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Zhong Q, Pan X, Chen Y, Lian Q, Gao J, Xu Y, Wang J, Shi Z, Cheng H. Prosthetic Metals: Release, Metabolism and Toxicity. Int J Nanomedicine 2024; 19:5245-5267. [PMID: 38855732 PMCID: PMC11162637 DOI: 10.2147/ijn.s459255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 05/13/2024] [Indexed: 06/11/2024] Open
Abstract
The development of metallic joint prostheses has been ongoing for more than a century alongside advancements in hip and knee arthroplasty. Among the materials utilized, the Cobalt-Chromium-Molybdenum (Co-Cr-Mo) and Titanium-Aluminum-Vanadium (Ti-Al-V) alloys are predominant in joint prosthesis construction, predominantly due to their commendable biocompatibility, mechanical strength, and corrosion resistance. Nonetheless, over time, the physical wear, electrochemical corrosion, and inflammation induced by these alloys that occur post-implantation can cause the release of various metallic components. The released metals can then flow and metabolize in vivo, subsequently causing potential local or systemic harm. This review first details joint prosthesis development and acknowledges the release of prosthetic metals. Second, we outline the metallic concentration, biodistribution, and elimination pathways of the released prosthetic metals. Lastly, we discuss the possible organ, cellular, critical biomolecules, and significant signaling pathway toxicities and adverse effects that arise from exposure to these metals.
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Affiliation(s)
- Qiang Zhong
- Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Xin Pan
- Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Yuhang Chen
- Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Qiang Lian
- Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Jian Gao
- Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Yixin Xu
- Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Jian Wang
- Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Zhanjun Shi
- Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Hao Cheng
- Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, People’s Republic of China
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Saito N, Haniu H, Aoki K, Nishimura N, Uemura T. Future Prospects for Clinical Applications of Nanocarbons Focusing on Carbon Nanotubes. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2022; 9:e2201214. [PMID: 35754236 PMCID: PMC9404397 DOI: 10.1002/advs.202201214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/18/2022] [Indexed: 06/15/2023]
Abstract
Over the past 15 years, numerous studies have been conducted on the use of nanocarbons as biomaterials towards such applications as drug delivery systems, cancer therapy, and regenerative medicine. However, the clinical use of nanocarbons remains elusive, primarily due to short- and long-term safety concerns. It is essential that the biosafety of each therapeutic modality be demonstrated in logical and well-conducted experiments. Accordingly, the fundamental techniques for assessing nanocarbon biomaterial safety have become more advanced. Optimal controls are being established, nanocarbon dispersal techniques are being refined, the array of biokinetic evaluation methods has increased, and carcinogenicity examinations under strict conditions have been developed. The medical implementation of nanocarbons as a biomaterial is in sight. With a particular focus on carbon nanotubes, these perspectives aim to summarize the contributions to date on nanocarbon applications and biosafety, introduce the recent achievements in evaluation techniques, and clarify the future prospects and systematic introduction of carbon nanomaterials for clinical use through practical yet sophisticated assessment methods.
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Affiliation(s)
- Naoto Saito
- Institute for Biomedical Sciences, Interdisciplinary Cluster for Cutting Edge Research, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Hisao Haniu
- Institute for Biomedical Sciences, Interdisciplinary Cluster for Cutting Edge Research, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Kaoru Aoki
- Department of Applied Physical Therapy, Shinshu University School of Health Sciences, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Naoyuki Nishimura
- Institute for Biomedical Sciences, Interdisciplinary Cluster for Cutting Edge Research, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Takeshi Uemura
- Institute for Biomedical Sciences, Interdisciplinary Cluster for Cutting Edge Research, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
- Division of Gene Research, Research Center for Supports to Advanced Science, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
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Haffer H, Bender A, Krump A, Hardt S, Winkler T, Damm P. Is Training With Gym Machines Safe After Hip Arthroplasty?—An In Vivo Load Investigation. Front Bioeng Biotechnol 2022; 10:857682. [PMID: 35402408 PMCID: PMC8989469 DOI: 10.3389/fbioe.2022.857682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 02/07/2022] [Indexed: 12/12/2022] Open
Abstract
Background: Training with gym machines is one of the most popular physical activities after total hip arthroplasty (THA). However, to date, there are no evidence-based recommendations for physical activity after THA, worldwide. The aim of the study is to evaluate the in vivo hip joint loads during exercises on four widely used gym machines in order to provide a source for an evidence-based patient counselling for arthroplasty surgeons. Methods: The in vivo hip joint loads in seven patients (59.6 ± 6.4 years, 28.6 ± 2.1 kg/m2) with instrumented hip implants were assessed. The resulting force (Fres), bending moment (Mbend), and torsional moment (Mtors) were evaluated during the training on leg curl/leg extension machines (loads: 20, 30, and 40 kg), leg press machine [backrest: 10°, 30°, and 60°; load: 50, 75, and 100%BW (bodyweight)], and a rope pull machine (abduction/adduction/flexion/extension; each ipsi- and contralateral; load 10 kg). These loads were compared with the loads during walking on treadmill at 4 km/h (median peak values: Fres 303%BW, Mbend 4.25%BWm, and Mtors 2.70%BWm). Results: In each of the four performed exercises with a total of 23 different load conditions or exercise modes analyzed, a significantly lower or not different load was detected with respect to Fres, Mbend, and Mtors measured while walking with 4 km/h. Nevertheless, Fres and Mbend demonstrated a trend to increased loading during the ipsilateral monopod standing rope pull exercises hip flexion, extension, and abduction. Conclusion: Based on our investigation, we assume that the investigated gym machines and external loads can be considered mainly as low-impact sports (with some exceptions) and thus as safe physical activity after THA. Due to the fact that the examinations were conducted in the mean 17.4 months after THA, the applicability of the results to the immediate postoperative period is limited.
