関節置換術、関節置換

WordNet

come into the company of; "She joined him for a drink"
cause to become joined or linked; "join these two parts so that they fit together" (同)bring together
make contact or come together; "The two roads join here" (同)conjoin
become part of; become a member of a group or organization; "He joined the Communist Party as a young man" (同)fall_in, get together
united or combined; "a joint session of Congress"; "joint owners"
marijuana leaves rolled into a cigarette for smoking (同)marijuana cigarette, reefer, stick, spliff
a disreputable place of entertainment
junction by which parts or objects are joined together
(anatomy) the point of connection between two bones or elements of a skeleton (especially if it allows motion) (同)articulation, articulatio
provide with a joint; "the carpenter jointed two pieces of wood" (同)articulate
affecting or involving two or more; "joint income-tax return"; "joint ownership"
fasten with a joint
fit as if by joints; "The boards fit neatly"
involving both houses of a legislature; "a joint session of Congress"
separate (meat) at the joint
the act of furnishing an equivalent person or thing in the place of another; "replacing the star will not be easy" (同)replacing
the act of bringing two things into contact (especially for communication); "the joining of hands around the table"; "there was a connection via the internet" (同)connection, connexion
having joints or jointed segments;

PrepTutorEJDIC

〈二つ以上のもの〉‘を'『つなぐ』,結合する《+『名』+『together』(『up』)》;(…に)…‘を'つなぐ《+『名』+『to』(『onto』)+『名』》 / (線などで)〈二つ以上のもの〉‘の'間を結ぶ(つなぐ)《+『名』+『by』(『with』)+『名』》 / (友情・結婚などで)〈人〉‘を'結びつける《+『名』+『in』+『名』》 / 〈川・道などが〉…‘と'いっしょになる,合流する / 〈会など〉‘に'『加入する』 / (…で)〈人〉‘の'『仲間に入る』,‘と'いっしょになる《+『名』〈人〉+『in』(『for』)+『名』,+『名』〈人〉+『in』do『ing』》 / (…に)『加わる』《+『in』+『名』〈事〉/+『in』『with』+『名』〈人〉》 / (人と…を)『ともにする』《+『with』+『名』〈人〉+『in』+『名』(doing)》 / 〈川・道などが〉『いっしょになる』,合流する / 接合箇所(点,面,線);継ぎ目
『関節』 / 『継ぎ目』,接合箇所,合わせ目 / 継ぎ目と継ぎ目の間の部分,節 / (二つの部分を継いだり支えたりするのに用いる)継ぎ手,ジョイント / (枝や葉の)つけ根,節 / (骨付きの)肉の大切り身 / 《俗》安酒場,とばく宿,アヘン窟(くつ) / 『共同の』,共有の;連帯の,連合の / 両院合同の;二院制議会の両院の / …‘を'継ぎ合わせる;…‘を'継ぎ目(関節)でつなぐ / …‘を'継ぎ目で分ける;〈鳥・肉など〉‘を'関節で切り分ける
置き換わること,取り替えること,元へ戻すこと;返済・置き換わる物(人),代理;補充員補充物
継ぎ目のある;関節のある

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/05/30 21:46:24」(JST)

wiki en

Replacement arthroplasty [from Greek arthron, joint, limb, articulate, + -plassein, to form, mould, forge, feign, make an image of], or joint replacement surgery, is a procedure of orthopedic surgery in which the arthritic or dysfunctional joint surface is replaced with an orthopedic prosthesis. Joint replacement is considered as a treatment when there is severe joint pain or dysfunction is not alleviated by less-invasive therapies.

Joint replacement surgery is becoming more common with knees and hips replaced most often. As of 2009, about 773,000 Americans have a hip or knee replaced each year".^[1]

Background

Stephen S. Hudack, a surgeon based in New York City, began animal testing with artificial joints in 1939.^[2] By 1948, he was at the New York Orthopedic Hospital (part of the Columbia Presbyterian Medical Center) and with funding from the Office of Naval Research, was replacing hip joints in humans.^[2]

Two previously^[when?] popular forms of arthroplasty were: (1) interpositional arthroplasty', with interposition of some other tissue like skin, muscle or tendon to keep inflammatory surfaces apart and (2) excisional arthroplasty in which the joint surface and bone were removed leaving scar tissue to fill in the gap. Other forms of arthroplasty include resection(al) arthroplasty, resurfacing arthroplasty, mold arthroplasty, cup arthroplasty, and silicone replacement arthroplasty. Osteotomy to restore or modify joint congruity is also a form of arthroplasty.

In recent decades the most successful and common form of arthroplasty is the surgical replacement of a joint or joint surface with a prosthesis. For example, a hip joint that is affected by osteoarthritis may be replaced entirely (total hip arthroplasty) with a prosthetic hip. This procedure involves replacing both the acetabulum (hip socket) and the head and neck of the femur. The purpose of doing this surgery is to relieve pain, to restore range of motion and to improve walking ability, leading to the improvement of muscle strength.

