One of the biggest challenges facing the development of next-generation orthopedic prostheses is improving their biocompatibility with the human body [29]. This is critical for ensuring long-term success of the prosthesis and minimizing the risk of complications such as inflammation and rejection [28]. To achieve improved biocompatibility, researchers and engineers are exploring the use of new materials and surface treatments that are better tolerated by the body [30]. In addition, there is ongoing research into the development of advanced coating and surface modification techniques, such as the use of bioactive coatings, which can promote the integration of the prosthesis with the surrounding tissues and improve its biocompatibility [31]. Table 2 summarizes major challenges for advances orthopedic prosthesis design.
Table 2 Challenges and opportunities in modern prosthesis designFull size table
Another key challenge in the development of next-generation orthopedic prostheses is improving their durability and longevity. This is critical for ensuring that the prosthesis is able to withstand the rigors of daily use over an extended period of time, and reducing the need for frequent replacements and revisions [37]. To achieve enhanced durability, researchers are exploring the use of advanced materials and manufacturing techniques, such as 3D printing and additive manufacturing depicted in Fig. 3 for advance bio-printing of prosthetic tissue [38]. These techniques allow for the production of prostheses with improved strength, durability, and biocompatibility, as well as the ability to tailor the design to the individual patient's needs and anatomy [39].
Fig. 3Cell composition-additives and sensor integration in 3D-printed multi-material prosthesis with 3D CAD design
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A major challenge in the development of next-generation orthopedic prostheses is improving their integration with the surrounding natural bones and tissues [40]. This is critical for ensuring the long-term stability of the prosthesis, and for maximizing its functionality and restoring mobility to the patient [41]. To achieve better integration with natural bones and tissues, researchers are exploring the use of advanced surgical techniques, such as computer-assisted and robot-assisted surgery, 3D bioprinting (Fig. 3) which allow for more precise and accurate production/implantation of the prosthesis. In addition, there is ongoing research into the development of new materials and surface treatments that promote the integration and osseointegration of the prosthesis with the surrounding bones and tissues [42].
Another key challenge in the development of next-generation orthopedic prostheses is improving their sensory feedback. This is critical for restoring the sense of touch and proprioception to the patient, which can improve the overall functionality of the prosthesis and enhance the patient's quality of life [43]. To achieve advanced sensory feedback, researchers are exploring the integration of advanced sensors and robotics technologies into the prosthesis design. These technologies can provide real-time feedback to the patient, allowing them to better control the movement of the prosthesis and improve their overall mobility and functionality [44].
Finally, a major challenge in the development of next-generation orthopedic prostheses is increasing their functionality, to more closely mimic the natural joint and restore mobility to the patient [33]. This requires the integration of advanced technologies and materials, such as robotics and shape memory alloys, which can improve the functionality and flexibility of the prosthesis [45]. 3D printing has revolutionized the field of prosthetics by providing a unique opportunity for advanced prosthesis design. With the ability to create precise and intricate three-dimensional structures, 3D printing technology [46] allows for the customization of prosthetic devices to fit the unique needs of each individual patient [9]. This means that prosthesis can be designed with a higher level of accuracy, comfort, and functionality, leading to better outcomes and quality of life for the patients. Additionally, 3D printing offers a cost-effective and efficient way to produce prosthetic devices, making them more accessible to those who need them. Overall, the opportunities provided by 3D printing in the field of prosthetics are immense, and they have the potential to change the lives of countless individuals in need of prosthetic devices.
One of the major drawbacks of AI in healthcare is bias. AI algorithms are only as good as the data they are trained on, and if the data is biased, the algorithm will be biased as well. This can lead to incorrect diagnoses or treatments, particularly for underrepresented populations. One potential solution to this problem is to develop more diverse and representative datasets for AI algorithms to be trained on. Additionally, researchers can implement bias checks and validation tests to ensure that AI algorithms are not perpetuating biases. Another drawback of AI in orthopedics is the lack of interpretability due to limited human related data. AI algorithms often work as a “black box”, meaning that it is difficult to understand how they arrive at their conclusions [47]. This can make it difficult for healthcare providers to trust the results and make informed decisions. One potential solution to this problem is to develop AI algorithms that are more transparent and interpretable. This can be achieved using explainable AI techniques that provide more insight into the decision-making process of the algorithm [48].
Privacy and security are also major concerns when it comes to AI in healthcare. Medical data is sensitive and should be protected from unauthorized access or use. One potential solution to this problem is to implement strong data privacy and security protocols that ensure the protection of patient data. Additionally, researchers can develop AI algorithms that are trained on encrypted data, which can help to protect patient privacy while still allowing for the development of accurate algorithms. Finally, there is the issue of the "human touch" in orthopedic research. While AI has the potential to improve efficiency and accuracy in healthcare, it cannot replace the empathy and compassion that healthcare providers add to human life. One potential solution to this problem is to integrate AI into healthcare workflows in a way that enhances, rather than replaces, the human touch [49]. For example, AI can be used to automate routine tasks, allowing healthcare providers to spend more time with patients and provide more personalized care. In conclusion, the development of next-generation orthopedic prostheses presents a number of grand challenges, including improved biocompatibility, enhanced durability, better integration with natural bones and tissues, advanced sensory feedback, and increased functionality [50]. Addressing these challenges requires a multidisciplinary approach, including advances in materials science, surgical techniques, and robotics and sensory technologies [51]. Table 2 provides advanced key points for next generation smart prosthesis. The tools listed in this table are not exhaustive and there may be other solutions and technologies available for addressing the grand challenges of orthopedic prosthesis design, which are beyond scope to this technical paper [36]. The important remarks section highlights the key benefits and considerations of each challenge and the associated tools.
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