MassMassachachuusesettstts InInssttiittuutte of Technole of TechnoloogygyHaHarvarvarrd Md Meedicadicall SScchohoololBrBrigighaham am annddWWoomemenn’’s Hs HoossppitalitalVA BVA Boossttonon HeHealalthcthcaare Sre Syysstteemm2.782J/3.961J/BEH.451J/HST524J2.782J/3.961J/BEH.451J/HST524JBIOCOMPATIBILITY:BIOCOMPATIBILITY:LOCAL AND SLOCAL AND SYYSTEMIC EFFECTSSTEMIC EFFECTSM. SpectoM. Spectorr,, Ph.DPh.DBIOMATERIBIOMATERIALSALS--TISSUETISSUEINTERACTIONSINTERACTIONSPaParticlesrticlesBIOMATERIALBIOMATERIALTISSUETISSUE1010nmnm101000nmnm11µµmm1010µµmm101000 µµmm11mmmm1 se1 secc1 d1 daayy1010 ddaayyss10100 da0 daysysLength ScLength ScalealeTime ScTime ScalealeStrengthStrengthMoModuluduluss ooffElElasasticiticittyyFracture mecFracture mechanichanicssProteinProteinAdsorptionAdsorptionCellCellReResponsesponseIonIonReleaseReleaseWearWearMeMetaltal corcorrroossiioonnPolymer degrPolymer degradationadationBONEBONETissueTissueRemodelingRemodelingCellCell--cecellllininteractionteractionssECM pECM prroteinoteinsCyCytokinetokinesEicosanoidsEicosanoidsEnzEnzyymesmesPage 1BIOMATERIALSBIOMATERIALS--TISSUE INTERACTIONS:TISSUE INTERACTIONS:Tissue Response to ImTissue Response to Implant Breakplant BreakddownownParticlesParticlesIMPLANTIMPLANTTISSUE RESPONSETISSUE RESPONSEDegradationDegradationProducts/IonsProducts/IonsFractureFractureWearWearMetal CorrosionMetal CorrosionPolymerPolymerDegradationDegradationDegradation:Degradation:Fibrous TissueFibrous TissueBoBoneneFibroblastFibroblastMacrophageMacrophageOsteoclastOsteoclast(Cell Con(Cell Conttractractiioonn??))RESPONSE TO IMPLANTS:RESPONSE TO IMPLANTS:WOUND HEALINGWOUND HEALINGInjuryInjuryMildMild Moderate/SevereModerate/SevereVascularizVascularizeded TiTissuessue NonNon--vascvasc..ResolutionResolution(Inflammation)(Inflammation)NoNoHealingHealingReparative (Healing)Reparative (Healing)ProcessProcessRepairRepair(S(Scar)car) RegenerationRegenerationPage 2RESPONSE TO IMPLANTS:RESPONSE TO IMPLANTS:WOUND HEALINGWOUND HEALINGInjuryInjuryMildMild Moderate/SevereModerate/SevereVascularizVascularizeded TiTissuessue NonNon--vascvasc..ResolutionResolution(Inflammation)(Inflammation)NoNoHealingHealingReparative (Healing)Reparative (Healing)ProcessProcessRepairRepair(S(Scar)car) RegenerationRegeneration4 T4 Tiissssue Cue CaatetegorgoriieessConneConnectictivvee TissueTissueEpitheliEpitheliumumNerveNerveMuscMuscleleRESPONSE TO IMPLANTS:RESPONSE TO IMPLANTS:WOUND HEALINGWOUND HEALINGInjuryInjuryMildMild Moderate/SevereModerate/SevereVascularizVascularizeded TiTissuessue NonNon--vascvasc..ResolutionResolution(Inflammation)(Inflammation)NoNoHealingHealingReparative (Healing)Reparative (Healing)ProcessProcessRepairRepair(S(Scar)car) RegenerationRegeneration4 T4 Tiissssue Cue CaatetegorgoriieessConneConnectictivvee TissueTissueEpitheliEpitheliumumNerveNerveMuscMuscleleCT:BoneCT:BoneMuMu: S: SMMEpEp: Epider: EpidermimissCT:CT:Art.Art. CCaartrt..CT: DerCT: Dermmis,is,LigLig..MuMu:: SkSkelel.,., CardCard..Page 3RESPONSE TO IMPLANTS:RESPONSE TO IMPLANTS:WOUND HEALINGWOUND HEALINGInjuryInjuryRegenerationRegenerationRepairRepairTissue ofTissue of LabileLabileTissue ofTissue ofandand StableStableCellsCellsPermanentPermanentCellsCellsFramewFramework*ork*FramewFrameworkorkScarScarIntactIntact