What are the remaining “Unmet Clinical Needs” in Orthopedics?
I am publicly compiling a list of “Unmet Clinical Needs” in Orthopedics. No agenda. Just trying to help move orthopedics forward. This list is open source and for everyone. Here is the permalink – https://orthostreams.com/2021/03/unmet/
#1 – Non-permanent implants for trauma and extremities. (Ossio is working on this).
#2 – Joint replacements that never need revisions. Bearings that never wear out. Bio-integrates forever with bone. (there are ~300,000 joint revisions performed in the US each year).
#3 – An ankle replacement that actually works.
#4 – The 4-part proximal humeral fracture in fragility patients. (The toughest problem in trauma. Patients are never happy. Surgeons are never happy with results.)
#5 – Meniscus repair that lasts. (Active Implants is working on a total meniscus replacement).
#6 – Cartilage repair that lasts forever.
#7 – Extend the life of a growth plate (physis) in a child.
#8 – Early detection and reversal of osteoporosis. (OsteoApp is doing the first part of this).
#9 – Closing large annular defects following lumbar discectomy to prevent re-herniation while enabling surgeons to preserve the disc (Intrinsic Therapeutics has brought a solution).
#10 – Modularity in ALIF cage design to allow for uncoupled height and lordosis as well as coronal correction. (Axis Spine is bringing this solution to the US market).
#11 – Slowing OA disease progression. (Early research with the prolonged mechanical separation of the bones at the joint for treatment of end-stage osteoarthritis, eg: delaying joint replacement surgery.)
#12 – Rotator cuff tears, especially full repair of massive tears.
#13 – Lower the 25% death rate within one year of elderly hip fractures.
#14 – Prediction of infection following a TJR.
#15 – Osteonecrosis/AVN, both etiology and a biologic treatment
#16 – Interpositional implants to buy early OA patients decades of time before the TJR. (Notes: Unispacer was a good start, but pulled in 2011. NuSurface not approved in the US).
#17 – Natural repair for tendon and ligaments. (Biorez is working on this).
#18 – Nucleus replacement. (Orthoson is working on this).
#19 – Right-sized implant solutions for kids (Orthopediatrics and WishBone are working on this).
#20 – Wireless cameras for arthroscopy (Lazurite is working on this)
#21 – Prevent hip fractures from falls in the elderly (Tango is working on this)
#22 – Software for robotic total knee replacement that allows kinematic/restricted kinematic alignment, linked to patient outcomes and machine learning. (submitted by Dr. H. Gene Dossett @ Mayo-Phoenix)
#23 – Non-surgical management of scoliosis in adolescents is typically done with Boston braces that are hard turtle shells. Boston braces hurt, do not correct the curve, inhibits kids from eating or breathing correctly, muscle atrophy and compliance is terrible. [Green Sun Medical is working on this with the Whisper solution.]
#24 – Early monitoring of aseptic/septic loosening, and fracture healing around implants. [OrthoDX is working on sensor without batteries for precise measurement of micro-motion between hardware and host bone.]
#25 – ACL repair without the need for harvesting (harm to patella tendon or hamstring) or allografts (quality issues). Miach Orthopedics is working on this.
#26 – Fragility Fractures in the Pelvis (FFP) – only 10,000 FFP US patients are treated annually out of the 100,000. [ CurvaFix has developed an implant that follows a patient’s unique shape and stabilizes fragility fractures of the pelvis.
#27 – Printing cartilage in the patients cells for unlimited grafts and no morbidity – [CellBricks is working on this].
#28 – Predicting the risk of surgery complications with DNA sequencing. For instance, sensitivity to cobalt chrome or titanium. [ExplantLab is working on this with a simple blood test].
#29 – Adjustable Arthroplasty post-op. Arthroplasty implants that can mechanically (or otherwise) adjust their position/alignment, yrs post implantation. e.g. in case of changes in spinopelvic alignment, an implanted acetabular shell would sense load changes, send an alert, and be remotely adjusted to new optimized position to reduce potential for wear and/or dislocation.
#30 -Infection is the number one cause for revision arthroplasty according to the registries around the world. The mortality rate associated with PJI is higher than several common forms of cancer. Reducing historical complication rates in total joint replacement suggests past improvements (bearing surfaces, technology-assisted surgery) are improving implant survivorship. However, the infection problem remains unsolved.
#31 – A total disc replacement designed to replicate the natural biomechanics of human discs while providing reliable long-term clinical outcomes. The primary drawbacks of disc replacements include the risk of mechanical failure or subsidence into the vertebral body, particularly in cases of poor bone quality or improper implant positioning. While designed to preserve motion, disc replacements can still lead to adjacent segment degeneration and stress on facet joints, similar to fusion procedures. Success heavily depends on accurate patient selection, with conditions like osteoporosis or multilevel disease often disqualifying candidates. Additionally, long-term data on implant durability and outcomes are limited, and the procedure requires precise surgical execution, which adds complexity and risk. (suggestion from Subash Manannal)
