Abstract
Precise simulators can replicate complete understanding of the models. In this survey, we focus on orthopedic simulators that are not only in replicating real-world models but also in educating with complete procedure: surgical, for instance. It covers 18 hip replacement, three-knee replacement, three facial surgeries, one spine surgery and six orthopedic psycho-motor skills training and assessment-based simulators. We also provide comparative studies and highlight current trends and possible challenges. We observed that orthopedic training methodologies have undergone a paradigm shift. This means that the simulators replace the use of sensitive hospital settings for training and skill acquisition. In brief, we address classified overview on existing orthopedic simulators: physical and Virtual Reality (VR)-based simulators. Key steps to develop computer-assisted, VR-based simulator are explored. Experts’ opinion on the use of simulation technologies in the field of orthopedics is discussed.
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Notes
EdHeads Hip Resurfacing Online Game (2007), available at: https://edheads.site-ym.com/page/hip_resurfacing
About the BoneDoc Simulator. http://bonedoc.org/about.html
ATI Multi-Axis Force/Torque Sensors. http://www.ati-ia.com/products/ft/sensors.aspx
Sawbone. Orthopedic models. https://www.sawbones.com/products/orthopaedic-models.html
Construct validity: the degree to which the simulator can assess the technical skills of the trainees.
Face validity: degree to which a simulator appears similar to the real procedure.
Transfer validity: extent to which the simulator learned skills are transferred into improved skill in-vivo.
Sewmac ArthoVisionⓇ. http://www.swemac.com/simulators/arthrovision
Sewmac TraumaVisionⓇ. http://www.swemac.com/simulators/traumavision
OSSimTech Sim-orthoTM. https://ossimtech.com/en-us/Simulators
VirtaMed ArtroSTM. https://www.virtamed.com/en/medical-training-simulators/arthros/
Blender3D. https://www.blender.org/
3D slicer. https://www.slicer.org/
3D doctor. http://www.ablesw.com/3d-doctor/
3D systems. Geomagic Touch. https://www.3dsystems.com/haptics-devices/touch
3D systems. Geomagic Touch X. https://www.3dsystems.com/haptics-devices/geomagic-touch-x
Force Dimension. Omega 3. http://www.forcedimension.com/products/omega-3/specifications
Force Dimension. Omega 6. http://www.forcedimension.com/products/omega-6/specifications
Ascension, 3D Guidance trackSTAR and drivebay 6DoF. https://www.ascension-tech.com/products/trakstar-drivebay/
Polhemus FASTRAK. https://polhemus.com/motion-tracking/all-trackers/fastrak
Polhemus G4. https://polhemus.com/motion-tracking/all-trackers/g4
Northern Digital Inc., Polaris optical tracking system. https://www.ndigital.com/medical/products/polaris-family/
References
Torkington, J., Smith, S. G., Rees, B. I., and Darzi, A., The role of simulation in surgical training. Ann. R. Coll. Surg. Engl. 82(2):88–94, 2000.
Akhtar, K. S. N., Chen, A., Standfield, N. J., and Gupte, C. M., The role of simulation in developing surgical skills. Curr. Rev. Muscoskelet. Med. 7(2):155–160, 2014.
Ziv, A., Small, S.D., and Wolpe, P.R., Patient safety and simulation-based medical education. Med. Teach. 22(5):489–495, 2000.
Mabrey, Jay D., Reinig, Karl D., and Dilworth Cannon, W., Virtual reality in orthopaedics: is it a reality. Clin. Orthop. Relat. Res. 468(10):2586–2591, 2010.
Mohan, A., and Proctor, M., Virtual reality – a ’play station’ of the future A review of virtual reality and orthopaedics. Acta Orthop. Belg. 72(6):659–663, 2006.
Gaba, D.M., The future vision of simulation in health care. Qual. Saf. Health Care 13(suppl 1):i2–i10, 2004.
Windsor, J.A., Role of simulation in surgical education and training. ANZ J. Surg. 79(3):127–132, 2009.
