Perspectives of Orthopedic Surgeons on the Clinical Use of Bioprinted Cartilage: Qualitative Study

Abstract

Background: Over the past 60 years, no technique used for treating cartilage disorders has been completely successful. Bioprinting provides a highly anticipated, novel alternative solution to this problem. However, identifying barriers to this new technology is crucial in order to overcome them when bioprinting reaches the implementation stage. This kind of research has been declared essential because clinical efficacy and safety studies alone do not always lead to successful implementation.Objective: This qualitative study aimed to explore the stance of orthopedic surgeons on the use of bioprinted cartilage grafts for cartilaginous lesions. The study sought to summarize and classify the barriers and facilitators of this technique and to identify the key factors for successful implementation of bioprinted cartilage in routine clinical practice.Methods: A qualitative thematic analysis method was used to evaluate data obtained from semistructured interviews and from focus groups. Data were collected between June 2017 and February 2018. Interviews focused on the collection of expert opinions on bioprinted cartilage. Results:The perceived barriers to the adoption of this technology were (1) awareness of a lack of information on the status and possibilities of this technology, (2) uncertainty regarding compliance with current health care regulations and policies, and (3) demands for clinical evidence. The facilitators were (1) lack of surgical alternatives, (2) the perception that research is the basis of the current health system, and (3) the hope of offering a better quality of life to patients. Conclusions:The results of this study are preliminary in nature and cannot be generalized without a broader group of participants. However, the key factors identified provide a frame of reference to help understand the challenges of bioprinted cartilage and help facilitate the transition toward its clinical use. These findings will also provide information for use at multidisciplinary meetings in scientific societies; create bridges between researchers, orthopedic surgeons, and regulators; and open a debate on the funding of this technique and the business model that needs to be developed.

Orthopedic Surgeons’ Perspectives on the Decision-Making Process for the Use of Bioprinter Cartilage Grafts: Web-Based Survey

“…In our previous research [24], which identified the barriers and facilitators for the bioprinted cartilage use and this new approach, we validated the conclusion that orthopedic surgeons should receive information of higher quality from reliable sources, thus enabling the implementation of the bioprinted cartilage, and that researchers should consider what surgeons believe the cartilage graft should be like.…”

“…The results of this study show that the information received impacts the decision-making process of orthopedic surgeons in a complex and diverse way, as it depends on several variables: the type and origin of the information and its relevance to their demographic data. Previous research [24] found that the amount and quality of the information received was one of the main barriers for the implementation of new technologies. The sample analyzed here shows that orthopedic surgeons lack the specific knowledge of 3D printing as applied to cartilage (Table 4), where 50% of the survey participants who admit to being informed in an unspecific way have almost zero knowledge about it.…”

“…This survey and its questions were defined in the context of both a previous qualitative study [24] about the barriers and facilitators in the clinical use of bioprinted cartilage, which had derived conclusions from semistructured interviews and focus groups with orthopedic surgeons, and a literature review. Both these approaches helped identify the most pressing issues, on which this survey was focused.…”

“…The goal is to understand how and why the researchers’ new suggestions are understood in the clinical sphere and find the best approaches to develop them [23]. In previous research [24] focusing on orthopedic surgeons, the information aspect was highlighted. Therefore, this study will focus on the information received, with the aim of understanding the surgeons’ process of decision-making and to identify their expectations regarding the ideal bioprinted cartilage graft.…”

Trends in Scientific Reports on Cartilage Bioprinting: Scoping Review

“…Better understanding of how to optimize patient care can improve outcomes and quality of life, allowing more efficient use of health resources. Results of previous research [7,8] suggest that the most logical next step is to examine surgeons’ responses to this new therapeutic possibility. Reviewing, analyzing, and categorizing the different research activities in this new field [9] will help define the scope and depth of future research and identify gaps in critical knowledge [10].…”