Total knee replacement surgery (TKRS) involves the removal of damaged and painful areas of the knee joint and replace it with specialised metal and plastic. A lecture by Dr. Nick Evans reflected on the disadvantages and problems with prostheses. He highlighted that internal prostheses comes with many issues, such a finite lifespan and can only be used for certain problems. 

With this surgery comes many serious complications of joint replacement surgery, and these include: wound infection, blood clotting, malfunction of prosthesis or nerve injury. Upon reading these statistics, it made me feel inclined to research and find alternative, less invasive treatments for those in need of knee replacements.

Knee osteoarthritis is a degenerative joint disease that breaks down joint cartilage and mostly affects middle-aged and older adults. It is the most common reason for knee replacement surgery, with 4.7 million estimated to have undergone TKRS in 2010. Mobility is significantly reduced and patients often experience constant pain even when resting. It is evident that this type of knee damage can be a burden for those suffering from it and I understand why people consider surgery to resolve it.

Common current treatment options

The most common surgical treatment for knee osteoarthritis is a cemented prosthesis. This is the process in which a layer of bone cement is placed in between the patient’s natural bone and prosthetic joint component. The advantages of cemented prostheses is that bone cement is fast-drying (10 minutes) upon application so there is confidence that the prosthetic is firmly in place, as well as early pain relief. However, with all surgery options, there are drawbacks. These include irritation of surrounding soft tissues and inflammation as a result of cement debris, and breakdown of cement can cause loose artificial joints in which patients would need to undergo another surgery. So if this current treatment for knee replacement is too invasive for the patient, then what other treatments are available that come with less serious complications and disadvantages?

Other treatment options

Something that shocked me was that there are many different alternative treatments for knee replacements. Here are some that particularly stood out to me, and ones that I would consider if I suffered from knee osteoarthritis. 

Cartilage regeneration is the replacement of cartilage instead of the entire joint for joints with limited arthritis. Autologous chondrocyte implantation (ACI) is a procedure that involves taking a sample of the patient’s cartilage cells, growing them in the lab and surgically replanting them into the knee. This may be a treatment offered for those effected by cartilage loss, with this implantation producing good/excellent results in 90% of patients with femoral condylecartilage loss (Minas and Chiu 2000). This may be promising for those who are looking at alternative treatment plans before fully committing to TKRS.

Current research has revolutionised TKRS with a new technique called the minimally invasive total knee replacement (MITKR). This involves smaller incisions than regular TKRS, which requires less muscle dissection and results in quicker and less painful recovery. This approach is said to have potential for dramatically reducing pain for muscles and tendons that have previously been cut during the standard TKRS. These benefits for this surgery has paved the way for less complications like less blood loss during surgery, and increased range of motion sooner after surgery. Overall, this promising and innovative minimally invasive total knee surgery has the potential to be the more commonly used treatment over others like cement prostheses. Video of this procedure can be found here.

Concluding thoughts

As I researched more into the field of alternate knee replacement treatments, I didn’t think that there were this many other forms available. I believe that it is beneficial for those in need of knee replacements to have many treatments available, especially for those that are unsure about fully committing to TKRS due to its invasive nature and serious complications. I personally would choose MITKR over the standard knee replacement surgery if I suffered from knee osteoarthritis, with its promising benefits and minimally invasive nature. With developing surgical treatments, such as MITKR, I will definitely keep up to date on the current and emerging treatments for knee replacements to further enrich my knowledge.

Three-dimensional motion analysis is often used in therapy to observe a pattern of movement in an individual. For example, patients in rehabilitation after a prosthetic leg replacement can be observed to check for any rigidity in movement. Since it’s an upgrade from 2-dimensional motion analysis, which introduced parallax and perspective errors, it’s allowed us to measure the angles in more than one plane in a 3D space. Our lecturer spoke about how this method was used to help her teach piano to her students, and this inspired me to look at the potential uses of this in sports.

How does it work?

The process works by placing a series of cameras around the person and creating a capture volume. The cameras are then calibrated with respect to each other and the room. Markers are placed on the area of interest as well as surrounding it, specifically on any bony areas. these markers can then be followed in each frame of the video as the person moves. The advantage of having multiple cameras is that it allows precise recording of any markers that would otherwise be hidden from a camera. As long as at least 2 cameras could clearly record the marker, we can work out the point and angle of flexion of muscles.