Riaz, A. A., and Alexander, J. F., The role and validity of surgical simulation. Int. Surg. 100(2):155–160, 2015.
Vaughan, N., Dubey, V.N., Wainwright, T.W., and Middleton, R.G.: Does virtual-reality training on orthopaedic simulators improve performance in the operating room? In: Science and information conference (SAI), pages 51–54. IEEE, 2015
G Lopez, R., Wright, D., Martin, J., Bracey, J.D., and Gupta, R., A cost-effective junior resident training and assessment simulator for orthopaedic surgical skills via fundamentals of orthopaedic surgery: AAOS exhibit selection. J. Bone Joint Surg. Am. 97(8):659–666, 2015.
Stirling, E.R.B., Lewis, T.L., and Ferran, N.A., Surgical skills simulation in trauma and orthopaedic training. J. Orthop. Surg. Res. 9(1):126–135, 2014.
Johns, B.D., The creation and validation of an augmented reality orthopaedic drilling simulator for surgical training. PhD thesis: University of Iowa, 2008.
Issenberg, B.S., McGaghie, W.C., Hart, I.R., Mayer, J.W., Felner, J.M., Petrusa, E.R., Waugh, R.A., Brown, D.D., Safford, R.R., and Gessner, I.H., Simulation technology for health care professional skills training and assessment. Jama 282(9):861–866, 1999.
Vankipuram, M., Kahol, K., McLaren, A., and Panchanathan, S., A virtual reality simulator for orthopedic basic skills: A design and validation study. J. Biomed. Inform. 43(5):661–668, 2010.
Madan, S.S., and Pai, D.R., Role of simulation in arthroscopy training. Simul. Healthc. 9(2):127–135, 2014.
Pedowitz, R.A., Esch, J., and Snyder, S., Evaluation of a virtual reality simulator for arthroscopy skills development. Arthroscopy: The J. Arthroscopic and Related Surgery 18(6):1–6, 2002.
Thomas, G.W., Anderson, D.D., Karam, M.D., Johns, B., Murillo, M.J., and ans Lawrence, S.R.: A flexible orthopaedic trauma surgery box skills trainer. Abstract and poster presented at the 37th Annual Meeting of the American Society of Biomechanics, Omaha, NE, 3, 2013
Chou, Y.-J., Sun, S.-P., and Liu, H.-H., Calcaneal osteotomy preoperative planning system with 3d full-sized computer-assisted technology. J. Med. Syst. 35(5):755–763, 2011.
Wagner, A., Ploder, O., Enislidis, G., Truppe, M., and Ewers, R., Image-guided surgery. Int. J. Oral Maxillofac. Surg. 25(2):147–151, 1996.
Comaneanu, R.M., Tarcolea, M., Vlasceanu, D., and Cotrut, M.C., Virtual 3d reconstruction, diagnosis and surgical planning with mimics software. Int. J. Nano Biomater. 4(1):69–77, 2012.
Kyselova, O., Marchenko, A., Nastenko, I., Rudenko, K., and Mamalyha, A.: The use of three – dimensional modeling system mimics in studying process of medical-engineering specialty. In: Proceedings of International Conference ”Biomedical Engineering, pages 224–227. Biomedical Engineering Institute of Kaunas University of Technology, Kaunas, 2010.
Materialise: Mimics student edition course work. Minics, 2015
O’Toole, R.V., Jaramaz, B., DiGioia, A.M., Visnic, C.D., and Reid, R.H., Biomechanics for preoperative planning and surgical simulations in orthopaedics. Comput. Biol. Med. 25(2):183188–186191, 1995.
Seel, M.J., Hafez, M.A., Eckman, K., Jaramaz, B., Davidson, D., and DiGioia III, A.M., Three – dimensional planning and virtual radiographs in revision total hip arthroplasty for instability. Clin. Orthop. Relat. Res. 442:35–38, 2006.
Jun, Y., and Park, S., Polygon-based 3 D surgical planning system for hip operation. Int. J. Precis. Eng. Manuf. 12(1):157–160, 2011.
