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Implant Wear in Total Joint Replacement: Clinical and Biologic Issues, Material and Design Considerations Edited by Timothy M. Wright, PhD and Stuart B. Goodman, MD, PhD A symposium held in October 2000 Table of Contents Clinical Issues Chapter 1 What is the clinical scope of implant wear in the hip and how has it changed since 1995? Chapter 2 What is the clinical scope of implant wear in the knee and how has it changed since 1995? Chapter 3 What patient-related factors contribute to implant wear? Chapter 4 What surgical-related factors contribute to implant wear? Chapter 5 How should wear-related implant surveillance be carried out and what methods are indicated to diagnose wear-related problems? Chapter 6 What are the systemic consequences of wear debris clinically? Chapter 7 What guidelines/algorithms (both operative and nonoperative) are there for the treatment of osteolysis? Chapter 8 What are the best outcome measures for wear? Chapter 9 What is the outcome of the treatment of osteolysis? Biologic Issues Chapter 10 What are the local and systemic biologic reactions to wear debris? Chapter 11 What are the mediators (cellular, molecular, etc) of the local and systemic biologic reactions to wear debris? Chapter 12 Are there host factors that determine/modulate the biologic response to wear particles? Chapter 13 What specific features of wear particles are most important in determining the adverse biologic reactions? Chapter 14 What is the role of endotoxin and fluid pressure in osteolysis? Chapter 15 What experimental approaches (tissue retrieval, in vivo, in vitro, etc) have been used to investigate the biologic effects of particles? Chapter 16 Are there biologic markers of wear? Chapter 17 What potential biologic treatments are there for osteolysis? Material and Design Considerations Chapter 18 What design and material factors influence wear in total joint replacement? Chapter 19 What is the role of wear testing and joint simulator studies in discriminating among materials and designs? Chapter 20 What design factors influence wear behavior in total knee replacement? Chapter 21 What design factors influence wear behavior at the articulating surfaces in total hip replacement? Chapter 22 What are the wear mechanisms and what controls them? Chapter 23 What material properties and manufacturing procedures influence wear mechanisms? Chapter 24 What modifications can be made to materials to improve wear behavior? Chapter 25 What evidence is there for using alternative bearing materials?

A case of Total Hip Arthroplasty infection with Staphylococcus aureus co-infected with Salmonella choleraesuis was treated with two-stage exchange and administration of vancomycin and ciprofloxacin. No signs of re-infection have appeared 14 months after surgery. Cases of Salmonella infection of hip prostheses are quite rare, with only a handful of reports in the literature.

Wheeless Textbook of Orthopaedics Discussion: - most common complication in total hip arthroplasty and most common cause of component failure; - osteolysis is a time dependent process which arises from inflammatory reaction against polyethylene particulate debris; - patho-biology: - osteolysis is mediated primary by macrophages (fibroblasts and endothelial cells also play a role); - these cells are activated by wear debris (primarily polyethylene, but also metal and polymethylmethacrylate debris); - chemical mediators include: interleukin-1 (bone-resorbing cytokine) and tumor necrosis factor; - in the report by Yanming Bi et al (JBJS 2001), the authors present study showed that titanium particles induced both murine marrow cells and human peripheral blood monocytes to produce factors that stimulated osteoclast differentiation; - mean increase in osteoclast differentiation was 29.3 ± 9.4-fold. - they showed that titanium particles stimulate in vitro bone resorption primarily by inducing osteoclast differentiation;