Indications

Osteoarthritis (OA)
Rheumatoid arthritis (RA)
Avascular necrosis (AVN) or osteonecrosis (ON)
Congenital dislocation of the hip joint (CDH)
Acetabular dysplasia (shallow hip socket)
Frozen shoulder & Loose shoulder
Traumatized and malaligned joint
Joint stiffness

Procedural timeline

Before major surgery is performed, a complete pre-anaesthetic work-up is required. In elderly patients this usually would include ECG, urine tests, hematology and blood tests. Cross match of blood is routine also, as a high percentage of patients receive a blood transfusion. Pre-operative planning requires accurate Xrays of the affected joint, implant design selecting and size-matching to the xray images (a process known as templating).

A few days' hospitalization is followed by several weeks of protected function, healing and rehabilitation. This may then be followed by several months of slow improvement in strength and endurance.

Early mobilisation of the patient is thought to be the key to reducing the chances of complications^[1] such as venous thromboembolism and Pneumonia. Modern practice is to mobilize patients as soon as possible and ambulate with walking aids when tolerated. Depending on the joint involved and the pre-op status of the patient, the time of hospitalization varies from 1 day to 2 weeks, with the average being 4–7 days in most regions.

Physiotherapy is used extensively to help patients recover function after joint replacement surgery. A graded exercise programme is needed initially, as the patients' muscles take time to heal after the surgery; exercises for range of motion of the joints and ambulation should not be strenuous. Later when the muscles have healed, the aim of exercise expands to include strengthening and recovery of function.

Materials

Some ceramic materials commonly used in joint replacement are alumina (Al₂O₃), zirconia (ZrO₂), silica (SiO₂), hydroxyapatite (Ca₁₀(PO₄)₆(OH)₂), titanium nitride (TiN), silicon nitride (Si₃N₄). A combination of titanium and titanium carbide is a very hard ceramic material often used in components of arthroplasties due to the impressive degree of strength and toughness it presents, as well as its compatibility with medical imaging.

Titanium carbide has proved to be possible to use combined with sintered polycrystalline diamond surface (PCD), a superhard ceramic which promises to provide an improved, strong, long-wearing material for artificial joints. PCD is formed from polycrystalline diamond compact (PDC) through a process involving high pressures and temperatures. When compared with other ceramic materials such as cubic boron nitride, silicon nitride, and aluminum oxide, PCD shows many better characteristics, including a high level of hardness and a relatively low coefficient of friction. For the application of artificial joints it will likely be combined with certain metals and metal alloys like cobalt, chrome, titanium, vanadium, stainless steel, aluminum, nickel, hafnium, silicon, cobalt-chrome, tungsten, zirconium, etc.^[3]

In joints such as knee replacements there are two parts that are ceramic and they can be made of either the same ceramic or a different one. If they are made of the same ceramic, however, they have different weight ratios. These ceramic parts are configured so that should shards break off of the implant, the particles are benign and not sharp. They are also made so that if a shard were to break off of one of the two ceramic components, they would be noticeable through x-rays during a check-up or inspection of the implant. With implants such as hip implants, the ball of the implant could be made of ceramic, and between the ceramic layer and where it attaches to the rest of the implant, there is usually a membrane to help hold the ceramic. The membrane can help prevent cracks, but if cracks should occur at two points which create a separate piece, the membrane can hold the shard in place so that it doesn't leave the implant and cause further injury. Because these cracks and separations can occur, the material of the membrane is a bio-compatible polymer that has a high fracture toughness and a high shear toughness.^[4]

Risks and complications

Medical risks

The Stress of the operation may result in medical problems of varying incidence and severity.

Heart Attack
Stroke
Venous Thromboembolism
Pneumonia
Increased confusion
Urinary Tract Infection (UTI)

Intra-operative risks

Mal-positioning of the components
- Shortening;
- Instability/dislocation;
- Loss of range of motion;
Fracture of the adjacent bone;
Nerve damage;
Damage to blood vessels.

Immediate risks

Infection
- Superficial
- Deep
Dislocation

Medium-term risks

Dislocation;
Persistent pain;
Loss of range of motion;
Weakness;
Indolent infection.

Long-term risks

Loosening of the components: the bond between the bone and the components or the cement may break down or fatigue. As a result the component moves inside the bone, causing pain. Fragments of wear debris may cause an inflammatory reaction with bone absorption which can cause loosening. This phenomenon is known as osteolysis.

