Preface
References
Contents
Contributors
1: Current Evidence in Designs and Fixation Surfaces in Total Hip Arthroplasty
Introduction
Achieving Implant Incorporation
Bone-Cement Interface
Cement-Femoral Stem Interface
The Test of Time
Cemented Cups
Cemented Stems
Bone-Implant Interface
The Test of Time
Evidence-Based Data
Conclusion
References
2: Early and Late Mechanical Stability of the Cementless Bone-Implant Interface in Total Joint Arthroplasty
Introduction
Development of Cementless Components
Primary Stability
Secondary Stability
Design Factors
Implant Morphology
Coating Design
Summary
References
3: Bone-Cement Interface in Total Joint Arthroplasty
Cementing Technique
Thickness of the Cement Mantle
Surface Texture of the Femoral Component
Shape of the Femoral Component and Metallurgy
Cemented Fixation of the Acetabulum
References
4: The Implant-Cement Interface in Total Hip Arthroplasty
Introduction
Effect of Prosthetic Design and Choice of Material on Stem-Cement Interface
Stem Material
Cross-Sectional Shape
Stem Design Different Philosophies
Surface Roughness
Stem Migration and Wear
The Cement Mantle
Creep
The Influence of Porosity at the Stem-Cement Interface
Migration Pattern of Cemented Femoral Stems
RSA Studies Evaluating the Stem-Cement Interface
References
5: Cobalt–Chrome Porous-Coated Implant-Bone Interface in Total Joint Arthroplasty
Cobalt–Chrome Alloys
Porous Metallic Coatings
Forms and Fabrication Techniques
Bond Failure of Sintered Porous Coatings
Ion Implantation
Hydroxyapatite-Coated Co–Cr Porous-Coated Implants
Biocompatibility of Co–Cr Porous-Coated Implants
Outcome of Co–Cr Porous-Coated Implants
Metallic Ions Release from Co–Cr Porous-Coated Implants
Corrosion Behavior of Co–Cr Porous Coatings
Metallic Failures of Co–Cr Porous-Coated Implants
Influence of Co–Cr Porous Coating on Infection
Influence of Sex and Estrogens on Co–Cr Porous Coating Ingrowth
Novel Techniques for Micro-structural Metal Surface Texture
References
6: Titanium Porous-Coated Implant-Bone Interface in Total Joint Arthroplasty
Introduction
History
Titanium Properties
Coating Methods and Types of Titanium Coatings
Animal Studies
Human Studies
Total Hip Arthroplasty
Femoral Component
Acetabulum
Cemented Fixation
Total Knee Arthroplasty
Other Joint Arthroplasties
References
7: Grit-Blasted Implant Bone Interface in Total Joint Arthroplasty
Introduction
Data from Basic Sciences and Experimental Studies
Data from Clinical Human Studies
Surgery and Different Application
References
8: HA-Coated Implant: Bone Interface in Total Joint Arthroplasty
Introduction
Electrochemical HA (EDHA) Application Technique
Experimental Studies on Plasma-Sprayed HA-Coated Implants
Clinical Motivation for Experimental Studies
Basic Experimental Design Studies Establishing Plasma-Sprayed HA as an Implant Coating
Animals
Implants and Surface Coatings
Models for Implantation
Evaluation
Findings of Experimental HA Plasma-Sprayed Implant Studies
Effect of a Gap Between Bone and Implant
Effect of Bone Grafting on Implant Fixation
Effect of Micromotion on Implant Fixation
500 μm Movements
150 μm Movements
Magnitude of Motion
Effect of HA Coating on Implant Fixation
Summary of Experimental HA Plasma-Sprayed Implant Studies
Experimental Studies on Electrochemical-Deposited HA (EDHA) Coated Implants
EDHA Versus Titanium
EDHA Versus HA Plasma-Spray
Clinical Results of HA Coatings
Clinical Studies on Electrochemical-Deposited HA
Conclusion
References
9: Trabecular Metal: Bone Interface in Total Joint Arthroplasty
Introduction
Structure
Experimental Data
Retrieval Studies
Clinical Studies
References
10: Assessment of a Failed (Painful?) Total Joint Arthroplasty
Introduction
Pain
History
Clinical Examination
Laboratory Tests
