Biomaterials in Hand Surgery

153 Pages·2009·6.376 MB·English

by  P. Tranquilli Leali, A. Merolli (auth.), Antonio Merolli, Thomas J. Joyce (eds.)

Biomaterials in Hand Surgery
Antonio Merolli Thomas J. Joyce (Eds.)
•
Biomaterials
in Hand Surgery
Foreword by
Frédéric Schuind
123
Editors
Antonio Merolli
Orthopaedics and Hand Surgery
The Catholic University School of Medicine
Rome
Italy
Thomas J.Joyce
School of Mechanical and Systems Engineering
Newcastle University
Newcastle upon Tyne
United Kingdom
ISBN 978-88-470-1194-6 e-ISBN 978-88-470-1195-3
DOI 10.1007/978-88-470-1195-3
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Foreword
Biomaterials are used in many areas of medicine, particularly in surgery and den-
tistry. In orthopedic surgery, total hip arthroplasty has been extremely successful,
and has been called ‘the operation of the 20th century’. Total hip arthroplasty is rou-
tinely performed every day in most orthopedic departments. Over the last decades,
many efforts have been made to better integrate the components within the recipient
bones, to decrease the friction at the prosthetic interface, and to minimize wear.
Minimally invasive procedures have been developed, and various designs are intend-
ed to preserve as much as possible of the bone stock of young patients. By contrast,
the clinical results have been less favorable after various hand and wrist joint
replacements. Many early designs have failed, the clinical data of the current pros-
theses are frequently quite limited, and there is often insufficient biomechanical
information available, although trapezio-metacarpal arthroplasty in particular has
become quite popular in recent years. In order to promote progress in hand and wrist
arthroplasty, Antonio Merolli and Thomas J. Joyce have edited this lovely book,
whose chapters discuss current research and recent advances in hand and wrist
arthroplasty. The problems of metacarpophalangeal joint prostheses are particularly
developed.
Biomaterials have many other potential applications in hand surgery. New fixa-
tion designs are low profile and stable, yet allow immediate postoperative motion,
which is so important for rapid and total recovery of hand function. Coated implants
could be used in contaminated situations. Biodegradable osteosynthesis implants,
although currently disappointing, will possibly be improved in the coming years,
especially for use in the hand and wrist. The hand surgeon is also faced with devas-
tating traumas, where tissue engineering could in the future be the solution to replace
various tissues. As discussed in the book, biomaterial coating of flexor tendon sutures
could improve tendon gliding. Novel biomaterials could also very soon replace nerve
autografts, which are of limited supply and require additional surgery for harvesting;
they could possibly also enhance axonal regeneration. This book, the first to my
v
vi Foreword
knowledge devoted to biomaterials in hand surgery, is, therefore, recommended
as required reading for those interested in advances in hand reconstruction, whether
undergraduate medical or engineering students or consultants in hand surgery,
rheumatologists or material scientists.
Brussels, June 2009 Frédéric Schuind,MD,PhD
Department of Orthopaedics and Traumatology
Erasme University Hospital
Brussels, Belgium
Preface
This book is the first devoted to the application of biomaterials in hand surgery. It pres-
ents the fundamentals of biomaterials, tissue engineering and regenerative medicine, the
finite elements method, and hand joint prostheses. It examines in depth the key topic of
metacarpophalangeal joint prostheses in rheumatoid patients. In addition, it reviews the
trends in tendon research and peripheral nerve regeneration with artificial nerve guides.
Several topics are current fields of research and debate, so they have been informed
by the personal experience of the contributing authors; they do not intend to give the
definitive solution for a problem but instead propose a way to reach such a resolution.
Our main purpose is to gather information in the field of biomaterials in hand surgery
in a single dedicated book that can be accessed by readers with different levels of knowl-
edge (from undergraduate medical or engineering students to consultants in hand surgery)
and different specialized interests (for example: clinicians caring for rheumatoid patients,
or material scientists wishing to improve their knowledge about peripheral nerve regener-
ation).
The authors are aware that it is possible some topics may have been neglected or over-
looked; for others, progress is very fast and new data have accumulated while the book
was being produced; for these reasons the contributors will be happy to receive comments
and suggestions for improving and updating this book. Together we hope you will help us
to create a reference text for the field of biomaterials in hand surgery.
Antonio Merolli
Thomas J.Joyce
vii
Contents
1 Fundamentals of Biomaterials
Paolo Tranquilli Leali and Antonio Merolli
1.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.2 Metals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
1.3 Polymers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
1.3.1 Polymethyl-methacrylate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
1.3.2 Polyethylene . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
1.3.3 Biodegradable Polymers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
1.4 Ceramics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
1.4.1 Hydroxyapatite . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
1.4.2 Bioactive Glass . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
1.5 Composites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
2 Potential Applications of Tissue Engineering in Hand Surgery
Matteo Santin
2.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
2.1.1 Limitations of Permanent Implants . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
