A review of virtual reality based training simulators for orthopaedic surgery

Medical Engineering and Physics

Volumn 38, Issue 2, 2016, Pages 59-71

  Vaughan, Neil ^a   Dubey, Venketesh N ^a   Wainwright, Thomas W ^a,b   Middleton, Robert G ^a,b  

^a BOURNEMOUTH UNIVERSITY   (United Kingdom)

^b ROYAL BOURNEMOUTH HOSPITAL   (United Kingdom)

Author keywords

Haptics; Hip replacement; Modelling; Orthopaedic; Resurfacing; Simulator

Indexed keywords

E-LEARNING; HIP PROSTHESES; IMPLANTS (SURGICAL); MODELS; ORTHOPEDICS; SIMULATORS; SURGERY; TRANSPLANTATION (SURGICAL); VIRTUAL REALITY;

FURTHER DEVELOPMENT; HAPTICS; HIP REPLACEMENTS; ORTHOPAEDIC SURGERY; PRE-OPERATIVE PLANNING; RESURFACING; SURGICAL PROCEDURES; TRAINING SIMULATION;

SURGICAL EQUIPMENT;

BIOLOGICAL MODEL; COMPUTER ASSISTED TOMOGRAPHY; COMPUTER MODEL; COMPUTER PROGRAM; FRACTURE FIXATION; HIP INJURY; ORTHOPEDIC SURGERY; PRIORITY JOURNAL; RESURFACING DEVICE; REVIEW; SIMULATION; SIMULATOR; THREE DIMENSIONAL IMAGING; TOTAL HIP PROSTHESIS; TOTAL KNEE REPLACEMENT; TRAUMATOLOGY; VIRTUAL REALITY BASED TRAINING SIMULATOR; COMPUTER SIMULATION; EDUCATION; HUMAN; MEDICAL EDUCATION; PROCEDURES; SOFTWARE;

COMPUTER SIMULATION; EDUCATION, MEDICAL; HUMANS; ORTHOPEDIC PROCEDURES; SOFTWARE;

EID: 84958115974     PISSN: 13504533     EISSN: 18734030     Source Type: Journal    
DOI: 10.1016/j.medengphy.2015.11.021     Document Type: Review

References (109)

