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Coulthard P, Esposito M, Slater M, Worthington HV, Kay EJ. Prevention. Part 5: Preventive strategies for patients requiring osseointegrated oral implant treatment. Br Dent J 2003; 195:187-94. [PMID: 12970693 DOI: 10.1038/sj.bdj.4810435] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Prevention for patients requiring rehabilitation with oral implants is about preventing implant failure and biomechanical complications. This paper describes preventative strategies for the planning stage for implant treatment and the later maintenance period and indicates the level of scientific evidence supporting these strategies.
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Affiliation(s)
- P Coulthard
- Head of Oral and Maxillofacial Surgery, University Dental Hospital of Manchester.
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52
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Lappalainen R, Selenius M, Anttila A, Konttinen YT, Santavirta SS. Reduction of wear in total hip replacement prostheses by amorphous diamond coatings. J Biomed Mater Res B Appl Biomater 2003; 66:410-3. [PMID: 12808601 DOI: 10.1002/jbm.b.10026] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Wear-debris-induced periprosthetic bone loss and aseptic loosening is regarded as the main long-term problem of total hip replacements (THRs). In this study the amount of wear debris from articulating surfaces of THRs was reduced so as to be close to negligible by the use of high-quality amorphous diamond (AD) coatings deposited by pulsed plasma arc techniques. The wear rates determined in a commercial hip simulator for 15 million walking cycles (corresponding to about 15 years of clinical use) in serum lubrication were even 1,000,000 times lower than the clinical values for conventional THRs (polyethylene-metal or metal-metal pairs). Elimination of wear debris and good biomechanical performance should provide a substantial improvement of the clinical longevity of the THRs.
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Affiliation(s)
- Reijo Lappalainen
- Department of Applied Physics, University of Kuopio, P.O. Box 1627, FIN-70211 Kuopio, Finland.
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53
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Goodman SB, Song Y, Yoo JY, Fox N, Trindade MCD, Kajiyama G, Ma T, Regula D, Brown J, Smith RL. Local infusion of FGF-2 enhances bone ingrowth in rabbit chambers in the presence of polyethylene particles. J Biomed Mater Res A 2003; 65:454-61. [PMID: 12761835 DOI: 10.1002/jbm.a.3000] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Osseointegration of porous-coated implants during revision arthroplasty procedures is often impeded due to the presence of residual granuloma, particulate debris, and a sclerotic, dysvascular bone bed. We hypothesized that local infusion of recombinant fibroblast growth factor (FGF-2) would increase bone ingrowth in an in vivo model of tissue differentiation in the rabbit tibia in the presence of phagocytosable polyethylene particles. A drug test chamber (DTC) was implanted in the proximal medial tibial metaphysis of mature rabbits unilaterally. The chamber contained a 1x 1 x 5-mm tunnel for tissue ingrowth, and was connected to an osmotic diffusion pump. FGF-2 was infused at dosages of 0, 0.5, 5, 50, or 500 ng/day for a 3-week period, with subsequent harvesting of the ingrown tissue after each 3-week treatment. The effects of ultrahigh molecular weight polyethylene particles (0.5-microm diameter) on tissue ingrowth were determined by adding particles to the chamber at concentrations of 5.8 x 10(11) (low dose) or 1.7 x 10(12) (high dose) particles/mL, with and without infusion of 50 ng/day of FGF for 3 weeks. The tissue forming in the chamber was harvested after each treatment for histologic processing and morphometric analysis of bone ingrowth. Statistical analysis was performed using parametric tests (ANOVA), nonparametric tests (Kruskal-Wallis test) and post hoc tests. In the absence of particles, infusion of 50 ng FGF-2 per day yielded the greatest amount of bone ingrowth. The high dose of particles suppressed bone ingrowth into the chamber, but the low dose particles did not (p = 0.0002, 95% confidence limits = 9.19-18.80). Infusion of 50 ng FGF-2 per day significantly increased net bone formation in the presence of high-dose UHMWPE particles (p = 0.039, 95% confidence limits = 1.41-6.79). There was a trend for decreased numbers of vitronectin-receptor positive (osteoclast-like) cells with the addition of FGF-2, compared to particles alone (p = 0.08). Local delivery of FGF-2 may prove useful in mitigating the adverse effects of wear debris (e.g., in treating early osteolytic lesions), and facilitating osseointegration of revision total joint replacements in situations where the bone bed is suboptimal and residual particles and granulomatous tissue are present.
