SUTD-led research sets the groundwork for patient-specific 3D printed meniscus

Even though a significant amount of work and research has been carried out on prostheses and implants, meniscal implants in particular seem to have been significantly overlooked. It was only in 2015 that the first meniscal got implanted in humans during a clinical trial and more recently in September 2019 that the U. S. Food and Drug Administration approved the first artificial meniscus based on clinical trial results. To bridge this research gap, Singapore University of Technology and Design's (SUTD) Medical Engineering and Design (MED) Laboratory collaborated with the University of Miyazaki's Biomechanics Laboratory and developed a novel methodology for the early-stage design assessment and verification of meniscal implants using computational modeling and simulation. This initial-design stage development paves the way for the manufacturing of 3D printed meniscus, which will allow for customized, anatomically shaped meniscus for a more optimal fit for the patient when they have a meniscal implant. Their research paper has been published in IEEE. This new development will provide medical practitioners and industry experts valuable insights into understanding how the remnant hard and soft tissues in the knee joint would react biomechanically should an artificial meniscus be implanted. They can then use this information to evaluate aspects of in vivo performance without subjecting patients as well as animals to potential harm or unnecessary risk. Also, the computational models can be used to evaluate options that would otherwise have been impossible experimentally or clinically. This study could also explain the development of knee osteoarthritis due to increased contact stresses and altered joint kinematics caused by the loss of meniscal tissue. This novel synthetic meniscal implantation approach restores the joint mechanics close to the intact meniscus state and appears to be a promising strategy for treating patients with severe meniscal injuries. The model developed in this study sheds light on the knowledge of joint mechanics after injury or repair, and therefore can also assist in the clinical evaluation of other alternative repair techniques. "This computational model's ability to study the effects of various meniscal implant configurations in a non-invasive manner provides clinicians and researchers with insights to make more informed decisions and enhance implant designs, positioning, anchoring to the bone as well as the choice of material properties. More importantly, it sets the groundwork for the future of patient-specific 3D printed meniscus for implantation," said lead researcher, Subburaj Karupppasamy from SUTD's Engineering Product Development pillar.

Micro implants could restore standing and walking

Researchers are focused on restoring lower-body function after severe spinal injuries using a tiny spinal implant. In new research, the team showcases a map to identify which parts of the spinal cord trigger the hip, knees, ankles and toes, and the areas that put movements together. Vivian Mushahwar, at the University of Alberta, but the Canada Research Chair in Functional Restoration, first wrote about her idea to fix paralysis by rewiring the spinal cord more than two decades ago. Mushahwar is still fixated on the dream of helping people walk again. And thanks to an electrical spinal implant pioneered in her laboratory and work in mapping the spinal cord, that dream could become a reality in the next decade. Because an injured spinal cord dies back, it's not simply a matter of reconnecting a cable. Three herculean feats are needed. You must translate brain signals. You must figure out and control the spinal cord. And you have got to get the two sides talking again. Mushahwar said the spinal cord has built-in intelligence. A complex chain of motor and sensory networks regulate everything from breathing to bowels, while the brain stem's contribution is basically "go!" and "faster!" The spinal cord isn't just moving muscles, it give a person a natural gait. Mushahwar's research has focused on restoring lower-body function after severe injuries using a tiny spinal implant. Hair-like electrical wires plunge deep into the spinal grey matter, sending electrical signals to trigger the networks that already know how to do the hard work. In a new paper in Scientific Reports, the team showcases a map to identify which parts of the spinal cord trigger the hip, knees, ankles and toes, and the areas that put movements together. The work has shown that the spinal maps have been remarkably consistent across the animal spectrum, but further work is required before moving to human trials. "We think that intraspinal stimulation itself will get people to start walking longer and longer, and maybe even faster," said Mushahwar. "That in itself becomes their therapy. There's been an explosion of knowledge in neuroscience over the last 20 years. We're at the edge of merging the human and the machine."

Physiotherapy 'postcode lottery' uncovered

The amount of physiotherapy available following hip and knee replacements comes down to a 'postcode lottery' according to new research from the University of East Anglia (UAE). New findings published Nov. 27, 2019, show that patients are more likely to receive physiotherapy after hip or knee replacement in London and the North of England. Patients in the South West are the least likely to receive physiotherapy. The research also finds a range of other factors impacting whether patients receive physiotherapy – including how old the patient is, their gender and ethnicity. Hip and knee replacements are two of the most common surgical procedures performed worldwide. More than 200,000 were carried out in England and Wales in 2017. This is the first nationwide study to investigate and map the provision of physiotherapy after a knee or hip replacement. The research team studied data from the UK's National Joint Registry – the largest joint replacement registry in the world. They looked at data collected about more than 37,000 patients in their first year after surgery. They studied the amount of physiotherapy received and compared it to factors such as the patient's level of disability, geographical location, age, social deprivation, gender and ethnicity. Lead researcher Toby Smith from UEA's School of Health Sciences, said: "Generally we found that physiotherapy provision was greater following a knee replacement compared to a hip. In the first year after the operation, 79% of people who had a knee replacement received at least one physiotherapy session compared to only 53% of those who had a hip replacement. "But we found that there is substantial variation in the provision of physiotherapy nationally. What we don't know yet is exactly what the causes of this disparity are. Individual patient willingness to seek and take part in physiotherapy may be part of the problem. But we hope that organizations who aim for parity in service provision across the U.K., such as NHS England, Nice and the Quality Care Commission, will act to correct the patient inequality we have shown." “Demographic and geographical variability in physiotherapy provision following hip and knee replacement. An analysis from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man,” was published in the journal Physiotherapy.

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