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J Am Acad Orthop Surg, Vol 16, No suppl_1, July 2008, x-xi.
© 2008 the American Academy of Orthopaedic Surgeons
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in-brief

Introduction

Stuart B. Goodman, MD, PhD and Timothy Wright, PhD

The project described was supported by an NIH conference support grant (1U13AR055732-01) through NIAMS. The content is solely the responsibility of the authors and does not necessarily represent the official views of NIAMS or NIH.

Wear of total joint replacements and the subsequent detrimental effects of wear debris remain among the most important problems in joint arthroplasty. As the population ages and life spans are extended, and as joint replacements are being performed in younger, more active patients, revision surgeries associated with prosthetic wear are becoming more common. In 2004, 46,000 revision total hip replacements and 40,000 revision total knee replacements were performed in the United States.1 Most of these surgeries were needed because of wear-associated loosening and periprosthetic osteolysis. Revision procedures are costlier and more technically difficult than primary procedures and have higher complication rates and less predictable clinical outcomes. The surgery is often accompanied by significant bone loss, necessitating the use of extensive bone grafting and special prosthetic devices. Consequently, the clinician should be familiar with the basic clinical, biologic, design, and material principles relevant to prosthetic wear to prevent, diagnose, and treat wear-associated problems.

Thirteen years ago, experts in biomechanics and biomaterials, biology, medicine, and surgery gathered for a 3-day workshop on the subject of implant wear of joint arthroplasties. This first workshop in 1995 resulted in a book entitled Implant Wear: The Future of Total Joint Replacement, published by the American Academy of Orthopaedic Surgeons (AAOS) in 1996.2

In 2000, a second workshop was held on the topic. Like the 1995 workshop, the 2000 workshop was sponsored by the National Institutes of Health (NIH), the National Institute of Standards and Technology, AAOS, the Orthopaedic Research Society, the Orthopaedic Research and Education Foundation, the American Association of Hip and Knee Surgeons, the Knee Society, and industry sponsors. The workshop was centered on a series of questions, posed to the participants in advance, on issues directly relevant to implant wear. The results of the second symposium were summarized in a book entitled Implant Wear in Total Joint Replacement: Clinical and Biologic Issues, Material and Design Considerations, published in 2001.3 These results are also available on the AAOS Website.

The Implant Wear 2000 workshop stimulated future areas for research that in turn led to a Program Announcement (PA) by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) and the National Institute of Child Health and Human Development (NICHD) to encourage the submission of applications for research to enhance the understanding of orthopaedic implant wear (PA-01-141).4 Through the use of this PA, NIAMS and NICHD received grant applications for a broad range of basic science and translational studies intended to enhance understanding of the biology and biomechanics of implant wear, as well as to expand our knowledge of how biomaterial and implant design variables influence wear and how the effects of implant wear can be treated or prevented in the clinical setting.

Important advancements related to wear have been made since the 2000 workshop in terms of surgical technique, imaging, bearing materials, implant design, and our understanding of the biologic processes elicited by wear debris. A third workshop was held November 9-11, 2007, in Austin, Texas. At the AAOS/NIH Osteolysis and Implant Wear: Biological, Biomedical Engineering and Surgical Principles research symposium, participants addressed clinical, biologic, engineering, and material questions relevant to implant wear and developed future research directions. In this special issue of the Journal of the American Academy of Orthopaedic Surgeons, we present the state of the art of osteolysis and implant wear.

We would like to congratulate our five young investigators, who earned an invitation to attend the symposium based on an open competition for which we received more than 30 applications. Those investigators are James Huddleston, MD, Stanford University School of Medicine, Francis Young-In Lee, MD, Columbia University, Amanda D. Marshall, MD, University of Texas Health Science Center–San Antonio, Ebru Oral, PhD, Massachusetts General Hospital/Harvard Medical School, and Jeremy Wilkinson, PhD, FRCS (Orth), University of Sheffield, United Kingdom. Their attendance at the symposium was kindly supported by the Orthopaedic Research Society.

The 2007 AAOS/NIH Osteolysis and Implant Wear research symposium and this special issue were supported by funding from the AAOS and a conference support grant from the NIAMS of the NIH. The AAOS acknowledges the following organizations as collaborative partners: the American Association of Hip and Knee Surgeons, the Knee Society, the Orthopaedic Research and Education Foundation, and the Orthopaedic Research Society. The AAOS further acknowledges the industry sponsors: Silver-level sponsor DePuy, and Bronze-level sponsors DePuy Spine, Smith & Nephew, Stryker Orthopaedics, Synthes Spine, and Zimmer.

We would also like to thank the symposium faculty and the numerous individuals and groups that made this symposium possible: Denis R. Clohisy, MD, and the AAOS Research Development Committee; Joshua J. Jacobs, MD, and the AAOS Council on Research, Quality Assessment and Technology; James H. Beaty, MD, E. Anthony Rankin, MD, Joseph Zuckerman, MD, and the AAOS Board of Directors, including immediate Past President Richard Kyle, MD; and AAOS staff leadership, including Christy M. P. Gilmour, Erin L. Ransford, Laura Goetz, and David Smith.

Stuart B. Goodman, MD, PhD

Co-Chair

Timothy Wright, PhD

Co-Chair


   References
Top
 References
 

  1. American Academy of Orthopaedic Surgeons: Patient demographics. Available at: http://www.aaos.org/Research/stats/patientstats.asp. Accessed January 22, 2008.
  2. Wright TM, Goodman SB (eds): Implant Wear: The Future of Total Joint Replacement. Rosemont, IL: American Academy of Orthopaedic Surgeons, 1996.
  3. Wright TM, Goodman SB (eds): Implant Wear in Total Joint Replacement: Clinical and Biologic Issues, Material and Design Considerations. Rosemont, IL: American Academy of Orthopaedic Surgeons, 2001.
  4. National Institute of Arthritis and Musculoskeletal and Skin Diseases: National Institute of Child Health and Human Development: Program Announcement: Orthopaedic implant wear. Bethesda, MD: National Institutes of Health, September 25, 2001, PA-01-141. Available at: http://grants.nih.gov/grants/guide/pa-files/PA-01-141.html. Accessed January 18, 2008.




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