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Siskey RL, Yarbrough RV, Spece H, Hodges SD, Humphreys SC, Kurtz SM. In Vitro Wear of a Novel Vitamin E Crosslinked Polyethylene Lumbar Total Joint Replacement. Bioengineering (Basel) 2023; 10:1198. [PMID: 37892928 PMCID: PMC10604298 DOI: 10.3390/bioengineering10101198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/06/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND A novel, lumbar total joint replacement (TJR) design has been developed to treat degeneration across all three columns of the lumbar spine (anterior, middle, and posterior columns). Thus far, there has been no in vitro studies that establish the preclinical safety profile of the vitamin E-stabilized highly crosslinked polyethylene (VE-HXLPE) lumbar TJR relative to historical lumbar anterior disc replacement for the known risks of wear and impingement faced by all motion preserving designs for the lumbar spine. QUESTIONS/PURPOSE In this study we asked, (1) what is the wear performance of the VE-HXLPE lumbar TJR under ideal, clean conditions? (2) Is the wear performance of VE-HXLPE in lumbar TJR sensitive to more aggressive, abrasive conditions? (3) How does the VE-HXLPE lumbar TJR perform under impingement conditions? METHOD A lumbar TJR with bilateral VE-HXLPE superior bearings and CoCr inferior bearings was evaluated under clean, impingement, and abrasive conditions. Clean and abrasive testing were guided by ISO 18192-1 and impingement was assessed as per ASTM F3295. For abrasive testing, CoCr components were scratched to simulate in vivo abrasion. The devices were tested for 10 million cycles (MC) under clean conditions, 5 MC under abrasion, and 1 MC under impingement. RESULT Wear rates under clean and abrasive conditions were 1.2 ± 0.5 and 1.1 ± 0.6 mg/MC, respectively. The VE-HXLPE components demonstrated evidence of burnishing and multidirectional microscratching consistent with microabrasive conditions with the cobalt chromium spherical counterfaces. Under impingement, the wear rates ranged between 1.7 ± 1.1 (smallest size) and 3.9 ± 1.1 mg/MC (largest size). No functional or mechanical failure was observed across any of the wear modes. CONCLUSIONS Overall, we found that that a VE-HXLPE-on-CoCr lumbar total joint replacement design met or exceeded the benchmarks established by traditional anterior disc replacements, with wear rates previously reported in the literature ranging between 1 and 15 mg/MC. CLINICAL RELEVANCE The potential clinical benefits of this novel TJR design, which avoids long-term facet complications through facet removal with a posterior approach, were found to be balanced by the in vitro tribological performance of the VE-HXLPE bearings. Our encouraging in vitro findings have supported initiating an FDA-regulated clinical trial for the design which is currently under way.
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Affiliation(s)
| | | | - Hannah Spece
- School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, PA 19104, USA
| | | | | | - Steven M. Kurtz
- School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, PA 19104, USA
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Yin Z, Gong G, Liu X, Yin J. Mechanism of regulating macrophages/osteoclasts in attenuating wear particle-induced aseptic osteolysis. Front Immunol 2023; 14:1274679. [PMID: 37860014 PMCID: PMC10582964 DOI: 10.3389/fimmu.2023.1274679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 09/22/2023] [Indexed: 10/21/2023] Open
Abstract
Joint replacement surgery is the most effective treatment for end-stage arthritis. Aseptic loosening caused by periprosthetic osteolysis is a common complication after joint replacement. Inflammation induced by wear particles derived from prosthetic biomaterials is a major cause of osteolysis. We emphasize that bone marrow-derived macrophages and their fusion-derived osteoclasts play a key role in this pathological process. Researchers have developed multiple intervention approaches to regulate macrophage/osteoclast activation. Aiming at wear particle-induced periprosthetic aseptic osteolysis, this review separately discusses the molecular mechanism of regulation of ROS formation and inflammatory response through intervention of macrophage/osteoclast RANKL-MAPKs-NF-κB pathway. These molecular mechanisms regulate osteoclast activation in different ways, but they are not isolated from each other. There is also a lot of crosstalk among the different mechanisms. In addition, other bone and joint diseases related to osteoclast activation are also briefly introduced. Therefore, we discuss these new findings in the context of existing work with a view to developing new strategies for wear particle-associated osteolysis based on the regulation of macrophages/osteoclasts.
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Affiliation(s)
- Zhaoyang Yin
- Department of Orthopedics, The Affiliated Lianyungang Hospital of Xuzhou Medical University (The First People’s Hospital of Lianyungang), Lianyungang, China
| | - Ge Gong
- Department of Geriatrics, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Xinhui Liu
- Department of Orthopedics, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, China
| | - Jian Yin
- Department of Orthopedics, The Affiliated Jiangning Hospital with Nanjing Medical University, Nanjing, China
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Huang S, Xu D, Zhang L, Hao L, Jia Y, Zhang X, Cheng T, Chen J. Therapeutic Effects of Curcumin Liposomes and Nanocrystals on Inflammatory Osteolysis: In Vitro and In Vivo Comparative Study. Pharmacol Res 2023; 192:106778. [PMID: 37094714 DOI: 10.1016/j.phrs.2023.106778] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 04/20/2023] [Accepted: 04/20/2023] [Indexed: 04/26/2023]
Abstract
Curcumin could inhibit periprosthetic osteolysis induced by wear debris and adherent endotoxin, which commonly cause prosthesis loosening and negatively influence the long-term survival of joint arthroplasty. However, its limited water solubility and poor stability pose challenges for its further clinical application. To address these issues, we developed curcumin liposomes for intraarticular injection, as liposomes possess good lubricant capacity and pharmacological synergy with curcumin. Additionally, a nanocrystal dosage form was prepared to enable comparison with the liposomes based on their ability to disperse curcumin effectively. A microfluidic method was used for its controllability, repeatability, and scalability. The Box-Behnken Design was employed to screen the formulations and flow parameters, while computational fluid dynamics was used to simulate the mixing process and predict the formation of liposomes. The optimized curcumin liposomes (Cur-LPs) had a size of 132.9nm and an encapsulation efficiency of 97.1%, whereas the curcumin nanocrystals (Cur-NCs) had a size of 172.3nm. Both Cur-LPs and Cur-NCs inhibited LPS-induced pro-inflammatory polarization of macrophages and reduced the expression and secretion of inflammatory factors. The mouse air pouch model further demonstrated that both dosage forms attenuated inflammatory cell infiltration and inflammatory fibrosis in subcutaneous tissues. Interestingly, the anti-inflammatory effect of Cur-LPs was more potent than that of Cur-NCs, both in vitro and in vivo, although the cellular uptake of Cur-NCs was quicker. In conclusion, the results demonstrate that Cur-LPs have great potential for the clinical treatment of inflammatory osteolysis and that the therapeutic effect is closely related to the liposomal dosage form.