Dick, C., Georgii, J., Burgkart, R., and Westermann, R.: A 3 D simulation system for hip joint replacement planning. In: World congress on medical physics and biomedical engineering, September 7-12, 2009, pp. 363–366. Springer, Munich, 2010.
Koch, R.M., Roth, M.S.H., Gross, M.H., Zimmermann, A.P., and Sailer, H.F.: A framework for facial surgery simulation. In: Proceedings of the 18th spring conference on Computer graphics, pp. 33–42 ACM, 2002
Schmidt, J., Berti, G., Fingberg, J., Cao, J., and Wollny, G.: A finite element based tool chain for the planning and simulation of maxillo-facial surgery. Sciences New York, 1–17, 2004
Digioia, A.M., Jaramaz, B., Nikou, C., Labarca, R.S., Moody, J.E., and Colgan, B.D., Surgical navigation for total hip replacement with the use of Hipnav. Oper. Tech. Orthop. 10(1):3–8, 2000.
O’Toole, R. V., Colgan, B., and Kischel12, E.: Hipnav: pre-operative planning and intra-operative navigational guidance for acetabular implant placement in total hip replacement surgery. In: Proceedings of the Computer Assisted Orthopaedic Surgery Symposium, Bern, Switzerland, pp. 3–8, 1996
DiGioia, A.M., Jaramaz, B., Blackwell, M., Simon, D.A., Morgan, F., Moody, J.E., Nikou, C., Colgan, B.D., Aston, C.A., and LaBarca, R.S.: An image guided navigation system for accurate alignment in total hip replacement surgery. The Robotics Institute Carnegie Mellon University, 1998
Sabri, H., Cowan, B., Kapralos, B., Porte, M., Backstein, D., and Dubrowskie, A., Serious games for knee replacement surgery procedure education and training. Procedia. Soc. Behav. Sci. 2(2):3483–3488, 2010.
Cowan, B.B.D., Total knee replacement serious game for surgical education and training. PhD thesis: University of Ontario Institute of Technology (Canada, 2012.
Półjanowicz, W., Roszak, M., Kowalewski, W., and Kołodziejczak, B., Using a virtual learning environment as a key to the development of innovative medical education. Studies in Logic, Grammar and Rhetoric 39(1):123–142, 2014.
Blyth, P., Stott, N. S., and Anderson, I. A., A simulation-based training system for hip fracture fixation for use within the hospital environment. Injury 38(10):1197–1203, 2007.
Tsai, M.-D., Hsieh, M.-S., and Jou, S.-B., Virtual reality orthopedic surgery simulator. Comput. Biol. Med. 31(5):333–351, 2001.
Delp, S.L., Loan, P.J., Hoy, M.G., Zajac, F.E., Topp, E.L., and Rosen, J.M., An interactive graphics-based model of the lower extremity to study orthopaedic surgical procedures. IEEE Trans. Biomed. Eng. 37(8):757–767, 1990.
Blyth, Dr P.: Virtual reality simulation of hip surgery. PhD thesis, Bioengineering Institute University of Auckland, 2008
Blyth, P., Stott, N. S., and Anderson, I. A., Virtual reality assessment of technical skill using the Bonedoc DHS simulator. Injury 39(10):1127–1133, 2008.
Blyth, P., and Sehgal, P.: Use of the Bonedoc DHS simulator by fifth year medical students: A pilot study. In: Proceedings of ASCILITE-Australian society for computers in learning in tertiary education annual conference, 74–80, 2009
Pransky, J., ROBODOC - surgical robot success story. Industrial Robot: An International Journal 24(3): 231–233, 1997.
Assassi, L., Charbonnier, C., Schmid, J., Volino, P., and Magnenat-Thalmann, N., From MRI to anatomical simulation of the hip joint. Comput. Anim. Virtual Worlds 20(1):53–66, 2009.
