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Rob Nelissen

‘That’s what I need!’

Bio

Bio

Rob Nelissen graduated in Medicine in 1985 at Leiden University. In 1994 he became a consultant orthopaedic surgeon at Leiden University Medical Center. He received his PhD in 1995. Five years later he became the Director of the residency programme and in 2005 he was appointed Professor of Experimental Orthopaedics and later became Professor of Orthopaedics in 2008. In 2006 he was appointed Chair of the Department of Orthopaedics. He is founder of the Dutch Arthoplasty Register and currently he is the President of the Netherlands Orthopaedic Association.

POSITION AT:

LUMC: Orthopaedics
TU Delft: Biomechanical Engineering

ROLE WITHIN MEDICAL DELTA:

Member of the Programme Committtee

 

Doctor and engineer

“In an academic hospital, you can come up with all kinds of great ideas – but then you need someone to put them into practice. What’s great is that engineers and doctors have different ways of thinking – and it is all about interaction. Someone at Delft will come up with a device on the drawing board that looks absolutely great, and everything has been calculated with the utmost precision. But it’s then up to a doctor to make sure it actually works in a living patient. That’s why you need to have doctors working with the engineers. For my part, I feel I am a bit of both, which is pretty characteristic for orthopaedic surgeons, I think. They enjoy working with their hands. My days in the operating theatre are the most relaxed days of the week. But I also enjoy academic work!”

An adenovirus to remove tissue

“The best example of this interaction is, of course, our joint approach to prostheses in older patients that have become loose. In such cases, operating is not a good idea because of the risk. Non-invasive therapies are more advisable. In order to reattach the prosthesis (usually an artificial hip), we use cement that we spray between the bone and the prosthesis. But before that, the tough ‘interphase tissue’ that has grown in between them needs to be removed. Rob Hoeben, from the LUMC, had contact with a British company that was working on gene therapy. In collaboration with them, we developed a method which involved treating the tissue using a genetically manipulated adenovirus (the virus that causes sore throats). An additional gene had been added to the virus that initiates cell death, breaking down the tissue. Here in Leiden, we were the first to use gene therapy in this way. Twelve patients were involved. The early results were reasonable, but the British company wanted its money, and we did not have it. As a result, we had to come up with an alternative solution.”

“We looked at such options as water jets and laser’s. But one day I was talking to a urologist, Rob Pelger of the LUMC. He was working on a catheter for kidneys – and I thought: I need something like that! I want to use it to get inside and deal with the tissue. They are now working on the device at TU Delft. It may be possible to remove the tissue mechanically using the catheter, but we could also use it in combination with gene therapy, which would enable us to apply the virus in a much more targeted way. So that it reaches where it really needs to be. This is something we are still in the process of considering.”

Ideal surgeons

“What I would like to do is compare this approach using gene therapy with the current methods we use. But it’s difficult to do this based on people’s perception of pain, which can be very subjective. You also need to measure whether the prosthesis has shifted. Normal x-ray does not offer the accuracy needed for that. This all brings me back to  some great collaboration with TU Delft: we have developed RSA, Roentgen Stereometric Analysis. It measures the migration of the prosthesis to an accuracy of 0.01 mm and rotation to an accuracy of 0.1 degrees. It’s really fantastic. It means you need large groups of patients for research but can work with small groups to demonstrate an effect. That makes the research more interesting for companies that want to market new implants. The result is therefore better products – and more PhD students for us, of course.”

“Surgeons and engineers need to come together. This is why we – Leiden, Delft and the Erasmus MC – launched the Bachelor’s degree programme in Clinical Technology in September 2014. It is a three-year programme that prepares students for the Master’s degree programme in Biomedical Engineering or ... for Medicine. In this way, doctors who are semi-engineers. They could end up becoming the ideal surgeons.”

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