Daniel Penello, MD, discusses orthopedic technology and what lies ahead.
Question: What trends in orthopedic surgery technology are you most excited about right now? What is on the forefront of the field?
Dr. Daniel Penello: Although we are currently witnessing an era of exciting technological advancements in the fields of robotics and artificial intelligence, I am most excited about the emerging trend of additive manufacturing (commonly known as 3D printing), in the development of patient-matched devices and superior implants.
Surgeons have had access to custom implants for years. Custom implants have helped surgeons treat patients with complex anatomical variances due to trauma, tumor resection or atypical body size. However, the traditional custom implants are time-consuming and resource intensive to manufacture, making them very expensive and impractical to mass produce. The additive manufacturing process has the ability to develop custom implants and patient-specific jigs and targeting devices in a much more cost-effective and scalable way.
Another important clinical application of this technology is the manufacturing of highly complex geometric structures such as porous coatings, detailed surface features and internal channels to improve osseous integration, biomechanical properties and to allow for the incorporation of important biologics into the devices themselves. On an even greater scale, 3D printing technology has an opportunity to drastically alter supply chain logistics with virtually on-demand component printing at the point of service.
Q: What innovations in the healthcare space will make the patient experience better? Where is there room for improvement?
DP: The answer to both of these questions is the field of regenerative medicine. I truly believe that the use of growth factors and stem cells will one day revolutionize the field of medicine. Have diabetes? We'll regenerate Islet cells. Have dementia? We'll regenerate those neurons. One day perhaps, but for now the science is still in its infancy.
Currently, in my field of orthopedic surgery, most physicians employ a shotgun approach when applying regenerative medicine techniques to treat conditions such as chronic tendinopathy or arthritis. Commonly, a collection of various cells and/or growth factors obtained from amniotic tissue, the umbilical cord or the patient themselves is injected into a joint or tissue with the hope that the concoction will stimulate healing of the damaged tissue, be it tendon, cartilage, etc. Although there is research indicating promise in this field, there is much room for improvement.
Tissue healing is a complex process involving numerous biological, biochemical and biomechanical factors interacting at specific points in time. A single injection cannot be expected to replicate this process adequately. Important questions which will need to be answered include: What are the growth factors critical to tissue regeneration? Does it depend on the type of tissue we are attempting to regenerate? What is the necessary dose? What is the appropriate dosing schedule? What is the best delivery method?
Although the evolution of regenerative medicine is expected to be slow, it is immensely important to continue researching and investing in this field as the impact on patients will be vast and life-altering.