2.1.2 Biodegradable Biomaterials: from Tissue Replacement to
Tissue Regeneration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
2.2 Tissue Engineering . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
2.3 Scaffold Fabrication Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
2.4 Cell Types in Tissue Engineering Constructs . . . . . . . . . . . . . . . . . . . . . 17
2.4.1 Embryonic Stem Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
2.4.1.1 Technical Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
2.4.1.2 Ethical Concerns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
2.4.1.3 Regulatory Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
2.4.2 Adult Mesenchymal Stem Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
2.4.3 Induced Pluripotent Stem Cells . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
ix
x Contents
2.5 Biomimetic Materials, Bioligands and Bioactive Molecules for Tissue
Engineering Constructs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
2.5.1 Collagen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
2.5.2 Fibrin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
2.5.3 Glycosaminoglycans (GAGs) and Proteoglycans (PGNs) . . . . . . . . . . . 22
2.5.4 Ceramics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
2.5.5 Synthetic Bioligands . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
2.5.6 Bioactive Molecules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
2.6 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
3 The Finite Element Method for the Design of Biomedical Devices
Francesco Mollica and Luigi Ambrosio
3.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
3.2 What is the Finite Element Method? . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
3.3 The Main Steps Involved in a FEM Analysis . . . . . . . . . . . . . . . . . . . . . 34
3.3.1 Preprocessing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
3.3.2 Solution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
3.3.3 Postprocessing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
3.4 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Further Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
4 Prostheses for the Joints of the Hand
Antonio Merolli
4.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
4.2 Arthrosis and Arthritis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
4.3 Metacarpophalangeal Joint Prostheses . . . . . . . . . . . . . . . . . . . . . . . . . . 49
4.4 Trapezio-metacarpal Joint Prostheses . . . . . . . . . . . . . . . . . . . . . . . . . . 56
4.5 Prostheses for the Interphalangeal Joints . . . . . . . . . . . . . . . . . . . . . . . . 58
4.6 Prostheses for the Scaphoid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
4.7 Prostheses for the Lunate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
4.8 Mid-carpal Replacement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
5 Causes of Failure in Flexible Metacarpophalangeal Prostheses
Thomas J. Joyce
5.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
5.2 Analysis of Explanted Sutter Metacarpophalangeal Prostheses . . . . . . 73
5.2.1 Clinical Details . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
5.2.2 Macroscopic Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
5.2.3 Microscopic Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
5.3 Looking Ahead . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
Contents xi
6 Prosthetic Surgery of Metacarpophalangeal Joints in Rheumatoid Patients:
an Open Problem
Francesco Catalano
6.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
6.2 Prosthetic Surgical Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
6.3 Pathological Physiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
6.3.1 Involvement of the Wrist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
6.3.1.1 Ulnar Onset . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
6.3.1.2 Central Onset . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
6.3.1.3 Radial Onset . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
6.3.2 Involvement of the Metacarpophalangeal Joints . . . . . . . . . . . . . . . . . . 87
6.3.3 Involvement of the Interphalangeal Joints . . . . . . . . . . . . . . . . . . . . . . . 88
6.4 Problems Associated with Prosthetic Surgery of Metacarpophalangeal
Joints in Rheumatoid Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
Further Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
7 Requirements for a Metacarpophalangeal Joint Prosthesis for Rheumatoid
Patients and Suggestions for Design
Antonio Merolli
7.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
7.2 Four-dimensional Kinematics of the Metacarpophalangeal Joint . . . . . 96
7.3 Solid Modeling and Rapid Prototyping . . . . . . . . . . . . . . . . . . . . . . . . . 98
7.4 Clinical Requirement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
7.5 Two Surgical Constraints . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
7.6 Choice of Biomaterials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101
7.7 A Possible Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
7.8 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
8 Research Trends for Flexor Tendon Repair
Stavros Thomopoulos
8.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
8.2 Animal Models for Studying Flexor Tendon Injury and Repair . . . . . . 109
8.3 Mechanical Approaches for Enhanced Flexor Tendon Healing . . . . . . . 109
8.4 Biomaterials for Enhanced Flexor Tendon Gliding . . . . . . . . . . . . . . . . 111
8.5 Biomaterials for Growth Factor-enhanced Flexor Tendon Healing . . . . 114
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
9 Peripheral Nerve Regeneration by Artificial Nerve Guides
Antonio Merolli and Lorenzo Rocchi
9.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
9.2 Tubular Nerve Guides . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128
9.3 Glue versus Stitches . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131