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Affiliation(s)
- Stuart B Goodman
- Division of Orthopaedic Surgery, R144, Stanford University Medical Center, 300 Pasteur Drive, Stanford, California 94305-5341, USA.
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54
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Søballe K, Mouzin ORG, Kidder LA, Overgaard S, Bechtold JE. The effects of hydroxyapatite coating and bone allograft on fixation of loaded experimental primary and revision implants. ACTA ORTHOPAEDICA SCANDINAVICA 2003; 74:239-47. [PMID: 12899541 PMCID: PMC4495908 DOI: 10.1080/00016470310014139] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We used our established experimental model of revision joint replacement to examine the roles of hydroxyapatite coating and bone graft in improving the fixation of revision implants. The revision protocol uses the Søballe micromotion device in a preliminary 8-week period of implant instability for the presence of particulate polyethylene. During this procedure, a sclerotic endosteal bone rim forms, and a dense fibrous membrane is engendered, having macrophages with ingested polyethylene and high levels of inflammatory cytokines. At the time of revision after 8 weeks, the cavity is revised with either a titanium alloy (Ti) or a hydroxyapatite (HA) 6.0 mm plasma-sprayed implant, in the presence or absence of allograft packed into the initial 0.75 mm peri-implant gap. The contralateral limb is subjected to primary surgery with the same implant configuration, and serves as control. 8 implants were included in each of the 8 treatment groups (total 64 implants in 32 dogs). The observation period was 4 weeks after revision. Outcome measures are based on histomorphometry and mechanical pushout properties. The revision setting was always inferior to its primary counterpart. Bone graft improved the revision fixation in all treatment groups, as also did the HA coating. The sole exception was revision-grafted HA implants, which reached the same fixation as primary Ti and HA grafted implants. The revision, which was less active in general, seems to need the dual stimulation of bone graft and HA implant surface, to obtain the same level of fixation associated with primary implants. Our findings suggest that the combination of HA implant and bone graft may be of benefit in the clinical revision implant setting.
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Affiliation(s)
- Kjeld Søballe
- Department of Orthopaedic Surgery, Aarhus University Hospital, Denmark.
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55
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Goodman S, Trindade M, Ma T, Lee M, Wang N, Ikenou T, Matsuura I, Miyanishi K, Fox N, Regula D, Genovese M, Klein J, Bloch D, Smith RL. Modulation of bone ingrowth and tissue differentiation by local infusion of interleukin-10 in the presence of ultra-high molecular weight polyethylene (UHMWPE) wear particles. J Biomed Mater Res A 2003; 65:43-50. [PMID: 12635153 DOI: 10.1002/jbm.a.10279] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Interleukin-10 (IL-10) is a cytokine that plays a major role in suppressing the inflammatory response, particularly cell-mediated immunity that is characteristic of the TH1 response. The purpose of this study was to determine whether local infusion of IL-10 could mitigate the suppression of bone ingrowth associated with polyethylene wear particles. Drug test chambers were implanted in the proximal tibia of 20 mature New Zealand White rabbits. The DTC provided a continuous 1 x 1 x 5-mm canal for tissue ingrowth. After a 6-week period for osseointegration, the DTC was then connected to an osmotic diffusion pump. IL-10 at doses of 0.1-100 ng/mL (0.25 microL/h) was infused with or without ultra-high molecular weight polyethylene particles (0.5 +/- 0.2 microm diameter, 10(12) particles/mL) present in the chamber for a 3- or 6-week period. The tissue in the chamber was harvested after each treatment; sections were stained with hematoxylin and eosin for morphometric analysis. Osteoclast-like cells were identified by immunohistochemical staining using a monoclonal antibody directed against the alpha chain of the vitronectin receptor, CD51. Osteoblasts were identified using alkaline phosphatase staining. In dose-response studies, infusion of 1 ng/mL IL-10 yielded the greatest bone ingrowth in the presence of particles. The addition of polyethylene particles evoked a marked foreign body reaction and fibrosis; bone ingrowth was significantly suppressed (p = 0.0003). Bone ingrowth was increased by over 48% with infusion of IL-10 for the final 3 weeks of a 6-week ultra-high molecular weight polyethylene particle exposure compared with particles alone (p = 0.027). IL-10 is a cytokine that plays a major role in suppressing the inflammatory response, especially cell-mediated immunity that is characteristic of the TH1 response. Local infusion of immune-modulating cytokines such as IL-10 may prove to be useful in abating particle-induced periprosthetic osteolysis.
