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Translate the pageEnhancing Care for people with bone & joint disorders and injuries: Inspiring the Next Generation
In the rapidly evolving field of orthopaedic care, Professor Xavier Griffin stands at the forefront of innovation and research. As the inaugural Chair of Bone and Joint Health at Queen Mary University London and Barts Health NHS Trust, he is dedicated to providing evidence of the effectiveness of orthopaedic treatments and training the next generation of clinician scientists. With a focus on cutting-edge technologies and data-driven methodologies, Professor Griffin’s work seeks to not only advance treatment options but also address the pressing challenges facing healthcare today. In this discussion, he shares insights on macro trends in MedTech, the importance of effective data utilisation, and the future of bone and joint health care.
Note the views expressed herein are those solely of the author.
What are the key macro trends in orthopaedics, particularly in MedTech?
One major trend is the increasing integration of robotics and advanced imaging techniques in surgery. These enhance treatment planning, automate the delivery of existing procedures and allow surgeons to visualise anatomical structures. The advanced imaging is available before and even during surgery, enabling surgeons to practise and rehearse procedures before surgery, and allows for imaging to be integrated into the operating field. Ultimately this can enhance our understanding of the anatomy and improve component placement during surgery.
Additionally, there is a notable trend towards combining biological therapies with mechanical and implant-based treatments. This includes the integration of cell and small molecule therapies within scaffolds to drive biological activity, representing a shift towards more holistic approaches in managing diseases.
Can you describe your research and its integration into clinical practice?
My research focuses on the far end of the translation spectrum, primarily involving human pathways of care and complex interventions. I evaluate the clinical and cost-effectiveness of these interventions at both the policy and individual patient levels. This involves conducting many randomised controlled trials, which represent the gold standard for assessing effectiveness. Additionally, I engage in health services research using large datasets to evaluate the impact of policies over time and across different geographical areas; for example, the clinical effectiveness of the reorganisation of major trauma care in England on outcomes following open fracture of the tibia, using data from the Trauma Audit and Research Network.
When it comes to integrating this research into clinical practice, the aim is to inform and enhance clinical decision-making. We identify gaps in current clinical knowledge and pinpoint areas of substantial variation, where policies may not be consistently applied across the healthcare spectrum. By targeting these specific areas, we generate evidence that can lead to changes in clinical guidelines, ultimately improving care delivery in clinical settings.
With the explosion of data in healthcare, where do you see the most untapped potential in accelerating MedTech innovation? Are there any disruptive innovations on the horizon?
The UK is grossly under-utilising the routinely collected health data across primary, secondary, and social care. The untapped potential is enormous. We possess some of the most comprehensive and granular data collection systems in the world, making it possible to conduct impactful research at a scale of 68 million people, if we could integrate those systems. While countries like those in Scandinavia have impressive datasets and integration, their smaller populations limit their potential. Within our co-ordinated health system, if we could effectively consolidate and leverage this data, we would be world leaders in healthcare research – a fact recognised in numerous reports. The challenge lies in implementation, and that’s where the UK is currently struggling – which has been brought out clearly in the recent Sudlow review.
As for disruptive innovations, one of the most exciting developments is the response to the Cumberlege Report, which addresses MedTech and medicine safety by utilising data to enhance safety and effectiveness in the MedTech space. This initiative is being operationalised through the Outcomes and Registry Programme (ORP). Successfully implementing this will mark a significant advancement in our research capabilities. Additionally, the Report outlines strategies for improving clinical trials, thereby accelerating the innovation deployment lifecycle. Together, these initiatives could lead to truly transformative outcomes in MedTech innovation in the UK.
Are there areas where we’re collecting data but failing to leverage it effectively? Alternatively, are there areas where we should be collecting more data, and if so, why?
I believe it’s the former rather than the latter. Our primary focus should be on effectively utilising the data we’ve already collected, rather than gathering more. The reality is that we could collect an essentially infinite amount of data but fail to ever put it to use. Currently, we’re failing to leverage the data from primary, secondary, and social care effectively due to a lack of integration across these systems in the UK healthcare landscape.
What’s particularly frustrating is that there’s no valid reason why we shouldn’t be able to make these systems work together. If we could successfully leverage the data we have, it would significantly benefit our population.
When using patient data to drive MedTech development, how do we balance innovation and ethics? Are current approaches fit for purpose?
I spend a significant amount of time discussing this issue with patients. When they understand that the purpose of using their data is to advance healthcare treatments for their benefit and that of their friends and family, most are quite willing to give permission for their data to be used in this way. Many patients also want to be able to access their own data easily too; a co-ordinated strategy for making these data available would be welcomed by many people.
However, two key factors must be considered: the security of the data and its proper de-identification, as well as the assurance that it’s for the greater good of the UK population.
Concerns arise when there’s a lack of oversight, especially if companies appear to be indiscriminately collecting data. This often leads to discomfort among patients. However, when data is handled by trusted entities like the NHS, universities, or reputable organisations with robust structures in place, people are more willing to allow their data to be used. My experience is that most people genuinely want to see innovation take place.
