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How Game Theory could keep expensive civil cases out of court Press and Media Find an expert News Features Prosthesis for children that can be lengthened within the body as they grow Don't stop moving For those of us lucky enough to be in good health, with full mobility, it’s easy to take our ease of movement for granted. But whether from illness, ageing or an accident, things can change – sometimes overnight. You could easily find yourself struggling to do everyday activities – walking the dog, popping out to get milk from the corner shop, playing sport or a musical instrument. A wealth of research by Professor Gordon Blunn at the University of Portsmouth is finding ways to minimise how much a change in mobility might also change your life. Gordon is a specialist in biomedical engineering. He focuses on the musculoskeletal system – the functional network of bones, cartilage, tendons and ligaments, which allows us to move. His research has made a difference to many lives. For example, in collaboration with the Royal National Orthopaedic Hospital he helped to create a special implant for children with bone cancers. He explains: “We developed an implant that grew as the patient grew. The concept wasn’t entirely new, but what we did was make it a non-invasive technique.” Bone cancers often occur in young children who are still growing. Before Gordon and his colleagues developed the implant, kids would need operations to extend their legs. We developed a bone implant which was able to extend and grow as the patient grew, and that just required a trip to outpatients. The concept wasn’t entirely new, but what we did was make it a non-invasive technique. Professor Gordon Blunn, Theme Professor (Health and Wellbeing) “This meant there was a risk of infection, it was more costly, the patients had to stay in hospital for a couple of days. So we developed an implant which was able to extend and grow as the patient grew, and that just required a trip to outpatients.” This had huge positive benefits for unwell children, by reducing an emotional burden at what could already be a traumatic time. As Gordon says, “It’s quite a big deal.” Today, that non-invasive implant has become a product used all over the world – the effect of Gordon’s explorative spirit spreading far and wide. Driven to make the benefits accessible to people everywhere, Gordon has been involved in developing three spin-out companies based on various research findings. “It’s always very nice to have your ideas translated into something that’s useful for society, and I think that’s more important than the commercial side of things.” New ideas and a new lease of life Gordon’s research is animated by an instinct to pioneer. Working with amputees, he and his team developed a new type of implant which is transcutaneous. This means the implant is locked into the skeleton and projects through the skin, so that an external prosthesis can be attached to it. Why is this so revolutionary? “You see people who run Paralympic races very successfully with prostheses attached to their body with a stump-socket device. They have a stump as part of their amputation, and over that they fit a socket with their artificial leg attached. “But some people don’t do that well with their stump-socket device, particularly patients that have amputations very high up. The reason why is that it sometimes has to be attached by a series of harnesses and straps, which take time to put on and off. In the case of patients with proximal amputation of the femur, this can lead to discomfort in the groin. I’m working with a company that’s producing a bone tumour implant where they 3D print the metal. A lot of these implants are custom-made, because by 3D printing you can design and produce an implant for the specific patient. Professor Gordon Blunn, Theme Professor (Health and Wellbeing) “Sometimes patients gain or lose weight and their socket has to be adapted, and sometimes there’s some rubbing of the soft tissues against the socket which can create sores and infection.” By enabling the prosthesis to be attached to an implant which projects through the skin, rather than strapping it directly against soft tissue, the new solution has a transformational impact on people’s lives. “People who have not worn their external prosthesis for many years are now walking and able to do things they couldn’t before.” Gordon is not stopping there. One of his latest clinical trials is pushing the boundaries of what the very latest technology can deliver in the field of implants. “I’m working with a company that’s producing a bone tumour implant where they 3D print the metal. A lot of these implants are custom-made, because by 3D printing you can design and produce an implant for the specific patient.” That’s not all. The shape, size and 3D printing means you can actually print a porous structure, which is very difficult to produce in metals. This means the bone grows into the porous structure and stabilises the implant. It becomes one. Professor Gordon Blunn, Theme Professor (Health and Wellbeing) “The shape, size and 3D printing means you can actually print a porous structure, which is very difficult to produce in metals. This means the bone grows into the porous structure and stabilises the implant. It becomes one.” If the clinical trials are successful, Gordon will have helped to take the human race one step closer to having mobility-aiding implants which fuse seamlessly into our bodies – giving us a whole new lease of life. Making implant operations safer Gordon has two other new clinical trials on the way. Both have the potential to improve people’s experience of implants. The first project centres on a very small hip replacement. As Gordon explains, “You don’t have to cut off as much bone as you would in a standard hip replacement, and if you do have to revise the