FAILURE MECHANISMS OF REVISION JOINT REPLACEMENT

修正关节置换的失效机制

• 批准号: 2748640
• 负责人: Joan E Bechtold
• 金额: $ 11.49万
• 依托单位: HENNEPIN HEALTHCARE RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 1996
• 资助国家: 美国
• 起止时间: 1996-08-01 至 2001-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2748640
• 关键词: biological models; biomaterial compatibility; biomaterial evaluation; biomaterial interface interaction; bone transplantation; dogs; implant; joint prosthesis; longitudinal animal study; mechanical stress; radiography

DESCRIPTION (Adapted from investigator's abstract): Total joint arthroplasty has substantially improved the quality of life for millions of people, yet a significant number of joint replacements fail each year, particularly "revision" joint replacements (i.e., replacements inserted after failure of the "primary" or original replacement). The basic objective of the work proposed is to investigate the pathomechanics of revision failure, focusing on the biologic characteristics of bone and soft tissue and the effects of implant motion and particulate debris. The role of bone grafting will also be studied. Four hypotheses will be tested: 1): the density of foreign body giant cells in a revision cavity depends on the size of the polyethylene particles in the model; 2) bone ingrowth and implant fixation are greater for a primary implant cavity than a revision cavity, both with and without implant motion; 3) bone grafting improves implant fixation and bone ingrowth in a revision cavity, with and without motion; and 4) when bone grafting is used, implant fixation and bone ingrowth are superior for a primary cavity than for a revision cavity. Soballe implants will be inserted into the femoral condyles of 28 adult mongrel dogs (the unstable Soballe implant provides a controlled amount of axial motion; the stable Soballe implant does not move). The study will proceed as follows: in Year 1, the study of the particle size on membrane and bone characteristics will be completed. This ongoing experiment shows the applicability of the Soballe implant for generating the essential features of a loosened cemented implant (i.e., revision cavity). In Years 2-3, the effects of implant motion and bone grafting in this revision cavity will be investigated. The following conditions will be studied: stable primary, unstable primary, stable revision, unstable revision, stable primary with bone graft, unstable primary with bone graft, stable revision with bone graft, and unstable revision with bone graft. At euthanasia, anteroposterior and lateral radiographs will be obtained and bacterial cultures will be taken, and the block of bone and membrane surrounding the implant will be removed. Analyses and intergroup comparisons (Years 4-5) will be conducted for implant/interface shear strength, fibrous membrane thickness, bone ingrowth, and presence of macrophages, fibroblasts, synovial cells, foreign body giant cells, and debris presence. The results of these studies are intended to provide quantitative data on the differences between primary and revision joint replacement, with and without bone graft, and indicate directions for improving the clinical success rate of revision joint replacement.

描述（改编自研究者摘要）：全关节 关节成形术大大改善了数百万人的生活质量， 的人，但有相当数量的关节置换失败， 年，特别是“翻修”关节置换（即，替代品 在“主”或原始替换件失效后插入）。 的 拟议工作的基本目标是调查 翻修失败的病理力学，重点关注生物学 骨和软组织的特点及种植体的作用 运动和微粒碎片。 骨移植的作用也将是 研究了 将检验四个假设：1）：异物密度 翻修腔内的巨细胞取决于聚乙烯的尺寸 2）骨长入和植入物固定更大 对于初次种植体腔，而不是翻修腔， 无植入物移动; 3）骨移植改善了植入物固定， 翻修腔内的骨长入，有和无运动;以及4）当 采用植骨，植入物固定和骨长入均优于上级 而不是修复洞。 将Soballe植入物插入28名成人的股骨髁中 杂种狗（不稳定的Soballe植入物提供了受控的量， 轴向运动;稳定的Soballe植入物不会移动）。 研究 将进行如下：在第1年，对颗粒尺寸的研究 膜和骨特性将完成。 这一持续 实验显示了Soballe植入物用于生成的适用性 松动的骨水泥植入物的基本特征（即，修订 腔）。 在第2-3年，种植体移动和骨移植的影响 在这个修正洞将进行调查。 以下条件 将研究：稳定初次、不稳定初次、稳定翻修， 翻修不稳定，初次稳定，植骨，初次不稳定， 植骨、植骨稳定翻修和植骨不稳定翻修 骨移植 安乐死时，将拍摄前后位和侧位X光片， 将获得并进行细菌培养，并将骨块 并且将移除围绕植入物的膜。 分析和 将进行组间比较（第4-5年）， 植入物/界面剪切强度、纤维膜厚度、骨 向内生长，以及巨噬细胞，成纤维细胞，滑膜细胞， 异物巨细胞和碎片的存在。 的结果予以 研究旨在提供有关差异的定量数据， 初次和翻修关节置换术之间，有骨和无骨 为提高临床成功率指明了方向 翻修关节置换术