Plain Radiographs
Cemented Components
Cementless Stems
Cemented Acetabular Components
Cementless Acetabular Components
Aspiration: Anesthetic Injection
Fluoroscopic Imaging
Arthrography
Radionuclide Imaging
TPBS
Gallium-67 Citrate Imaging
Indium-111-Labeled Leukocytes Scintigraphy
Imaging with Investigational Agents
PET (Positron Emission Tomography Based on 2-Fluoro-2-Deoxy- d -Glucose)
Modern Techniques
Dynamic Computed Tomography Scanning
In Vivo Wear Measurements of Bearing Surfaces
Serum Metal Ion Levels
References
11: The Biology of Aseptic Loosening
Introduction
Comments on Causative Theories
Micromotion
Stress Shielding
High Fluid Pressure
Endotoxins
Particle Disease
Particle Production
Aseptic Loosening Pathways
Other Cells, Molecules, and Pathways
Treatment Options
References
12: Cement-Bone Interface in Revision Arthroplasty
Revision Total Hip Arthroplasty
Cemented Acetabular Revision
Cemented Femoral Revision
Cemented Acetabular Revision with Impaction Grafting Technique
Cement-in-Cement Technique
Surgical Technique of Cement-in-Cement Revision Surgery
Indications for Cement-in-Cement Revision Surgery
Cemented Fixation of Revision Total Knee Arthroplasty
Conclusion
References
13: Cementless Fully Porous-Coated Implant-Bone Interface in Revision Total Hip Arthroplasty
Introduction
A Historical Overview
Properties of an Ideal Porous Coating
Optimal Pore Sizes for Bone
Mechanical Properties of Porous Biomaterials
Closed-Cell or Open-Cell Porosity
Forms and Fabrication Techniques
Traditional Metallic Coatings
Metallic Foams
Titanium-Based Coatings
Characteristics of Bone Ingrowth and Interface Mechanics
Concerns About Porous-Coated Implants
Future Directions
References
14: Cementless Tapered Fluted Implant-Bone Interface in Revision Total Joint Arthroplasty
Introduction
Clinical Results
Primary Stability
Secondary Stability
Proximal Femoral Bone Restoration
Stem Subsidence
References
15: Bone-Graft and Implant-Graft Interface in Total Hip Arthroplasty
Introduction
Biology of Bone Grafting
Osteoconduction
Osteoinduction
Osteogenesis
Bone Graft Options [ 11 – 17 ]
Autograft
Autologous Bone Marrow
Autologous Cancellous Bone
Autologous Cortical Bone
Vascularized Autologous Bone Graft
Allograft [ 11 – 15, 18 ]
Allograft Cancellous Bone
Allograft Cortical Bone
Massive Osteochondral Allografts
Allogenic Demineralized Bone Matrix
Synthetic Bone Substitutes
Impairment of Bone Graft Healing
Bone Grafting in Hip Surgery
Acetabular Bone Grafting [ 4, 9, 22, 23, 25 – 36 ]
Diagnosing and Assessing Acetabular Bone Loss
Plain Radiographs and Special Views
CT Scans
Magnetic Resonance Imaging
Acetabular Defect Classification [ 27, 33, 36 ]
Surgical Management Options for Massive Acetabular Bone Loss
Acetabular Impaction Grafting [ 9, 23, 25, 27, 32 – 36 ]
Biology of Impaction Bone Grafting [ 11, 14 ]
Preparation of Particulate Graft for Impaction Bone Grafting
Incorporation of Particulate Graft
Histology of Retrieved Particulate Allograft for Treatment of Acetabular Defects
Acetabular Impaction Grafting Surgical Technique [ 27 ]
Clinical Applications and Results of Impaction of Particulate Grafts for Acetabular Reconstruction [ 23, 27, 32 – 38 ]
Structural Allograft
Modular Porous Metal Augments in Cementless Reconstructions
Ring and Cage Reconstruction
Cup-Cage Reconstruction
Triflange Reconstruction
Femoral Bone Grafting in Hip Surgery [ 57 – 78 ]
Diagnosing and Assessing Femoral Bone Loss
Surgical Management Options for Massive Femoral Bone Loss
Structural and Cancellous Allograft
Clinical Applications and Results of Use of Structural and Cancellous Grafts for Femoral Reconstruction
Femoral Impaction Grafting
Histology of Retrieved Particulate Allograft for Treatment of Femoral Defects
