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Aug 31

The possibilities of surgical rehabilitation

Georgina Cade

in News

Bionic Limbs, Surgeons Learning Through Virtual Reality, Scaffolding in Joints: #ScienceThatHeals through #SurgicalRehab

  • We are delighted to be able to showcase some of UCL’s pioneering research in orthopaedics surgery as part of our exhibition at New Scientist Live (28th Sept – 1st October). In preparation for this, we would like to tell you more about the work we’ve been doing around surgical rehabilitation.

  • Surgical Advancements for Patient Impact

    The central demonstration of our orthopaedics research that will be shown at New Scientist Live is a surgical skills simulator, which will allow visitors to try out the role of surgeon themselves and mimic performing a hip replacement. Using Virtual Reality (VR) so participants can ‘see’ and haptic feedback so that they ‘feel’, the simulator will create an immersive experience for them to practice their surgical skills. Simulators are increasingly being used as a component of surgical training, allowing novice surgeons and students to repeatedly practice the movements of procedures away from the operating theatre and without the risk of making a mistake on patients. For a generation already acclimatised to video games and interactive technology, well-designed simulations can be assets that reduce training time and enhance precision skills.

    What is unique about the simulator that researchers at UCL are developing is its adoption of patient specific data. By combining the technology with advanced imaging techniques, the simulation is able to run using personalised patient data to recreate an exact replica of a patient’s joint and anatomy. This will crucially assist with preoperative planning by allowing surgeons to practice various scenarios as they might actually arise, helping to reduce some of the element of risk of surgery. This project is being developed by researchers at the UCL Aspire CREATe Centre for Rehabilitation Engineering and Assistive Technology (Aspire CREATe), part of the UCL Institute of Orthopaedics and based at the Royal National Orthopaedic Hospital (RNOH).

  • One of the most complex but unfortunately very common procedures is acetabular reconstruction, fixing failed hip implants. UCL consultant surgeon Prof Alister Hart’s research focuses on achieving lifelong function for these patients. In collaboration with Prof John Skinner, he established the London Implant Retrieval Centre (LIRC) in 2007 and since then they have collected over 8,000 failed orthopaedic implants to investigate the causes of failure and published 130 PubMed journal papers to share their findings.

    This work is particularly pertinent as the global challenge of metal-on-metal hip failures continues to unfold, with failure rates of up to 13% at 5 years after implantation impacting over a million patients in the past decade and often resulting in permanent injury and invasive corrective surgery. The LIRC’s research has directly improved treatment for these patients, leading to changes in clinical practice, health policy, monitoring procedures and informing surgical decision-making.

  • Photo above is case study seven of an acetabular reconstruction from ComplexHipSurgery.com, Prof Alister Hart’s free online learning resource.

  • The challenges around hip replacements are being tackled by advancements in the field from many directions. At the UCL Centre for Materials Research, researchers aim to increase the success of these procedures by improving the materials used for implants and by developing tissue engineering that could offer an alternative to replacement surgery by restoring and regenerating patients’ musculoskeletal tissues. One pioneering area of the centre’s work focuses on developing bactericidal surfaces and antifouling coatings for implants that would kill biofilm formation on devices’ surfaces. Biofilm formation remains a significant complication following hip replacements and a key cause of implant failure – preventing infection from this would have a dramatic patient impact. This project is funded by Innovate UK and is led by Dr Harry Hothi and colleagues. 

    By taking a spotlight look at research around just one procedure within orthopaedics surgery, such as hip replacements, it becomes clear how technological innovations and advancements are being bought together with the same core aim of delivering patient impact.

  • How can experimental techniques feed into future clinical practice?

    UCL researchers in surgical orthopaedics are working at the very cutting edge of interdisciplinary healthcare, pushing the boundaries of what is perceived possible by using experimental techniques and engineering technologies to tackle clinical challenges.

  • One rapidly advancing area of innovation within orthopaedics aims to combat phantom limb pain. Experiencing a feeling of discomfort or pain in a limb that is no longer there is known as Phantom Limb Syndrome and affects up to 80% of amputees. However, these symptoms can be lessened if the mind can be tricked into a feeling of ‘embodiment’, where the patient believes they still have control of their missing limb. Early attempts at this used mirrors to create an illusion, however new technologies have advanced these capabilities by using Virtual Reality (VR) to recreate the experience of still having a limb.