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Affiliation(s)
- Shan Huang
- School of Pharmacy, Shanghai Jiao Tong University, Shanghai, China
| | - Dongdong Xu
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li Zhang
- Instrumental Analysis Center, Shanghai Jiao Tong University, No.800, Shanghai, China
| | - Liang Hao
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yujie Jia
- School of Pharmacy, Shanghai Jiao Tong University, Shanghai, China
| | - Xianlong Zhang
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tao Cheng
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jian Chen
- School of Pharmacy, Shanghai Jiao Tong University, Shanghai, China
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Spece H, Yarbrough RV, Kurtz SM. In Vivo Performance of Vitamin E Stabilized Polyethylene Implants for Total Hip Arthroplasty: A Review. J Arthroplasty 2022; 38:970-979. [PMID: 36481286 DOI: 10.1016/j.arth.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/28/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Vitamin E stabilization was introduced to improve the oxidative stability, wear resistance, and mechanical properties of highly crosslinked polyethylene (HXLPE). In this literature review, we asked: (1) How has vitamin E-stabilized HXLPE (VEPE) performed in vivo for total hip arthroplasty (THA) and how does it compare with conventional ultra-high molecular weight polyethylene (UHMWPE) and HXLPE without vitamin E; and (2) Is there an apparent difference in the clinical performance of VEPE created by blending versus diffusion? METHODS We performed a systematic search of the literature according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines using PubMed and Embase. Included studies reported the in vivo behavior of VEPE in THA. We reviewed 41 studies. RESULTS For all studies that compared polyethylene with and without VE stabilization, outcomes for VEPE were either equivalent or superior to the control group (for HXLPE without VE and conventional UHMWPE controls, respectively). Hip insert wear rates were generally less than 0.1 mm/year and in most cases were less than 0.05 mm/year. No VEPE components were revised for osteolysis or adverse outcomes specific to VE incorporation. CONCLUSION Across the literature, we found that VEPE was reported to be clinically effective for THA applications, with much of the research indicating positive clinical outcomes and lower or equivalent wear rates compared to conventional UHMWPE and HXLPE controls without VE. Instances of early component fracture were reported, but have multiple potential causes. There is a gap in the literature for comparison of blended and diffused components, so the in vivo impact of VE incorporation method remains to be seen. Overall, this study provides a comprehensive summary of VEPE clinical performance for THA and may serve as a resource for future investigations.
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Affiliation(s)
- Hannah Spece
- Implant Research Core, School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA; Gyroid, LLC, Haddonfield, NJ
| | | | - Steven M Kurtz
- Implant Research Core, School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA; Gyroid, LLC, Haddonfield, NJ
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Zhang H, Guo Y, Tian F, Qiao Y, Tang Z, Zhu C, Xu J. Discussion of Orientation and Performance of Crosslinked Ultrahigh-Molecular-Weight Polyethylene Used for Artificial Joints. ACS APPLIED MATERIALS & INTERFACES 2022; 14:29230-29237. [PMID: 35700194 DOI: 10.1021/acsami.2c05549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Previously, the orientation structure of ultrahigh-molecular-weight polyethylene (UHMWPE) for artificial joints was considered to be unchanged after irradiation crosslinking. Therefore, much of the research related to the long-term failure of artificial joints has focused on material improvements. In this study, ultrasmall-angle X-ray scattering (USAXS) and the small/wide-angle X-ray scattering (SAXS-WAXS) combined technique reveal that the orientation structures of UHMWPE materials at all scales (nanoscale to microscale) are responsible for the long-term failure of artificial joints. To further illustrate the formation of these hierarchical oriented structures, a simple model is presented. In this model, first, the migration of free radicals plays a vital role, and the different steric hindrances in different directions directly lead to uneven migration behavior of free radicals. Second, the uneven migration of free radicals contributes to an inhomogeneous concentration of free radicals, thus resulting in observable crosslinking nonuniformities. Finally, all the hierarchical structural nonuniformities promote long-term failure of artificial joints after long-term wear.
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Affiliation(s)
- Hao Zhang
- College of Textile Science and Engineering (International Institute of Silk), Zhejiang Sci-Tech University, Hangzhou 310018, China
- Institute of Low-dimensional Materials Genome Initiative, College of Chemistry and Environmental Engineering of Shenzhen University, Shenzhen 518060, China
| | - Yuhai Guo
- College of Textile Science and Engineering (International Institute of Silk), Zhejiang Sci-Tech University, Hangzhou 310018, China
| | - Feng Tian
- Shanghai Advanced Research Institute, Chinese Academy of Sciences, Shanghai 201210, China
| | - Yongna Qiao
- Institute of Low-dimensional Materials Genome Initiative, College of Chemistry and Environmental Engineering of Shenzhen University, Shenzhen 518060, China
| | - Zheng Tang
- Institute of Low-dimensional Materials Genome Initiative, College of Chemistry and Environmental Engineering of Shenzhen University, Shenzhen 518060, China
| | - Caizhen Zhu
- Institute of Low-dimensional Materials Genome Initiative, College of Chemistry and Environmental Engineering of Shenzhen University, Shenzhen 518060, China
| | - Jian Xu
- College of Textile Science and Engineering (International Institute of Silk), Zhejiang Sci-Tech University, Hangzhou 310018, China
- Institute of Low-dimensional Materials Genome Initiative, College of Chemistry and Environmental Engineering of Shenzhen University, Shenzhen 518060, China
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Revision Risk of Total Hip Arthroplasty With Vitamin E Doped Liners: Results From the Danish Hip Arthroplasty Register. J Arthroplasty 2022; 37:1136-1142. [PMID: 35149169 DOI: 10.1016/j.arth.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/03/2022] [Accepted: 02/03/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Vitamin E-doped cross-linked polyethylene (VEPE) liners were introduced in total hip arthroplasty (THA) to reduce wear and risk of aseptic loosening and liner fracture. We report this nationwide population-based study to investigate the safety of VEPE liners for THA compared to cross-linked annealed or remelted polyethylene (XLPE). METHODS We included THAs from The Danish Hip Arthroplasty Register from January 1, 2008 to June 30, 2019, with uncemented cup, VEPE or XLPE liner, and metal or ceramic head. The outcome was revision due to (1) polyethylene-related endpoints (aseptic loosening, granuloma, osteolysis, or liner fractures) and (2) other endpoints. RESULTS A total of 110,803 THAs were assessed for eligibility and 53,842 THAs (46,645 patients) were included in the study: 5069 (9.4%) THAs with a VEPE liner and 48,773 (91.6%) with a XLPE liner. Median observation time was 5.48 (interquartile range 3.80-7.15) years for VEPE and 4.85 (interquartile range 2.68-7.76) for XLPE. VEPE had a lower risk of revision for polyethylene-related endpoints compared to XLPE (hazard ratio [HR] 0.60, 95% confidence interval 0.36-0.98) during complete follow-up. THAs with VEPE liners were associated with increased risk of any revision within the first 3 months (HR 1.62, 1.36-1.94), revision recorded as aseptic loosening within 3 months (HR 4.46, 2.26-8.80), and periprosthetic fracture within 3 months (HR 2.57, 1.98, 3.33). CONCLUSION VEPE liners had a lower risk of revision due to polyethylene-related endpoints, but a higher risk of all-cause revision within 3 months.
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Hodges NA, Sussman EM, Stegemann JP. Aseptic and septic prosthetic joint loosening: Impact of biomaterial wear on immune cell function, inflammation, and infection. Biomaterials 2021; 278:121127. [PMID: 34564034 DOI: 10.1016/j.biomaterials.2021.121127] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 09/01/2021] [Accepted: 09/07/2021] [Indexed: 12/17/2022]
Abstract
The success of total joint replacements has led to consistent growth in the use of arthroplasty in progressively younger patients. However, more than 10 percent of patients require revision surgeries due to implant failure caused by osteolytic loosening. These failures are classified as either aseptic or septic and are associated with the presence of particulate wear debris generated by mechanical action between implant components. Aseptic loosening results from chronic inflammation caused by activation of resident immune cells in contact with implant wear debris. In contrast, septic loosening is defined by the presence of chronic infection at the implant site. However, recent findings suggest that subclinical biofilms may be overlooked when evaluating the cause of implant failure, leading to a misdiagnosis of aseptic loosening. Many of the inflammatory pathways contributing to periprosthetic joint infections are also involved in bone remodeling and resorption. In particular, wear debris is increasingly implicated in the inhibition of the innate and adaptive immune response to resolve an infection or prevent hematogenous spread. This review examines the interconnectivity of wear particle- and infection-associated mechanisms of implant loosening, as well as biomaterials-based strategies to combat infection-related osteolysis.