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Affiliation(s)
- Stuart Goodman
- Division of Orthopaedic Surgery, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94305, USA.
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56
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Pioletti DP, Müller J, Rakotomanana LR, Corbeil J, Wild E. Effect of micromechanical stimulations on osteoblasts: development of a device simulating the mechanical situation at the bone-implant interface. J Biomech 2003; 36:131-5. [PMID: 12485648 DOI: 10.1016/s0021-9290(02)00301-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Many experimental models have been developed to investigate the effects of mechanical stimulation of cells, but none of the existing devices can simulate micromotions at the cellular-mechanical interface with varying amplitudes and loads. Osteoblasts are sensitive to mechanical stimuli, so to study the bone-implant interface it would be important to quantify their reaction in a situation mimicking the mechanical situation arising at that interface. In this study, we present the development of a new device allowing the application of micromotions and load on cells in vitro. The new device allowed the cells to be stimulated with sinusoidal motions of amplitudes comprised between +/- 5 and +/- 50 microm, frequencies between 0.5 and 2 Hz, and loads between 50 and 1000 Pa. The device, with a total length of 20 cm, was designed to work in an incubator at 37 degrees C and 100% humidity. Expression of various bone important genes was monitored by real-time RT-PCR. Micromotions and load were shown to affect the behavior of osteoblasts by down-regulating the expression of genes necessary for the creation of organic extracellular matrix (collagen type I) as well as for genes involved in the mineralization process (osteocalcin, osteonectin). The developed device could then be used to simulate different mechanical situations at the bone-implant interface.
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Affiliation(s)
- Dominique P Pioletti
- Bone Bioengineering Group, Laboratory of Orthopaedic Research, Institute for Biomedical Engineering, Swiss Federal Institute of Technology, Lausanne, Switzerland. dominique.pioletti@
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57
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Goodman S, Ma T, Trindade M, Ikenoue T, Matsuura I, Wong N, Fox N, Genovese M, Regula D, Smith RL. COX-2 selective NSAID decreases bone ingrowth in vivo. J Orthop Res 2002; 20:1164-9. [PMID: 12472224 DOI: 10.1016/s0736-0266(02)00079-7] [Citation(s) in RCA: 124] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Whether non-steroidal anti-inflammatory drug (NSAID)-induced suppression of bone ingrowth is due to cyclooxygenase-1 (COX-1) inhibition, cyclooxygenase-2 (COX-2) inhibition, or through a yet unidentified pathway is unknown. In this study, the effects of a non-specific COX-1 and COX-2 inhibitor, versus a specific COX-2 inhibitor on bone ingrowth and tissue differentiation are examined in vivo. Harvest chambers were implanted unilaterally in the tibiae of eight mature, New Zealand white rabbits. After a 6-week period for osseointegration of the chamber, the following oral treatments were given for 4 weeks each, followed by a harvest in each case: drinking water with no NSAID (control 1), Naproxen sodium--a COX-1 and COX-2 non-specific inhibitor at a dose of 110 mg/kg/day in the drinking water, drinking water with no NSAID (control 2), and Rofecoxib-a COX-2 inhibitor at a dose of 12.5 mg/day inserted directly into