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Insua A, Galindo-Moreno P, Miron RJ, Wang HL, Monje A. Emerging factors affecting peri-implant bone metabolism. Periodontol 2000 2024; 94:27-78. [PMID: 37904311 DOI: 10.1111/prd.12532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/05/2023] [Accepted: 09/10/2023] [Indexed: 11/01/2023]
Abstract
Implant dentistry has evolved to the point that standard implant osseointegration is predictable. This is attributed in part to the advancements in material sciences that have led toward improvements in implant surface technology and characteristics. Nonetheless, there remain several cases where implant therapy fails (specifically at early time points), most commonly attributed to factors affecting bone metabolism. Among these patients, smokers are known to have impaired bone metabolism and thus be subject to higher risks of early implant failure and/or late complications related to the stability of the peri-implant bone and mucosal tissues. Notably, however, emerging data have unveiled other critical factors affecting osseointegration, namely, those related to the metabolism of bone tissues. The aim of this review is to shed light on the effects of implant-related factors, like implant surface or titanium particle release; surgical-related factors, like osseodensification or implanted biomaterials; various drugs, like selective serotonin reuptake inhibitors, proton pump inhibitors, anti-hypertensives, nonsteroidal anti-inflammatory medication, and statins, and host-related factors, like smoking, diet, and metabolic syndrome on bone metabolism, and aseptic peri-implant bone loss. Despite the infectious nature of peri-implant biological complications, these factors must be surveyed for the effective prevention and management of peri-implantitis.
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Affiliation(s)
- Angel Insua
- Department of Periodontology and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Pablo Galindo-Moreno
- Department of Periodontology and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Oral Surgery and Implant Dentistry, University of Granada, Granada, Spain
| | - Richard J Miron
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Hom-Lay Wang
- Department of Periodontology and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Alberto Monje
- Department of Periodontology and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Periodontology, University of Bern, Bern, Switzerland
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
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Arevalo S, Arthurs C, Molina MIE, Pruitt L, Roy A. An overview of the tribological and mechanical properties of PEEK and CFR-PEEK for use in total joint replacements. J Mech Behav Biomed Mater 2023; 145:105974. [PMID: 37429179 DOI: 10.1016/j.jmbbm.2023.105974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 07/12/2023]
Abstract
Poly-ether-ether-ketone (PEEK) and PEEK composites are outstanding candidates for biomedical applications, such as orthopedic devices, where biocompatibility and modulus match with surrounding tissue are requisite for long-term success. The mechanical properties can be optimized by incorporating fillers such as continuous and chopped carbon fibers. While much is known about the mechanical and tribological behavior of PEEK composites, there are few articles that summarize the viability of using PEEK reinforced with carbon fibers in orthopedic implants. This paper reviews biocompatibility, tribological, and mechanical studies on PEEK and their composites with carbon fibers, notably PEEK reinforced with polyacrylonitrile (PAN)-based carbon fibers and PEEK reinforced with pitch-based carbon fibers, for application in orthopedics and total joint replacements (TJRs). The main objectives of this review are two-fold. Firstly, this paper aims to assist designers in making informed decisions on the suitability of using PEEK and PEEK composites in orthopedic applications; as it is not well understood how these materials perform on the whole in orthopedics and TJRs. Secondly, this paper aims to serve as a centralized paper in which researchers can gain information on the tribological and mechanical advancements of PEEK and PEEK composites.
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Affiliation(s)
- Sofia Arevalo
- Department of Mechanical Engineering, University of California, Berkeley, CA, USA
| | - Claire Arthurs
- Department of Mechanical Engineering, University of California, Berkeley, CA, USA
| | | | - Lisa Pruitt
- Department of Mechanical Engineering, University of California, Berkeley, CA, USA
| | - Anurag Roy
- Department of Mechanical Engineering, University of California, Berkeley, CA, USA.
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3
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Polan C, Brenner C, Herten M, Hilken G, Grabellus F, Meyer HL, Burggraf M, Dudda M, Jahnen-Dechent W, Wedemeyer C, Kauther MD. Increased UHMWPE Particle-Induced Osteolysis in Fetuin-A-Deficient Mice. J Funct Biomater 2023; 14:jfb14010030. [PMID: 36662077 PMCID: PMC9865936 DOI: 10.3390/jfb14010030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 12/30/2022] [Accepted: 12/31/2022] [Indexed: 01/06/2023] Open
Abstract
Particle-induced osteolysis is a major cause of aseptic prosthetic loosening. Implant wear particles stimulate tissue macrophages inducing an aseptic inflammatory reaction, which ultimately results in bone loss. Fetuin-A is a key regulator of calcified matrix metabolism and an acute phase protein. We studied the influence of fetuin-A on particle-induced osteolysis in an established mouse model using fetuin-A-deficient mice. Ten fetuin-A-deficient (Ahsg−/−) mice and ten wild-type animals (Ahsg+/+) were assigned to test group receiving ultra-high molecular weight polyethylene (UHMWPE) particle implantation or to control group (sham surgery). After 14 days, bone metabolism parameters RANKL, osteoprotegerin (OPG), osteocalcin (OC), alkaline phosphatase (ALP), calcium, phosphate, and desoxypyridinoline (DPD) were examined. Bone volume was determined by microcomputed tomography (μCT); osteolytic regions and osteoclasts were histomorphometrically analyzed. After particle treatment, bone resorption was significantly increased in Ahsg−/− mice compared with corresponding Ahsg+/+ wild-type mice (p = 0.007). Eroded surface areas in Ahsg−/− mice were significantly increased (p = 0.002) compared with Ahsg+/+ mice, as well as the number of osteoclasts compared with control (p = 0.039). Fetuin-A deficiency revealed increased OPG (p = 0.002), and decreased levels of DPD (p = 0.038), OC (p = 0.036), ALP (p < 0.001), and Ca (p = 0.001) compared with wild-type animals. Under osteolytic conditions in Ahsg−/− mice, OPG was increased (p = 0.013), ALP (p = 0.015) and DPD (p = 0.012) were decreased compared with the Ahsg+/+ group. Osteolytic conditions lead to greater bone loss in fetuin-A-deficient mice compared with wild-type mice. Reduced fetuin-A serum levels may be a risk factor for particle-induced osteolysis while the protective effect of fetuin-A might be a future pathway for prophylaxis and treatment.
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Affiliation(s)
- Christina Polan
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany
- Correspondence: ; Tel.: +49-201-723-1301
| | - Christina Brenner
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany
| | - Monika Herten
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany
| | - Gero Hilken
- Central Animal Laboratory, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany
| | - Florian Grabellus
- Institute of Pathology and Neuropathology, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany
| | - Heinz-Lothar Meyer
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany
| | - Manuel Burggraf
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany
| | - Marcel Dudda
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany
| | - Willi Jahnen-Dechent
- Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University Hospital, 52074 Aachen, Germany
| | - Christian Wedemeyer
- Department of Orthopaedic Surgery, St. Barbara Hospital Gladbeck, 45964 Gladbeck, Germany
| | - Max Daniel Kauther
- Department of Trauma Surgery and Orthopedics, Pediatric Orthopedics, Agaplesion Diakonieklinikum Rotenburg (Wümme), 27356 Rotenburg, Germany
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Griffiths G, Gruenberg J, Marsh M, Wohlmann J, Jones AT, Parton RG. Nanoparticle entry into cells; the cell biology weak link. Adv Drug Deliv Rev 2022; 188:114403. [PMID: 35777667 DOI: 10.1016/j.addr.2022.114403] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 12/22/2022]
Abstract
Nanoparticles (NP) are attractive options for the therapeutic delivery of active pharmaceutical drugs, proteins and nucleic acids into cells, tissues and organs. Research into the development and application of NP most often starts with a diverse group of scientists, including chemists, bioengineers and material and pharmaceutical scientists, who design, fabricate and characterize NP in vitro (Stage 1). The next step (Stage 2) generally investigates cell toxicity as well as the processes by which NP bind, are internalized and deliver their cargo to appropriate model tissue culture cells. Subsequently, in Stage 3, selected NP are tested in animal systems, mostly mouse. Whereas the chemistry-based development and analysis in Stage 1 is increasingly sophisticated, the investigations in Stage 2 are not what could be regarded as 'state-of-the-art' for the cell biology field and the quality of research into NP interactions with cells is often sub-standard. In this review we describe our current understanding of the mechanisms by which particles gain entry into mammalian cells via endocytosis. We summarize the most important areas for concern, highlight some of the most common mis-conceptions, and identify areas where NP scientists could engage with trained cell biologists. Our survey of the different mechanisms of uptake into cells makes us suspect that claims for roles for caveolae, as well as macropinocytosis, in NP uptake into cells have been exaggerated, whereas phagocytosis has been under-appreciated.
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Affiliation(s)
- Gareth Griffiths
- Department Biosciences, University of Oslo, Blindernveien 31, PO Box 1041, 0316 Oslo, Norway.
| | - Jean Gruenberg
- Department of Biochemistry, University of Geneva, 30 quai E. Ansermet, 1211-Geneva-4, Switzerland
| | - Mark Marsh
- Laboratory for Molecular Cell Biology, University College London, Gower Street, London, WC1E 6BT, UK
| | - Jens Wohlmann
- Department Biosciences, University of Oslo, Blindernveien 31, PO Box 1041, 0316 Oslo, Norway
| | - Arwyn T Jones
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Redwood Building, Cardiff, Wales CF103NB, UK
| | - Robert G Parton
- Institute for Molecular Bioscience and Centre for Microscopy and Microanalysis, The University of Queensland, Qld 4072, Australia
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Weber A, Schwiebs A, Solhaug H, Stenvik J, Nilsen AM, Wagner M, Relja B, Radeke HH. Nanoplastics affect the inflammatory cytokine release by primary human monocytes and dendritic cells. ENVIRONMENT INTERNATIONAL 2022; 163:107173. [PMID: 35303527 DOI: 10.1016/j.envint.2022.107173] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/13/2022] [Accepted: 03/03/2022] [Indexed: 06/14/2023]
Abstract
So far, the human health impacts of nano- and microplastics are poorly understood. Thus, we investigated whether nanoplastics exposure induces inflammatory processes in primary human monocytes and monocyte-derived dendritic cells. We exposed these cells in vitro to nanoplastics of different shapes (irregular vs. spherical), sizes (50-310 nm and polydisperse mixtures) and polymer types (polystyrene; polymethyl methacrylate; polyvinyl chloride, PVC) using concentrations of 30-300 particles cell-1. Our results show that irregular PVC particles induce the strongest cytokine release of these nanoplastics. Irregular polystyrene triggered a significantly higher pro-inflammatory response compared to spherical nanoplastics. The contribution of chemicals leaching from the particles was minor. The effects were concentration-dependent but varied markedly between cell donors. We conclude that nanoplastics exposure can provoke human immune cells to secrete cytokines as key initiators of inflammation. This response is specific to certain polymers (PVC) and particle shapes (fragments). Accordingly, nanoplastics cannot be considered one homogenous entity when assessing their health implications and the use of spherical polystyrene nanoplastics may underestimate their inflammatory effects.