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Affiliation(s)
- Nicholas A Hodges
- University of Michigan, Department of Biomedical Engineering, Ann Arbor, MI, 48109, USA; Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, FDA, Silver Spring, MD, 20993, USA.
| | - Eric M Sussman
- Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, FDA, Silver Spring, MD, 20993, USA.
| | - Jan P Stegemann
- University of Michigan, Department of Biomedical Engineering, Ann Arbor, MI, 48109, USA.
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Abstract
AbstractThe success of implant performance and arthroplasty is based on several factors, including oxidative stress-induced osteolysis. Oxidative stress is a key factor of the inflammatory response. Implant biomaterials can release wear particles which may elicit adverse reactions in patients, such as local inflammatory response leading to tissue damage, which eventually results in loosening of the implant. Wear debris undergo phagocytosis by macrophages, inducing a low-grade chronic inflammation and reactive oxygen species (ROS) production. In addition, ROS can also be directly produced by prosthetic biomaterial oxidation. Overall, ROS amplify the inflammatory response and stimulate both RANKL-induced osteoclastogenesis and osteoblast apoptosis, resulting in bone resorption, leading to periprosthetic osteolysis. Therefore, a growing understanding of the mechanism of oxidative stress-induced periprosthetic osteolysis and anti-oxidant strategies of implant design as well as the addition of anti-oxidant agents will help to improve implants’ performances and therapeutic approaches.
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Bistolfi A, Giustra F, Bosco F, Sabatini L, Aprato A, Bracco P, Bellare A. Ultra-high molecular weight polyethylene (UHMWPE) for hip and knee arthroplasty: The present and the future. J Orthop 2021; 25:98-106. [PMID: 33994706 PMCID: PMC8102204 DOI: 10.1016/j.jor.2021.04.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/18/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE to review advances and clinical performance of polyethylene in total joint arthroplasty, summing up historical problems and focusing on the latest innovations. METHODS search for medical grade Ultra-High-Molecular-Weight-Polyethylene (UHMWPE); Data Sources: PubMed, Scopus, Cochrane Library. RESULTS the increasing number of joint arthroplasties and high-activity patients led to progressive developments of bearing surfaces to improve performance and durability. Different strategies such as crosslinking UHMWPE (HXLPE) and the addition of vitamin-E (HXLPE) have been tested to improve wear and oxidation resistance. CONCLUSION Recent innovations about UHMWPE showed improvements either for hip and knee, with the potential of long-term survivorship.
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Affiliation(s)
- Alessandro Bistolfi
- Department of Orthopaedics, Traumatology and Rehabilitation, C.T.O. Hospital. AOU Città della Salute e della Scienza, Via Zuretti 29, 10126, Turin, Italy
| | - Fortunato Giustra
- Department of Orthopaedics, Traumatology and Rehabilitation, C.T.O. Hospital. AOU Città della Salute e della Scienza, Via Zuretti 29, 10126, Turin, Italy
| | - Francesco Bosco
- Department of Orthopaedics, Traumatology and Rehabilitation, C.T.O. Hospital. AOU Città della Salute e della Scienza, Via Zuretti 29, 10126, Turin, Italy
| | - Luigi Sabatini
- Department of Orthopaedics, Traumatology and Rehabilitation, C.T.O. Hospital. AOU Città della Salute e della Scienza, Via Zuretti 29, 10126, Turin, Italy
| | - Alessandro Aprato
- Department of Orthopaedics, Traumatology and Rehabilitation, C.T.O. Hospital. AOU Città della Salute e della Scienza, Via Zuretti 29, 10126, Turin, Italy
| | - Pierangiola Bracco
- Department of Chemistry and NIS (Nanostructured Interfaces and Surfaces) Center, University of Torino, 10125, Torino, Italy
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Di Foggia M, Affatato S, Taddei P. Does the addition of vitamin E to conventional UHMWPE improve the wear performance of hip acetabular cups? Micro-Raman characterization of differently processed polyethylene acetabular cups worn on a hip joint simulator. Braz J Med Biol Res 2020; 53:e9930. [PMID: 32813853 PMCID: PMC7437989 DOI: 10.1590/1414-431x20209930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 06/15/2020] [Indexed: 11/22/2022] Open
Abstract
In knee replacements, vitamin E-doped ultra-high molecular weight polyethylene (UHMWPE) shows a better wear behavior than standard UHMWPE. Therefore, different sets of polyethylene (PE) acetabular cups, i.e. standard UHMWPE and cross-linked polyethylene irradiated with 50 kGy and 75 kGy, were compared, at a molecular level, with vitamin E-doped UHMWPE to evaluate their wear performance after being tested on a hip joint simulator for five million cycles. Unworn control and worn acetabular cups were analyzed by micro-Raman spectroscopy to gain insight into the effects of wear on the microstructure and phase composition of PE. Macroscopic wear was evaluated through mass loss measurements. The data showed that the samples could be divided into two groups: 1) standard and vitamin E-doped cups (mass loss of about 100 mg) and 2) the cross-linked cups (mass loss of about 30-40 mg). Micro-Raman spectroscopy disclosed different wear mechanisms in the four sets of acetabular cups, which were related to surface topography data. The vitamin E-doped samples did not show a better wear behavior than the cross-linked ones in terms of either mass loss or morphology changes. However, they showed lower variation at the morphological level (lower changes in phase composition) than the UHMWPE cups, thus confirming a certain protecting role of vitamin E against microstructural changes induced by wear testing.
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Affiliation(s)
- M Di Foggia
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - S Affatato
- Medical Technology Laboratory, IRCCS - Rizzoli Orthopaedic Institute, Bologna, Italy
| | - P Taddei
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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Hameister R, Kaur C, Dheen ST, Lohmann CH, Singh G. Reactive oxygen/nitrogen species (ROS/RNS) and oxidative stress in arthroplasty. J Biomed Mater Res B Appl Biomater 2020; 108:2073-2087. [PMID: 31898397 DOI: 10.1002/jbm.b.34546] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 11/19/2019] [Accepted: 12/08/2019] [Indexed: 12/16/2022]
Abstract
The interplay between implant design, biomaterial characteristics, and the local microenvironment adjacent to the implant is of utmost importance for implant performance and success of the joint replacement surgery. Reactive oxygen and nitrogen species (ROS/RNS) are among the various factors affecting the host as well as the implant components. Excessive formation of ROS and RNS can lead to oxidative stress, a condition that is known to damage cells and tissues and also to affect signaling pathways. It may further compromise implant longevity by accelerating implant degradation, primarily through activation of inflammatory cells. In addition, wear products of metallic, ceramic, polyethylene, or bone cement origin may also generate oxidative stress themselves. This review outlines the generation of free radicals and oxidative stress in arthroplasty and provides a conceptual framework on its implications for soft tissue remodeling and bone resorption (osteolysis) as well as implant longevity. Key findings derived from cell culture studies, animal models, and patients' samples are presented. Strategies to control oxidative stress by implant design and antioxidants are explored and areas of controversy and challenges are highlighted. Finally, directions for future research are identified. A better understanding of the host-implant interplay and the role of free radicals and oxidative stress will help to evaluate therapeutic approaches and will ultimately improve implant performance in arthroplasty.
