The University of Southampton

Author: Oliver Stiles

The Future of Joint Replacements: Robotics and 3D Printing

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Looking back on the topics this module has covered so far this year, joint replacements and its future prospects particularly resonated with me. This is because a few of my family members have had knee replacements and for the most part it has completely changed their lives for the better. However, this is not always the case for people receiving joint replacements, and I believe further research into joint replacements is vital. So in this blog, I am going to explore the current problem with prosthetic joints and the exciting future prospects that have the potential to and are currently revolutionising joint replacements.

The Current Problem

The most common cause of replacement failure and revision of surgery is aseptic loosening, which is the loosening of the prosthesis from bone in the absence of infection or trauma. The main causes of aseptic loosening include Mechanical wear, particle debris, poor initial fixation and bone resorption and with the number of joint replacements surgeries increasing, it is paramount that we continue the research into the causes of aseptic loosening as this can reduce the revision burden. you can read more about the causes of aseptic loosening here: https://www.sciencedirect.com/science/article/pii/S1877132720300385

Robotic-Assisted Joint Replacement

One of the most crucial developments in joint replacement is robotic-assisted surgery. Specialised sensors and software utilised by robots allow for more precise operations. This is because before surgery, it is used to produce a 3D image of the patients joint, therefore giving the surgeon the ability to create a customised surgical plan and the ideal implant sizes for that patient. Furthermore, it greatly reduces the risk of poor initial fixation (one of the causes for aseptic loosening) as the joint prosthetic is better aligned and stable due to the customised surgical plan. You can watch this video, which answers some of the questions around robotic-assisted surgery and how it compares to traditional surgery:

3D Printing: The Era of Custom Implants

Image highlighting how 3D printing has innovated knee replacementsRevolutionizing Medicine: 3D Printed Knee Replacement Innovations

Another revolutionary advancement in joint prosthetics is 3D printing, which is enabling the production of fully customisable prosthetics and the creation of complex surgical models. It further enhances surgical precision, improving patient outcomes and expanding our understanding of what is surgically possible. Some of the benefits already being seen from 3D printing are enhanced fit and comfort, improved biocompatibility and integration, reduced surgery time and minimised complications. Overall, I believe that the 3D printing of prosthetics offers an exciting improvement to patient well-being following joint surgery, but it does raise the interesting question of will the future bring about implants constructed from bioengineered materials that integrate with our body flawlessly? Only time will tell, but current developments of scaffolds and hydrogels show promise. You can read more about 3D printing in surgery here: https://highsurgery.com/3d-printing-in-surgery-customizing-implants-and-surgical-models/

A Future Worth Anticipating

To me, it is clear that joint replacements are beginning to shift from a standardised mechanical solution to a more precise, personalised and effective approach. However, the development of joint prosthetics is far from over, and I believe that it is essential to utilise the continuing technological advancements to better joint replacements to further improve patient well-being post op.

References:

admin (2025). 3D Printing in Surgery: Customizing Implants and Surgical Models – HighSurgery. [online] HighSurgery. Available at: https://highsurgery.com/3d-printing-in-surgery-customizing-implants-and-surgical-models/.

Jones, M.D. and Buckle, C.L. (2020). How does aseptic loosening occur and how can we prevent it? Orthopaedics and Trauma, 34(3). doi:https://doi.org/10.1016/j.mporth.2020.03.008.

Mills, J. (2024). The Evolution of Joint Replacement Surgery: How Technology is Changing Recovery Times. [online] Intelligent Living. Available at: https://www.intelligentliving.co/joint-replacement-surgery-techn-recovery/ [Accessed 28 Mar. 2025].

Ning, L., Gil, C., Hwang, B., Theus, A.S., Perez, L., Tomov, M.L., Bauser-Heaton, H. and Vahid Serpooshan (2020). Biomechanical factors in three-dimensional tissue bioprinting. 7(4), pp.041319–041319. doi:https://doi.org/10.1063/5.0023206.

www.orthoinfo.org. (n.d.). Robotic-Assisted Joint Replacement – OrthoInfo – AAOS. [online] Available at: https://www.orthoinfo.org/en/treatment/robotic-assisted-joint-replacement/.

Embryonic Stem Cells: A Revolutionary Science Caught in Ethical Debate

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Embryonic stem cells (ESCs), derived from the inner cell mass of a blastocyst, are pluripotent stems cells which give rise to all somatic cell types in an embryo. Therefore, making them an invaluable tool in the understanding of complex processes involved in the production of specialised cells and the building of organ structures. The First ESCs were derived in 1981 by two scientists, M. J. Evans and M. H. Kaufman, in which they took 3.5 day old blastocysts from mice and grew them in a cell culture containing mouse embryonic fibroblasts. It was only 8 years later for the first human ESCs to be isolated!