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Affiliation(s)
- Annkatrin Weber
- Goethe University, Department of Aquatic Ecotoxicology, Faculty of Biological Sciences, Max-von-Laue-Straße 13, 60438 Frankfurt am Main, Germany
| | - Anja Schwiebs
- Goethe University Hospital, Institute of General Pharmacology and Toxicology, pharmazentrum frankfurt, Theodor-Stern-Kai 7/75, 60596 Frankfurt am Main, Germany
| | - Helene Solhaug
- Norwegian University of Science and Technology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Erling Skjalgssons gate 1, Trondheim, Norway
| | - Jørgen Stenvik
- Norwegian University of Science and Technology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Erling Skjalgssons gate 1, Trondheim, Norway; Norwegian University of Science and Technology, Centre of Molecular Inflammation Research, Olav Kyrres gate 17, Trondheim, Norway
| | - Asbjørn M Nilsen
- Norwegian University of Science and Technology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Erling Skjalgssons gate 1, Trondheim, Norway
| | - Martin Wagner
- Norwegian University of Science and Technology, Department of Biology, Høgskoleringen 5, Realfagbygget, 7491 Trondheim, Norway.
| | - Borna Relja
- Otto-von-Guericke University, Department of Radiology and Nuclear Medicine, Experimental Radiology, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Heinfried H Radeke
- Goethe University Hospital, Institute of General Pharmacology and Toxicology, pharmazentrum frankfurt, Theodor-Stern-Kai 7/75, 60596 Frankfurt am Main, Germany
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6
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Uhler M, Braun S, Schroeder S, Renkawitz T, Kretzer JP. Wear investigation based on a novel, anatomic shoulder prosthesis with bearing materials inversion. J Mech Behav Biomed Mater 2022; 127:105080. [DOI: 10.1016/j.jmbbm.2022.105080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 12/30/2021] [Accepted: 01/08/2022] [Indexed: 11/26/2022]
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7
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Orita K, Minoda Y, Sugama R, Ohta Y, Ueyama H, Takemura S, Nakamura H. Vitamin E-infused highly cross-linked polyethylene did not reduce the number of in vivo wear particles in total knee arthroplasty. Bone Joint J 2020; 102-B:1527-1534. [PMID: 33135435 DOI: 10.1302/0301-620x.102b11.bjj-2020-0413.r1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
AIMS Vitamin E-infused highly cross-linked polyethylene (E1) has recently been introduced in total knee arthroplasty (TKA). An in vitro wear simulator study showed that E1 reduced polyethylene wear. However there is no published information regarding in vivo wear. Previous reports suggest that newly introduced materials which reduce in vitro polyethylene wear do not necessarily reduce in vivo polyethylene wear. To assist in the evaluation of the newly introduced material before widespread use, we established an in vivo polyethylene wear particle analysis for TKA. The aim of this study was to compare in vivo polyethylene wear particle generation between E1 and conventional polyethylene (ArCom) in TKA. METHODS A total of 34 knees undergoing TKA (17 each with ArCom or E1) were investigated. Except for the polyethylene insert material, the prostheses used for both groups were identical. Synovial fluid was obtained at a mean of 3.4 years (SD 1.3) postoperatively. The in vivo polyethylene wear particles were isolated from the synovial fluid using a previously validated method and examined by scanning electron microscopy. RESULTS The total number of polyethylene wear particles obtained from the knees with E1 (mean 6.9, SD 4.0 × 107 counts/knee) was greater than that obtained from those with ArCom (mean 2.2, SD 2.6 × 107 counts/knee) (p = 0.001). The particle size (equivalent circle of diameter) from the knees with E1 was smaller (mean 0.5 μm, SD 0.1) than that of knees with ArCom (mean 1.5, SD 0.3 μm) (p = 0.001). The aspect ratio of particles from the knees with E1 (mean 1.3, SD 0.1) was smaller than that with ArCom (mean 1.4, SD 0.1) (p < 0.001 ). CONCLUSION This is the first report of in vivo wear particle analysis of E1. E1 polyethylene did not reduce the number of in vivo polyethylene wear particles compared with ArCom in early clinical stage. Further careful follow-up of newly introduced E1 for TKA should be carried out. Cite this article: Bone Joint J 2020;102-B(11):1527-1534.
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Affiliation(s)
- Kumi Orita
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yukihide Minoda
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Ryo Sugama
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yoichi Ohta
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hideki Ueyama
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Susumu Takemura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
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8
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Bucknall C, Altstädt V, Auhl D, Buckley P, Dijkstra D, Galeski A, Gögelein C, Handge UA, He J, Liu CY, Michler G, Piorkowska E, Slouf M, Vittorias I, Wu JJ. Structure, processing and performance of ultra-high molecular weight polyethylene (IUPAC Technical Report). Part 3: deformation, wear and fracture. PURE APPL CHEM 2020. [DOI: 10.1515/pac-2019-0406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Three grades of polyethylene, with weight-average relative molar masses,
M
‾
W
${\bar{M}}_{\text{W}}$
, of approximately 0.6 × 106, 5 × 106, and 9 × 106, were supplied as compression mouldings by a leading manufacturer of ultra-high molecular weight polyethylene (UHMWPE). They were code-named PE06, PE5, and PE9, respectively. Specimens cut from these mouldings were subjected to a wide range of mechanical tests at 23 °C. In tensile tests, deformation was initially elastic and dominated by crystallinity, which was highest in PE06. Beyond the yield point, entanglement density became the dominant factor, and at 40 % strain, the rising stress–strain curves for PE5 and PE9 crossed the falling PE06 curve. Fracture occurred at strains above 150 %. Differences in stress–strain behaviour between PE5 and PE9 were relatively small. A similar pattern of behaviour was observed in wear tests; wear resistance showed a marked increase when
M
‾
W
${\bar{M}}_{\text{W}}$
was raised from 0.6 × 106 to 5 × 106, but there was no further increase when it was raised to 9 × 106. It is concluded that the unexpected similarity in behaviour between PE5 and PE9 was due to incomplete consolidation during moulding, which led to deficiencies in entanglement at grain boundaries; they were clearly visible on the surfaces of both tensile and wear specimens. Fatigue crack growth in 10 mm thick specimens was so severely affected by inadequate consolidation that it forms the basis for a separate report – Part 4 in this series.
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Affiliation(s)
- Clive Bucknall
- School of Aerospace, Transport & Manufacturing B 61 , Cranfield University , Bedford, MK43 0AL , UK
| | - Volker Altstädt
- Department of Polymer Engineering , Universität Bayreuth , Bayreuth , Germany
| | - Dietmar Auhl
- Fakultät III – Werkstoffwissenschaft Technische , Universität Berlin , Berlin, D-10623 , Germany
| | - Paul Buckley
- Department of Engineering Science , University of Oxford , Oxford, OX1 3PJ , UK
| | | | - Andrzej Galeski
- Centre for Molecular and Macromolecular Sciences , Polish Academy of Sciences , Lodz , Poland
| | | | - Ulrich A. Handge
- Institute of Polymer Research , Helmholtz-Zentrum Geesthacht , Max-Planck-Strasse 1 , 21502, Geesthacht , Germany
| | - Jiasong He
- Chinese Academy of Sciences, Laboratory of Polymer Science and Materials , Beijing , China, 100190
| | - Chen-Yang Liu
- Chinese Academy of Sciences, Laboratory of Polymer Science and Materials , Beijing , China, 100190
| | - Goerg Michler
- Martin-Luther-Universität , Halle-Wittenberg , Germany
| | - Ewa Piorkowska
- Centre for Molecular and Macromolecular Sciences , Polish Academy of Sciences , Lodz , Poland
| | - Miroslav Slouf
- Institute of Macromolecular Chemistry CAS , Prague , Czech Republic
| | - Iakovos Vittorias
- Omya International AG , Baslerstrasse 42 , CH-4665, Oftringen , Switzerland
| | - Jun Jie Wu
- Department of Engineering , Durham University , Stockton Road , Durham, DH1 3LE , UK
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Hallab NJ, Jacobs JJ. Orthopedic Applications. Biomater Sci 2020. [DOI: 10.1016/b978-0-12-816137-1.00070-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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10
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Impergre A, Trunfio-Sfarghiu A, Der-Loughian C, Brizuela L, Mebarek S, Ter-Ovanessian B, Bel-Brunon A, Berthier Y, Normand B. Tribocorrosion of Polyethylene/Cobalt Contact Combined with Real-Time Fluorescence Assays on Living Macrophages: Development of A Multidisciplinary Biotribocorrosion Device. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.biotri.2019.100091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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11
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Motojima N, Nakashima Y, Fujiwara Y, Komohara Y, Takeya M, Miura H, Hino K, Higaki H, Hata H, Nakanishi Y. Relationship between wear behaviour of ultra‐high‐molecular‐weight polyethylene and surface profile of Co–Cr–Mo alloy in artificial joint. BIOSURFACE AND BIOTRIBOLOGY 2019. [DOI: 10.1049/bsbt.2018.0029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Nana Motojima
- Graduate School of Science and TechnologyKumamoto University2‐39‐1 Kurokami Cyuo‐kuKumamoto860‐8555Japan
| | - Yuta Nakashima
- Faculty of Advanced Science and TechnologyKumamoto UniversityKumamotoJapan
| | - Yukio Fujiwara
- Faculty of Life Science and TechnologyKumamoto UniversityKumamotoJapan
| | | | - Motohiro Takeya
- Faculty of Life Science and TechnologyKumamoto UniversityKumamotoJapan
| | | | - Kazunori Hino
- Graduate School of MedicineEhime UniversityEhimeJapan
| | | | - Hidehiro Hata
- Faculty of Advanced Science and TechnologyKumamoto UniversityKumamotoJapan
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Moro T, Ishihara K, Takatori Y, Tanaka S, Kyomoto M, Hashimoto M, Ishikura H, Hidaka R, Tanaka T, Kawaguchi H, Nakamura K. Effects of a roughened femoral head and the locus of grafting on the wear resistance of the phospholipid polymer-grafted acetabular liner. Acta Biomater 2019; 86:338-349. [PMID: 30590185 DOI: 10.1016/j.actbio.2018.12.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 12/13/2018] [Accepted: 12/17/2018] [Indexed: 11/30/2022]
Abstract
Although laboratory tests and mid-term clinical outcomes show the clinical safety and remarkable wear resistance of the highly cross-linked polyethylene (HXLPE) acetabular liner with a nanometer-scaled graft layer of poly(2-methacryloyloxyethyl phosphorylcholine) (PMPC), the wear resistance of the layer under severe abrasive conditions is concerning. We evaluated the effects of a roughened femoral head and the grafting locus on the wear resistance of the PMPC-grafted HXLPE liner and the effect of PMPC grafting on wear resistance of the HXLPE substrate by removing the PMPC-grafted layer using a severely roughened femoral head. Against a moderately roughened femoral head, the PMPC-grafted HXLPE liner showed negative wear, although an untreated HXLPE liner increased the wear by 154.1% compared with wear against a polished femoral head, confirming that PMPC grafts were unaffected. Against a severely roughened femoral head, the PMPC-grafted layer of the head contact area might be removed under severe conditions. However, the wear rate was reduced by 52.5% compared to that of untreated HXLPE liners. Moreover, the head non-contact area-modified PMPC-grafted HXLPE liner against a polished femoral head reduced the wear by 76.8% compared with untreated HXLPE liner; thus, this area may be also important in the development of fluid-film lubrication. STATEMENT OF SIGNIFICANCE: Here we describe effects of a roughened femoral head and the locus of grafting on the wear-resistance of the phospholipid polymer grafted highly cross-linked polyethylene (PMPC-HXLPE) liner. Against a moderately roughened femoral head, the PMPC-HXLPE liner showed negative wear, confirming that PMPC grafts were unaffected. After removing the PMPC layer of the head contact area using a severely roughened femoral head, the wear rate not only exceeded that of untreated HXLPE liners, but was reduced by 52.5%, confirming that PMPC grafting does not affect the wear-resistance of the HXLPE substrate. In addition, the head non-contact area-modified PMPC-HXLPE liner reduced the wear by 76.8%. Thus, this area may also may be important in the development of fluid-film lubrication.
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Affiliation(s)
- Toru Moro
- Division of Science for Joint Reconstruction, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; Sensory & Motor System Medicine, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Kazuhiko Ishihara
- Department of Materials Engineering, School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan.
| | - Yoshio Takatori
- Division of Science for Joint Reconstruction, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Sakae Tanaka
- Sensory & Motor System Medicine, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Masayuki Kyomoto
- Division of Science for Joint Reconstruction, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; Department of Materials Engineering, School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan; Corporate R&D Group, KYOCERA Corporation, 800 Ichimiyake, Yasu 520-2362, Japan
| | - Masami Hashimoto
- Japan Fine Ceramics Center, 2-4-1 Mutsuno, Atsuta-ku, Nagoya 456-8587, Japan
| | - Hisatoshi Ishikura
- Sensory & Motor System Medicine, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Ryo Hidaka
- Sensory & Motor System Medicine, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Takeyuki Tanaka
- Sensory & Motor System Medicine, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Hiroshi Kawaguchi
- Japan Community Health Care Organization, Tokyo Shinjuku Medical Center, Spine Center, 5-1 Tsukudo, Shinjuku-ku, Tokyo 162-8543, Japan
| | - Kozo Nakamura
- Sensory & Motor System Medicine, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
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13
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Hallab NJ, Samelko L, Hammond D. The Inflammatory Effects of Breast Implant Particulate Shedding: Comparison With Orthopedic Implants. Aesthet Surg J 2019; 39:S36-S48. [PMID: 30715176 PMCID: PMC6355107 DOI: 10.1093/asj/sjy335] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Currently, there is a dearth of information regarding the degree of particle shedding from breast implants (BIs) and what are the general biological consequences of BI debris. Thus, it is unclear to what degree BI debris compromises the long-term biological performance of BIs. For orthopedic implants, it is well established that the severity of biological reactivity to implant debris governs long-term clinical performance. Orthopedic implant particulate debris is generally in the range of 0.01 to 100 μm in diameter. Implant debris-induced bioreactivity/inflammation is mostly a peri-implant phenomenon caused by local innate immune cells (eg, macrophages) that produce proinflammatory cytokines such as tumor necrosis factor-α, interleukin-1β, interleukin-6, and prostaglandin 2 (PGE2). In orthopedics, there have been few systemic concerns associated with polymeric implant debris (like silicone) other than documented dissemination to remote organs (eg, liver, spleen, etc.) with no known associated pathogenicity. This is not true of metal implant debris where normal (well-functioning) implants can induce systemic reactions such as delayed type hypersensitivity. Diagnostic analysis of orthopedic tissues has focused on innate (macrophage mediated) and adaptive (lymphocyte-mediated hypersensitivity) immune responses. Orthopedic implant debris-associated lymphocyte cancers have not been reported in over 40 years of orthopedic literature. Adaptive immune responses such as hypersensitivity reactions to orthopedic implant debris have been dominated by certain implant types that produce specific kinds of debris (eg, metal-on-metal total joint prostheses). Orthopedic hypersensitivity responses and atypical BI bioreactivity such as BI-associated anaplastic large cell lymphoma share crossover markers for diagnosis. Differentiating normal innate immune reactivity to particles from anaplastic large cell lymphoma reactions from delayed type hypersensitivity reactions to BI-associated implant debris remains unclear but vital to patients and surgeons.
