In the medical industry, saving lives is no doubt the top priority for medical practitioners. Yet, in the pursuit of doing so, plenty of waste is generated in single-use plastics, surgical towels or fabrics, latex gloves and more. With even more breakthroughs in new medical technology, waste is further generated as manufacturers deviate toward single-use devices. Inadvertently, to the dismay of many environmentalists and medical officers alike, the medical sector is well on its way to becoming one of the biggest pollutants on the planet, exacerbated in recent years due to the pandemic.
by Mr Goh Khoon Seng
Some change can be witnessed as medical staff become more aware of the pressing need to weigh medical solutions against the safety of their patients. Some doctors have even adopted the practice pof sanitising and re-using single-use plastics in medical procedures yet this is unimaginable in healthcare practices, especially for “wealthier establishments”.1
Around the world, organisations are calling for solutions to manage the medical waste problem particularly due to the hazardous nature of waste we generate. At the cost of containing the pandemic in 2021 alone, the World Health Organization reported that the medical industry has potentially generated about 144,000 tonnes of additional waste in the form of syringes, needles, and safety boxes.2 In Singapore, the medical industry saw an increase in the amount of biohazardous waste generated and disposed of 4,400 to 5,700 tonnes, a 5 per cent increase per annum from 2016 to 2020.3
While this increase can be attributed to several reasons, it can be agreed upon that there should be an intervention, whether in the form of new protocols or product development, to help manage and reduce medical waste on the ground and in other branches of medicine. It is important to note that sustainability does not just refer to the amount of waste generated but the number of resources, like energy and manpower, we are utilising daily due to traditional medical protocols.
Fast and Responsible Way of Manufacturing Medical Implants Through 3D Printing
General medical practices can be sustainable if the right manufacturing technology and productive use of time and manpower are adopted mindfully and strategically to achieve the same result of saving countless lives. Unlike traditional metal implants that were widely used previously, we found that 3D-printing technology allows surgeons to achieve the same result but with conceivably lesser emissions produced from the use of machines daily and waste generated from that.
3D printing has been around and has been creating a buzz in the medical industry since the mid-1990s when dental and custom implants were first made. Since then, experts have observed that beyond greater ease of product inventory management, 3D printing has also contributed to lower waste.
First, 3D printing allows the targeted creation of more complex geometries that mimic the shape and function of natural bone, and also the efficient production of customised implants. Because this production of a physical object is essentially from a digital design, this enables consistent quality and also reduces the likelihood of failed pieces especially when complex designs are in question. This is unlike traditional manufacturing methods which might involve subtractive manufacturing, whereby a block of material is subtracted to produce the final product and as a result, create a lot of waste material. In contrast, 3D printing is a process of additive manufacturing that builds the product layer by layer according to the 3D design that our software feeds the machine with, this minimises waste material generation.
Compared to the traditional methods injection moulding, which requires large amounts of raw materials because it is high volume production, this mode of production is not suitable for small to mid-volume production. Therefore, layering through 3D printing ensures specifications are met with the least amount of resources possible. In the market, it has been reported that the process results in an overall lesser amount of waste generated of between 70 and 90 per cent compared to some traditional manufacturing methods such as CNC manufacturing.4 Osteopore’s product design and manufacturing methods do not require a support structure that entitles us to further reduce waste material – to an average of 2 to 5 per cent of waste material per product in 2021.
Next, the timeliness of 3D printing products has allowed for efficient inventory management which plays a huge part in keeping waste to a minimum. In addition to customised implants designed based on the patient’s and surgeon’s treatment plan, Osteopore’s products also come in many different forms including Osteomesh, Osteoplug, and Osteoplug-C, all in various sizes. We understand the urgency of surgeries which is why some of these products are available off-the-shelf to allow surgeons quick access to products so that they can treat patients as soon as possible. However, we ensure that our inventory turnover time is kept low to avoid overproduction. Fortunately, 3D printing encourages just-in-time manufacturing to avoid bulk production which may result in spoilage or contamination over time due to overproduction.
This is evident in our average inventory turnover days is 51 days which is 33 per cent less than the average traditional inventory turnover time of 155 days in 2020.5 Other efficient inventory management practices to be adopted can come in the form of marketing or even product ideation, especially when we are always creating customised devices and implants for patients. For a company of our nature, it is common to incur some product wastage, but we have also managed to recycle half of our product waste material for non-surgical use in 2021 such as models for surgical planning and marketing purposes.
Extending Sustainability Into Medical Practice
Finally, with what we have achieved, it would be natural to move towards automation – producing implants around the clock and even remotely. This is particularly crucial especially if there is a compelling commercial demand for the technology, alongside medical rationale with the option to customise for every type of patient.
The true value of what 3D printing can bring to the medical field will be recognised once the industry understands and accepts the technology and its benefits. It is more important for us to understand that 3D printing is existentially reshaping what implants can do, how patients can be treated, patient comfort and experience during recovery, as well as the efficiency during operations that involve implants.
As an add-on to creating implants, other Osteopore’s 3D printed products are a game-changer for surgical procedures and have enabled surgeons to minimise the time during operations – this makes the procedure shorter, safer, and also provides better management of hospital resources, especially during this pandemic when manpower is scarce.