    Researchers at Aspire CREATe in collaboration with RNOH have been working on a project called AMPSIM to push this to the next step by combining patient sessions using VR with a haptic robot. Patients receive proprioceptive and kinaesthetic feedback while performing a manipulation task to create an even more realistic experience of embodiment. Results of this trial have been successful and showed a significant reduction in patients’ symptoms of pain. One of the participants whose pain had been removed through this study found that her symptoms returned after an operation. The team’s next advancement will be 3D printing an Open Bionic limb for her in the hopes that this will rid her of pain long-term. Funding under “case for innovative treatment” has recently been secured to develop this.

  • An experimental technique made possible by recent advances in tissue engineering and regenerative medicine is osteochondral scaffold technology. Scaffolding is implanted in the osteochondral defect in a patient’s joint where it acts as a physical support structure for cell growth. Once in place, it works with the body’s own natural mechanisms to promote the regeneration of articular cartilage and underlining subconhondral bone (see photos to left).

    After promising results implanting the scaffolding in pet dogs’ shoulders, a £2m Innovate UK-MoST grant was awarded to help researchers progress the technology into manufacturing for clinical use. This type of procedure would provide a one-step surgical solution to treat patients with osteoarthritis, offering a faster, cost-effective alternative to joint replacement surgery and enhancing patients’ quality of life. Osteoarthritis affects at least 8 million people in the UK so the scaffolding has a potentially huge impact. The technology is being developed by a team led by Dr Chaozong Liu and colleagues at UCL, in collaboration with Oxford MEStar Ltd and partners in China.

  • Whilst many experimental techniques being developed are still at the earlier stages of their translational pathway their focus remains on delivering future clinical impact, and they are advancing understandings and capabilities within orthopaedics.

    Our vision of surgical rehabilitation

    UCL’s work within orthopaedics surgery takes an interdisciplinary and collaborative approach. Many of the projects and technologies being developed are underpinned by the innovative research that takes place at the Aspire CREATe Centre based at the RNOH in Stanmore. Researchers there are investigating pioneering techniques in areas such as spinal cord injuries, amputations, muscular dystrophy and age-related mobility issues.

  • Much of the different orthopaedics research UCL is involved with is brought together under the umbrella of our flagship programme Moving Forward: From Brain to Muscle and Beyond. This programme forms a crucial backbone of support and collaboration that then feeds into our various projects and furthers the common goal of assisting ‘whole body’ movement rehabilitation and functional independence. The programme’s sandpit events are an important part of this, bringing together engineers and clinicians to identify crucial challenges within the field and brainstorm ways to tackle them. More information about our most recent sandpit event can be found here.

    Flagship lead, Dr Rui Loureiro, has said, “Our flagship will have a strong user involvement, inspire the younger generations and galvanise experts to tackle the challenges ahead through collaboration”. Dr Loureiro also chaired RehabWeek 2017, an event which brought together 4 conferences and over 1,200 renowned engineers, clinicians, researchers and industry leaders working in the field of rehabilitation technology. The event captured the same spirit of interdisciplinary collaboration that UCL has long embraced, showcasing the latest technologies that push the boundaries of what is thought to be possible within orthopaedics, rehabilitation and healthcare.

  • Attendees at RehabWeek 2017 try out new technologies on display (photo above).

  • The uniqueness of our vision at UCL really stems from the understanding that surgical technologies are integral to patients’ overall rehabilitation. We perceive both surgery and rehab as necessary components for recovery that should complement one another, hence our interpretation of the whole process as ‘surgical rehabilitation’. The ultimate aim underlying this is to take a holistic approach to getting patients mobile again and active in society. As experimental techniques and research advancements continue to be developed and translated into clinical practice, it is likely that surgery will be increasingly recognised as a central part of patients’ rehabilitation and recovery. We look forward to exploring the possibilities of surgical rehabilitation in more detail at the New Scientist Live event and would love for you to join us there at stand 1229.

  • New Scientist Live exhibition, London ExCel, 28 September 2017-01 October 201, Stand 1229.

    To buy tickets or find out more, please visit the New Scientist Live website.