EM12: Biomedical Innovation in Osteoarticular Surgery

The Biomedical Innovation in Osteoarticular Surgery group arises from the interest in maintaining collaboration between health professionals and other areas of knowledge in the field of osteoarticular surgery, especially in the fields of engineering and information technology.

The preferred areas of work are additive manufacturing (3D printing) applied to osteoarticular surgery, organizational innovation in the health field and research into results in Orthopedic Surgery and Traumatology (COT).

These areas have been working on for about two years, verifying that they are of great interest for strengthening the research capacity of the professionals who participate in it and the development of stable structures for biomedical innovation in the field of orthopedics, traumatology and engineering surgery.

It has been sought that the lines of work allow obtaining protectable results through the registration of intellectual or industrial property, in the form of patents, utility models, etc., as pertinent in each case. The group is working in collaboration with the OTT-SSPA to coordinate the entire process of valorization and protection of results, having submitted two requests for the protection of results up to now, despite not having received financial aid to date.

The group considers it necessary to direct its work also to the valorization of the results through collaboration agreements with companies and possible exploitation license of the generated patents. For this, two confidentiality agreements with companies and a declaration of interest in the results of an innovation project submitted to the 2019 call of the Ministry of Health and Families have been signed through INiBICA.

• Pablo Andrés Cano:
• E-mail: pablo.andres.sspa@juntadeandalucia.es.
• Researchgate: https://www.researchgate.net/profile/Pablo-Andres-Cano.

• Metallic additive manufacturing applied to osteoarticular surgery. This line, started in June 2018, thanks to the collaboration between researchers from the TEP231 group of the UCA and the university hospitals of Puerta del Mar in Cádiz and Virgen del Rocío in Seville, is aimed at the use of metallic additive manufacturing printers, based on laser sintering of metal alloy powders (Direct Metal Laser Sintering), for the parameterized design and manufacture of surgical instruments and devices with improved properties. In a first phase, the surgical instruments used in COT have been detected that could be improved by manufacturing them by DMLS. Next, the selected instruments have been redesigned in order to reduce their weight, improve their ergonomics, customize their size and modify their shape to incorporate new features. In a second phase, work is being done on the design and development of personalized surgical implants in spinal surgery. To this end, it proposes starting a line of work aimed at the use of metal additive manufacturing printers, based on laser sintering of metal alloy powders, among which is the so-called Direct Metal Laser Sintering (DMLS). Contrary to what happens with 3D printing in other materials, DMLS printers have a high cost and, in addition, they require a parallel infrastructure necessary to carry out the final finishing tasks of the pieces. The Higher School of Engineering (ESI) of the University of Cádiz has a fully equipped metal additive manufacturing laboratory, which is a unique infrastructure in public research centers in Andalusia. Until now, this equipment has had an industrial use and with this project it is intended to make available to the Andalusian public health both the existing infrastructure and the experience that ESI researchers have in the use of this technology.
• COT applications of additive manufacturing in non-metallic materials. Of the different additive manufacturing technologies on the market, the one that has achieved the greatest implementation in the healthcare sector is the so-called FDM (Fused Deposition Modeling). This technology allows parts to be built by fusing and advancing a fine plastic wire through a computer-controlled extrusion head. One of the advantages of FDM technology is that it allows you to use a wide variety of materials with different properties and even combine them in the same manufacturing. In this way, through FDM it is possible to manufacture using different types of plastics, such as ABS, Nylon, PC, ULTEM, PLA, PEEK or PET. On the other hand, this technology is the one that is reaching the greatest diffusion, which allows one to start using the technology making very low investments, being able to obtain quality results at a very low cost. For this reason, FDM technology has aroused a lot of interest in the medical sector and, in fact, additive manufacturing units are beginning to be created in SSPA hospitals, including the HUPM and HUVR hospitals, where part of the researchers in this group. One of the applications that is reaching greater diffusion is the manufacture of anatomical models that are already used as a complement to imaging tests such as computed tomography (CT) and magnetic resonance imaging. They have been proposed for use in advanced COT training, surgical planning, material development, and surgical prototyping. In the bibliography there are several works that evaluate the use of 3D printing technology in COT for the development of personalized surgical guides for shoulder surgery, treatment of complex fractures of various locations.
• Organizational innovation in the health field: MQ-AH process management involves a large set of complex decisions whose result has a high final impact on the quality of care. Through this line of work, it is intended to Develop Support Systems for Decision Making (SSD) for the management of MQ-AH processes. These SSD seek to integrate the decision models and resolution procedures that are determined, together with the hospital information systems (SIH) available in the Andalusian Public Health System (SSPA). These SSDs will not only facilitate the demand management of the MQ-AH scope, but will also provide decision makers with a tool to visualize and manage the use of resources (how resources are distributed among the different phases in the planning horizon). . With this tool it will also be possible to evaluate alternative management policies.
• Research on results in COT: Results research or outcomes research (OR) is the study of the effectiveness of health interventions, that is, to what extent an intervention achieves its objectives when applied under normal working conditions in the health system. Since, generally, the effectiveness of interventions is less than their efficacy, OR studies are necessary, since on occasions, the effectiveness of an intervention or treatment may be null in routine clinical practice. Among the areas of preferential interest for research on results in Orthopedic Surgery and Traumatology, we consider:
  • - The evaluation of the impact of health problems (frequency, trends, geographic variation and identification of risk groups).
  • - Identification of determinants of use of health services and specific interventions.
  • - Analysis of the effectiveness and efficiency of health interventions.

Cirugía Ortopédica y Traumatología (Traumatology and Orthopaedic Surgery)

• Principal Investigators:
  • Pablo Andrés Cano (PI).
• Investigators:
  • Tomás Vela Panés.
  • Juan José Domínguez Amador.
  • Magdalena Casas Ruiz.
  • Javier Tallón López.
  • Nicolás Cachero Rodríguez.
  • Inmaculada Noble Sánchez.
  • Fernando Oliva Moya.
  • Miguel Suffo Pino.
  • Alberto Pérez Cobo (IF).
• Postdoctoral Researchers:
  • Jara Orta Chincoa.

• Consejería de Salud y Familias, Junta de Andalucía, PIN-0053-2019. PI: José A Andrés García. Apoyo a la toma de decisiones en la gestión de listas de espera en la Atención Hospitalaria.

1. Andrés-Cano P, Calvo-Haro JA, Fillat-Gomà F, Andrés-Cano I, Perez-Mañanes R. Role of the orthopaedic surgeon in 3D printing: current applications and legal issues for a personalized medicine. Papel del cirujano ortopédico y traumatólogo en la impresión 3D: aplicaciones actuales y aspectos legales para una medicina personalizada. Rev Esp Cir Ortop Traumatol (Engl Ed). 2021;65(2):138-151. doi:10.1016/j.recot.2020.06.014 (Indexada SRJ: Revista Española de Cirugía Ortopédica y Traumatología 1888-4415 1988-8856 Orthopedics and Sports Medicine (Q3) Surgery (Q3)). Not comply with INIBICA affiliation regulations.