A Study of the Total Joint Systems for the Limb-Salvage Surgery for the Malignant Musculoskeletal Tumors

Research Project

Project/Area Number	62570684
Research Category	Grant-in-Aid for General Scientific Research (C)
Allocation Type	Single-year Grants
Research Field	Orthopaedic surgery
Research Institution	Ehime University
Principal Investigator	SHIBATA Taihoh Ehime University School of Medicine Professor, 医学部, 教授 (00077645)
Co-Investigator(Kenkyū-buntansha)	TSURUOKA Hiroaki Ehime University School of Medicine Instructor, 医学部・附属病院, 助手 (50207453) ITOH Toshio Ehime University School of Medicine Instructor, 医学部, 助手 (30193501) KUSHIBE Hideo Ehime University School of Medicine Instructor (10177991) SASAKI Masatoshi Ehime University School of Medicine Instructor (90170696)
Project Period (FY)	1987 – 1989
Project Status	Completed (Fiscal Year 1989)
Budget Amount *help	¥1,800,000 (Direct Cost: ¥1,800,000) Fiscal Year 1989: ¥500,000 (Direct Cost: ¥500,000) Fiscal Year 1988: ¥600,000 (Direct Cost: ¥600,000) Fiscal Year 1987: ¥700,000 (Direct Cost: ¥700,000)
Keywords	limb-salvage surgery / total joint replacement / biomaterial / hydroxyapatite / pure porous Titanium mesh block / polyester fiber / vasculaized periosteal garft / biological fixation / 血管柄付骨膜弁 / biological bonding / チタニウム多孔体 / 犬用人工股関節 / bone ingrowth / biologial bonaing / 腱 / 骨付着部 / 骨模 / 移動 / Sharpey線維 / 複合材料人工関節 / 筋腱接合 / コラーゲン / ハイドロオキシアパタイト接着
Research Abstract	Recently, limb-salvage surgery for malignant musculoskeletal tumors has improved owing to the integration of better diagnostic skills, a more developed chemotherapy regimen and the introduction of the Surgical Staging System. However, it is difficult to save much of the functional limb in limb-salvage surgery because the region involving the joint and insertions of muscle must be widely resected for greater curability. The purpose of this study was to resolve problems concerning the interface between metal and soft tissue, for example, anchoring of the gluteus medius muscle to the trochanter of the prosthesis in the case of total hip replacement. We have investigated 1)structural and mechanical properties of the biological insertion of tendon and muscle into the bone in rabbit, 2)biocompatibility of hydroxyapatite, porous pure titanium mesh blocks and polyester fiber(Leeds-Keio artificial ligament) in vivo, 3)vascuralized tibial periosteal graft in rabbits, and 4)total hip replacement in dogs. We have concluded that there are two approaches to limb-salvage surgery : 1)interposing bones to achieve biological fixation between the metal insertion and muscle, or 2)tightening of the metal insertion with polyester fiber. In the former approach it is thought that interposed bone such as a vascularized periosteal graft, can bond with the biological muscle and the mechanical metal insertion, resulting in a strong sequential bonding. We observed, however, an eventual disappearance of the newly formed bone at the metal insertion site under non-loading conditions. In the latter approach the polyester fiber can augment the insertion and bind the metal to the muscle tightly to achieve biological bonding. As this is owing to mechanical bonding between the metal insertion and polyester fiber, it becomes critical when the bond weakens and breakage occurs between them. We must solve these disadvantages in order to obtain permanent functional condition after limb-salvage surgery.