Joint Replacement and Bone Resorption: Pathology, Biomaterials and Clinical Practice

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ISBN: 9780824729547 | 0824729544
Cover: Hardcover
Copyright: 11/9/2005

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This detailed reference studies the basic science, mechanisms, and treatment practices for joint replacements and bone resorption--reviewing the properties of ceramic, metal, and polymer materials used in orthopedic procedures, as well as current research on bone remodeling, modern surgical techniques, alternate bearing materials, and future developments in gene therapy and tissue engineering.

Foreword

Jorge O. Galante

Foreword

vii

Jonathan Black

Preface

Contributors

xxvii

SECTION I: CLINICAL PICTURE

1. Periprosthetic Osteolysis Around Total Hips and Total Knees

(12)

William H. Harris

References

(5)

2. Fixation of Implants

(40)

Calin S. Moucha, Robert M. Urban, Thomas M. Turner, Joshua J. Jacobs, and Dale R. Sumner

Introduction

(1)

Definitions

(1)

Bone Ingrowth and Fracture Healing

(1)

Surgically Induced Injury and the Biological Response

(3)

Implant Stability and Micromotion

(1)

Pore Size

(1)

Interface Gaps

(1)

Factors Known to Inhibit Cementless Fixation

(1)

Clinical Behavior of Cementless Fixation

(4)

Animal Studies

(2)

Retrieval Studies

(8)

Conclusion

(1)

References

(17)

3. Fixation of Implants with Bone Cement

(10)

Hans Georg Willert and Georg Köster

Introduction to the Use of Polymethylmethacrylate as Bone Cement

(1)

Disadvantages of PMMA Bone Cement and Resultant Issues for Clinical Use

(6)

Question of the Gold Standard

(1)

References

(2)

4. Total Hip Replacement: Incidence of Osteolysis and Clinical Presentation

(26)

Rajiv K. Sethi, Sanjeev Agarwal, Harry E. Rubash, and Arun Shanbhag

Introduction

(2)

Incidence

(6)

Diagnosis and Clinical Symptoms

(1)

Radiographic Appearance

(7)

References

(10)

5. Total Knee Arthroplasty: Incidence of Osteolysis and Clinical Presentation

(16)

Jeffrey Wiley and Daniel M. Estok, II

Introduction

(1)

Incidence

(1)

Clinical Presentation

(2)

Radiographic Evaluation

(4)

Other Imaging Studies

(1)

Laboratory Evaluation

(2)

Treatment

100

(1)

Summary

101

(1)

References

101

(4)

6. Histopathology of Periprosthetic Tissues

105

(18)

Stuart B. Goodman and Victor Fornasier

Introduction

105

(1)

Histopathology of Well-Fixed Joint Replacements

105

(5)

Histopathology of Loose Joint Replacements

110

(5)

Improving Osseointegration and Longevity of Joint Replacements: The Future

115

(1)

References

116

(7)

SECTION II: BASIC SCIENCE

7. Properties of Biomaterials Used in Joint Replacements

123

(22)

Timothy M. Wright and Robert F. Closkey Jr.

Introduction

123

(1)

Metallic Alloys

124

(6)

Polymers

130

(6)

Ceramics

136

(3)

Summary

139

(1)

References

140

(5)

8. Wear of Joint Replacements

145

(26)

John Fisher

Introduction

145

(1)

Lubrication, Friction, and Wear

146

(2)

Basic Mechanisms, Types of Wear and Debris Generation

148

(6)

Basic Laws of Wear and Factors that Influence Wear Rates

154

(1)

Wear of Polyethylene in Hip Prostheses

155

(4)

Wear of Stabilized and Cross-Linked Polyethylene in Hip Prostheses

159

(2)

Wear of Ceramic–Ceramic Hips

161

(1)

Wear of Metal–Metal Hips

162

(1)

Wear of Polyethylene in Knee Prostheses

162

(2)

Future Perspectives Bearing Surfaces and Reduction in Wear

164

(1)

