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Silva MMB, Gjertsen JE, Moldestad IO, Furnes ON, Khan M, Høl PJ. Effects of implant precoating and fat contamination on the stability of the tibial baseplate. Knee 2024; 49:266-278. [PMID: 39059126 DOI: 10.1016/j.knee.2024.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 05/31/2024] [Accepted: 07/02/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Approximately 5% of primary total knee arthroplasty patients require revision within 10 years, often due to distal component loosening. Application of a thin layer of PMMA cement as precoating on the tibial component aims to prevent aseptic loosening. This study investigates the impact of precoating and fat contamination on tibial baseplate stability. METHODS Two groups of NexGen® stemmed tibial implants (size 4) were studied: Option implants (N = 12) and PMMA Precoat implants (N = 12). Each implant design was divided into two subgroups, (N = 6), with one subgroup featuring bone marrow fat at the implant-cement interface and the other without contamination. In a mechanical testing machine, the implants underwent uniaxial loading for 20,000 cycles, while recording vertical micromotion and migration of the tibial baseplates. Subsequently, a push-out test assessed fixation strength at the cement interfaces. Results were compared using non-parametric statistics and presented as median and min-to-max ranges. RESULTS Option implants exhibited higher micromotion in dry conditions compared to precoated implants (p = 0.03). Under contamination, both designs demonstrated similar micromotion values. Fixation strength did not significantly differ between designs under dry, uncontaminated conditions (p > 0.99). However, under contaminated conditions, the failure load for the non-coated Option implant was nearly half that of the uncontaminated counterparts (3517 N, 2603-4367 N vs 7531 N, 5163-9000 N; p = 0.002). Precoat implants displayed less susceptibility to fat contamination (p = 0.30). CONCLUSION NexGen® implant PMMA precoating might reduce the risk of aseptic loosening and revision surgery in case of eventual bone-marrow fat contamination.
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Affiliation(s)
- Maya Maya Barbosa Silva
- Biomatlab, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway.
| | - Jan-Erik Gjertsen
- The Norwegian Arthroplasty Register, Department of Ortopaedic Surgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Irene Ohlen Moldestad
- Biomatlab, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Ove Nord Furnes
- The Norwegian Arthroplasty Register, Department of Ortopaedic Surgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Michelle Khan
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Paul Johan Høl
- Biomatlab, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Xie Y, Peng Y, Fu G, Jin J, Wang S, Li M, Zheng Q, Lyu FJ, Deng Z, Ma Y. Nano wear particles and the periprosthetic microenvironment in aseptic loosening induced osteolysis following joint arthroplasty. Front Cell Infect Microbiol 2023; 13:1275086. [PMID: 37854857 PMCID: PMC10579613 DOI: 10.3389/fcimb.2023.1275086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 09/05/2023] [Indexed: 10/20/2023] Open
Abstract
Joint arthroplasty is an option for end-stage septic arthritis due to joint infection after effective control of infection. However, complications such as osteolysis and aseptic loosening can arise afterwards due to wear and tear caused by high joint activity after surgery, necessitating joint revision. Some studies on tissue pathology after prosthesis implantation have identified various cell populations involved in the process. However, these studies have often overlooked the complexity of the altered periprosthetic microenvironment, especially the role of nano wear particles in the etiology of osteolysis and aseptic loosening. To address this gap, we propose the concept of the "prosthetic microenvironment". In this perspective, we first summarize the histological changes in the periprosthetic tissue from prosthetic implantation to aseptic loosening, then analyze the cellular components in the periprosthetic microenvironment post prosthetic implantation. We further elucidate the interactions among cells within periprosthetic tissues, and display the impact of wear particles on the disturbed periprosthetic microenvironments. Moreover, we explore the origins of disease states arising from imbalances in the homeostasis of the periprosthetic microenvironment. The aim of this review is to summarize the role of relevant factors in the microenvironment of the periprosthetic tissues, in an attempt to contribute to the development of innovative treatments to manage this common complication of joint replacement surgery.
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Affiliation(s)
- Yu Xie
- Department of Orthopedics, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Yujie Peng
- Department of Orthopedics, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Guangtao Fu
- Department of Orthopedics, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Jiewen Jin
- Department of Endocrinology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shuai Wang
- Department of Orthopedics, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Mengyuan Li
- Department of Orthopedics, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Qiujian Zheng
- Department of Orthopedics, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Feng-Juan Lyu
- The Sixth Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Zhantao Deng
- Department of Orthopedics, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Yuanchen Ma
- Department of Orthopedics, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
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Schroeder S, Braun S, Mueller U, Sonntag R, Jaeger S, Kretzer JP. Particle analysis of shape factors according to American Society for Testing and Materials. J Biomed Mater Res B Appl Biomater 2019; 108:225-233. [PMID: 30977963 DOI: 10.1002/jbm.b.34382] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 02/12/2019] [Accepted: 03/20/2019] [Indexed: 11/07/2022]
Abstract
Polyethylene wear is one of the major factors influencing the survivorship of joint replacements. Depending on the number, size and morphology of the polyethylene particles, biological responses of the periprosthetic soft tissue in terms of inflammatory processes can occur, leading to loosening of the implant. Various parameters are used to analyze wear particles, which are usually determined by examining scanning electron microscopy (SEM) images with a particle analysis program. In this study, three different software solutions for particle analysis (self-developed Particleanalyzer_HD, Leica QWin and ImageJ) were compared regarding particle number, size and morphology. These solutions were also compared to the American Society for Testing and Materials (ASTM) F1877-16 specifications regarding particle morphology. SEM image analysis revealed no differences for the equivalent circle diameter (p = 0.969). However, a significant difference was found for the aspect ratio between the Particleanalyzer_HD and the other two software solutions (p < 0.001) and between Leica QWin and the other two software solutions regarding the roundness (p < 0.001). Only the Particleanalyzer_HD showed an excellent agreement with the ASTM standard for both morphology parameters (intraclass correlation = 1.000). Only the Particleanalyzer_HD calculated the two morphology parameters according to the ASTM standard. A comparison of the particle morphology between different studies is barely possible, as different algorithms for particle analysis are used. It is strongly recommended that the calculation according to the ASTM standard is used to improve future comparability of findings from wear analysis studies. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 108B:225-233, 2020.
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Affiliation(s)
- Stefan Schroeder
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Steffen Braun
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Ulrike Mueller
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Robert Sonntag
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Sebastian Jaeger
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Jan Philippe Kretzer
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
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Li J, Li Z, Tu J, Jin G, Li L, Wang K, Wang H. In vitro and in vivo investigations of a-C/a-C:Ti nanomultilayer coated Ti6Al4V alloy as artificial femoral head. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 99:816-826. [PMID: 30889756 DOI: 10.1016/j.msec.2019.02.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 01/15/2019] [Accepted: 02/06/2019] [Indexed: 12/13/2022]
Abstract
Hydrogen-free a-C/a-C:Ti nanomultilayer (a-C NM) films were deposited on medical Ti6Al4V by the magnetron sputtering technique under bias-graded voltage. Cell tests and implantations were performed for the a-C NM films coated Ti6Al4V with the uncoated Ti6Al4V as the control. The canine total hip arthroplasty (THA) surgeries were conducted for 12 dogs using the coated femoral heads, with the CoCr heads as the control. Results of cell tests showed that the coated Ti6Al4V had no cytotoxicity, and there was no statistical difference of the cell attachment rates between the coated and uncoated sample (P = 0.091). No significant difference of the tissue response around the coated and uncoated implants were observed after the intramuscular (P = 0.679) and intraosseous implantations (P = 0.122). After two years of successful canine THA, the polyethylene wear particles isolated from periprosthetic soft tissue showed similar sizes, shapes and counts in the two groups (all of the P values >0.05). The retrieved femoral heads showed slightly change of the surface roughness, but no statistical differences between groups (P = 0.696). However, the systemic metal ion analysis indicated that the content of Co and Cr ions released in the coated group (Co: 0.71 ± 0.06 μg/L, Cr: 0.52 ± 0.05 μg/L) were significant lower than that in the control (Co: 1.98 ± 0.16 μg/L, Cr: 1.17 ± 0.19 μg/L) (both P < 0.005). Histological analysis of the periprosthetic tissue in CoCr group showed a severer histiocyte response than that in the coated group (P = 0.029). The head-taper interfaces showed galvanic corrosion attack in the CoCr group, but not in the coated Ti6Al4V group. Therefore, the a-C NM films coated Ti6Al4V exhibited good biocompatibility as an implant material. Compared with the CoCr, the coated Ti6Al4V femoral head could provide comparable in vivo wear properties, release less harmful metal ions and reduce the inflammatory response in periprosthetic tissue, which may help to prolong the longevity of prostheses.
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Affiliation(s)
- Ji Li
- Department of Orthopedics, General Hospital of PLA, No. 28 Fuxing Road, Haidian District, Beijing 100853, China
| | - Zhongli Li
- Department of Orthopedics, General Hospital of PLA, No. 28 Fuxing Road, Haidian District, Beijing 100853, China.
| | - Jiangping Tu
- State Key Laboratory of Materials and Department of Materials Science and Engineering, Zhejiang University, Hangzhou 310027, China
| | - Gong Jin
- ZhongAoHuiCheng Technology Co., No. 20 Kechuang Road, Economic and Technological Development Zone, Beijing 100176, China
| | - Lingling Li
- State Key Laboratory of Materials and Department of Materials Science and Engineering, Zhejiang University, Hangzhou 310027, China
| | - Ketao Wang
- Department of Orthopedics, General Hospital of PLA, No. 28 Fuxing Road, Haidian District, Beijing 100853, China
| | - Haoran Wang
- Department of Orthopedics, General Hospital of PLA, No. 28 Fuxing Road, Haidian District, Beijing 100853, China
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Li J, Wang K, Li Z, Tu JP, Jin G, Su J, Zhai B. Mechanical tests, wear simulation and wear particle analysis of carbon-based nanomultilayer coatings on Ti6Al4V alloys as hip prostheses. RSC Adv 2018; 8:6849-6857. [PMID: 35540330 PMCID: PMC9078386 DOI: 10.1039/c7ra12080j] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 02/06/2018] [Indexed: 11/21/2022] Open
Abstract
Carbon-based nanomultilayer coatings were deposited on medical-grade Ti6Al4V alloy using a magnetron sputtering technique under a graded bias voltage.