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Affiliation(s)
- Nadim James Hallab
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL
| | - Lauryn Samelko
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL
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14
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Braun S, Sonntag R, Schroeder S, Mueller U, Jaeger S, Gotterbarm T, Kretzer JP. Backside wear in acetabular hip joint replacement. Acta Biomater 2019; 83:467-476. [PMID: 30408561 DOI: 10.1016/j.actbio.2018.10.045] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/30/2018] [Accepted: 10/31/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Besides head-insert articulation in hip joint replacements, micro-motions between the backside of assembled polyethylene acetabular liners and the metal cup may cause additional wear. Pelvic osteolysis frequently occurs in the region of screw holes, and cup loosening hints to clinically relevant amounts of polyethylene backside wear. It has yet to be confirmed whether backside wear particles differ in size and morphology compared to articulating wear. Previous methods have been limited to subjective assessment of backside surface damages without consideration of wear debris. The aim of this study was to develop and validate a method for quantitative in vitro measurements of polyethylene backside wear in artificial hip cups and to characterize these wear particles for the first time. METHODS Titanium cup-systems (Plasmafit®Plus7, Aesculap, UHMWPE liner) were sinusoidally loaded (2.5 kN) and a torque of 5 Nm was simultaneously applied. The front and rear side of the cup were separated to isolate backside wear. After 2 × 106 cycles the surrounding fluid was filtered and a particle analysis was performed. RESULTS Backside wear had a particles size of 64.1 ± 1.9 nm and was verified as round and oval particles with partly rough outlines. An estimated total number of particles of 1.26 × 109 ± 1.67 × 108 per 106 cycles was determined. CONCLUSION Backside wear was estimated to be several times lower than published values of articulating wear. However, polyethylene backside wear particles represented significantly smaller particles with partly roughened outlines than articulating wear particles and may therefore cause higher biological response in macrophage-mediated bone resorption compared to articulated particles. STATEMENT OF SIGNIFICANCE Within this study, an analytical method for quantitative measuring polyethylene backside wear of artificial hip cups was successfully developed and validated for the first time. It could be shown that backside wear is still present, even in modern cup-systems. These findings can be further used for investigations of the osteolytic potential of polyethylene particles, for evaluating and improving new implant systems and to evaluate the effectiveness of screw hole plugs to prevent the particle migration to the acetabulum.
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15
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Schipper ON, Haddad SL, Fullam S, Pourzal R, Wimmer MA. Wear Characteristics of Conventional Ultrahigh-Molecular-Weight Polyethylene Versus Highly Cross-Linked Polyethylene in Total Ankle Arthroplasty. Foot Ankle Int 2018; 39:1335-1344. [PMID: 30019605 DOI: 10.1177/1071100718786501] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aim of this study was to compare the polyethylene wear rate, particle size, and particle shape of primary semiconstrained, fixed-bearing, bone-sparing total ankle arthroplasty using conventional ultrahigh-molecular-weight polyethylene (CPE) versus highly cross-linked polyethylene (HXLPE) by applying a level walking input using a joint simulator. METHODS Two fixed-bearing total ankle replacement systems with different types of polyethylene liners were tested: (1) CPE sterilized in ethylene oxide, and (2) HXLPE sterilized with gas plasma after electron beam irradiation. Three implants for each design underwent wear testing using gravimetric analysis over 5 million simulated walking cycles. A fourth implant was used as a load soak control. Equivalent circle diameter (ECD) and equivalent shape ratio (ESR) were computed to determine particle size and particle shape, respectively. RESULTS The mean wear rate from 1.5 to 5 million cycles (MC) was 2.0 ± 0.3 mg/MC for HXLPE and 16.7 ± 1.3 mg/MC for CPE ( P < .001). The total number of particles per cycle generated for HXLPE and CPE were 0.17 × 106 particles/cycle and 0.53 × 106 particles/cycle, respectively ( P < .001). The mean ECD of HXLPE particles (0.22 ± 0.11 μm) was significantly smaller than the mean ECD of CPE particles (0.32 ± 0.14 μm) ( P < .001). HXLPE particles were significantly more round than CPE particles ( P < .001). CONCLUSIONS HXLPE liners had a significantly lower wear rate and produced significantly fewer and rounder particles than CPE liners. The results of this study suggest that HXLPE has more favorable wear characteristics for total ankle arthroplasty. CLINICAL RELEVANCE Polyethylene wear particles have been linked to osteolysis after total ankle arthroplasty. There is no consensus on the importance of highly cross-linked polyethylene in total ankle arthroplasty with regard to implant wear. This is the first nonindustry study to compare the polyethylene wear rate, particle size, and particle shape of fixed-bearing total ankle arthroplasty conventional polyethylene versus highly cross-linked polyethylene. The lower wear rate and different particle size/morphology of highly cross-linked polyethylene could be beneficial in vivo to decrease osteolysis.
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Affiliation(s)
| | | | - Spencer Fullam
- 3 Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Robin Pourzal
- 3 Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Markus A Wimmer
- 3 Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
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16
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Galliera E, Ragone V, Marazzi MG, Selmin F, Banci L, Corsi Romanelli MM. Vitamin E-stabilized UHMWPE: Biological response on human osteoblasts to wear debris. Clin Chim Acta 2018; 486:18-25. [DOI: 10.1016/j.cca.2018.07.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 07/09/2018] [Indexed: 12/31/2022]
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17
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Singh V, Rawlinson J, Hallab N. Stainless steel wear debris of a scoliotic growth guidance system has little local and systemic effect in an animal model. J Orthop Res 2018; 36:1980-1990. [PMID: 29323741 DOI: 10.1002/jor.23855] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 01/08/2018] [Indexed: 02/04/2023]
Abstract
Options to treat early-onset scoliosis include guided-growth systems with sliding action between rods and pedicle screws. The wear was previously measured in an in vitro test, and in this in vivo rabbit model, we evaluated the local and systemic biological response to the stainless steel debris. Compared to the previous study, a relatively higher volume of representative wear particles with a median particle size of 0.84 μm were generated. Bolus dosages were injected into the epidural space at L4-L5 for a minimum of 36 rabbits across three treatment groups (negative control, 1.5 mg, and 4.0 mg) and two timepoints (12 and 24 weeks). Gross pathology evaluated distant organs and the injection site with a dorsal laminectomy to examine the epidural space and dosing site. Peri-implanted particle tissues were stained for immunohistochemical and quantitatively analyzed for IL-6 and TNF-α cytokines. Based on ISO 10993-6:2007 scoring, particles in the high-dose group were primarily non-irritant (12 weeks) with one slightly irritant. At 24 weeks, inflammatory cell infiltration was non-existent to minimal with all groups considered non-irritant at the injection site. Material characterization confirmed that particles detected in distant organs were stainless steel or contaminants. At 12 weeks, stainless steel groups demonstrated statistically increased amounts of cytokine levels compared to control but there was a statistical decrease for both at 24 weeks. These findings indicate that stainless steel wear debris, comparable to the expected usage from a simulated growth guidance system, had no discernible untoward biological effects locally and systemically in an animal model. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1980-1990, 2018.
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Affiliation(s)
- Vaneet Singh
- Medtronic Spine, 2600 Sofamor Danek Dr., Memphis, Tennessee, 38132
| | - Jeremy Rawlinson
- Medtronic Spine, 2600 Sofamor Danek Dr., Memphis, Tennessee, 38132
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18
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Su CY, Huang SS, Fang HW. Effects of Major Components of Synovial Fluid on the Morphology and Wear Rate of Polyetheretherketone (PEEK) Particles under an Accelerated Wear Process. Polymers (Basel) 2018; 10:polym10060635. [PMID: 30966669 PMCID: PMC6403845 DOI: 10.3390/polym10060635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 06/05/2018] [Accepted: 06/06/2018] [Indexed: 12/03/2022] Open
Abstract
Wear particle-induced biological responses are the major factors for the failure of total joint arthroplasties, but it is possible to improve the lubrication and reduce the wear of an artificial joint system. Polyetheretherketone (PEEK), with ultra-high molecular weight polyethylene, is a suitable bearing material due to its resistance to fatigue strain. However, the effects of major compositions of synovial fluid on the wear of PEEK are unclear. We characterized the effects of three major components of synovial fluid including albumin, globulin, and phospholipids on the morphology and wear rate of PEEK wear particles. Our results demonstrated that the concentrations of albumin and globulin could affect the morphology of PEEK wear particles. In addition, a higher concentration of globulin and phospholipids (12.5 mg/mL) resulted in an increase in the amount of wear particles by 2.8- and 1.7-fold, respectively. In contrast, increasing albumin caused a reduction of wear particle numbers. These results indicate increasing concentration of albumin or reducing concentration of globulin or phospholipids has a better effect on reducing the numbers of wear particles and provides a potential solution of reducing PEEK wear particles, thus it can be more effectively applied in other biomedical systems.
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Affiliation(s)
- Chen-Ying Su
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology, 1, Sec. 3, Zhongxiao E. Rd., Taipei 10608, Taiwan.
| | - Shih-Shuan Huang
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology, 1, Sec. 3, Zhongxiao E. Rd., Taipei 10608, Taiwan.
| | - Hsu-Wei Fang
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology, 1, Sec. 3, Zhongxiao E. Rd., Taipei 10608, Taiwan.
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, No. 35, Keyan Road, Zhunan Town, Miaoli County 35053, Taiwan.
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19
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Minoda Y, Hata K, Goto K, Itohara T, Nakamura H. Sequentially annealed highly cross-linked polyethylene reduced in vivo wear particle generation in total knee arthroplasty. J Orthop Surg (Hong Kong) 2018; 25:2309499017718909. [PMID: 28681671 DOI: 10.1177/2309499017718909] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Sequentially annealed highly cross-linked polyethylene (HXLPE) was recently introduced to reduce the wear in total knee arthroplasty (TKA). However, an in vivo advantage of sequentially annealed HXLPE on wear particle generation is still controversial. The purpose of this study is to compare the characteristics of in vivo wear particles between sequentially annealed HXLPE and conventional polyethylene after TKA. MATERIALS AND METHODS Synovial fluid was obtained from the eight knees with sequentially annealed HXLPE and from eight knees with conventional polyethylene 12 months after the operation. Polyethylene particles were isolated and examined using a scanning electron microscope and image analyzer. RESULTS Total number of wear particles in each knee was 2.1 ± 1.0 × 107 with sequentially annealed HXLPE (mean ± standard deviation) and 4.9 ± 3.6 × 107 with conventional polyethylene ( p = 0.036). Particle size (equivalent circle diameter) was 1.01 ± 0.26 μm with sequentially annealed HXLPE and 1.02 ± 0.20 μm with conventional polyethylene ( p = 0.674). Aspect ratio was 1.33 ± 0.04 with sequentially annealed HXLPE and 1.39 ± 0.10 with conventional polyethylene ( p = 0.462). CONCLUSIONS The sequentially annealed HXLPE reduced the in vivo polyethylene wear particles by 58% compared with conventional polyethylene without the significant change of particle size and shape.