the rabbit's mouth. Harvested specimens were snap frozen, cut into serial 6 microm sections and stained with hematoxylin and eosin for general morphological characterization, and alkaline phosphatase (osteoblast marker). Sections were also processed for immunoperoxidase staining using monoclonal antibodies to identify cells expressing the vitronectin receptor (osteoclast-like cells). With drinking water alone, the percentage of bone ingrowth averaged 24.8 +/- 2.9% and 29.9 +/- 4.5% respectively. Naproxen sodium in the drinking water and oral Rofecoxib decreased bone ingrowth significantly (15.9 +/- 3.3%. p = 0.031 and 18.5 +/- 2+/-4%, p = 0.035 compared to drinking water respectively). Both Naproxen sodium (p = 0.026) and Rofecoxib (p = 0.02) decreased the number of CD51 positive osteoclast-like cells per section compared with drinking water alone. Rofecoxib decreased the area of osteoblasts per section area (p = 0.014) compared to controls, although the value for Naproxen sodium did not reach statistical significance. The results of the present study suggest that bone formation is suppressed by oral administration of an NSAID which contains a COX-2 inhibitor. COX-2 inhibitors currently taken for arthritis and other conditions may potentially delay fracture healing and bone ingrowth.
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Affiliation(s)
- Stuart Goodman
- Division of Orthopaedic Surgery, Orthopaedic Research Laboratory, Stanford University Medical Center, 300 Pasteur Drive, R144, Stanford, CA 94305, USA.
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58
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Sundfeldt M, Widmark M, Johansson CB, Campbell P, Carlsson LV. Effect of submicron polyethylene particles on an osseointegrated implant: an experimental study with a rabbit patello-femoral prosthesis. ACTA ORTHOPAEDICA SCANDINAVICA 2002; 73:416-24. [PMID: 12358115 DOI: 10.1080/00016470216314] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In a rabbit model of a weight bearing, articulating prosthetic joint we repeatedly injected submicron particles of Ultra-High-Molecular-Weight-Polyethylene (UHMWPE) produced in a hip simulator. The contralateral knee with the same prosthesis was injected with carrier (NaCl) without UHMWPE. Histomorphometrical studies on undecalcified cut and ground sections at 26 and 42 weeks involved quantifications of the entire bone to metal contact and the bone area around each implant. We found no statistically significant differences between test and control groups, and the UHMWPE debris did not induce any significant osteolysis, indicating that an osseointegrated implant with a sealed interface may not be affected by UHMWPE debris or progress to aseptic loosening.
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59
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Kammeyer G, Proussaefs P, Lozada J. Conversion of a complete denture to a provisional implant-supported, screw-retained fixed prosthesis for immediate loading of a completely edentulous arch. J Prosthet Dent 2002; 87:473-6. [PMID: 12070507 DOI: 10.1067/mpr.2002.123985] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This article describes the fabrication of a provisional implant-supported, screw-retained restoration for immediate loading of a completely edentulous arch. The technique can be applied to patients with partially edentulous arches as well. Until immediate loading of dental implants becomes a well-documented treatment modality, the described method should not be applied on a routine basis or without careful evaluation.
