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PhD: Studentship in Orthopaedic Implant Technology

University College London - London Implant Retrieval Centre

Qualification Type: PhD
Location: Stanmore
Funding for: UK Students, EU Students, International Students
Funding amount: Fully funded (EU stipend and fees)
Hours: Full Time
Placed On: 16th July 2018
Closes: 16th October 2018
 

Primary Supervisor: Prof Alister Hart
Research Site: University College London, Royal National Orthopaedic Hospital, UK.
Funding: Fully funded (EU stipend and fees) 3-year project.
Contact: a.hart@ucl.ac.uk or h.hothi@ucl.ac.uk

Summary

Come and join the exciting area of bioengineering research to help innovate orthopaedic surgical technology. During this fully funded studentship you will work in the leading medical implant retrieval research group, at the largest university in Europe (ranked 1st for Bioengineering), onsite at the largest orthopaedic hospital in the UK.

You will use state-of-the-art imaging, computational and measurement technology and work directly with leading orthopaedic surgeons to optimise implant design and clinical outcome in patients. You will have access to engineering equipment and expertise across all UCL sites (e.g. at Stanmore and central London).

The best orthopaedic engineers are those that can put clinical meaning to their measurements. To train you for this, you will regularly visit operating theatres, multi-disciplinary clinical team meetings (led by surgeons, radiologists and arthroplasty practitioners) and have opportunities to interact with patients. You will develop an understanding of the use of blood tests and imaging (e.g. X-rays and CT scans) in helping to interpret your engineering analysis.

Career Opportunities

You will complete this PhD with: (1) a track-record of peer-reviewed publications, (2) an expertise in implant, imaging and computational analysis methods and (3) an ability to interact with engineers and surgeons of all levels. This unique PhD will offer a strong foundation for building an academic career but equally, your experience will position you very well for a successful career in industry, where clinical knowledge in engineers is sought after (we have worked with all major orthopaedic manufacturers).

Background

The orthopaedic industry has seen a number of high profile implant failures. The largest of these led to the recall of the DePuy ASR hip replacement devices in 2010, having impacted more than 96,000 patients. 8 years following the recall, the surgical, implant and patient (SIP) factors associated with the higher revision rates are still poorly understood.

Similarly, the mechanisms of failure leading to early revision of knee implants are not fully understood. Recent orthopaedic innovations have led to the introduction of several new knee implants with modified geometries, materials, and manufacturing methods; understanding the clinical impact of these changes is essential in assuring patient safety.

The London Implant Retrieval Centre (LIRC) has collected several thousand retrieved knee, hip and spine components. A large subset of these have been collected together with very detailed and complete clinical and imaging data for each patient. This offers a unique opportunity to untangle the SIP factors influencing failure and identify differences between designs.

In addition to understanding devices failures, there is a considerable focus in investigating the clinical and radiological outcomes following surgical reconstruction of massive acetabular defects for patients having under gone extensive revision THR. The surgical management of these patients continues to be extremely challenging and a cost-effective implant solution continues to be an unmet need.

Through recent advances in additive manufacturing technology, 3D printed trabecular titanium implants are now available to the surgeon, with the aim of improving osteointegration. The robust evaluation of the structural outcome of current implant and surgical strategies are becoming essential for the patient, surgeon and health provider. The use of Finite element analysis methods (FEA) by engineers can aid implant design and planning by identifying bone with sufficient quality to optimise implant positioning and identify areas for optimal screw fixation.

Research Questions

The focus and research questions of this research project will be determined based on the research interests and skills of the successful candidate. Suggested topics for a project focused on hip and knee implant retrieval are:

  1. How do implant wear patterns vary between different designs?
  2. What are the surgical, implant and patient factors associated with increased component wear?
  3. Does the tapered head-stem junction explain differences in revision rates between the ASR-XL and ASR hip resurfacing?
  4. What are the factors influencing component loosening and how can clinical imaging inform this retrieval work?

Suggested topics for a project focus on optimising 3D printed implants are:

  1. The use of software for the evaluation bony implant and screw fixation
  2. Planned vs achieved analysis of implant position
  3. Implant design and bony fixation
  4. Osteointegration and implantation analysis / CT imaging implant migration - (CT follow-up)
  5. Post-op FEA analysis, retrieval analysis for implant-associated cause in cases of failure.

Key Milestone Requirements of Project

You will be encouraged to attend UCL courses (e.g. in research study design, good clinical practice, medical statistics, time management, paper writing).

Your thesis will consist of at least 4 well-developed chapters, in addition to chapters discussing a detailed literature review, introduction and discussion. You will be expected to publish peer-reviewed papers for each chapter of your thesis.

Impact of Project

The results of this project will (1) directly impact the management of patients implanted with these implants, (2) inform clinical decision making with implants of other similar designs, (3) help separate out surgeon error from implant design in failed cases and (4) influence changes in future component designs by manufacturers.

Track Record

The LIRC is based on site at the Royal National Orthopaedic Hospital (RNOH) and is leading research in understanding failure in orthopaedic implants. Since 2007, the centre has collected over 7,000 spine, hip and knee components from 27 countries, published 80 papers in peer-reviewed journals with 150 co-authors and been cited more than 1,000 times. The RNOH is the largest orthopaedic hospital in the UK with over 1,500 NHS and UCL staff working together. UCL

There are 300 hip and knee revision procedures performed annually here and 20% of all UK orthopaedic surgeons will have some form of training here. It houses the largest spinal injuries centre in Europe and a £25 million academic centre is planned to open in early 2019.

The successful candidate will join a highly motivated team in the Biomedical Engineering hub, and all research students have access to training and personal development opportunities offered by UCL across a wide range of campuses. The student will interact and build working relationships with other engineers, scientists, orthopaedic surgeons and other clinicians.

   
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