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Affiliation(s)
- Yukihide Minoda
- 1 Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Abeno-ku, Osaka, Japan.,2 Department of Orthopaedic Surgery, Shitennouji Hospital, Tennouji-ku, Osaka, Japan
| | - Kanako Hata
- 1 Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Abeno-ku, Osaka, Japan
| | - Katsuko Goto
- 2 Department of Orthopaedic Surgery, Shitennouji Hospital, Tennouji-ku, Osaka, Japan
| | - Tomonobu Itohara
- 2 Department of Orthopaedic Surgery, Shitennouji Hospital, Tennouji-ku, Osaka, Japan
| | - Hiroaki Nakamura
- 1 Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Abeno-ku, Osaka, Japan
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20
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Li J, Li Y, Peng X, Li B, Qin H, Chen Y. In vivo analysis of the effects of CoCrMo and Ti particles on inflammatory responses and osteolysis. RSC Adv 2018; 8:5151-5157. [PMID: 35542395 PMCID: PMC9082049 DOI: 10.1039/c7ra12325f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 01/23/2018] [Indexed: 11/25/2022] Open
Abstract
Metal wear particles play a major role in periprosthetic osteolysis and aseptic loosening in patients with total joint arthroplasty. The ability to induce osteolysis depends on the size, shape, dose, and type of the particles. However, much remains unknown regarding which type of metal particles are most reactive. We compared the inflammatory response and bone loss induced by two metal wear particles, cobalt-chromium-molybdenum (CoCrMo) and titanium (Ti), in a mouse calvaria model of osteolysis. We found that CoCrMo particles caused markedly greater bone resorption than Ti particles, according to three-dimensional images of the calvariae. CoCrMo particles activated more functional osteoclasts by significantly increasing the expression of the osteoclast-specific gene tartrate-specific acid phosphatase (Trap), calcitonin receptor (Ctr), and nuclear factor of activated T cells c1 (Nfatc1), and induced a greater increase in the ratio of receptor activator of nuclear factor kappa B ligand (RANKL)/osteoprotegerin (OPG) than Ti particles. CoCrMo particles also induced a stronger local inflammatory response, markedly increasing the expression and secretion of tumor necrosis factor-α and interleukin-1β compared with Ti particles. Therefore, CoCrMo particles induced a more severe inflammatory response and greater osteolysis than Ti particles in vivo.
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Affiliation(s)
- Juehong Li
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai China +86-21-24058102
| | - Yamin Li
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai China +86-21-24058102
| | - Xiaochun Peng
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai China +86-21-24058102
| | - Bin Li
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai China +86-21-24058102
| | - Hui Qin
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai China +86-21-24058102
| | - Yunsu Chen
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai China +86-21-24058102
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21
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Terkawi MA, Hamasaki M, Takahashi D, Ota M, Kadoya K, Yutani T, Uetsuki K, Asano T, Irie T, Arai R, Onodera T, Takahata M, Iwasaki N. Transcriptional profile of human macrophages stimulated by ultra-high molecular weight polyethylene particulate debris of orthopedic implants uncovers a common gene expression signature of rheumatoid arthritis. Acta Biomater 2018; 65:417-425. [PMID: 29109029 DOI: 10.1016/j.actbio.2017.11.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 10/27/2017] [Accepted: 11/02/2017] [Indexed: 01/09/2023]
Abstract
Osteolysis is a serious postoperative complication of total joint arthroplasty that leads to aseptic loosening and surgical revision. Osteolysis is a chronic destructive process that occurs when host macrophages recognize implant particles and release inflammatory mediators that increase bone-resorbing osteoclastic activity and attenuate bone-formation osteoblastic activity. Although much progress has been made in understanding the molecular responses of macrophages to implant particles, the pathways/signals that initiate osteolysis remain poorly characterized. Transcriptomics and gene-expression profiling of these macrophages may unravel key mechanisms in the pathogenesis of osteolysis and aid the identification of molecular candidates for therapeutic intervention. To this end, we analyzed the transcriptional profiling of macrophages exposed to ultra-high molecular weight polyethylene (UHMWPE) particles, the most common components used in bearing materials of orthopedic implants. Regulated genes in stimulated macrophages were involved in cytokine, chemokine, growth factor and receptor activities. Gene enrichment analysis suggested that stimulated macrophages elicited common gene expression signatures for inflammation and rheumatoid arthritis. Among the regulated genes, tumor necrosis factor superfamily member 15 (TNFSF15) and chemokine ligand 20 (CCL20) were further characterized as molecular targets involved in the pathogenesis of osteolysis. Treatment of monocyte cultures with TNFSF15 and CCL20 resulted in an increase in osteoclastogenesis and bone-resorbing osteoclastic activity, suggesting their potential contribution to loosening between implants and bone tissues. STATEMENT OF SIGNIFICANCE Implant loosening due to osteolysis is the most common mode of arthroplasty failure and represents a great challenge to orthopedic surgeons and a significant economic burden for patients and healthcare services worldwide. Bone loss secondary to a local inflammatory response initiated by particulate debris from implants is considered the principal feature of the pathogenesis of osteolysis. In the present study, we analyzed the transcriptional profiling of human macrophages exposed to UHMWPE particles and identified a large number of inflammatory genes that were not identified previously in macrophage responses to wear particles. Our data provide a new insight into the molecular pathogenesis of osteolysis and highlights a number of molecular targets with prognostic and therapeutic implications.
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22
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Du Z, Wang S, Wang Y. Preferential CD8 rather than CD4 T-cell response to wear particles of polyether-ether-ketone and highly cross-linked polyethylene. RSC Adv 2018; 8:1866-1874. [PMID: 35542597 PMCID: PMC9077207 DOI: 10.1039/c7ra10589d] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 12/26/2017] [Indexed: 11/21/2022] Open
Abstract
The efficacy of polyether-ether-ketone (PEEK) as a bearing material in knee components, a potential alternative to the currently used highly cross-linked polyethylene (HXLPE), has attracted a lot of attention recently. This study aimed to systematically assess the effect of particulate wear debris on CD4 and CD8 T-cell responses. HXLPE and PEEK particles (96% less than 5 μm) were generated by custom cryo-milling and pulverization in liquid nitrogen, and then incubated with blood collected from 25 donors. The phenotypes of the T-cells were systematically analyzed by immunostaining and flow cytometry. For the in vivo study, 0.1 mL of each particle suspension (about 1.0 × 108 wear particles) was injected into murine knee joints; the synovium and spleen were collected one week later for histological examination and immunofluorescence staining. PEEK and HXLPE particles did not induce CD4+ T-cell responses; however, CD8+ T-cells might be involved in mediating particle-induced reactions. The T-cell and inflammatory responses induced by PEEK and HXLPE particles were comparable. Further investigations into the frictional properties of materials should be performed to expand on our results. Enriching the understanding of the effects of the particles on the adaptive immune response.![]()
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Affiliation(s)
- Zhe Du
- Department of Bone and Joint Surgery
- Renji Hospital
- School of Medicine
- Shanghai Jiaotong University
- Shanghai
| | - Shujun Wang
- Department of Immunology
- Shanghai Institute of Immunology
- Shanghai Jiaotong University School of Medicine
- Shanghai
- China
| | - You Wang
- Department of Bone and Joint Surgery
- Renji Hospital
- School of Medicine
- Shanghai Jiaotong University
- Shanghai
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23
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Highly Cross-Linked Polyethylene Reduces Osteolysis Incidence and Wear-Related Reoperation Rate in Cementless Total Hip Arthroplasty Compared With Conventional Polyethylene at a Mean 12-Year Follow-Up. J Arthroplasty 2017; 32:3771-3776. [PMID: 28734615 DOI: 10.1016/j.arth.2017.06.047] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 05/18/2017] [Accepted: 06/28/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND A number of studies on total hip arthroplasty have compared highly cross-linked polyethylene (HXLPE) with conventional polyethylene (CPE) liners beyond 10 years. However, the impact of HXLPE on the wear-related reoperation rate is unclear. The purpose of this study was to evaluate the clinical advantage of using a single manufacturer's HXLPE in terms of reducing the reoperation rate. METHODS The study was a follow-up retrospective cohort study over a mean of 12 years that examined patients aged 45-70 years with cementless total hip arthroplasty using a 26-mm-diameter cobalt-chromium head. Sixty-seven patients (79 hips; HXLPE group = 41 hips, CPE group = 38 hips) were evaluated for a minimum 10-year follow-up. Kaplan-Meier survival analysis was performed, with wear-related reoperations and radiographic osteolysis serving as the end points. The polyethylene wear rate was also assessed. RESULTS The mean 12-year follow-up rates of survivorship that were evaluated using wear-related reoperations as the end point were 100% and 91.4% in the HXLPE and CPE groups, respectively (P = .007), and the mean 12-year follow-up rates of survivorship with osteolysis as the end point were 100% and 36.2%, respectively (P < .001). Compared with the CPE group, the HXLPE group presented a significantly reduced wear rate (HXLPE group, 0.035 mm/y; CPE group, 0.118 mm/y). CONCLUSION A unique strength of this study is that we assessed a single manufacturer's HXLPE while keeping most other implant parameters uniform. This study reveals the clinical advantage of using a single manufacturer's HXLPE in terms of a reduced wear-related reoperation rate at a mean 12-year follow-up.
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Moro T, Takatori Y, Tanaka S, Ishihara K, Oda H, Kim YT, Umeyama T, Fukatani E, Ito H, Kyomoto M, Oshima H, Tanaka T, Kawaguchi H, Nakamura K. Clinical safety and wear resistance of the phospholipid polymer-grafted highly cross-linked polyethylene liner. J Orthop Res 2017; 35:2007-2016. [PMID: 27813260 DOI: 10.1002/jor.23473] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 10/28/2016] [Indexed: 02/04/2023]
Abstract
To reduce the production of wear particles and subsequent aseptic loosening, we created a human articular cartilage-mimicked surface for a highly cross-linked polyethylene liner, whose surface grafted layer consisted of a biocompatible phospholipid polymer, poly(2-methacryloyloxyethyl phosphorylcholine). Although our previous in vitro findings showed that poly(2-methacryloyloxyethyl phosphorylcholine)-grafted particles were biologically inert and caused no subsequent bone resorptive responses, and poly(2-methacryloyloxyethyl phosphorylcholine) grafting markedly decreased wear in hip joint simulator tests, the clinical safety, and in vivo wear resistance of poly(2-methacryloyloxyethyl phosphorylcholine)-grafted highly cross-linked polyethylene liners remained open to question. Therefore, in the present study, we evaluated clinical and radiographic outcomes of poly(2-methacryloyloxyethyl phosphorylcholine)-grafted highly cross-linked polyethylene liners 5 years subsequent to total hip replacement in 68 consecutive patients. No reoperation was required for any reason, and no adverse events were associated with the implanted liners. The average Harris Hip Score increased from 38.6 preoperatively to 96.5 5 years postoperatively, and health-related quality of life, as indicated by the Short Form 36 Health Survey, improved. Radiographic analyses showed no periprosthetic osteolysis or implant migration. Between 1 and 5 years postoperatively, the mean steady-state wear rate was 0.002 mm/year, which represented a marked reduction relative to other highly cross-linked polyethylene liners, and appeared to be unaffected by patient-related or surgical factors. Although longer follow up is required, poly(2-methacryloyloxyethyl phosphorylcholine)-grafted highly cross-linked polyethylene liners improved mid-term clinical outcomes. The clinical safety and wear-resistance results are encouraging with respect to the improvement of long-term clinical outcomes with poly(2-methacryloyloxyethyl phosphorylcholine)-grafted highly cross-linked polyethylene liners. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2007-2016, 2017.
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Affiliation(s)
- Toru Moro
- Division of Science for Joint Reconstruction, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Sensory and Motor System Medicine, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yoshio Takatori
- Division of Science for Joint Reconstruction, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Sakae Tanaka
- Sensory and Motor System Medicine, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kazuhiko Ishihara
- Department of Materials Engineering, School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8656, Japan
| | - Hiromi Oda
- Department of Orthopaedic Surgery, Saitama Medical University School of Medicine, 38 Morohongo Moroyama-machi, Iruma-gun, Saitama, 350-0495, Japan
| | - Yoon Taek Kim
- Department of Orthopaedic Surgery, Saitama Medical University School of Medicine, 38 Morohongo Moroyama-machi, Iruma-gun, Saitama, 350-0495, Japan
| | - Takashige Umeyama
- Department of Orthopedic Surgery, NTT Medical Center Tokyo, 5-9-22 Higashigotanda, Shinagawa-ku, Tokyo, 141-0022, Japan
| | - Eisei Fukatani
- Department of Orthopaedic Surgery, JR Tokyo General Hospital, 2-1-3 Yoyogi, Shibuya-ku, Tokyo, 151-8528, Japan
| | - Hideya Ito
- Department of Orthopaedic Surgery, Japan Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan
| | - Masayuki Kyomoto
- Division of Science for Joint Reconstruction, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Department of Materials Engineering, School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8656, Japan.,Department of Research, KYOCERA Medical Corporation, 3-3-31 Miyahara, Yodogawa-ku, Osaka, 532-0003, Japan
| | - Hirofumi Oshima
- Division of Science for Joint Reconstruction, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Sensory and Motor System Medicine, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Takeyuki Tanaka
- Sensory and Motor System Medicine, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroshi Kawaguchi
- Japan Community Healthcare Organization, Tokyo Shinjuku Medical Center, Spine Center, 5-1 Tsukudo, Shinjuku-ku, Tokyo, 162-8543, Japan
| | - Kozo Nakamura
- Sensory and Motor System Medicine, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.,Rehabilitation Services Bureau, National Rehabilitation Center for Persons With Disabilities, 4-1, Namiki, Tokorozawa, Saitama, 359-8555, Japan
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Wright TM. CORR Insights ®: Periprosthetic UHMWPE Wear Debris Induces Inflammation, Vascularization, and Innervation After Total Disc Replacement in the Lumbar Spine. Clin Orthop Relat Res 2017; 475:1382-1385. [PMID: 27535283 PMCID: PMC5384907 DOI: 10.1007/s11999-016-5026-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 08/05/2016] [Indexed: 01/31/2023]
Affiliation(s)
- Timothy M Wright
- Department of Biomechanics, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021-4892, USA.