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Affiliation(s)
- Rita Hameister
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Charanjit Kaur
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Shaikali Thameem Dheen
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Christoph H Lohmann
- Department of Orthopaedic Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Gurpal Singh
- Centre for Orthopaedics Pte Ltd, Singapore, Singapore
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Total knee arthroplasty application of polyetheretherketone and carbon-fiber-reinforced polyetheretherketone: A review. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 100:70-81. [DOI: 10.1016/j.msec.2019.02.082] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 02/13/2019] [Accepted: 02/21/2019] [Indexed: 12/31/2022]
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Takemura S, Minoda Y, Sugama R, Ohta Y, Nakamura S, Ueyama H, Nakamura H. Comparison of a vitamin E-infused highly crosslinked polyethylene insert and a conventional polyethylene insert for primary total knee arthroplasty at two years postoperatively. Bone Joint J 2019; 101-B:559-564. [PMID: 31039001 DOI: 10.1302/0301-620x.101b5.bjj-2018-1355.r1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
AIMS The use of vitamin E-infused highly crosslinked polyethylene (HXLPE) in total knee prostheses is controversial. In this paper we have compared the clinical and radiological results between conventional polyethylene and vitamin E-infused HXLPE inserts in total knee arthroplasty (TKA). PATIENTS AND METHODS The study included 200 knees (175 patients) that underwent TKA using the same total knee prostheses. In all, 100 knees (77 patients) had a vitamin E-infused HXLPE insert (study group) and 100 knees (98 patients) had a conventional polyethylene insert (control group). There were no significant differences in age, sex, diagnosis, preoperative knee range of movement (ROM), and preoperative Knee Society Score (KSS) between the two groups. Clinical and radiological results were evaluated at two years postoperatively. RESULTS Differences in postoperative ROM and KSS were not statistically significant between the study and control groups. No knee exhibited osteolysis, aseptic loosening, or polyethylene failure. Additionally, there was no significant difference in the incidence of a radiolucent line between the two groups. One patient from the study group required irrigation and debridement, due to deep infection, at six months postoperatively. CONCLUSION Clinical results were comparable between vitamin E-infused HXLPE inserts and conventional polyethylene inserts at two years after TKA, without any significant clinical failure. Cite this article: Bone Joint J 2019;101-B:559-564.
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Affiliation(s)
- S Takemura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Y Minoda
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - R Sugama
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Y Ohta
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - S Nakamura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - H Ueyama
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - H Nakamura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
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Terkawi MA, Kadoya K, Takahashi D, Tian Y, Hamasaki M, Matsumae G, Alhasan H, Elmorsy S, Uetsuki K, Onodera T, Takahata M, Iwasaki N. Identification of IL-27 as potent regulator of inflammatory osteolysis associated with vitamin E-blended ultra-high molecular weight polyethylene debris of orthopedic implants. Acta Biomater 2019; 89:242-251. [PMID: 30880234 DOI: 10.1016/j.actbio.2019.03.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 03/11/2019] [Accepted: 03/13/2019] [Indexed: 12/18/2022]
Abstract
Vitamin E-blended ultra-high molecular weight polyethylene (VE-UHMWPE) is a newly introduced material for prosthetic components that has proven a better mechanical performance with lesser adverse cellular responses than conventional polyethylene in experimental animal models. However, the mechanisms by which VE-UHMWPE particles trigger a reduced osteolytic activity are unclear and remain to be investigated. Therefore, the current study aims at exploring a possible anti-osteolytic mechanism associated with VE-UHMWPE particles. Transcriptional profiling and bioinformatic analyses of human macrophages stimulated by VE-UHMWPE particles revealed a distinct transcriptional program from macrophages stimulated with UHMWPE particles. Out of the up-regulated genes, IL-27 was found to be significantly elevated in macrophages cultured with VE-UHMWPE particles as compared to these with UHMWPE particles (p = 0.0084). Furthermore, we studied the potential anti-osteolytic function of IL-27 in osteolysis murine model. Interestingly, administration of recombinant IL-27 onto calvariae significantly alleviated osteolytic lesions triggered by UHMWPE particles (p = 0.0002). Likewise, IL-27 inhibited differentiation of osteoclasts (p = 0.0116) and reduced inflammatory response (p < 0.0001) elicited by conventional UHMWPE particles in vitro. This is the first study demonstrating the involvement of IL-27 in macrophage response to VE-UHMWPE particles and its regulatory role in osteolysis. Our data highlight a novel therapeutic agent for treatment of inflammatory osteolysis induced by polyethylene debris. STATEMENT OF SIGNIFICANCE: Aseptic loosening due to inflammatory osteolysis remains the major cause of arthroplasty failure and represents a substantial economic burden worldwide. Ideal approach to prevent this failure should be directed to minimize inflammatory response triggered by wear particles at the site of implant. Understanding the mechanism by which VE-UHMWPE particles triggers lesser cellular responses and reduced osteolysis as compared to conventional UHMWPE particles may aid in discovery of regulatory factors. In the current study, we reported that IL-27 is a potent regulator of inflammatory osteolysis involved in the reduced biologic activities and osteolytic potentials associated with VE-UHMWPE particles. Initiating the production IL-27 in vivo after total joint arthroplasties might be a novel strategy to prolong the life-spam of implant.
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Affiliation(s)
- Mohamad Alaa Terkawi
- Department of Orthopedic Surgery, Hokkaido University, Faculty of Medicine and Graduate School of Medicine, Kita-15, Nish-7, Kita-ku, Sapporo 060-8638, Japan; Global Institution for Collaborative Research and Education (GI-CoRE), Frontier Research Center for Advanced Material and Life Science Bldg No 2, Hokkaido University, Japan.
| | - Ken Kadoya
- Department of Orthopedic Surgery, Hokkaido University, Faculty of Medicine and Graduate School of Medicine, Kita-15, Nish-7, Kita-ku, Sapporo 060-8638, Japan
| | - Daisuke Takahashi
- Department of Orthopedic Surgery, Hokkaido University, Faculty of Medicine and Graduate School of Medicine, Kita-15, Nish-7, Kita-ku, Sapporo 060-8638, Japan.