1. Johns B.D. PhD Thesis. The creation and validation of an augmented reality orthopaedic drilling simulator for surgical training May 2014, University of Iowa.
2. Rambani R., Ward J., Viant W. Desktop-based computer-assisted orthopedic training system for spinal surgery. J Surgical Edu 2014, 71(6):805-809.
3. Madan S.S., Pai D.R. Role of simulation in arthroscopy training. Simul Healthcare: The J Soc Simul Healthcare 2014, 9(2):127-135.
4. Frank R.M., Erickson B., Frank J.M., Bush-Joseph C.A., Bach Jr B.R., Cole B.J., et al. Utility of modern arthroscopic simulator training models. Arthroscopy: The J Arthroscopic Related Surgery 2014, 30(1):121-133.
5. Levine A.I., DeMaria Jr S., Schwartz A.D., Sim A.J. The comprehensive textbook of healthcare simulation 2013, Springer Science & Business Media.
6. Kelsey J.L., Hoffman S. Risk factors for hip fracture. The New England J Med 1987, 145(9):786-793.
7. Cummings S.R., Rubin S.M., Black D. The future of hip fractures in the United States: numbers, costs, and potential effects of postmenopausal estrogen. Clinical Orthopaedics Related Res 1990, 252:163-166.
8. Tosteson A.N., Burge R.T., Marshall D.A., Lindsay R. Therapies for treatment of osteoporosis in US women: cost-effectiveness and budget impact considerations-page 4. Am J Manag Care 2008, 14:605-615.
9. Cooper C., Campion G., Melton I.I.I.L. Hip fractures in the elderly: a worldwide projection. Osteoporosis Int 1992, 2:285-289.
10. Morrey B.F., An K.N. Reconstructive surgery of the joints (Vol. 1) 1996, Churchill Livingstone.
11. Maher S.A., Lipman J.D. Influence of acetabular rim profile on hip dislocation. Proc Inst Mech Eng, Part H: J Eng Med 2006, 220(8):881-887.
12. Willert H.G., Buchhorn G.H., Fayyazi A., Flury R., Windler M., Köster G., et al. Metal-on-metal bearings and hypersensitivity in patients with artificial hip jointsA clinical and histomorphological study. The J Bone Joint Surg 2005, 87(1):28-36.
13. Akhtar K.S.N., Chen A., Standfield N.J., Gupte C.M. The role of simulation in developing surgical skills. Current Rev Musculoskeletal Med 2014, 7(2):155-160.
14. Pedowitz R.A. Marsh JL Motor skills training in orthopaedic surgery: a paradigm shift toward a simulation-based educational curriculum. J Amer Acad Orthopaedic Surgeons 2012, 20(7):407-409.
15. Seymour N.E., Gallagher A.G., Roman S.A., O'Brien M.K., Bansal V.K., Andersen D.K. Virtual reality training improves operating room performance: results of a randomized double-blinded study. Ann Surg 2002, 236:458-463.
16. Gurusamy K., Aggarwal R., Palanivelu L., Davidson B.R. Systematic review of randomized controlled trials on the effectiveness of virtual reality training for laparoscopic surgery. Br J Surg 2008, 95:1088-1097.
17. Sutherland C.J., Bresina S.J., Gayou D.E. Use of general purpose mechanical computer assisted engineering software in orthopaedic surgical planning: advantages and limitations. Comput Med Imaging Graph 1994, 18(6):435-442.
18. Tonetti J., Vadcard L., Girard P., Dubois M., Merloz P., Troccaz J. Assessment of a percutaneous iliosacral screw insertion simulator. Orthopaed Traumatology: Surgery Res 2009, 95(7):471-477.
19. Pettersson J., Palmerius K.L., Knutsson H., Wahlstrom O., Tillander B., Borga M. Simulation of Patient Specific Cervical Hip Fracture Surgery With a Volume Haptic Interface. IEEE Trans Biomed Eng 2008, 55:1255-1265.
20. Hohn E.A., Brooks A.G., Leasure J., Camisa W., van Warmerdam J., Kondrashov D. Development of a surgical skills curriculum for the training and assessment of manual skills in orthopedic surgical residents. J Surg Edu 2015, 1:47-52.
21. Shantz J.A.S., Leiter J.R., Gottschalk T., MacDonald P.B. The internal validity of arthroscopic simulators and their effectiveness in arthroscopic education. Knee Surgery, Sports Traumatology, Arthroscopy 2014, 22(1):33-40.