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Veruva SY, Lanman TH, Isaza JE, Freeman TA, Kurtz SM, Steinbeck MJ. Periprosthetic UHMWPE Wear Debris Induces Inflammation, Vascularization, and Innervation After Total Disc Replacement in the Lumbar Spine. Clin Orthop Relat Res 2017; 475:1369-1381. [PMID: 27488379 PMCID: PMC5384906 DOI: 10.1007/s11999-016-4996-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The pathophysiology and mechanisms driving the generation of unintended pain after total disc replacement (TDR) remain unexplored. Ultrahigh-molecular-weight polyethylene (UHMWPE) wear debris from TDRs is known to induce inflammation, which may result in pain. QUESTIONS/PURPOSES The purpose of this study was to determine whether (1) periprosthetic UHMWPE wear debris induces immune responses that lead to the production of tumor necrosis factor-α (TNFα) and interleukin (IL)-1ß, the vascularization factors, vascular endothelial growth factor (VEGF) and platelet-derived growth factor-bb (PDGFbb), and the innervation/pain factors, nerve growth factor (NGF) and substance P; (2) the number of macrophages is associated with the production of the aforementioned factors; (3) the wear debris-induced inflammatory pathogenesis involves an increase in vascularization and associated innervation. METHODS Periprosthetic tissues from our collection of 11 patients with contemporary TDRs were evaluated using polarized light microscopy to quantify UHMWPE wear particles. The major reason for revision (mean implantation time of 3 years [range, 1-6 years]) was pain. For control subjects, biopsy samples from four patients with degenerative disc disease with severe pain and autopsy samples from three normal patients with no history of back pain were also investigated. Immunohistochemistry and histology were used to identify secretory factors, macrophages, and blood vessels. Immunostained serial sections were imaged at ×200 magnification and using MATLAB and NIH ImageJ, a threshold was determined for each factor and used to quantify positive staining normalized to tissue sectional area. The Mann-Whitney U test was used to compare results from different patient groups, whereas the Spearman Rho test was used to determine correlations. Significance was based on p < 0.05. RESULTS The mean percent area of all six inflammatory, vascularization, and innervation factors was higher in TDR tissues when compared with normal disc tissues. Based on nonparametric data analysis, those factors showing the most significant increase included TNFα (5.17 ± 1.76 versus 0.05 ± 0.03, p = 0.02), VEGF (3.02 ± 1.01 versus 0.02 ± 0.002, p = 0.02), and substance P (4.15 ± 1.01 versus 0.08 ± 0.04, p = 0.02). The mean percent area for IL-1ß (2.41 ± 0.66 versus 0.13 ± 0.13, p = 0.01), VEGF (3.02 ± 1.01 versus 0.34 ± 0.29, p = 0.04), and substance P (4.15 ± 1.01 versus 1.05 ± 0.46, p = 0.01) was also higher in TDR tissues when compared with disc tissues from patients with painful degenerative disc disease. Five of the factors, TNFα, IL-1ß, VEGF, NGF, and substance P, strongly correlated with the number of wear particles, macrophages, and blood vessels. The most notable correlations included TNFα with wear particles (p < 0.001, ρ = 0.63), VEGF with macrophages (p = 0.001, ρ = 0.71), and NGF with blood vessels (p < 0.001, ρ = 0.70). Of particular significance, the expression of PDGFbb, NGF, and substance P was predominantly localized to blood vessels/nerve fibers. CONCLUSIONS These findings indicate wear debris-induced inflammatory reactions can be linked to enhanced vascularization and associated innervation/pain factor production at periprosthetic sites around TDRs. Elucidating the pathogenesis of inflammatory particle disease will provide information needed to identify potential therapeutic targets and treatment strategies to mitigate pain and potentially avoid revision surgery. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Sai Y Veruva
- Implant Research Center, Drexel University, 3401 Market Street, Suite 345, Philadelphia, PA, 19104, USA
| | - Todd H Lanman
- Department of Neurosurgery, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | | | - Theresa A Freeman
- Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Steven M Kurtz
- Implant Research Center, Drexel University, 3401 Market Street, Suite 345, Philadelphia, PA, 19104, USA
- Exponent, Inc, Philadelphia, PA, USA
| | - Marla J Steinbeck
- Implant Research Center, Drexel University, 3401 Market Street, Suite 345, Philadelphia, PA, 19104, USA.
- Department of Orthopaedic Surgery, Drexel University College of Medicine, Philadelphia, PA, USA.
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Łapaj Ł, Mróz A, Kokoszka P, Markuszewski J, Wendland J, Helak-Łapaj C, Kruczyński J. Peripheral snap-fit locking mechanisms and smooth surface finish of tibial trays reduce backside wear in fixed-bearing total knee arthroplasty. Acta Orthop 2017; 88:62-69. [PMID: 27781667 PMCID: PMC5251266 DOI: 10.1080/17453674.2016.1248202] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 07/31/2016] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Severe backside wear, observed in older generations of total knee replacements (TKRs), led to redesign of locking mechanisms to reduce micromotions between tibial tray and inlay. Since little is known about whether this effectively reduces backside wear in modern designs, we examined backside damage in retrievals of various contemporary fixed-bearing TKRs. Patients and methods - A consecutive series of 102 inlays with a peripheral (Stryker Triathlon, Stryker Scorpio, DePuy PFC Sigma, Aesculap Search Evolution) or dovetail locking mechanism (Zimmer NexGen, Smith and Nephew Genesis II) was examined. Articular and backside surface damage was evaluated using the semiquantitative Hood scale. Inlays were examined using scanning electron microscopy (SEM) to determine backside wear mechanisms. Results - Mean Hood scores for articular (A) and backside (B) surfaces were similar in most implants-Triathlon (A: 46, B: 22), Genesis II (A: 55, B: 24), Scorpio (A: 57, B: 24), PFC (A: 52, B: 20); Search (A: 56, B: 24)-except the NexGen knee (A: 57, B: 60), which had statistically significantly higher backside wear scores. SEM studies showed backside damage caused by abrasion related to micromotion in designs with dovetail locking mechanisms, especially in the unpolished NexGen trays. In implants with peripheral liner locking mechanism, there were no signs of micromotion or abrasion. Instead, "tray transfer" of polyethylene and flattening of machining was observed. Interpretation - Although this retrieval study may not represent well-functioning TKRs, we found that a smooth surface finish and a peripheral locking mechanism reduce backside wear in vivo, but further studies are required to determine whether this actually leads to reduced osteolysis and lower failure rates.
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Affiliation(s)
- Łukasz Łapaj
- Department of General Orthopaedics, Musculoskeletal Oncology and Trauma Surgery, Poznań University of Medical Sciences
| | | | - Paweł Kokoszka
- Department of General Orthopaedics, Musculoskeletal Oncology and Trauma Surgery, Poznań University of Medical Sciences
| | - Jacek Markuszewski
- Department of General Orthopaedics, Musculoskeletal Oncology and Trauma Surgery, Poznań University of Medical Sciences
| | - Justyna Wendland
- Department of General Orthopaedics, Musculoskeletal Oncology and Trauma Surgery, Poznań University of Medical Sciences
| | - Celina Helak-Łapaj
- Department of Bioinformatics and Computational Biology, Poznań University of Medical Sciences
- Clinical Eye Unit and Pediatric Ophtalmology Service, Heliodor Swiecicki University Hospital, Poznań University of Medical Sciences, Poznań, Poland
| | - Jacek Kruczyński
- Department of General Orthopaedics, Musculoskeletal Oncology and Trauma Surgery, Poznań University of Medical Sciences
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Tsukamoto M, Ohnishi H, Mori T, Kawasaki M, Uchida S, Sakai A. Fifteen-Year Comparison of Wear and Osteolysis Analysis for Cross-Linked or Conventional Polyethylene in Cementless Total Hip Arthroplasty for Hip Dysplasia-A Retrospective Cohort Study. J Arthroplasty 2017; 32:161-165.e1. [PMID: 27444850 DOI: 10.1016/j.arth.2016.06.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 06/05/2016] [Accepted: 06/07/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Cross-linked polyethylene (XLPE) acetabular liners used in cementless total hip arthroplasty (THA) have demonstrated better wear resistance at 10 years compared with conventional polyethylene (CPE) liners. No clinical studies have compared XPLE to CPE liners beyond 10 years. METHODS We performed a 15-year retrospective cohort study on cementless THA performed in patients with developmental hip dysplasia to measure the differences in polyethylene wear rates and the presence of osteolysis. Twenty-four THAs with XLPE and 17 THAs with CPE were evaluated. The mean age of patients was 55.9 years (41-68) in the XLPE group and 54.4 years (40-67) in the CPE group. The mean follow-up period was 15.1 years (13.9-16.1) in the XLPE group and 15.2 years (14.5-16.0) in the CPE group. RESULTS The XLPE group had a significantly lower wear rate at 5 and 10 years compared with the CPE group; however, no significant difference was found at 15 years (XLPE group, 0.040 mm/y; CPE group, 0.034 mm/y). In addition, the incidence of osteolysis did not differ significantly between the groups. However, the incidence of excessive wear between 10 and 15 years after surgery in the XLPE group was significantly higher than that in the CPE group. CONCLUSION XLPE demonstrated no advantage in the wear rate or the incidence of osteolysis at 15 years, despite having superior wear resistance up to 10 years. It is concerning that the incidence of excessive wear was higher in the XLPE group between 10 and 15 years, and this finding should alert the arthroplasty community to this possible problem with the more highly cross-linked polyethylene.
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Affiliation(s)
- Manabu Tsukamoto
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Hideo Ohnishi
- Department of Orthopaedic Surgery, Moji Medical Center, Kitakyushu, Japan
| | - Toshiharu Mori
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Makoto Kawasaki
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Soshi Uchida
- Department of Orthopaedic Surgery, Wakamatsu Hospital for the University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Akinori Sakai
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
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The Biologic Response to Polyetheretherketone (PEEK) Wear Particles in Total Joint Replacement: A Systematic Review. Clin Orthop Relat Res 2016; 474:2394-2404. [PMID: 27432420 PMCID: PMC5052196 DOI: 10.1007/s11999-016-4976-z] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 07/06/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Polyetheretherketone (PEEK) and its composites are polymers resistant to fatigue strain, radiologically transparent, and have mechanical properties suitable for a range of orthopaedic applications. In bulk form, PEEK composites are generally accepted as biocompatible. In particulate form, however, the biologic response relevant to joint replacement devices remains unclear. The biologic response to wear particles affects the longevity of total joint arthroplasties. Particles in the phagocytozable size range of 0.1 µm to 10 µm are considered the most biologically reactive, particularly particles with a mean size of < 1 µm. This systematic review aimed to identify the current evidence for the biologic response to PEEK-based wear debris from total joint arthroplasties. QUESTIONS/PURPOSES (1) What are the quantitative characteristics of PEEK-based wear particles produced by total joint arthroplasties? (2) Do PEEK wear particles cause an adverse biologic response when compared with UHMWPE or a similar negative control biomaterial? (3) Is the biologic response affected by particle characteristics? METHODS Embase and Ovid Medline databases were searched for studies that quantified PEEK-based particle characteristics and/or investigated the biologic response to PEEK-based particles relevant to total joint arthroplasties. The keyword search included brands of PEEK (eg, MITCH, MOTIS) or variations of PEEK types and nomenclature (eg, PAEK, CFR-PEEK) in combination with types of joint (eg, hip, knee) and synonyms for wear debris or immunologic response (eg, particles, cytotoxicity). Peer-reviewed studies, published in English, investigating total joint arthroplasty devices and cytotoxic effects of PEEK particulates were included. Studies investigating devices without articulating bearings (eg, spinal instrumentation devices) and bulk material or contact cytotoxicity were excluded. Of 129 studies, 15 were selected for analysis and interpretation. No studies were found that isolated and characterized PEEK wear particles from retrieved periprosthetic human tissue samples. RESULTS In the four studies that quantified PEEK-based particles produced using hip, knee, and spinal joint replacement simulators, the mean particle size was 0.23 µm to 2.0 µm. The absolute range reported was approximately 0.01 µm to 50 µm. Rod-like carbon particulates and granular-shaped PEEK particles were identified in human tissue by histologic analysis. Ten studies, including six animal models (rat, mouse, and rabbit), three cell line experiments, and two human tissue retreival studies, investigated the biologic response to PEEK-based particles. Qualitative histologic assessments showed immunologic cell infiltration to be similar for PEEK particles when compared with UHMWPE particles in all six of the animal studies identified. However, increased inflammatory cytokine release (such as tumor necrosis factor-α) was identified in only one in vitro study, but without substantial suppression in macrophage viability. Only one study tested the effects of particle size on cytotoxicity and found the largest unfilled PEEK particles (approximately 13 µm) to have a toxic effect; UHMWPE particles in the same size range showed a similar cytotoxic effect. CONCLUSIONS Wear particles produced by PEEK-based bearings were, in almost all cases, in the phagocytozable size range (0.1-10 µm). The studies that evaluated the biologic response to PEEK-based particles generally found cytotoxicity to be within acceptable limits relative to the UHMWPE control, but inconsistent when inflammatory cytokine release was considered. CLINICAL RELEVANCE To translate new and advanced materials into clinical use more quickly, the clinical relevance and validity of preclinical tests need to be improved. To achieve this for PEEK-based devices, human tissue retrieval studies including subsequent particle isolation and characterization analyses are required. In vitro cell studies using isolated wear particles from tissue or validated joint replacement simulators, instead of manufactured particles, are also required.
