Issues of biotribology (wear, lubrication and friction within artificial and natural joints) are truly a European as well as global phenomenon with the deleterious wear related failure of artificial joints running at record levels and predicted to get higher. This European Training Network (ETN) is timely as it is a response to the highly significant economic and patient issues relating to early failure in metal-on-metal total hip and resurfacing replacements. The media have defined this as a significant public health issue and substantial issues persist with very recent reports of inadequate devices. This is a truly European problem with, for instance, new devices manufactured in the UK being first implanted, unsuccessfully, in Belgium, Germany and the Netherlands. The scientific and clinical communities are acutely aware of these detrimental issues and are partaking in a debate which focuses on alternative materials and designs for replacement systems. Furthermore these problems have brought growing concerns from regulatory authorities on how to effectively test new devices, pre-clinically, as the current spate of failures appear not to have been recognised with current standard tests.
The potential impact of these deleterious failures is immense. The need for replacement joints is increasing with 10% of men and 18% of women suffering from osteoarthritis (OA) in the global North. In response to OA, and the aging population more generally, the number of joint replacements has increased in recent years in the EU, with 189 hips and 130 knees being implanted per 100,000 population. More generally, whilst total joint replacements have been a remarkable success in providing pain-free lives with improved mobility, there are still a considerable number of revision procedures that take place.
The recorded failure rate is of the order of 5% at 10 years; with significant differences in performance as a function of prosthesis type as well as other factors; an observation that suggests that implants need to survive longer and be more robust against the variability encountered in vivo. Within the US, these failures in artificial hip and knee joints are approaching 100,000 patients per year, with Europe’s healthcare system showing similar signs of economic stress. Solutions to these needs include new materials that move from the existing polymeric and metal designs. Coupled to this are new generation of soft-tissue interventions which spare the natural tissue, for which there are no standardised method of pre-clinical assessment. Testing of the these materials requires biotribological simulators to deliver a functional assessment which can then be used to enable a comparative exploration of new technologies prior to implantation. Failure to implement adequate pre-clinical testing leads to poor outcomes including the loss in the quality of life and continued disability for the patient.
The overall vision of the BioTrib ETN is:
BioTrib will develop a unique, bioengineering-based, integrated approach to the development of early stage researchers as future research and innovation leaders across interdisciplinary and inter-sectoral domains; this will deliver a step-change in the use of joint arthroplasty technology and their assessment as well as the exploitation of the technology and ideas generated within this ambitious programme.
