Hip arthritis is one of the most debilitating conditions affecting older adults worldwide, and Malta is no exception. Total hip replacement is often described as “the operation of the century”, yet many patients still live with restrictions, fear of dislocation and the risk of needing further surgery later in life.

As people live longer, stay active into older age, and expect to sit, squat and move freely, conventional hip implants are being pushed to their limits.​

Garland Surgical Ltd, a spin-out from the University of Malta led by Maltese-British founder and CEO Simon Mifsud, is developing a new kind of hip replacement designed to meet these expectations: the MaltaHip.

The company’s mission is simple but ambitious – to create a single-lifetime hip replacement that restores confidence and natural movement for patients of all ages, body types and activity levels.​

Why hip instability is still a problem

Standard hip replacements use a ball-and-socket design, which has changed relatively little for over 50 years. For many patients this works well, but the design has inherent limitations, and certain movements – such as deep bending, twisting or crossing the legs – can increase the risk of dislocation. 

Younger or more active patients, people with hip dysplasia, and those who have had spinal surgery are particularly vulnerable to instability and repeat operations over their lifetime.​

Revision surgery to fix a failing or dislocating hip is complex, costly and difficult for patients to go through, and it places growing pressure on healthcare systems trying to manage limited resources sustainably. Against this backdrop, there is a clear need for implants that last longer and remain stable even under demanding, real-world movement patterns.​

A hip designed around real movement

MaltaHip takes a different approach to the problem. Instead of relying on a single ball moving inside a cup, it uses three precisely engineered, cylinder-like bearing surfaces that slide in different directions to mirror the natural motion of the hip:  forwards and backwards, side to side and internal and external rotation. This tri-axial design is intended to:​

• Provide high stability at extreme angles, reducing the risk of dislocation during everyday activities.​
• Spread loads more evenly across the bearing surfaces, dramatically reducing long-term wear.​
• Allow patients to regain a broader range of movement, including deep flexion and floor-level activities that are important in many cultures and daily routines.​

Independent laboratory testing and cadaveric studies have shown that the MaltaHip concept can reduce wear by around 75% compared to conventional implants, with projected durability of up to 50 years under standard test conditions. These early results suggest that a single-lifetime hip replacement may be achievable for many patients, significantly reducing the need for revision surgery over time.​

A Malta–UK collaboration with deep local roots

Garland Surgical grew out of collaboration between the University of Malta’s engineering and clinical researchers and UK-based expertise in orthopaedic device development and commercialisation. The company is headquartered in the UK, with a Maltese subsidiary based at the Malta Life Sciences Park (MLSP), reflecting its long-term commitment to Malta’s innovation ecosystem.​

One of the original inventors of MaltaHip, Dr Donald Dalli, now works within Garland Surgical as Principal Development Engineer, ensuring continuity between the early research and the current product development programme. This close link between local inventors, academic partners and an experienced international development team is central to the project’s progress.​

Building MaltaHip with grant funding and seed investment

To date, Garland Surgical has been able to advance MaltaHip primarily through non-dilutive grant funding and targeted innovation support programmes, including UK and European schemes focused on high-potential medical technologies. This has allowed the team to progress the design, secure intellectual property, complete early testing and build key partnerships while preserving equity for future strategic investors.​

The company is now in the process of closing a €2 million seed round in December, which will be used to complete the next phase of product development, expand testing and validation, and prepare for first-in-human studies and regulatory submissions. This combination of grant-backed R&D and private investment is helping to de-risk the technology and create a strong foundation for a larger Series A round.​

Looking outward: Malta, Europe and Asia

In 2025, Garland Surgical was selected for Innovate UK’s Global Business Innovation Programme in Health & Medical Technologies, joining a small cohort of UK companies on a trade mission to Singapore to explore opportunities across Asia. For MaltaHip, regions such as South-East Asia are especially interesting because deep squatting, kneeling and floor-level activities are part of everyday life, making hip stability and range of movement even more critical.​

What this could mean for Malta

Although Malta has a relatively small population, the burden of hip arthritis and the demand for joint replacement surgery are expected to grow as people live longer and remain active. Solutions that reduce revision rates, shorten hospital stays and support patients to maintain independence will be increasingly important for the health service and for society.​

Technologies like MaltaHip could offer several potential benefits:

• Fewer repeat hip operations over a patient’s lifetime, reducing risk and cost.​
• Better functional outcomes – the ability to sit, crouch and move confidently without fear.​
• More sustainable use of healthcare resources through less waste and a lower long-term treatment burden.​

Garland Surgical is currently advancing MaltaHip through product development, regulatory preparation and partnership discussions with leading manufacturers and clinical centres. The company is preparing for a future Series A investment round to fund broader clinical studies and regulatory submissions in key markets.​

A Maltese innovation to watch

From its roots at the University of Malta to its presence at Malta Life Sciences Park and its growing international footprint, MaltaHip is an example of how research, engineering and clinical insight from a small island can contribute to solving a global problem.

If successful, this technology could help thousands of patients in Malta, Europe and beyond to enjoy a more active, independent life after hip replacement.​

For readers, clinicians and policymakers interested in learning more about MaltaHip, Garland Surgical and potential collaboration opportunities, further information is available on request from Garland Surgical www.garlandsurgical.health.

09.12.2025.