Polyethylene synovitis - Wear of the weight-bearing surfaces: polyethylene is thought to wear in weight-bearing joints such as the hip at a rate of 0.3mm per year^{[citation needed]}. This may be a problem in itself since the bearing surfaces are often less than 10 mm thick and may deform as they get thinner. The wear debris may also cause problems, as inflammation can be caused by increased quantities of polyethylene wear particles in the synovial fluid.

There are many controversies. Much of the research effort of the orthopedic-community is directed to studying and improving joint replacement. The main controversies are

the best or most appropriate bearing surface - metal/polyethylene, metal-metal, ceramic-ceramic;
cemented vs uncemented fixation of the components;
Minimally invasive surgery.

References

^ ^a ^b Joint Replacement Surgery and You. (April, 2009) In Arthritis, Musculoskeletal and Skin Disease online. Retrieved from http://www.niams.nih.gov/#.
^ ^a ^b Joints of Steel and Plastic. Life. April 12, 1948. pp. 127–130. ISSN 0024-3019. Retrieved 2011-03-19.
^ Pope, Bill et al. (2011) International Patent No. 127321A. Orem, UT: US http://worldwide.espacenet.com
^ Monaghan, Matthew, David Miller. (2013). US Patent No. 0282134A1. Warsaw, IN: US http://worldwide.espacenet.com/

External links

Patient Information from the American Academy of Orthopedic Surgeons
Patient Information from the FDA
P. Benum; A. Aamodt; and K. Haugan Uncementeed Custom Femoral Components In Hip Arthroplasty
Joint Replacement Treatments
Finkelstein, JA; Anderson, GI; Richards, RR; Waddell, JP (1991). "Polyethylene synovitis following canine total hip arthroplasty. Histomorphometric analysis". The Journal of arthroplasty. 6 Suppl: S91–6. PMID 1774577.

UpToDate Contents

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1. 人工関節感染の疫学および予防 epidemiology and prevention of prosthetic joint infections
2. 重度の関節リウマチに対する全関節置換術 total joint replacement for severe rheumatoid arthritis
3. 人工関節感染の治療 treatment of prosthetic joint infections
4. 全人工膝関節置換術 total knee arthroplasty
5. 膝および股関節の変形性関節症に対する外科治療の概要 overview of surgical therapy of knee and hip osteoarthritis

English Journal

Study on the friction of κ-carrageenan hydrogels in air and aqueous environments.

Kozbial A1, Li L2.Author information 1Department of Chemical & Petroleum Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA.2Department of Chemical & Petroleum Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA; Department of Mechanical Engineering & Materials Science, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA. Electronic address: lel55@pitt.edu.AbstractUnderstanding the friction mechanism of polysaccharide hydrogels, which is the key component of human cartilage that has very low friction coefficient, is critical to develop next generation artificial joint replacement materials. In this study, the friction of the polysaccharide κ-carrageenan hydrogel was investigated to elucidate the effect of external load, cross-linking density, velocity, and environment on friction. Our experimental results show that (1) coefficient of friction (COF) decreases with normal load in air and remains constant in water, (2) increasing cross-linking density concurrently increases friction and is proportional to Young's modulus, (3) COF increases with testing velocity in both air and water, and (4) friction is reduced in aqueous environment due to the lubricating effect of water. The underlying frictional mechanism is discussed on the basis of water transport from bulk to surface and a previously proposed "repulsion-adsorption" model.
Materials science & engineering. C, Materials for biological applications.Mater Sci Eng C Mater Biol Appl.2014 Mar 1;36:173-9. doi: 10.1016/j.msec.2013.12.003. Epub 2013 Dec 14.
Understanding the friction mechanism of polysaccharide hydrogels, which is the key component of human cartilage that has very low friction coefficient, is critical to develop next generation artificial joint replacement materials. In this study, the friction of the polysaccharide κ-carrageenan hydr
PMID 24433901

Near infrared Ag/Au alloy nanoclusters: Tunable photoluminescence and cellular imaging.