Uses in sports

Motion analysis can also be used for analyzing movement in sports. it’s currently used a lot in sports such as football, which I am very keen on. I have been playing football for a year in university and I think it’s amazing that people can benefit from technology such as this, in order to improve their gameplay. This is often used to train Olympic athletes and help them discover their weaknesses. It is done by creating a skeletal structure of the athlete to match their body shape and size. Trainees are often asked to wear a mocap suit which mimics the athletes’ movements and shows the movement of all the joints. This technology can capture details of movement within milliseconds, allowing coaches to precisely pinpoint the errors.

Another benefit of using this technology is that it can be used in matches in real time to help referees locate the exact movement of the players and call out a fair judgment. I think this is really useful in the field of sports especially since the idea of ‘false judgment’ can start a lot of fights amongst the audience, and with technology to clearly showcase the evidence, it makes the game smoother.

In addition, it can also be used to simulate football players’ movements in video games such as FIFA 22. I really like this game because I feel like it truly showcases the strategies used in gameplay and has refined movements for each character, which adds a sense of realism.

Overall, I really like how improvements in technology transitioning from 2D to 3D motion capture have helped with a wide range of activities, including football, which I’m very passionate about. I hope that technology like this will help the players improve and eventually be introduced into smaller football training camps, to help young aspiring players improve.

References:

For more information, check out this website:

https://www.rokoko.com/insights/motion-capture-in-sport

Ethics in the sciences has always been something that I have been interested in. During our first lecture, we watched a clip from a professor of research saying that he thought ethics was nonsense. The idea that scientists weren’t willing to look at and understand the ethical implications of their work surprised me.

Learning about how over many years philosophers have viewed and explained ethics in such different ways and how in each theory there are flaws. So how do we know what the right theory is? I ponder this question and decide to investigate how ethics are used in decision-making around the allocation of medical devices. How does a medical professional decide who gets what? A specific example of this was the allocation of ventilators during the Covid-19 pandemic. Ventilators are machines, known as artificial lungs, that pump air into the lung. This occurs in a normal breathing pattern allowing for inhalation and exhalation of air. How a ventilator works is demonstrated in the video below. They are used when a person cannot do this themselves. Ventilators are expensive, with the average price being £18,300, and require a high level of training to operate.

The nature of the pandemic meant that there was a huge strain on medical services globally and all the companies developing devices that could be used to help treat this disease. One of the major devices that could be used to help people who were very sick with Covid-19 was a ventilator. Before the pandemic, the NHS had 7,400 mechanical ventilators with models showing that they would need up to 90,000 beds with ventilators to be able to treat the expected number of patients just for Covid-19. This number did not include any other illnesses that might require ventilators, such as accidents, strokes, or flu. With this huge difference between the number of ventilators available and the expected amount of patients needed the decision of who gets them was put onto the doctors.

When I think about having to make these decisions it seems overwhelming and a big responsibility. To try to understand more about how these decisions are made by doctors I spoke to a friend of mine who is a doctor at Plymouth Hospital. We spoke about how decisions are made around treatments for patients. It was interesting to hear the way he spoke about how they take a holistic view of each patient. Asking questions like, how likely are they to survive? What will their quality of life be like after the treatment? And very basic questions such as can they walk up and down stairs, cook for themselves or do the shopping? To get an overview of the patient’s lifestyle before making these decisions. After talking about this it made me understand that to trained medical professionals these decisions weren’t as daunting, they were part of everyday working life. In saying it was clear that if there was an alternative to having to make these decisions that would’ve been better.

During the pandemic engineering researchers at the University of Canterbury, New Zealand alongside medical professionals in New Zealand, Belgium, and Malaysia designed an adaptation to a ventilator that would double the capacity, allowing two patients to be treated by one ventilator. Demonstrated in the video below. This ventilator works in series so the amount of air doesn’t half when delivering to two patients. In series means they pump at different times. A life-saving invention that would help to prevent doctors from having to make decisions about who receives the ventilator. With this technology implemented into the NHS, it would double the number of ventilators available. Going from about 30,000+ ventilators with the potential to treat 30,000 patients to 60,000 patients. This adaptation is low cost as well which also means that it is not met with the issue of expense as ventilators can be very expensive.

With the pandemic in the past and all the lessons we have learned from treatment and management at the forefront of everyone’s mind, I think that technologies like the one from the researchers at the University of Canterbury will become more common. But with this comes a whole new set of ethical questions that will need to be discussed moving forward. As learn more about science and technology I understand that ethics will always be an important part of this industry and I believe it should be a topic that is more widely discussed to ensure that ethics are upheld in all aspects of research.