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Affiliation(s)
- Ji Li
- Department of Orthopedics
- General Hospital of PLA
- Beijing 100853
- China
| | - Ketao Wang
- Department of Orthopedics
- General Hospital of PLA
- Beijing 100853
- China
| | - Zhongli Li
- Department of Orthopedics
- General Hospital of PLA
- Beijing 100853
- China
| | - J. P. Tu
- State Key Laboratory of Materials and Department of Materials Science and Engineering
- Zhejiang University
- Hangzhou 310027
- China
| | - Gong Jin
- ZhongAoHuiCheng Technology Co
- Economic and Technological Development Zone
- Beijing 100176
- China
| | - Jian Su
- Beijing Institute of Medical Instruments
- Beijing 101111
- China
| | - Bao Zhai
- Beijing Institute of Medical Instruments
- Beijing 101111
- China
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Cyndari KI, Goodheart JR, Miller MA, Oest ME, Damron TA, Mann KA. Peri-Implant Distribution of Polyethylene Debris in Postmortem-Retrieved Knee Arthroplasties: Can Polyethylene Debris Explain Loss of Cement-Bone Interlock in Successful Total Knee Arthroplasties? J Arthroplasty 2017; 32:2289-2300. [PMID: 28285038 PMCID: PMC5469692 DOI: 10.1016/j.arth.2017.01.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 01/06/2017] [Accepted: 01/25/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Loss of mechanical interlock between cement and bone with in vivo service has been recently quantified for functioning, nonrevised, cemented total knee arthroplasties (TKAs). The cause of interlocking trabecular resorption is not known. The goal of this study is to quantify the distribution of PE debris at the cement-bone interface and determine if polyethylene (PE) debris is locally associated with loss of interlock. METHODS Fresh, nonrevised, postmortem-retrieved TKAs (n = 8) were obtained en bloc. Laboratory-prepared constructs (n = 2) served as negative controls. The intact cement-bone interface of each proximal tibia was embedded in Spurr's resin, sectioned, and imaged under polarized light to identify birefringent PE particles. PE wear particle number density was quantified at the cement-bone interface and distal to the interface, and then compared with local loss of cement-bone interlock. RESULTS The average PE particle number density for postmortem-retrieved TKAs ranged from 8.6 (1.3) to 24.9 (3.1) particles/mm2 (standard error) but was weakly correlated with years in service. The average particle number density was twice as high as distal (>5mm) to the interface compared to at the interface. The local loss of interlock at the interface was not related to the presence, absence, or particle density of PE. CONCLUSION PE debris can migrate extensively along the cement-bone interface of well-fixed tibial components. However, the amount of local bone loss at the cement-bone interface was not correlated with the amount of PE debris at the interface, suggesting that the observed loss of trabecular interlock in these well-fixed TKAs may be due to alternative factors.
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Affiliation(s)
- Karen I Cyndari
- Department of Orthopaedic Surgery, State University of New York Upstate Medical University, Syracuse, New York
| | - Jacklyn R Goodheart
- Department of Orthopaedic Surgery, State University of New York Upstate Medical University, Syracuse, New York
| | - Mark A Miller
- Department of Orthopaedic Surgery, State University of New York Upstate Medical University, Syracuse, New York
| | - Megan E Oest
- Department of Orthopaedic Surgery, State University of New York Upstate Medical University, Syracuse, New York
| | - Timothy A Damron
- Department of Orthopaedic Surgery, State University of New York Upstate Medical University, Syracuse, New York
| | - Kenneth A Mann
- Department of Orthopaedic Surgery, State University of New York Upstate Medical University, Syracuse, New York
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7
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Dinjaski N, Ebrahimi D, Qin Z, Giordano JEM, Ling S, Buehler MJ, Kaplan DL. Predicting rates of in vivo degradation of recombinant spider silk proteins. J Tissue Eng Regen Med 2017; 12:e97-e105. [PMID: 27943629 DOI: 10.1002/term.2380] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 10/18/2016] [Accepted: 12/06/2016] [Indexed: 11/08/2022]
Abstract
Developing fundamental tools and insight into biomaterial designs for predictive functional outcomes remains critical for the field. Silk is a promising candidate as a biomaterial for tissue engineering scaffolds, particularly where high mechanical loads or slow rates of degradation are desirable. Although bioinspired synthetic spider silks are feasible biomaterials for this purpose, insight into how well the degradation rate can be programmed by fine tuning the sequence remains to be determined. Here we integrated experimental approaches and computational modelling to investigate the degradation of two bioengineered spider silk block copolymers, H(AB)2 and H(AB)12 , which were designed based on the consensus domains of Nephila clavipes dragline silk. The effect of protein chain length and secondary structure on degradation was analysed in vivo. The degradation rate of H(AB)12 , the silk with longer chain length/higher molecular weight, and higher crystallinity, was slower when compared to H(AB)2 . Using full atomistic modelling, it was determined that the faster degradation of H(AB)2 was due to the lower folded molecular structure of the silk and the greater accessibility to solvent. Comparison of the specific surface areas of proteins via modelling showed that higher exposure of random coil and lower exposure of ordered domains in H(AB)2 led to the more reactive silk with a higher degradation rate when compared with H(AB)12 , as validated by the experimental results. The study, based on two simple silk designs demonstrated that the control of sequence can lead to programmable degradation rates for these biomaterials, providing a suitable model system with which to study variables in protein polymer design to predict degradation rates in vivo. This approach should reduce the use of animal screening, while also accelerating translation of such biomaterials for repair and regenerative systems. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Nina Dinjaski
- Department of Biomedical Engineering, Tufts University, Medford, MA, USA.,Department of Civil and Environmental Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Davoud Ebrahimi
- Department of Civil and Environmental Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Zhao Qin
- Department of Civil and Environmental Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Jodie E M Giordano
- Department of Biomedical Engineering, Tufts University, Medford, MA, USA
| | - Shengjie Ling
- Department of Biomedical Engineering, Tufts University, Medford, MA, USA.,Department of Civil and Environmental Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Markus J Buehler
- Department of Civil and Environmental Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - David L Kaplan
- Department of Biomedical Engineering, Tufts University, Medford, MA, USA
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How Does Wear Rate Compare in Well-functioning Total Hip and Knee Replacements? A Postmortem Polyethylene Liner Study. Clin Orthop Relat Res 2016; 474:1867-75. [PMID: 26891896 PMCID: PMC4925408 DOI: 10.1007/s11999-016-4749-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 02/10/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND The longevity of total hip (THR) and knee replacements (TKR) that used historical bearing materials of gamma-in-air sterilized UHMWPE was affected more by osteolysis in THRs than in TKRs, although osteolysis remains a concern in TKRs. Therefore, the study of polyethylene wear is still of interest for the knee, particularly because few studies have investigated volumetric material loss in tibial knee inserts. For this study, a unique collection of autopsy-retrieved TKR and THR components that were well-functioning at the time of retrieval was used to compare volumetric wear differences between hip and knee polyethylene components made from identical material. QUESTIONS/PURPOSES The following questions were addressed: (1) How much did the hip liners wear and what wear patterns did they exhibit? (2) How much did the knee inserts wear and what wear patterns did they exhibit? (3) What is the ratio between TKR and THR wear after controlling for implantation time and patient age? METHODS We compared 23 THR components (Harris-Galante [HG] and HG II) and 20 TKR components (Miller-Galante [MG II]) that were retrieved postmortem. The components were made from the same polyethylene formulation and with similar manufacturing and sterilization (gamma-in-air) processes. Twenty-one patients (12 males, nine females) had THRs and 16 (four males, 12 females) had TKRs. Patients who had TKRs had an older (p = 0.001) average age than patients who had THRs (age, 75 years; SD, 10, versus 66 years; SD, 12, respectively). Only well-functioning components were included in this study. Therefore, implants retrieved postmortem from physically active patients and implanted for at least 2 years were considered. In addition, only normally wearing TKR components were considered, ie, those with fatigue wear (delamination) were excluded. The wear volume of each component was measured using metrology. For the tibial inserts an autonomous mathematic reconstruction method was used for quantification. RESULTS The acetabular liners of the THR group had a wear rate of 38 mm(3) per year (95% CI, 29-47 mm(3)/year). Excluding patients with low-activity, the wear rate was 47 mm(3) per year (95% CI, 37-56 mm(3)/year). The wear rate of normally wearing tibial inserts was 17 mm(3) per year (95% CI, -6 to 40 mm(3)/year). After controlling for the relevant confounding variable of age, we found a TKR/THR wear rate ratio of 0.5 (95% CI, 0.29-0.77) at 70 years of age with a slightly increasing difference with increasing age. CONCLUSIONS Excluding delamination, TKRs exhibited lower articular wear rates than THRs for historical polyethylene in these two unique cohorts of postmortem retrievals. CLINICAL RELEVANCE The lower TKR wear rate is in line with the lower incidence of osteolysis in TKRs compared with THRs.
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Effect of particle size on biological response by human monocyte-derived macrophages. BIOSURFACE AND BIOTRIBOLOGY 2016. [DOI: 10.1016/j.bsbt.2016.02.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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10
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Analysis of UHMWPE wear particles produced in the simulation of hip and knee wear mechanisms with the RandomPOD system. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.biotri.2015.03.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Comparison of periprosthetic tissues in knee and hip joints: differential expression of CCL3 and DC-STAMP in total knee and hip arthroplasty and similar cytokine profiles in primary knee and hip osteoarthritis. Osteoarthritis Cartilage 2014; 22:1851-60. [PMID: 25151085 DOI: 10.1016/j.joca.2014.08.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 07/11/2014] [Accepted: 08/03/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To identify expression profiles (EP) associated with aseptic loosening of total knee arthroplasty (TKA) and to compare them with EP observed in total hip arthroplasty (THA), and primary knee and hip osteoarthritis (OA). DESIGN Gene EP of TNF, IL-6, IL-8, CHIT1, BMP4, CCL3, CCL18, MMP9, RANKL, OPG, DC-STAMP and SOCS3 were assessed using quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR) on tissues retrieved from patients with aseptically failed TKA (n = 21), THA (n = 41) and primary knee (n = 20) and hip (n = 17) OA. Immunohistochemistry was applied to localize the proteins. RESULTS When compared to knee OA, the pseudosynovial tissue in TKA exhibit (1) elevation of alternative macrophage activation marker (CHIT1), chemokine (IL-8), and a proteolytic enzyme (MMP9); (2) downregulation of pro-inflammatory cytokine (TNF), osteoclastic regulator (OPG) and a stimulator of bone formation (BMP4); (3) no difference in IL-6, CCL3, CCL18, RANKL, DC-STAMP and SOCS3. The EP in TKA differed from EP in aseptically failed THA by lower CCL3 and DC-STAMP mRNA and protein expression. EP of all studied inflammatory and osteoclastogenic molecules were similar in knee and hip OA. CONCLUSIONS Comparing to OA, aseptic loosening of TKA is associated with upregulated expression of CHIT1, IL-8 and MMP9, dysregulated RANKL:OPG ratio and low levels of inflammatory cytokines. Similar cytokine profiles were associated with primary knee and hip OA. Further research is required to explain the differences in CCL3 and DC-STAMP expression between failed TKA and THA.
