Joint reconstruction and infection

Research lines

For many years I have special interest in patients with hip dysplasia and patients  in need for (infected) revision surgery of the hip and knee. I am driven to improve the clinical outcomes of these patients.

As an orthopedic surgeon I try to perform my operative procedures in a way that I correct and repair anatomical defects such that the healing capacity of the body is maximally supported for its intrinsic regenerative capacity. These procedures in my orthopedic practice mostly occur in bone and cartilage of the joints. These tissues can be heavily deteriorated as a consequence of arthritis and in general orthopedic practice this is repaired by replacing the natural joint with an artificial implant.

Connected to natural hip instability (hip dysplasia) I have initiated a new implant concept using 3D printing that repairs the hip bone dysplasia deformity with a small implant using a minimal invasive procedure. The latter project has instigated a strong collaboration with veterinary dog scientist/surgeons that have similar problems with regard to hip dysplasia in dogs and now start to use the new implant design along in their surgical procedure along the lines of the ‘one-health’ concept. Currently I try to transfer this idea to treat shoulder instability and also to improve it further using biofabrication tools to make the implant resorbable being fully replaced in a regenerative process by natural bone.

In most cases joint replacement is an established successful procedure without many complications. However, in my academic practice I am specialized in the complex cases where an implant has failed, e.g. as a consequence of long-term bone loss or due to implant infection that is associated with bone loss. Therefore, my research is focused on implant infections and the regenerative mechanisms of bone, needed to fixate implants.

An implant infection can be a devastating complication that is often accompanied with large bone defects and requires removal of the infected material and placement of a revision implant. Often these implants cannot be standard off-the-shelf and I try to incorporate 3D printing techniques to improve the surgical outcome. In collaboration with medical microbiology we perform in vitro and in vivo experiments to study bacterial (biofilm) growth on implants and we have started to develop new minimally invasive and non-surgical treatment methods. One approach is using novel implant coatings that can release local bactericidal compounds to prevent infections. The other approach uses antibodies that can target bacteria of biofilm products and currently we try to eradicate the infection with radioactive elements that are attached to infection-seeking antibodies.

My goal is to implement this new biofabricated dysplasia implant in humans and bring together with Medical Microbiology and Nuclear Medicine radioimmune therapy for infections to a first-in-human trial within the UMCU.

People

Bruce van Dijk

Publications

Contact for internships

Dr. van der Wal, Principal investigator, B.C.H.vanderWal[at]umcutrecht.nl