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Affiliation(s)
- Henryk Haffer
- Center for Musculoskeletal Surgery Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Alwina Bender
- Julius Wolff Institute, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Alexander Krump
- Julius Wolff Institute, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Sebastian Hardt
- Center for Musculoskeletal Surgery Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Tobias Winkler
- Center for Musculoskeletal Surgery Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Julius Wolff Institute, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Berlin Institute of Health Center for Regenerative Therapies, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Philipp Damm
- Julius Wolff Institute, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- *Correspondence: Philipp Damm,
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Improved Anti-Washout Property of Calcium Sulfate/Tri-Calcium Phosphate Premixed Bone Substitute with Glycerin and Hydroxypropyl Methylcellulose. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11178136] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Calcium sulfate/calcium phosphate (CS-CP)-based bone substitutes have been developed in premixed putty for usage in clinical applications. However, it is difficult to completely stop the bleeding during an operation because premixed putty can come into contact with blood or body fluids leading to disintegration. Under certain conditions depending on particle size and morphology, collapsed (washed) particles can cause inflammation and delay bone healing. In this context, anti-washout premixed putty CS-CP was prepared by mixing glycerin with 1, 2, and 4 wt% of hydroxypropyl methylcellulose (HPMC), and the resultant anti-washout properties were evaluated. The results showed that more than 70% of the premixed putty without HPMC was disintegrated after being immersed into simulated body fluid (SBF) for 15 min. The results demonstrated that the more HPMC was contained in the premixed putty, the less disintegration occurred. We conclude that CS-CP pre-mixed putty with glycerin and HPMC is a potential bone substitute that has good anti-washout properties for clinical applications.
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Haffer H, Popovic S, Martin F, Hardt S, Winkler T, Damm P. In vivo loading on the hip joint in patients with total hip replacement performing gymnastics and aerobics exercises. Sci Rep 2021; 11:13395. [PMID: 34183711 PMCID: PMC8239021 DOI: 10.1038/s41598-021-92788-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/09/2021] [Indexed: 01/17/2023] Open
Abstract
A further increase in the number of total hip arthroplasty (THA) is predicted, in particular the number of young THA patients has raised and with it their demands. There is no standardized evidence-based rehabilitation program and no reliable guidelines for sports activities after THA. Stretching and strengthening gymnastics are routinely performed in rehabilitation and aerobics as a sport after THA. The aim of the investigation was to determine the in vivo force and moments acting on the hip prosthesis during gymnastics and aerobic exercises to provide a source for evidence-based recommendations. Hip joint loads were measured in six patients with instrumented hip implants. The resulting force FRes, bending moment MBend at the neck and torsional moment MTors at the stem were examined during seven strengthening (with two different resistance bands) and four stretching gymnastic exercises and seven aerobic exercises with and without an aerobic step board compared to the loads during the reference activity walking. The stretching and strengthening gymnastics exercises and the aerobic exercises with and without a board demonstrated in their median peak force and moments mostly lower or similar values compared to walking. Significantly increased loads were recorded for the flexor stretching exercise in monopod stand (Fres and MBend), the strengthening abduction exercise on the chair (MTors) and the strengthening flexion exercise with the stronger resistance band (MTors). We also found a significant increase in median peak values in aerobic exercises with a board for the "Basic Step" (ipsilateral started Fres and MTors; contralateral started MTors), "Kickstep ipsilateral started" (Fres and MTors) and "Over the Top contralateral started" (Fres). The in vivo loads in THA patients during frequently performed stretching, strengthening and aerobic exercises were demonstrated for the first time. It was proved that stretching gymnastic exercises are safe in terms of resulting force, bending and torque moments for THA patients, although an external assistance for stabilization may be considered. Strengthening gymnastics exercises are reliable in terms of Fres, MBend and MTors, but, based on our data, we recommend to adhere to the communicated specific postoperative restrictions and select the resistance bands with lower tension. Aerobic exercises without an aerobic board can be considered as reliable activity in terms of force and moments for THA patients. Aerobic exercises with a board are not recommended for the early postoperative period and in our opinion need to be adapted to the individual muscular and coordinative resources.
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Affiliation(s)
- Henryk Haffer
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Srdan Popovic
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
| | - Franziska Martin
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
| | - Sebastian Hardt
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Tobias Winkler
- Berlin-Institute of Health, Center for Regenerative Therapies, Center for Musculoskeletal Surgery, Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Philipp Damm
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany.
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Rheologic Behavior of Bovine Calf Serum. MATERIALS (BASEL, SWITZERLAND) 2021; 14:ma14102538. [PMID: 34068363 PMCID: PMC8153264 DOI: 10.3390/ma14102538] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/06/2021] [Accepted: 05/08/2021] [Indexed: 12/23/2022]
Abstract
Recent studies have illuminated the rheological behavior of synovial fluid and the role of protein and hyaluronan (HA). However, with respect to artificial joint replacement in standardized wear simulations, bovine serum is used as fluid test medium. Little is known about the rheological characteristics of bovine serum, which are needed for precise tribological investigations. The steady shear viscosity η of bovine calf serum is determined for protein concentrations used in standardized wear simulations depending on shear rate γ˙ and temperature T. Additionally, the density of the serum is determined for both protein concentrations. The results show shear thinning behavior of bovine calf serum with a nearly Newtonian behavior in the range of high shear rates. Within the range of high shear rates, mean viscosities of η = 0.82-0.88 mPa·s were found for protein concentrations of 20 g/L and mean viscosities of η = 0.88-0.94 mPa·s for 30 g/L, decreasing with temperature. Densities of 1.004-1.005 g/cm3 and 1.007-1.008 g/cm3 were found for 20 and 30 g/L protein concentrations, respectively.