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Park DY, Min BH, Kim DW, Song BR, Kim M, Kim YJ. Polyethylene wear particles play a role in development of osteoarthritis via detrimental effects on cartilage, meniscus, and synovium. Osteoarthritis Cartilage 2013; 21:2021-9. [PMID: 24161707 DOI: 10.1016/j.joca.2013.09.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 08/31/2013] [Accepted: 09/28/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE While ultra-high molecular weight polyethylene (UHMWPE) wear particles are known to cause periprosthetic osteolysis, its interaction with other intra-articular tissues in the case of partial joint arthroplasties is not well understood. We hypothesized that UHMWPE particles per se would interact with intra-articular tissue, which by acting as inflammatory reservoirs, would subsequently induce osteoarthritic (OA) changes. Our goal was to assess the inflammatory response, phagocytic activity, as well as apoptosis of intra-articular cells in the presence of UHMWPE particles in vitro, and the in vivo response of those tissues after intra-articular injection of particles in a murine model. DESIGN Three cell types were used for the in vitro study; chondrocytes, meniscal fibrochondrocytes, and synoviocytes. Each cell type was cultured with two different concentrations of UHMWPE particles. Pro-inflammatory cytokine production, phagocytosis, and apoptosis were analyzed. In vivo experiments were done by injecting two concentrations of UHMWPE particles into normal and murine OA model knee joints. RESULTS In vitro experiments showed that UHMWPE particles increase pro-inflammatory cytokine and mediator (IL-1β, IL-6, TNF-α, Nitric Oxide, and Prostaglandin E2) production, phagocytosis of particles, and apoptosis in all cell types. In vivo experiment showed degeneration of cartilage and meniscus, as well as synovitis after particle injection. CONCLUSIONS UHMWPE wear particles per se exert detrimental effects in cartilage, synovium, and meniscus of the knee joint resulting in pro-inflammatory cytokine release, phagocytosis of particles and apoptosis. Particles induced and exacerbated OA changes in a murine model.
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Affiliation(s)
- D Y Park
- Department of Anatomy, Ajou University School of Medicine, San 5 Wonchon-dong, Youngtong-gu, Suwon, Kyounggi-do 443-721, Republic of Korea.
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Schröder C, Reinders J, Zietz C, Utzschneider S, Bader R, Kretzer JP. Characterization of polyethylene wear particle: The impact of methodology. Acta Biomater 2013; 9:9485-91. [PMID: 23933100 DOI: 10.1016/j.actbio.2013.07.039] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 07/25/2013] [Accepted: 07/31/2013] [Indexed: 10/26/2022]
Abstract
Due to the prevalence of problems caused by wear particles, the reduced durability of total joint replacements is well documented. The characterization of wear debris enables the size and morphology of these wear particles to be measured and provides an assessment of the biological response in vivo. However, the impact of different methodologies of particle analysis is not yet clear. Hence, the aim of this investigation was to analyze the influence of different particle characterization methods performed by three research centers within the scope of a "round robin test". To obtain knowledge about possible pitfalls, single steps of the particle characterization process (storage, pore size of the filter, coating durations by gold sputtering and scanning electron microscopy (SEM) magnification) were analyzed. The round robin test showed significant differences between the research groups, especially for the morphology of the particles. The SEM magnification was identified as having the greatest influence on the size and shape of the particles, followed by the storage conditions of the wear particle containing lubricant. Gold sputter coating and filter pore size also exhibit significant effects. However, even though they are statistically significant, it should be emphasized that the differences are small. In conclusion, particle characterization is a complex analytical method with a multiplicity of influencing factors. It becomes apparent that a comparison of wear particle results between different research groups is challenging.
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Total knee prosthesis polyethylene wear reduction by a new
metal part finishing method. J Appl Biomater Funct Mater 2013; 11:e99-e105. [PMID: 23728542 DOI: 10.5301/jabfm.5000153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2012] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The purpose of this study was to assess a new metal component finishing designed to improve total knee prosthesis durability. Wear of ultrahigh molecular-weight polyethylene (UHMWPE), with generation of submicrometer- and micrometer-sized particles, has been associated with osteolysis and artificial joint failure. Wear extent is influenced by several factors, some of which are related to manufacturing. METHODS UHMWPE wear was assessed in metal prosthesis components finished with the Microloy® technology and in traditionally finished components by wear simulation experiments (pin on disk and knee simulator tests) and analysis of wear debris. RESULTS Microloy®-finished prosthesis showed a 48.5% reduction in UHMWPE total weight loss compared with traditional components (P=0.002). A statistically significant (P<0.05) reduction of UHMWPE debris were detected from the Microloy®-finished compared with the traditionally finished components. CONCLUSIONS These findings suggest the Microloy® metal finishing may enhance the long-term performance of knee prostheses.
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Gallo J, Goodman SB, Konttinen YT, Wimmer MA, Holinka M. Osteolysis around total knee arthroplasty: a review of pathogenetic mechanisms. Acta Biomater 2013; 9:8046-58. [PMID: 23669623 DOI: 10.1016/j.actbio.2013.05.005] [Citation(s) in RCA: 214] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 04/12/2013] [Accepted: 05/02/2013] [Indexed: 01/31/2023]
Abstract
Aseptic loosening and other wear-related complications are some of the most frequent late reasons for revision of total knee arthroplasty (TKA). Periprosthetic osteolysis (PPOL) pre-dates aseptic loosening in many cases, indicating the clinical significance of this pathogenic mechanism. A variety of implant-, surgery- and host-related factors have been delineated to explain the development of PPOL. These factors influence the development of PPOL because of changes in mechanical stresses within the vicinity of the prosthetic device, excessive wear of the polyethylene liner, and joint fluid pressure and flow acting on the peri-implant bone. The process of aseptic loosening is initially governed by factors such as implant/limb alignment, device fixation quality and muscle coordination/strength. Later, large numbers of wear particles detached from TKA trigger and perpetuate particle disease, as highlighted by progressive growth of inflammatory/granulomatous tissue around the joint cavity. An increased accumulation of osteoclasts at the bone-implant interface, impairment of osteoblast function, mechanical stresses and increased production of joint fluid contribute to bone resorption and subsequent loosening of the implant. In addition, hypersensitivity and adverse reactions to metal debris may contribute to aseptic TKA failure, but should be determined more precisely. Patient activity level appears to be the most important factor when the long-term development of PPOL is considered. Surgical technique, implant design and material factors are the most important preventative factors, because they influence both the generation of wear debris and excessive mechanical stresses. New generations of bearing surfaces and designs for TKA should carefully address these important issues in extensive preclinical studies. Currently, there is little evidence that PPOL can be prevented by pharmacological intervention.
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Affiliation(s)
- J Gallo
- Department of Orthopaedics, Faculty of Medicine and Dentistry, University Hospital, Palacky University Olomouc, I.P. Pavlova Str. 6, CZ-775 20 Olomouc, Czech Republic.
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An Y, Tai Z, Qi Y, Yan X, Liu B, Xue Q, Pei J. Friction and wear properties of graphene oxide/ultrahigh-molecular-weight polyethylene composites under the lubrication of deionized water and normal saline solution. J Appl Polym Sci 2013. [DOI: 10.1002/app.39640] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Yingfei An
- State Key Laboratory of Solid Lubrication; Lanzhou Institute of Chemical Physics, Chinese Academy of Sciences; Lanzhou 730000 China
- School of Stomatology; Lanzhou University; Lanzhou 730000 China
| | - Zhixin Tai
- State Key Laboratory of Solid Lubrication; Lanzhou Institute of Chemical Physics, Chinese Academy of Sciences; Lanzhou 730000 China
| | - Yuanyuan Qi
- State Key Laboratory of Solid Lubrication; Lanzhou Institute of Chemical Physics, Chinese Academy of Sciences; Lanzhou 730000 China
- School of Stomatology; Lanzhou University; Lanzhou 730000 China
| | - Xingbin Yan
- State Key Laboratory of Solid Lubrication; Lanzhou Institute of Chemical Physics, Chinese Academy of Sciences; Lanzhou 730000 China
| | - Bin Liu
- School of Stomatology; Lanzhou University; Lanzhou 730000 China
| | - Qunji Xue
- State Key Laboratory of Solid Lubrication; Lanzhou Institute of Chemical Physics, Chinese Academy of Sciences; Lanzhou 730000 China
| | - Jinying Pei
- School of Stomatology; Fourth Military Medical University; Xi'an 710032 China
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Day JS, Baxter RM, Ramsey ML, Morrey BF, Connor PM, Kurtz SM, Steinbeck MJ. Characterization of wear debris in total elbow arthroplasty. J Shoulder Elbow Surg 2013; 22:924-31. [PMID: 23582703 DOI: 10.1016/j.jse.2013.02.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 02/04/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate wear debris in periprosthetic tissues at the time of revision total elbow arthroplasty. Polyethylene, metallic, and bone cement debris were characterized, and the tissue response was quantified. MATERIALS AND METHODS Capsular and medullary tissue samples were collected during revision surgery. Polyethylene debris was characterized by scanning electron microscopy after tissue digestion. The concentrations of metal and cement debris were quantified by inductively coupled plasma mass spectrometry. Tissue response was graded with a semiquantitative histologic method. RESULTS Polyethylene particle size varied from the submicron range to over 100 μm. The mean diameter ranged from 0.6 μm to about 1 μm. Particles in the synovial tissues were larger and less abundant than those in tissues from the medullary canal. Cement, titanium alloy, and low levels of cobalt-chrome debris were also present, with cement predominating over metal debris. Histiocyte response was associated with small polyethylene particles (0.5-2 μm), and giant cells were associated with large polyethylene particles (>2 μm). Histiocyte scores positively correlated with the polyethylene particle number and the presence of metal. DISCUSSION We have shown that periprosthetic tissues of total elbow patients who have undergone revision for loosening and osteolysis contain polyethylene, cement, and metal debris. Although the polyethylene particles were of a size and shape that have been previously shown to result in activation of phagocytic cells, osteolysis after total elbow arthroplasty is a multimodal process. Because of the presence of multiple wear particle sources, a cause-and-effect relationship between polyethylene debris and osteolysis cannot be established with certainty.