| | - Yuan Tian
- Department of Orthopedic Surgery, Hokkaido University, Faculty of Medicine and Graduate School of Medicine, Kita-15, Nish-7, Kita-ku, Sapporo 060-8638, Japan
| | - Masanari Hamasaki
- Department of Orthopedic Surgery, Hokkaido University, Faculty of Medicine and Graduate School of Medicine, Kita-15, Nish-7, Kita-ku, Sapporo 060-8638, Japan
| | - Gen Matsumae
- Department of Orthopedic Surgery, Hokkaido University, Faculty of Medicine and Graduate School of Medicine, Kita-15, Nish-7, Kita-ku, Sapporo 060-8638, Japan
| | - Hend Alhasan
- Department of Orthopedic Surgery, Hokkaido University, Faculty of Medicine and Graduate School of Medicine, Kita-15, Nish-7, Kita-ku, Sapporo 060-8638, Japan
| | - Sameh Elmorsy
- Department of Orthopedic Surgery, Hokkaido University, Faculty of Medicine and Graduate School of Medicine, Kita-15, Nish-7, Kita-ku, Sapporo 060-8638, Japan; Department of Orthopedic Surgery, Beni-Suef University, Faculty of Medicine, Mokbel 62511, Beni-Suef, Egypt
| | - Keita Uetsuki
- R&D Center, Teijin Nakashima Medical Co., Ltd., 5322, Haga, Kita-ku, Okayama 701-1221, Japan
| | - Tomohiro Onodera
- Department of Orthopedic Surgery, Hokkaido University, Faculty of Medicine and Graduate School of Medicine, Kita-15, Nish-7, Kita-ku, Sapporo 060-8638, Japan; Global Institution for Collaborative Research and Education (GI-CoRE), Frontier Research Center for Advanced Material and Life Science Bldg No 2, Hokkaido University, Japan
| | - Masahiko Takahata
- Department of Orthopedic Surgery, Hokkaido University, Faculty of Medicine and Graduate School of Medicine, Kita-15, Nish-7, Kita-ku, Sapporo 060-8638, Japan
| | - Norimasa Iwasaki
- Department of Orthopedic Surgery, Hokkaido University, Faculty of Medicine and Graduate School of Medicine, Kita-15, Nish-7, Kita-ku, Sapporo 060-8638, Japan; Global Institution for Collaborative Research and Education (GI-CoRE), Frontier Research Center for Advanced Material and Life Science Bldg No 2, Hokkaido University, Japan
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15
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Magnesium Filled Polylactic Acid (PLA) Material for Filament Based 3D Printing. MATERIALS 2019; 12:ma12050719. [PMID: 30823676 PMCID: PMC6427143 DOI: 10.3390/ma12050719] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 02/22/2019] [Accepted: 02/25/2019] [Indexed: 11/30/2022]
Abstract
The main objective of this research is to prove the viability of obtaining magnesium (Mg) filled polylactic acid (PLA) biocomposites as filament feedstock for material extrusion-based additive manufacturing (AM). These materials can be used for medical applications, thus benefiting of all the advantages offered by AM technology in terms of design freedom and product customization. Filaments were produced from two PLA + magnesium + vitamin E (α-tocopherol) compositions and then used for manufacturing test samples and ACL (anterior cruciate ligament) screws on a low-cost 3D printer. Filaments and implant screws were characterized using SEM (scanning electron microscopy), FTIR (fourier transform infrared spectrometry), and DSC (differential scanning calorimetry) analysis. Although the filament manufacturing process could not ensure a uniform distribution of Mg particles within the PLA matrix, a good integration was noticed, probably due to the use of vitamin E as a precursor. The results also show that the composite biomaterials can ensure and maintain implant screws structural integrity during the additive manufacturing process.
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16
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Popoola OO, Orozco Villasenor DA, Fryman JC, Mimnaugh K, Rufner A. High cycle in vitro hip wear of and in vivo biological response to vitamin E blended highly crosslinked polyethylene. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.biotri.2018.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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17
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Lambert B, Neut D, van der Veen HC, Bulstra SK. Effects of vitamin E incorporation in polyethylene on oxidative degradation, wear rates, immune response, and infections in total joint arthroplasty: a review of the current literature. INTERNATIONAL ORTHOPAEDICS 2018; 43:1549-1557. [PMID: 30470866 DOI: 10.1007/s00264-018-4237-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 11/14/2018] [Indexed: 02/04/2023]
Abstract
Highly cross-linked ultrahigh molecular weight polyethylene (UHMWPE) was introduced to decrease wear debris and osteolysis. During cross-linking, free radicals are formed, making highly cross-linked polyethylene vulnerable to oxidative degradation. In order to reduce this process, anti-oxidant vitamin E can be incorporated in polyethylene. This review provides an overview of the effects of vitamin E incorporation on major complications in total joint arthroplasty: material failure due to oxidative degradation, wear debris and subsequent periprosthetic osteolysis, and prosthetic joint infections. Secondly, this review summarizes the first clinical results of total hip and knee arthroplasties with vitamin E incorporated highly cross-linked polyethylene. Based on in vitro studies, incorporation of vitamin E in polyethylene provides good oxidative protection and preserves low wear rates. Incorporation of vitamin E may have the beneficial effect of reduced inflammatory response to its wear particles. Some microorganisms showed reduced adherence to vitamin E-incorporated UHMWPE; however, clinical relevance is doubtful. Short-term clinical studies of total hip and knee arthroplasties with vitamin E-incorporated highly cross-linked UHMWPE reported good clinical results and wear rates similar to highly cross-linked UHMWPE without vitamin E.
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Affiliation(s)
- Bart Lambert
- Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
| | - Daniëlle Neut
- Department of Biomedical Engineering, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands
| | - Hugo C van der Veen
- Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands.
| | - Sjoerd K Bulstra
- Department of Orthopedic Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
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Kurcz B, Lyons J, Sayeed Z, Anoushiravani AA, Iorio R. Osteolysis as it Pertains to Total Hip Arthroplasty. Orthop Clin North Am 2018; 49:419-435. [PMID: 30224004 DOI: 10.1016/j.ocl.2018.06.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Osteolysis is a long-term complication of total hip arthroplasty (THA). As the projected number of THAs performed annually increases, osteolysis will likely continue to occur. However, because of advancements in prosthesis design, metallurgy, and enhanced bearing surfaces, fewer revision THAs will be linked to osteolysis and aseptic loosening. Despite these improvements, no preventative therapies are currently available for the management of osteolysis other than removing and replacing the source of bearing wear.
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Affiliation(s)
- Brian Kurcz
- Division of Orthopaedic Surgery, Southern Illinois University, 701 North 1st Street, Springfield, IL 62781, USA
| | - Joseph Lyons
- Department of Surgery, Chicago Medical School, 3333 Green Bay Road, North Chicago, IL 60064, USA
| | - Zain Sayeed
- Department of Orthopaedic Surgery, Detroit Medical Center, 4201 Saint Antoine, Detroit, MI 48201, USA
| | - Afshin A Anoushiravani
- Division of Orthopaedic Surgery, Albany Medical Center, 43 New Scotland, Albany, NY, USA
| | - Richard Iorio
- Division of Orthopaedic Surgery, Albany Medical Center, 43 New Scotland, Albany, NY, USA.
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19
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Ponzio DY, Weitzler L, deMeireles A, Esposito CI, Wright TM, Padgett DE. Antioxidant-stabilized highly crosslinked polyethylene in total knee arthroplasty. Bone Joint J 2018; 100-B:1330-1335. [DOI: 10.1302/0301-620x.100b10.bjj-2018-0061.r2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The aim of this study was to evaluate the surface damage, the density of crosslinking, and oxidation in retrieved antioxidant-stabilized highly crosslinked polyethylene (A-XLPE) tibial inserts from total knee arthroplasty (TKA), and to compare the results with a matched cohort of standard remelted highly crosslinked polyethylene (XLPE) inserts. Materials and Methods A total of 19 A-XLPE tibial inserts were retrieved during revision TKA and matched to 18 retrieved XLPE inserts according to the demographics of the patients, with a mean length of implantation of 15 months (1 to 42). The percentage areas of PE damage on the articular surfaces and the modes of damage were measured. The density of crosslinking of the PE and oxidation were measured at loaded and unloaded regions on these surfaces. Results A-XLPE inserts had higher rates of burnishing and lower rates of pitting and scratching compared with XLPE. There were no differences in the density of crosslinking at loaded and unloaded regions. A-XLPE showed higher oxidation indices in the unloaded surface region compared with XLPE. There were no differences in the levels of oxidation in the loaded regions. Conclusion Retrieval analysis of A-XLPE did not reflect a clinically relevant difference in surface damage, density of crosslinking, or oxidation compared with XLPE tibial inserts at short-term evaluation. Cite this article: Bone Joint J 2018;100-B:1330–5.