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Calo C, Preston H, Clements A. Retroperitoneal lymphadenopathy secondary to joint replacement wear and debris, a case report. Gynecol Oncol Rep 2018; 23:10-12. [PMID: 29892683 PMCID: PMC5993519 DOI: 10.1016/j.gore.2017.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 11/29/2017] [Accepted: 12/13/2017] [Indexed: 11/16/2022] Open
Abstract
We present a case of a 63-year-old female who initially presented with complaints of vulvar swelling and was subsequently found to have isolated retroperitoneal lymphadenopathy on imaging. Biopsy was performed and was indicative of weakly polarizable material that raised the consideration of joint prosthesis wear debris. Due to the patient's concern for an underlying malignancy of gynecologic origin, a laparoscopic lymphadenectomy was ultimately performed and final pathology was consistent with reactive changes due to joint wear and debris from the patient's bilateral total knee arthroplasties placed approximately 16 years prior. While this is a rare presentation, it is important to consider this in the differential of retroperitoneal lymphadenopathy as these patients are often referred to a gynecologic oncologist for further workup. Lymphadenopathy due to joint wear and debris from arthroplasty is a rare finding. While the differential is broad, it should include this etiology. Gynecologic oncologists should be aware of this finding and manage accordingly.
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Affiliation(s)
- C Calo
- Riverside Methodist Hospital, 3535 Olentangy River Rd, Columbus, OH 43214, United States
| | - H Preston
- South Pointe Hospital, 20000 Harvard Rd, Warrensville Heights, OH 44122, United States
| | - A Clements
- Riverside Methodist Hospital, 3535 Olentangy River Rd, Columbus, OH 43214, United States
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Abstract
The chemical composition, surface structure and topography of a biomaterial have an essential influence on the effects of an implant in the human body. In orthopedic and trauma surgery they make a relevant contribution to solve the current and future challenges. Particularly high are the requirements of permanent implants in bone. Besides material aging due to oxidation, implants are subjected to cyclic loading that leads to relevant biomechanical wear and abrasion. To date significant efforts have been made to minimize adverse implant-associated immunoreactions as well as the risk of periprosthetic infections. This review gives an overview of surface modifications of implants designed for clinical application and their effects in vivo. Beside material-specific and biological principles, different surface modifications for distinct clinical applications are presented. Furthermore, current developmental strategies for the targeted clinical application of implant surfaces are outlined.
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Affiliation(s)
- Marcus Jäger
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandst. 55, 45147, Essen, Deutschland.
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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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10
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Dyskova T, Gallo J, Kriegova E. The Role of the Chemokine System in Tissue Response to Prosthetic By-products Leading to Periprosthetic Osteolysis and Aseptic Loosening. Front Immunol 2017; 8:1026. [PMID: 28883822 PMCID: PMC5573717 DOI: 10.3389/fimmu.2017.01026] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 08/08/2017] [Indexed: 12/27/2022] Open
Abstract
Millions of total joint replacements are performed annually worldwide, and the number is increasing every year. The overall proportion of patients achieving a successful outcome is about 80–90% in a 10–20-years time horizon postoperatively, periprosthetic osteolysis (PPOL) and aseptic loosening (AL) being the most frequent reasons for knee and hip implant failure and reoperations. The chemokine system (chemokine receptors and chemokines) is crucially involved in the inflammatory and osteolytic processes leading to PPOL/AL. Thus, the modulation of the interactions within the chemokine system may influence the extent of PPOL. Indeed, recent studies in murine models reported that (i) blocking the CCR2–CCL2 or CXCR2–CXCL2 axis or (ii) activation of the CXCR4–CXCL12 axis attenuate the osteolysis of artificial joints. Importantly, chemokines, inhibitory mutant chemokines, antagonists of chemokine receptors, or neutralizing antibodies to the chemokine system attached to or incorporated into the implant surface may influence the tissue responses and mitigate PPOL, thus increasing prosthesis longevity. This review summarizes the current state of the art of the knowledge of the chemokine system in human PPOL/AL. Furthermore, the potential for attenuating cell trafficking to the bone–implant interface and influencing tissue responses through modulation of the chemokine system is delineated. Additionally, the prospects of using immunoregenerative biomaterials (including chemokines) for the prevention of failed implants are discussed. Finally, this review highlights the need for a more sophisticated understanding of implant debris-induced changes in the chemokine system to mitigate this response effectively.