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Yoshioka R, Nakashima Y, Fujiwara Y, Komohara Y, Takeya M, Nakanishi Y. The biological response of macrophages to PMMA particles with different morphology and size. BIOSURFACE AND BIOTRIBOLOGY 2016. [DOI: 10.1016/j.bsbt.2016.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Histopathological Analysis of PEEK Wear Particle Effects on the Synovial Tissue of Patients. BIOMED RESEARCH INTERNATIONAL 2016; 2016:2198914. [PMID: 27766256 PMCID: PMC5059511 DOI: 10.1155/2016/2198914] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 07/04/2016] [Indexed: 12/13/2022]
Abstract
Introduction. Increasing interest developed in the use of carbon-fiber-reinforced-poly-ether-ether-ketones (CFR-PEEK) as an alternative bearing material in knee arthroplasty. The effects of CFR-PEEK wear in in vitro and animal studies are controversially discussed, as there are no data available concerning human tissue. The aim of this study was to analyze human tissue containing CFR-PEEK as well as UHMWPE wear debris. The authors hypothesized no difference between the used biomaterials. Methods and Materials. In 10 patients during knee revision surgery of a rotating-hinge-knee-implant-design, synovial tissue samples were achieved (tibial inserts: UHMWPE; bushings and flanges: CFR-PEEK). One additional patient received revision surgery without any PEEK components as a control. The tissue was paraffin-embedded, sliced into 2 μm thick sections, and stained with hematoxylin and eosin in a standard process. A modified panoptical staining was also done. Results. A “wear-type” reaction was seen in the testing and the control group. In all samples, the UHMWPE particles were scattered in the tissue or incorporated in giant cells. CFR-PEEK particles were seen as conglomerates and only could be found next to vessels. CFR-PEEK particles showed no giant-cell reactions. In conclusion, the hypothesis has to be rejected. UHMWPE and PEEK showed a different scatter-behavior in human synovial tissue.
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Brulefert K, Córdova LA, Brulin B, Faucon A, Hulin P, Nedellec S, Gouin F, Passuti N, Ishow E, Heymann D. Pro-osteoclastic in vitro effect of Polyethylene-like nanoparticles: Involvement in the pathogenesis of implant aseptic loosening. J Biomed Mater Res A 2016; 104:2649-57. [PMID: 27254768 DOI: 10.1002/jbm.a.35803] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 03/07/2016] [Accepted: 03/16/2016] [Indexed: 12/21/2022]
Abstract
Polyethylene micro-sized wear particles released from orthopedic implants promote inflammation and osteolysis; however, less is known about the bioactivity of polyethylene nanosized wear particles released from the last generation of polymer-bearing surfaces. We aim to assess the internalization of fluorescent polyethylene-like nanoparticles by both human macrophages and osteoclasts and also, to determine their effects in osteoclastogenesis in vitro. Human macrophages and osteoclasts were incubated with several ratios of fluorescent polyethylene-like nanoparticles between 1 and 72 h, and 4 h, 2, 4, 6, and 9 days, respectively. The internalization of nanoparticles was quantified by flow cytometry and followed by both confocal and video time-lapse microscopy. Osteoclast differentiation and activity was semiquantified by tartrate-resistant acid phosphatase (TRAP) staining, TRAP mRNA relative expression, and pit resorption assay, respectively. Macrophages, osteoclast precursors and mature osteoclasts internalized nanoparticles in a dose- and time-dependent manner and maintained their resorptive activity. In addition, nanoparticles significantly increased the osteoclastogenesis as shown by upregulation of the TRAP expressing cell number. We conclude that polyethylene-like nanosized wear particles promote osteoclast differentiation without alteration of bone resorptive activity of mature osteoclasts and they could be considered as important actors in periprosthetic osteolysis of the last new generation of polymer-bearing surfaces. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 104A: 2649-2657, 2016.
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Affiliation(s)
- Kevin Brulefert
- Laboratory of Pathophysiology of Bone Resorption and Therapy of Primary Bone Tumours, INSERM, UMR 957, Nantes, 44035, France.,University of Nantes, Nantes Atlantique Universities, Nantes, France.,Nantes University Hospital, Nantes, France
| | - Luis A Córdova
- Laboratory of Pathophysiology of Bone Resorption and Therapy of Primary Bone Tumours, INSERM, UMR 957, Nantes, 44035, France. .,University of Nantes, Nantes Atlantique Universities, Nantes, France. .,Department of Oral and Maxillofacial Surgery-Faculty of Dentistry, University of Chile-Conicyt, Santiago, Chile.
| | - Bénédicte Brulin
- Laboratory of Pathophysiology of Bone Resorption and Therapy of Primary Bone Tumours, INSERM, UMR 957, Nantes, 44035, France.,University of Nantes, Nantes Atlantique Universities, Nantes, France
| | - Adrien Faucon
- CEISAM-UMR CNRS 6230, University of Nantes, Nantes, France
| | - Philipe Hulin
- Nantes University Hospital, Nantes, France.,MicroPICell Platform, SFR Santé François Bonamy, INSERM, UMS 016-UMS CNRS 3556, Nantes, France
| | - Steven Nedellec
- Nantes University Hospital, Nantes, France.,MicroPICell Platform, SFR Santé François Bonamy, INSERM, UMS 016-UMS CNRS 3556, Nantes, France
| | - François Gouin
- Laboratory of Pathophysiology of Bone Resorption and Therapy of Primary Bone Tumours, INSERM, UMR 957, Nantes, 44035, France.,University of Nantes, Nantes Atlantique Universities, Nantes, France.,Nantes University Hospital, Nantes, France
| | - Norbert Passuti
- Laboratory of Pathophysiology of Bone Resorption and Therapy of Primary Bone Tumours, INSERM, UMR 957, Nantes, 44035, France.,University of Nantes, Nantes Atlantique Universities, Nantes, France.,Nantes University Hospital, Nantes, France
| | - Eléna Ishow
- CEISAM-UMR CNRS 6230, University of Nantes, Nantes, France
| | - Dominique Heymann
- Laboratory of Pathophysiology of Bone Resorption and Therapy of Primary Bone Tumours, INSERM, UMR 957, Nantes, 44035, France.,University of Nantes, Nantes Atlantique Universities, Nantes, France.,Nantes University Hospital, Nantes, France.,Department of Oncology and Metabolism, University of Sheffield, The Medical School, Sheffield, England, United Kingdom
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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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Li Y, Boraschi D. Endotoxin contamination: a key element in the interpretation of nanosafety studies. Nanomedicine (Lond) 2016; 11:269-87. [DOI: 10.2217/nnm.15.196] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The study of toxicity and potential risks of engineered nanoparticles is of particular importance in nanomedicine. Endotoxin, a common contaminant of bacterial origin, has biological effects that can mask the true biological effects of nanoparticles, if its presence is overlooked. In this review, we report the features of nanoparticle contamination by endotoxin, and the different biological effects of endotoxin-contaminated nanoparticles. We will describe different methods for endotoxin detection applied to nanoparticles, and discuss their pros and cons. Eventually, we describe various methods for eliminating endotoxin contamination in nanoparticles. Although there is no universal technique for efficiently removing endotoxin from nanoparticles, specific solutions can be found case by case, which can allow us to perform nanosafety studies in biologically relevant conditions.
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Affiliation(s)
- Yang Li
- Laboratory of Innate Immunity & Cytokines, Institute of Protein Biochemistry, National Research Council, 80131 Naples, Italy
| | - Diana Boraschi
- Laboratory of Innate Immunity & Cytokines, Institute of Protein Biochemistry, National Research Council, 80131 Naples, Italy
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35
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Material Science in Cervical Total Disc Replacement. BIOMED RESEARCH INTERNATIONAL 2015; 2015:719123. [PMID: 26523281 PMCID: PMC4615218 DOI: 10.1155/2015/719123] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 09/17/2015] [Indexed: 12/12/2022]
Abstract
Current cervical total disc replacement (TDR) designs incorporate a variety of different biomaterials including polyethylene, stainless steel, titanium (Ti), and cobalt-chrome (CoCr). These materials are most important in their utilization as bearing surfaces which allow for articular motion at the disc space. Long-term biological effects of implanted materials include wear debris, host inflammatory immune reactions, and osteolysis resulting in implant failure. We review here the most common materials used in cervical TDR prosthetic devices, examine their bearing surfaces, describe the construction of the seven current cervical TDR devices that are approved for use in the United States, and discuss known adverse biological effects associated with long-term implantation of these materials. It is important to appreciate and understand the variety of biomaterials available in the design and construction of these prosthetics and the considerations which guide their implementation.
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Liu A, Richards L, Bladen CL, Ingham E, Fisher J, Tipper JL. The biological response to nanometre-sized polymer particles. Acta Biomater 2015; 23:38-51. [PMID: 26004221 PMCID: PMC4535318 DOI: 10.1016/j.actbio.2015.05.016] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 05/08/2015] [Accepted: 05/15/2015] [Indexed: 11/01/2022]
Abstract
Recently, nanometre-sized UHMWPE particles generated from hip and knee replacements have been identified in vitro and in vivo. UHMWPE particles in the 0.1-1.0μm size range have been shown to be more biologically active than larger particles, provoking an inflammatory response implicated in late aseptic loosening of total joint replacements. The biological activity of nanometre-sized particles has not previously been studied. The biological response to clinically-relevant UHMWPE wear particles including nanometre-sized and micrometre-sized, along with polystyrene particles (FluoSpheres 20nm, 60nm, 200nm and 1.0μm), and nanometre-sized model polyethylene particles (Ceridust 3615®), was determined in terms of osteolytic cytokine release from primary human peripheral blood mononuclear cells (PBMNCs). Nanometre-sized UHMWPE wear particles, nanometre-sized Ceridust 3615® and 20nm FluoSpheres had no significant effect on TNF-α, IL-1β, IL-6 and IL-8 release from PBMNCs at a concentration of 100μm(3) particles per cell after 12 and 24h. The micrometre-size UHMWPE wear particles (0.1-1.0μm) and 60nm, 200nm and 1.0μm FluoSpheres caused significantly elevated osteolytic cytokine release from PBMNCs. These results indicated that particles below circa 50nm fail to activate PBMNCs and that particle size, composition and morphology played a crucial role in cytokine release by particle stimulated macrophages.
