A highly anticipated update to a groundbreaking medical development from 2020 brings exciting prospects for a potential natural knee-cartilage replicant, poised for integration into replacement surgeries by 2023.
The genesis of knee pain lies in the gradual degradation of cartilage within the knee joint, a condition known as osteoarthritis, impacting nearly one in six adults globally — amounting to a staggering 867 million individuals.
For those seeking alternatives to total knee joint replacement, a promising solution may emerge, offering patients a swift, pain-free recovery and sustained relief. Duke University reported a noteworthy breakthrough in 2020, unveiling a water-based gel meticulously crafted to replace deteriorated cartilage in knee joints, inspired by the biodesign principles inherent in our naturally occurring cartilage.
The innovative material is synthesized by taking thin sheets of cellulose fibers and saturating them with polyvinyl alcohol—a viscous substance comprised of stringy chains of repeating molecules—to create a resilient gel. Remarkably, despite being 60% water, a mere quarter-sized disc of this specialized gel can support the weight of a 100-pound kettlebell without succumbing to tears or deformation.
Under tension, the cellulose fibers exhibit resistance, contributing to the material’s structural integrity. When compressed, the negative charges along the rigid polymer chains repel, adhering to water and facilitating the gel’s ability to spring back to its original shape.
In durability assessments, the material withstood 100,000 cycles of repetitive pulling, matching the performance of porous titanium commonly used in bone implants. Further, in a million iterations of rubbing against natural cartilage, the gel displayed a smooth, self-lubricating surface that proved as wear-resistant as genuine cartilage and four times more durable than synthetic cartilage implants currently FDA-approved for use in the significant toe joint. This breakthrough heralds a potential paradigm shift in knee joint replacement surgeries, offering patients a groundbreaking alternative for enhanced mobility and enduring relief.
“If everything goes according to plan, the clinical trial should start as soon as April 2023,” Duke chemistry professor Benjamin Wiley, the research leader, had shared.
Since the year 2020, the team has found increasing optimism in the advancements in design, foreseeing a future where these innovations become commonplace.
Historically, scientists seeking to enhance the strength of hydrogels employed a freeze-thaw method to generate crystals within the gel, expelling water and aiding in the cohesion of polymer chains.
In this recent study, rather than resorting to the conventional freeze-thaw approach, researchers employed a heat treatment known as annealing to induce a more extensive formation of crystals within the polymer network.
The augmentation of crystal content resulted in the creation of a gel capable of withstanding five times the stress from pulling and nearly twice the stress from squeezing compared to the conventional freeze-thaw methods. Moreover, tests revealed that the designed hydrogel adheres 68% more securely to natural cartilage on bone.
For individuals, especially the younger demographic, grappling with deteriorated knee cartilage—perhaps due to an extensive career in high-level sports—a complete knee replacement poses an unappealing prospect. Modern knee prosthetics wear out over time, necessitating additional total replacement surgeries in their lifespan. The hydrogel offers a promising alternative, as it can be easily replaced in the event of damage, providing a more sustainable and flexible solution.
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