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Affiliation(s)
- Judd S Day
- Implant Research Center, School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, PA 19104, USA.
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Baxter RM, MacDonald DW, Kurtz SM, Steinbeck MJ. Severe impingement of lumbar disc replacements increases the functional biological activity of polyethylene wear debris. J Bone Joint Surg Am 2013; 95:e751-9. [PMID: 23780545 PMCID: PMC3748985 DOI: 10.2106/jbjs.k.00522] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Wear, oxidation, and particularly rim impingement damage of ultra-high molecular weight polyethylene total disc replacement components have been observed following surgical revision. However, neither in vitro testing nor retrieval-based evidence has shown the effect(s) of impingement on the characteristics of polyethylene wear debris. Thus, we sought to determine (1) differences in polyethylene particle size, shape, number, or biological activity that correspond to mild or severe rim impingement and (2) in an analysis of all total disc replacements, regardless of impingement classification, whether there are correlations between the extent of regional damage and the characteristics of polyethylene wear debris. METHODS The extent of dome and rim damage was characterized for eleven retrieved polyethylene cores obtained at revision surgery after an average duration of implantation of 9.7 years (range, 4.6 to 16.1 years). Polyethylene wear debris was isolated from periprosthetic tissues with use of nitric acid and was imaged with use of environmental scanning electron microscopy. Subsequently, particle size, shape, number, biological activity, and chronic inflammation scores were determined. RESULTS Grouping of particles by size ranges that represented high biological relevance (<0.1 to 1-μm particles), intermediate biological relevance (1 to 10-μm particles), and low biological relevance (>10-μm particles) revealed an increased volume fraction of particles in the <0.1 to 1-μm and 1 to 10-μm size ranges in the mild-impingement cohort as compared with the severe-impingement cohort. The increased volume fractions resulted in a higher specific biological activity per unit particle volume in the mild-impingement cohort than in the severe-impingement cohort. However, functional biological activity, which is normalized by particle volume (mm3/g of tissue), was significantly higher in the severe-impingement cohort. This increase was due to a larger volume of particles in all three size ranges. In both cohorts, the functional biological activity correlated with the chronic inflammatory response, and the extent of rim penetration positively correlated with increasing particle size, number, and functional biological activity. CONCLUSIONS The results of this study suggest that severe rim impingement increases the production of biologically relevant particles from motion-preserving lumbar total disc replacement components. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Ryan M. Baxter
- Implant Research Center, School of Biomedical Engineering, Science & Health Systems, Drexel University, 3401 Market Street, Suite 345, Philadelphia, PA 19104. E-mail address for M.J. Steinbeck:
| | - Daniel W. MacDonald
- Implant Research Center, School of Biomedical Engineering, Science & Health Systems, Drexel University, 3401 Market Street, Suite 345, Philadelphia, PA 19104. E-mail address for M.J. Steinbeck:
| | - Steven M. Kurtz
- Implant Research Center, School of Biomedical Engineering, Science & Health Systems, Drexel University, 3401 Market Street, Suite 345, Philadelphia, PA 19104. E-mail address for M.J. Steinbeck:
| | - Marla J. Steinbeck
- Implant Research Center, School of Biomedical Engineering, Science & Health Systems, Drexel University, 3401 Market Street, Suite 345, Philadelphia, PA 19104. E-mail address for M.J. Steinbeck:
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Bach JS, Cherkaoui M, Corté L, Cantournet S, Ku DN. Design Considerations for a Prosthetic Anterior Cruciate Ligament. J Med Device 2012. [DOI: 10.1115/1.4007945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Anterior cruciate ligament (ACL) tearing is a common knee injury often requiring reconstruction with an autograft or an allograft. A prosthetic ligament replacement with off-the-shelf availability could potentially provide significant advantages over the current options for both patients and surgeons. Limitations of previous prosthetics include lack of biocompatibility and susceptibility to fatigue, creep, and failure of bony incorporation. This paper describes design considerations and possible improvements for the next generation prosthetic ACL. Design controls, as mandated by the FDA, are a systematic set of practices within the design and development process used to ensure that a new medical device meets the needs of the intended users. The specified requirements, called the design inputs, for a prosthetic ACL are discussed pertaining to material and structural properties, resistance to creep and fatigue, ability to support secure initial fixation, biocompatibility, and long-term osseointegration. Design innovations to satisfy the design inputs are discussed with regards to material selection, textile pattern, bone tunnel features, and short term fixation. A risk analysis is presented along with descriptions of proposed testing. Design control methodology and tissue engineering may be used to develop a next generation prosthetic ligament, solving multiple problems, simultaneously, on a holistic level, providing major improvements over earlier devices and current treatment options.
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Affiliation(s)
| | - Mohammed Cherkaoui
- e-mail: George W. Woodruff School of Mechanical Engineering, Georgia Tech Lorraine, 2 Rue Marconi, 57070 Metz, France
| | | | - Sabine Cantournet
- e-mail: Centre des Matériaux, Mines Paris, Paristech, CNRS UMR 7633, BP 87, F-91003 Evry Cedex, France
| | - David N. Ku
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, 30332 e-mail:
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Brandt JM, MacDonald SJ, Bourne RB, Medley JB. Retrieval analysis of modular total knee replacements: factors influencing backside surface damage. Knee 2012; 19:306-15. [PMID: 21784646 DOI: 10.1016/j.knee.2011.06.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Revised: 05/13/2011] [Accepted: 06/05/2011] [Indexed: 02/02/2023]
Abstract
Retrieved knee implants were examined to investigate the influence of patient and implant related factors on backside damage. Fifty-two implants of three different models were examined that all had cemented tibial trays without screw holes. A semi-quantitative grading system supplied backside damage scores (BDS) for each polyethylene (PE) tibial insert. Evidence was obtained to support the use of a constraining partial-peripheral locking mechanism and polished tibial tray surface (particularly for male patients) to reduce backside damage. Overall, male patients in the present study were associated with higher body mass and higher BDS compared with female patients. Furthermore, PE inserts sterilized by gamma-in-air had higher BDS than PE inserts sterilized in inert environments (gas-plasma or ethylene-oxide). Also, the proximal surfaces of tibial trays that had been grit-blasted showed embedded particles that may have increased backside damage. While none of these overall findings was unexpected, the present study provided detailed supporting analysis based on data from clinical retrievals, which may further support the use of a polished tibial tray combined with partial-peripheral locking mechanism to reduce BDS.
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Affiliation(s)
- Jan-M Brandt
- Concordia Hip and Knee Institute, Suite 310-1155 Concordia Ave., Winnipeg, MB, Canada R2K 2M9.
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21
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Baxter RM, Freeman TA, Kurtz SM, Steinbeck MJ. Do tissues from THA revision of highly crosslinked UHMWPE liners contain wear debris and associated inflammation? Clin Orthop Relat Res 2011; 469:2308-17. [PMID: 21136220 PMCID: PMC3126969 DOI: 10.1007/s11999-010-1713-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Polyethylene wear debris is a major contributor to inflammation and the development of implant loosening, a leading cause of THA revisions. To reduce wear debris, highly crosslinked ultrahigh-molecular-weight polyethylene (UHMWPE) was introduced to improve wear properties of bearing surfaces. As highly crosslinked UHMWPE revision tissues are only now becoming available, it is possible to examine the presence and association of wear debris with inflammation in early implant loosening. QUESTIONS/PURPOSES We asked: (1) Does the presence of UHMWPE wear debris in THA revision tissues correlate with innate and/or adaptive immune cell numbers? (2) Does the immune cell response differ between conventional and highly crosslinked UHMWPE cohorts? METHODS We collected tissue samples from revision surgery of nine conventional and nine highly crosslinked UHMWPE liners. Polarized light microscopy was used to determine 0.5- to 2-μm UHMWPE particle number/mm2, and immunohistochemistry was performed to determine macrophage, T cell, and neutrophil number/mm2. RESULTS For the conventional cohort, correlations were observed between wear debris and the magnitude of individual patient macrophage (ρ=0.70) and T cell responses (ρ=0.71) and between numbers of macrophages and T cells (ρ=0.77) in periprosthetic tissues. In comparison, the highly crosslinked UHMWPE cohort showed a correlation between wear debris and the magnitude of macrophage responses (ρ=0.57) and between macrophage and T cell numbers (ρ=0.68). Although macrophages and T cells were present in both cohorts, the highly crosslinked UHMWPE cohort had lower numbers, which may be associated with shorter implantation times. CONCLUSIONS The presence of wear debris and inflammation in highly crosslinked UHMWPE revision tissues may contribute to early implant loosening.