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20
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Lal S, Caseley EA, Hall RM, Tipper JL. Biological Impact of Silicon Nitride for Orthopaedic Applications: Role of Particle Size, Surface Composition and Donor Variation. Sci Rep 2018; 8:9109. [PMID: 29904079 PMCID: PMC6002550 DOI: 10.1038/s41598-018-27494-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 05/23/2018] [Indexed: 01/29/2023] Open
Abstract
The adverse biological impact of orthopaedic wear debris currently limits the long-term safety of human joint replacement devices. We investigated the role of particle size, surface composition and donor variation in influencing the biological impact of silicon nitride as a bioceramic for orthopaedic applications. Silicon nitride particles were compared to the other commonly used orthopaedic biomaterials (e.g. cobalt-chromium and Ti-6Al-4V alloys). A novel biological evaluation platform was developed to simultaneously evaluate cytotoxicity, inflammatory cytokine release, oxidative stress, and genotoxicity potential of particles using peripheral blood mononuclear cells (PBMNCs) from individual human donors. Irrespective of the particle size, silicon nitride did not cause any adverse responses whereas cobalt-chromium wear particles caused donor-dependent cytotoxicity, TNF-α cytokine release, oxidative stress, and DNA damage in PBMNCs after 24 h. Despite being similar in size and morphology, silicon dioxide nanoparticles caused the release of significantly higher levels of TNF-α compared to silicon nitride nanoparticles, suggesting that surface composition influences the inflammatory response in PBMNCs. Ti-6Al-4V wear particles also released significantly elevated levels of TNF-α cytokine in one of the donors. This study demonstrated that silicon nitride is an attractive orthopaedic biomaterial due to its minimal biological impact on human PBMNCs.
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Affiliation(s)
- Saurabh Lal
- School of Biomedical Sciences, University of Leeds, LS2 9JT, Leeds, UK.
- School of Mechanical Engineering, University of Leeds, LS2 9JT, Leeds, UK.
| | - Emily A Caseley
- School of Biomedical Sciences, University of Leeds, LS2 9JT, Leeds, UK
- School of Mechanical Engineering, University of Leeds, LS2 9JT, Leeds, UK
| | - Richard M Hall
- School of Mechanical Engineering, University of Leeds, LS2 9JT, Leeds, UK
| | - Joanne L Tipper
- School of Biomedical Sciences, University of Leeds, LS2 9JT, Leeds, UK
- School of Mechanical Engineering, University of Leeds, LS2 9JT, Leeds, UK
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21
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Kyomoto M, Moro T, Yamane S, Watanabe K, Hashimoto M, Tanaka S, Ishihara K. A phospholipid polymer graft layer affords high resistance for wear and oxidation under load bearing conditions. J Mech Behav Biomed Mater 2018; 79:203-212. [PMID: 29306728 DOI: 10.1016/j.jmbbm.2017.12.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 12/21/2017] [Accepted: 12/29/2017] [Indexed: 11/28/2022]
Abstract
Manipulating the surface and substrate of cross-linked polyethylene (CLPE) is an essential approach for obtaining life-long orthopedic bearings. We therefore proposed a bearing material comprised of an antioxidative substrate generated by vitamin E blending (HD-CLPE[VE]) with a poly(2-methacryloyloxyethyl phosphorylcholine) (PMPC)-grafted surface, and investigated its wear resistance and oxidative stability under accelerated aging and load bearing conditions. Neither the hydration nor friction kinetics of the molecular network structure of the PMPC-grafted surface or the HD-CLPE(VE) substrate were influenced by accelerated aging but rather exhibited high stability even under high oxidation conditions. The characteristics of the PMPC-grafted surface improved the wear and impact fatigue resistance of the HD-CLPE(VE) liner regardless of accelerated aging. Notably, the PMPC-grafted surface was found to affect the potential oxidative stability at the rim part of the acetabular liner. PMPC chains serve several important functions on the surface regardless of load bearing, such as high lubricity or low lipophilicity attributed to phosphorylcholine groups and/or surrounding water-fluid film, and suppression of lipid diffusion attributed to methacrylate main chains on the surface. Together, these results provide preliminary evidence that the PMPC graft layer and vitamin E-blended substrate might positively affect the extent of orthopedic implant durability.
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Affiliation(s)
- Masayuki Kyomoto
- Department of Materials Engineering, School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan; Division of Science for Joint Reconstruction, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; Medical R&D Center, Corporate R&D Group, KYOCERA Corporation, 800 Ichimiyake, Yasu 520-2362, Japan
| | - 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
| | - Shihori Yamane
- Department of Materials Engineering, School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8656, Japan; Division of Science for Joint Reconstruction, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; Medical R&D Center, Corporate R&D Group, KYOCERA Corporation, 800 Ichimiyake, Yasu 520-2362, Japan
| | - Kenichi Watanabe
- Division of Science for Joint Reconstruction, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; Medical R&D Center, Corporate R&D Group, KYOCERA Corporation, 800 Ichimiyake, Yasu 520-2362, Japan
| | - Masami Hashimoto
- Materials Research and Development Laboratory, Japan Fine Ceramics Center, 2-4-1 Mutsuno, Atsuta-ku, Nagoya 456-8587, Japan
| | - Sakae Tanaka
- 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.
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22
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Chen W, Bichara DA, Suhardi J, Sheng P, Muratoglu OK. Effects of vitamin E-diffused highly cross-linked UHMWPE particles on inflammation, apoptosis and immune response against S. aureus. Biomaterials 2017; 143:46-56. [DOI: 10.1016/j.biomaterials.2017.07.028] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 07/17/2017] [Accepted: 07/20/2017] [Indexed: 01/31/2023]
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23
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Brown TS, Van Citters DW, Berry DJ, Abdel MP. The use of highly crosslinked polyethylene in total knee arthroplasty. Bone Joint J 2017; 99-B:996-1002. [PMID: 28768774 DOI: 10.1302/0301-620x.99b8.bjj-2017-0028.r1] [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: 01/06/2017] [Accepted: 03/28/2017] [Indexed: 01/13/2023]
Abstract
Advances in polyethylene (PE) in total hip arthroplasty have led to interest and increased use of highly crosslinked PE (HXLPE) in total knee arthroplasty (TKA). Biomechanical data suggest improved wear characteristics for HXLPE inserts over conventional PE in TKA. Short-term results from registry data and few clinical trials are promising. Our aim is to present a review of the history of HXLPEs, the use of HXLPE inserts in TKA, concerns regarding potential mechanical complications, and a thorough review of the available biomechanical and clinical data. Cite this article: Bone Joint J 2017;99-B:996-1002.
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Affiliation(s)
- T S Brown
- Mayo Clinic, 200 First Street S.W., Rochester, MN 55905, USA
| | - D W Van Citters
- Dartmouth College, 14 Engineering Drive, Hanover, NH 03755, USA
| | - D J Berry
- Mayo Clinic, 200 First Street S.W., Rochester, MN 55905, USA
| | - M P Abdel
- Mayo Clinic, 200 First Street S.W., Rochester, MN 55905, USA
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24
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Bracco P, Bellare A, Bistolfi A, Affatato S. Ultra-High Molecular Weight Polyethylene: Influence of the Chemical, Physical and Mechanical Properties on the Wear Behavior. A Review. MATERIALS (BASEL, SWITZERLAND) 2017; 10:E791. [PMID: 28773153 PMCID: PMC5551834 DOI: 10.3390/ma10070791] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 07/06/2017] [Accepted: 07/08/2017] [Indexed: 01/03/2023]
Abstract
Ultra-high molecular weight polyethylene (UHMWPE) is the most common bearing material in total joint arthroplasty due to its unique combination of superior mechanical properties and wear resistance over other polymers. A great deal of research in recent decades has focused on further improving its performances, in order to provide durable implants in young and active patients. From "historical", gamma-air sterilized polyethylenes, to the so-called first and second generation of highly crosslinked materials, a variety of different formulations have progressively appeared in the market. This paper reviews the structure-properties relationship of these materials, with a particular emphasis on the in vitro and in vivo wear performances, through an analysis of the existing literature.
