Hot topics, future research and a lively panel discussion were the order of the day at the annual Biomechanics Symposium at the University of Bath, says Tony Miles
The Centre for Orthopaedic Biomechanics, in the Department of Mechanical Engineering at the University of Bath, celebrated the tenth anniversary of its annual Biomechanics Symposium on Monday 15 September 2014. The Biomechanics Symposium, which was entitled ‘Current Issues and Future Opportunities in Orthopaedic Research’, attracted over 90 attendees from around the world, including the USA, Switzerland, Germany, Italy, the Netherlands and the UK. The attendees included orthopaedic surgeons, industry representatives and academic researchers. Eight companies sponsored the Biomechanics Symposium and exhibited their products throughout the day.
The one-day event, which was held in the new Chancellors’ Building, consisted of four sessions, each introduced by a keynote lecture delivered by a distinguished speaker. The four speakers were Professor Philip Noble from the Baylor College of Medicine (Houston, USA), Dr Oliver Kessler from the Centre for Orthopaedics & Sport in Zurich (Switzerland), Professor Marco Viceconti from the University of Sheffield (UK) and Professor Gordon Bannister from the University of Bristol (UK).
Philip Noble addressed the subject of treating patients as individuals by focusing on their specific expectations. He highlighted that there is little evidence to suggest that an individual’s satisfaction following an orthopaedic procedure correlates with population outcomes. He went on to suggest that the recent focus on patient-centred advances in orthopaedics is one way of creating specific diagnoses and treatment plans, to ensure that the outcomes are both evidence-based and relevant to the priorities of the individual patient.
Oliver Kessler introduced a new hydrogel biomaterial formed from the structural protein silk fibroin, which is extracted from commercial mulberry silk fibres and can be formed into porous tissue scaffolds. These scaffolds could be used to repair defects in both the meniscus and load-bearing articular cartilage. The properties of fibroin make it well suited for use as an orthopaedic biomaterial as it can be modelled to provide a precise fit for target defects. He presented results of in vivo ovine studies which demonstrated the material’s promising performance when used in both meniscal and articular cartilage repair.
Marco Viceconti discussed the potential use of in silico methods to assess orthopaedic devices. Regulatory agencies, such as the FDA, are starting to consider computer simulations and in silico clinical trials as an additional aspect in the approval of new medical devices. Therefore, it is important to review previous computational biomechanical studies used for joint replacement and identify gaps and potential for future research. This would help to define future research agendas, enabling the creation of standardised methods. His review of current work showed that when surgical simulators are used to capture inter-surgeon variability, taking into account both patient- and surgery-specific determinants, it is possible to predict the common failure scenarios observed following joint replacements.
Gordon Bannister set the scene for the final session with a provocative talk about the impact of poor governance. A primary example related to the cemented flatback Charnley stem and high-density polyethylene cup, which was first implanted in 1962. The Charnley had a revision rate of 6% after 10 years in North America and South Africa. The principal causes of failure of the device were fractures of the stem and radiological loosening of the cup. Many modifications of the original Charnley hip were produced by orthopaedic companies but none resulted in any significantly improved longevity, and the price paid by patients in whom these experimental implants failed was high. He highlighted the fact that inadequate governance, aggressive advertising, a gullible market and the inadequacy of pre-clinical mechanical tests have all contributed to avoidable complications in the past.
A broad portfolio of papers, highlighting current hot topics and defining future research agendas were presented in the first three sessions. As always, the highlight of the day was the panel discussion in the final session where current issues and future prospects of orthopaedic research were discussed and debated. Professor Tony Miles, the Director of the Centre for Orthopaedic Biomechanics, said: “This was the certainly most successful Biomechanics Symposium hosted by the Centre and the new Chancellors’ Building was an ideal venue for the event”.
Keynote speakers and session chairs: Nick Bishop, Oliver Kessler, Grey Giddins, Tony Miles, Andy Toms, Christina Doyle, Gordon Bannister, Philip Noble and Marco Viceconti
Professor Tony Miles is head of the Department of Mechanical Engineering and director of the Centre for Orthopaedic Biomechanics at the University of Bath.