Background

Osteoarthritis (OA). OA is a degenerative joint disease, typified by a loss of quality of cartilage and bone at the interface of a joint, resulting in pain, stiffness and reduced mobility. The process is not confined to the joint but can involve regional muscles and ligaments. Treatment can be considered non-surgical and surgical. Non-surgical treatment includes exercise, weight loss, physical therapy and medication (e.g. pain relief).

For severe disease, when the non-surgical measures cannot control the symptoms, there is currently no other widely recognised treatment other than joint replacement (including newer designs such as joint resurfacing). OA is the most frequent form of arthritis in humans, and is significantly disabling. Survey data indicates that it affects over 11% of females and 7% of males by the time they reach their mid-fifties, rising to over 33% of females and 19% of males by the time they reach their mid-70's1.

The current global market in joint replacements is estimated to be in excess of €7 billion, with in excess of €2 billion within the EU and the bulk of this is hip and knee procedures for OA. Within the project we will seek to develop early stage interventions for OA, capable of being applied to local defects within the joint, through minimally invasive surgical techniques. OA puts significant pressure on healthcare systems and developing procedures which are minimally invasive and "day case" will reduce this pressure, significantly delay or completely remove the need for a total joint replacement, and significantly enhance quality of life.

 

Vertebral Compression Fractures (VCF). Increased life expectancy is leading to a rise in age related pathologies which often involve the decay of bone quality (for example from osteoporosis) causing vertebral compression fractures. Approximately 35-50% of women and 20-30% of men develop vertebral compression fractures, and approximately 50% of those affected develop multiple fractures throughout their life2. In addition, trauma, bone diseases, and cancers can lead to vertebral fractures and bone loss in younger patients. Vertebroplasty (VP) and kyphoplasty (KP) are two surgical minimally invasive procedures that are now considered the "gold standard" for the medical treatment of VCF.

They both aim to augment and stabilize the weakened vertebral body and KP also aims to restore as much of the height and functional state as possible. VP consists of the percutaneous injection of bone cement directly into the fractured vertebral body. KP injects bone cement into a cavity created in the vertebral body by the inflation of a balloon. The global market in products for VCF is in excess of €400 million, and is growing significantly as a result of the ageing population. Within the project we will develop new injectable bioactive ceramic composites able to stimulate bone regeneration and to deliver specific drugs to the target site.

 

Maxillofacial Bone Fracture Alignment. Maxillofacial bone fractures occur either as a result of trauma or as part of a surgical procedure designed to correct a developmental fault. Fractures of the mandible account for around 6% of trauma cases3, with an increasing incidence of cases seen in the elderly over the last 30 years4, and the global market for maxillofacial bone fracture alignment devices is estimated at €100 million.

The limited anatomical space within the maxillofacial region means that fractures of the bones are usually aligned using internal fixation plates, with correct alignment of the bones to allow correct eating, speaking and the quality of life of the patient post operatively. However, there are a significant numbers of revisions required each year due to post-operative problems associated with current plate designs.

The development of new materials that will reduce the need for these revisions will greatly reduce the economic burden on the health systems and improve the quality of life of the patient. Within the project we will develop new bioceramic polymer composites, which can be manufactured to conform to the patient's anatomy, possess sufficient stiffness and strength to protect and support the broken bone, and which will resorb non-toxically within 24 months of placement.

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