A novel thermodynamic bone remodeling framework for artificial joint optimization

人工关节假体被用来替代病变的关节表面，为患者提供疼痛缓解。在大约10年的使用后，这些人工关节往往会导致严重的并发症，如骨折再骨折、感染和种植失败。这些失败的植入物需要通过昂贵的翻修手术进行替换，与初次替换相比，这些手术更困难，结果更不令人满意。这些并发症与关节表面产生磨损颗粒和骨-种植体界面的骨丢失有关，也称为骨重建。这种骨重建是人工关节置换术中的一个主要问题，尤其是对患有骨质疏松症或骨关节炎的老年患者。目前，用于关节置换的大多数植入物都是由钛和钴铬合金等硬质材料制成的。这种植入物的使用改变了骨骼内的应力水平，导致植入物附近的骨骼重塑。因此，了解、监测和控制种植体周围发生的重塑是很重要的。这项研究的目的是通过开发、实施和验证一个先进的骨重建数学框架来改进关节植入物的设计。这一独特的数学框架使用不可逆热力学来结合在骨骼重建过程中同时起作用的所有因素，包括机械和代谢(生物和化学)。这一先进的模型在预测骨重建和患者治疗方面具有多种潜在的应用。在短期内，它将有助于改进金属和仿生假体的设计。它还将用于评估和监测全髋关节和髋关节表面置换等外科手术后骨再骨折的风险。从长远来看，它可以形成与骨质疏松等骨吸收相关的骨疾病的虚拟模拟的基础，这将允许开发新的治疗策略。

Artificial joint prostheses are used to replace diseased articular surfaces and provide pain relief for patients. After approximately 10 years of service, these artificial joints often cause major complications such as, bone re-fracture, infection and implant failure. These failed implants need to be replaced through costly revision surgeries, that are more difficult with less satisfactory outcomes compared to the primary replacement. These complications have been linked to the production of wear particles at the articular joint surface and bone loss also known as bone remodeling at the bone-implant interface. This bone remodeling is a major issue in artificial joint replacement particularly for elderly patients suffering from osteoporosis or osteoarthritis. Currently, most implants used in joint replacements are made from stiff materials such as titanium and cobalt-chrome alloys. The use of such implants changes the levels of stress within the bone, resulting in bone remodeling adjacent to the implant. Therefore, it is important to understand, monitor and control the remodeling that occurs around implants. The aim of this research is to improve the joint implants design by developing, implementing and validating an advanced mathematical framework for bone remodeling. This unique mathematical framework uses irreversible thermodynamics to combine all factors, mechanical, and metabolic (biological and chemical) which are simultaneously at play in the bone remodeling process. This advanced model has multiple potential applications in predicting bone remodeling and patient therapy. In the short term, it will assist in improving the design of metallic and biomimetic prostheses. It will also be used to assess and monitor the risk of bone re-fracture after surgical procedures such as total hip and hip resurfacing arthroplasty. Over the long term it can form a basis for virtual simulations of bone diseases associated with bone resorption such as osteoporosis, which will allow for the development of new therapeutic strategies.