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Future Shock In Orthopaedics
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Future Shock In Orthopaedics


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The future development & its implication in next 20 years in the field of orthopaedic surgery

The future development & its implication in next 20 years in the field of orthopaedic surgery

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  • 1. Orthopaedics → 2020 Vinod Naneria
  • 2. Our Journey 7 million years ago - present
  • 3. Hands & feet of tarsier , Change in shape of dental arches orangu tan, gorilla and man Essential changes Pelvic girdle Changes in skull from ape to human. Arrows position of foramen magnum
  • 4. July 20, 1969 Aldrin stepping onto the surface of the Moon Giant step to moon
  • 5. Leonov’s A quantum leap in space 8th March, 1965.
  • 6. The world is getting Ready for “Future Shock” quot;too much change in too short a period of timequot;.
  • 7. TRUTH? • There is nothing like absolute truth. • Truth is time bound. • Truth of yesterday is not the truth of today and truth of today will not be the truth of tomorrow. Change = Reality
  • 8. WHAT WAS YESTERDAY Trauma and arthritis • Plaster of Paris • Thomas Splint/ traction • Open nailing/plating/ wiring • Bone grafting • Corrective surgery for malunion and neuromuscular disorders • Arthritis – conservative - NSAIDs
  • 9. Why change? • Plaster disease? Prolonged immobilization • Complicated fractures – high velocity • High morbidity and mortality • Infection – antibiotics – drug resistance – another antibiotic • Arthritis crippling deformities and uncontrolled pain and disability
  • 10. What we have today • Closed interlocking nailing/ MIS plating • Illizarov” technique - answer to all • Arthroscopy – diagnostic and operative • Early mobilization and Rehabilitation • Minimal but still infection and antibiotics • Atleast 15 years – 25 lasting arthroplasty for all major joints • Good DMRDs and safe NSAIDs
  • 11. Philosophy of Replacement V/s repair • Disc implantation and Joint replacements • Newer bio compatible materials like ceramics, highly cross linked polyethylene, better design consideration. • MRI, Dynamic MRI, Ultrasound, Isotopes scanning, & Multi-slicer 3D CT scanning. • Image intensifier and key – hole surgery.
  • 12. Tx Between “4 R” • Repair • Replace • Reconstruct • Regenerate Time line
  • 13. Why then Change? • Implant failure common. • Fixing fracture is no guarantee of union. • Who has time to wait for 6 – 12 weeks for fracture union? • Patients expectations, demands and requirements have changed. • Metallurgy can not replace biology. • Arthroplasty failing in young patients
  • 14. What should change? • Any thing which- – Guarantee Healing / union in minimal • Time • Minimally invasive • Minimal risk of infection • Biology should replace metallurgy • Prevention – trauma and auto immune diseases. • Philosophy of replacement than repair Biology —> Biology
  • 15. What is going on? • Tissue engineering • Gene therapy • Bio-compatible material • Early detection of diseases • Better diagnostic techniques • Precision (computer assisted) surgery
  • 16. Tissue Engineering • Regeneration of tissue and the restoration of the function of the organs by the implantation of cells or tissues grown outside the body, or by the stimulation of cells to grow into an implanted matrix. • Articular cartilage defects. • Large bone defects in limb salvage surgery. • Extremely comminuted fractures with boneloss.
  • 17. Nanotechnology a quot;smartquot; implant that can sense and report on bone growth. A titanium surface covered by carbon nanotubes for faster, better growth of implanted bone-growing cells.The nanotubes could even self-reporting, informing about the healing process.
  • 18. Gene therapy • Transfer of a gene is to compensate for genetic defects in recipients suffering from monogenic diseases such as hemophilia. Genes may also be transferred to individuals who are genetically unremarkable but in whom the product of the transferred gene may nevertheless produce a beneficial clinical effect.
  • 19. Gene therapy • In Gene therapy of rheumatoid arthritis, the human IL-1Ra gene is transferred to the synovial lining of the joint by an ex vivo method utilizing a retrovirus. Encouraging pre-clinical data have been obtained for osteoarthritis, bone healing , cartilage repair, meniscus healing and the healing of ligaments and tendon.
  • 20. Year 2020 – Bone healing • Prevention – strict traffic regulation • Precision surgery – Robotic telesurgery – Computer assisted navigation surgery – No infection – no antibiotics • MIS / Key-hole surgery • Bio degradable- bio-compatible, & bio-inductive material.
  • 21. Bone healing • Supplementation with BMP-2 and bio absorbable cement / glue to speed up union • Supplementation by factory made osteoprogenitor cells / stem cells and bone matrix.
  • 22. This micro-CT image provides a detailed look at both the vascularization and mineralization of a bone sample
  • 23. Cartilage • Prevention of age related chondrocyte damage • Replacement of damaged cartilage by cartilage transplantation with factory made cartilage matrix. • Surface resurfacing of damaged cartilage in arthritic joints by cartilage transplantation
  • 24. Cartilage • Identification of genes responsible for collagen disorders. • Correction of gene therapy • Early detection and Immuno-regulatory drugs. • Better understanding of triggering mechanism for increased production of endo morphine level in brain – for pain tolerance and no pain killer. • Computer assisted non cemented bio-compatible implant material for replacement arthroplasty, if required.
  • 25. 2020 and beyond • What we want? – Minimum accidents – Immediate fixation and mobility in polytrauma – NO to all preventable gene related arthritis / musculo skeletal disorder. – Availability of factory made spare parts in cases of loss of limb due to injury or disease – Regaining the natural power of tissue regeneration in cases of tissue loss. – NO to osteoporosis/no fracture risk in elderly – Normal fully enjoyable life, as long as alive
  • 26. Program cell death (apoptosis) Is genetically predisposed, which can be modified by: Changing the environmental factors Increase synthesis of dying cells. All degenerative conditions including aging can be delayed for indefinite time. The best example of it: Certain African community in spite of highly loaded with HIV virus, do not have any effect because of extra production of B-Lymphocytes. Means, there is always a surplus of B- Lymphocytes then the number of Lymphocytes destroyed by HIV virus.  - osteocytes - ↓ - osteoporosis ↑ - Chondrocytes - ↓ - Osteoarthritis
  • 27. Every Homo sapiens will be labeled according to his genotype. That label will be added with his name, making people aware of his genotypes. The best example will be prevention of AVN
  • 28. Journey Continue………….
  • 29. It’s a crime to think small - A.P.J. Abdul Kalam