Having grown up with mild to moderate bilateral sensorineural and conductive hearing loss, I have always worn hearing aids. This sparked an interest in audiology and hearing technology which has inspired me to research the intricacies of cochlear implants, particularly as we will be learning more about this later in the module.

So, what is a cochlear implant….

A cochlear implant (CI) is a device that allows people with severe to profound hearing loss to experience sound by transmitting electrical signals via the auditory nerve. The user interprets these sensations as sound. In contrast, my hearing aids only amplify the frequencies I cannot hear.  

A CI is composed of external and internal components, as illustrated in the diagrams below. External components include a microphone, speech processor and transmitter, whilst the surgically fitted internal components are a receiver and an electrode array.  

The mechanics behind CIs is relatively straightforward. Externally, the microphone transmits sound to the speech processor which converts sound into a digital signal. This signal is sent, using a magnet, via a transmitter to a receiver located under the skin. The receiver circulates signals to the electrode array in the inner ear that stimulates nerve fibres triggering the auditory nerve in the cochlea. As a result, the brain recognises incoming sounds. Remarkable!

A helpful video on cochlear implants is below:

Whilst researching CIs, what astounded me the most was the rehabilitation process. It had never occurred to me just how difficult it would be to adjust to sounds if the user has no hearing memory and therefore struggled when sound was different to what they perceived it might be.

To understand this, I contacted a friend who is profoundly deaf in both ears since she was 21 months old.  She received her left CI at 2½ years and right CI aged 8. Her CI has hugely benefitted her communication with others and listening to music, both of which she previously found challenging.

The hardest part of her rehabilitation process was undergoing years of speech therapy to adjust to the new sounds. To adapt to the second CI, she read her schoolbook aloud only wearing the second CI. After several months she could hear properly through it. However, she found it difficult to adjust to the new directionality of sound introduced by the right CI. Unfortunately, this meant she never fully acclimatised to hearing through both CIs and for that reason she only wears her first CI.

This intrigued me further to investigate what facilitates the rehabilitation process.

According to the British Cochlear Implant Group, rehabilitation is a structured programme, known as auditory training, involving exercises and a Speech and Language Specialist. This helps users to interpret and differentiate sounds, as well as translate words into speech.

Whilst my friend was unable to recall her auditory training, another blog highlighted strategies for successful rehabilitation:

• Commit to daily exercises incorporating them into everyday activities (e.g., listening and repeating categories of words in quiet and loud environments)
• Listen to audiobooks and podcasts altering volume, speed and accents
• Use interactive apps (e.g., Cochlear CoPilot)

My final closing thoughts …

Writing this blog has opened my eyes to the incredible resilience and dedication required by a CI user when adapting to new sounds. Furthermore, a CI is an amazing device that significantly improves the user’s quality of life and therefore socioeconomic opportunities. One paper illustrated a 21% increase in self-reported benefit as well as an average word perception increase up to 53.9% (Boisvert, et al., 2020).

Further interesting links include:

• Rehabilitation – British Cochlear Implant Group (bcig.org.uk)
• Cochlear Implant Surgery Explained | Cochlear
• What is a Cochlear Implant? – Oxford University Hospitals (ouh.nhs.uk)

“Innovation is all about delivering real-life practicality that improves people’s lives” is a quote which I strongly believe, said by the founder of Taska, Mat Jury, and which I think exactly reflects the goal of each scientist in the biomedical field.

Damien Seguin, born and raised in France, is 43 years old and was the first disabled navigator to finish in the top 10 in the Vendée Globe. It is a non-stop and unassisted solo regatta around the world, thanks to which Damien has launched an important message: disability is not a limit, it resides only in the eyes of the beholder, but not in the heart of those who fight against it.
Damien was born with a pathology that prevented the physiological development of his left hand. He has always lived with his handicap, but he has been denied participation in sporting events several times until he was not able to found a team willing to support him in his greatest dream.The boats taking part in the Vendeè globe are IMOCA 60s, 60 feet long and extremely avant-garde. they are built specifically for solo racing and to be able to face the ocean without ever having to call for help from land. Despite his handicap, Damien hasn’t made any particular modifications to his boat “Group Apicil” except for having adapted the so-called “coffee grinder”, the winch column with which the sails are hoisted, retrieved and adjusted: he has a sleeve for hand prosthesis so that the left arm can also be used, but otherwise has the same equipment as the other skippers.