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Affiliation(s)
- Greg Kammeyer
- Graduate Program in Implant Dentistry, School of Dentistry, Loma Linda University, CA 92350, USA
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60
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Lacouture ME, Schaffer JL, Klickstein LB. A comparison of type I collagen, fibronectin, and vitronectin in supporting adhesion of mechanically strained osteoblasts. J Bone Miner Res 2002; 17:481-92. [PMID: 11874239 DOI: 10.1359/jbmr.2002.17.3.481] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
We used an adhesion assay for cells cultured under high dynamic strain to measure human osteoblast-like HOS cell adherence to immobilized type I collagen, fibronectin, and vitronectin. These conditions were designed to model the increased forces present at unstable fractures or loose joint prostheses. At a constant, low protein-coating density (1000 molecules/microm2) and 20% cyclic strain for 24 h, type I collagen, fibronectin, and vitronectin supported 24.6 +/- 2%, 16.7 +/- 3%, and 1.1 +/- 1% adherence, respectively, which paralleled the relative number of integrin-binding sites in each protein. Thus, when the number of available binding sites was limited, strain resistance was proportional to the number of integrin-ligand interactions. In contrast, at high protein-coating densities (> or = 2,500 molecules/microm2), vitronectin supported greater adherence (45.7 +/- 2%) when compared with type I collagen (37 +/- 2%) or fibronectin (34.8 +/- 2%) and directed constitutive expression of osteopontin (OPN), which suggested that there exist discrete signals on vitronectin receptor occupancy that promoted cell adherence and survival under strain. Integrin-mediated binding was necessary for resistance to strain, as evidenced by the low levels of strain resistance observed when cells were adherent in a nonintegrin-dependent manner. These findings support the utilization of at least two distinct mechanisms (i.e., tensegrity and integrin-mediated signal transduction) by HOS cells to remain adherent and viable on exposure to mechanical forces.
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Affiliation(s)
- Mario E Lacouture
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA
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61
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van Steenberghe D, Quirynen M, Jacobs R. Clinical Procedures of Guided Bone Augmentation. Oral Maxillofac Surg Clin North Am 2001. [DOI: 10.1016/s1042-3699(20)30132-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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62
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Proussaefs P, Lozada J. Immediate loading of single root form implants with the use of a custom acrylic stent. J Prosthet Dent 2001; 85:382-5. [PMID: 11319536 DOI: 10.1067/mpr.2001.114841] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This article describes a technique for fabricating a provisional screw-retained restoration for immediate loading of single implants. Until immediate loading of single implants becomes a well-documented treatment modality, this technique should be used cautiously.
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Affiliation(s)
- P Proussaefs
- School of Dentistry, Loma Linda University, Loma Linda, Calif., USA.
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63
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Abstract
A total of 51 patients with bilateral simultaneous Charnley total hip arthroplasties were studied for wear behavior. The mean observation time was 14.7 years. Fourteen hips had been revised during follow-up. The mean wear rate was 0.071 mm/y for left hips and 0.081 mm/y for right hips. There were considerable side differences for individual patients and little agreement between the wear measurements of left and right hips. Linear wear was increased in men, in patients with high body weight. Linear wear after hip arthroplasty is not side related.
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Affiliation(s)
- A Joshi
- Centre for Hip Surgery, Wrightington Hospital, Wigan, Lancashire, England
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64
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Goodman S, Song Y, Chun L, Aspenberg P, Plouhar P, Glancy T, Regula D, Smith RL. Effects of local infusion of TGFbeta on bone ingrowth in rabbit chambers. JOURNAL OF BIOMEDICAL MATERIALS RESEARCH 2000; 53:475-9. [PMID: 10984694 DOI: 10.1002/1097-4636(200009)53:5<475::aid-jbm5>3.0.co;2-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The local delivery of exogenous growth factors may help achieve a stable, long-lasting prosthetic interface around primary and revision joint replacements. This study examines the effects of local infusion of transforming growth factor beta (TGFbeta) in an in vivo model of tissue differentiation within bone. The Drug Test Chamber was implanted in the proximal medial tibial metaphysis of 8 mature rabbits unilaterally. The chamber contained a 1 x 1 x 5 mm canal for tissue ingrowth. The chamber was connected to an osmotic diffusion pump via polyvinyl tubing. 3.5 microg of recombinant TGFbeta1 was infused for 1 day or 1 week with subsequent harvesting of the ingrown tissue after 3 weeks. Each TGFbeta treatment was followed by two, 3-week infusions of carrier alone and harvesting of the ingrown tissue. TGFbeta for 1 day increased, and TGFbeta for 1 week decreased the percentage of bone in the chamber, compared to the initial control harvest after carrier alone. These changes, however, did not reach statistical significance. The number of vitronectin receptor positive cells in total, adjacent to bone and away from bone was higher after treatment with TGFbeta for 1 day, compared to 1 week. In an "unperturbed" bone ingrowth system (i.e., if bone ingrowth is not initially suppressed by other stimuli), this dose of TGFbeta did not enhance bone ingrowth using the DTC model.