References

165

(6)

9. Human Motion and Its Relevance to Wear and Failure in Total Knee Arthroplasty

171

(40)

Markus A. Wimmer and Thomas P. Andriacchi

Introduction

171

(1)

The System Approach of Tribology

172

(2)

Evolution of Knee Prosthesis Design

174

(1)

Functional Knee Joint Kinematics and Kinetics

175

(9)

Estimation of Contact Forces

184

(8)

Fatigue and Wear Due to Tractive Forces

192

(7)

State-of-the-Art Knee Wear Testing

199

(2)

Conclusions

201

(1)

Appendix

202

(1)

References

203

(8)

10. Corrosion of Metallic Implants

211

(44)

Nadim James Hallab, Joshua J. Jacobs, and Jeremy L. Gilbert

Introduction

211

(1)

General Corrosion Concept

212

(6)

In Vitro Corrosion Testing Methods

218

(5)

Corrosion of Orthopaedic Alloys

223

(10)

Metal Release

233

(4)

Local Tissue Effects

237

(2)

Remote and Systemic Effects

239

(7)

Future Directions and Conclusions

246

(1)

References

247

(8)

11. Inflammation and the Role of Macrophages in the Foreign Body Reaction

255

(26)

James M. Anderson

Introduction

255

(1)

Early, Transient Tissue/Material Responses

256

(9)

Late, Persistent Tissue Responses

265

(10)

Future Perspectives

275

(1)

References

276

(5)

12. Cytokines and Mediators in Physiologic and Pathologic Bone Resorption

281

(46)

David R. Haynes and Tania N. Crotti

Introduction

281

(7)

Factors Regulating Peri-implant Osteoclast Formation

288

(13)

Peri-implant Factors Which Influence Osteolytic Mediators

301

(5)

Summary and Overview

306

(2)

References

308

(19)

SECTION III: MECHANISMS OF PERI-IMPLANT BONE LOSS

13. Wear Debris Mediated Osteolysis: An Overview

327

(18)

Arun Shanbhag

Introduction

327

(1)

Historical Perspective

328

(2)

Analysis of Clinical Material

330

(1)

Types of Wear Debris Involved in Osteolysis

331

(2)

In Vitro Evidence of Wear Mediated Osteolysis

333

(3)

In Vivo Models for Osteolysis

336

(2)

Summary

338

(1)

References

338

(7)

14. Role of the Immune Response in Implant Loosening

345

(30)

Paul H. Wooley

Introduction

345

(1)

The Normal Immune Response

346

(4)

Hypersensitivity—The Allergic Response

350

(3)

Effects of Polymers on the Immune Response

353

(3)

Immune Response to Metals

356

(2)

Immune Response to Bone

358

(5)

The Immune Response in Clinical Practice

363

(5)

Summary

368

(1)

References

368

(7)

15. Stress-Related Bone Resorption

375

(24)

J.D. Bobyn, M. Tanzer, and A.H. Glassman

Introduction

375

(2)

Bone Resorption in the Hip–Femur

377

(8)

Bone Resorption in the Hip–Acetabulum

385

(2)

Bone Resorption in the Knee–Femur

387

(1)

Bone Resorption in the Knee–Tibia

388

(2)

Discussion and Conclusions

390

(2)

References

392

(7)

16. Pressure- and Motion-Induced Factors in Implant Loosening

399

(14)

Per Aspenberg

Introduction: A Lesson from the Dentists

399

(1)

Early Migration Predicts Late Loosening

400

(2)

When Initial Fixation Is Lost, Secondary Resorptive Stimuli Appear

402

(4)

Particles Appear Less Important than Pressure and Instability

406

(1)

Early Loss of Fixation Theory Implies New Means to Prevent Loosening

407

(1)

References

408

(5)

17. Role of Endotoxin in Implant Loosening

413

(16)

Fabian von Knoch, Harry E. Rubash, Arun Shanbhag, Steven R. Goldring, and David R. Cho

