Rapid innovation continues in orthopaedic technology

With interest in orthopaedic technology trends remaining high, organiser UBM Canon plans to build on the success of last year’s event. OrthoTec Europe 2011, to be held in Zürich on 28 and 29 September 2011, will focus on development and production, bringing together businesses from all parts of the industry.

Large numbers of patients worldwide owe their quality of life to innovations in orthopaedic technology and treatment. Researchers and manufacturers are working intensively on improved materials and processes, new technology, and knowledge transfer from related areas.

For example, tomorrow’s intelligent implants will be much smaller, but more complex and versatile. They will be designed for maximum compatibility with the human physiology, offering greater medical benefit to patients and avoiding the stress of follow-up operations.

Aurore Domange of UBM Canon, who is responsible for managing the event, says: “OrthoTec Europe offers designers and manufacturers a chance to share knowledge about the future of orthopaedic products, right in the heart of Europe.” The event comprises a two-day exhibition and accompanying conference.

Future medical technology, particularly in orthopaedics, will increasingly combine biological ingredients with implant hardware. New implants, such as resorbable scaffolds, are specially designed for this purpose. Yves-Alain Ratron, director of global research at Tornier in Saint-Ismier, France, says that any orthopaedic implant could be seen as a framework for tissue structure replacing or complementing muscular or skeletal functions.

eDisc, a spinal column implant with over 100 components, fits into a space of less than two cubic centimetres.

Unlike long-term titanium and other solutions, resorbable implants will boost cell activity to facilitate and accelerate healing. For example, flexible, tissue-like products will be used to repair tendons because they support mechanical stress at the beginning of the healing process. Coatings and other specialist treatments support cell adhesion to encourage implant bonding and tissue growth and regeneration. These cell carriers gradually break down during the healing process.

A great deal of research is also being carried out into cartilage replacement, which Yves-Alain Ratron describes as “a hugely complex task”. Intelligent implant technology will provide and respond to feedback on stress, movement and wear, help to prevent adverse events, and allow doctors and patients to monitor them more effectively and take prompt rehabilitation or other measures.

But, as Yves-Alain Ratron points out, predicting what intelligent implants will be able to do before they even exist is a risky undertaking, just as was the case with smartphones. Also, he says, it is still not clear whether the technology is sufficiently mature to be used in all implants at reasonable cost. “As with so much other technology, there will be a market for intelligent implants as soon as they become sufficiently cost-effective.”

Another company represented at OrthoTec Europe, the contract manufacturer and designer Valtronic, is developing high-quality precision microelectronic tools for the intelligent implant market. These will provide biofeedback by monitoring the patient’s condition and sending details to the doctor. Valtronic, which has a great deal of experience in this area, has managed to fit the electronics for the eDisc, a spinal column implant with over 100 components, into a space of less than two cubic centimeters. The eDisc will allow doctors to monitor and control the progress of healing after surgery.

Intelligent dental implant technology has also been used for patients with xerostomia, a disorder affecting saliva production: a microchip screwed into the oral cavity detects low saliva levels and stimulates increased production.
Apart from intelligent implants, electronics can help to make instruments more effective. One example is the wireless handheld PediGuard, developed by SpineGuard, which measures electrical conductivity during pedicle screw placement.

Many new developments in orthopaedics are attracting particular attention. Dr Urs Schneider, head of the orthopaedics and locomotor systems department at the Fraunhofer IPA contract research organisation in Stuttgart, says these include “individual knee endoprostheses, with all their pros and cons, disposable instruments such as hip rasps, and intelligent holders which will reduce staffing requirements and make surgery less invasive, and complex titanium-alloy hip-socket surfaces made using additive manufacturing technology.”

Schneider says that while a huge amount of new orthopaedic technology is being developed, some areas are evolving more quickly than others. In his opinion, the growth rate depends very much on the product, and ranges from 4.5 percent to over 15 percent a year.

A formed and CNC-machined macrostructure used to increase the primary stability of a Ti-6AI-4V shell. These macrostructures are much cheaper to make than Ti plasma coatings.

Patients and doctors benefit from innovation. For example, improved surface design leads to better ingrowth, and Yves-Alain Ratron says that this has much to do with rapid advances in nanotechnology, with surface coatings being used as carriers for biologically active molecules. “Probably one of the most interesting developments in this area is antibacterial coatings that release drugs to reduce the risk of infection.”