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Affiliation(s)
- Ryan M. Baxter
- School of Biomedical Engineering, Science and Health Systems, Drexel University, 323 Bossone, 3120 Market Street, Philadelphia, PA 19104 USA
| | - Theresa A. Freeman
- Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, PA USA
| | | | - Marla J. Steinbeck
- School of Biomedical Engineering, Science and Health Systems, Drexel University, 323 Bossone, 3120 Market Street, Philadelphia, PA 19104 USA
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Yang SY, Zhang K, Bai L, Song Z, Yu H, McQueen DA, Wooley PH. Polymethylmethacrylate and titanium alloy particles activate peripheral monocytes during periprosthetic inflammation and osteolysis. J Orthop Res 2011; 29:781-6. [PMID: 21437959 DOI: 10.1002/jor.21287] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Accepted: 09/20/2010] [Indexed: 02/04/2023]
Abstract
We investigated the interactions of particulate PMMA or titanium alloy, patient blood monocytes, and periprosthetic tissues using a SCID-hu model of aseptic loosening. Periprosthetic tissues and bone chips obtained at revision surgery for loosening were transplanted into muscles of SCID mice. Peripheral blood monocytes (PBMCs) isolated from the same donors were fluorescently labeled and co-cultured with PMMA or Ti-6Al-4V particles before intraperitoneal injection. Control mice with periprosthetic tissue or non-inflammatory ligament xenografts received naive PBMCs transfusion. Mice were euthanized 2 weeks after PBMC transfusion. The human tissues were well accepted in SCID mice. Transfused fluorescent-labeled PBMCs were markedly accumulated in transplanted periprosthetic tissues. Multinucleated osteoclast-like cells were commonly seen within retrieved xenograft tissue, and focal bone erosions were ubiquitous. Total cell densities and CD68+ cells within the xenograft were significantly increased in mice transfused with PMMA and Ti-provoked PBMCs compared to the naïve PBMC animals (p < 0.05). Immunohistochemical staining identified much stronger positive IL-1 and TNF stains in xenografts from either PMMA or Ti-stimulated monocytes transfusion groups (p < 0.05). TRAP+ cells were found around bone chips in both activated-PBMCs groups, although markedly more aggregated TRAP+ cells in the PMMA-challenged group than in the titanium group (p < 0.05). MicroCT assessment confirmed the significant decrease of bone mineral density in chips interacted with activated-monocytes/osteoclasts. In conclusion, PMMA or titanium particles readily activate peripheral monocytes and promote the cell trafficking to the debris-containing prosthetic tissues. Particles-provoked PBMCs participated in and promoted the local inflammatory process, osteoclastogenesis, and bone resorption.
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Affiliation(s)
- Shang-You Yang
- Orthopaedic Research Institute, Via Christi Regional Medical Center, Wichita, Kansas, USA.
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Baxter RM, Ianuzzi A, Freeman TA, Kurtz SM, Steinbeck MJ. Distinct immunohistomorphologic changes in periprosthetic hip tissues from historical and highly crosslinked UHMWPE implant retrievals. J Biomed Mater Res A 2010; 95:68-78. [PMID: 20740602 DOI: 10.1002/jbm.a.32813] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Assessment of immune response to implant wear debris in periprosthetic tissue following total hip arthroplasty suggests that multiple factors are involved in the loss implant function. The current study investigated wear debris and the associated immunohistomorphologic changes in tissues from nine patients with historical (gamma air-sterilized) and nine highly crosslinked UHMWPE implant components. Paraffin embedded tissue sections were evaluated for the presence of histiocytes, giant cells, fibrocartilage/bone, and necrosis. To determine the incidence, degree and co-localization of immunohistomorphologic changes and wear, overlapping full-field tissue arrays were collected in brightfield and polarized light. The historical cohort tissues predominantly showed histiocytes associated with significant accumulations of small wear (0.5-2 microm), and giant cells associated with large wear (> or =2 microm). Frequently, focal regions of necrosis were observed in association with wear debris. For the highly crosslinked cohort, inflammation and associated wear debris were limited, but in tissues from patients revised after implantation times of >2 years a response was observed. Whereas significant amounts of fibrocartilage/bone were observed in patients at earlier implantation times. In both cohorts, tissue responses were more extensive in the retroacetabular or proximal femoral regions. The current findings suggest that wear debris-induced inflammation may be a major contributor to the loss of implant function for both the historical and highly crosslinked cohorts, but it is not the primary cause of early implant loosening. This study highlights the importance of using a more quantitative and standardized assessment of immunohistomorphologic responses in periprosthetic tissues, and emphasizes differences in specific anatomical regions of individual patient tissues.
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Affiliation(s)
- Ryan M Baxter
- Department of Biomedical Engineering, School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania 19104, USA
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Popoola OO, Yao JQ, Johnson TS, Blanchard CR. Wear, delamination, and fatigue resistance of melt-annealed highly crosslinked UHMWPE cruciate-retaining knee inserts under activities of daily living. J Orthop Res 2010; 28:1120-6. [PMID: 20162713 DOI: 10.1002/jor.21104] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The wear, delamination, and fatigue resistance of artificially aged gamma irradiation-sterilized conventional polyethylene (CPE) and gas-plasma-sterilized melt-annealed highly crosslinked polyethylene tibial inserts (HXPE) were compared. Six CPE and 12 HXPE (six irradiated at 58 kGy and six at 72 kGy) left knee inserts were wear tested for 5.5 million cycles (Mc) under loads and motions that mimic activities of daily living, such as walking, chair rise, stair ascent, and deep squatting. Another six HXPE (72 kGy) and six CPE inserts were also tested under conditions that could produce severe delamination for 8 Mc. Ten other knees (five 72 kGy HXPE and five CPE) were subjected to posterior edge loading fatigue testing for 5 Mc. The HXPE inserts had an average wear rate reduction of about 80% relative to their CPE counterparts during all activities. All of the CPE inserts delaminated and fractured during high cycle deep squat (152 degrees flexion) motions, while all the HXPE remained intact. None of the HXPE inserts delaminated after 8 Mc, while all of the CPE inserts developed delamination damage within 1.5-5.8 Mc of delamination testing. All CPE inserts developed subsurface cracks and delamination within 2.8 Mc during posterior edge loading fatigue studies, while none of the HXPE inserts showed cracking or delamination after 5 Mc. These results show that aged HXPE has higher wear and fatigue resistance than aged CPE, and offers potential long-term advantages for young active patients with sustained activities of daily living.
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Affiliation(s)
- Oludele O Popoola
- Corporate Research Laboratory, Zimmer, Inc., 1800 West Center Street, P.O. Box 708, Warsaw, Indiana 46581-0708, USA.
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25
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The Bryan Cervical Disc Replacement. Tech Orthop 2010. [DOI: 10.1097/bto.0b013e3181df2f78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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A FUNCTIONAL AND ROENTGENOGRAPHIC PRELIMINARY COMPARATIVE STUDY USING METAL-BACKED AND ALL-POLYETHYLENE TIBIAL COMPONENTS IN TOTAL KNEE ARTHROPLASTY. Rev Bras Ortop 2010; 45:295-301. [PMID: 27022556 PMCID: PMC4799093 DOI: 10.1016/s2255-4971(15)30372-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To describe and clinically and radiographically compare patients who underwent total knee arthroplasty (TKA) with all-polyethylene (ALP) and metal-backed (MTB) tibial implants. METHODS Patients who underwent TKA between January 1988 and December 2004 were grouped according to the type of implant received: all-polyethylene or metal-backed. Sixty patients came for evaluations, totaling 82 operated knees. Among these, 22 patients had undergone TKA only with ALP (12 unilateral and 10 bilateral cases), 33 patients only with MTB (26 unilateral and 7 bilateral cases) and five patients underwent TKA with ALP in one knee and MTB in the other. The knees were divided thus: group 1, 37 knees with ALP; and group 2, 45 knees with MTB. RESULTS There were no differences in clinical or functional evaluations between the groups. The mean radiolucency in the femur was 0.838 mm for the patients in group 1 and 0.356 mm for the patients in group 2 (p = 0.049). For the tibia, in the AP view, there was a mean value of 2.703 mm for group 1 and 0.733 mm for group 2 (p = 0.000). In the lateral view, the mean values for osteolysis was 0.405 mm for group 1 and 0.200 mm for group 2 (p = 0.074). CONCLUSIONS There were no differences between the groups in the functional and clinical evaluations. However, greater radiolucency was observed in the arthroplasties with ALP, both in the femur in the lateral view and in the tibia in the AP view. Level of evidence IV - case series study.
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Baxter RM, Steinbeck MJ, Tipper JL, Parvizi J, Marcolongo M, Kurtz SM. Comparison of periprosthetic tissue digestion methods for ultra-high molecular weight polyethylene wear debris extraction. J Biomed Mater Res B Appl Biomater 2009; 91:409-18. [PMID: 19507139 DOI: 10.1002/jbm.b.31416] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
There is considerable interest in characterization of wear debris from polyethylene (UHMWPE) bearing components used in total joint replacement. To isolate UHMWPE wear debris, tissue samples must be excised from regions adjacent to revised UHMWPE implant components, followed by exposure to one of many available tissue digestion methods. Numerous studies demonstrate successful digestion, but the relative efficiency of each method is not clear. The purpose of this study was to evaluate a variety of conditions for tissue digestion to provide a quantitative comparison of methods. Porcine and human hip tissues were exposed for 24 h to basic, acidic or enzymatic agents, filtered and digestion efficiency calculated based on the percentage of initial to final tissue weight. Of the conditions tested, 5 M NaOH, 5 M KOH, 15 M KOH or 15.8 M HNO(3) yielded the most complete porcine hip tissue digestion (<1% residual tissue weight; p < 0.05). Proteinase K and Liberase Blendzyme 3 did not effectively digest tissue in a 24 h period. Similar to results from the porcine dataset, human tissues digestion was most efficient using 5 M NaOH, 5 M KOH or 15.8 M HNO(3) (<1% residual tissue weight; p < 0.05). To verify that particle surface modifications did not occur after prolonged reagent exposure, GUR415 and Ceridust 3715 particles were immersed in each solution for 24 h. Overall, this study provides a framework for thorough and efficient digestive methods for UHMWPE wear debris extraction.
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Affiliation(s)
- Ryan M Baxter
- Department of Biomedical Engineering, Drexel University, Philadelphia, Pennsylvania 19104, USA
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LIU JL, ZHU YY, WANG QL, GE SR. Biotribological behavior of ultra high molecular weight polyethylene composites containing bovine bone hydroxyapatite. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/s1006-1266(08)60303-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Lombardi AV, Ellison BS, Berend KR. Polyethylene wear is influenced by manufacturing technique in modular TKA. Clin Orthop Relat Res 2008; 466:2798-805. [PMID: 18791779 PMCID: PMC2565045 DOI: 10.1007/s11999-008-0470-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2007] [Accepted: 08/07/2008] [Indexed: 01/31/2023]
Abstract
Polyethylene insert backside surface wear is implicated in osteolysis and failure of total knee arthroplasty. Manufacturing and sterilization methods reduce articular-sided wear. We questioned whether manufacturing technique influences the severity of backside wear. We examined 39 explanted tibial bearings in a blinded fashion using visual, stereomicroscopic, and scanning electron microscopic techniques. We examined 26 direct compression molded components and 13 nondirect compression molded components and applied a new backside wear severity score. The score characterized the magnitude of the various modes of wear with severity ranging from 0 (no wear) to 27 (severe wear). Time in vivo, tibial baseplate material, and manufacturing technique were used as variables for comparison. Backside wear was related to polyethylene manufacturing process with direct compression molded implants having a wear score of 2.3 and nondirect compression molded a score of 5.7. Time in vivo influenced backside wear, although direct compression molded predicted decreased backside wear independent of time in vivo. The data suggest manufacturing technique influences backside wear in total knee arthroplasty polyethylene inserts.
