Hip, knee, and spine surgeons are testing modified surgical techniques and new implant materials on cadaver specimens in a robotic testing rig to keep patients out of the operating theatre for a second time. Osteoarthritis is a leading cause of disability worldwide, but most treatments only address end-stage disease. Early intervention procedures aim to delay or prevent progression, yet they often fail to restore healthy joint mechanics. This research tackles that gap by systematically testing how different surgical cuts and repairs affect joint loads, cartilage pressures, and ligament strains during simulated walking and other activities. If successful, the work will produce two concrete outputs: modified surgical techniques that better preserve joint function, and prototype titanium implants with precisely controlled stiffness to guide bone remodelling. For patients, this could mean fewer revision surgeries and better long-term mobility. For the NHS, it could reduce the cost burden of repeat joint replacements. The project also includes a fundamental component—studying how muscles spanning multiple joints influence loading patterns, which could inform future surgical planning.
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Background Osteoarthritis is one of the leading causes for disability worldwide. The most established treatments are designed to treat end stage disease, but early intervention procedures to prevent or delay the disease progression are getting popular. This research aims to improve these treatments by better recreating healthy biomechanics post-surgery. Aims & Objectives The proposed research aims to restore healthy biomechanics after early intervention orthopaedic surgery. Specific objectives are to: (1) Assess the efficacy of different joint preserving surgical techniques and propose modified techniques that better restore healthy biomechanics. (2) Create a method to manufacture implant materials that control bone strain (which drives bone mechanoresponse). (3) Design prototype implants for hip, knee and spine applications. Methods The joint preserving surgical techniques will be performed on cadaver specimens, and the biomechanics tested in a robot that makes the specimens perform physiological activities. Using this system, we will investigate surgery for femoroacetabular impingement and developmental dysplasia of the hip (DDH), and measure synovial fluid pressures, joint loads, cartilage contact pressures, ligament strains and joint kinematics for different activities. Then we will propose modified surgical techniques related to incision and repair of structures that may improve the biomechanics post-intervention and increase efficacy of the procedures. We will also investigate how muscles that span multiple joints at the hip and knee influence the loading within those joints. Implantable technology will be created that can generate a desired strain gradient in the bone to invoke a desired mechanoresponse. This will be achieved by manufacturing lattice Titanium structures in a range of stiffness that can increase, reduce or maintain the bone strain and thus cause bone formation, loss or maintain homeostasis. Prototypes will be manufactured for different early intervention procedures in the hip and knee, and also a lumbar spine application. Timelines for delivery 20 months: Femoroacetabular impingement study complete, prototype compartmental knee implant validated in cadaver model. 40 months: DDH study of shelf surgery complete, prototype shelf implant and low profile implant fixation surfaces validated in cadaver model. 60 months: DDH study of periacetabular osteotomy complete, prototype spine and osteotomy fixation plate implants validated in cadaver model. Study into multi-segment-spanning muscle loading complete. Anticipated impact and dissemination The impact will be improved early intervention orthopaedic surgery, better patient function at reduced cost to the tax-payer. Dissemination will be via the conventional route of journal publications and conference presentations, but also via unconventional routes including Twitter, Pint of Science, Imperial festival, Patient Public Involvement meetings and other outreach activities that I now routinely use to disseminate research news. Translation to clinical practice will be through surgeon collaborations (the surgical techniques) and industry partnerships (the implant technology).
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