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The ability to intraoperatively assess bone quality is important for orthopedic surgeons because bone quality might be a decisive factor for treatment strategy.1 However, this ability is usually not systematically taught in the surgical curriculum. Orthopedic residents learn about the physical property of the bone early in their formation. They also learn about the radiological assessment of bone quality by computed tomography, measuring bone mineral density2 or by measuring the cortical thickness of the proximal humeral diaphysis in standard anterior-posterior X-rays or the deltoid tuberosity index.3,4 However, these preoperative radiological measurements are indirect assessments of bone quality that cannot dispense orthopedic surgeons from direct intraoperative assessment. The bone quality of humeral metaphysis is crucial for the use of new stemless shoulder arthroplasty systems because the humeral component could loosen early (primary nonbonding) if press-fit fixation in the cancellous bone is not reliable.5 The decision if the bone shows “adequate” quality for using a particular implant design relies on the intraoperative judgment of the surgeon and depends on his manual skill and experience. Tools for intraoperative assessment of bone quality have been developed6,7 but are complicated and not readily available in a routine clinical setting, whereas simple tactile (haptic) assessment by the surgeon can easily be performed. In surgical courses, young residents learn mainly operative techniques, especially the handling of surgical instruments and implants. Interestingly, however, assessment of bone quality by haptic perception is not systematically taught in the clinical training of orthopedics residents. It seems that surgeons individually develop a “feeling” about what is “adequate bone quality” by trial and error. However, we do not know if this feeling is the same for all orthopedic surgeons. We believe that even in highly specialized and more technological medicine simple manual testing and haptic assessment remains crucial and might get lost in the contemporary education of young surgeons. Following questions arise: Can haptic assessment of bone quality regarding load-bearing capacity be standardized and systematically be taught and trained? The purpose of this perspective, therefore, is to discuss the intraoperative haptic assessment of bone quality and to evaluate the precision of the assessment, its training and its learning process. This might open new questions and further directions in surgical education.

Haptic assessment of bone quality in orthopedic surgery: no consensus but perspective for high training potential