Biological materials are important because they open up new treatment options for patients and doctors. Metals and polymers can be used to make screws, nails and artificial implants, while newer materials such as bioresorbable poly(lactic-co-glycolic acid) (PLGA), pyrolitic carbon and human-tissue-based additives are among the products now available to technologists. This wider choice of materials means, for example, that prostheses can be more easily adjusted for elasticity.

“Lightweight materials make orthopaedic technology more comfortable, and simulation know-how makes it easier to design and develop implants“, says Urs Schneider, who will be co-chairing two events at the OrthoTec Europe conference: one on advanced production processes for orthopaedic implants, and the other on potential drivers of future orthopaedic technology. These will discuss new resorbable and non-resorbable implant production, and various aspects of simulation in development, including hygienic design and improved operating-theatre efficiency – issues which could potentially make orthopaedic surgery much easier in the future.

On the first day of OrthoTec Europe, Dr. Urs Schneider will give a presentation on Brazil’s fast-growing market for prostheses, implants and other orthopaedic products. He says the country offers real opportunities for European medical technology companies, but there are still some issues which need to be ironed out in the medium term.

Until now, most of Brazil’s medical technology has come from the United States and Europe, but a number of local joint ventures are now taking shape. His organisation, Fraunhofer IPA, has carried out a study of the Brazilian market, including the possibility of supply cooperation, and he says there are plans to establish a joint orthopaedics innovation centre. The conference also includes a presentation on hybrid manufacturing by Dr. Martin Schmidt, head of international markets at Jossi Orthopaedics Ltd. in Islikon, Switzerland. This method promises significant potential savings in materials and processing costs. His company is a contract manufacturer of orthopaedic and trauma surgery components and instruments using a wide range of metals and polymers. It has gained ISO 13485 certification, and offers development and production services from idea through to packaged sterile product.

Hybrid manufacturing is a combination of forming and machining processes, with sheet materials being formed into shapes as close as possible to the finished product so that minimal machining is required. It is particularly suitable for complex expanded structures with thin walls made from expensive materials. Orthopaedics companies incorporate Jossi’s technology, such as thin shells for metal backs, within their own implant designs.

A microchip in the oral cavity identifies low saliva levels and stimulates increased production. It is fixed in place using a special screw.

Large ball diameters for artificial hip joints give increased freedom of movement and a reduced tendency to dislocation. Because sliding surfaces made from materials such as CoCr and ceramics must have a specific thickness, designers are trying to use very thin osteoconductive metal backs to reduce wall thickness. Making these from bars or forging blanks requires a great deal of time and materials, so alternative production methods are being sought. “Hybrid manufacturing allows thin-walled shells to be made at low cost,” says Dr Schmidt. Even macrostructures such as fins and barbs can be formed, and a coating can be applied either as an alternative or additionally. The shells, some of them less than one millimetre thick, are mostly made from Ti-6AI-4V. The metal back can be fitted to the sliding surface in-house, since Jossi Orthopaedics offers all the technology under one roof.

The artificial hip is still a milestone, paving the way for modern orthopaedics and showing that progress is limited only by the imagination. OrthoTec will provide a comprehensive picture of the future of implant technology: in the words of Yves-Alain Ratron, “anyone with a specific interest in this area will find it a valuable source of information, ideas and potential cooperation opportunities, all of which will help to make implants even better.”

German Summary
Das Interesse an Trends in der Orthopädietechnik ist ungebrochen groß. An den großen Erfolg des vergangenen Jahres will Veranstalter UBM Canon am 28. und 29. September in Zürich anknüpfen. Die entwicklungs- und fertigungsorientierte Fachveranstaltung Ortho Tec Europe 2011 bringt all diejenigen Unternehmen zusammen, aus denen sich die Wertschöpfungskette der Orthopädieindustrie zusammensetzt. Hochkarätige Referenten bieten im Rahmen des begleitenden Kongressprogramms strategische und technische Informationen über die Marktentwicklung, neue Fertigungstechniken, Qualitätsmanagement und die Gestaltung von orthopädischen Geräten. Der deutschsprachige Beitrag ist nachzulesen auf www.meditec-international.com/medi0411ortho