DestroyedDestroyedRegenerationRegeneration ScarScar** ““StStromaroma””RESPONSE TO IMPLANTS:RESPONSE TO IMPLANTS:WOUND HEALINGWOUND HEALINGSurgical ImplantationSurgical ImplantationVascular ResponseVascular ResponseClottingClottingPhagocytosisPhagocytosisNeovascularizNeovascularizaationtionNew Collagen SynthesisNew Collagen SynthesisTissue of Labile and Stable CellsTissue of Labile and Stable CellsTissue of PerTissue of Permmanenanent Cellt CellssFraFrammeworkeworkFramFrameworkeworkScarringScarringIntactIntact DestroyedDestroyed(fibrous encapsulation;(fibrous encapsulation;synoviumsynovium))RegenRegen.. ScarringScarringChronic InflChronic Inflammationammation((incorpincorp.. (fibrous en(fibrous encapsulation;capsulation;of imof implant)plant)ssyynoviunoviumm))Chronic InflammaChronic InflammattiiononAcuteAcute InflammatioInflammationnGranulationGranulationTissueTissueImplImplant Moveant MovementmentInc. timeInc. timePage 4I. Metchnikoff I. Metchnikoff First identified “macrophages” and “microphages” (polymorphonuclear neutrophils, PMNs) in an organism around a foreign body Page 5Page 6 Smith-PetersonIn 1923 a piece of glass was removed from a patient’s back; it had been there for a year. It was surrounded by a minimal amount of fibrous tissue, lined by a glistening synovial sac, containing a few drops of clear yellow fluid. J. Bone Jt. Surg., 30-B:59 (1948)I. SilverDiagrams removed due to copyright restrictions.Photo removed due to copyright restrictions.Page 7 Photo removed due to copyright restrictions. Tissue response to a cylindrical implant of polysulfone in lapine skeletal muscle, 2 yrs. post-opFibrous tissueSkeletal musclePhoto removed due to copyright restrictions. Synovium:Macrophage-like (Type A) and Fibroblast-like (Type B) CellsPage 8 PolyethylenePolyethylenePolyethylene implant,6 mos. post-opMFBGCMΦPorous CoatedCo-Cr Tibial Component(retrieved 1 yr. post-op)Photo removed due to copyright restrictions. Photo removed due to copyright restrictions.RESPONSE TO IMPLANTS:RESPONSE TO IMPLANTS:WOUND HEALINGWOUND HEALINGSurgical ImplantationSurgical ImplantationVascular ResponseVascular ResponseClottingClottingPhagocytosisPhagocytosisNeovascularizNeovascularizaationtionNew Collagen SynthesisNew Collagen SynthesisTissue of Labile and Stable CellsTissue of Labile and Stable CellsTissue of PerTissue of Permmanenanent Cellt CellssFraFrammeworkeworkFramFrameworkeworkScarScar**IntactIntact DestroyedDestroyed(fibrous encapsulation;(fibrous encapsulation;synoviumsynovium))RegenRegen.. ScarringScarring**Chronic InflChronic Inflammationammation((incorpincorp.. (fibrous en(fibrous encapsulation;capsulation;of imof implant)plant)ssyynoviunoviumm))Chronic InflammaChronic InflammattiiononAcuteAcute InflammatioInflammationnGranulationGranulationTissueTissueImplImplant Moveant MovementmentInc. timeInc. time** InInccllududinging conconttraractctionionPage 9FIBROBLAST BEHAVIOR IN FIBROUSFIBROBLAST BEHAVIOR IN FIBROUS TISSUE AROUND IMPLANTSTISSUE AROUND IMPLANTS••Proliferation and increased matrixProliferation and increased matrix synthesis of fibsynthesis of fibrroblasts leads to anoblasts leads to an increaseincrease in the thickness and density of the scarin the thickness