Orthopedics- VR, Implants, and Regeneration
Author: Kalter Hali
TLDR
Virtual and Augmented Reality - PrecisionOS and OssoVR offer virtual simulations of operating room experiences
Implant Innovations - Companies like NuVasiv leverage 3D printing technology to improve spinal surgery outcomes
Regenerative Medicine- Products such as MACI use cell therapy to promote healing and improve function
Virtual and Augmented Reality
Augmented reality (AR) is a display technology that combines digital images from the virtual world with the real world. On the other hand, virtual reality (VR) generates digital images and videos to create real visual experiences for users. VR allows the user to transport from the real world to a 3D virtual world. Mixed reality is a combination of these two technologies which integrates 3D holograms into the real world seen by users. This establishes an interactive feedback loop between the virtual world and the real world to enhance the sense of reality and space of user experience. The development of these technologies has provided incredible opportunities for innovation in orthopaedic surgery.
The development of VR is revolutionizing surgical training methods through shifting surgery training from the operating room and cadaveric labs to virtual operating rooms. This is a cost-effective method that provides a low-stakes environment allowing surgery residents to become comfortable with the steps of different orthopaedic surgeries. Products such as PrecisionOS and OssoVR offer users virtual simulations that recreate actual operating room experiences that surgeons face in the real world. The Fundamental Surgery platform also includes real-feel force feedback haptics that is proven to be a more effective way of transferring clinical skills and developing necessary experience. These platforms also provide training analytics to provide learners with objective performance feedback and enable them to measure knowledge, efficiency and accuracy. Relevant to future VR platforms aiming to improve surgical training outcomes, a recent literature review discusses different factors required for the successful integration of VR platforms in orthopaedic surgical training programs (Bajuri et al 2021).
In addition, VR/AR/MR technology allows for the 3D reconstruction of medical images to allow for improved perioperative planning. These images can also be viewed while performing a procedure to allow for the visualization of 3D image-specific anatomy giving surgeons in-depth insights about a patient’s health throughout the surgery. PrecisionOS’ Invision software enables the automatic conversion of the patient’s computed tomography (CT) scan from any imaging system into a 3D reconstruction viewed on an Oculus Quest 2. ImmersiveTouch is another technology which allows surgeons to convert 2D medical images into 3D spatial models by uploading scans into the software. In doing so, the technology allows surgeons to easily view the targeted anatomy and manufacture models needed for surgery, including positioning guides, splints, marking guides, and 3D anatomical models.
Implant Innovation
3D printing in orthopaedics is gaining momentum in the production of customized implants, medical devices and orthotics from diverse materials. 3D printing technology reduces surgery times, saves money, improves the implant's stability, and improves the clinical outcomes of surgical procedures. 3D printing fuses materials together in a layer-by-layer fashion to construct a final 3D product. This technology allows flexibility in the design process and enables efficient production of both off-the-shelf and personalized medical products that accommodate patient needs better than traditional manufacturing processes. There are multiple use cases for innovation in orthopaedics for the use of 3D implants. A recent systematic review discusses the benefits of 3D models in orthopaedic surgery. These include, but are not limited to i) preoperative planning of complex cases, ii) teaching, iii) personalized prostheses that integrate with the unique biomechanical metrics of individuals, and iv) the creation of highly customized implants that perfectly match the patient's anatomy which greatly reduces the risk of implant failure.
Companies leading the 3D printing innovation in orthopaedics include giants like Stryker, Smith & Nephew (spine), Zimmer Biomet (knee) and Medtronic (spine). Spinal implants are among those most commonly 3D printed with NuVasive, Seaspine and Orthofix Medical, Tsunami Medical, and Innovasis launching 3D-printed solutions aimed at improving spinal surgery outcomes.
Taking implant innovation one step further, bioprinting technology allows for the incorporation of living cells and/or growth factors into scaffolds aiming to mimic the structure and properties of native bone. To date, a wide range of biomaterials (either natural or synthetic polymers), as well as various cells and growth factors, have been explored for use in scaffold bioprinting. A recent systematic review discusses the promising state-of-the-art pathways or strategies recently developed for bioprinting bone scaffolds.
Regenerative Medicine
Cell therapy (also called cellular therapy, cell transplantation, or cytotherapy) is a therapy in which viable cells are injected, grafted or implanted into a patient in order to effectuate a medicinal effect. The goal of cell therapy in orthopaedic surgery is to promote healing and improve function in damaged or diseased tissue, which can be caused by a variety of conditions, including osteoarthritis, tendonitis, ligament tears and bone fractures. Several types of cells are being studied for use in cell therapy including mesenchymal stem cells, endothelial progenitor cells, and immune cells.
MACI (autologous cultured chondrocytes on porcine collagen membrane) is an FDA-approved product that utilizes tissue engineering to grow cells on scaffolds using healthy cartilage tissue from the patient’s own knee. It’s used to repair symptomatic, full-thickness cartilage defects of the knee in adult patients which can result from an injury or overuse and general wear and tear. Medtronis’s INFUSE Bone Graft is recombinant human bone morphogenetic protein-2 (rhBMP-2) applied to an absorbable collagen sponge carrier. Through its high osteoconductivity, the product functions to stimulate natural bone formation. CARTISTEM uses allogeneic umbilical cord blood-derived mesenchymal stem cells for the treatment of repetitive and/or traumatic cartilage degeneration.
Overall, regenerative medicine is a rapidly growing field with great potential to improve the lives of patients with musculoskeletal conditions. While there is still much research to be done, the results of early studies are promising and suggest that cell therapy will one day be a viable treatment option for patients.
Further Reading:
Virtual and Augment Reality
https://www.cbc.ca/news/health/virtual-reality-surgical-simulator-precisionos-1.5895914
https://www.frontiersin.org/articles/10.3389/fbioe.2022.740507/full
https://link.springer.com/article/10.1007/s12178-021-09699-3
3D printed implants
https://www.cast21.com/blog/latest-advances-in-orthopedic-medicine
https://www.3dprintingmedia.network/category/medical/implants/
https://all3dp.com/1/3d-printing-orthopedics-knee-hip-spine-implants/
Biologics