Dr. GK Ananda, a resident consultant from Gleneagles Hospital Medini Johor has been using Osteomesh® for his surgeries for five years now in Orbital Floor Reconstruction.6 He shares further that while the number of follow-ups with his patients is kept regular due to standard protocol, regardless of whether it’s resorbable or non-resorbable implants, the mesh has helped him cut down surgery time due to the simplicity of the product, “It’s easy to use – and I can trim or cut the mesh easily to fit the defect.”
Osteopore’s Sustainable 3D-Printed Bioresorbable Bone Implants
Osteopore harnesses the technological advantage that 3D printing has over traditional manufacturing techniques and creates a microstructure that is representative of native bone while also imitating the interconnected pores necessary to facilitate the stages of tissue healing. By combining 3D printing and the bioresorbable material, a conducive environment for bone cells and blood vessels to grow into is created. As the first of its kind to be developed and commercialised for surgical use, the intricate product design of Osteopore’s bioresorbable implants was designed to be metabolised into water and carbon dioxide within the body after performing its function – leaving only natural, healthy bone.
Osteopore has specifically chosen to use bioresorbable polymers for utility and functional reasons – the nature of this material makes it particularly well-suited for use across various applications in craniofacial, orthopaedic, oral maxillofacial, and dental surgery. This bioresorbable polymer degrades and is absorbed by the body over 18 to 24 months, where natural tissue regeneration occurs and eventually the patient’s own natural bone takes over.
The disappearance of the foreign material in the body helps reduce post-surgery complications commonly associated with permanent implants.
We have clinical studies7 of the Osteopore Regenerative Mesh in Orbital Floor Reconstruction, conducted over a 10-year period that shows minimised complications such as orbit compartment syndrome of permanent implants. Similarly, in his five-year experience in over 50 cases, Dr. GK found that Osteopore’s 3D printed product has worked well for his surgeries. There have been no issues with infections or any complaints about electrical sensations from his patients, which happens with metal implants – except for a rarity where 4 per cent of the cases had some displacement of the mesh that required a second procedure. Displacement can happen when our surgeons trial new technology. Through regular use and development of our products, we strive to aim to be in a favourable position where our partners can afford to minimise follow-ups due to increased familiarity with bioresorbable implants. This saves both the patient's and surgeon's time as well as the hospital resources which can be put to better use.
This shows that the adoption of sustainable medical practices like Osteomesh can eventually lead to positive medical goals too. Sustainability in the medical industry can be achieved through increased education and the adoption of the right technology like 3D printing. Contrary to traditional belief, sustainable medical technology does not necessarily have to be part of a moral dilemma to be weighed against a patient’s safety – especially when the odds of the surgery going well have significantly increased with the product’s benefits.
Adopting progressive and eco-friendly medical devices and methods can also lead to positive business goals such as better management of hospital staff, and better surgeries. We believe that Osteopore’s products can provide an intervention that the medical industry is looking for to help subdue the rising amount of medical waste generated and create long-term, lasting positive impacts whether it is for the environment, or our surgeons and patients.
- Ngo, H. (2020, August 14). How do you fix healthcare’s medical waste problem? BBC. Retrieved March 31, 2022, from https://www.bbc.com/future/article/20200813-the-hidden-harm-of-medical-plastic-waste-and-pollution
- Tonnes of COVID-19 health care waste expose urgent need to improve waste management systems. (2022, February 1). WHO | World Health Organization. Retrieved March 31, 2022, from https://www.who.int/news/item/01-02-2022-tonnes-of-covid-19-health-care-waste-expose-urgent-need-to-improve-waste-management-systems
- Yip, H. W. H. (2021, May 10). AMOUNT OF MEDICAL WASTE FROM HOSPITALS AND CLINICS IN PAST YEAR COMPARED WITH FIVE YEARS AGO AND MEASURES TO REDUCE AND MANAGE SUCH WASTE. MOH. Retrieved March 31, 2022, from https://www.moh.gov.sg/news-highlights/details/amount-of-medical-waste-from-hospitals-and-clinics-in-past-year-compared-with-five-years-ago-and-measures-to-reduce-and-manage-such-waste
- Taylor, K. (2021, January 12). How is 3D Printing a Sustainable Manufacturing Method? Azom.com. Retrieved April 1, 2022, from https://www.azom.com/article.aspx?ArticleID=20017
- Industry ratios (benchmarking): Inventory turnover (days). (n.d.). ReadyRatios.com. Retrieved April 5, 2022, from https://www.readyratios.com/sec/ratio/inventory-turnover/
- Orbital Floor Reconstruction. Osteopore. (n.d.). Retrieved from https://www.osteopore.com/surgeons/orbital-floor-reconstruction
- Seen, S., Young, S., Lang, S. S., Lim, T. C., Amrith, S., & Sundar, G. (2021). Orbital Implants in Orbital Fracture Reconstruction: A Ten-Year Series. Craniomaxillofacial Trauma & Reconstruction, 14(1), 56-63.
About the Author
Goh Khoon Seng
Chief Executive Officer (M.Eng (Mech) (Singapore))
Mr Goh’s 30-year career spans both start-ups and global multinational corporations, with responsibilities in research & development, manufacturing, regional sales and marketing, and country management. Prior to joining Osteopore, Mr Goh spent over 20 years with Medtronic plc (Medtronic plc is the world’s largest medical device company) and Edwards Lifesciences Asia in various senior management roles. Mr Goh has been a Director of Osteopore Pte Ltd, since 2015 and has been involved in all aspects of the Company.
Mr Goh holds a Masters in Engineering (National University of Singapore) and post graduate diploma with Chartered Institute of Marketing (UK).