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Affiliation(s)
- Tereza Dyskova
- Faculty of Medicine and Dentistry, Department of Immunology, Palacky University Olomouc, Olomouc, Czechia
| | - Jiri Gallo
- Faculty of Medicine and Dentistry, Department of Orthopaedics, Palacky University Olomouc, University Hospital Olomouc, Olomouc, Czechia
| | - Eva Kriegova
- Faculty of Medicine and Dentistry, Department of Immunology, Palacky University Olomouc, Olomouc, Czechia
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Lewicki KA, Bell JE, Van Citters DW. Analysis of polyethylene wear of reverse shoulder components: A validated technique and initial clinical results. J Orthop Res 2017; 35:980-987. [PMID: 27346226 DOI: 10.1002/jor.23353] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 06/21/2016] [Indexed: 02/04/2023]
Abstract
One of the most prevalent phenomena associated with reverse total shoulder arthroplasty (rTSA) is scapular notching. Current methods examine only the damage to the scapula and no methods are available for quantifying the total wear volume of the polyethylene humeral bearing. Quantifying the polyethylene material loss may provide insight into the mechanism for scapular notching and into the particle dose delivered to the patient. A coordinate measurement machine (CMM) and custom computer algorithms were employed to quantify the volumetric wear of polyethylene humeral bearings. This technique was validated using two never-implanted polyethylene humeral liners with a controlled amount of wear in clinically relevant locations. The technique was determined to be accurate to within 10% of the known value and within 5 mm3 of the gravimetrically determined values. Following validation, ten retrieved polyethylene humeral liners were analyzed to determine a baseline for future clinical tests. Four of the ten polyethylene humeral liners showed visible and measureable wear volumes ranging from 40 to 90 mm3 total with a maximum wear rate as high as 470 mm3 /year in one short duration and significantly damaged humeral liner. This validated technique has the potential to relate patient outcomes such as scapular notching grades to polyethylene release into the body. While the total wear volumes are less than reported in literature for cases of osteolysis in knee and hip patients, dosages are well within the osteolytic thresholds that have been suggested, indicating that osteolysis may be a clinical concern in the shoulder. This work provides the basis for future studies that relate volumetric wear to patient outcomes. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:980-987, 2017.
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Affiliation(s)
- Kathleen A Lewicki
- Thayer School of Engineering, Dartmouth College, 14 Engineering Drive, Hanover, New Hampshire 03755
| | - John-Erik Bell
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03766
| | - Douglas W Van Citters
- Thayer School of Engineering, Dartmouth College, 14 Engineering Drive, Hanover, New Hampshire 03755
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12
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Neuerburg C, Loer T, Mittlmeier L, Polan C, Farkas Z, Holdt LM, Utzschneider S, Schwiesau J, Grupp TM, Böcker W, Aszodi A, Wedemeyer C, Kammerlander C. Impact of vitamin E-blended UHMWPE wear particles on the osseous microenvironment in polyethylene particle-induced osteolysis. Int J Mol Med 2016; 38:1652-1660. [PMID: 27779642 PMCID: PMC5117748 DOI: 10.3892/ijmm.2016.2780] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 09/23/2016] [Indexed: 12/29/2022] Open
Abstract
Aseptic loosening mediated by wear particle-induced osteolysis (PIO) remains the major cause of implant loosening in endoprosthetic surgery. The development of new vitamin E (α-tocopherol)-blended ultra-high molecular weight polyethylene (VE-UHMWPE) with increased oxidation resistance and improved mechanical properties has raised hopes. Furthermore, regenerative approaches may be opened, as vitamin E supplementation has shown neuroprotective characteristics mediated via calcitonin gene-related peptide (CGRP), which is known to affect bone remodeling in PIO. Therefore, the present study aimed to further clarify the impact of VE-UHMWPE wear particles on the osseous microenvironment and to identify the potential modulatory pathways involved. Using an established murine calvaria model, mice were subjected to sham operation (SHAM group), or treated with UHMWPE or VE-UHMWPE particles for different experimental durations (7, 14 and 28 days; n=6/group). Morphometric analysis by micro-computed tomography detected significant (p<0.01) and comparable signs of PIO in all particle-treated groups, whereas markers of inflammation [tumor necrosis factor (TNF)-α/tartrate resistant acid phosphatase (TRAP) staining] and bone remodeling [Dickkopf-related protein 1 (DKK-1)/osteoprotegerin (OPG)] were most affected in the early stages following surgery. Taking the present data into account, VE-UHMWPE appears to have a promising biocompatibility and increased ageing resistance. According to the α-CGRP serum levels and immunohistochemistry, the impact of vitamin E on neuropeptidergic signaling and its chance for regenerative approaches requires further investigation.
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Affiliation(s)
- Carl Neuerburg
- Experimental Surgery and Regenerative Medicine, Department of General, Trauma and Reconstructive Surgery, Munich University Hospital LMU, Munich, Germany
| | - Theresa Loer
- Department of Orthopedics and Trauma Surgery, University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Lena Mittlmeier
- Experimental Surgery and Regenerative Medicine, Department of General, Trauma and Reconstructive Surgery, Munich University Hospital LMU, Munich, Germany
| | - Christina Polan
- Department of Orthopedics and Trauma Surgery, University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Zsuzsanna Farkas
- Experimental Surgery and Regenerative Medicine, Department of General, Trauma and Reconstructive Surgery, Munich University Hospital LMU, Munich, Germany
| | - Lesca Miriam Holdt
- Institute of Laboratory Medicine, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Sandra Utzschneider
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Munich University Hospital LMU, Munich, Germany
| | - Jens Schwiesau
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Munich University Hospital LMU, Munich, Germany
| | - Thomas M Grupp
- Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Munich University Hospital LMU, Munich, Germany
| | - Wolfgang Böcker
- Experimental Surgery and Regenerative Medicine, Department of General, Trauma and Reconstructive Surgery, Munich University Hospital LMU, Munich, Germany
| | - Attila Aszodi
- Experimental Surgery and Regenerative Medicine, Department of General, Trauma and Reconstructive Surgery, Munich University Hospital LMU, Munich, Germany
| | - Christian Wedemeyer
- KKEL St. Barbara Hospital, Department of Orthopedics and Trauma Surgery, Gladbeck, Germany