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Affiliation(s)
- S Goodman
- Division of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA 94305, USA.
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65
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Santavirta SS, Lappalainen R, Pekko P, Anttila A, Konttinen YT. The counterface, surface smoothness, tolerances, and coatings in total joint prostheses. Clin Orthop Relat Res 1999:92-102. [PMID: 10611864 DOI: 10.1097/00003086-199912000-00010] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Proper counterface material combinations, surface finish, and tolerances of contact surfaces are important issues in minimizing friction, wear, and corrosion of total joint prostheses. In the current study, the potential of novel amorphous diamond coatings to solve some present problems in total joint prostheses was studied by using tribological tests with a hip joint simulator and pin-on-disk testers. Based on the tests, the wear of amorphous diamond is negligible compared with conventional hip joint materials (10,000 to 1,000,000 times lower). The coefficient of friction of diamond-coated artificial hip joint was 0.03 to 0.06 when tested in saline solution with loads from 200 to 1000 kg for as many as two million cycles. The friction remained stable throughout the tests. Methylmethacrylate (bone cement) is a typical source of third body wear particles in cemented total hip replacements. The wear tests showed that bone cement (containing hard ceramic particles of barium sulfate or zirconia) severely scratched cobalt chromium molybdenum alloy samples. These scratches enhance the wear of softer counterpart materials, such as polyethylene or bone cement, whereas diamond-coated surfaces remained undamaged. High quality amorphous diamond coatings offer superior stability (minimal wear debris release in surrounding tissues) and good biomechanical performance.
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Affiliation(s)
- S S Santavirta
- Department of Orthopaedics and Traumatology, University of Helsinki, Finland
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66
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Monti L, Cristofolini L, Viceconti M. Methods for quantitative analysis of the primary stability in uncemented hip prostheses. Artif Organs 1999; 23:851-9. [PMID: 10491034 DOI: 10.1046/j.1525-1594.1999.06287.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Torsional loads of daily activities contribute to the failure of the primary fixation of hip prostheses. Implant torsional stability must be evaluated prior to in vivo clinical trials. Whereas previous work has investigated this phenomenon, descriptions of physiologically accurate and reproducible in vitro methodologies are rare. The present study aimed to detect and control the sources of error and variability that influence in vitro methods. A typical set-up for the analysis of primary stability of hip stems was studied. Load cycles included proximal-to-distal axial force, torque, and bending moment. The effects of loading frequency and strain distribution across the cortical bone were investigated in order to optimize testing conditions and measurement set-up. The relative shear motion at the bone-stem interface was measured transcortically using linear variable displacement transducers. The procedures developed for mounting specimens on the testing machine and for positioning sensors on the specimen were standardized and tested for reproducibility. The protocol was finally tested for repeatability and accuracy. Measurement errors were 2.3 microm between load cycles and 4.9 microm for repeated set-ups, comparing favorably with the literature.
