Surgeons hesitant to adopt medical innovations for bone defects

Two million bone transplants are performed worldwide yearly, including half a million in the United States alone. Yet, a QUT-led study has found surgeons are slow to adopt newly developed biomaterials or tissue-engineered solutions.

Published in BMC Medicine, the paper - Lost in translation: the lack of agreement between surgeons and scientists regarding biomaterials research and innovation for treating bone defects - explores why even though biomaterials science, tissue engineering and regenerative medicine has taken enormous leaps in the creation of new medical innovations, the uptake into clinical practise is lagging.

QUT author Dr Stephen Whyte said bone ranked second only to blood in the frequency of transplants, yet some advancements still need to be passed on to patients.

“This high global demand is largely driven by the ongoing challenges posed by bone defects, particularly following trauma or surgical interventions such as tumour excision,” said Dr Whyte, who is a behavioural economist, Senior Research Fellow and Deputy Director of the QUT Centre for Behavioural Economics, Society and Technology (BEST Centre).

“Limitations associated with autologous bone grafts, a procedure where the bone is transplanted from one part of a patient's body to another, is driving exploration into replacements, including allografts, synthetic substitutes, and 3D-printed scaffolds.

“Yet while both surgeons and scientists agree on the importance of developing advanced biomaterials to treat bone defects, surgeons do not appear to embrace them in practice.

“The treatment of bone defects is a clinical challenge associated with high reintervention rates, high patient morbidity, and extremely high associated healthcare costs. A more cohesive interdisciplinary approach would greatly address those issues.”

In collaboration with researchers from Germany’s LMU University Hospital, Aachen University Hospital, and Heidelberg University, as well as the University of Canberra, Dr Stephen Whyte and Dr Ben Chan from the QUT School of Economics and Finance, along with Distinguished Professor Dietmar W. Hutmacher from the QUT School of Mechanical, Medical and Process Engineering, conducted as a prospective website-based survey using electronic questionnaires.

Funded by the Alexander von Humboldt Foundation in Berlin and the Australian Research Council, data was collected anonymously from 337 surgeons and 99 scientists, most of whom are based in Germany.

Professor Hutmacher said the scientists surveyed were significantly more optimistic than surgeons regarding the future replacement of autologous bone grafts with advanced biomaterials or tissue-engineered products.

“Scientists foresee a fundamental change from autologous bone grafts to biomaterial and tissue-engineered solutions, reflecting their confidence in the ongoing advancements within this field,” said Professor Hutmacher, who is Director of the Centre of Regenerative Medicine and Director of the Max Planck Queensland Centre for the Materials Science of Extracellular Matrices at QUT.

“Simultaneously, they expressed the need for a more significant focus on clinical relevance in preclinical studies and regulatory clarity around 3D-printed bone scaffolds.

“Bioengineering and biotechnology have evolved dramatically over the last 20 years, but this surge in scientific knowledge has not been matched by a corresponding increase in clinical implementation that directly benefit patient care. 

“All the participants agreed that witnessing the technology in action was deemed most influential in adopting new bone regeneration methods in a surgical setting.”

Dr Whyte said the study's outcomes highlighted the urgent need for meaningful interdisciplinary collaboration between surgeons and scientists, often referred to as the need to “walk the talk”.

“Our findings underscore the critical importance of aligning clinical needs, research outcomes, and regulatory frameworks to improve the development and implementation of biomaterial-based bone graft substitutes that demonstrate efficacy and efficiency in bone defect treatment,” Dr Whyte said.

“Advancements in automation, speed, reproducibility, and flexibility with small batches, coupled with the potential for reduced manufacturing costs, make the areas of bone replacement products and 3D printing technologies for orthopaedic trauma surgery very attractive in principle.”

Read the full paper online at https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-024-03734-z#Sec11