Dr. Amir Kamali
European Hip and Knee Research Manager, Smith & Nephew
Q: What’s your background?
A: Having completed my PhD in bioengineering at Leeds University, I joined Smith & Nephew’s tribology team in 2004 as a research engineer in Memphis, US. A year later, I moved to Smith & Nephew’s Leamington Spa site in the UK as a research manager with the aim of setting up a hip research & development centre. There with the help of Mr Roger Ashton (Director of Manufacturing and Development), in 2006 we established the Implant Development Centre (IDC). We have since then become one of the most active orthopaedic hip research centers in the UK. Since 2010, I’ve also been managing Smith & Nephew’s European Centre for Knee Research (ECKR) in Leuven, Belgium.
Q: What is the IDC?
A: The IDC is the technological hub for Smith and Nephew’s Global Hip Franchise and is housed alongside the ‘Aurora’ facility where the market leading metal-on-metal technologies from Smith & Nephew are manufactured. The IDC contains high spec research laboratories, hip wear and friction simulators, and cutting edge scientific equipment that make it one of the most advanced total hip arthroplasty research facilities in the world.
The IDC, in partnership with the ABS group (Advanced Bearing Systems) and the Aurora manufacturing facility, is resourced with multi-skilled individuals and equipment to provide services to the clinical community. The IDC is involved in blue sky thinking for both implant design and bearing technology and offers a scientific platform on which to share ideas as well as investigate and solve current and future issues facing the hip arthroplasty surgeon.
Q: Is the IDC an accredited centre for testing implants?
A: The IDC is the only UKAS (United Kingdom Accreditation Service) accredited hip wear and friction simulator testing centre in the world.
Q: Why is UKAS accreditation important?
A: This accreditation means that IDC’s hip wear and friction simulator studies have been assessed against internationally recognised standards to demonstrate the centre’s technical competence, impartiality and performance capability. UKAS accreditation also means that the customers (healthcare professionals) reduce the risk of selecting an incompetent evaluator or more seriously, acting upon invalid results.
Q: What research has been carried out that surgeons might be familiarised with?
- Physiologically relevant hip simulator testing: the IDC team initially carried out a step activity monitoring study on young and active patients in order to investigate these patients’ daily activities. The results from that study were then utilised to develop a more physiologically relevant hip simulator test protocol.
- Heat treatment of CoCr metal on metal hip devices: Using its novel and physiologically relevant hip simulator test protocol, the IDC researchers have demonstrated for the first time that the as cast CoCr devices perform better in terms of wear than the heat treated CoCr devices in vitro. These results have been confirmed by various clinical studies.
- Edge loading: In a collaborative study with the Oxford group, the IDC showed a direct correlation between edge loaded metal on metal hip devices with high wear and pseudotumour incidence.
- Implant orientation: this study highlighted the importance of implant orientation and showed a correlation between implant mal-orientation and edge loading incidence.
- Effect of clearance: In a unique friction simulator study, the researchers at the IDC showed that when blood is used as lubricant, the low clearance hip devices would generate significantly higher friction than the high clearance hip devices. The high friction in low clearance hip devices may adversely affect their longevity in vivo.
Q: What are the current aims of the IDC?
A: The aim of the IDC has always been the same and that is to keep pushing the boundaries and being the frontier in orthopaedic research.
Q: How has all of this research assisted in the everyday practice of the surgeon?
A: We would like to think that our research work has assisted the surgeons to choose the best implant designs for their patients.
Q: How does a research centre evaluate the quality and relevance of their research?
- UKAS accreditation for the research work that the research centre carries out
- Peer reviewed scientific abstracts and papers
- Number of presentations and invited talks in conferences
Q: What is the ‘Retrieval Analysis Project’?
A: From the design conception of the BIRMINGHAM HIP™ Resurfacing system, forensic analysis of retrieved historical metal-on-metal devices was an integral piece of the puzzle when gaining an understanding of the recipe to success. From the intimate comprehension of this process and continued pursuit for insight, the retrieval analysis project was initiated as a scientific resource in July of 2000 and continued by Smith & Nephew from 2004 with the intention of studying retrieved hip arthroplasty devices to gain a further insight into their function and performance within the body.
Q: What are the benefits of this to the surgeon and patient?
A: In conjunction with clinical information, a picture can be pieced together of the implant’s in vivo performance and in the case of revision, possible causative mechanisms. This in turn can assist the surgeon’s understanding and clinical decision making process. Retrieval analysis also adds to the body of evidence about how current implants function and how to positively affect their longevity and durability, potentially providing benefit to patients both now and in the future.
When retrieved implants are received they are assigned to the retrievals database and given a unique catalogue number for tracking purposes. Objective analysis is then carried out to the surgeons’ request.