implant it’s nowhere near as destructive as if you were to revise a standard hip replacement.” This matters because hip replacements are becoming a victim of their own success. The process is so effective that people are now having them at increasingly younger ages. Around 10% of current hip operations are to replace previous implants, because the debris released by everyday wear and tear causes inflammation. With around 80,000 hips inserted in the UK every year, there’s a lot to replace in future. And with the age of patients getting lower, and people living longer, the numbers are set to increase. Gordon himself has two implants, so he knows how important it is to get to grips with this challenge. He explains the possible impact if clinical trials are successful: “The design is shaped to the specific shape of part of your femur very high up, and it’s coated with a plasma called hydroxyapatite, which is the mineral component of bone you can make in the laboratory. “You’d use it on young patients. It means the revision of the hip replacement will be less disastrous because you’ve utilised less bone initially. With every operation there is a sacrifice you have to make in terms of bone, because you have to take the implant out.” Put simply, people could have more replacements over their lifetime, with fewer negative side effects as less bone would be removed each time. Gordon’s other clinical trial has potential to make implants, like hip replacements, more stable and safe. “We have developed what we call an autologous stem cell glue. It’s a glue which is made from your own blood. “You take your blood and process it into a glue. And you take some bone marrow and isolate stem cells from it, because they have the ability to differentiate into bone cells. We have developed what we call an autologous stem cell glue. It’s a glue which is made from your own blood. You take some bone marrow and isolate stem cells from it, because they have the ability to differentiate into bone cells. Then you add the bone cells to the glue, and spray it onto the surface of a prosthesis. Professor Gordon Blunn, Theme Professor (Health and Wellbeing) “Then you add the bone cells to the glue, and spray it onto the surface of a prosthesis.” Because there are bone cells in the glue, it starts to replicate bone as it fuses together. And there’s more. The infection rate for hip replacements is around 1-2 per cent. It may not sound like a lot, but consider the increasing number of hip replacements, along with the growing number of re-replacements as younger people with implants get older. It’s a time bomb. “If you get an infection, it’s disastrous from a personal point of view because you have to have a re-operation. Some of those can be very complicated. And some can involve a six week stay in hospital to get rid of the infection. It’s very expensive as well. “So we’re incorporating things like antibiotics in the glue. When you spray it on the surface of a prosthesis, not only do the bone cells enhance the bone formation, but the antibiotic releases and hopefully kills off any bacteria locally.” It’s inventive, life-changing stuff. New frontiers in health and wellbeing Gordon was drawn to Portsmouth by a unique opportunity to lead one of our university-wide research and innovation themes – in Health and Wellbeing. “There’s massive potential,” he says. “I want to continue with my research but also utilise my experience to the benefit of other people.” Gordon aims to foster inter-disciplinary research between diverse departments. “Research into health and wellbeing is scattered across the whole of the campus. People in engineering are interested in developing new design concepts and computer modelling to investigate how implants perform in the body. People in pharmacy are developing new biomaterials. People in biomedical sciences are interested in cellular interactions with biomaterials. “That’s specifically about the area I’m interested in, but my remit goes much further. For example, the University has a very active exercise and sports department, and that’s interesting - especially when you are interested in the musculoskeletal system and mobility. There is also huge cross faculty research in the area of mental health and wellbeing.” It’s a priority for Gordon to consolidate the theme in the field of mental health. The University has a very active exercise and sports department, and that’s interesting - especially when you are interested in the musculoskeletal system and mobility. There is also huge cross faculty research in the area of mental health and wellbeing. Professor Gordon Blunn, Theme Professor (Health and Wellbeing) “Wellbeing and health generally are so important. Probably one of the biggest motivators in anybody’s life is wellbeing. You get up in the morning because it makes you feel good. And if you don’t feel good about yourself, I think your health deteriorates and vice versa. If you are unhealthy then you don’t have good wellbeing.” Gordon’s vision for the future of research at Portsmouth doesn’t end there. He also has exciting plans about developing centres of excellence in biomedical engineering, and in health and wellbeing. What’s more, he is keen to tap into the enthusiasm of companies across the UK’s thriving medical device tech industry, to foster collaborations. In collaboration with the University, Portsmouth Hospitals NHS Trust have recently opened a Technology Trial Unit, which translates innovations to help patients at the local Queen Alexandra Hospital. The future may hold many more difference-making ventures, with all kinds of partners. By deepening the scope of inter-disciplinary research and broadening the reach of innovative discoveries, Gordon Blunn and his fellow researchers at Portsmouth will take the differences their knowledge can make further than ever before. 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