Periodic Reporting for period 2 - BioTrib (Advanced Research Training for the Biotribology of Natural and Artificial Joints in the 21st Century)
Berichtszeitraum: 2023-01-01 bis 2024-12-31
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.
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.
The overall work conducted throughout this period has been focused on ensuring the early stage researchers (ESRs) have been able to develop the technical aspects required for the network deliverables. All ESRs have continued to work toward a PhD and progress with their individual personal career development plan to completion alongside their research. This includes participating in training and network wide activities including two conference events across the consortium. Secondment activities have all been delivered with ESRs attending several different institutions to carry out and investigate the innovations required advancing the field and achieving the network goals. As novel ideas have been generated by the ESRs and outcomes realised, communication by means of conference talks, posters, and papers has taken place. All network deliverables have been completed and submitted to the REA, subject to the approval of an amendment.
Highlights of the technical results achieved include:
• Advanced understanding of additive manufacturing processes for biomaterials and medical implants through in depth mechanical and biological testing.
• Addressed fundamental tribology and the challenges associated with joint replacements through innovations in computational modelling and surface analysis.
• Focused on soft articulations and the development of bio-printed bone and cartilage materials through a combined experimental and computational approach.
• The development of new materials and testing technology which address challenges of wear and corrosion in hard-on-hard interfaced bearings.
Significant dissemination and exploitation of the research findings and programme in general have taken place in this period. The BioTrib website (biotrib.eu) has been live throughout the period with several thousand visitors in total, various blogs from ESRs on the latest developments in their research are hosted online. A repository of publicly available deliverable reports is also hosted on the website. A total of 43 conference posters/presentations were delivered by ESRs to disseminate research findings, so far three journal publications have taken place with the research carried out leading to a planned total of 44 papers. Exploitation of IP and potential commercialisation of outcomes will be realised based on the planned dissemination activities by ESRs
Highlights of the technical results achieved include:
• Advanced understanding of additive manufacturing processes for biomaterials and medical implants through in depth mechanical and biological testing.
• Addressed fundamental tribology and the challenges associated with joint replacements through innovations in computational modelling and surface analysis.
• Focused on soft articulations and the development of bio-printed bone and cartilage materials through a combined experimental and computational approach.
• The development of new materials and testing technology which address challenges of wear and corrosion in hard-on-hard interfaced bearings.
Significant dissemination and exploitation of the research findings and programme in general have taken place in this period. The BioTrib website (biotrib.eu) has been live throughout the period with several thousand visitors in total, various blogs from ESRs on the latest developments in their research are hosted online. A repository of publicly available deliverable reports is also hosted on the website. A total of 43 conference posters/presentations were delivered by ESRs to disseminate research findings, so far three journal publications have taken place with the research carried out leading to a planned total of 44 papers. Exploitation of IP and potential commercialisation of outcomes will be realised based on the planned dissemination activities by ESRs
Academic impact has been accrued through the start up phase of BioTrib around the sharing of best-practice on recruitment and induction including an agreement between ESRs and the consortium. In a wider perspective all the deliverables have been submitted on time including both "Training and Career Development" and "Exploitation and Dissemination" plans. Within the deliverables ethical issues have been considered and clarified. In terms of the science, four of the consortium members has also had success in the award of a UK Research and Innovation Programme Grant. The grant has three core partners including the University of Leeds and Imperial College London, and involves the addition of Uppsala University and ETH Zurich through the the Global Network component.
The expected scientific and technology impact of the BioTrib ETN includes:
(1) New technologies which improve the articulation and fixation of these artificial joint interventions.
(2) The development of new test methodologies that provide a more holistic approach to the assessment of these interventions including the incorporation of more adverse scenarios.
(3) Communication of this knowledge, where appropriate, to the public and patients to enhance understanding, engender trust in the scientific concept and provide a patient perspective on the research activity.
Wider impacts include enhancing the ESRs career perspectives through career training, exposure to suitable role models and wider soft skills professional development.
The expected scientific and technology impact of the BioTrib ETN includes:
(1) New technologies which improve the articulation and fixation of these artificial joint interventions.
(2) The development of new test methodologies that provide a more holistic approach to the assessment of these interventions including the incorporation of more adverse scenarios.
(3) Communication of this knowledge, where appropriate, to the public and patients to enhance understanding, engender trust in the scientific concept and provide a patient perspective on the research activity.
Wider impacts include enhancing the ESRs career perspectives through career training, exposure to suitable role models and wider soft skills professional development.