery (57.1%) and fewer complications (53.2%) with NAV. In contrast, with AR and robotics, most patients (>50%) expected no specific benefits. Most respondents did not see these technologies would be helpful for pain relief. The primary reported concerns of respondents were lack of surgeon experience with the technology and increased cost. Overall, 50% of participants had a preference for surgeons who use these technologies, and most (68.8%) thought surgeons using these technologies are of similar skill compared to surgeons who do not utilize technology. Multivariate regression modeling revealed that respondents of Asian race were more likely to prefer surgeons who do not use technology (p= 0.042). Conclusion The public appears to be unaware of various forms of technology used today in shoulder surgery and there are misperceptions of superior outcomes with these technology-assisted surgeries. Brief descriptions of these technologies did appropriately enhance patients’ understanding and expectation for these technologies applied in shoulder surgery. More patient-directed education is needed if we are to incorporate these innovative technologies in surgery. Furthermore, this may prove to be a powerful marketing tool for surgeons and hospitals.