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Affiliation(s)
- L Monti
- Engineering Faculty, University of Bologna, Italy
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67
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Massat BJ, Miller RT, DeYoung BA, Schiller RA, Aberman HM, DeYoung DJ. Single-stage revision using an uncemented, porous-coated, anatomic endoprosthesis in two dogs: case report. Vet Surg 1998; 27:268-77. [PMID: 9605238 DOI: 10.1111/j.1532-950x.1998.tb00125.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe the clinical and radiographic features of septic and aseptic failure of two femoral endoprostheses and their successful revision. STUDY DESIGN Case report. ANIMALS OR SAMPLE POPULATION Two skeletally mature male research dogs. METHODS An uncemented porous-coated anatomic (PCA) endoprosthesis was implanted in a single-stage revision procedure after thorough debridement and lavage of the femoral canal. An autogenous cancellous bone graft was used in dog 2 (aseptic loosening). Serial clinical and radiographic examinations were performed postoperatively. The dogs were euthanatized 1 year (dog 1) and 2 years (dog 2) after revision surgery, and necropsy was performed. High-resolution contact radiographs and histopathologic evaluation of femoral sections were obtained. RESULTS The cause of implant failure was septic loosening in dog 1 and aseptic loosening in dog 2. In both dogs, clinical function returned to normal after revision. Serial radiographic assessment after revision documented disappearance of the bone pedestal and the periprosthetic lucency. Cancellous hypertrophy seen adjacent to the proximal porous-coated region of the implants provided radiographic evidence of bony fixation. Histological evaluation of femoral sections documented successful implant integration with bone and fibrous tissue. CONCLUSION Revision with an uncemented implant in a single-stage procedure was successful in the two dogs described in this report. CLINICAL RELEVANCE This report provides a detailed description of the clinical course and serial radiographic assessment of septic and aseptic loosening of two femoral endoprostheses. Single-stage revision is a potential treatment for either condition as demonstrated by the successful outcome in these two dogs.
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Affiliation(s)
- B J Massat
- Department of Companion Animal and Special Species Medicine, College of Veterinary Medicine, North Carolina State University, Raleigh 27606, USA
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68
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van Luyn MJ, Khouw IM, van Wachem PB, Blaauw EH, Werkmeister JA. Modulation of the tissue reaction to biomaterials. II. The function of T cells in the inflammatory reaction to crosslinked collagen implanted in T-cell-deficient rats. JOURNAL OF BIOMEDICAL MATERIALS RESEARCH 1998; 39:398-406. [PMID: 9468048 DOI: 10.1002/(sici)1097-4636(19980305)39:3<398::aid-jbm8>3.0.co;2-e] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Unwanted tissue reactions are often observed resulting in events such as early resorption of the biomaterial, loosening of the implant, or a chronic (immunologic) response. From immunologic studies it is known that inflammatory reactions can be modulated by use of (anti)-growth factors or anti-inflammatory drugs. Before this can be employed with respect to biomaterials, the role of individual factors (humoral and cellular) has to be studied. In this part of the investigation, the role of T cells was studied by use of T-cell-deficient (nude) rats and control (AO) rats. Hexamethylenediisocyanate-crosslinked dermal sheep collagen (HDSC) was selected as the test material. The results showed that T cells or T cell-related factors played a prominent role in the attraction of macrophages and the formation of giant cells, their antigen presentation, and their phagocytotic capacity. As a consequence, degradation of HDSC was strongly delayed. This study also showed that infiltration of fibroblasts and creation of stromal areas in HDSC was restricted to areas subjected to degradation. However, in time, absence of T cells resulted in increased formation and maturation of autologous rat collagen. Results obtained suggest that the inflammatory reaction to biomaterials might be modulated by controlling T-cell activation.
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Affiliation(s)
- M J van Luyn
- Laboratory for Cell Biology and Electron Microscopy, Groningen University, Faculty of Medical Sciences, The Netherlands
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69
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Aspenberg P, Anttila A, Konttinen YT, Lappalainen R, Goodman SB, Nordsletten L, Santavirta S. Benign response to particles of diamond and SiC: bone chamber studies of new joint replacement coating materials in rabbits. Biomaterials 1996; 17:807-12. [PMID: 8730965 DOI: 10.1016/0142-9612(96)81418-9] [Citation(s) in RCA: 80] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Wear particles from total joint replacements are thought to accelerate prosthetic loosening. Diamond coating may improve the smoothness and wear characteristics of the femoral head component of total hip replacements, and thus increase their longevity. The brittleness of a thin diamond coat may be overcome by using an SiC-whisker diamond composite. This study describes the reactions of regenerating bone tissue to phagocytosable particles of diamond and SiC, using implanted bone harvest chambers in rabbits. The particles were dispersed in hyaluronan and introduced into a canal transversing the implant. The tissue that entered the canal during the following 3 weeks was then harvested. In previous studies using this model, particles of high density polyethylene, bone cement and chromium-cobalt all caused an inflammatory reaction and a marked decrease in the amount of ingrown bone. In the present study, neither the diamond nor the SiC particles caused any decrease in bone formation. It appears that particles of diamond and SiC are comparatively harmless.
