In the future, surgeons in training can virtually practice one of the most...
In the future, surgeons in training can virtually practice one of the most complicated steps in hip replacement surgery.
Source: Project "HIPS"

VR and lightweight robot simulate hip replacement

In Germany, more than 200,000 patients undergo hip replacement surgery each year. In order to avoid complications and to extend the life span of the artificial joint the implants have to fitted precisely in the hip socket, the acetabulum. The procedure, particularly milling the acetabulum, is not only difficult, it is also difficult to teach and train. This is where HIPS comes in, the “HüftImplantatPfannenfräsSimulator”, developed by a research consortium. “HIPS is the worldwide first Virtual Reality training simulator for hip replacement surgery that provides haptic feedback and can simulate interventions that require high and stable forces,” explains Mario Lorenz of the Technical University of Chemnitz, who initiated the cooperation project.

Prime goal of the researchers was to improve specialist physician training, as Lorenz underlines: “Today, specialist physicians in training practice on phantoms, i.e. artificial bones. Material behaviour, however, does not mirror real material behaviour closely enough, which in fact also holds true for donor bone material – a rare and extremely valuable resource in medical training and research.”

Specialist physicians in training have to assist in a number of surgeries before they are asked to perform the milling step themselves. “Wouldn’t it be much better if the physicians in training had performed several simulations that are as close as possible to the real thing before that crucial moment arrives? Wouldn’t it be better to give them an opportunity to develop the necessary feel for the procedure, build self-confidence and allow them to make errors from which they can learn?“, Lorenz asks. In minimally invasive surgery such as keyhole interventions, VR training has been around for about 20 years, Lorenz points out and adds that “For procedures that require high forces such simulation products are not available, neither commercially nor for research purposes.”

The HIPS users see the virtual patient’s hips through VR glasses while they operate a surgical milling instrument which in turn is connected to a lightweight robot, the BR iiwa. The user has to mill the hip joint’s acetabulum – something that is difficult to teach, train and learn. The robot delivers direct haptic feedback by simulating the resistance of a real bone. Thus the user acquires a better feel for the forces at work and the area that can be worked.

Research

The simulation is based on real data. In order to compute the forces and torques when milling the hip the researchers conducted biomechanical tests with anatomical specimens. “We found out that we are dealing with up to 200 Newton. The force is needed when the surgeon applies pressure on the acetabulum. The forces applied on the surgeon’s wrists when the machine stops is between 20 and 50 Newton depending on the size of the wrist,” Lorenz reports.

With these measurement data researchers at the University of Bremen, Germany, designed a material model which allows the surgeon to compute within a millisecond where the surgical milling instrument meets the acetabulum and which forces are present.

In a next step a software module was developed which features a user interface integrated by FAKT Software GmbH. The result is an interactive application based on an anatomical model by CAT Production GmbH which had created the anatomical 3D models and the virtual OR.

The team at the Technical University Chemnitz developed the interface with the robot arm to “tell” the robot the force it has to simulate. “Originally, the robot was certified for collaborative human-machine tasks on the shop floor. We managed to use the existing interface to provide the user with haptic feedback while maintaining the certification,” Lorenz explains.

Virtually practising hip surgery with the...
Virtually practising hip surgery with the “HüftImplantatPfannenfräsSimulator” (HIPS).
Source: TU Chemnitz/Rene Apitzsch

The Project

The three-year HIPS project received €670,000 from the German Federal Ministry of Economics and Energy (BMWi). The project consortium consisted of the Chair of Machine Tools at the Technical University Chemnitz, the Institute of Computer Graphics and Virtual Reality at the University of Bremen, Leipzig-based FAKT Software GmbH in Leipzig and CAT Production GmbH in Munich.

The medical development partner was the Clinic for Orthopaedics, Trauma und Plastic Surgery at University Hospital Leipzig, ZESBO (Centre for Research on the Musculoskeletal System), the research team Clinical Anatomy at the University of Otago, New Zealand, and the Department of Medical Technology at Fraunhofer Institute for Machine Tools and Forming Technology.

Virtual milling on the surgical training simulator.
Virtual milling on the surgical training simulator.
Source: Screenshot “Video report of project meeting”

Profile:
In 2011, after having completed his informatics program at Westsächsische Hochschule Zwickau, Germany, in the previous year, Mario Lorenz was appointed assistant at the Chair of Machine Tools at the Technical University Chemnitz in the field of VR and Augmented Reality (AR). Since 2016, he has also been guest scientist at the Clinic for Orthopaedics, Trauma und Plastic Surgery at University Hospital Leipzig. His research focuses on the use of VR and AR technologies in production and medical training.


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