| | - Christian Kammerlander
- Experimental Surgery and Regenerative Medicine, Department of General, Trauma and Reconstructive Surgery, Munich University Hospital LMU, Munich, Germany
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13
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Vasconcelos DM, Ribeiro-da-Silva M, Mateus A, Alves CJ, Machado GC, Machado-Santos J, Paramos-de-Carvalho D, Alencastre IS, Henrique R, Costa G, Barbosa MA, Lamghari M. Immune response and innervation signatures in aseptic hip implant loosening. J Transl Med 2016; 14:205. [PMID: 27387445 PMCID: PMC4937545 DOI: 10.1186/s12967-016-0950-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 06/21/2016] [Indexed: 01/09/2023] Open
Abstract
Background Aseptic loosening (AL) of hip prosthesis presents inflammation and pain as sign and symptom similarly to arthritis pathologies. Still, the immune and innervation profiles in hip AL remain unclear and their interplay is poorly explored. Herein, local tissue inflammatory response, sensory and sympathetic innervation as well as associated local mediators were assessed in hip joint microenvironment underlying AL and compared to osteoarthritis (OA). Methods Histopathological analysis, immune cells (macrophages, T, B cells and PMNs) as well as sensory and sympathetic nerve fibers (SP+, CGRP+, TH+) distribution and profiles were analyzed on tissues retrieved from patients with failed hip prostheses due to AL (n = 20) and hip OA (n = 15) by immunohistochemistry. Additionally, transcriptional levels of pro-inflammatory cytokines (TNF-α, IL-1β, IL-6, IL-12a, iNOS), anti-inflammatory cytokine (IL-10), osteoclastic factor (RANKL) and bone remodeling factor (TGF-β1) were locally evaluated by qRT-PCR. Serum TGF-β1 levels were assessed preoperatively by ELISA. Results Histopathological analysis revealed that tissues, aseptic interface membranes of AL patients had distinct tissue architecture and immune cells profile when compared to OA synovial tissues. Macrophages, T cells and B cells showed significant differences in tissue distribution. In OA, inflammation is mostly confined to the vicinity of synovial membrane while in AL macrophages infiltrated throughout the tissue. This differential immune profile is also accompanied with a distinct pattern of sensory and sympathetic innervation. Importantly, in AL patients, a lack of sympathetic innervation aseptic interface membranes without compensation mechanisms at cellular levels was observed with simultaneous reorganization of sensorial innervation. Despite the different histopathological portrait, AL and OA patients exhibited similar transcriptional levels of genes encoding key proteins in local immune response. Nevertheless, in both pathologies, TGF-β1 expression was prominent in sites where the inflammation is occurring. However, at systemic level no differences were found. Conclusion These findings indicate that AL patients exhibit different local inflammatory response and innervation signatures from OA patients in hip joint. These insights shed the light on neuro-immune interplay in AL and highlight the need to better understand this crosstalk to unravel potential mechanisms for targeted-therapies to improve hip joint lifetime and treatment. Electronic supplementary material The online version of this article (doi:10.1186/s12967-016-0950-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Daniel M Vasconcelos
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal.,ICBAS - Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Manuel Ribeiro-da-Silva
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal.,Serviço de Ortopedia e Traumatologia, Centro Hospitalar São João, Porto, Portugal.,Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - António Mateus
- Serviço de Ortopedia e Traumatologia, Centro Hospitalar São João, Porto, Portugal.,Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Cecília Juliana Alves
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal
| | - Gil Costa Machado
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal
| | - Joana Machado-Santos
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal
| | - Diogo Paramos-de-Carvalho
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal
| | - Inês S Alencastre
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal
| | - Rui Henrique
- ICBAS - Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal.,Instituto Português de Oncologia do Porto, Porto, Portugal
| | - Gilberto Costa
- Serviço de Ortopedia e Traumatologia, Centro Hospitalar São João, Porto, Portugal.,Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Mário A Barbosa
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal.,ICBAS - Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Meriem Lamghari
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal. .,INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal. .,ICBAS - Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal.
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14
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Yan Y, Chen H, Feng J, Chen K, Zhou K, Hong W, Wang Y, Liu Z, Zhang J, Yang Q, Guo L, He C. Poor performance of Enduron polyethylene liner in total hip arthroplasty: a minimum ten-year follow up and ultra-morphological analysis of wear particles. INTERNATIONAL ORTHOPAEDICS 2016; 41:723-730. [PMID: 27178441 DOI: 10.1007/s00264-016-3217-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Accepted: 04/25/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of the present study was to investigate the long-term outcome and the wear characteristics of two distinct types of ultra-high molecular weight polyethylene (UHMWPE) liners in total hip arthroplasty (THA). METHODS We conducted a retrospective clinical study on patients which were treated with total hip arthroplasty using either Enduron polyethylene (Enduron PE) or Trilogy polyethylene (Trilogy PE) liners based on a minimum of ten year follow up data. Morphological analyses of wear particles from tissue samples, which were harvested during revision surgeries, were also performed. RESULTS A total of 79 THAs in the Enduron group and 55 THAs in the Trilogy group were available for analysis. Kaplan-Meier survival with revision for wear-related complications as the endpoint of the Enduron PE liners was lower than that of Trilogy PE liners at ten years (93.5 % and 100 %, P = 0.03). The Enduron group had higher mean linear wear rate than that of the Trilogy group (0.20 ± 0.09 and 0.09 ± 0.03 mm/year, P < 0.01). The incidence of osteolysis for the Enduron group was higher than that of the Trilogy group (33.3 % and 12 %, P = 0.04). Under transmission electron microscopy, the Enduron group had more than 82 % of the particles less than 1.0 μm in size and more than 57 % of the particles less than 0.5 μm. CONCLUSION The long-term performance of Enduron liners was worse than that of Trilogy liners. Further clinical follow-up may be necessary in patients with Enduron PE liners in order to avoid catastrophic complications.
