Orthopedic Researchers Racing to Find Ways to Improve Knee Replacements (video)

Imagine a time when orthopedic surgeons can turn to high-tech 3-D devices to print out living cartilage cells that can be injected into arthritic knees to regrow healthy cartilage tissue. 

In this episode of San Diego Health, host Susan Taylor sits down with Darryl D'Lima, MD, to discuss the significant work being conducted by physicians and scientists at the Scripps Clinic Shiley Center for Orthopaedic Research and Education (SCORE).

“We’re lucky that working under one roof, one umbrella, one Scripps, we have the capabilities to do laboratory studies, preclinical studies, mechanical testing and clinical trials,” said Dr. D'Lima, director of orthopedic research at SCORE.

SCORE was established in 1983 by Clifford Colwell, MD, an orthopedic surgeon, who in 2004 implanted the world’s first electronic knee, or “e-knee,” into a patient at Scripps Green Hospital.

Dr. D’Lima has conducted extensive orthopedic research using the e-knee, which contains a computer chip that measures forces inside the knee while the patient participates in various activities. His research has led to the development of better knee implants and improved rehabilitation protocols following knee replacement surgery.

At SCORE, Dr. D’Lima conducts research on cartilage injury and investigates new approaches to cartilage regeneration, including 3-D bioprinting, which has been gaining attention in recent years because of the promise it has shown in the artificial creation of human tissue and even organs.

“We can now construct a three-dimensional model of your tissue inside the laboratory. We can construct it in the shape that matches the shape that is needed for the patient,” Dr. D’Lima said.

"We’re constructing this droplet by droplet and layer by layer. We call it ‘bio-ink’ because we put cells in the ink. So, after printing, you actually have a live tissue that has been artificially printed,” he said.

SCORE is currently working on developing a robotic arm that can be attached to the 3-D bioprinting device.

“The robotic arm acts like a surgeon’s arm and is technically capable of printing inside a joint,” Dr. D’Lima said.

Researchers are also exploring possible stem cell use as an option to treat osteoarthritis, which is the most common joint disorder. The knee is one of the most commonly affected areas.

Caused by the deterioration of cartilage between joints, osteoarthritis affects more than 30 million people in the United States, according to the Centers for Disease Control and Prevention (CDC).

“Osteoarthritis is caused by wear and tear of your joint. As the cartilage wears away, you expose the bone, and when you have bone on bone, you can get extreme pain,” Dr. D’Lima said.

Researchers at SCORE are now studying the potential benefits of using stem cells to grow cartilage.

“Stem cells are the cells that actually produce the tissues in your body,” Dr. D’Lima said. “We want to test the theory that we can place stem cells in an arthritic joint where they will generate new tissue to replace cartilage that was lost because of osteoarthritis. However, we are in the process of determining the efficacy of this approach.

“Right now on a very limited basis, we are collecting stem cells from a patient’s bone marrow, purifying them and injecting them into the patient’s knee joint," Dr. D'Lima said. “We are collecting outcome data with the goal of identifying who responds favorably to this treatment and who doesn’t. That way, when we launch a clinical trial to test the efficacy of this therapy, we can pre-select participants who are most likely to benefit from it,” he said.