Developing a Total Knee Arthroplasty Simulator: A Qualitative Study to Find the Best Model Publisher



Attar MKA ; Maghbouli N ; Same K ; Vosoughi F ; Nikkhah A ; Ghaffari A ; Foroughi N ; Ershadi FS ; Nabian MH ; Zanjani LO
Source: Journal of Iranian Medical Council Published:2026

Abstract

Background: Concerns about patient safety, resident work hour restrictions, and recent technology improvements have increased interest in surgical simulations. This study was designed to find the most effective and applicable model for total knee arthroplasty simulator. Methods: This is a qualitative study using Focus Group Discussion (FGD) to collect data and grounded theory for analysis. A topic guide including main questions in a structured approach was used by the moderators. Three FGD sessions were held using video chat. Session’s content was recorded and extracted data was analyzed by inductive content analysis method. Results: Eligible 5 orthopedic residents, 4 orthopedic fellowships, and 7 academic professors from referral tertiary center hospital were interviewed. The main domains of discussion were about the necessity of a Total Knee Arthroplasty (TKA) simulator, virtual vs. physical model, bone and soft tissue characteristics, and the feedback system. Twelve percent of the participants believed a virtual model has more advantages while the others thought physical model is more applicable and 12% of them suggested a mixed model. Gap balancing was noticed as a crucial part by 40% of the participants to be included in the model. Conclusion: All the participants deemed the existence of a simulator for TKA necessary. The essential parts of the TKA simulator like foot, ankle, hip, soft tissue elements, ligaments and tendons (especially collateral ligaments) were emphasized. To improve the simulator, the participants suggested that it should have a modular design and also sensors to alarm any damage to the vital elements. Also, they pointed out having feedback option for development of TKA simulator. © 2026, Islamic Republic of Iran Medical Council. All rights reserved.