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Singh G, Nuechtern JV, Meyer H, Fiedler GM, Awiszus F, Junk-Jantsch S, Bruegel M, Pflueger G, Lohmann CH. Particle characterisation and cytokine expression in failed small-diameter metal-on-metal total hip arthroplasties. Bone Joint J 2015; 97-B:917-23. [DOI: 10.1302/0301-620x.97b7.35163] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The peri-prosthetic tissue response to wear debris is complex and influenced by various factors including the size, area and number of particles. We hypothesised that the ‘biologically active area’ of all metal wear particles may predict the type of peri-prosthetic tissue response. Peri-prosthetic tissue was sampled from 21 patients undergoing revision of a small diameter metal-on-metal (MoM) total hip arthroplasty (THA) for aseptic loosening. An enzymatic protocol was used for tissue digestion and scanning electron microscope was used to characterise particles. Equivalent circle diameters and particle areas were calculated. Histomorphometric analyses were performed on all tissue specimens. Aspirates of synovial fluid were collected for analysis of the cytokine profile analysis, and compared with a control group of patients undergoing primary THA (n = 11) and revision of a failed ceramic-on-polyethylene arthroplasty (n = 6). The overall distribution of the size and area of the particles in both lymphocyte and non-lymphocyte-dominated responses were similar; however, the subgroup with lymphocyte-dominated peri-prosthetic tissue responses had a significantly larger total number of particles. 14 cytokines (interleukin (IL)-1ß, IL-2, IL-4, IL-5, IL-6, IL-10, IL-13, IL-17, interferon (IFN)-γ, and IFN-gamma-inducible protein 10), chemokines (macrophage inflammatory protein (MIP)-1α and MIP-1ß), and growth factors (granulocyte macrophage colony stimulating factor (GM-CSF) and platelet derived growth factor) were detected at significantly higher levels in patients with metal wear debris compared with the control group. Significantly higher levels for IL-1ß, IL-5, IL-10 and GM-CSF were found in the subgroup of tissues from failed MoM THAs with a lymphocyte-dominated peri-prosthetic response compared with those without this response. These results suggest that the ‘biologically active area’ predicts the type of peri-prosthetic tissue response. The cytokines IL-1ß, IL-5, IL-10, and GM-CSF are associated with lymphocyte-dominated tissue responses from failed small-diameter MoM THA. Cite this article: Bone Joint J 2015;97-B:917–23.
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Affiliation(s)
- G. Singh
- National University Health System, 1E
Kent Ridge Road, 119228, Singapore
| | - J. V. Nuechtern
- University of Hamburg-Eppendorf, Martinistrasse
52, D-20246 Hamburg, Germany
| | - H. Meyer
- Otto-von-Guericke University, Leipziger
Strasse 44, D-39120 Magdeburg, Germany
| | - G. M. Fiedler
- Bern University Hospital, F603, CH-3010
Bern, Switzerland
| | - F. Awiszus
- Otto-von-Guericke University, Leipziger
Strasse 44, D-39120 Magdeburg, Germany
| | - S. Junk-Jantsch
- Evangelisches Krankenhaus, Hans-Sachs-Gasse
10-12, A-1180 Vienna, Austria
| | - M. Bruegel
- Ludwig-Maximilians-University, Marchioninistrasse
15, 81377 Munich, Germany
| | - G. Pflueger
- Evangelisches Krankenhaus, Hans-Sachs-Gasse
10-12, A-1180 Vienna, Austria
| | - C. H. Lohmann
- Otto-von-Guericke University, Leipziger
Strasse 44, D-39120 Magdeburg, Germany
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Hata K, Minoda Y, Ikebuchi M, Mizokawa S, Ohta Y, Miyazaki N, Miyake Y, Nakamura H. In vivo wear particles of remelted highly crosslinked polyethylene after total hip arthroplasty: report of four cases. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2015; 26:133. [PMID: 25712074 DOI: 10.1007/s10856-015-5472-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Accepted: 01/20/2015] [Indexed: 06/04/2023]
Abstract
This is the first report of in vivo wear particles from four total hip arthroplasties using remelted highly crosslinked polyethylene. The number of particles was (1.51 ± 0.45) × 10(7) g(-1) (mean ± standard error); particle size (equivalent circle diameter), 0.72 ± 0.15 µm; and roundness, 1.45 ± 0.05. Remelted highly crosslinked polyethylene generates fewer, rounder, equivalently sized particles compared with corresponding reported values for particles generated from conventional polyethylene.
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Affiliation(s)
- Kanako Hata
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
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Glyn-Jones S, Thomas GER, Garfjeld-Roberts P, Gundle R, Taylor A, McLardy-Smith P, Murray DW. The John Charnley Award: Highly crosslinked polyethylene in total hip arthroplasty decreases long-term wear: a double-blind randomized trial. Clin Orthop Relat Res 2015; 473:432-8. [PMID: 25123239 PMCID: PMC4294892 DOI: 10.1007/s11999-014-3735-2] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The use of highly crosslinked polyethylene (HXLPE) is now commonplace for total hip arthroplasty. Hip simulator studies and short-term in vivo measurements suggest that the wear rate of some types of HXLPE is significantly less than conventional ultrahigh-molecular-weight polyethylene (UHMWPE). However, there are few long-term data to support its use. QUESTIONS/PURPOSES The aim of this study was to measure the long-term steady-state wear of HXLPE compared with UHMWPE liners in a prospective, double-blind, randomized controlled trial using radiostereometric analysis. METHODS Fifty-four patients were randomized to receive hip arthroplasties with either UHMWPE liners or HXLPE liners. Complete followup was available on 39 of these patients (72%). All patients received the same cemented stem and an uncemented acetabular component. Three-dimensional penetration of the head into the socket was determined at 10 years using a radiostereometric analysis system, which has an in vivo accuracy of <0.1 mm. Oxford Hip Scores were compared between the groups. RESULTS At 10 years there was significantly less wear of HXLPE (0.003 mm/year; 95% confidence interval [CI], ±0.010; SD 0.023; range, -0.057 to 0.074) compared with UHMWPE (0.030 mm/year; 95% CI, ±0.012; p<0.001; SD 0.0.27; range, -0.001 to 0.164). The volumetric penetration from 1 to 10 years for the UHMWPE group was 98 mm3 (95% CI, ±46 mm3; SD 102 mm3; range, -4 to 430 mm3) compared with 14 mm3 (95% CI, ±40 mm3; SD 91 mm3; range, -189 to 242 mm3) for the HXLPE group (p=0.01). CONCLUSIONS This study demonstrates that HXLPE has little detectable steady-state in vivo wear. This may result in fewer reoperations from loosening; however, careful clinical followup into the second decade still needs to be performed. LEVEL OF EVIDENCE Level I, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Siôn Glyn-Jones
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, NIHR Musculoskeletal Biomedical Research Unit, Nuffield Orthopaedic Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD UK
| | - Geraint E. R. Thomas
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, NIHR Musculoskeletal Biomedical Research Unit, Nuffield Orthopaedic Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD UK
| | - Patrick Garfjeld-Roberts
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, NIHR Musculoskeletal Biomedical Research Unit, Nuffield Orthopaedic Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD UK
| | - Roger Gundle
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, NIHR Musculoskeletal Biomedical Research Unit, Nuffield Orthopaedic Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD UK
| | - Adrian Taylor
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, NIHR Musculoskeletal Biomedical Research Unit, Nuffield Orthopaedic Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD UK
| | - Peter McLardy-Smith
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, NIHR Musculoskeletal Biomedical Research Unit, Nuffield Orthopaedic Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD UK
| | - David W. Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, NIHR Musculoskeletal Biomedical Research Unit, Nuffield Orthopaedic Centre, University of Oxford, Windmill Road, Oxford, OX3 7LD UK
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How has the introduction of new bearing surfaces altered the biological reactions to byproducts of wear and modularity? Clin Orthop Relat Res 2014; 472:3699-708. [PMID: 24942963 PMCID: PMC4397759 DOI: 10.1007/s11999-014-3725-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Biological responses to wear debris were largely elucidated in studies focused on conventional ultrahigh-molecular-weight polyethylene (UHMWPE) and some investigations of polymethymethacrylate cement and orthopaedic metals. However, newer bearing couples, in particular metal-on-metal but also ceramic-on-ceramic bearings, may induce different biological reactions. QUESTIONS/PURPOSES Does wear debris from the newer bearing surfaces result in different biological responses compared with the known responses observed with conventional metal-on-UHMWPE bearings? METHODS A Medline search of articles published after 1996 supplemented by a hand search of reference lists of included studies and relevant conference proceedings was conducted to identify the biological responses to orthopaedic wear debris with a focus on biological responses to wear generated from metal-on-highly crosslinked polyethylene, metal-on-metal, ceramic-on-ceramic, and ceramic-on-polyethylene bearings. Articles were selected using criteria designed to identify reports of wear debris particles and biological responses contributing to prosthesis failure. Case reports and articles focused on either clinical outcomes or tribology were excluded. A total of 83 papers met the criteria and were reviewed in detail. RESULTS Biological response to conventional UHMWPE is regulated by the innate immune response. It is clear that the physical properties of debris (size, shape, surface topography) influence biological responses in addition to the chemical composition of the biomaterials. Highly crosslinked UHMWPE particles have the potential to alter, rather than eliminate, the biological response to conventional UHMWPE. Metal wear debris can generate elevated plasma levels of cobalt and chromium ions. These entities can provoke responses that extend to the elicitation of an acquired immune response. Wear generated from ceramic devices is significantly reduced in volume and may provide the impression of an "inert" response, but clinically relevant biological reactions do occur, including granulomatous responses in periprosthetic tissues. CONCLUSIONS The material composition of the device, the physical form of the debris, and disease pathophysiology contribute to complex interactions that determine the outcome to all wear debris. Metal debris does appear to increase the complexity of the biological response with the addition of immunological responses (and possibly direct cellular cytotoxicity) to the inflammatory reaction provoked by wear debris in some patients. However, the introduction of highly crosslinked polyethylene and ceramic bearing surfaces shows promising signs of reducing key biological mechanisms in osteolysis.
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Schwarzkopf R, Carlson EM, Tibbo ME, Josephs L, Scott RD. Synovial fluid differential cell count in wear debris synovitis after total knee replacement. Knee 2014; 21:1023-8. [PMID: 25112210 DOI: 10.1016/j.knee.2014.07.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 03/21/2014] [Accepted: 07/21/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Determining the cause of synovitis following total knee arthroplasty (TKA) can be challenging. The differential diagnoses include infection, hemarthrosis, instability, crystalline disease, wear debris or idiopathic causes. Wear particle synovitis can mimic periprosthetic infection with symptoms of pain and effusion. Radiographs and physical exam are often inconclusive in differentiating the two. Synovial fluid analysis is routinely used in evaluating periprosthetic infections. We examined the association between synovial white blood cell count and differentials, and polyethylene wear and osteolysis, to see if fluid analysis can aid in establishing the diagnosis of wear particle synovitis. METHODS A cell count and differential was obtained from synovial fluid samples from 54 TKAs undergoing revision for aseptic failure. Explanted polyethylene inserts were analyzed for linear and volumetric wear, oxidation (ketone peak height), and damage features. Analysis was performed to assess the relationship between cell counts and polyethylene wear indicators as well as severity of intra-operative and radiographic osteolysis. RESULTS Total and percent mononuclear (monocyte and lymphocyte) cell counts were found to be elevated in the presence of documented wear debris synovitis and an association was suggested between their levels and maximum ketone levels. CONCLUSION The present study implies that the differential cell count of knee fluid can help distinguish wear debris from infection as a source of synovitis following TKA and identifies the value of the mononuclear cell count as a possible tool to assess abnormal wear rates of the polyethylene insert. Further research into identifying the exact role of monocytes in the wear debris synovitis and osteolytic pathways is warranted. LEVEL OF EVIDENCE Level II, diagnostic study.
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Affiliation(s)
- Ran Schwarzkopf
- University of California Irvine Medical Center, Orange, CA, USA.
| | - Evan M Carlson
- Thayer School of Engineering, Dartmouth College, NH, USA
| | - Meagan E Tibbo
- Thayer School of Engineering, Dartmouth College, NH, USA
| | - Lee Josephs
- New England Baptist Hospital, Harvard Medical School, Boston, MA, USA
| | - Richard D Scott
- New England Baptist Hospital, Harvard Medical School, Boston, MA, USA
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Pajarinen J, Lin TH, Sato T, Yao Z, Goodman SB. Interaction of Materials and Biology in Total Joint Replacement - Successes, Challenges and Future Directions. J Mater Chem B 2014; 2:7094-7108. [PMID: 25541591 PMCID: PMC4273175 DOI: 10.1039/c4tb01005a] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Total joint replacement (TJR) has revolutionized the treatment of end-stage arthritic disorders. This success is due, in large part, to a clear understanding of the important interaction between the artificial implant and the biology of the host. All surgical procedures in which implants are placed in the body evoke an initial inflammatory reaction, which generally subsides over several weeks. Thereafter, a series of homeostatic events occur leading to progressive integration of the implant within bone and the surrounding musculoskeletal tissues. The eventual outcome of the operation is dependent on the characteristics of the implant, the precision of the surgical technique and operative environment, and the biological milieu of the host. If these factors and events are not optimal, adverse events can occur such as the development of chronic inflammation, progressive bone loss due to increased production of degradation products from the implant (periprosthetic osteolysis), implant loosening or infection. These complications can lead to chronic pain and poor function of the joint reconstruction, and may necessitate revision surgery or removal of the prosthesis entirely. Recent advances in engineering, materials science, and the immunological aspects associated with orthopaedic implants have fostered intense research with the hope that joint replacements will last a lifetime, and facilitate pain-free, normal function.
