Four generations of surgical implant development will be discernible by the end of this century:
1. A first generation of industrial materials (materials originally fabricated for industrial applications
other than medical devices) in ad hoc devices that had little impact on the practices of medicine
and surgery.
2. Industrial materials in bioengineered devices to effect the replacement of damaged structures. While these devices returned function to millions of people, formed the basis for a new industry, and forever changed the practices of medicine and surgery, their components have proved less than ideal.
3. Bioengineered materials fabricated specifically for medical device use—that are meant to be bioactive
rather than inert—and that promise to improve the performance of some devices.
4. Tissue engineering, which while yet to be utilized in widely marketed devices, promises to usher
in revolutionary changes at least as dramatic as those caused by the second-generation bioengineered
devices.
Fourth-generation technologies will focus on repair and regeneration rather than reconstruction
and replacement; they will emphasize therapeutic prevention of disease and early
intervention. The minimally invasive nature of these new technologies will cause medical
practitioners to partially displace surgeons, and fewer hospital beds and operating rooms
will be needed. While such technology may involve high startup costs, in the long run the
total costs of care should decline because of more efficient, less expensive procedures.