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Affiliation(s)
- Yufei Yan
- Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Shanghai, China.,Department of Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, People's Republic of China
| | - Hao Chen
- Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Shanghai, China.,Department of Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, People's Republic of China
| | - Jianmin Feng
- Department of Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, People's Republic of China
| | - Kaizhe Chen
- Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Shanghai, China.,Department of Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, People's Republic of China
| | - Kaidi Zhou
- Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Shanghai, China.,Department of Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, People's Republic of China
| | - Weixiang Hong
- Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Shanghai, China.,Department of Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, People's Republic of China
| | - Yi Wang
- Department of Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, People's Republic of China
| | - Zhihong Liu
- Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Shanghai, China.,Department of Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, People's Republic of China
| | - Jiong Zhang
- Department of Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, People's Republic of China
| | - Qingming Yang
- Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Shanghai, China.,Department of Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, People's Republic of China
| | - Lei Guo
- Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Shanghai, China. .,Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, China.
| | - Chuan He
- Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopaedics, Shanghai, China. .,Department of Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Road, Shanghai, 200025, People's Republic of China.
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15
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Gallo J, Raska M, Konttinen YT, Nich C, Goodman SB. Innate immunity sensors participating in pathophysiology of joint diseases: a brief overview. J Long Term Eff Med Implants 2015; 24:297-317. [PMID: 25747032 DOI: 10.1615/jlongtermeffmedimplants.2014010825] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The innate immune system consists of functionally specialized "modules" that are activated in response to a particular set of stimuli via sensors located on the surface or inside the tissue cells. These cells screen tissues for a wide range of exogenous and endogenous danger/damage-induced signals with the aim to reject or tolerate them and maintain tissue integrity. In this line of thinking, inflammation evolved as an adaptive tool for restoring tissue homeostasis. A number of diseases are mediated by a maladaptation of the innate immune response, perpetuating chronic inflammation and tissue damage. Here, we review recent evidence on the cross talk between innate immune sensors and development of rheumatoid arthritis, osteoarthritis, and aseptic loosening of total joint replacements. In relation to the latter topic, there is a growing body of evidence that aseptic loosening and periprosthetic osteolysis results from long-term maladaptation of periprosthetic tissues to the presence of by-products continuously released from an artificial joint.
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Affiliation(s)
- Jiri Gallo
- Department of Orthopedics, University Hospital and Faculty of Medicine and Dentistry, Palacky University, Olomouc 775 20, Czech Republic
| | - Milan Raska
- Department of Immunology, Faculty of Medicine & Dentistry, Palacky University, Hnevotinska 3, 775 15 Olomouc, Czech Republic
| | - Yrjo T Konttinen
- Department of Clinical Medicine, University of Helsinki and ORTON Orthopaedic Hospital of the Invalid Foundation, Helsinki, Finland
| | - Christophe Nich
- Laboratoire de Biomecanique et Biomateriaux Osteo-Articulaires - UMR CNRS 7052, Faculte de Medecine - Universite Paris 7, Paris, France; Department of Orthopaedic Surgery, European Teaching Hospital, Assistance Publique - Hopitaux de Paris
| | - Stuart B Goodman
- Department of Orthopaedic Surgery Stanford University Medical Center Redwood City, CA
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16
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Abstract
Osteolysis and aseptic loosening currently contribute 75 % of implant failures. Furthermore, with over four million joint replacements projected to be performed in the United States annually, osteolysis and aseptic loosening may continue to pose a significant morbidity. This paper reviews the osteolysis cascade leading to osteoclast activation and bone resorption at the biochemical level. Additionally, the metal ion release mechanism from metallic implants is elucidated. Even though metal ions are not the predominating initiator of osteolysis, they do increase the concentration of key inflammatory cytokines that stimulate osteoclasts and prove to be a contributor to osteolysis and aseptic loosening. Osteolysis is a competitive mechanism among a number of biological reactions, which includes debris release, macrophage and osteoclast activation, an inflammatory response as well as metal ion release. Pharmacological therapy for component loosening has also been reviewed. A non-surgical treatment of osteolysis has not been found in the literature and thus may become an area of future research. Even though this research is warranted, comprehensively understanding the immune response to orthopedic implants and their metallic ions, and thus, creating improved prostheses appears to be the most cost-effective approach to decrease the morbidity related to osteolysis and to design implants with greater longevity. The ionic forms, cytokines, toxicity, gene expression, biological effects, and hypersensitivity responses of metallic elements from metal implants are summarized as well.
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17
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THE EXPERIENCE OF USE OF CERAMIC-POLYETHYLENE PROSTHESES IN TOTAL HIP ARTHROPLASTY. КЛИНИЧЕСКАЯ ПРАКТИКА 2015. [DOI: 10.17816/clinpract6152-60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
From 2004 to 2014 there were conducted more than 400 operations with the use of ceramic- polyethylene prostheses in the Hospital №13 (clinical base of the Department of Traumatology and Orthopedics of Peoples’ Friendship University of Russia). In any case there were no signs of aseptic loosening of prosthesis components. Nowadays the use of low friction ceramic-polyethylene friction pair in hip arthroplasty is widespread for most patients with hip joint pathology in all age groups.