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Affiliation(s)
- Pierangiola Bracco
- Department of Chemistry and NIS (Nanostructured Interfaces and Surfaces) Center, University of Torino, 10125 Torino, Italy.
| | - Anuj Bellare
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
| | | | - Saverio Affatato
- Medical Technology Laboratory, Rizzoli Orthopaedic Institute, 40136 Bologna, Italy.
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25
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Liu Y, Shi F, Gong K, Liu Y, Zhi W, Weng J, Qu S. Study on critical-sized ultra-high molecular weight polyethylene wear particles loaded with alendronate sodium: in vitro release and cell response. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2017; 28:56. [PMID: 28210968 DOI: 10.1007/s10856-017-5865-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 02/06/2017] [Indexed: 06/06/2023]
Abstract
The aim of this study was to investigate the in vitro release and the effect of RAW 264.7 macrophages of critical-sized wear particles of ultra-high molecular weight polyethylene (UHMWPE) loaded with alendronate sodium (ALN), one of the most effective drugs to treat osteoporosis in clinic. The critical-sized UHMWPE-ALN 0.5 wt.% wear particles were prepared by vacuum gradient filtration combined with Pluronic F-68. In vitro release of ALN from critical-sized UHMWPE-ALN wear particles was investigated in phosphate buffered saline (PBS) at 37 °C with a shaker. Cell morphology, proliferation, lactate dehydrogenase (LDH) leakage and secretions of cytokines were evaluated after co-cultured with critical-sized UHMWPE-ALN wear particles in vitro. Results showed that ALN released from critical-sized UHMWPE-ALN wear particles included burst release and slow release in vitro. Macrophages would be chemotaxis and aggregated around the critical-sized UHMWPE-ALN or UHMWPE wear particle, which was phagocytosed with time. The proliferation of macrophages co-cultured with critical-sized UHMWPE-ALN wear particles was significantly decreased compared with that of critical-sized UHMWPE group. Meanwhile, the critical-sized UHMWPE-ALN wear particles significantly induced the LDH leakage of macrophages, which indicated the cell death. The death of macrophages induced by ALN was one of pathways to inhibit their proliferation. The secretions of cytokines (interleukin-6 and tumor necrosis factor-alpha) in critical-sized UHMWPE-ALN group were significantly lower than those in critical-sized UHMWPE group due to the released ALN. The present results suggested that UHMWPE-ALN had the potential application in clinic to treat osteolysis induced by wear particles.
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Affiliation(s)
- Yumei Liu
- Key Lab of Advanced Technologies of Materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, 610031, China
| | - Feng Shi
- Key Lab of Advanced Technologies of Materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, 610031, China
| | - Kemeng Gong
- Key Lab of Advanced Technologies of Materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, 610031, China
| | - Yang Liu
- Key Lab of Advanced Technologies of Materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, 610031, China
| | - Wei Zhi
- Key Lab of Advanced Technologies of Materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, 610031, China
| | - Jie Weng
- Key Lab of Advanced Technologies of Materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, 610031, China
| | - Shuxin Qu
- Key Lab of Advanced Technologies of Materials, Ministry of Education, School of Materials Science and Engineering, Southwest Jiaotong University, Chengdu, 610031, China.
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26
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Suñer S, Gowland N, Craven R, Joffe R, Emami N, Tipper JL. Ultrahigh molecular weight polyethylene/graphene oxide nanocomposites: Wear characterization and biological response to wear particles. J Biomed Mater Res B Appl Biomater 2016; 106:183-190. [DOI: 10.1002/jbm.b.33821] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 11/06/2016] [Accepted: 11/08/2016] [Indexed: 11/08/2022]
Affiliation(s)
- S. Suñer
- Division of Machine Elements; Luleå University of Technology; Luleå Sweden
| | - N. Gowland
- Institute of Medical and Biological Engineering; University of Leeds; Leeds UK
| | - R. Craven
- Institute of Medical and Biological Engineering; University of Leeds; Leeds UK
| | - R. Joffe
- Division of Materials Science; Luleå University of Technology; Luleå Sweden
| | - N. Emami
- Division of Machine Elements; Luleå University of Technology; Luleå Sweden
| | - J. L. Tipper
- Institute of Medical and Biological Engineering; University of Leeds; Leeds UK
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27
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Mouthuy PA, Snelling SJ, Dakin SG, Milković L, Gašparović AČ, Carr AJ, Žarković N. Biocompatibility of implantable materials: An oxidative stress viewpoint. Biomaterials 2016; 109:55-68. [DOI: 10.1016/j.biomaterials.2016.09.010] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 09/06/2016] [Accepted: 09/13/2016] [Indexed: 12/13/2022]
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Yousef S, Visco A, Galtieri G, Nocita D, Espro C. Wear behaviour of UHMWPE reinforced by carbon nanofiller and paraffin oil for joint replacement. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2016; 73:234-244. [PMID: 28183604 DOI: 10.1016/j.msec.2016.11.088] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 11/03/2016] [Accepted: 11/23/2016] [Indexed: 11/30/2022]
Abstract
The majority of artificial joints incorporate biomedical grade Ultra High Molecular Weight Poly Ethylene (UHMWPE), whose wear is considered most important in controlling service time of the whole joint. The aim of this work was to improve wear resistance of UHMWPE through the addition of 0.5-2.0wt% of Carbon Nano Filler (CNF) and 2% wt of Paraffin Oil (PO) using ball milling (BM) and extrusion techniques (EX). The wear tests on these nanocomposites were conducted by a pin on disc in dry (air) and wet media (simulated synovial fluid or artificial lubricant, and bovine synovial fluid or natural lubricant). Mechanical tests (tensile and hardness), physical analysis (calorimetric, density, wet ability, roughness) and morphological observations were also performed. The experimental results showed that natural lubricant provides the greatest reduction in wear rate while the largest one occurred in air. Furthermore, the BM mixed nanocomposites with a filler load of 1.0% exhibited the best wear resistance among all the samples with an improvement of 42%, 64% and 83% in air, artificial and natural lubricant, respectively. This is due to its higher ductility and thermal features, and lower wet ability in the two lubricants.