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Affiliation(s)
- P Aspenberg
- Department of Orthopedics, University Hospital, Lund, Sweden
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70
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Baslé MF, Bertrand G, Guyetant S, Chappard D, Lesourd M. Migration of metal and polyethylene particles from articular prostheses may generate lymphadenopathy with histiocytosis. JOURNAL OF BIOMEDICAL MATERIALS RESEARCH 1996; 30:157-63. [PMID: 9019479 DOI: 10.1002/(sici)1097-4636(199602)30:2<157::aid-jbm4>3.0.co;2-q] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Wear particles released from hip or knee prostheses are known to be involved in the fibrohistiocytic membrane interposed between bone and implant. During surgical treatment for pelvic carcinoma (5 cases) and for isolated pseudomalignant lymphadenopathy (4 cases) lymph nodes in 9 patients who had had lower limb articular replacement were harvested. Light microscopy and image analysis of the nodes showed florid endosinusal histiocytosis, predominant in the cortical area. Using Oil Red O staining and polarized light, metal particles and polyethylene particles were detected in the large histiocytes. Scanning electron microscopy with electron backscattering allowed us to localize metal particles and perform elemental microanalysis. Iron, cobalt, chromium, nickel, zirconium, and barium, known to be used in prosthetic and cementing materials, were identified as component of these particles. Large amounts of polyethylene particles appeared in all cases while metal particles were found to be abundant in only 2 cases. Thus, migration of polyethylene debris from the prosthetic site seems to be the major factor in development of the histiocytes induced in satellite lymph nodes.
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Affiliation(s)
- M F Baslé
- Laboratoire d'Histologie-Embryologie, Faculté de Médecine, Angers, France
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71
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Carlsson AS, Rydberg J, Onnerfält R. A large collar increases neck resorption in total hip replacement. 204 hips evaluated during 5 years. ACTA ORTHOPAEDICA SCANDINAVICA 1995; 66:339-42. [PMID: 7676822 DOI: 10.3109/17453679508995557] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We evaluated the effect of a prosthetic collar on the proximal femoral bone in 204 hips without any signs of loosening after 5 years. The patients were operated on at 5 centers, using different prosthetic designs, but the same cementing technique. Resorption was more often found in cases with a true and large collar (Lubinus, HD2, Scanhip) than in cases with a flanged or tapered stem (Charnley, Exeter). The resorption was also more pronounced with the former designs. It was concluded that, in spite of theoretical advantages, a large collar is not only unnecessary but may also have negative long-term effects.
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Affiliation(s)
- A S Carlsson
- Department of Orthopedics, Malmö University Hospital, Sweden
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72
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Linder L. Implant stability, histology, RSA and wear--more critical questions are needed. A view point. ACTA ORTHOPAEDICA SCANDINAVICA 1994; 65:654-8. [PMID: 7839856 DOI: 10.3109/17453679408994626] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
I discuss the radiostereometry (RSA) of prosthetic micromovement from clinical and histological viewpoints. Even in non-migrators there is a wide variety of interfaces with various resistances to trigger factors, such as mechanical forces and sequels of wear. I suggest that the various forms of bone resorption seen with conventional radiography are caused by such trigger factors and that their anatomical appearance is determined by the structure of the interface obtained at surgery.
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Affiliation(s)
- L Linder
- Department of Orthopedics, Gävle Hospital, Sweden
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