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Laurent MP, Johnson TS, Crowninshield RD, Blanchard CR, Bhambri SK, Yao JQ. Characterization of a highly cross-linked ultrahigh molecular-weight polyethylene in clinical use in total hip arthroplasty. J Arthroplasty 2008; 23:751-61. [PMID: 18534394 DOI: 10.1016/j.arth.2007.06.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2005] [Accepted: 06/18/2007] [Indexed: 02/01/2023] Open
Abstract
This article reports on a commercially available extensively cross-linked ultrahigh molecular-weight polyethylene (HXPE) produced by subjecting molded GUR 1050 ultrahigh molecular-weight polyethylene (UHMWPE) to 100 +/- 10 kGy of electron beam radiation followed by melt annealing and sterilization by gas plasma. When compared to contemporary conventional molded GUR 1050 UHMWPE sterilized by 37 kGy of gamma radiation, the HXPE material has enhanced wear properties, has no detectable free radicals, and is resistant to oxidation and oxidative-related material property changes. The relative wear improvement of the HXPE is maintained in the presence of bone cement or alumina particles. The HXPE produced greater than 90% fewer wear particles in all size ranges and statistically significantly (P < .0001) smaller average-size particles than did the conventional UHMWPE.
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Affiliation(s)
- Michel P Laurent
- Research Department, Zimmer, Inc, PO Box 708, Warsaw, Indiana 46581-0708, USA
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31
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Kaufman AM, Alabre CI, Rubash HE, Shanbhag AS. Human macrophage response to UHMWPE, TiAlV, CoCr, and alumina particles: analysis of multiple cytokines using protein arrays. J Biomed Mater Res A 2008; 84:464-74. [PMID: 17618502 DOI: 10.1002/jbm.a.31467] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Aseptic loosening of total joint replacements is believed to be initiated by a macrophage response to prosthetic wear debris. To better characterize the early response to clinically relevant wear debris, we challenged primary human macrophages from four donors with ultra high molecular weight polyethylene (UHMWPE), TiAlV, CoCr, and alumina particles. After a 24-h culture, protein arrays were used to quantify the secretion of 30 different cytokines and chemokines. Macrophages secreted detectable levels of nine mediators in culture: Interleukin-1alpha (IL-1alpha), tumor necrosis factor-alpha (TNF-alpha), IL-1beta, MCP-1, IL-8, IL-6, GM-CSF, IL-10, and IL-12p40. TiAlV particles were the most stimulatory, causing 5- to 900-fold higher cytokine expression compared with nonstimulated cells and uniquely eliciting high levels of IL-1alpha, IL-6, IL-10, and GM-CSF. CoCr and alumina were mildly stimulatory and typically elicited two- to fivefold greater levels than nonstimulated cells. Surprisingly, UHMWPE did not elicit a significant increase in cytokine release. Our data suggests that IL-1alpha, TNF-alpha, IL-1beta, and MCP-1 are the primary initiators of osteolysis and implicates metallic debris as an important trigger for their release.
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Affiliation(s)
- Adam M Kaufman
- Biomaterials Lab, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02474, USA
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How have wear testing and joint simulator studies helped to discriminate among materials and designs? J Am Acad Orthop Surg 2008; 16 Suppl 1:S111-9. [PMID: 18612005 DOI: 10.5435/00124635-200800001-00022] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Historically, hip joint simulators most often have been used to model wear of a bearing surface against a bearing surface. These simulators have provided highly accurate predictions of the in vivo wear of a broad spectrum of bearing materials, including cross-linked polyethylenes, metal-on-metal, ceramic-on-ceramic, and others in development. In recent years, more severe conditions have been successfully modeled, including jogging, stair climbing, ball-cup micro separation, third-body abrasion, and neck-socket impingement. These tests have served to identify improved materials and to eliminate some with inadequate wear resistance prior to their clinical use. Simulation of the knee joint is inherently more complex than it is for the hip. It is more difficult to compare the results of laboratory tests with actual clinical performance, due to the lack of accurate in vivo measures of wear. Nevertheless, knee simulators, based on force control or motion control, have successfully reproduced the type of surface damage that occurs in vivo (eg, burnishing, scratching, pitting) as well as the size and shapes of the resultant wear particles. Knee simulators have been used to compare molded versus machined polyethylene components, highly cross-linked polyethylenes, fixed versus mobile bearings, and oxidized zirconia and other materials, under optimal conditions as well as more severe wear modes, such as malalignment, higher loading and activity levels, and third-body roughening.
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What patient and surgical factors contribute to implant wear and osteolysis in total joint arthroplasty? J Am Acad Orthop Surg 2008; 16 Suppl 1:S7-13. [PMID: 18612018 DOI: 10.5435/00124635-200800001-00004] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Total joint arthroplasty has been a successful operation for decades. Our current patients are younger and more active than those in the past. They place higher demands on themselves and have expectations commensurate with their lifestyles. Time-limited longevity with the large number of anticipated total joint replacement procedures and their potential burden to health care is a growing concern. In the past two decades, implant wear and osteolysis have been identified as major causes for the failure of otherwise well-functioning implants. Osteolysis can be divided into several categories: patient-specific, implant-specific, and the result of surgical factors. Although these categories are interrelated and not mutually exclusive, they enable us to build a framework in which to further advance our understanding of osteolysis and apply this information in a clinically relevant manner.
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How prevalent are implant wear and osteolysis, and how has the scope of osteolysis changed since 2000? J Am Acad Orthop Surg 2008; 16 Suppl 1:S1-6. [PMID: 18612002 DOI: 10.5435/00124635-200800001-00003] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Although the incidence of failures resulting from wear-related osteolysis and associated severe bone defects are expected to diminish with important advances in polyethylene manufacturing and processing, alternative bearing surfaces, implant design, and revision techniques, current failures still reflect concerns regarding earlier ultra-high-molecular-weight polyethylene sterilization and degradation. Clinical experience before the year 2000 included rates of wear and osteolysis from 10% to as high as 70% at 7- to 14-year follow-up. With recent advances, early clinical results are encouraging, demonstrating 50% to 81% decreases in radiographic wear rates. These improvements should eventually reduce the burden of future revision hip and knee surgery. However, the long-term in vivo durability of total hip arthroplasties using these alternative materials and bearing couples has not yet been well established, and considerably fewer clinical data are available for other types of joint arthroplasties, such as total knee arthroplasty.
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Gupta SK, Chu A, Ranawat AS, Slamin J, Ranawat CS. Osteolysis after total knee arthroplasty. J Arthroplasty 2007; 22:787-99. [PMID: 17826267 DOI: 10.1016/j.arth.2007.05.041] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2007] [Accepted: 05/25/2007] [Indexed: 02/01/2023] Open
Abstract
Osteolysis ranks as the most significant cause of revision surgery in both total hip arthroplasty and total knee arthroplasty (TKA). The factors leading to osteolysis in TKA are unique and sometimes preventable. Changes in polyethylene manufacturing and implant design are striving to improve overall wear. In this review, we discuss osteolysis as it relates to TKAs. The etiology, diagnosis, contributing factors, and management are presented. The final section focuses on future improvements in TKA design, which may ultimately decrease the rate of osteolysis.
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Affiliation(s)
- Sanjay K Gupta
- Department of Orthopedic Surgery, Ranawat Orthopedic Center, Lenox Hill Hospital, New York, NY 10021, USA
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36
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Abu-Amer Y, Darwech I, Clohisy JC. Aseptic loosening of total joint replacements: mechanisms underlying osteolysis and potential therapies. Arthritis Res Ther 2007; 9 Suppl 1:S6. [PMID: 17634145 PMCID: PMC1924521 DOI: 10.1186/ar2170] [Citation(s) in RCA: 317] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Total joint replacement, although considered an excellent surgical procedure, can be complicated by osteolysis induced by implant particles and subsequent aseptic loosening of the implant. The pathogenesis of implant-associated osteolysis includes inflammatory and osteolytic processes. The sustained chronic inflammatory response initiated by particulate debris at the implant-bone interface is manifested by recruitment of a wide array of cell types. These cells include macrophages, fibroblasts, giant cells, neutrophils, lymphocytes, and--most importantly--osteoclasts, which are the principal bone resorbing cells. The 'cellular response' entails secretion of osteoclastogenic and inflammatory cytokines that favor exacerbated osteoclast activity and enhanced osteolysis. An appreciation of the complex network that leads to these cellular and inflammatory responses will form a foundation on which to develop therapeutic interventions to combat inflammatory periprosthetic bone loss.
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Affiliation(s)
- Yousef Abu-Amer
- Department of Orthopaedic Surgery and Department of Cell Biology & Physiology, Washington University School of Medicine, Barnes Hospital Plaza, Saint Louis, Missouri 63110, USA.
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Moro T, Takatori Y, Ishihara K, Nakamura K, Kawaguchi H. 2006 Frank Stinchfield Award: grafting of biocompatible polymer for longevity of artificial hip joints. Clin Orthop Relat Res 2006; 453:58-63. [PMID: 17053564 DOI: 10.1097/01.blo.0000246553.33434.5f] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Aseptic loosening induced by wear particles from the polyethylene liner is likely the most common cause of long-term total hip arthroplasty failure. We developed a novel hip polyethylene liner with the surface graft of a biocompatible phospholipid polymer, 2-methacryloyloxyethyl phosphorylcholine (MPC), and previously reported the grafting decreased the short-term production of wear particles and the subsequent bone resorptive responses. For clinical application, we investigated the stability of the 2-methacryloyloxyethyl phosphorylcholine grafting during sterilization and the wear resistance of the sterilized liner during longer loading comparable to clinical usage. Radiographic spectroscopy confirmed the stability of the 2-methacryloyloxyethyl phosphorylcholine polymer on the liner surface after the gamma irradiation. We used a hip wear simulator up to 1 x 10(7) cycles to test sterilized cross-linked polyethylene liners with and without 2-methacryloyloxyethyl phosphorylcholine grafting. The 2-methacryloyloxyethyl phosphorylcholine grafting markedly decreased the friction, the production of wear particles, and the wear of the liner surface. These data suggest a marked improvement in the wear resistance of the polyethylene liner by the 2-methacryloyloxyethyl phosphorylcholine grafting for clinically relevant periods after sterilization, indicating 2-methacryloyloxyethyl phosphorylcholine grafting is a promising technology for extending longevity of artificial hips.
