“I’m R&D Director Joint Replacement; in the Symbionica project I lead the team of engineers involved in the design of personalised hip and knee demonstrator cases.”
Tell us more about…MEDACTA!
Medacta® International is a world leading manufacturer of orthopaedic implants, neurosurgical systems, and instrumentation. Medacta’s revolutionary approach and responsible innovation have resulted in standard of care breakthroughs in hip replacement with the AMIS® system and total knee replacement with MyKnee® patient matched technology. Over the last 10 years, Medacta has grown dramatically by taking a different approach and placing value on all aspects of the care experience from design to training to sustainability. Medacta has its headquarters in Castel San Pietro, Switzerland, and is operational in over 30 countries. To learn more about Medacta International, please visit www.medacta.com or follow @Medacta on Twitter.
What are the benefits that the Symbionica machine can offer to the prosthesis market?
The Symbionica technology could improve clinical outcomes through the production of personalised multi-material knee or hip implants based on the specific anatomy of the patient, offering the opportunity to restore the natural kinematic of the articulation. In the meantime, this technology will streamline the production and the delivery of the prosthetic implants, resulting in a significant reduction of the costs. The reduction is mainly due to the removal of the inventories both in industries and the hospitals since the implants printed by the Symbionica machines will be pre-sterilised and delivered a few days before the surgery.
Can you describe the application and the characteristics of your demonstrator use case?
The demonstrator cases involved in the Symbionica project are two of the most popular products, currently available in the market, that replace the damaged surfaces of the hip and knee joints. These products are: the total hip implant, which replaces the hip joint entirely, and the unicondylar knee implant that replaces only one compartment of the knee joint (lateral or medial).
Although the above products currently represent the medical standard for pathologies of the joints such as osteoarthritis, there are several unresolved problems that affect the healthcare of patients. The existing solutions fit the entire patient population through a wide range of sizes designed to minimise the compromise with patient anatomy. In the near future the new 3D printing technologies will become more affordable offering the opportunity to easily personalise each hip and knee implant according to the specific anatomy of the patient and providing improved joint balancing. The new multi-material 3D printing technologies will make possible the production of a “single” solid component made of different parts and materials minimising both stress at the interfaces and debris generation with a reduction of possible risks of tissue reactions and implant mobilisation.
Despite the excellent longevity of total knee arthroplasty, some patients continue to experience functional deficits after surgery. According to the literature, 20% of patients report issues 1 year post-op. One of the main causes of not total satisfaction is related to the implant coverage, that may not fit uniformly the shape of the bone causing overhang or underhang. Overhang occurs when the implant is bigger than the bone surface, which may impinge upon the soft tissues surrounding the knee joint causing pain. Likewise, underhang occurs when the implant does not cover all the exposed cut bone which may also result in pain. The design of customised prosthetic implants will be based on Patient 3D Data that closely matches the natural shape and curves of the patient’s anatomy preventing the issues discussed previously. Dedicated algorithms will convert the images to a 3D model by mapping the articular surface of the joint and defining the area of disease. In Medacta we firmly believe in the efficacy of Patient Specific Solutions and we have developed a patient matched technology called MyKnee®, a patient-specific cutting block which starts from a CT or MRI based preoperative planning and provides an easy way to produce precise bone cuts that are essential to accurately position the implant with respect to the bones. The availability of the Symbionica machine will help to achieve the opportunity presented at the beginning, in fact the production of multi-material monoblock implants will contribute to limit the mechanical stresses at the coupled surfaces. This will also allow the production of personalised multi-material knee or hip implants based on the specific anatomy of the patient.
Medacta’s mission today is to continue to excel in all fields the Company has expanded, with the personal commitment to provide the best possible quality of care. Innovation is our key product, the way to our present and future success. Innovation is the foundation of all our projects; it guides us and is reflected in the originality of our internationally patented products. We truly believe that by providing multimaterial monoblock customised implants, in addition to our patient specific instrumentation, the clinical outcome of the patients could improve considerably. This totally reflects our vision: passion, innovation and medical education to create products and services that improve care and return patients to a life free from pain and disability.
Would you buy the Symbionica machine or would you buy the Symbionica service offered by a third company?
I think we would buy the Symbionica machine to produce both personalised implants and surgical instrumentation considering the multimaterial nature of our products. Furthermore, we will use the Symbionica machine to produce prototypes for the projects of the R&D department where, for example, sensors will be added to the implants.
How does Symbionica impact on your value chain?
The product lifecycle can be significantly impacted by eliminating parts of the current manufacturing process. In fact, the current manufacturing process is based on multiple steps, operations that require a large quantity of equipment and labour (e.g. machining, coatings, finishing compression moulding, etc..). In addition, the current process includes a large accumulation of stock of raw materials, semi-finished and finished products, which has a massive financial impact. Our hope is to drastically reduce the manufacturing process where only one single Symbionica machine will be able to execute the production of the implants on request without stocking the implants in an inventory and reduce significantly the financial impact of the current manufacturing process.
Have you considered the possibility to train engineers or designers in order to create a new generation of high-level specialists in the Additive manufacturing process field?
Well, as I mentioned before, we already use additive manufacturing technology in Medacta for the production of MyKnee® patientspecific cutting blocks, therefore with a specific training programme it is relatively easy to create high- level specialists to further help improve the AM technology field.
Massimiliano Bernardoni, MEDACTA