Dev, P., Fellingham, L.L., Vassiliadis, A., Woolson, S.T., White, D.N., and Young, S.L.: 3D graphics for interactive surgical simulation and implant design. In: 28th annual technical symposium, pp. 52–57. International Society for Optics and Photonics, 1984
Seth, T., Chaudhary, V., Buyea, C., and Bone, L.: A virtual interactive navigation system for orthopaedic surgical interventions. In: Proceedings of the 4th International Symposium on Applied Sciences in Biomedical and Communication Technologies, pp. 71. ACM, 2011
Cecil, J., Ramanathan, P., Rahneshin, V., Prakash, A., and Pirela-Cruz, M.: Collaborative virtual environments for orthopedic surgery. In: 2013 IEEE international conference on automation science and engineering CASE, pp. 133–137. IEEE, 2013
Fuerst, D., Hollensteiner, M., and Schrempf, A.: Assessment parameters for a novel simulator in minimally invasive spine surgery. In: 2015 37th annual international conference of the IEEE engineering in medicine and biology society (EMBC), pp. 5110–5113. IEEE, 2015
Vankipuram, M., Haptic rendering of volumetric data through perceptual parameterization. PhD thesis: Arizona state university, 2008.
Tsai, M.D., Hsieh, M.S., and Tsai, C.H., Bone drilling haptic interaction for orthopedic surgical simulator. Comput. Biol. Med. 37(12):1709–1718, 2007.
Hsish, M.S., Tsai, M.D., and Yeh, Y.D., An amputation simulator with bone sawing haptic interaction. Biomed Eng Appl Basis Commun 18(05):229–236, 2006.
Wang, Q., Qin, J., Wang, W., Shan, J., Zhang, J., Liu, X., and Heng, P.-A.: Haptic rendering of drilling process in orthopedic surgical simulation based on the volumetric object. In: 2015 IEEE international conference on digital signal processing (DSP), pp. 1098–1101. IEEE, 2015
Aziz, M.H., and Ayub, M.A., Measurement of forces and torques during non homogeneous material drilling operation. Int. J. Adv. Sci. Eng. Inf. Technol. 1(1):92–97, 2011.
Boiadjiev, G., Kastelov, R., Boiadjiev, T., Delchev, K., and Zagurski, K., Automatic bone drilling-more precise, reliable and safe manipulation in the orthopaedic surgery. J. Theor. Appl. Mech. 46(2):51–64, 2016.
Pinto, M.L., Sabater, J.M., Sofrony, J., Badesa, F.J., Rodriguez, J., and Garcia, N.: Haptic simulator for training of total knee replacement. In: 2010 3rd IEEE RAS and EMBS International Conference on Biomedical Robotics and Biomechatronics (BioRob), pp. 221–226. IEEE, 2010
Lin, Y., Wang, X., Fule, W.U., Chen, X., Wang, C., and Shen, G., Development and validation of a surgical training simulator with haptic feedback for learning bone-sawing skill. J. Biomed. Inform. 48:122–129, 2014.
Rambani, R., Ward, J., and Viant, W., Desktop-based computer-assisted orthopedic training system for spinal surgery. J. Surg. Educ. 71(6):805–809, 2014.
Rambani, R., Viant, W., Ward, J., and Mohsen, A., Computer-assisted orthopedic training system for fracture fixation. J. Surg. Educ. 70(3):304–308, 2013.
Barrow, A., Akhtar, K., Gupte, C., and Bello, F., Requirements analysis of a 5 degree of freedom haptic simulator for orthopedic trauma surgery. Stud. Health Technol. Inform. 184:43–47, 2013.
Morris, D., Sewell, C., Barbagli, F., Salisbury, K., Blevins, N.H., and Girod, S.: Visuohaptic simulation of bone surgery for training and evaluation. IEEE Computer Graphics and Applications, 26(6), 2006
Goswami, B., and Misra, S.K.R., 3D modeling of X-ray images: A review. Int. J. Comput. Appl. 132(7): 40–46, 2015.
Elvins, T.T., A survey of algorithms for volume visualization. ACM Siggraph Comput. Graph. 26(3):194–201, 1992.
