Product development and research for stronger, active bodies. FortisNet
The Challenge
FortisNet
Welcome advances in medicine mean that we are living longer, but with an increased burden of age-related diseases and associated reductions in quality of life. The clinical problem is significant; for example, bone fractures alone cost the European economy €17 billion and the US economy $20 billion each year; the numbers of hip fractures worldwide will increase from 1.7 million in 1990 to 6.3 million in 2050. Diabetic amputations have increased to 7,000 per year in the UK, an estimated 40,000 in India and over 70,000 in the USA. Almost 300 Service personnel suffered traumatic limb loss in recent UK military operations in the Middle East, with over a third involving significant multiple amputations. Amputees will require sophisticated rehabilitation and, even with modern medicine, specialised care for years to come. Meanwhile, in many lower and middle income countries there is limited access to orthopaedic surgery, modern prosthetics or assistive technologies, so we must develop intelligent, low-cost solutions to meet those needs.
The aim of the network is to develop products and processes for enhanced musculoskeletal health that will improve lives, attract new businesses to our region and create jobs for our skilled graduates. We believe we have the opportunity to develop a national hub of expertise with international impact in musculoskeletal research and technology.
At the Institute for Life Sciences, University of Southampton, our response to these challenges is to launch FortisNet (‘Fortis’ meaning strong): an interdisciplinary and vocational network in regenerative medicine, orthopaedics, prosthetics and assistive technologies.
Cover image: fabricating surfaces for skeletal stem cells, courtesy of Professor Richard Oreffo, Centre for Human Development, Stem Cells and Regeneration
Strength through Collaboration FortisNet promotes a collaborative and interdisciplinary approach to solving musculoskeletal challenges. We actively encourage and catalyse research projects that connect clinicians, enterprise, the end-users of research and academic researchers, so that our research clearly serves clinical, end-user and market needs.
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No single group or research team has all the expertise. The problems users face are so complex and multifaceted that we really need to pull in all the expertise for the delivery of new technology.
Dr David Moser Head of Research, Chas A Blatchford & Sons
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Motion analysis technology is used to understand the causes of injury and inform ways of preventing the development of osteoarthritis in sport and exercise. Image courtesy of Dr Martin Warner. Photo credit: Jon Banfield.
FortisNet Members
How to get involved
Led by the Institute for Life Sciences Director, Professor Peter JS Smith, FortisNet started in January 2016 as a platform network of over 40 leading researchers and clinicians at the University of Southampton and University Hospital Southampton NHS Trust. We have been joined by experts from UK universities, hospitals, industry, local government, defence organisations, health networks and the end-users of research to begin shaping the research priorities for FortisNet and the UK.
We welcome new members. If you are a researcher, clinician, member of the public, charity, donor, policy maker or work in industry; if you share our collegiate, interdisciplinary vision and want to help shape the future of musculoskeletal research we would like to hear from you.
FortisNet Activities
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We host a programme of events to initiate and catalyse collaborative research that will address challenges in musculoskeletal health. We provide an informal and stimulating environment to bring people with different perspectives, insights and skills together. We are actively pursuing opportunities to support network activities and the translational pipeline.
Please contact Dr Alexandra Mant a.mant@southampton.ac.uk for more information.
My own career providing insights into musculoskeletal disease, notably osteoporosis, has taught me the value of interdisciplinary endeavour. FortisNet offers this and more, putting our specialised and broad-based expertise in the UK firmly on the map.
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Professor Cyrus Cooper Professor of Rheumatology and Director, MRC Lifecourse Epidemiology Unit, University of Southampton and Professor of Epidemiology at the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford
HRH The Duchess of Cornwall discusses musculoskeletal research challenges at the Institute for Life Sciences, after receiving an Honorary Doctorate from the University of Southampton in recognition of her work supporting osteoporosis research, management and prevention. Photo credit: Jon Banfield.
Case Studies Components
Limbs
Translating pioneering developmental and stem cell science for patient benefit
Measuring and classifying the shape and size of residual limbs to ensure optimal fit for prosthetic limbs
Our increased life expectancy introduces new challenges. Skeletal fractures alone cost the European economy €17 billion and the US economy $20 billion each year. Work pioneered by our researchers demonstrated the practicability of using patients’ own bone stem cells together with a biocompatible scaffold to create a ‘living bone composite’, essentially a patient can regrow their own bone.
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Image courtesy of Professor Richard Oreffo, Centre for Human Development, Stem Cells and Regeneration, University of Southampton. www.stemcells.org.uk
Southampton Orthopaedics: Centre for Arthoplasty and Revision Surgery (SOCARS)
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Over 90,000 primary hip replacements are performed each year in the UK, many of which subsequently need complex revision surgery, especially in younger patients. Through collaboration with industrial partners, we use imaging and analysis of retrieved joints to understand why some joints fail prematurely, aiming to improve the outcome of joint replacement surgery for patients. Images show Images courtesy of Dr Richard Cook, patterns of wear and tear University of Southampton and on retrieved replacement RedLux Ltd. hip joints. Normal wear is shown above, whereas below, the joint head has rubbed on the edge of its socket cup. Microvascular networks on a chip to mimic the blood flow around regenerating bone Microfluidic lab-on-achip devices enable us to measure simulated blood flow with very high resolution over space and time, to help understand a range of processes, including drug delivery and revascularisation as bone heals from a fracture.
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4 Images of 3D scanning to digitise a residual limb cast courtesy of Dr Alex Dickinson and Dr Peter Worsley, University of Southampton.