22. Vaughan N., Dubey V.N., Wee M.Y.K., Isaacs R. A review of epidural simulators: where are we today?. Med Eng Phys 2013, 35(9):1235-1250.
23. Materialise (2014) Mimics Innovation Suite. Available at: (Accessed: 18 December 2015). http://biomedical.materialise.com/mis.
24. Medical Image Processing and Visualization. Available at: (Accessed: 18 December 2015). http://mipav.cit.nih.gov/.
25. Medical Imaging Interaction Toolkit Workbench. Available at: (Accessed: 18 December 2015). http://mitk.org.
26. 3DSlicer Medical Imaging Software. Available at: http://www.slicer.org (Accessed: 18 December 2015).
27. Simpleware 3D image data visualisation, analysis and model generation software. Available at: (Accessed: 18 December 2015). http://www.simpleware.com/software.
28. Modelling 3.D.Doctor., image processing and measurement software for MRI, CT, PET, microscopy. Available at: (Accessed: 18 December 2015). http://www.ablesw.com/3d-doctor.
29. Software O.I., Open-source pacs and dicom viewer. Available at: (Accessed: 18 December 2015). http://www.osirix-viewer.com.
30. EdHeads (2007) Hip replacement online game 1. Available at: (Accessed: 18 December 2015). http://www.edheads.org/activities/hip/.
31. EdHeads (2007) Hip resurfacing online game 2. Available at: (Accessed: 18 December 2015). http://www.edheads.org/activities/hip2/.
32. Sato Y., Sasama T., Sugano N., Nakahodo K., Nishii T., Ozono K. Intraoperative simulation and planning using a combined acetabular and femoral (CAF) navigation system for total hip replacement. Medical Image Computing and Computer-Assisted Intervention-MICCAI 2000, 1114-1125.
33. Jun Y., Park S. Polygon-based 3D surgical planning system for hip operation. Int J Precision Eng Manufact 2011, 12(1):157-160.
34. Dick C., Georgii J., Burgkart R., Westermann R. A 3D simulation system for hip joint replacement planning. In World Congress on Medical Physics and Biomedical Engineering. Springer Berlin Heidelberg. 2010, 363-366.
35. Digioia A.M., Jaramaz B., Nikou C., Labarca R.S., Moody J.E., Colgan B.D. Surgical navigation for total hip replacement with the use of HipNav. Operative Techniques Orthopaedics 2000, 10(1):3-8.
36. Digioia A.M., Simon D., Jaramaz B., Blackwell M., Morgan F.M., O'Toole R.V. HipNav: pre-operative planning and intra-operative navigational guidance for acetabular implant placement in total hip replacement surgery 1995, Computer Assisted Orthopaedic Surgery Symposium.
37. Sinha R.K. Hip replacement: current trends and controversies 2002, CRC Press.
38. Digioia A., Jaramaz B., Blackwell M., Simon D., Morgan F., Moody J.E. Image guided navigation system to measure intraoperatively acetabular implant alignment. Clin Orthop Rel Res 1998, 355:8-22.
39. Assassi L., Charbonnier C., Schmid J., Volino P., Magnenat-Thalmann N. From MRI to anatomical simulation of the hip joint. Comput Animation Virtual Worlds 2009, 20(1):53-66.
40. Pollard T.C., Khan T., Price A.J., Gill H.S., Glyn-Jones S., Rees J.L. Simulated hip arthroscopy skills: learning curves with the lateral and supine patient positions: a randomized trial. The J Bone Joint Surg 2012, 94(10):68.
41. Taylor R.H., Joskowicz L., Williamson B., Guéziec A., Kalvin A., Kazanzides P., et al. Computer-integrated revision total hip replacement surgery: concept and preliminary results. Med Image Anal 1999, 3(3):301-319.
42. Pransky J. ROBODOC-surgical robot success story. Indus Robot: An Int J 1997, 24(3):231-233.
43. Nishihara S., Sugano N., Nishii T., Tanaka H., Yoshikawa H. Comparison of the fit and fill between the anatomic hip femoral component and the VerSys Taper femoral component using virtual implantation on the Orthodoc workstation. J Orthopaedic Sci 2003, 8(3):352-360.
