By Arun Shanbhag, Harry E. Rubash, Joshua J. Jacobs
This primary consultant dedicated to this burgeoning subject, this authoritative reference provides the present realizing of the phenomenon of aseptic loosening of overall joint replacements from the molecular and mobile mechanisms of periprosthetic bone loss to the medical presentation and administration strategies-reviewing the houses of ceramic, steel, and polymer fabrics utilized in the substitute of joints, in addition to present learn on bone home improvement, put on resistance, the long term care of implants, and rising advancements in gene remedy and tissue engineering.
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Extra resources for Joint Replacement and Bone Resorption: Pathology, Biomaterials and Clinical Practice
Numerous reports of using various grafting materials to improve bone ingrowth can be found in the literature (65,67,107,116,130,143,146,147, 164,202,207,212,248). Most of these are either osteoconductive and/or osteogenic. Allogeneic bone and porous ceramics such as hydroxyapatite and tricalcium phosphate, serving as a ‘‘scaffold’’ for bone ingrowth, are considered osteoconductive. Autologous bone, on the other hand, is both osteoconductive and osteogenic (bone producing). Whereas bone ingrowth into porous structures leads to the formation of a microinterlock, host bone interaction with these grafts results in a chemical bond (115–117).
The big ﬂakes, which are generally associated with delamination, do not incite the same macrophage response. Nevertheless, there have been striking examples of periprosthetic osteolysis around total knee replacements, generally associated with implants which had either inferior polyethylene or inferior design such that the adhesive–abrasive wear of the polyethylene was accelerated (29,30). Thus, around total knee replacements, even over longer periods of time, periprosthetic osteolysis is less of a problem than it is around total hip replacements.
Figure 2 Distribution of bone ingrowth in a canine model. In the tibial component of cementless porous coated knee replacements, areas with relatively minimal micromotion (within a 1- to 3-mm radius around the tibial implant pegs) consistently achieve bone ingrowth, whereas other areas have highly variable amounts of bone ingrowth. 5% appositional bone. Source: From Ref. 247. porous-coated femoral component and postoperative radiographs conﬁrm appropriate canal ﬁt, biological ﬁxation occurs whether or not a partial or full weight-bearing postoperative protocol is followed (263).