Wang C1, Xu L2, Xu X3, Cheng H4, Sun H3, Lin Q5, Zhang C4.Author information 1China-Australia Joint Research Centre for Functional Molecular Materials, School of Chemical & Material Engineering, Jiangnan University, Wuxi 214122, PR China. Electronic address: wangcx@jiangnan.edu.cn.2State Key Laboratory of Supramolecular Structure and Materials, College of Chemistry, Jilin University, Changchun 130012, PR China.3School of Stomatology, Jilin University, Changchun 130041, PR China.4China-Australia Joint Research Centre for Functional Molecular Materials, School of Chemical & Material Engineering, Jiangnan University, Wuxi 214122, PR China.5State Key Laboratory of Supramolecular Structure and Materials, College of Chemistry, Jilin University, Changchun 130012, PR China. Electronic address: linquan@jlu.edu.cn.AbstractThe fluorescent nanomaterials play an important role in cellular imaging. Although the synthesis of fluorescent metal nanoclusters (NCs) have been developing rapidly, there are many technical issues in preparing metal alloy NCs. Herein, we used a facile galvanic replacement reaction to prepare Ag/Au alloy NCs. The characterizations of UV, PL, HRTEM, EDX and XPS confirm one fact the Ag/Au alloy NCs are carried out. As-prepared Ag/Au alloy NCs display near-infrared (NIR) fluorescence centered at 716nm and show tunable luminescence from visible red (614nm) to NIR (716nm) by controlling the experimental Ag/Au ratios. Moreover, as-prepared Ag/Au alloy NCs are protected by glutathione (GSH) whose some functional groups including thiol, carboxyl and amino groups make the as-prepared alloy NCs exhibit good dispersion in aqueous solution, high physiological stability and favorable biocompatibility. Together with NIR fluorescence, these advantages make alloy NCs be promising candidate in biological labeling.
Journal of colloid and interface science.J Colloid Interface Sci.2014 Feb 15;416:274-9. doi: 10.1016/j.jcis.2013.11.011. Epub 2013 Nov 18.
The fluorescent nanomaterials play an important role in cellular imaging. Although the synthesis of fluorescent metal nanoclusters (NCs) have been developing rapidly, there are many technical issues in preparing metal alloy NCs. Herein, we used a facile galvanic replacement reaction to prepare Ag/Au
PMID 24370431

Analysis of parameters influencing the release of antibiotics mixed with bone grafting material using a reliable mixing procedure.

Bormann N1, Schwabe P2, Smith MD3, Wildemann B4.Author information 1Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Germany; Berlin-Brandenburg Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Germany.2Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Germany.3German Institute for Cell and Tissue Replacement, Berlin, Germany.4Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Germany; Berlin-Brandenburg Center for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Germany; Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Germany. Electronic address: britt.wildemann@charite.de.AbstractLocal infections arising from fracture fixation, defect reconstruction or joint replacement can cause extreme pain and impaired healing, lead to revision operations, prolong hospital stay and increase costs. Treatment options including prophylaxis are afforded by the use of grafts and biomaterials loaded with antibiotics. These can produce local therapeutic concentrations with a reduced systemic concentration and reduced systemic side-effects. Patient-specific loading of osteogenic graft materials with antibiotic could be an important option for orthopaedic surgeons. A local therapeutic concentration must be available for the desired duration and cytotoxic effects must be kept within an acceptable range. The present study investigates a simple and reliable mixing procedure that could be used for the perioperative combination of antibiotic powders and solutions with bone grafting materials. The potential influence of concentration and sampling regime on the release kinetics of gentamicin, tobramycin and vancomycin was studied over a period of 56days and potency and cytotoxicity were evaluated. In all treatment groups, gentamicin and tobramycin were completely released within 3days whilst vancomycin was released over a period of 14days. The results clearly show that the main parameter influencing release is the molecular weight of the drug. Growth of Staphylococcus aureus was inhibited in all 3 treatment groups for at least 3days. Cell viability and alkaline phosphatase activity of primary osteoblast-like cells were not significantly affected by the antibiotic concentrations obtained from the elution experiments. Bone grafting is an established component of surgery for bone defect filling and for biological stimulation of healing. Patient-specific enhancement of such procedures by incorporation of antibiotics for infection prevention or by addition of cytokines for promotion of impaired healing or for treatment of critical size defects will be a relevant issue in the future.
Bone.Bone.2014 Feb;59:162-72. doi: 10.1016/j.bone.2013.11.005. Epub 2013 Nov 12.
Local infections arising from fracture fixation, defect reconstruction or joint replacement can cause extreme pain and impaired healing, lead to revision operations, prolong hospital stay and increase costs. Treatment options including prophylaxis are afforded by the use of grafts and biomaterials l
PMID 24239495

Japanese Journal

変形性指PIP関節症に対するセメントレス人工関節 (特集手指の変形性関節症に対する治療)

森澤妥
整形・災害外科 58(1), 45-50, 2015-01
NAID 40020319168

手指変形性関節症に対する人工関節のデザインと手術 (特集手指の変形性関節症に対する治療)

久保和俊,前田利雄,稲垣克記
整形・災害外科 58(1), 39-44, 2015-01
NAID 40020319140

変形性関節症を理解する

久保俊一,齊藤正純
The Japanese Journal of Rehabilitation Medicine 52(4-5), 256-264, 2015
… Osteoarthritis (OA) is a non-inflammatory joint disease that is characterized by cartilage degeneration. … OA can develop in any joint with synovium and articular cartilage. … OA induces pain, contracture, hydrarthrosis and joint deformity. … On plain radiography, joint space narrowing, osteophyte formation and bone cysts are observed. … Surgical therapies are categorized into osteotomy, arthroplasty, arthrodesis and replacement arthroplasty. …
NAID 130005068619