Interaction of Materials and Biology in Total Joint Replacement - Successes, Challenges and Future Directions.
Interaction of Materials and Biology in Total Joint Replacement - Successes, Challenges and Future Directions.
复制标题
DOI：
10.1039/c4tb01005a
复制
发表时间：
2014-11-07
期刊：
影响因子：
--
通讯作者：
Goodman SB
中科院分区：
文献类型：
--
作者：
Pajarinen J;Lin TH;Sato T;Yao Z;Goodman SB
全关节置换术（TJR）彻底改变了终末期关节炎疾病的治疗。这一成功在很大程度上归功于对人工植入物与宿主生物学之间重要相互作用的清晰理解。所有植入体内的外科手术都会引起最初的炎症反应，通常会在几周内消退。此后，发生一系列稳态事件，导致植入物在骨和周围肌肉骨骼组织内逐渐整合。手术的最终结果取决于植入物的特性、手术技术和手术环境的精确度以及宿主的生物环境。如果这些因素和事件不是最佳的，则可能发生不良事件，例如慢性炎症的发展、由于植入物降解产物的产生增加而导致的进行性骨丢失（假体周围骨质溶解）、植入物松动或感染。这些并发症可能导致慢性疼痛和关节重建功能不良，并可能需要翻修手术或完全取出假体。工程学、材料科学和与骨科植入物相关的免疫学方面的最新进展促进了深入的研究，希望关节置换能够持续一生，并促进无痛的正常功能。
Total joint replacement (TJR) has revolutionized the treatment of end-stage arthritic disorders. This success is due, in large part, to a clear understanding of the important interaction between the artificial implant and the biology of the host. All surgical procedures in which implants are placed in the body evoke an initial inflammatory reaction, which generally subsides over several weeks. Thereafter, a series of homeostatic events occur leading to progressive integration of the implant within bone and the surrounding musculoskeletal tissues. The eventual outcome of the operation is dependent on the characteristics of the implant, the precision of the surgical technique and operative environment, and the biological milieu of the host. If these factors and events are not optimal, adverse events can occur such as the development of chronic inflammation, progressive bone loss due to increased production of degradation products from the implant (periprosthetic osteolysis), implant loosening or infection. These complications can lead to chronic pain and poor function of the joint reconstruction, and may necessitate revision surgery or removal of the prosthesis entirely. Recent advances in engineering, materials science, and the immunological aspects associated with orthopaedic implants have fostered intense research with the hope that joint replacements will last a lifetime, and facilitate pain-free, normal function.