Introduction

413

(1)

Basic Science of LPS

413

(2)

Role of LPS in Particle-Induced Osteolysis

415

(1)

Effects of LPS on Particle–Cell Interactions In Vitro

416

(5)

LPS in Clinical Osteolysis

421

(2)

Summary

423

(1)

References

424

(5)

18. Signal Transduction and Gene Regulation in Cell–Material Interactions

429

(24)

Elizabeth A. Frit, Kenneth A. Roebuck, and Tibor T. Giant

Introduction

429

(1)

Intracellular Signal Transduction

430

(1)

NF-kappaB/Rel Transcription Factor Family

431

(2)

AP-1 Transcription Factor Family

433

(2)

NF-IL6 Transcription Factor Family

435

(1)

STAT Transcription Factor Family

435

(2)

MAP Kinase Signaling Pathways

437

(1)

Particle-Induced Signal Transduction

438

(2)

Signaling Mechanisms: Particle Phagocytosis vs. Redox-Regulation

440

(3)

Redox Mechanisms in Particle-Mediated Signaling

443

(1)

Conclusions and Future Directions

444

(1)

References

445

(8)

19. In Vitro and In Vivo Models for Understanding Osteolysis

453

(26)

Brian L. Puskas, Mark I Neavyn, and Arun Shanbhag

Introduction

453

(1)

Techniques in Analyzing Clinical Material

454

(2)

In Vitro Models

456

(7)

In Vivo Models

463

(6)

Summary

469

(1)

References

470

(9)

SECTION IV: SOLUTIONS AND TREATMENTS

20. Surgical Techniques: Modern Cementing Techniques

479

(18)

Craig J. Della Valle and Richard A. Berger

Radiographic Analysis

480

(2)

Evolution of Cement Technique

482

(10)

Present Technique for the Insertion of Cemented Femoral Components

492

(2)

Conclusions

494

(1)

References

494

(3)

21. Treating Hip and Pelvic Osteolysis

497

(44)

Eric L. Martin, Stephen Burnett, and Wayne Paprosky

Introduction

497

(1)

Particle Generators

498

(1)

Clinical Presentation

498

(1)

Differential Diagnosis

499

(1)

History

499

(2)

Physical Examination

501

(1)

Blood Tests

501

(1)

Radiographs

502

(1)

Cemented Femoral Components

503

(2)

Noncemented Femoral Components

505

(1)

Cemented Acetabular Components

506

(2)

Noncemented Acetabular Components

508

(1)

Radiographic Follow-Up

508

(1)

Aspiration

509

(1)

Intraoperative Tests

509

(1)

Classification

509

(3)

Femoral Defect Classification Systems

512

(2)

Results

514

(4)

Surgical Treatment

518

(1)

Acetabular Osteolysis—Management

518

(7)

Femoral Osteolysis—Management

525

(8)

Conclusion

533

(1)

References

534

(7)

22. Managing Knee Osteolysis

541

(18)

John Lyon and Aaron Rosenberg

Introduction

541

(1)

Pathophysiology and Natural History

541

(1)

The Clinical Presentation of Osteolysis

542

(3)

Prophylaxis: Anticipating and Preventing Osteolysis

545

(2)

Management of Established Osteolysis

547

(1)

Surgical Treatment of Osteolysis and Wear

548

(7)

Conclusion

555

(1)

References

555

(4)

23. Advances in Metals

559

(34)

Cheryl R. Blanchard, Dana J. Medlin, and Ravi Shetty

Introduction

559

(3)

Metal Manufacturing Processes

562

(6)

Cobalt—Chromium Alloys

568

(4)

Titanium and Titanium Alloys

572

(2)

Stainless Steel Alloys

574

(3)

Mechanical Properties

577

(3)

Mechanical Integrity of Implants—Materials and Design Elements

580

(2)

Porous Coatings for Bone Ingrowth

582

(4)

Surface Treatments for Improved Wear Resistance

586

(1)

