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

至少有15%的人患有骨性关节炎。目前，除药物干预和止痛外，唯一有效的治疗方法是终末期全关节置换术。目前，全关节置换术在65岁以上、要求相对较低的患者中非常成功，10年内成功率超过90%。越来越多的更年轻、更活跃的患者被诊断为骨关节炎，他们希望有积极的生活方式，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溶解，与固定/骨丢失、松动和较高的翻修率相关。翻修失败的假体目前是NHS的一大手术负担，与初次关节成形术相比，这些手术通常更昂贵，发病率更高。人们不愿在更年轻和更活跃的患者中使用终末期关节置换，并且希望开发用于关节早期退行性疾病的组织节约型替代治疗和再生治疗。有必要发展关节软骨功能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，并使新一代临床前研究得以进行，以加快新技术向患者的转化，并通过对长期临床结果的更好的短期预测来提高安全性和有效性。该计划的总体目标是开发一个新的研究平台，以在较长的一段时间内，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)研究完整的自然关节的生物摩擦学。一旦建立了这些新颖的软骨生物摩擦学模拟系统，我们将能够与学术和工业团体合作，研究和支持新的软骨替代手术干预和骨关节炎早期干预的再生疗法的开发。三个重要的自然关节系统的髋关节，膝盖和脊柱将被介绍。计划拨款的结果将有助于行业和先进医疗产品的制造商开发改进的、更安全的介入疗法，并帮助外科医生更好地了解使用新疗法的决定。这项工作还将告知监管和标准机构，如MHRA(英国)、FDA(美国)和ISO。这将为英国NHS带来巨大的经济效益，也将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.