Femoral Impaction Grafting Surgical Technique
Clinical Applications and Results of Impaction of Particulate Grafts for Femoral Reconstruction
Complications of Femoral Impaction Grafting
Induced Membrane Technique for Reconstruction of Bone Loss
Future Developments
References
16: The Effect of Pharmacological Agents on the Bone-Implant Interface
Introduction
Terminology
The Role of Pharmacological Agents at the Bone-Implant Interface
Pharmacological Agents Positively Affecting Osseointegration
Antibiotics
Anti-inflammatory Agents
The RANK/RANKL/OPG System
Statins
Calcitonin
Bisphosphonates
Strontium Ranelate
Parathyroid Hormone (PTH) and Teriparatide
Biocoatings
Pharmacological Agents Negatively Affecting Osseointegration
Conclusions
References
17: Bone-Implant Interface in Biofilm-Associated Bone and Joint Infections
Introduction
Pathogenesis of Implant-Related Infections
Bacterial Biofilms as the Cause of Tissue Destruction
The Innate Immune Response
The Role of Neutrophils Against Staphylococcus Biofilms
The Role of Macrophages Against Staphylococcus Biofilms
Septic Interface Pathology
Prevention of Biofilm Infections
Surface Cleaning of Orthopedic Implants
Quorum Sensing Inhibition
Future Perspectives and Innovative Strategies to Combat Implant Infections: The Role of Biomaterial Science
Conclusion
References
18: Modular Interfaces
Introduction
Total Hip Replacement
Acetabular Components
Modular Stems
Clinical Advantages and Disadvantages
Mechanisms of Corrosion, Fretting, Cracking, and Failure of Modular Interface
Debris and Wear
Stress Distribution and Micromotion
Assembling Process
Total Knee Replacement
Tibial Inserts
Augmentation Devices
Stems
Shoulder Arthroplasty
Humeral Head-Stem
Metal-Backed Glenoid Components
Conclusions
References
19: Local and Distant Reaction to Metallic Wear Debris
Introduction
Wear Particle Origin and Composition
Biological Responses to Metal Wear Debris
Cytotoxicity
Immunologic Response
Mutagenesis
Local Sequelae
Soft Tissue Reactions
Aseptic Loosening and Osteolysis
Infection
Systemic Sequelae
Hematopoietic Tissues
Hepatobiliary System
Renal System
Nervous System
Respiratory System
Cardiovascular System
The Visual and Auditory Systems
Endocrine and Reproductive Effects
Skin
Musculoskeletal System
Developmental Toxicology
Carcinogenesis
References
20: Bone-Implant Interface in Spine Surgery
Biomechanics of Bone-Implant Interface
Basic Principles
Types of Bone-Implant Interface
Abutting Bone-Implant Interface
Penetrating Bone-Implant Interface
Gripping Bone-Implant Interface
Conforming Bone-Implant Interface
Osseointegration
Toe-In and Toe-Out Screws (Triangulation)
Size of the Implant: Disc Replacement
Graft End-Plate Interface
Conclusion
References
21: Bone-Tendon and Bone-Ligament Interface
Introduction
Morphology of the Native Bone–Tendon Insertion Site
Tendon Healing in a Bone Tunnel
Physiology of Tendon Healing in a Bone Tunnel
Factors Affecting Tendon-to-Bone Tunnel Healing (Table 21.1)
Type of Graft Used
BPTB vs. Soft Tissue Autografts
Allografts vs. Autografts
Graft Placement
Graft Fixation
Graft Length and Diameter Within the Bone Tunnel
Graft Tensioning
Rehabilitation
Variations Within and Between Tunnels
Tunnel Widening After ACL Reconstruction
Interventions to Enhance Tendon-to-Bone Tunnel Healing
Biomaterials
Chemical and Biological Agents
Biophysical Modalities
Growth Factors and Gene Therapy
Cell Therapy
Artificial Tissue Engineering
Tendon Healing to a Bone Surface
Factors Affecting Tendon-to-Bone Surface Healing
Interventions to Enhance Tendon-to-Bone Surface Healing
Challenges and Controversies
Conclusions
References
22: Bone-Implant Interface in Patients with Neoplasmatic Disease
Introduction
References
Index