Rheumatoid arthritis (RA) is a painful disease of the joints which affects significant numbers of adults. Powerful drugs are available to treat the disease, however these drugs do have limitations; they are typically expensive and require hospital care to administer. Development of new drugs for RA is hampered by the clinical tools available to assess the progress of the disease. Clinical trials are typically conducted using radiographs (X-rays) of the hand, evaluated by experts. Radiographs are excellent at visualising bone damage, but this kind of damage is now uncommon in RA. Magnetic resonance (MR) imaging, which can visualise soft tissues and swelling are becoming common. Typically MR images are also ‘read’ by experts; this method provides an improvement over the reading of radiographs, but remains unable to discriminate the very small changes which occur within clinical trials. Agreement between experts is poor, due to the difficulty in assessing complex 3D images, and the semi-quantitative methodology is relatively insensitive to change. Imorphics has proved successful at accurately measuring musculoskeletal structures using proprietary 3-dimensional statistical modelling using MR images. Imorphics recently identified that this technology could be applied to the field of RA measurement, using models of the whole of the hand, including bone, ligaments, tendons, cartilage, joint capsule and skin. The POC project objectives are to technically demonstrate that MR images of an RA hand can be consistently and automatically processed to provide accurate quantitative measurements. Removing inconsistencies in clinical assessment will provide increased accuracy in both treatment and clinical trials. Commercially, the effective measurement of small improvements in RA management and treatment could result in quicker drug testing, lower overheads and therefore reduced time to market.

Acetabular and femoral bone resorption is one of the few remaining clinical challenges to be addressed when considering the long term success of orthopaedic joint replacements, particularly in hip prostheses. Bone resorption around the proximal femoral stem and acetabular cup due to stress shielding contributes to bone loss and reduced bone mineral density, ultimately leading to clinical complications such as periprosthetic fracture, aseptic loosening, joint pain and the loss of bone. The aim of project SHIELD is to develop novel acetabular and femoral components that minimise bone resorption. This will be achieved through a combination of component design and material optimisation by which the load transfer from prosthesis to bone will attempt to mimic bone stress levels pre-operation. Bone resorption during the ageing process will be predicted through finite element models of the physiological scenario derived from in-vivo CT/MRI images. These models will allow state-of-the-art optimisation algorithms to be employed for the implant design and subsequent analyses. Structural integrity will be tested through a series of laboratory tests including cadaveric studies, that will validate predictions from finite element models and evaluate clinical viability. Tribological performance and biocompatibility studies will be evaluated through state-of-the-art methodologies.

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