44. Savuc G., Forna D., Forna N.C. The contribution of medical robots to clinical performance: up-to-date. Romanian J Oral Rehab 2012, 4(4):67.
45. Handels H., Ehrhardt J., Plötz W., Pöppl S.J. Virtual planning of hip operations and individual adaption of endoprostheses in orthopaedic surgery. Int J Med Infor 2000, 58:21-28.
46. Handels H., Ehrhard J., Plötz W., Pöppl S.J. Three-dimensional planning and simulation of hip operations and computer-assisted construction of endoprostheses in bone tumor surgery. Comput Aid Surg 2001, 6(2):65-76.
47. Sawbones (2014). Mannikin based hip arthrosopy bench-top simulator. Available at: (Accessed: 18 December 2015). http://www.sawbones.com/Catalog/Orthopaedic%20Models/Hip/9077-9.
48. Tsai M.D., Hsieh M.S., Tsai C.H. Bone drilling haptic interaction for orthopedic surgical simulator. Comput Biol Med 2007, 37:1709-1718.
49. Geomagic (2014) Touch X haptic device. Available at: (Accessed: 18 December 2015). http://www.geomagic.com/en/products/phantom-desktop/overview.
50. Vankipuram M., Kahol K., McLaren A., Panchanathan S. A virtual reality simulator for orthopedic basic skills: a design and validation study. J Biomed Inf 2010, 43(5):661-668.
51. Froelich J.M., Milbrandt J.C., Novicoff W.M., Saleh K.J., Allan D.G. Surgical simulators and hip fractures: a role in residency training?. J Surg Edu 2011, 68(4):298-302.
52. Imperial College London H.O.O.T. (2014), HOOT Simulator by Imperial College London. Available at: (Accessed: 18 December 2015). http://www1.imperial.ac.uk/simms/research/procedure_modelling_simulation/hoot/.
53. Barrow A., Akhtar K., Gupte C., Bello F. Requirements analysis of a 5 degree of freedom haptic simulator for orthopedic trauma surgery. Stud Health Technol Informatics 2012, 184:43-47.
54. Blyth P., Stott N.S., Anderson I.A. A simulation-based training system for hip fracture fixation for use within the hospital environment. Injury 2007, 38:1197-1203.
55. Blyth P. A Virtual Reality simulator for Hip Surgery November 2008, University of Auckland, PhD Thesis.
56. Blyth P., Stott N.S., Anderson I.A. Virtual reality assessment of technical skill using the Bonedoc DHS simulator. Injury 2008, 39:1127-1133.
57. Blyth P., Sehgal P. Use of the Bonedoc DHS simulator by fifth year medical students: A pilot study. Proceedings of ASCILITE - Australian Society for Computers in Learning in Tertiary Education Annual Conference 2009, 74-80.
58. Rambani R., Viant W., Ward J., Mohsen A. Computer-assisted orthopedic training system for fracture fixation. J Surg Edu 2013, 70(3):304-308.
59. Linköping University, Sweden, 2012. Haptic simulation of hip fracture surgery, Available at: (Accessed: 18 December 2015). http://www.imt.liu.se/mi/Research/simulator.
60. A W., Pettersson J., Knutsson H. Non-rigid registration using morphons 2005, 501-510. Springer Berlin Heidelberg Image Analysis.
61. Pettersson J., Knutsson H., Nordqvist P., Borga M. A hip surgery simulator based on patient specific models generated by automatic segmentation. Stud Health Technol Informatics 2005, 119:431.
62. Pettersson J., Knutsson H., Borga M. Generation of patient specific bone models from volume data using morphons. IFMBE Proceedings: NBC'05 13th Nordic Baltic Conference Biomedical Engineering and Medical Physics 2005, 199-200.
63. Pettersson J., Knutsson H., Borga M. Automatic hip bone segmentation using non-rigid registration. Proceedings of the IEEE 18th International Conference on Pattern Recognition 2006. ICPR 2006, 3:946-949.
64. Tseng C.H. On the development of a computer-assisted patient-doctor relationship and preoperative evaluation system for hip surgery July 2011, PhD Thesis, National Central University Taiwan, PhD Thesis.