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Affiliation(s)
- J Pajarinen
- Department of Orthopaedic Surgery, Orthopaedic Surgery Laboratories, Stanford University, Stanford, CA, USA
| | - T-H Lin
- Department of Orthopaedic Surgery, Orthopaedic Surgery Laboratories, Stanford University, Stanford, CA, USA
| | - T Sato
- Department of Orthopaedic Surgery, Orthopaedic Surgery Laboratories, Stanford University, Stanford, CA, USA
| | - Z Yao
- Department of Orthopaedic Surgery, Orthopaedic Surgery Laboratories, Stanford University, Stanford, CA, USA
| | - S B Goodman
- Department of Orthopaedic Surgery, Orthopaedic Surgery Laboratories, Stanford University, Stanford, CA, USA
- Department of Bioengineering, Orthopaedic Surgery Laboratories, Stanford University, Stanford, CA, USA
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Prokopovich P. Interactions between mammalian cells and nano- or micro-sized wear particles: physico-chemical views against biological approaches. Adv Colloid Interface Sci 2014; 213:36-47. [PMID: 25307126 DOI: 10.1016/j.cis.2014.09.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Revised: 08/20/2014] [Accepted: 09/06/2014] [Indexed: 11/26/2022]
Abstract
Total joint arthroplasty (TJA) is a more and more frequent approach for the treatment of end-stage osteoarthritis in young and active adults; it successfully relieves joint pain and improves function significantly enhancing the health-related quality of life. Aseptic loosening and other wear-related complications are some of the most recurrent reasons for revision of TJA. This review focuses on current understanding of the biological reactions to prosthetic wear debris comparing in vivo and in vitro results. Mechanisms of interactions of various types of cells with metal, polymeric and ceramic wear particles are summarised. Alternative views based on multidisciplinary approaches are proposed to consider physico-chemical, surface parameters of wear particles (such as: particle size, geometry and charge) and material (particle chemical composition and its nature) with biological effects (cellular responses).
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44
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Wang Z, Huang W, Ma Y. Micro-scale abrasive wear behavior of medical implant material Ti–25Nb–3Mo–3Zr–2Sn alloy on various friction pairs. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2014; 42:211-8. [DOI: 10.1016/j.msec.2014.05.039] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Revised: 04/07/2014] [Accepted: 05/18/2014] [Indexed: 10/25/2022]
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Grosse S, Haugland HK, Lilleng P, Ellison P, Hallan G, Høl PJ. Wear particles and ions from cemented and uncemented titanium-based hip prostheses-a histological and chemical analysis of retrieval material. J Biomed Mater Res B Appl Biomater 2014; 103:709-17. [PMID: 25051953 PMCID: PMC4413358 DOI: 10.1002/jbm.b.33243] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 06/10/2014] [Accepted: 07/08/2014] [Indexed: 12/13/2022]
Abstract
Wear debris-induced inflammation is considered to be the main cause for periprosthetic osteolysis in total hip replacements (THR). The objective of this retrieval study was to examine the tissue reactions and exposure to metal ions and wear particles in periprosthetic tissues and blood samples from patients with titanium (Ti)-based hip prostheses that were revised due to wear, osteolysis, and/or aseptic loosening. Semiquantitative, histological tissue evaluations in 30 THR-patients revealed numerous wear debris-loaded macrophages, inflammatory cells, and necrosis in both groups. Particle load was highest in tissues adjacent to loosened cemented Ti stems that contained mainly submicron zirconium (Zr) dioxide particles. Particles containing pure Ti and Ti alloy elements were most abundant in tissues near retrieved uncemented cups. Polyethylene particles were also detected, but accounted only for a small portion of the total particle number. The blood concentrations of Ti and Zr were highly elevated in cases with high abrasive wear and osteolysis. Our findings indicate that wear particles of different chemical composition induced similar inflammatory responses, which suggests that particle size and load might be more important than the wear particle composition in periprosthetic inflammation and osteolysis. © 2014 The Authors. Journal of Biomedical Materials Research Part B: Applied Biomaterials Published by Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 103B:709–717, 2015.
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Affiliation(s)
- Susann Grosse
- Department of Clinical Medicine, University of Bergen, N-5021, Norway
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Biotribology of a mobile bearing posterior stabilised knee design - Effect of motion restraint on wear, tibio-femoral kinematics and particles. J Biomech 2014; 47:2415-23. [DOI: 10.1016/j.jbiomech.2014.04.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 04/11/2014] [Accepted: 04/11/2014] [Indexed: 11/19/2022]
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47
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Zhang K, Yang SY, Yang S, Bai L, Li P, Liu D, Schurman JR, Wooley PH. Different influence of Ti, PMMA, UHMWPE, and Co-Cr particles on peripheral blood monocytes during periprosthetic inflammation. J Biomed Mater Res A 2014; 103:358-64. [PMID: 24659563 DOI: 10.1002/jbm.a.35176] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 03/19/2014] [Accepted: 03/21/2014] [Indexed: 12/28/2022]
Affiliation(s)
- Kai Zhang
- Department of Orthopaedics; Affiliated Hospital to Binzhou Medical College; Binzhou China
| | - Shang-You Yang
- Department of Biological Sciences; Wichita State University; Wichita Kansas 67214
- Orthopaedic Research Institute; Via Christi Hospital St. Francis; Wichita Kansas 67214
| | - Shuye Yang
- Department of Orthopaedics; Affiliated Hospital to Binzhou Medical College; Binzhou China
- Department of Biological Sciences; Wichita State University; Wichita Kansas 67214
| | - Ling Bai
- Orthopaedic Research Institute; Via Christi Hospital St. Francis; Wichita Kansas 67214
| | - Peng Li
- Department of Orthopaedics; Affiliated Hospital to Binzhou Medical College; Binzhou China
| | - Dong Liu
- Department of Orthopaedics; Affiliated Hospital to Binzhou Medical College; Binzhou China
| | | | - Paul H. Wooley
- Department of Biological Sciences; Wichita State University; Wichita Kansas 67214
- Orthopaedic Research Institute; Via Christi Hospital St. Francis; Wichita Kansas 67214
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Liu GD, Yu HJ, Ou S, Luo X, Ni WD, Huang XK, Chen JY, Wang Y, Javard P, Fei J. Human beta-defensin-3 for the diagnosis of periprosthetic joint infection and loosening. Orthopedics 2014; 37:e384-90. [PMID: 24762845 DOI: 10.3928/01477447-20140401-61] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 11/22/2013] [Indexed: 02/03/2023]
Abstract
In this study, the difference in expression of human beta-defensin-3 in periprosthetic tissue and cancellous bone was observed in the periprosthetic tissue and cancellous bone of patients in the periprosthetic joint infection group, the aseptic loosening group, and the spacer treatment group as well as the synovial membrane and ilium of the normal control group. Hematoxylin and eosin staining of the synovial tissue showed different levels of neutrophil infiltration in all groups except for the normal control group. Immunofluorescence staining of periprosthetic tissue and cancellous bone showed the most positive cells expressing human beta-defensin-3 and the largest mean optical density in the periprosthetic joint infection group, followed by the aseptic loosening group, the spacer treatment group, and the normal control group, with a significant difference in comparison between the periprosthetic joint infection group and the other 3 groups (P<.01). White blood cell count, erythrocyte sedimentation rate, and C-reactive protein level were highest in the periprosthetic joint infection group, whereas no difference was found between the other 3 groups. Taken together, high levels of human beta-defensin-3 protein expression were found in the periprosthetic tissue and cancellous bone of patients with periprosthetic joint infection and aseptic loosening, but there are differential expressions of human beta-defensin-3, and this may provide a new marker for the differential diagnosis of infection and loosening of the artificial joint.
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Liu A, Ingham E, Fisher J, Tipper JL. Generation of a large volume of clinically relevant nanometre-sized ultra-high-molecular-weight polyethylene wear particles for cell culture studies. Proc Inst Mech Eng H 2014; 228:418-26. [PMID: 24658586 PMCID: PMC4232278 DOI: 10.1177/0954411914528308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
It has recently been shown that the wear of ultra-high-molecular-weight polyethylene in hip and knee prostheses leads to the generation of nanometre-sized particles, in addition to micron-sized particles. The biological activity of nanometre-sized ultra-high-molecular-weight polyethylene wear particles has not, however, previously been studied due to difficulties in generating sufficient volumes of nanometre-sized ultra-high-molecular-weight polyethylene wear particles suitable for cell culture studies. In this study, wear simulation methods were investigated to generate a large volume of endotoxin-free clinically relevant nanometre-sized ultra-high-molecular-weight polyethylene wear particles. Both single-station and six-station multidirectional pin-on-plate wear simulators were used to generate ultra-high-molecular-weight polyethylene wear particles under sterile and non-sterile conditions. Microbial contamination and endotoxin levels in the lubricants were determined. The results indicated that microbial contamination was absent and endotoxin levels were low and within acceptable limits for the pharmaceutical industry, when a six-station pin-on-plate wear simulator was used to generate ultra-high-molecular-weight polyethylene wear particles in a non-sterile environment. Different pore-sized polycarbonate filters were investigated to isolate nanometre-sized ultra-high-molecular-weight polyethylene wear particles from the wear test lubricants. The use of the filter sequence of 10, 1, 0.1, 0.1 and 0.015 µm pore sizes allowed successful isolation of ultra-high-molecular-weight polyethylene wear particles with a size range of < 100 nm, which was suitable for cell culture studies.
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Affiliation(s)
- Aiqin Liu
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, Faculty of Engineering, University of Leeds, Leeds, UK
| | - Eileen Ingham
- Institute of Medical and Biological Engineering, School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, UK
| | - John Fisher
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, Faculty of Engineering, University of Leeds, Leeds, UK
| | - Joanne L Tipper
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, Faculty of Engineering, University of Leeds, Leeds, UK
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50
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Piñol I, Torres A, Gil G, Prats E, Puig-Verdier L, Hinarejos P. Polyethylene particles in joint fluid and osteolysis in revision total knee arthroplasty. Knee 2014; 21:402-5. [PMID: 24238652 DOI: 10.1016/j.knee.2013.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 09/06/2013] [Accepted: 10/22/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND One of the most frequent reasons for total knee arthroplasty late failure is osteolysis. It has been related to foreign body reaction to polyethylene particles. The aim of this study is to analyse the number, size and morphology of polyethylene particles in synovial fluid in total knee arthroplasty revision and correlate them to the pathology and the degree of osteolysis. METHODS Synovial fluid was obtained in 12 patients before the revision total knee arthroplasty. Polyethylene particles were isolated and analysed through scanning electron microscopy. Samples of synovial tissue were analysed with optical microscopy while considering the parameters of particles and histiocytic infiltration. Osteolysis was analysed with plain radiography and the macroscopic aspect during surgery. RESULTS The statistical analysis showed a significant correlation between a high concentration of polyethylene particles in synovial fluid and a high degree of osteolysis. The concentration of particles in synovial fluid also showed a significant correlation with a high degree of particles and histiocytes in the histological analysis. There was a relationship between the size of particles and the degree of osteolysis. No relationship was found between the shape of the particles and the histological findings or the degree of osteolysis. CONCLUSIONS In an "in vivo" TKA scenario, the presence of a high concentration of polyethylene particles in the synovial fluid seems to be the cause of a highly active foreign body histological reaction, with an increased number of histiocytes, which seems to be the cause of a significant degree of osteolysis around the implant.
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Affiliation(s)
- Ignasi Piñol
- Hospital del Mar. Servei de COT., Passeig Maritim 25-29, Barcelona CP: 08003, Spain.
| | - Alberto Torres
- Hospital del Mar. Servei de COT., Passeig Maritim 25-29, Barcelona CP: 08003, Spain
| | - Gabriel Gil
- Hospital del Mar. Servei de COT., Passeig Maritim 25-29, Barcelona CP: 08003, Spain
| | - Eva Prats
- Hospital del Mar. Servei de COT., Passeig Maritim 25-29, Barcelona CP: 08003, Spain
| | - Lluis Puig-Verdier
- Hospital del Mar. Servei de COT., Passeig Maritim 25-29, Barcelona CP: 08003, Spain
| | - Pedro Hinarejos
- Hospital del Mar. Servei de COT., Passeig Maritim 25-29, Barcelona CP: 08003, Spain
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