第3回 HITプログラム 2

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1 Hip Implant Technology (HIT) :00-20:30 D

2 Hip Implant Technology (HIT) THA に関連した議論はすでに日本人工関節学会 日本股関節学会を中心に広く行われておりますが その多くは手術手技 成績 合併症など臨床的な側面がテーマとなっています しかし 元来 THA は荷重環境下で人工材料による関節形成術を行うという さまざまな問題点とリスクが潜在する特殊なテクノロジーです 従いまして THA に関わる金属材料学 生体材料学 生体力学 デザイン理論とこれに関連した手術技術論などの Hip Implant Technology の重要性を再認識し これを理解し 研究していくことは非常に意義深いことであると考えます Hip Implant Technology (HIT) 研究会はこのような理念のもとに THA において確実な固定性による短期成績と良好な骨温存を確保した長期成績の両立をめざし これに最適なインプラントの材質 デザイン 適応 手術手技などを研究することを目的として設立されました 整形外科医 ( 正会員 A) 以外の会員として 工学系の会員 ( 正会員 B) そしてインプラント企業のスタッフ ( 正会員 C) も会員に含め 分野を超えて本質を追求する議論を行うことを目指しています JCHO / HIT (Hip Implant Technology) 研究会事務局東京慈恵会医科大学附属第三病院整形外科内 東京都狛江市和泉本町 / 大谷卓也 ( 担当秘書 : 吉田 ) hit@jikei.ac.jp

3 18:00-18:05 HIT 3 18:05-18:45 THA 18:45-20:30?! [1] G7 Acetabular System Stryker Smith & Nephew VERILAST OXINIUM +

4 [2] Andrea Leto 15 years of mixed ceramic in total hip arthroplasty [3] Smith & Nephew JCHO

5 Memo

6 ?!

7 G7 Acetabular System Hip 100 G7 Acetabular System G7 E E1 E1 Massachusetts General Hospital 7 Biolox Delta Ceramic on Ceramic 4 Delta 3

8 1970Prof. Bousquet 2013 Freedom G7 Acetabular System G7 Acetabular System

9 Stryker X3 (Total Hip Arthroplasty: THA) THA 1 StrykerX3 X3 3 9MRads ( 1) 97%10 RSA0.01mm/y % ROM Jump Distance ( 2) X3 3 Dual Mobility (MDM ) Dual Mobility Stryker 1 ADM

10 MDM 2 Dual Mobility System Stryker CoCr stainless steel Alumina Delta X3 Alumina StrykerX3 Dual Mobility! 1! 2

11 Smith & Nephew VERILAST OXINIUM + OXINIUM VERILASTVERILAST Very Last VERILAST 4 OXINIUM CoCr99.9% 1 OXINIUM CoCr 8059kgf OXINIUM9071kgf 2 OXINIUM OXINIUM Co Cr Ni 3 THA mm R3 3

12 図 1 傷処理理を施した CoCr と OXINIUM を 用いた 300 万 8059 kgf 負荷 9071 kgf 負荷 ジルコニア強化アルミナセラミック 図 2 圧縮破壊試験結果 OXINIUM 外観写真 元素分析結果 外観写真 元素分析結果 CoCr 骨頭 OXINIUM 骨頭 図 3 各 骨頭とインプラントされていたTi 合 金金ステムの分析結果

13 Ceramic on Polyethylene BIOCERAM AZUL HEAD Aquala! Fig. 1 BIOCERAM AZUL HEAD Aquala BIOCERAM AZUL 37,000! Fig. 2 Hip Simulator

14 !! Aquala BIOCERAM AZUL HEAD C on C Aquala C on C Separation C on C Fig.3 Fig.4

15 THA GS ( 3D ) BLEND-E XL (E ) Co-Cr-Mo 10/12 Ti-6Al-4V or Co-Cr-Mo GS3D 640mm 250mm BLEND-E XL E E 0.3wt% 300kGy ( ) [1-4] E UHMWPE [5-8]

16 10 f 22, 28, 32, mm [9] [1] A. C. Turner et al., J. Biomechanical Science and Engineering (2015)1-8 [2] K. Uetsuki et al., ORS (2012) 1073 [3] K. Uetsuki et al., ORS (2012) 1074 [4] K. Uetsuki et al., ORS (2016) 1099 [5] M. A. Terkawi et al., Acta Biomaterialia 65 (2018) [6] T. Yutani et al., ORS (2018) 221 [7] M. A. Terkawi et al., ORS (2017) 1312 [8] T. Yutani, et al., ORS (2016) 1098 [9], 34(2013)

17 CeramTec 15 years of mixed ceramic in total hip arthroplasty A. Leto 1,2, A.A. Porporati 1 1 CeramTec GmbH, CeramTec-Platz 1-9, Plochingen, Germany 2 CeramTec - Kyoto office, 2 Tokaidocho Anshu Yamashina, Kyoto Japan Arthroplasty registries show the excellent long-term survivorship of mixed ceramic in THA. The ceramic composite BIOLOX delta (CeramTec GmbH, Germany) has been in clinical use for 15 years and millions of components have been implanted. The outstanding mechanical properties of this ceramic composite in combination with an accurate surgical handling have proven to be prerequisites for a long survivorship of the ceramic implants. Furthermore, there is a consensus supported by increasing evidence that ceramic heads independently from the head size - can mitigate the occurrence of fretting corrosion. In addition, the sleeved-ceramic heads (BIOLOX OPTION) have been effectively used as a safe option to revise patients affected by metal-related pathologies. The immuno-allergological compatibility of ceramic components, coupled with a high wear resistance and low friction offer an answer to the dilemma between the large diameter and taper issues; as arthroplasty registries have pointed out for the ceramic-on-ceramic bearing surfaces.

18 Memo

19 C

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