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18
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Risk factors for periacetabular osteolysis and wear in asymptomatic patients with uncemented total hip arthroplasties. ScientificWorldJournal 2014; 2014:905818. [PMID: 25478600 PMCID: PMC4248425 DOI: 10.1155/2014/905818] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 10/29/2014] [Indexed: 11/17/2022] Open
Abstract
Osteolysis is a silent disease leading to aseptic loosening. This has not been studied in a cohort of asymptomatic patients. The aim of this study was to detect factors that might be associated with the development of periacetabular osteolysis and wear around an uncemented cup. We assessed 206 patients with an uncemented cup, measuring wear and periacetabular osteolysis using computed tomography with a median follow-up of 10 years after surgery (range 7–14 years). EQ5D, pain from the hip, and satisfaction were assessed. The association between periacetabular osteolysis and wear, age, gender, activity, BMI, cup type, cup age, positioning of the cup, and surface coating was investigated with a proportional odds model. Wear and male gender were associated with an increased risk for periacetabular osteolysis. There was no association with periacetabular osteolysis for time from operation, patient age, UCLA Activity Score, liner thickness at time of operation, BMI, cup positioning, and type of implant. A thin liner at time of operation is correlated to increased wear. Linear wear rate was 0.18 mm/year and 46 of 206 patients had large periacetabular osteolysis. Asymptomatic patients with these implants should be followed up on a regular basis with a sensitive method such as CT in order to detect complications early.
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19
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Nich C, Takakubo Y, Pajarinen J, Ainola M, Salem A, Sillat T, Rao AJ, Raska M, Tamaki Y, Takagi M, Konttinen YT, Goodman SB, Gallo J. Macrophages-Key cells in the response to wear debris from joint replacements. J Biomed Mater Res A 2013; 101:3033-45. [PMID: 23568608 PMCID: PMC3775910 DOI: 10.1002/jbm.a.34599] [Citation(s) in RCA: 162] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 11/16/2012] [Accepted: 01/12/2013] [Indexed: 12/14/2022]
Abstract
The generation of wear debris is an inevitable result of normal usage of joint replacements. Wear debris particles stimulate local and systemic biological reactions resulting in chronic inflammation, periprosthetic bone destruction, and eventually, implant loosening, and revision surgery. The latter may be indicated in up to 15% patients in the decade following the arthroplasty using conventional polyethylene. Macrophages play multiple roles in both inflammation and in maintaining tissue homeostasis. As sentinels of the innate immune system, they are central to the initiation of this inflammatory cascade, characterized by the release of proinflammatory and pro-osteoclastic factors. Similar to the response to pathogens, wear particles elicit a macrophage response, based on the unique properties of the cells belonging to this lineage, including sensing, chemotaxis, phagocytosis, and adaptive stimulation. The biological processes involved are complex, redundant, both local and systemic, and highly adaptive. Cells of the monocyte/macrophage lineage are implicated in this phenomenon, ultimately resulting in differentiation and activation of bone resorbing osteoclasts. Simultaneously, other distinct macrophage populations inhibit inflammation and protect the bone-implant interface from osteolysis. Here, the current knowledge about the physiology of monocyte/macrophage lineage cells is reviewed. In addition, the pattern and consequences of their interaction with wear debris and the recent developments in this field are presented.
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Affiliation(s)
- Christophe Nich
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California; Laboratoire de Biomécanique et Biomatériaux Ostéo-Articulaires-UMR CNRS 7052, Faculté de Médecine-Université Paris 7, Paris, France; Department of Orthopaedic Surgery, European Teaching Hospital, Assistance Publique-Hôpitaux de Paris-Université Paris 5, Paris, France
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20
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Baxter RM, MacDonald DW, Kurtz SM, Steinbeck MJ. Severe impingement of lumbar disc replacements increases the functional biological activity of polyethylene wear debris. J Bone Joint Surg Am 2013; 95:e751-9. [PMID: 23780545 PMCID: PMC3748985 DOI: 10.2106/jbjs.k.00522] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Wear, oxidation, and particularly rim impingement damage of ultra-high molecular weight polyethylene total disc replacement components have been observed following surgical revision. However, neither in vitro testing nor retrieval-based evidence has shown the effect(s) of impingement on the characteristics of polyethylene wear debris. Thus, we sought to determine (1) differences in polyethylene particle size, shape, number, or biological activity that correspond to mild or severe rim impingement and (2) in an analysis of all total disc replacements, regardless of impingement classification, whether there are correlations between the extent of regional damage and the characteristics of polyethylene wear debris. METHODS The extent of dome and rim damage was characterized for eleven retrieved polyethylene cores obtained at revision surgery after an average duration of implantation of 9.7 years (range, 4.6 to 16.1 years). Polyethylene wear debris was isolated from periprosthetic tissues with use of nitric acid and was imaged with use of environmental scanning electron microscopy. Subsequently, particle size, shape, number, biological activity, and chronic inflammation scores were determined. RESULTS Grouping of particles by size ranges that represented high biological relevance (<0.1 to 1-μm particles), intermediate biological relevance (1 to 10-μm particles), and low biological relevance (>10-μm particles) revealed an increased volume fraction of particles in the <0.1 to 1-μm and 1 to 10-μm size ranges in the mild-impingement cohort as compared with the severe-impingement cohort. The increased volume fractions resulted in a higher specific biological activity per unit particle volume in the mild-impingement cohort than in the severe-impingement cohort. However, functional biological activity, which is normalized by particle volume (mm3/g of tissue), was significantly higher in the severe-impingement cohort. This increase was due to a larger volume of particles in all three size ranges. In both cohorts, the functional biological activity correlated with the chronic inflammatory response, and the extent of rim penetration positively correlated with increasing particle size, number, and functional biological activity. CONCLUSIONS The results of this study suggest that severe rim impingement increases the production of biologically relevant particles from motion-preserving lumbar total disc replacement components. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Ryan M. Baxter
