A Bone To Pick: Bone Banks and 3D printing in Orthopedics

About a week ago, I caught up with a friend of mine who is an Orthopedic surgeon in Bangalore. Although we met to catch up and reminisce about medical college days of yonder, as is the norm, we fell victim to workaholism. He began talking about a couple of challenging trauma cases he had come upon the weeks gone by and I probed and pressed for ‘unmet needs’ which could be potentially addressed through new technology. As we delved in to the morbid world of orthopedic interventions in the aforementioned patients, we began talking about compensating for the less of large segments of bone and finally to the realm of bone banks.

Organ donation has increased 4 fold in India in the last 5 years but the supply and demand are as mismatched as chalk and cheese. Even if we do match the world leaders, Spain, we would still lag far far behind the necessary demand in the country. Bone donation in India lags even further behind. There are three main sources of bone graft material: autologous (harvested from the patient’s own body), allograft (from cadaveric bone) and synthetic substitutes. These bone grafts can be used in patients with significant bone loss due to trauma, congenital defects, bone tumours etc..

The first cadaveric bone bank was started in AIIMS in 1999, yet in the 18 years since there have been just a meagre 24 donations! The key factors associated with these dismal numbers are said to be lack of public awarness coupled with misconceptions and religious sentiments. The common perception is that in extracting the bones of a deceased individual, it will lead to mutilation and disfigurement of the body. However, this in itself in merely a misconception as once the bones are taken out, the body is reconstructed and structure of the limbs restored using wood and cotton and wool. On average it is said that the actual removal of the bones takes 10 minutes and reconstruction a further 30. This is truly unfortunate in a country where the Ministry of Road Transport & Highways claims that there are 1317 road traffic accidents a day let alone other forms of trauma!

Since an Australian man who received a 3D printed bone transplant in 2017, 3D printing has been touted as the next big step to bridge the ‘bone gap’ literally and figuratively. Despite recent advances it still seems some distance away as companies such as Xilloc, Materialise, Layerwise as well as technology developed in multiple universities is mostly in the early stages of development. There is even research in the space of material technology too, like the stretchable, cut-able and fold-able ‘hyperelastic bone’.

The concept of organ donation has picked up significantly in India but not so much so in bone donation. As much as I yearn to see the day that we can 3D print anything, anywhere and anytime the age of Cyborgization is still a while away. All in all the bone bank conundrum is a multi-factorial problem, including perceptions, infrastructure and resources, but we do need to figure out a way to fix this ‘fracture’ in our healthcare system.

Rohan D’Souza

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