The sleeve was made of carbon, a high-performance material widely used in the nautical industry due to its extreme strength and lightness.
Thanks to Damien’s story, we can appreciate how, through advanced biomedical engineering, it is possible to tear apart the architectural barriers in sports and regain one’s own autonomy and strength. Sport is everyone’s right and that is why research and innovation must be supported and financed.
Prostheses in the sports field vary from the most rudimentary and least expensive like Damien’s to the most complex which can cost up to 60,000 pounds.
But what are the most recent advances in the field of sports prosthesis, and how much innovation has played a significant role in the performance of disabled athletes? In fact, each activity necessitates precise motions, a particular weight balance, and the usage of distinct muscles. As a result, unique prostheses for each activity have been researched in order to favor the athlete’s movements and enhance the comfort.
In the case of water sports such as sailing but also swimming, canoeing, fishing and many others, there is a need to have a support that is waterproof. TASK company is the first in the world to have developed a robust and waterproof hand. Highly technological, all fingers and the tip of the thumb are capacitive and can be used on any common touch screen. In the case of a sailor like Damien, it can be used to use all the on-board technological equipment mainly composed of screens for routing and weather.

This prosthesis can also be used outside sport, for all daily actions, but I believe that in the case of an athlete it can guarantee precision especially in gripping movements which must be quick and stable.
Certainly great strides have been made in the field of prostheses but in my opinion, in the future it will be necessary to achieve a level of comfort and accessibility such as to feel the prosthesis as an integral part of one’s body.

“the world’s first water-resistant prosthetic hand”

I have always been interested in ethical problems; after completing an ethics and philosophy A level I knew I would be interested in the subjects covered in the ethics and law lecture. My mum works for NHS organ and tissue donation, specifically working to improve the way our organ donation system works. This includes the ethical implications that come hand in hand with organ donation. Due to this, I have always been fascinated by ethical issues regarding organ donation.

As soon as I heard about the Alder Hey organ scandal it instilled a great deal of emotion in me, due to the baffling concept of organ removal, retention, and disposal without consent. Especially as a key aspect of the UK’s current organ donation system is based on consent.

What was the Alder Hey scandal?

In 1999 it surfaced that the Alder Hey hospital in Liverpool had been removing various whole organs, hearts, and brains at necropsy from children, without the consent of parents₁ . After the inquiry in January 2001, a singular pathologist named Dick van Velzen was charged with committing malpractice.

As outlined in the inquiry the pathologist removed around 850 organs during or after post-mortem and left them in jars, incorrectly processed and uncared for. Many of which were not histologically examined. 

Reflecting on this information I realised the severity of the Alder Hey scandal. It is difficult to imagine how devastating it would’ve been for parents realising they were denied the opportunity to bury their children whole. For parents processing the unexplainable grief of losing a child, I could only feel pain thinking about how much more difficult the process was made because of the Alder Hey scandal.

What happened as a result of the Alder Hey scandel?

The Alder hey scandal came off the back of the BRI cardiac scandal. Due to the nature and timing of the public release the NHS and government were under a lot of pressure to make a change. The Alder Hey scandal caused a revision of the human tissue act of 1961₂. The revision claimed to remove any confusion between ‘lack of objection’ and ‘informed consent’ which was where the original confusion lay when collecting organs in the Alder Hey scandal. The department of health and royal college of pathologists should instruct all pathologists that written consent is needed to retain tissue samples and organs. Consent must be gained for each organ retained.

The revision of this act also brought to light the lack of training for physicians, when talking to and gaining consent from family members. It is not known how many organs and tissue samples collected before the Alder Hey scandal was as a result of proper consent. This showed the need for change. When looking at laws and medical practice and as our technologies and advancements change our laws and practice should change along with them.

The alder hey scandal was specifically eye-opening to me due to my mum’s background in organ donation, along with my idealistic view of our healthcare system. The Alder Hey scandal definitely shook the nation, however I am hopeful that it helped us define consent regarding organ donation. As discussed in the journal, ‘what have we learned from the alder hey affair?’, this part of history will help prevent unethical practice. Teaching us to update medical laws, as we update medical technologies.

References

1. Royal Liverpool Children’s Inquiry. Report. London: Stationery Office; 2001. www.rlcinquiry.org.uk/ (accessed 2 February 2001) [Google Scholar]
2. Bauchner H, Vinci R. What have we learnt from the Alder Hey affair? That monitoring physicians’ performance is necessary to ensure good practice. BMJ. 2001 Feb 10;322(7282):309-10. doi: 10.1136/bmj.322.7282.309. PMID: 11159638; PMCID: PMC1119560.