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Affiliation(s)
- Toru Moro
- Department of Sensory and Motor System Medicine, Faculty of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo, Tokyo 113-0033, Japan.
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38
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Gill HS, Waite JC, Short A, Kellett CF, Price AJ, Murray DW. In vivo measurement of volumetric wear of a total knee replacement. Knee 2006; 13:312-7. [PMID: 16784859 DOI: 10.1016/j.knee.2006.04.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2005] [Revised: 03/16/2006] [Accepted: 04/03/2006] [Indexed: 02/02/2023]
Abstract
A new Roentgen Stereophotogrammetric Analysis (RSA) system is reported; it can measure penetration of the metallic femoral component of a Total Knee Replacement (TKR) prosthesis into the polyethylene bearing on the tibial component. This system was used to analyse a study group of six Anatomic Graduated Components (AGC) knee prostheses more than 6 years post-implantation, and to compare with a control group of six newly implanted AGC prostheses. The volumetric loss of polyethylene was estimated by imaging each prosthesis at a series of different knee flexion angles. The mean difference between the RSA measured polyethylene bearing thickness and the manufacturer's quoted values for the control group was -0.03 mm (SD 0.17). The estimated linear penetration at 6.4 years in this prosthesis was determined to be 0.1 mm/year. Volumetric wear was estimated to be 600-700 mm(3)/year at 6.4 years, equating to approximately 100 mm(3)/year. This does not appear to be clinically significant amount of wear as this prosthesis has excellent survival at 10 years.
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Affiliation(s)
- H S Gill
- OOEC/Nuffield Department of Orthopaedic Surgery, University of Oxford, Nuffield Orthopaedic Centre, Oxford, OX3 7LD, UK.
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Tipper JL, Galvin AL, Williams S, McEwen HMJ, Stone MH, Ingham E, Fisher J. Isolation and characterization of UHMWPE wear particles down to ten nanometers in size fromin vitro hip and knee joint simulators. J Biomed Mater Res A 2006; 78:473-80. [PMID: 16721797 DOI: 10.1002/jbm.a.30824] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
There is currently considerable interest in the wear debris and osteolytic potential of different types of bearings used in total joint replacements. The biological activity of the wear debris is dependent on the size and volume of the particles produced. Wear volume also plays an important role in the functional biological activity of a joint replacement. In vitro studies have shown that crosslinking of ultra high molecular weight polyethylene (UHMWPE) acetabular cups and tibial trays produces a reduction in wear volume, and crosslinking has now been introduced clinically for both types of prostheses. Previous studies have identified both micron and submicron-sized polyethylene wear particles. The aim of this study was to characterize the wear and wear particles generated from moderately crosslinked GUR 1,020 GVF UHMWPE acetabular cups and tibial trays in hip and knee joint wear simulators down to 10 nanometers in size. The wear rates of the two prosthesis types were very similar at 25.6 +/- 5.3 mm(3) per million cycles for the hip prostheses and 22.75 +/- 5.95 mm(3) per million cycles for the knee prostheses. Nanometer-sized wear particles were isolated and characterized from both hip and knee simulator lubricants for the first time. Significantly higher numbers (p < 0.05) of particles in the nanometer (<0.1 microm) size range were produced by the hip prostheses compared to the knee prostheses. The knee prostheses produced larger particles, with the mode of particle size in the 0.1-1.0 microm size range, compared to <0.1 microm size range for the hip prostheses. In addition, the knee prostheses produced a greater volumetric concentration of wear particles in the 1.0-10 microm size range, and consequently lower specific biological activity and functional biological activity indices. These results indicated that the knee prostheses had a lower osteolytic potential compared to the hip prostheses.
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Affiliation(s)
- J L Tipper
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, United Kingdom.
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40
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Abstract
Ultra-high molecular weight polyethylene remains the gold standard as a bearing surface for total knee arthroplasty. But problems of oxidative degradation and wear have prompted new sterilization techniques and new forms of more highly cross-linked polyethylene. The value of these solutions can be shown initially from laboratory data, but in the end their usefulness will be confirmed through clinical performance. The significance of new polyethylenes cannot be established on the basis of a single type of test or even on a single goal such as improved wear resistance. Rather, a range of requirements dictated by design goals (function, fixation, and wear) must be considered. The requirements can be competing, so that matching one compromises matching another that, if not taken into account, can lead to failure in clinical use. Previous improvements to polyethylene ultimately failed because not all the requirements were met. The same concern exists with highly cross-linked polyethylenes; improvements in wear resistance are tempered by a decrease in toughness. A case can be made for and against these polyethylenes, but early clinical results in hip arthroplasty show significantly improved wear, raising the possibility of also improving wear performance in knee arthroplasties.
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Garrigues GE, Cho DR, Rubash HE, Goldring SR, Herndon JH, Shanbhag AS. Gene expression clustering using self-organizing maps: analysis of the macrophage response to particulate biomaterials. Biomaterials 2005; 26:2933-45. [PMID: 15603788 DOI: 10.1016/j.biomaterials.2004.06.034] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2004] [Accepted: 06/01/2004] [Indexed: 10/26/2022]
Abstract
The most common cause of total joint replacement failure is peri-implant bone loss causing pain and prosthesis loosening. This process, known as osteolysis or aseptic loosening, is characterized by macrophage phagocytosis of particulate implant wear debris. In an incompletely defined step, particulate biomaterial debris induces macrophages to release a variety of inflammatory mediators and signaling proteins that lead to bone loss. In an in vitro model of this process, we used microarray technology and data analysis techniques, including the use of self-organizing maps (SOMs), to understand the mRNA gene expression changes occurring in macrophages exposed to clinically relevant particles of ultra-high molecular weight polyethylene and TiAlV alloy. Earlier studies have been limited by technology that only allowed analysis of a few genes at a time, but the microarray techniques used in this paper generate the quantitative analysis of over a thousand genes simultaneously. Our microarray analysis utilized an SOM clustering to elucidate general patterns in the data, lists of top up- and down-regulated genes for each time point and genes with differential expression under different biomaterial exposures. The expression levels of the majority of genes (>95%) did not vary over time or with exposure to different biomaterials, but a few important genes, such as TNF-alpha, IL-1beta, IL-6, and MIP1alpha, proved to be highly regulated in response to biomaterial exposure. We also uncovered a novel set of genes, which not only validates and logically extends the current model of the pathogenesis of osteolysis and aseptic loosening, but also provides new targets for further research and therapeutics.
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Affiliation(s)
- Grant E Garrigues
- Biomaterials Laboratory, Massachusetts General Hospital, Harvard Medical School, GRJ 1115, 55 Fruit Street, Boston, MA 02114, USA
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Moro T, Takatori Y, Ishihara K, Konno T, Takigawa Y, Matsushita T, Chung UI, Nakamura K, Kawaguchi H. Surface grafting of artificial joints with a biocompatible polymer for preventing periprosthetic osteolysis. NATURE MATERIALS 2004; 3:829-36. [PMID: 15502835 DOI: 10.1038/nmat1233] [Citation(s) in RCA: 366] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2004] [Accepted: 08/09/2004] [Indexed: 05/24/2023]
Abstract
Periprosthetic osteolysis-bone loss in the vicinity of a prosthesis-is the most serious problem limiting the longevity of artificial joints. It is caused by bone-resorptive responses to wear particles originating from the articulating surface. This study investigated the effects of graft polymerization of our original biocompatible phospholipid polymer 2-methacryloyloxyethyl phosphorylcholine (MPC) onto the polyethylene surface. Mechanical studies using a hip-joint simulator revealed that the MPC grafting markedly decreased the friction and the amount of wear. Osteoclastic bone resorption induced by subperiosteal injection of particles onto mouse calvariae was abolished by the MPC grafting on particles. MPC-grafted particles were shown to be biologically inert by culture systems with respect to phagocytosis and resorptive cytokine secretion by macrophages, subsequent expression of receptor activator of NF-kappaB ligand in osteoblasts, and osteoclastogenesis from bone marrow cells. From the mechanical and biological advantages, we believe that our approach will make a major improvement in artificial joints by preventing periprosthetic osteolysis.
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Affiliation(s)
- Toru Moro
- Department of Sensory & Motor System Medicine, Faculty of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo, Tokyo 113-0033, Japan
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Abstract
Object. The authors describe a new type of artificial disc called a single-unit artificial disc (SUAD). It is a single-unit disc without components, and there is no fixation system with which to maintain it in the disc space. It is theorized that its shape, hardness, and surface consistency, together with the compressive force exerted by the body's axial load, should be adequate to maintain the position of the disc in the disc space. In this paper the authors present their results of the kinematic tests in which the stability and integrity of the SUADs was tested.
Methods. Panorobot was used for kinematic test fixture for fatigue testing for different types of SUAD. The test was performed after placing the disc between the C-5 and C-6 vertebral bodies (VBs) obtained from a cadaver. Eight pounds of weight was placed on the top of the container housing the C-5 VB to account for the weight of the head. The robot performed the following movements: 1) flexion—extension, 4.7° each; 2) lateral left—right bending, ± 2.1°; and 3) coupled rotation, ± 3.8°. Two flat discs (FDs) of 85 durometer (D), four 30D FD, two recess-edged discs (REDs) of 85D, and four custom-designed discs (CDDs) (custom molded to the disc space) of 30D were tested.
None of the discs showed cracks or breakage at the end of the study. After 1 million cycles of excursions all 85D and 30D FD, and both 85D REDs showed weight loss. The 30D CDDs showed minimal weight gain at 1 million cycles. One of the CDDs, tested up to 5 million cycles, did lose weight at 5 million cycles.
One 85D FD was extruded after 0.2 million cycles and one 85D RED rotated within the disc space. All other discs maintained their position in the disc space. Dimensional changes were minimal. Scanning electron microscopy of particles collected from one 30D CDD sample after 1 million cycles showed rough irregular granular particles 1 to 600 µm in diameter.