- Implant Research Center, School of Biomedical Engineering, Science & Health Systems, Drexel University, 3401 Market Street, Suite 345, Philadelphia, PA 19104. E-mail address for M.J. Steinbeck:
| | - Daniel W. MacDonald
- Implant Research Center, School of Biomedical Engineering, Science & Health Systems, Drexel University, 3401 Market Street, Suite 345, Philadelphia, PA 19104. E-mail address for M.J. Steinbeck:
| | - Steven M. Kurtz
- Implant Research Center, School of Biomedical Engineering, Science & Health Systems, Drexel University, 3401 Market Street, Suite 345, Philadelphia, PA 19104. E-mail address for M.J. Steinbeck:
| | - Marla J. Steinbeck
- Implant Research Center, School of Biomedical Engineering, Science & Health Systems, Drexel University, 3401 Market Street, Suite 345, Philadelphia, PA 19104. E-mail address for M.J. Steinbeck:
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21
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Baxter RM, MacDonald DW, Kurtz SM, Steinbeck MJ. Characteristics of highly cross-linked polyethylene wear debris in vivo. J Biomed Mater Res B Appl Biomater 2013; 101:467-75. [PMID: 23436587 PMCID: PMC3928672 DOI: 10.1002/jbm.b.32902] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Revised: 11/12/2012] [Accepted: 12/20/2012] [Indexed: 12/12/2022]
Abstract
Despite the widespread implementation of highly cross-linked polyethylene (HXLPE) liners to reduce the clinical incidence of osteolysis, it is not known if the improved wear resistance will outweigh the inflammatory potential of HXLPE wear debris generated in vivo. Thus, we asked: What are the differences in size, shape, number, and biological activity of polyethylene wear particles obtained from primary total hip arthroplasty revision surgery of conventional polyethylene (CPE) versus remelted or annealed HXLPE liners? Pseudocapsular tissue samples were collected from revision surgery of CPE and HXLPE (annealed and remelted) liners, and digested using nitric acid. The isolated polyethylene wear particles were evaluated using scanning electron microscopy. Tissues from both HXLPE cohorts contained an increased percentage of submicron particles compared to the CPE cohort. However, the total number of particles was lower for both HXLPE cohorts, as a result there was no significant difference in the volume fraction distribution and specific biological activity (SBA; the relative biological activity per unit volume) between cohorts. In contrast, based on the decreased size and number of HXLPE wear debris there was a significant decrease in total particle volume (mm(3)/g of tissue). Accordingly, when the SBA was normalized by total particle volume (mm(3)/gm tissue) or by component wear volume rate (mm(3)/year), functional biological activity of the HXLPE wear debris was significantly decreased compared to the CPE cohort. Indications for this study are that the osteolytic potential of wear debris generated by HXLPE liners in vivo is significantly reduced by improvements in polyethylene wear resistance.
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Affiliation(s)
- Ryan M Baxter
- School of Biomedical Engineering, Science & Health Systems, Drexel University, Philadelphia, Pennsylvania, USA
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22
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Kretzer JP, Zietz C, Schröder C, Reinders J, Middelborg L, Paulus A, Sonntag R, Bader R, Utzschneider S. [Principles of tribological analysis of endoprostheses]. DER ORTHOPADE 2013; 41:844-52. [PMID: 23052851 DOI: 10.1007/s00132-012-1948-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
For the tribological characterization of artificial joints, various experimental methods are currently available. However, the in vitro test conditions applied are only comparable in a limited way and transferability to the in vivo situation is also restricted. This is due to the different wear simulation concepts used and partly insufficient simulation of clinical worst case situations. In the present paper current scientific methods and procedures for tribological testing of artificial joints are presented. In addition, the biological effects of wear products are described enabling clinicians to challenge tribological studies and to facilitate specific interpretation of scientific results taking the clinical situation into account.
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Affiliation(s)
- J P Kretzer
- Labor für Biomechanik und Implantatforschung, Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Heidelberg, 69120, Heidelberg, Deutschland.
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23
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Gallo J, Goodman SB, Konttinen YT, Raska M. Particle disease: biologic mechanisms of periprosthetic osteolysis in total hip arthroplasty. Innate Immun 2012; 19:213-24. [PMID: 22751380 DOI: 10.1177/1753425912451779] [Citation(s) in RCA: 162] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Numerous studies provide detailed insight into the triggering and amplification mechanisms of the inflammatory response associated with prosthetic wear particles, promoting final dominance of bone resorption over bone formation in multiple bone multicellular units around an implant. In fact, inflammation is a highly regulated process tightly linked to simultaneous stimulation of tissue protective and regenerative mechanisms in order to prevent collateral damage of periprosthetic tissues. A variety of cytokines, chemokines, hormones and specific cell populations, including macrophages, dendritic and stem cells, attempt to balance tissue architecture and minimize inflammation. Based on this fact, we postulate that the local tissue homeostatic mechanisms more effectively regulate the pro-inflammatory/pro-osteolytic cells/pathways in patients with none/mild periprosthetic osteolysis (PPOL) than in patients with severe PPOL. In this line of thinking, 'particle disease theory' can be understood, at least partially, in terms of the failure of local tissue homeostatic mechanisms. As a result, we envision focusing current research on homeostatic mechanisms in addition to traditional efforts to elucidate details of pro-inflammatory/pro-osteolytic pathways. We believe this approach could open new avenues for research and potential therapeutic strategies.
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Affiliation(s)
- Jiri Gallo
- Department of Orthopaedics, University Hospital, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic.
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