| Co-Investigator(Kenkyū-buntansha) |
KOBAYASHI Shinji Yamagata University School of Medicine, Division of Rehabilitation, and Department of Orthopaedic Surgery, Assistant Lecturer, 医学部, 助手 (60312740)
OGINO Toshihiko Yamagata University School of Medicine, Orthopaedic Surgery, Professor and Chairman, 医学部, 教授 (60109436)
武井 寛 山形大学, 医学部, 講師 (40292437)
高原 政利 山形大学, 医学部, 助教授 (10236341)
井田 英雄 山形大学, 医学部, 助教授 (40184600)
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| Budget Amount *help |
¥12,200,000 (Direct Cost: ¥12,200,000)
Fiscal Year 2003: ¥700,000 (Direct Cost: ¥700,000)
Fiscal Year 2002: ¥1,500,000 (Direct Cost: ¥1,500,000)
Fiscal Year 2001: ¥5,500,000 (Direct Cost: ¥5,500,000)
Fiscal Year 2000: ¥4,500,000 (Direct Cost: ¥4,500,000)
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| Research Abstract |
To analyze bone remodeling of heated morselized allobone chips and cellular host reaction between periprosthetic bone and total hip prosthesis implant) pathologic, biomaterial, and clinical analysis were analyzed.
1.Analysis of pathologic and material features.
In loose total hip joints, imbalance of MMPs (MMP-1, MMP-2, MMP-3, MMP-9, MMP-13, and MMP-14) and TIMPs (TIMP 1, TIMP-2, and TIMP-3) in the tissue around loose implants was abserved. This reaction seemed to be related to pathologic increased expression of EMMPRIN, fibronectin, laminin, and PGP 9.5, which are suggested to enhance MMP production in-situ. In joint fluid retrieved from loose hip prosthesis, increased level of MMPs (MMP-1, MMP-2, MMP-3, and MMP-9)) and TIMPs (TIMP-1 and TIMP-2) was found. As well, osteolytic cytokine, IL-I beta, IL-6, and M-CSF were found to be increase as local host response to implant and their debris. Osteolytic potential was confirmed by addition of the fluid to mouse bone marrow cells, which induc
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ed marked osteoclast formation and it was inhibited by addition of osteoprotegerin. Periprosthetic bone analysis revealed that high turnover bone remodeling with fragile bone quality. Process of bone resorption was dependent both on osteoclatic and non-osteoclastic mechanism. In non-osteoclastic mechanism, acidic pH and macrophage played major role in the process. The study also showed active involvement of mechanical stress in periprosthetic bone remodeling. Micromotion combined with inflammatory mediators seemed to enhance bone remodeling process. This pathologic condition was also considered to relate to periprothetic bone remodeling after heated morselized bone chip grafting by impaction methods. In-vitro analysis of osteoblast, mechanical stretch can produce mRNA of COX-2、MMP-1、and MMP-3, transiently, after stimuli. MMP-1 and its activator MMP-3 were potent candidate of bone remodeling factors of osteoblast in mechanical stress. The process of bone remodeling was also affected by the property of materials. Stainless steel, cobalt-chromium alloy, and titanium alloy were major materials for femoral implants. Ultra-high density polyethylene, almina/zirconia ceramics, stainless steel, and cobalt-chromium alloy have been used as gliding surface. Polymethylmethacrylate and porus coating techniques have been used between bone and implants. The properties of the materials and its behaviors in each interface were suggested to be analyzed in future in point of better understanding of periprosthetic bone remodeling after morselized allo-bone grafting by impaction methods.
2.Clinical analysis of the fate of heated morselized allo-bone chips after impaction technique. Clinical evaluation of periprosthetic bone remodeling and implant survival was performed. Heated morselized allo-bone chips, 2-3 mm, in diameter, after impaction technique showed favorable bone remodeling and revised THA implants functioned well. In acetabular area, rein force devidce, Kerboull and KT plate systems were so effective that they support the impacted bones and transfer, mechanical stress properly to the bone, which induced good bone remodeling in the area. In femoral side reconstruction, firm impactions and appropriate alignment technique of the stem were the decisive factor to obtain better tissue regeneration. Thus, heated morselized allo-bone chips after impaction technique revealed good biocompatibility and contribute to reconstruction of loose total hip joint with massive osteolysis, when proper support system were used in the procedure. Less
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