Although the title may seem farfetched, we aren’t as far away from this as it may seem. 3D printing is a technology which is rapidly growing, and is perhaps the answer to many problems within science and medicine.

I became fascinated with the possibilities of tissue engineering after a lecture a few weeks ago, which led me to further research some of the current advances and future possibilities in the field.

It has been 70 years since the first organ transplant, which was a kidney. Since then organ transplant has become a common procedure and has saved many lives. However, there is still some problems associated with it. According to a study by Conor Steward, as of the end of March 2022, there was 4,744 patients on the transplant list in the UK. This long list is costing lives everyday, 3D bioprinting can speed up this process and save lives every day.

So how does this work?

There are three key steps in the process:

1. Pre-bioprinting – A Digital file is created to input into the printer, telling it what to make. This is often made using MRI and CT scans of the organ you want to print. The cells are then mixed with a bioink, and imaged to ensure they are suitable for the procedure.
2. Bio-printing – the cell and bioink mixture is placed into the printer, along with the digital file. It is then mixed with a hydrogel as it prints, which is essential in created the structure, as it acts as a scaffold.
3. Post-printing – to further enhance the structure, the cells are cross linked. This may be via UV light or the application of an ionic solution, depending on the structure.

But where are these cells coming from?

Something that shocked me, whilst learning about tissue engineering, was the range of different sources of cells, and the ethical problems associated with some of them.

The cells may come from a donor, which is known as allogenic cells. There is the possibility here to violate two of the most important laws in biomedical research – confidentiality and consent. In addition to this, one of the problems that strikes me is that it does not reduce the possibility for rejection.

Perhaps one of the most controversial sources is Embryonic stem cells. This involves using embryos to derive stem cells for. However it brings up one of the most pressing questions in biomedical ethics – what is the moral status of an embryo.

However, these ethical issues can be overcome by using stem cells from the patient, that is undergoing the procedure. Cells from your own body are referred to as autogenic cells.

When this comes to mind, you may think of taking stem cells from the patients bone marrow, which is widely used. However I was fascinated to hear how umbilical cord blood can be stored, in the case that a person may need stem cells for any reason in the future. Imagine the possibilities of having your own stem cells, ready for use, in case you ever need them!!

3D bioprinting beyond transplantation

Before researching the use of 3D printing, I thought the only use for these organs was transplantation, however as a scientist, I was fascinated with how they are used for research.

The possibilities of the technology are endless, with studies creating beating hearts, pancreases to cure diabetes, and even a new ear to restore hearing! But in addition to this, we can print tumours or disease models to understand the behaviour of cells!

One study that caught my attention was using 3D printing to create mini tumours, in order to create a more personalised and potent treatment for cancer patients. Scientists at the Seoul National University College of Medicine, formulated a range of bioinks from patients with glioblastomas, which the most common type of brain tumour. A range of chemotherapy and drugs where then tested on these tumours, to allow the scientists to understand how best to treat these tumours. The applications of 3D printing in terms of drug development, is something I am excited to see develop in the future.

Where can it go wrong?

Despite avoiding some the ethical dilemmas associated with xenotransplantation or clinical organ donation, 3D printing brings its own range of moral questions associated with it. In order for the techniques to be readily available, there needs to be tight regulations put in place first.

One problem that strikes me, and many others, is the accessibility of these organs and even personalised medicine. With a technique so new, it will take some time to become widely available, so who gets it first? A problem that has arose a lot within medical ethics, is the use of these products for performance enhancement. This may be particularly prevalent within sports, however it applies to everyone. If you had the money to afford these technologies, you would be able to live a longer life or enhance your quality of life. This sounds great, right? But on the other hand, there is the patient stuck in hospital waiting for an organ transplant, with a life ahead of them with a strict drug regime to avoid the risk of rejection. Is this fair?

In order for the technique to work, particularly to begin with, laws would need to be put in place that the technique should only be used for medical practice, in terms of organ transplant. However personalised treatment plans may be a different issue, as it would be highly beneficial in terms of medical practise, however still separates society.

Personally, talking a utilitarian view point, I believe that the benefits of the techniques are huge, and therefore outweigh any possible socioethical issues that may arise. However as stated above, I don’t think it should be used primarily for performance enhancement, until the technique is widely accessible to everyone, as it creates a larger divide in society than there already is.