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Material Scientist Predicts Hip and Knee Advancements

Surgical assistance technologies and services to track episodes of care have dominated joint reconstruction product development conversations in recent years, as players seek to innovate in a space that already claims highly successful procedures and implants.

To better understand the hip and knee trends we’ll be talking about ten years from now, we sat down with Orhun Muratoglu, Ph.D.

His list of credentials includes:

  • Director of the Harris Orthopaedic Laboratory and Director of the Technology Implementation Research Center at Massachusetts General Hospital
  • Professor of Orthopaedic Surgery at Harvard Medical School
  • Pioneer of highly cross-linked UHMWPE and antioxidant vitamin E to further stabilize highly cross-linked UHMWPE

Infections, pain management and dislocation are among hip and knee implant issues that still need to be addressed, Muratoglu says. All of these concerns can be prevented by altering implant material and shape—areas which Muratoglu is researching.

Regarding infections, Muratoglu and his team are working on a two-stage revision in which polyethylene and gentamicin or vancomycin are mixed together and then machined into an implant—for instance, a hip. Following implantation, the antibiotic slowly releases into the joint space, clearing the periprosthetic infection. Once the infection clears, a new device is implanted. An ideal clearance by FDA would be an indication for up to six months use of the antibiotic-added implant.

Similar research is being performed with a mix of bupivacaine with polyethylene to control pain management. The bupivacaine slowly releases into the joint over a period of time to provide pain relief and eliminate the need for opioids or other narcotics.

While Muratoglu wouldn’t cite the level of progress for the group’s research, he did predict that in ten years, such implants will be on the market. He expects that their technology to prevent hip dislocation will be ready much sooner, possibly by 1Q18.

“The way to decrease dislocation in the hip is to increase the head size,” Muratoglu says. “When you get to the really large heads, more hardware protrudes out of the acetabulum. What invariably happens is that some patients experience groin pain, because the implant sticks out and will impinge on the psoas muscle or other soft tissues.”

The answer to this problem, according to Muratoglu, is an anatomically contoured femoral component; think the shape of a mushroom. The femoral heads, known as Contoura, are under development by CeramTec.

The last focus of our conversation with Muratoglu was on the use of PEEK in hip and knee implants. He says that the fallout from metal-on-metal may continue to push researchers and companies to find alternatives to metal replacements. Invibio and Maxx Medical are already working on a PEEK-OPTIMA femoral knee.

Muratoglu’s early research showed that cross-linked polyethylene wear was lower with PEEK than with cobalt chrome. His prediction is that if PEEK doesn’t work, it will be because of fixation and not fatigue issues.

We asked whether ten years is too long to wait for these technologies. His response: “Ten years is nothing in orthopaedics.”