This first guide devoted to this burgeoning topic, this authoritative reference presents the current understanding of the phenomenon of aseptic loosening of total joint replacements from the molecular and cellular mechanisms of periprosthetic bone loss to the clinical presentation and management strategies-reviewing the properties of ceramic, metal, and polymer materials used in the replacement of joints, as well as current research on bone remodeling, wear resistance, the long-term care of implants, and emerging developments in gene therapy and tissue engineering.
Clinical Practice. Historical Perspective. Fixation of Implants. THR: Incidence of Bone Loss and Clinical Presentation. TKR: Incidence of Bone Loss and Clinical Presentation. Histopathology of Periprosthetic Tissues. Biomaterials Wear Debris. Basic Science. Properties of Materials Used in Joint Replacements. Wear in Joint Replacements. Human Motion and its Relevance to Wear. Corrosion. Inflammation and the Role of Macrophages. Cytokines and Mediators in Physiological and Pathologic Bone Resorption. Mechanisms of Peri-Implant Bone Loss. Wear Debris Induced Osteolysis. Role of Immune-Response in Implant Loosening. Stress-Induced Bone Remodeling. Pressure and Motion Induced Factors in Implant Loosening. Role of Endotoxin in Implant Loosening. Signal Transduction and Gene Regulation in Cell-Material Interactions. In-Vitro and In-Vivo Models to Study Osteolysis. Solutions and Treatments. Surgical Techniques: Modern Cementing Techniques. Treating Hip and Pelvic Osteolysis. Managing Knee Osteolysis. Advances in Metals. Advances in Polyethylene. Improving UHMWPE Using Electron Beam Irradiation. Alternate Bearing Materials: Metal-on-Metal. Alternate Bearing Materials: Ceramic-on-Ceramic. Future Perspectives. Tissue Engineering Alternatives to Joint Replacement. Enhancing Bone Ingrowth. Gene Therapy for Osteolysis. Pharmaceutical Treatment of Lysis. Genomics: The Promise for Orthopaedics