Qi, Z., Eagleson, R., and Peters, T.M., Volume visualization: a technical overview with a focus on medical applications. J. Digit. Imaging 24(4):640–664, 2011.
Lorensen, W.E., and Cline, H.E.: Marching cubes: A high resolution 3d surface construction algorithm. In: ACM siggraph computer graphics, volume 21, pages 163–169. ACM, 1987
Salisbury, K., Conti, F., and Barbagli, F., Haptic rendering: introductory concepts. IEEE Comput. Graph. Appl. 24(2):24–32, 2004.
Kockara, S., Halic, T., Iqbal, K., Bayrak, C., and Rowe, R.: Collision detection: A survey. In IEEE international conference on systems, man and cybernetics, 2007. ISIC., pp. 4046–4051. IEEE, 2007
Markelj, P., Tomaževič, D., Likar, B., and Pernuš, F., A review of 3D/2D registration methods for image-guided interventions. Med. Image Anal. 16(3):642–661, 2012.
Hill, D.L.G., Batchelor, P.G., Holden, M., and Hawkes, D.J., Medical image registration. Phys. Med. Biol. 46(3):R1, 2001.
Escobar-Castillejos, D., Noguez, J., Neri, L., Magana, A., and Benes, B.: A review of simulators with haptic devices for medical training. Journal of medical systems, 40(4), 2016
Issenberg, S.B.: The scope of simulation-based healthcare education, 2006
Pedowitz, R.A., and Marsh, L.J., Motor skills training in orthopaedic surgery: A paradigm shift toward a simulation-based educational curriculum. J. Am. Acad. Orthop. Surg. 20(7):407–409, 2012.
Hohn, E.A., Brooks, A.G., Leasure, J., Camisa, W., van Warmerdam, J., Kondrashov, D., Montgomery, W., and McGann, W., Development of a surgical skills curriculum for the training and assessment of manual skills in orthopedic surgical residents. J. Surg. Educ. 72(1):47–52, 2015.
Blyth, P., Anderson, I.A., and Stott, S.N., Virtual reality simulators in orthopedic surgery: What do the surgeons think? J. Surg. Res. 131(1):133–139, 2006.
Vaughan, N., Dubey, V.N., Wainwright, T.W., and Middleton, R.G.: Can virtual-reality simulators assess experience and skill level of orthopaedic surgeons?. In: Science and Information Conference (SAI), 2015, pp. 105–108. IEEE, 2015
Kho, J.Y., Johns, B.D., Thomas, G.W., Karam, M.D., Marsh, L.J., and Anderson, D.D., A hybrid reality radiation-free simulator for teaching wire navigation skills. J. Orthop. Trauma 29(10):e385, 2015.
Waterman, B.R., Martin, K.D., Cameron, K.L., Owens, B.D., and Belmont, J.P., Simulation training improves surgical proficiency and safety during diagnostic shoulder arthroscopy performed by residents. Orthopedics 39(3):e479–e485, 2016.
Eversbusch, A., and Grantcharov, T.P., Learning curves and impact of psychomotor training on performance in simulated colonoscopy: a randomized trial using a virtual reality endoscopy trainer. Surgical Endoscopy And Other Interventional Techniques 18(10):1514–1518, 2004.
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Ministry of Electronics and Information Technology (MeitY), New Delhi for granting Visvesvaraya Ph.D. fellowship (file no.: PhD-MLA\4(34)\201-1 (05/11/2015)).
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First author: Ruikar, Darshan collected materials and prepared the draft under the supervision of Profs. Hegadi, R.S. and Santosh, K.C. The manuscript has gone through several rounds of internal revisions with Prof. Santosh, K.C. in the presence of remaining authors.
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Ruikar, D.D., Hegadi, R.S. & Santosh, K.C. A Systematic Review on Orthopedic Simulators for Psycho-Motor Skill and Surgical Procedure Training. J Med Syst 42, 168 (2018). https://doi.org/10.1007/s10916-018-1019-1
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DOI: https://doi.org/10.1007/s10916-018-1019-1