Hip Arthroplasty: Back to the Future?

Patents and intellectual property in orthopaedics and arthroplasty

The provision of musculoskeletal services comes at a cost. This is, in part, due to the expense of patent-protected orthopaedic implants. However, patents have a finite lifespan. Patents of the most successful implants are now beginning to expire. They will be exposed to competition from generic but equivalent implants. The net effect is potentially a dramatic diminution in cost. One company, Orthimo, has taken advantage of this and begun manufacturing generic implants with identical design specifications to the most bio-durable hip prostheses. This will ultimately have a radical impact upon musculoskeletal healthcare provision with regard to cost and accessibility. The expiration of drug patents, with the subsequent use of generic drugs saves £7.1 billion annually in the United Kingdom and $254 billion in the USA. Estimates suggest the introduction of equivalent implants could result in an annual cost saving to the United Kingdom National Health Service of £120 million. Intellectual property remains an enigmatic area of law. It encompasses anodyne principles that seek to protect innovation but are open to manipulation and exploitation. The last decade has seen the emergence of undesirable practices in the medical industry such as "patent trolling". Here we explore patents and their repercussions for musculoskeletal care.

Human Skeletal Stem Cell Response to Multiscale Topography Induced by Large Area Electron Beam Irradiation Surface Treatment

The healthcare socio-economic environment is irreversibly changing as a consequence of an increasing aging population, consequent functional impairment, and patient quality of life expectations. The increasing complexity of ensuing clinical scenarios compels a critical search for novel musculoskeletal regenerative and replacement strategies. While joint arthroplasty is a highly effective treatment for arthritis and osteoporosis, further innovation and refinement of uncemented implants are essential in order to improve implant integration and reduce implant revision rate. This is critical given financial restraints and the drive to improve cost-effectiveness and quality of life outcomes. Multi-scale modulation of implant surfaces, offers an innovative approach to enhancement in implant performance. In the current study, we have examined the potential of large area electron beam melting to alter the surface nanotopography in titanium alloy (Ti6Al4V). We evaluated the in vitro osteogenic response of human skeletal stem cells to the resultant nanotopography, providing evidence of the relationship between the biological response, particularly Collagen type I and Osteocalcin gene activation, and surface nanoroughness. The current studies demonstrate osteogenic gene induction and morphological cell changes to be significantly enhanced on a topography Ra of ~40 nm with clinical implications therein for implant surface treatment and generation.