Half a million times a year in the UK, surgeons screw a metal plate into a broken bone or replace a worn-out hip joint—and then hope for the best. These passive implants, which contain no electronics, cannot monitor healing, stimulate bone growth, or warn of infection. Patients are sent home after a single postoperative check, and problems like loosening or infection often go unnoticed until they become serious. This fellowship aims to turn orthopaedic implants into active devices by embedding miniature, low-cost electromechanical systems. The researcher will study how different implant designs deliver physical stimulus to bone, how bone cells respond to that stimulus, and whether the same stimulus can disrupt bacterial biofilms that cause implant infections. If successful, the work could lead to implants that actively speed recovery, deliver non-invasive therapies to prevent loosening, and transmit data for digital triaging—flagging problems early so patients who need care get it quickly, while the majority are reassured without unnecessary hospital visits. This would reduce the revision burden on the NHS and help healthcare systems cope with an ageing population.
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Passive surgical implants, those that do not include electronic components, are a cornerstone of modern medicine for the treatment of trauma and disease. Examples include joint replacements, fracture plates/screws, spine fusion devices, dental implants, and sports medicine soft-tissue anchors. In the UK, one out of every ten surgical procedures involve a passive implant. For the half million orthopaedic implant procedures undertaken in the UK each year, the treatment is open loop: patients receive an implant, are screened postoperatively for any anomalies, and then discharged home. Demand is increasing as the population ages, with these statistics mirrored worldwide. There are unmet clinical needs for: 1) Faster recovery, getting people back to work, recreational activities or independent living sooner. 2) Reducing revision burden, for better patient outcomes and a more financially sustainable healthcare provision. 3) Digital triaging, for more efficient workflows that give peace of mind to the majority and ensuring timely care for those in need. Active implants, with embedded electromechanical systems, could meet these needs. The implant could stimulate tissue growth into and around implants (meets need 1), provide a non-invasive therapy to avoid loosening or enhance infection treatment (meets need 2), and provide meaningful implant data to underpin digital triaging workflows (meets need 3). Innovation is needed to develop such technology, focusing on low-cost solutions suitable for high volume use. The aim of this fellowship is to develop controllable active therapies that can be delivered by an orthopaedic implant. The research will explore the functionalisation of implants with miniature low-cost electromechanical systems. The objectives are to: 1) Analyse the effects of implant design on deliverable stimulus. 2) Investigate how bone structure affects the apparent stimulus experienced by cells. 3) Research how bone cells respond to stimulus. 4) Develop a mechanistic understanding of how human bone responds to stimulus. 5) Explore how stimulus can be used to disrupt biofilm. If successful, this fellowship will lead the transition from passive to active implants, defining future goals for the wider field. A future where active implant therapies are tuned for individual patients to shorten their recovery time. Non-invasive therapies will become possible for those at risk of implant failure, and a reduced revision burden and digital triaging will enable more financially sustainable healthcare systems.
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