Thousands of amputees experience pain and discomfort while wearing replacement lower limbs. No two residual limbs are the same shape and they also substantially change shape over time, due to many factors, including temperature, hydration and muscle wasting, presenting a moving target for prosthesis fitting. Currently prosthetists use either physical measuring or laser scanning to create a template for the artificial limb. Our researchers are developing accurate, dynamic models of residual limb-socket interactions in lower limb amputees to predict how the residual tissues deform and respond to loads generated during daily living and how they adapt over longer timescales. These first-of-kind models will enable us to develop surgical and prosthetic treatments that speed up and reduce the discomfort of rehabilitation. Intelligent prosthetic liners could ease pain for lower limb amputees
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Mechanical forces at the interface between stump and prosthetic socket could lead to discomfort, pain and stump tissue breakdowns, especially for ill fitted sockets. In collaboration with Chas A Blatchford & Sons Ltd, our researchers are developing the world’s first ‘intelligent’ Image courtesy of Professor Liudi Jiang, University of Southampton liner with integrated and Chas A Blatchford & Sons Ltd. tri-axial pressure and shear (TRIPS) sensors to monitor the load at this critical interface, to aid socket fit and amputee care. This platform technology could be expanded to many other healthcare sectors and also enable active physical intervention for effective rehabilitation.
Case study 6 overleaf. Image courtesy of Dr Xunli Zhang and Dr Dario Carugo, University of Southampton.
FortisNet Interdisciplinary Collaborative Research
Intelligent prosthetic liners could ease pain for lower limb amputees.
Measuring and classifying the shape and size of residual limbs to ensure optimal fit for prosthetic limbs.
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Training the next generation of interdisciplinary scientists and engineers We believe the greatest advances in addressing societies’ problems will be made at the interface between disciplines. We are working to dissolve the boundaries between traditional ways of thinking and create a new generation of interdisciplinary life scientists and engineers.
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Imaging and biomechanics to understand the causes of sports injury.
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Commercial Impact
Ultrasound imaging is used to measure muscle size and for visual feedback to help re-educate muscle contraction.
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Impact Potential
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Economic Development We aim to develop a regional specialisation in regenerative biolog y, orthopaedics, prosthetics and assistive technologies that will create jobs, attract new businesses and retain our skilled graduates in the region.
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Imaging and analysis to understand why joint implants fail.
Using a patient’s own bone stem cells to regrow broken bones.
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Setting challenges to researchers
Vir tuous circle of product development We aim to build a collaborative landscape that capitalises on the many streng ths of our region. We will do this by connecting clinicians, researchers, enterprise and end-users to ensure that our research can be applied with ma ximum impact in the home, clinic and marketplace.
Impact Potential
Microvascular networks on a chip to mimic the blood flow around regenerating bone.
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Remote sensors, including mobile phones, to monitor and study arthritis.
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Product development and research for stronger, active bodies We will provide an integrated, interdisciplinary approach at the engineering-life sciences interface to develop and implement pioneering, effective, safe, valuefor-money physical interventions to treat impairments in hard (bone, teeth) and sof t (skin, car tilage, muscle) tissues.
Individual Musculoskeletal research for optimised function
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Image of scan through the anterior thigh, showing the quadriceps muscle, courtesy of Professor Maria Stokes, University of Southampton.
Our Active Living Technologies research aims to enhance musculoskeletal and general health across a wide range of ages, and includes a variety of conditions that affect people who are frail or sedentary, through to people undertaking recreational and elite sports. Our research to prevent development of osteoarthritis after injury and enable active living with arthritis forms part of the national Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis. Ultrasound imaging is used to measure muscle size and for visual feedback to help re-educate muscle contraction in rehabilitation. Remote sensors, including mobile phones, to monitor and study arthritis
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Intelligent, responsive technologies to advance stroke recovery for patients in their own homes
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Image courtesy of Professor Jane Burridge, University of Southampton.
Through close collaboration between engineers, rehabilitation researchers, clinicians, patients and carers we have transformed simple Functional Electrical Stimulation devices into intelligent, responsive therapeutic interventions. We have done this through the development and clinical testing of novel Iterative Learning Control Algorithms. The engineering challenge now is to design wearable electrode arrays and to interpret complex data. Through EPSRC funded research we have moved from simple movement in a planar robot to controlling stimulation to enable patients to practice everyday tasks. Our goal is a platform that can be used by therapists, and patients in their own home. This work can only be achieved through our multidisciplinary team, with the skills and experience to ensure that it translates into clinical practice. Augmented and virtual reality training for surgeons
10 Rheumatoid Arthritis is a chronic autoimmune disease that causes joint inflammation, pain and can lead to severe disability. It affects over 400,000 people in the UK. Mobile phone technology provides a means to monitor mobility and pain, levels of physical activity and mental wellbeing during daily life, to provide better information to the patient and clinician about treatment effectiveness. Professor Cyrus Cooper, Professor Christopher Edwards and Dr Alexander Forrester, University of Southampton.
Image courtesy of Mr Advait Gandhe, Portsmouth Hospitals NHS Trust.
Accessible technology like smartphones can be used to enhance surgical training across the globe. Mr Advait Gandhe, Trauma and Orthopaedics consultant at Portsmouth Hospitals NHS Trust has created software apps for simulated orthopaedic surgery, to provide a high quality, effective and enjoyable training experience.
www.southampton.ac.uk/fortisnet IfLSAdmin@southampton.ac.uk +44 (0)23 8059 5374