The Inert and the Living in Orthopedic Surgery
Seance of wednesday 14 june 2017 (LA JONCTION INERTE / VIVANT EN CHIRURGIE)
DOI number : 10.2699/2x2v-pd58/emem.2017.3.014
Abstract
Orthopedic surgeons used many different materials for bone repair or joint replacement; as well as for scoliosis cure or bone replacement following tumor excision.
The relationship between inert and living tissues is of major relevance if we want to insure durability and utility of these materials. Regarding fracture repair, plates, bolts, nails, screws are used on a regular basis to treat fracture. But they are useless after bone healing; More difficult are joint replacement materials because they must provide service and clinical good results for the full remaining life of the patients. Stems materials are now usually made of titanium alloy; fixation could be cemented or cementless depending of the country and the habit, sliding materials are of extreme importance; metal or ceramic on polyethylene bring the problem of macrophagic reactions against polyethylene debris. While ceramic on ceramic used since more than 45 years produced a very low debris formation and experienced very good biological acceptance by the body. Fracture and noise are the most common arguments against this material, but in practice these phenomenon are very anecdotical. Advantages are clear especially in more active and young population; recently it has been shown other advantages of this material: lower infection burden and increase stability; the occurrence of a strong and dense fibrous tissue might explain these occurrence. We must insist on the place of France in these material innovations: Judet brothers, Paul Gramont, Gilles Bousquet, Pierre Boutin, Jean Dubousset and many others did participate in these innovations of inert materials in orthopedics.
The relationship between inert and living tissues is of major relevance if we want to insure durability and utility of these materials. Regarding fracture repair, plates, bolts, nails, screws are used on a regular basis to treat fracture. But they are useless after bone healing; More difficult are joint replacement materials because they must provide service and clinical good results for the full remaining life of the patients. Stems materials are now usually made of titanium alloy; fixation could be cemented or cementless depending of the country and the habit, sliding materials are of extreme importance; metal or ceramic on polyethylene bring the problem of macrophagic reactions against polyethylene debris. While ceramic on ceramic used since more than 45 years produced a very low debris formation and experienced very good biological acceptance by the body. Fracture and noise are the most common arguments against this material, but in practice these phenomenon are very anecdotical. Advantages are clear especially in more active and young population; recently it has been shown other advantages of this material: lower infection burden and increase stability; the occurrence of a strong and dense fibrous tissue might explain these occurrence. We must insist on the place of France in these material innovations: Judet brothers, Paul Gramont, Gilles Bousquet, Pierre Boutin, Jean Dubousset and many others did participate in these innovations of inert materials in orthopedics.