Programme Grant Application in Bio Tribology of Articular Cartilage and Substitution Interventions

骨关节炎影响至少15%的人口。目前，除了药物干预和缓解疼痛外，唯一有效的治疗方法是终末期全关节置换术。目前的全关节置换手术在65岁以上的患者中非常成功，要求相对较低，10年成功率超过90%。越来越多的年轻和更活跃的患者被诊断为骨关节炎，他们期望积极的生活方式，并希望保持功能和长期工作。然而，目前的关节置换术在年轻患者中并不成功，髋关节和膝关节长期磨损和骨质溶解，与固定/骨丢失、松动和较高的翻修率相关。失败假体的翻修目前是NHS的一个巨大手术负担，与初次关节置换术相比，这些手术通常更昂贵，发病率也更高。不愿意在年轻和更活跃的患者中使用终末期关节置换术，并且希望开发用于关节关节中早期退行性疾病的组织保留替代治疗和再生治疗。有必要发展关节软骨的功能性生物摩擦学的研究能力，以支持软骨替代疗法和再生干预的研究和开发，并使新一代的前-进行临床研究，以加速将新技术转化为患者，并通过更好地预测长期临床结果来提高安全性和有效性。该项目旨在开发一个新的研究平台，在具有代表性的生理和解剖条件下（通过体外实验和计算模型），长时间研究全尺寸、整个天然关节的生物摩擦学。一旦建立，这些新的软骨生物摩擦学模拟系统将使我们能够与学术和工业团体合作，研究和支持开发新的软骨替代手术干预和骨关节炎早期干预的再生疗法。三个重要的自然关节系统的髋关节，膝关节和脊柱将得到解决。该计划赠款的研究结果将有助于先进医疗产品的行业和制造商开发更好和更安全的干预疗法，并使外科医生更好地了解使用新疗法的决定。这项工作还将通知监管和标准机构，如MHRA（英国），FDA（美国）和ISO。这将为英国国民保健服务带来巨大的经济效益，也为患者带来社会效益。

Osteoarthritis affects at least 15% of the population. Currently, apart from pharmacological intervention and pain relief the only effective treatment is end stage total joint replacement. Current total joint replacement surgery is highly successful in patients over 65 with relatively low demands, with success rates over 90% at ten years. Osteoarthritis is being diagnosed in increasing numbers of younger and more active patients, who have expectations of an active life style and desire to remain functional and working for extended periods. However, current joint replacement is not as successful in younger patients, with long term wear and osteolysis in the hip and knee, associated with loss of fixation/bone, loosening and higher revision rates. Revision of failed prostheses is currently a large operating burden in the NHS, and these operations are generally more expensive with increased morbidity compared to primary arthroplasty. There is a reluctance to utilise end stage joint replacement in younger and more active patients, and there is a desire to develop tissue sparing substitution treatments and regenerative treatments for early degenerative disease in articulating joints. There is a need to develop research capacity in the functional biotribology of articular cartilage to support research and development of cartilage substitution therapies and regenerative interventions and enable a new generation of pre-clinical studies to be undertaken to accelerate of the translation of new technology to the patient and enhance the safety and efficacy through better short term predictions of long term clinical outcomes.The overall aim of this programme is to develop a new research platform to study the biotribology of full scale, whole natural joints, over extended periods of time, under representative physiological and anatomical conditions (through in vitro experimental and computational models). Once established these novel simulation systems for cartilage biotribology will allow us to work collaboratively with academic and industrial groups to investigate and support development of new surgical interventions for cartilage substitution and regenerative therapies for early intervention in osteoarthritis. Three important natural articulating joint systems of the hip, the knee and the spine will be addressed. The findings from the programme grant will be valuable in helping industry and manufacturers of advanced medical products to develop improved and safer intervention therapies, and for surgeons to make better informed about decisions on use of new therapies. The work will also inform regulatory and standard bodies such as MHRA (UK), FDA (USA) and ISO. This will have tremendous economic benefit to the UK NHS as well as social benefit to the patients.