As someone working at the intersection of clinical practice and research, what do you view as the most significant opportunity for collaboration with MedTech companies? Are there any barriers?
I believe that clinical academic clusters, such as the Life Sciences cluster planned for Whitechapel, offer a unique chance for collaboration, particularly given their proximity to one of Europe’s largest hospitals. With the high volume of patients at Barts Health, establishing a life sciences cluster that fosters collaboration with MedTech companies could drive substantial advancements. Many innovations originate from clinicians pinpointing specific challenges, but often companies lack direct engagement with these issues in their R&D processes. Integrating life sciences research capabilities with industry at a location like Whitechapel is an exciting opportunity for Barts Health to become the NHS translational centre for innovation.
However, there are notable barriers to collaboration. These include navigating governance structures, especially when it comes to federated data sets and less conventional pathways. At Barts, we are addressing these challenges by enhancing support within our governance team, ensuring that collaborative efforts can proceed with the appropriate guardrails in place. If we can build the right connections and frameworks, the best ideas can thrive without the friction that typically hampers progress.
What types of industry players would you like to see embedded in the Life Sciences Cluster in Whitechapel to transform bone and joint health research?
There’s a vital opportunity for innovation within the implant sector. While orthopaedics is an established field, transformative advancements are still possible. The next frontier lies in merging drugs, cellular therapies and implants to boost their effectiveness. This integration could attract a dynamic range of industry players focused on these strategic goals.
Additionally, a significant challenge in surgery is improving procedural efficiency. These issues are systematic rather than solely about implants. We need to leverage digital tools, apps and patient-driven interfaces to enhance surgical processes. It’s surprising how little has changed since the early 20th century; although we may use more advanced materials for implants, patients still navigate largely the same pathways. We need more effective methods to assess their individual health journeys and outcomes.
Refining the care process is essential, for example moving from routine follow-up to patient initiated follow-up, as the NHS cannot continue on its current trajectory. The USA spends the most per capita on healthcare yet faces some of the poorest health outcomes for many individuals. Simply increasing expenditure does not guarantee better results.
Access to healthcare and reducing inequalities are also critical components. Life sciences can play a pivotal role here, particularly through precision medicine, ensuring that innovations benefit all patients and address disparities in care.
We often hear about the benefits of AI and data analytics in MedTech, but are there any approaches or innovations that you believe are overhyped? Are there other areas you think deserve more attention?
Personally, I have yet to see a significant impact of AI in orthopaedic care. I’m open to the argument, but I’m still not convinced that most of the data we manage in orthopaedics is complex enough to require AI solutions. Our primary challenge lies not in handling complex data but in collecting and processing sufficient data at scale to answer pressing questions. Contemporary research uncertainties often hinge around ever smaller benefits and harms as we refine care rather than introduce major novel treatments – detecting ever smaller but clinically important differences between implants for hip or knee arthritis requires ever larger studies. In contrast, areas using genomic data or other highly complex datasets in healthcare may indeed benefit more from AI methodologies.
As MedTech development accelerates through data, how do we ensure these innovations don’t exacerbate health inequalities?
A significant government report has indicated that health inequalities have worsened due to datasets generated from narrow segments of the population. One of the key advantages of working in North East London is our diverse population, which can more accurately represent the diverse communities across the UK and globally. This allows us to simulate a UK dataset, unlike datasets derived exclusively from specific groups. Additionally, the Whitechapel area is home to speakers of over 70 languages, enabling us to pose questions relevant to different contexts across the world but address them here in Whitechapel. This unique diversity provides an opportunity to gather insights that can better inform global health innovations.
Given the rapid pace of technological development, how can we future-proof bone and joint health care?
This is a major area of interest for me. Innovation is essential, but we also need to phase out treatments that become outdated or ineffective. Research is a crucial aspect of this innovation-deployment cycle; we need to determine when new innovations are effective and how they compare to existing treatments – whether they are more effective, less effective, or should be retired altogether. Currently, we lack clear evidence of the safety and efficacy of many implants. This situation can lead to the continued use of treatments that may actually be harmful, as has been seen in some significant cases within orthopaedics in the UK.
To make this cycle function effectively, we must prioritise research that aligns with the pace of life sciences development. If we can achieve that, we will be in a much stronger position to ensure the safety and effectiveness of the treatments we provide.
About the author
With over £15.5 million in research funding and more than 140 peer-reviewed publications, Xavier is dedicated to enhancing patient care. His research focuses on the clinical and cost-effectiveness of treatments for bone and joint health, frequently cited by the National Institute for Health and Care Excellence. He is passionate about developing methodologies that leverage routinely collected data while integrating the benefits of randomisation.
Xavier is also an expert in orthopaedic trauma surgery, specialising in pelvic and acetabular fractures, and works at Barts Health NHS Trust, Europe’s busiest orthopaedic trauma hospital. A graduate of the University of Cambridge and the University of Oxford, he trained as a National Institute of Health & Care Research integrated academic surgeon and completed a prestigious fellowship in Melbourne, Australia.
In addition to his academic and clinical roles, Xavier served in HM Reserve Forces. Outside of work, he enjoys mountain biking and rock climbing, often accompanied by his young sons.