Conclusions. These findings show that a 30D SUAD can maintain its position in the disc space without any anchoring device. Furthermore, at 1 million cycles of testing of 30 D SUAD, FDs did as well as the CDDs. This may be because softer discs mold to changes in dimension of the disc space. In addition the softer discs tend to wear less than the harder ones. Further fatigue study of 10 million cycles is needed to determine long-term efficacy, and the effects of wear on particles surrounding the joints need to be studied.
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Kellett CF, Short A, Price A, Gill HS, Murray DW. In vivo measurement of total knee replacement wear. Knee 2004; 11:183-7. [PMID: 15194093 DOI: 10.1016/s0968-0160(03)00070-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2002] [Accepted: 04/08/2003] [Indexed: 02/02/2023]
Abstract
Polyethylene wear is one of the most important causes of failure of total knee replacements (TKRs). Currently, wear can only be accurately measured by retrieval studies. There is a need for a method to measure wear accurately in vivo. We have developed a Roentgen stereophotogrammetric analysis (RSA) system that can measure penetration of the metallic femoral component into the polyethylene of the tibia. We have used this system to study six AGC TKRs at 6 years postoperatively and six control AGC TKRs at 2 weeks postoperatively. The mean difference between the RSA measured bearing thickness and the manufacturer's quoted values for the control group was -0.03 mm (S.D. 0.17). The average linear penetration in the study group was 0.8 mm (S.D. 0.46). This was significantly (P<0.0001) different from the control group. The average linear penetration rate was 0.13 mm per year (S.D. 0.08). We would expect the penetration to deepen with time. In young active patients, this could be a cause for concern, particularly with a thin bearing. The current system is accurate enough to measure wear at 5 years post TKR. It has the potential for predicting long-term wear problems with new designs of TKR and new materials within 2 years.
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Affiliation(s)
- C F Kellett
- Nuffield Department of Orthopaedic Surgery, University of Oxford, Nuffield Orthopaedic Centre, Headington, Oxford OX3 7LD, UK
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Abstract
STUDY DESIGN In vitro wear testing of the Bryan Cervical Disc prosthesis was performed in a cervical spine simulator. The biologic response was assessed in chimpanzee and goat animal models. OBJECTIVE Determine the wear characteristics of the Bryan disc. SUMMARY OF BACKGROUND DATA Large joint arthroplasties fail most commonly by wear and consequent formation of particulate material, which induces an inflammatory response. Therefore, measuring the wear characteristics of the new spinal disc replacements is important. METHODS Six prosthetic assembles were tested to 10 or 40 million cycles by load and motion and 3 additional assemblies were tested by load only in a cervical spine simulator. Any debris was examined using ASTM standards. The local biologic response to the prosthesis was examined in two chimpanzees. Nine goats were used to assess the biologic response in both local and distant tissues. Arthrodesis was performed on three additional control goats that received an allograft and an anterior cervical plate. RESULTS Wear results: cervical spine simulators that applied the loads and motions associated with activities of daily living produced wear particulate at a rate of 1.2 mg per million cycles. Device height decreased 0.02 mm per million cycles with approximately 77% of this decrease due to gradual creep of the nucleus under the constant compressive load. Particles generated were granular in shape with a mean feret diameter of 3.9 microm. All animals tolerated placement of the Bryan disc. Wear debris was present in the periprosthetic and epidural spaces in some animals. However, no significant inflammatory response was observed. No wear material was found distant from the implant in draining lymph tissue, the liver, or the spleen. CONCLUSIONS The Bryan disc has satisfactory wear characteristics and does not produce a significant inflammatory response.
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Affiliation(s)
- Paul A Anderson
- University of Wisconsin, Department of Orthopedic Surgery and Rehabilitation, University of Wisconsin Hospitals, Madison, Wisconsin 53792, USA.
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46
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Abstract
Silk fibers have potential biomedical applications beyond their traditional use as sutures. The physical properties of silk fibers and films make it a promising candidate for tissue engineering scaffold applications, particularly where high mechanical loads or tensile forces are applied or in cases where low rates of degradation are desirable. A critical issue for biomaterial scaffolds is biocompatibility. The direct inflammatory potential of intact silk fibers as well as extracts was studied in an in vitro system. The results indicate that silk fibers are largely immunologically inert in short- and long-term culture with RAW 264.7 murine macrophage cells while insoluble fibroin particles induced significant TNF release. Soluble sericin proteins extracted from native silk fibers did not induce significant macrophage activation. While sericin did not activate macrophages by itself, it demonstrated a synergistic effect with bacterial lipopolysaccharide. The low level of inflammatory potential of silk fibers makes them promising candidates in future biomedical applications.
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Affiliation(s)
- Bruce Panilaitis
- Department of Biomedical Engineering, Tufts University, Bioengineering Center, 4 Colby Street, Medford, Massachusetts, MA 02155, USA
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Mabrey JD, Afsar-Keshmiri A, Engh GA, Sychterz CJ, Wirth MA, Rockwood CA, Agrawal CM. Standardized analysis of UHMWPE wear particles from failed total joint arthroplasties. JOURNAL OF BIOMEDICAL MATERIALS RESEARCH 2003; 63:475-83. [PMID: 12209890 DOI: 10.1002/jbm.10302] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Periprosthetic tissue obtained at revision surgery from eight total hip replacement cases was hydrolyzed, and polyethylene debris particles were isolated from each case. Individual particles were analyzed by scanning electron microscopy (SEM) and computerized image analysis in accordance with ASTM F1877-98, a standard for quantitative description of wear debris. For comparison, periprosthetic tissues from eight total knee revision and four total shoulder revision cases were processed and analyzed with identical methods. A total of 2599 hip, 4345 knee, and 1200 shoulder particles were analyzed. The morphologies of the isolated polyethylene particles from the total hip specimens were distinctly different from the total knee and total shoulder particles. The mean equivalent circle diameter (ECD) for hip particles was 0.694 microm +/- 0.005; knee particles measured 1.190 microm +/-0.009; and shoulder particles 1.183 microm +/- 0.017. The ECD was significantly different between hip particles and those from the shoulder and knee. The mean aspect ratio (AR) for the hip particles was 1.626 +/- 0.015, compared to the knee particles at 1.935 +/- 0.015 and shoulder particles at 2.082 +/- 0.033. The AR was statistically different among all three groups. Other descriptors from the ASTM standard, elongation (E), form factor (FF), and roundness (R) were all significantly different among the three groups of joints. This study demonstrates the utility of ASTM F1877-98 in differentiating wear debris particles from different sources.
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Affiliation(s)
- Jay D Mabrey
- Department of Orthopedics, UTHSCSA Mail Code 7774, 7703 Floyd Curl Drive, San Antonio, Texas 78229, USA
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48
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Sieving A, Wu B, Mayton L, Nasser S, Wooley PH. Morphological characteristics of total joint arthroplasty-derived ultra-high molecular weight polyethylene (UHMWPE) wear debris that provoke inflammation in a murine model of inflammation. J Biomed Mater Res A 2003; 64:457-64. [PMID: 12579559 DOI: 10.1002/jbm.a.10368] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
It is recognized that the chronic inflammation in peri-prosthetic tissue that contributes to implant failure frequently is provoked by the presence of wear debris. Some wear debris is inevitable because of the nature of the prosthesis, but not all patients develop severe inflammatory responses. The precise factors that mediate the severity of tissue inflammation to wear debris has yet to be fully defined. Because wear debris retrieved from peri-prosthetic tissue consists of a heterogeneous mixture of materials with various sizes and shapes, this study evaluated the influence of two major physical aspects of ultra-high molecular weight polyethylene (UHMWPE) wear debris (shape and surface texture) using a model of tissue inflammation. UHMWPE debris particulates recovered from 50 peri-prosthetic tissue samples were examined by scanning electron microscopy and categorized into four groups based upon aspect ratio and surface texture of the material. The four groups were defined as: 1) smooth and globular, 2) smooth and fibular, 3) rough and globular, and 4) rough and fibular. Histological analysis and ELISA assays were conducted to evaluate variations in cellular responses and cytokine production between the groups. The strongest expression of tumor necrosis factor alpha and interleukin-1 beta was found in tissues exposed to UHMWPE debris with both a rough surface texture and fibular shape, and this response was significantly elevated over debris particles with a smooth surface texture and globular shape. The data suggest that both shape and texture influence the severity of specific inflammatory responses and that rough debris surface texture exerts a marked effect on adverse tissue responses when combined with particles that have a sharp, elongated shape.
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Affiliation(s)
- Allison Sieving
- Department of Orthopaedic Surgery, School of Medicine, Detroit, MI 48201, USA
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Muratoglu OK, Mark A, Vittetoe DA, Harris WH, Rubash HE. Polyethylene damage in total knees and use of highly crosslinked polyethylene. J Bone Joint Surg Am 2003; 85-A Suppl 1:S7-S13. [PMID: 12540663 DOI: 10.2106/00004623-200300001-00003] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Orhun K Muratoglu
- Orthopaedic Biomechanics and Biomaterials Laboratory, Massachusetts General Hospital, Boston 02114, USA.
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50
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Baldwin L, Flanagan BF, McLaughlin PJ, Parkinson RW, Hunt JA, Williams DF. A study of tissue interface membranes from revision accord knee arthroplasty: the role of T lymphocytes. Biomaterials 2002; 23:3007-14. [PMID: 12069343 DOI: 10.1016/s0142-9612(02)00059-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Despite four decades of advances in the design of orthopaedic devices aseptic loosening remains a major cause for the revision of total joint arthroplasty. This study used the techniques of immunohistochemistry and reverse transcription polymerase chain reaction to identify the inflammatory cell types, cytokines and chemokines within the interface tissue surrounding failed Accord Knee prostheses. Many T cells were identified within the tissue: however, the classical marker of activation, CD25 was expressed on very few cells. Molecular analysis failed to detect the synthesis of either Th1 or Th2 cytokines. These results suggest that the T cells are being actively recruited to the site of inflammation along the chemokine gradients but are not participating in a classical immune response.
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Affiliation(s)
- L Baldwin
- UK Centre for Tissue Engineering, Department of Clinical Engineering, Faculty of Medicine, Royal Liverpool University Hospital.
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