Recent Advances in Metals

587

(2)

Summary

589

(1)

References

589

(4)

24. Advances in Polyethylene

593

(26)

Anuj Bellare and Lisa A. Pruitt

Introduction

594

(1)

UHMWPE Wear: HIP vs. Knee Components

595

(1)

Polyethylene: Synthesis and Molecular Structure

596

(1)

UHMWPE: A Hierarchy of Structures

597

(3)

UHMWPE: The Role of Degree of Crystallinity or Density

600

(3)

UHMWPE: Powder Morphology

603

(2)

UHMWPE: Processing Techniques

605

(2)

UHMWPE: The Sterilization Issue

607

(1)

UHMWPE: Alternate Forms

608

(1)

UHMWPE: Cross-Linking

608

(1)

UHMWPE: Future Directions

609

(3)

References

612

(7)

25. Improving UHMWPE Using Electron Beam Irradiation

619

(24)

Orhun K. Muratoglu and William H. Harris

Introduction

619

(1)

Solutions to Polyethylene Oxidation and Wear

620

(2)

Basics of Radiation Chemistry of Polyethylene

622

(3)

Optimum Radiation Dose

625

(3)

In Vitro Evidence in Total Hip

628

(3)

In Vivo Evidence

631

(2)

In Vitro Evidence in Total Knee

633

(5)

Summary

638

(1)

References

638

(5)

26. Alternate Bearing Materials: Metal-on-Metal

643

(22)

Mauricio Silva and Thomas P. Schmalzried

Introduction

643

(1)

Frictional Torque

644

(1)

Materials and Design Considerations

644

(1)

Lubrication

645

(1)

Hip Simulator Tests

646

(1)

Retrieval Studies

647

(5)

Second-Generation Metal-on-Metal Bearings

652

(1)

Metal-on-Metal Wear Particles

653

(1)

Biological Considerations

654

(1)

Serum and Urine Ions

655

(1)

Hypersensitivity

656

(1)

Cancer Risk

657

(1)

Summary

657

(1)

References

658

(7)

27. Alternate Bearing Materials: Ceramic-on-Ceramic

665

(22)

Justin P. Hawes and Jonathan P. Garino

History

665

(4)

Biomechanics and Material Properties

669

(4)

Biocompatibility

673

(10)

Future Considerations and Summary

683

(1)

References

684

(3)

SECTION V: FUTURE PERSPECTIVES

28. Tissue Engineering Alternatives to Joint Replacement

687

(40)

B. Kinner and M. Spector

Introduction

687

(1)

Cartilage Repair Procedures: Historical Perspective

688

(3)

Cell-Based Therapies Currently Employed in the Clinic

691

(8)

Comparison of Results from Cartilage Repair Procedures Currently Employed in the Clinic

699

(1)

Novel Tissue Engineering Approaches for Cartilage Repair Currently Undergoing Investigation

700

(13)

Summary

713

(1)

References

713

(14)

29. Enhancing Cementless Fixation

727

(28)

Dale R. Sumner, Amarjit S. Virdi, Robert M. Leven, and Kevin E. Healy

Introduction

727

(1)

Cellular Environment of Fixation

728

(6)

Use of Growth Factors

734

(3)

Implant Surface Modification

737

(4)

Other Enhancing Agents

741

(1)

Conclusion

742

(1)

References

743

(12)

30. Cenome Sciences in Clinical Orthopaedics

755

(24)

Arun Slumbhag, Grant E. Garrigues, Adam M. Kaufman, and Harry E. Rubash

Introduction

755

(2)

Modern Genomic Techniques

757

(6)

Understanding the Pathogenesis of Osteoarthritis

763

(2)

Diagnosis by Gene Expression Profiling

765

(2)

Improving Orthopaedic Implants

767

(2)

Pharmogenomics

769

(4)

Summary

773

(1)

References

774

(5)

Index

779

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Joint Replacement and Bone Resorption: Pathology, Biomaterials and Clinical Practice

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