The University of Southampton

Author: Charlotte Mercer

Fancy a joint? Should age be a factor for joint replacements?

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From the perspective of someone who always found the human body intriguing, I never expected my own to become the subject of my fascination. Replacement joints helped make me feel 16 again and I could not imagine being told there was nothing that the doctors could do. This as well as the prothesis lecture by Alex Dickinsons guided me to look into the different types of surgery’s, how long they last for, and the statistics behind young patient joint replacements?

Joint replacements: What are the different types?

These are the parts that make up a hip replacement

Total Hip replacement: This procedure involves the removal of the femoral head and the cartilage that lines the socket, replacing them with a metal implant that extends into the femur and a plastic lining that is placed into the socket. The implants have three types: metal-on-plastic, ceramic-on-plastic, and ceramic-on-ceramic, each with their own advantages. Additionally, hip replacements can be cemented or uncemented, depending on the patient’s needs.

This is what a resurfaced hip looks like

Hip resurfacing: This is a procedure that occurs when the femoral head is trimmed and capped with a smooth metal shell. This is an alternative to a total hip replacement, recommended for younger patients. This is due to less damage occurring to the bone, preserving bone quality, and increases levels of activity when compared to a total hip replacement.

Advancements in hip replacement surgery: A personal perspective…

Due to experiencing a full hip replacement, I was inquisitive to see the procedure from a surgical point of view. This prompted me to reach out, which provided me with the opportunity to watch a total hip replacement surgery. This was very educating and I found it crazy that patients now experience this with only a sedative and nerve block as well as usually leaving hospital after a day. When I had my hip replacement I was fully sedated, had a nerve block, and stayed in hospital for five days. With my surgery they cut through the glute muscle, whereas with the surgery I saw they moved the muscles out of the way. This can, and has sped up recovery time. For there to be such a change in 5 years, it has made it clear that medicine is always advancing, so why should the age range for a procedure not change?

This is my hip replacement 6 weeks after surgery

Why is there usually an age requirement for hip replacements?

The reasoning behind the lack of young patients with hip replacement was due to the lifespan of a prothetic joint, meaning patients may need the replacement revised later in their life. Only so many revisions can occur due to the bone quality. This means that there is only a certain amount of replacements you can have. typically the younger the patient the more replacements needed. However due to the materials used lasting for longer than ever more young patients are able to get replacement joints.

This led me to look into patients with hip replacement and the statistics for young hip replacements, in April 2021-March 2022 for every 100,000 hip replacements 0.8 were aged 10-14 and 3.1 were aged 15-19.

My Thoughts…..

Hip replacements are designed to help people stop being in pain, so why are we preventing that? My hip replacement was the best thing to happen to me and I am so much happier for it. I think that hip replacements should be offered to younger people when needed. People should not be told they are too young to receive medical treatment!

Printing organs: how long till we can replace heart transplants with stem cell printed ones?

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Organoids: what are they and how are they made?

Organoids are a three dimensional miniaturised version of an organ or tissue that are derived from stem cells.

Heart organoids look like the the picture on the left, and act and function like a heart does.

These heart organoids that have been engineered from stem cells can be used for a variety of research as well as have medical applications.

Heart organoids can be used for disease modelling, especially coronary heart disease, and can be used to see scenarios which include ventricular septal defects that can happen during maternity. They may also be used for regenerative medicine and tissue engineering, as they can be engineered to produce specific cardiac tissues, that can be used to treat medical issues; such as myocardial infarction and heart failure. The risk of heart failure in the USA has increased to 24% in 2024. This is expected to carry on increasing. At the moment heart failure is treated with either a pacemaker, heart surgery or medication. These measures only help prevent heart failure from worsening. Cardiac organoids can be used to restore the damage on the cardiac tissue as well as restore the damaged blood vessels. This is still in the preclinical stages of testing, however is very promising, but leads to the question of how and where will we get these stem cells that are required to form the organoids?

Stem cells are able to regenerate/differentiate into specialised cell types. There are multiple different types of stem cells, Multipotent stem cells, Pluripotent stem cells, embryonic stem cells and induced pluripotent stem cells.

These all have different functions through the human life and are needed at different times throughout growth.

What is the difference between embryonal and induced pluripotent stem cells?

Embryonic stem cells are acquired from early stage embryos (blastocyst) and are able to differentiate in to any cell type within the body, they have no limitations. However, the use of embryonal stem cells leads to ethical concerns and debates. The testing and growing of embryos leads to multiple questions, when is an embryo considered alive? How long do can this embryo grow for before it becomes a cause for concern? What testing is allowed on the embryo?

I think these questions will always be open for debate, due to there being no definitive answer to any of these questions, so where do scientist draw the line? At the moment there is a 14 day rule, and after 14 days the embryos must be killed.

Should this be extended, reduced or kept the same?

The other type of stem cell that can be used to produce organoids are induced pluripotent stem cells. These are created by altering adult (somatic) stem cells by using genetic factors. The use of induced pluripotent stem cells eliminates the ethical debate that using embryonic stem cells creates.

This video explains how induced pluripotent stem cells are made using transcription factors.

Is stem cells the future of medicine? Will scientists eventually be able to grow organs and use them as transplants? Only time will tell.

References

Aleksandra Kostina, Volmert B, Aguirre A. Human heart organoids: current applications and future perspectives. European Heart Journal [Internet]. 2023 Dec 16;45(10). Available from: https://academic.oup.com/eurheartj/article/45/10/751/7476619?login=true

Delivering cardiac organoids to help the heart to recover after a heart attack [Internet]. Musc.edu. 2025 [cited 2025 Mar 11]. Available from: https://web.musc.edu/about/news-center/2023/06/05/cardiac-organoid-delivery

Bozkurt B, Ahmad T, Alexander K, Baker WL, Bosak K, Breathett K, et al. HF STATS 2024: Heart Failure Epidemiology and Outcomes Statistics An Updated 2024 Report from the Heart Failure Society of America. Journal of Cardiac Failure [Internet]. 2024 Sep 1;31(1). Available from: https://www.sciencedirect.com/science/article/pii/S107191642400232X?via%3Dihub