Close

We are using cookies to give you the best experience on our site. Cookies are files stored in your browser and are used by most websites to help personalise your web experience.

By continuing to use our website without changing the settings, you are agreeing to our use of cookies.

Find out more
For more information, go to www.arthritisresearchuk.org

3D-printed implants and scaffold technology – how bioengineering innovation could treat and prevent osteoarthritis

Arthritis Today Winter 2017 Issue 174A laser cutting machine in actionThe need for new and effective ways to treat and prevent osteoarthritis has never been more urgent. Demand for total joint replacements is rising every year, and expected to double by 2030, placing a huge strain on the NHS. Meanwhile, those living with the pain of early stage osteoarthritis or at risk of developing it due to injury face limited treatment options.

That’s why Arthritis Research UK is investing in innovative research dedicated to developing medical technologies which could provide an answer. By 'medical technologies' we mean cutting-edge medical devices, orthotics, implants and imaging techniques, harnessing the latest breakthroughs in bioengineering. Research Translation Manager for Arthritis Research UK Sarah Odoi says: "Our Medical Technologies fund is designed to make sure truly innovative ideas, which could one day transform quality of life for people with arthritis, don’t get stuck in the lab. Our close collaboration with the Medical Technologies Innovation and Knowledge Centre in Leeds also means we attract vital attention and support from industry.

"Our funding decisions are made with people with arthritis firmly in mind, ensuring we support research into practical, creative solutions we believe could have a big impact within the next five years."

In this edition we’re highlighting two studies we’ve funded making significant and exciting progress in this vital area.

Scaffold technology to repair and regenerate cartilage

At University College London a team of experts in orthopaedic bioengineering, led by Dr Chaozong Liu, has developed a scaffold type device which can be implanted into a damaged joint to create an environment in which cartilage can reform. This innovative product could offer a one-step surgical procedure to treat cartilage damaged by trauma or osteoarthritis.

Dr Liu says: "Our scaffold technology is designed to repair and regenerate cartilage damage at an early enough stage to stop or slow down the progression of osteoarthritis. It is suitable for patients who have experienced trauma to a joint, caused by a sports injury, fall or car accident. By finding an effective way to treat patients at an early stage of cartilage damage we could delay or avoid the need for a total joint replacement.""By finding an effective way to treat patients at an early stage of cartilage damage we could delay or avoid the need for a total joint replacement."Dr Chaozong Liu

Using recent advances in tissue engineering and regenerative medicine the team has designed a multi-layered support structure which works with the body’s natural mechanisms to bear the load of the joint, while encouraging the regeneration of cartilage and bone tissue. The scaffold is designed for use with large bones like the knee, hip and shoulder, but is flexible enough to be adapted to work with any joint in the body, large or small.

Dr Liu says: "We want to be able to offer an early surgical intervention to patients which will relieve pain and help them to stay active, vastly improving quality of life. Currently a total joint replacement is the only treatment option for many people with osteoarthritis, which means they have to wait until the disease has progressed to its later stages before they can live pain-free.

"And though total joint replacement is safe and effective, it's a major operation and expensive to perform. Surgery using our scaffold technology will be faster and more cost-effective which would benefit the NHS and should make a surgical solution accessible to more people with, or at risk of, osteoarthritis."

Thanks to funding and project management support from Arthritis Research UK and the Medical Technologies Innovation and Knowledge Centre (IKC) at the University of Leeds Dr Liu’s team could test the effectiveness of the scaffold in animals. They achieved promising results, successfully treating a large cartilage defect in a pet dog; a step forward which was broadcast on the Channel 4 series Supervet. The study has now received a £2million Innovate UK-MoST grant to continue the development of the scaffold technology into manufacturing for clinical use within five years.

Exploiting advances in imaging techniques and 3D printing

Arthritis Research UK is also funding the development of ToKa®: A High Precision Patient Specific High Tibial Osteotomy Procedure at the University of Bath, working with the Royal Exeter and Devon Hospital. Researchers, led by Professor of Healthcare Engineering Richie Gill and Professor Andrew Toms, believe by exploiting advances in imaging techniques and 3D printing they can offer an accessible, alternative surgery to treat early stage knee osteoarthritis.

Professor Gill says: "The urgent clinical need for innovative solutions to treat knee osteoarthritis shouldn't be underestimated. We see a growing number of younger people in pain with early stage knee osteoarthritis and we can’t offer them effective treatment. A third of people who have received a knee replacement recorded in the National Joint Registry are under 65 and one in four women over the age of 45 have symptomatic knee osteoarthritis. It’s a big problem."The urgent clinical need for innovative solutions to treat knee osteoarthritis shouldn't be underestimated."Professor Richie Gill

"High tibial osteotomy (HTO) is a surgical procedure suitable for patients who have osteoarthritis on one side of the knee, with healthy cartilage on the other side. Knee osteoarthritis often starts in the inside of the knee, meaning one side of the leg starts wearing out and the leg becomes bowed. HTO surgery realigns the knee joint by reorienting the tibia (shin bone), using a metal plate to support the bone while it heals; this allows the load to be transferred from the worn to the unworn side of the knee. It is a proven treatment, but there are barriers we need to overcome to make it a viable option for more people.

"At the moment, it's complicated to achieve the desired correction in the tibia. The surgical team rely on interoperative radiology, using equipment to look inside the bones throughout the operation to take measurements and check positioning. This requires radiology technicians being in theatre with the surgeons and makes the surgery lengthy and expensive to perform. We also see some patients complaining of soft tissue irritation around the metal plate, which can mean further surgery is needed, adding time to the patient’s recovery and expense to the NHS."

The ToKa team believe they have a solution to address both issues, devising a product which will improve the accuracy of the surgery, reduce the cost and resources involved and achieve better outcomes for the patient. They have developed a new procedure that uses 3D imaging techniques and software to design and 3D print a personalised medical grade titanium implant tailored to each patient’s bones. Professor Gill explains: "The level of precision we can achieve through 3D planning and metal printing, generating a plate contoured to the patient’s anatomy, removes the need for inter-operative radiology. The plate will only fit when the surgeon achieves the right correction in the leg.

"This should dramatically reduce both the length of the operation and the number of professionals involved. The customised plate will also reduce the risk of soft tissue irritation and the need for plate removal surgery so, as well as being cost-effective for the NHS, it will be better for the patient.

"By making HTO surgery more accessible we hope to improve quality of life for the large number of people with early stage osteoarthritis who fall into the treatment gap – those who have the pain, but their disease isn’t advanced enough for surgery. Intervening earlier can delay or prevent the need for knee replacement at all."

A virtual clinical trial of ToKa is underway using computer simulations to test and compare the ToKa plate with the current market leader in 30 patients. If successful, the team hope clinical trials will lead to their innovation becoming widely available by 2022.


What do we mean by imaging techniques?

Medical imaging techniques allow us to view inside the human body to diagnose, monitor or treat medical conditions, for example through x-rays, ultrasound scans and MRI scans.

What is 3D printing?

3D printing is the process of making a solid physical object from a three-dimensional digital model. The 3D printed object is created by laying down many thinly sliced layers of material in succession. This technique allows us to produce complex shapes using less material than traditional manufacturing methods.

Read next: Can symptom tracking apps help people manage their arthritis?

A new JIA app on a smartphone

With smartphones now an integral part of our lives, two pilot studies have worked closely with people with inflammatory arthritis to design, develop and test apps to help with symptom monitoring.

For more information, go to www.arthritisresearchuk.org.
Arthritis Research UK fund research into the cause, treatment and cure of arthritis. You can support Arthritis Research UK by volunteering, donating or visiting our shops.