Joint Replacement and Bone Resorption: Pathology, Biomaterials and Clinical Practice PDF

Preface

Over the last four decades, investigators around the globe have toiled in clinics, in laboratories, and in operating rooms trying to understand the causes of bone resorption around joint replacements. What is the impact on patients? What is the role of the engineering materials used for joint reconstruction? What are the potential solutions? How do we implement them? What does the future hold for joint replacements? Their findings have been tucked away in tens of thousands of research articles within hundreds of journals. In this volume, an interdisciplinary team of thought leaders from around the world have synthesized the knowledge and compiled it into concise and authoritative chapters.

Periprosthetic bone resorption, or osteolysis, remains an important and common clinical problem and will continue to be so for the foreseeable future. Improvements in implant design and bearing materials have the potential to reduce the prevalence of this phenomenon in modern implant systems introduced since the mid-1990s. Long-term clinical outcomes with newer materials are not yet know. There are also large numbers of patients who have functioning devices that were implanted prior to that era. Furthermore, indications for arthroplasty have expanded and patient demographics have altered dramatically, resulting in recipients placing increasing demands on their artificial joints-they tend to be younger at the time of their surgery, are more active and live longer. These considerations curtail any sense of complacency with regard to the elimination of this pathological bone resorptive process.

This book is separated into five sections. In Section I-Clinical Picture- we have compiled the historical perspective of joint replacement surgery, as well as the early investigations that have shed light on the host tissue reaction to the implanted materials and factors that have been associated with osteolysis, clinical failure, and clinical success. In Section II-Basic Science-we have taken the opportunity to re-acquaint ourselves-the perennial students-with the fundamentals of material science, wear, and the immune response, so that we may better understand the cellular, molecular, and engineering underpinnings of joint replacements and the host response. This should permit us to critically evaluate the progress we have made and the challenges that stand before us. In Section III-Mechanisms of Peri-implant Bone Loss-we have brought together the strongest proponents of various hypotheses for implant loosening and permitted them to make their case. This provides the reader with the opportunity to hear it from ‘‘the horse's mouth'' without the editorializing of critics and skeptics.

In Section IV-Solutions and Treatments-we asked leading clinicians, engineers, and scientists to summarize the latest developments in biomaterials science and surgical techniques. This section demonstrates the wide range of innovations that have taken root and aims to improve the quality of life of the patients we serve by extending the durability of joint replacements. The trajectory of these innovations gives us hope that joint replacement surgery may mature to the point when reconstruction will routinely last for the lifetime of the patient. In Section V-Future Directions-the contributors take a peek into the future of joint replacements and project how newer technologies could aid our understanding of the pathological processes of cartilage destruction, alter the course of arthritis and related diseases, offer opportunities for medical management and enhance surgical solutions.

This volume is intended as a ready reference to current knowledge in the field, with comprehensive treatment of each topic, written by those at the forefront of laboratory investigations and patient care. This book was written for the orthopaedic surgery resident and fellow, the biomedical engineering graduate student, and the orthopaedic researcher. Practicing clinicians will find a concise summary of the vast field of joint replacement. For those new to this information, this volume will provide a quick ‘‘entry'' into a dynamic field.