65. Ascension (2014), 3D Guidance trakSTAR™ 6-DOF. Available at: (Accessed: 18 December 2015). http://www.ascension-tech.com/products/trakstar-drivebay.
66. Northern Digital Inc. (2015) Polaris optical tracking system. Available at: (Accessed: 18 December 2015). http://www.ndigital.com/medical/products/polaris-family.
67. Jun Y., Lee K.Y., Gwak K.W., Lim D. Anatomic basis 3-surgical simulation system for custom fit knee replacement. Int J Precision Eng Manufacturing 2012, 13(5):709-715.
68. Mabrey J.D., Reinig K.D., Cannon W.D. Virtual reality in orthopaedics: is it a reality?. Clinical Orthopaedics Related Res 2010, 468(10):2586-2591.
69. Heng P.A., Cheng C.Y., Wong T.T., Xu Y., Chui Y.P., Chan K.M. A virtual-reality training system for knee arthroscopic surgery. IEEE Trans Inf Technol Biomed 2004, 8(2):217-227.
70. Mabrey J.D., Cannon W.D., Gillogly S.D., Kasser J.R., Sweeney H.J., Zarins B., et al. Development of a virtual reality arthroscopic knee simulator. Stud Health Technol Inform 1999, 70:192-194.
71. McCarthy A.D., Moody L., Waterworth A.R., Bickerstaff D.R. Passive haptics in a knee arthroscopy simulator: is it valid for core skills training?. Clin Orthop Relat Res 2006, 442:13-20.
72. Zivanovic A., Dibble E., Davies B. A high force haptic system for knee arthroscopy training. Int J Humanoid Robot 2006, 3(4):429-437.
73. Sourin A., Sourina O., Sen H.T. Virtual orthopedic surgery training. IEEE Comput Graph Appl 2000, 20:6-9.
74. Sourina O., A S., Sen H.T. Virtual orthopedic surgery training on personal computer. Int J Inf Technol 2000, 6:16-29.
75. Cimerman M., Kristan A. Preoperative planning in pelvic and acetabular surgery: the value of advanced computerised planning modules. Injury 2007, 38(4):442-449.
76. Tsai M.D., Hsieh M.S., Jou S.B. Virtual reality orthopedic surgery simulator. Comput Biol Med 2001, 31:333-351.
77. LeBlanc J., Hutchison C., Hu Y., Donnon T. A comparison of orthopaedic resident performance on surgical fixation of an ulnar fracture using virtual reality and synthetic models. The J Bone Joint Surg 2013, 95(9):60-61.
78. Braman J.P., Swee R.M., Hananel D.M., Ludewig P.M., Van Heest A.E. Development and validation of a basic arthroscopy skills simulator. Arthroscopy: The J Arthroscopic Related Surg 2014, 31(1):104-112.
79. Furnstahl P. PhD Thesis. Computer-assisted planning for orthopedic surgery 2010, Eidgenössische Technische Hochschule ETH Zürich, Nr. 19102.
80. Force Dimension (Switzerland), delta.6TM haptic device. Available at: (Accessed: 18 December 2015). http://www.forcedimension.com/products/delta-6/overview.
81. Pappas G., Gomoll A.H., Forsythe B., Warner J.J. Virtual reality simulation for shoulder arthroscopy. Orthopaedic J Harvard Med School 2008, 10:95-98.
82. Bliss J.P., Hanner-Bailey H.S., Scerbo M.W. Determining the efficacy of an immersive trainer for arthroscopy skills. Stud Health Technol Inform. 2005, 111:54-56.
83. Geomagic (2015) Premium 1.5 Haptic Device. Available at: (Accessed: 18 December 2015). http://www.geomagic.com/en/products/phantom-premium/overview.
84. Geomagic (2015) Touch Haptic Device. Available at: (Accessed: 18 December 2015). http://www.geomagic.com/en/products/phantom-omni/overview.
85. Sutherland L.M., Middleton P.F., Anthony A., Hamdorf J., Cregan P., Scott D., et al. Surgical simulation: a systematic review. Ann Surg 2006, 243(3):291.
86. Mark W.R., Randolph S.C., Finch M., Van Verth J.M., Taylor R.M. II, Adding force feedback to graphics systems: Issues and solutions. Proceedings of the 23rd annual conference on Computer graphics and interactive techniques 1996, 447-452.
87. Bould M.D., Crabtree N.A., Naik V.N. Assessment of procedural skills in anaesthesia. Br J Anaesth 2009, 103:472-483.
