Currently the main treatment is a knee replacement, but this is only available to those with end-stage disease – meaning sufferers face up to 20 years of pain and impaired mobility.
The need for a replacement can be delayed by a high tibial osteotomy (HTO), a procedure where a surgeon makes an incision into the shin bone to realign the joint then stabilises it with a metal plate. In their current form, HTOs are lengthy, complex procedures, and also carry a risk to structures such as ligaments within the knee.
TOKA – a new treatment created by Professor Richie Gill from our Department of Mechanical Engineering and Centre for Therapeutic Innovation and ORTHOSCAPE, a medtech company based at the University's Innovation Centre – aims to change this. It uses CT scans to create a computerised 3D model of the patient’s anatomy, which acts as a digital guide for the procedure. Crucially, it’s also used to design and 3D-print a plate that precisely fits the recipient.
This tailored technology has been tested on 25 patients at the Rizzoli Orthopaedic Centre in Bologna, Italy, with incredibly promising results. “The doctors have said that the surgery is much better,” Richie explains. “The alignment they achieve is excellent, they can do the surgery in less than 30 minutes and, most importantly, all the patients have recovered quickly.”
The project is about to enter a randomised clinical trial in the UK, and the team are hopeful that TOKA will be widely available in the next few years. “The Italian patients all now, within six months of their surgery, want their other knee done with the same technology,” says Richie. “That’s a remarkable result, because the pain of the recent surgery usually makes people wait at least a year before considering further operations!”