Bone-Implant Interface in Orthopedic Surgery: Basic Science to Clinical Applications

Total joint arthroplasty is an effective surgical procedure for end-stage osteoarthritis of major joints with satisfactory long term clinical outcome. A large and growing number of arthroplasties are performed annually worldwide and a great number of orthopaedic surgeons are practicing arthroplasty surgery as their main surgical activity. The biological behavior of the bone-implant interface is crucial for the long term survival of the artificial joint. All factors which have a positive or negative effect on the interface are of great interest for those practicing arthroplasty surgery. Basic scientists and the industry are continuously searching for new implant fixation mechanisms and improved materials. There is an accumulation of a great amount of basic science data (both biological, material and mechanical) related to the incorporation or loosening of the bone-implant interface. However, basic science data does not always translate to satisfactory clinical application, and orthopaedic practitioners often wonder which piece of information is clinically useful. A further problem is that basic scientists often speak their own scientific language and may not fully appreciate common clinical practice needs. In this textbook the biological and mechanical mechanisms of implant incorporation and loosening will be presented. All new data concerning materials and methods for incorporation enhancement will be critically analyzed. Data useful for clinical application will be stressed. Orthopaedic Surgeons will find information which will improve their clinical practice and basic scientists will be helped to understand and appreciate clinical needs.

What is the optimal design and fixation of the implants we use for orthopedic reconstructions?

What is the gold standard for the management of patients requiring implants?

Is there scope for improvement still further?

Huge efforts have been made both by research scientists in orthopedics and the implant industry to furthering the options available for arthroplasty without necessarily considering the cost-effectiveness of this research to clinical outcomes. It has also become apparent that theoretical and laboratory studies do not always match the results of long-term clinical studies of which there regretfully few of sufficient quality.

The Editor and his carefully chosen selection of contributors critically evaluate data from basic science, experimental in vivo and in vitro biological and mechanical models, autopsy specimens and long-term clinical studies to answer these questions.

Bone-Implant Interface in Orthopedic Surgery: Basic Science to Clinical Applications focuses on the bone-orthopedic implant interface in general and will be useful both for the novice who seeks a quick introduction to this specific topic and for more experienced surgeons who seek an in depth critical review of current practices.