88. Pedersen P., Palm H., Ringsted C., Konge L. Virtual-reality simulation to assess performance in hip fracture surgery. Acta orthopaedica 2014, 85(3):1-5.
89. Haughom B.D., Schairer W.W., Hellman M.D., Yi P.H., Levine B.R. Resident involvement does not influence complication after total hip arthroplasty: an analysis of 13,109 cases. The J Arthroplasty 2014, 29(10):1919-1924.
90. Blyth P., Anderson I.A., Stott N.S. Virtual reality simulators in orthopedic surgery: what do the surgeons think?. J Surg Res 2006, 131(1):133-139.
91. Karam M.D., Pedowitz R.A., Natividad H., Murray J., Marsh J.L. Current and future use of surgical skills training laboratories in orthopaedic resident education: a national survey. The J Bone Joint Surg 2013, 95(1):e4.
92. Tillander B., Ledin T., Nordqvist P., Skarman E., Wahlström O. A virtual reality trauma simulator. Med Teacher 2004, 26(2):189-191.
93. Torkington J., Smith S.G., Rees B.I., Darzi A. The role of simulation in surgical training. Ann Royal College Surg England 2000, 82(2):88.
94. Koehler R.J., Amsdell S., Arendt E.A., Bisson L.J., Bramen J.P., Butler A., Cosgarea A.J. The arthroscopic surgical skill evaluation tool (ASSET). The Amer J Sports Med 2013, 41(6):1229-1237.
95. Stefanidis D., Arora S., Parrack D.M., Hamad G.G., Capella J., Grantcharov T., Jones D.B. Research priorities in surgical simulation for the 21st century. The American J Surg 2012, 203(1):49-53.
96. Traumavision S. (2014) Swemac Traumavision. Available at: (Accessed: 18 December 2015). http://www.swemac.com/simulators/traumavision.
97. BoneDoc (2014) About the BoneDoc Simulator. Available at: (Accessed: 18 December 2015). http://bonedoc.org/about.html.
98. Pedowitz R.A., Esch J., Snyder S. Evaluation of a virtual reality simulator for arthroscopy skills development. Arthroscopy 2002, 18:e29.
99. Vaughan N., Dubey V.N., Wainwright T.W., Middleton R.G. Can virtual-reality simulators assess experience and skill level of orthopaedic surgeons?. IEEE Sci Inf Conf (SAI) 2015, 113.
100. Vaughan N., Dubey V.N., Wee M.Y.K., Isaacs R. Epidural simulation for patients of various BMI and body shapes. J Med Dev 2013, 7(3):30924.
101. Vaughan N., Dubey V.N., Wee M.Y.K., Isaacs R. Parametric model of human body shape and ligaments for patient-specific epidural simulation. Artif Intell Med 2014, 62(2):129-140.
102. Abbaszadeh F., Rahmati S., Kheirollahi H., Farahmand F. Design for manufacturing of custom-made femoral stem using CT data and rapid prototyping technology. Int J Rapid Manufact 2011, 2(1):76-91.
103. Simendo (2006) arthroscopy trainer. Available at: (Accessed: 18 December 2015). http://www.simendo.eu/.
104. Verdaasdonk E.G.G., Stassen L.P.S., Monteny L.J., Dankelman J. Validation of a new basic virtual reality simulator for training of basic endoscopic skills. Surgical Endoscopy Other Interventional Tech 2006, 20(3):511-518.
105. Vaughan N., Dubey V.N., Wainwright T.W., Middleton R.G. Can virtual-reality training on orthopaedic simulators improve performance in the operating room?. IEEE Sci Inf Conf (SAI) 2015, 112.
106. Simbionix (2012) Arthro mentor knee simulator. Available at: (Accessed: 18 December 2015). http://simbionix.com/simulators/arthro-mentor/.
107. Jacobsen M.E., Andersen M.J., Hansen C.O., Konge L. Testing basic competency in knee arthroscopy using a virtual reality simulator. The J Bone Joint Surg 2015, 97(9):775-781.
108. VirtaMed (2013) ArthroSTM knee and shoulder arthoscopy simulator. Available at: (Accessed: 18 December 2015). http://www.virtamed.com/en/medical-training-simulators/arthros/.
109. Rasool S., Sourin A., Xia P., Weng B., Kagda F. Towards hand-eye coordination training in virtual knee arthroscopy. Proceedings of the 19th ACM Symposium on Virtual Reality Software and Technology 2013, 17-26.