Establishing Links with China in the area of Biotribology of Natural Synovial Joints and Artificial Replacements

人工关节置换术已成为关节炎和创伤患者最成功的外科治疗方法之一。然而，大多数关节假体在体内10至15年后失效，这是由于对颗粒碎片的不良组织反应引起的松动。目前，有两个广泛的战略，以避免修订。一种是通过使用新型轴承对来改善传统的全关节置换术，以减少磨损和磨损颗粒的产生。另一种策略是通过使用细胞、支架和生物活性因子的组织工程方法来开发生物解决方案。尽管这些生物解决方案提供了长期的希望，但由于缺乏生物力学功能、整合失败以及商业实现的经济和监管障碍，目前它们尚未广泛用于临床。因此，早期干预方法逐渐受到关注，这些方法试图保留部分或全部功能性关节软骨。日益严格的伦理和监管环境要求进行更广泛的临床前研究，作为将任何新技术转化为患者的一部分。对关节面摩擦学和磨屑生物学反应的耦合研究为此类驱动器、新型关节面材料组合的开发和终末期全关节置换术的成功做出了重大贡献。然而，这些替代关节面超过20年的长期临床结局仍不清楚，仍然存在许多长期临床问题。在更现实的条件下进一步开发临床前模拟模型可能是必要的，特别是对于活跃和年轻患者所需的替代轴承。新型组织替代装置的引入和改进可以弥合终末期关节置换和生物组织工程解决方案之间的差距，从而潜在地为关节疾病提供连续的治疗。然而，这些新的手术方法的发展对实验室模拟提出了相当大的挑战，并且有一些关键问题迫切需要解决。目前没有临床前功能模拟模型可用于评估这些器械的潜在长期临床性能。此外，患者的解剖和生理特征可能成为器械的组成部分，患者特定问题变得重要。基于先进的患者特异性计算模型的临床前模拟可以为最佳治疗方案提供指导，并满足患者的特殊需求。近年来，中国人工关节的开发和这些器械的临床应用显着增加，从20世纪80年代的几百个增加到2005年的约90，000个。随着中国经济的增长，这些数字预计将大幅增加，越来越多的人将获得这种治疗。然而，尽管人工关节的使用迅速扩大，市场潜力巨大，但目前还没有一家主要的国际骨科公司能够广泛渗透到中国市场，仍然存在一些障碍。这包括中国人群的不同解剖结构，以及设计患者和人群特定植入物的需求。同样重要的是，中国在这一领域缺乏研究支持。该提案的目的是通过在生物摩擦学领域建立研究合作，特别是开发临床前模拟方法，并开发患者和人群特定的模拟模型，与中国的科学家和工程师建立新的战略长期关系。这些目标将通过互访、短期考察访问和组织生物摩擦学领域的国际会议来实现。

Artificial joint replacement has been one of the most successful surgical treatments to patients suffering from arthritis and trauma. However, the majority of joint prostheses fail after 10 to 15 years in the body, as a result of loosening, caused by adverse tissue reactions to particulate debris. Currently, there are two broad strategies to avoid revision. One is to improve conventional total joint replacements by using novel bearing couples to reduce wear and wear particle generation. The alternative strategy is to develop biological solutions through tissue engineering approaches using cells, scaffolds and bioactive factors. Although these biological solutions offer a long term hope, currently they are not widely used in clinics due to a lack of biomechanical function, failure of integration, and economic and regulatory barriers to commercial realisation. Consequently, there are emerging interests in earlier intervention approaches, which attempt to retain some or all of the functional articular cartilage.The increasingly rigorous ethical and regulatory environment is demanding more extensive pre-clinical studies, as part of the translation of any new technology to the patient. Coupled studies of tribology of the bearing surfaces and biological reactions to wear debris have contributed significantly to such drives, and developments of novel bearing material combinations and successes of end-stage total joint replacements. However, the long-term clinical outcome of these alternative bearings beyond 20 years remains unclear, and there are still a number of long-term clinical concerns. Further development of preclinical simulation models under more realistic conditions may become necessary, particularly for alternative bearings required for active and young patients. The introduction and refinement of novel tissue substitution devices may bridge the gap between the end stage joint replacement and the biological tissue engineering solution, potentially providing a continuum of therapies for joint diseases. However, the development of these new surgical approaches poses considerable challenges for laboratory simulation, and there are a number of key issues which need to be addressed urgently. There are currently no pre-clinical functional simulation models that can be used to assess the potential long-term clinical performance of these devices. Furthermore, the anatomical and physiological characteristics of the patient may become an integral part of the device and patient specific issues become important. Preclinical simulation based on advanced patient specific computational models may provide guidance for best treatment options as well as addressing special needs of patients.The development of artificial joints and the clinical use of these devices in China have increased significantly recently, from a few hundred in the 1980's to about 90,000 in 2005. These numbers are expected to increase dramatically as the economy in China grows and more and more people will be offered such treatments. However, despite of the rapid expansion of artificial joint usage and huge potential market, currently none of the major international orthopaedics companies have managed to penetrate into the Chinese market extensively and there are still a number of barriers. These include different anatomy of the Chinese population, and the need to design patient and population specific implants. Equally important is the lack of research support within China in this area.The aims of this proposal are to establish new strategic long-term relationships with scientists and engineers in China through establishing research collaboration in the area of biotribology, in particular to develop preclinical simulation methods and to develop patient and population specific simulation models. These objectives will be achieved through exchange visits, short term study visits and organisation of an international conference in the area of Biotribology.