Although, ESCs have high scientific potential, the method of isolating them raises many ethical concerns as they are typically harvested from surplus embryos from vitro fertilisation procedures (IVF)

Applications of Embryonic Stem Cells

The pluripotency and the indefinite self-renewal ability of ESCs has allowed for the in-vitro generation of a limitless number of distinct cell types. This has proved extremely useful in studies relating to early human development and regenerative medicine for degenerative diseases.

Applications of ESCs include but are not limited to the following:

  • Germline Modification – Correct potential genetic disorders by making genetic alterations on the ESCs but this raises many ethical issues.
  • Knockout Mice – Genetically modified mice, in which a specific gene or genes are selectively switched off. This enables studies of gene function and the modelling of human diseases and thus substantial advancements have been made in both genetic research and therapeutic development.
  • Treatment of Degenerative Diseases – ESCs have the capability to treat diseases such as Parkinson’s disease, Alzheimer’s disease and heart disease. This is due to ESCs being able to replace damaged tissues, for example, ESCs being directed to differentiate into dopamine-producing neurons to treat Parkinson’s disease. The added bonus of using ESCs is that there is a reduced risk of immune rejection due to their immature state.
  • Future Prospects of Organ Transplantation – As ESCs have furthered our understanding of how cells differentiate into specialised cells it provides hope for the potential of growing whole organs for transplantation.

The Ethical Debate and the 14-Day rule

Although there are many benefits to the pluripotency of human ESCs, there are also numerous ethical issues around how ESCs originate. This is because ESCs are extracted from human embryos therefore research on human ESCs correlates to human testing. Additionally, areas of research like Germline Gene editing on human embryos has many ethical implications around the breaching of human rights and the unknown consequences of gene editing in people.

To balance scientific progress and ethical considerations, the 14 day rule was established in 1990 under the Human Fertilisation and Embryology Act. This international guideline and key governing bodies like the Human Fertilisation and Embryology Authority (HFEA), restricts researchers from growing in-vitro human embryos for longer than 14 days. However, in recent years many scientists have called for an extension in the limit to enable further studies into early human development, provoking ongoing ethical debates.

Human Embryonic Stem Cells have the capability to transform medicine, whether it’s deepening our understanding of genetic disease and early human development or regenerating damaged tissues. However, the shroud of ethical debates regarding embryo destruction and the 14-day rule restricts their use as a potential source of regenerative medicine. Ultimately, finding and establishing a consensus that allows for both further scientific research and strong ethical standards is key to unlocking the full potential of human Embryonic Stem Cells.

Sources:

Eurostemcell (2018). Parkinson’s disease: how could stem cells help? | Eurostemcell. [online] Eurostemcell.org. Available at: https://www.eurostemcell.org/parkinsons-disease-how-could-stem-cells-help.

Hscn.org. (2023). Why Are Embryonic Stem Cells Useful For Medicine? [2023]. [online] Available at: https://www.hscn.org/post/why-are-embryonic-stem-cells-useful-for-medicine [Accessed 11 Mar. 2025].

Hyun, I., Wilkerson, A. and Johnston, J. (2016). Embryology policy: Revisit the 14-day rule. Nature, [online] 533(7602), pp.169–171. doi:https://doi.org/10.1038/533169a.

Lancs.ac.uk. (2023). Is it time to revisit the 14-day rule? [online] Available at: https://wp.lancs.ac.uk/futureofhumanreproduction/14-day-rule/.

McConnell, S.C. and Blasimme, A. (2019). Ethics, Values, and Responsibility in Human Genome Editing. AMA Journal of Ethics, [online] 21(12), pp.1017–1020. doi:https://doi.org/10.1001/amajethics.2019.1017..

National Research Council (US) and Institute of Medicine (US) Committee on the Biological and Biomedical Applications of Stem Cell Research (2002). Embryonic Stem Cells. [online] Nih.gov. Available at: https://www.ncbi.nlm.nih.gov/books/NBK223690/.

Vazin, T. and Freed, W.J. (2010). Human embryonic stem cells: Derivation, culture, and differentiation: A review. Restorative Neurology and Neuroscience, 28(4), pp.589–603. doi:https://doi.org/10.3233/rnn-2010-0543.