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Affiliation(s)
- Samy Yousef
- Department of Engineering, University of Messina, Contrada Di Dio, I-98166 Messina, Italy; Dept. of Production Engineering and Printing Technology, Akhbar Elyom Academy, 6th of October, Egypt
| | - Annamaria Visco
- Department of Engineering, University of Messina, Contrada Di Dio, I-98166 Messina, Italy.
| | - Giovanna Galtieri
- Department of Engineering, University of Messina, Contrada Di Dio, I-98166 Messina, Italy
| | - Davide Nocita
- Department of Engineering, University of Messina, Contrada Di Dio, I-98166 Messina, Italy
| | - Claudia Espro
- Department of Engineering, University of Messina, Contrada Di Dio, I-98166 Messina, Italy
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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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Affatato S, De Mattia JS, Bracco P, Pavoni E, Taddei P. Wear performance of neat and vitamin E blended highly cross-linked PE under severe conditions: The combined effect of accelerated ageing and third body particles during wear test. J Mech Behav Biomed Mater 2016; 64:240-52. [PMID: 27522313 DOI: 10.1016/j.jmbbm.2016.08.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 07/28/2016] [Accepted: 08/01/2016] [Indexed: 12/28/2022]
Abstract
The objective of this study is to evaluate the effects of third-body particles on the in vitro wear behaviour of three different sets of polyethylene acetabular cups after prolonged testing in a hip simulator and accelerated ageing. Vitamin E-blended, cross-linked polyethylene (XLPE_VE), cross-linked polyethylene (XLPE) and conventional polyethylene (STD_PE) acetabular cups were simulator tested for two million cycles under severe conditions (i.e. by adding third-body particles to the bovine calf serum lubricant). Micro-Fourier Transform Infrared and micro-Raman spectroscopic analyses, differential scanning calorimetry, and crosslink density measurements were used to characterize the samples at a molecular level. The STD_PE cups had twice mass loss than the XLPE_VE components and four times than the XLPE samples; statistically significant differences were found between the mass losses of the three sets of cups. The observed wear trend was justified on the basis of the differences in cross-link density among the samples (XLPE>XLPE_VE>STD_PE). FTIR crystallinity profiles, bulk DSC crystallinity and surface micro-Raman crystallinity seemed to have a similar behaviour upon testing: all of them (as well as the all-trans and ortho-trans contents) revealed the most significant changes in XLPE and XLPE_VE samples. The more severe third-body wear testing conditions determined more noticeable changes in all spectroscopic markers with respect to previous tests. Unexpectedly, traces of bulk oxidation were found in both STD_PE (unirradiated) and XLPE (remelting-stabilized), which were expected to be stable to oxidation; on the contrary, XLPE_VE demonstrated a high oxidative stability in the present, highly demanding conditions.
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Affiliation(s)
- Saverio Affatato
- Medical Technology Laboratory, Rizzoli Orthopaedic Institute, Bologna, Italy.
| | | | - Pierangiola Bracco
- Chemistry Department and Nanostructured Interfaces and Surfaces (NIS) Centre, University of Turin, Via Giuria 7, 10125 Turin, Italy
| | - Eleonora Pavoni
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Via Belmeloro 8/2, 40126 Bologna, Italy
| | - Paola Taddei
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Via Belmeloro 8/2, 40126 Bologna, Italy
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Does cyclic stress and accelerated ageing influence the wear behavior of highly crosslinked polyethylene? J Mech Behav Biomed Mater 2016; 59:418-429. [DOI: 10.1016/j.jmbbm.2016.02.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 02/22/2016] [Accepted: 02/23/2016] [Indexed: 12/28/2022]
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32
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WANG LING, PENG XIFENG, SUN CHANGNING, WANG HUAYI, LI DICHEN, ZHU JINYU, JIN ZHONGMIN, MIHCIN SENAY, LIU CHAOZONG. THE DETERMINATION OF THE VOLUMETRIC WEAR FOR SURGICALLY RETRIEVED HIP IMPLANTS BASED ON CMM. J MECH MED BIOL 2016. [DOI: 10.1142/s0219519416500597] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The effects of wear mechanisms on the long-term survivorship of artificial hip implants emphasized the importance of determining the 3D volumetric wear in retrieved hip replacements. Traditional methods for determining the volumetric wear on acetabular cups require reference surface from a pre-worn model, which is not feasible for clinical retrieved implants. In this study, a methodology based on co-ordinate measuring machine (CMM) measurement is proposed to reconstruct the reference surface by applying a mathematical model on those selected unworn regions of the acetabular liners. For validation purposes, three polyethylene liners from 5-million-cycle hip simulator testing were employed, whose wear volume at different measurement points was determined by applying the developed method and the results were compared to those determined via traditional approaches. Volumetric loss estimated by the developed method was found to correlate well with the results estimated by the traditional methods ([Formula: see text]). Moreover, two surgically retrieved inserts were analyzed using the developed methodology. The wear volume estimated from the two retrieved liners was also found to agree well with the observation from X-ray photograph. Results demonstrated that the proposed method is effective in determining the volumetric wear for retrieved components providing viable unworn regions on the liner.
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Affiliation(s)
- LING WANG
- State Key Laboratory for Manufacturing Systems Engineering, Xi’an Jiaotong University, Xi’an 710054, P. R. China
| | - XIFENG PENG
- State Key Laboratory for Manufacturing Systems Engineering, Xi’an Jiaotong University, Xi’an 710054, P. R. China
| | - CHANGNING SUN
- State Key Laboratory for Manufacturing Systems Engineering, Xi’an Jiaotong University, Xi’an 710054, P. R. China
| | - HUAYI WANG
- Department of Orthopaedics, Xijing Hospital, the Fourth Military Medical University, Xi’an 710032, P. R. China
| | - DICHEN LI
- State Key Laboratory for Manufacturing Systems Engineering, Xi’an Jiaotong University, Xi’an 710054, P. R. China
| | - JINYU ZHU
- Department of Orthopaedics, Xijing Hospital, the Fourth Military Medical University, Xi’an 710032, P. R. China
| | - ZHONGMIN JIN
- State Key Laboratory for Manufacturing Systems Engineering, Xi’an Jiaotong University, Xi’an 710054, P. R. China
- School of Mechanical Engineering, University of Leeds, Leeds, LS2 9JT, UK
| | - SENAY MIHCIN
- Institute for Medical Science and Technology, University of Dundee, Dundee, DD2 1FD, UK
| | - CHAOZONG LIU
- John Scale Centre for Biomedical Engineering, University College London, Royal National Orthopaedic Hospital, Stanmore, HA74LP, UK
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33
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de Villiers D, Shelton JC. Measurement outcomes from hip simulators. Proc Inst Mech Eng H 2016; 230:398-405. [DOI: 10.1177/0954411916628559] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 12/15/2015] [Indexed: 11/15/2022]
Abstract
Simulation of wear in total hip replacements has been recognised as an important factor in determining the likelihood of clinical success. However, accurate measurement of wear can be problematic with factors such as number and morphology of wear particles produced as well as ion release proving more important in the biological response to hip replacements than wear volume or wear rate alone. In this study, hard-on-hard (CoCr alloy, AgCrN coating) and hard-on-soft (CoCr alloy and CrN coating on vitamin E blended highly cross-linked polyethylene) bearing combinations were tested in an orbital hip simulator under standard and some adverse conditions. Gravimetric wear rates were determined for all bearings, with cobalt and where applicable, silver release determined throughout testing. Isolation of wear particles from the lubricating fluid was used to determine the influence of different bearing combinations and wear conditions on particle morphology. It was found that cobalt and silver could be measured in the lubricating fluid even when volumetric wear was not detectable. In hard-on-hard bearings, Pearson’s correlation of 0.98 was established between metal release into the lubricating fluid and wear volume. In hard-on-soft bearings, coating the head did not influence the polyethylene wear rates measured under standard conditions but did influence the cobalt release; the diameter influenced both polyethylene wear and cobalt release, and the introduction of adverse testing generated smaller polyethylene particles. While hip simulators can be useful to assess the wear performance of a new material or design, measurement of other outcomes may yield greater insight into the clinical behaviour of the bearings in vivo.
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Affiliation(s)
- Danielle de Villiers
- School of Engineering and Materials Science, Queen Mary University of London, London, UK
| | - Julia C Shelton
- School of Engineering and Materials Science, Queen Mary University of London, London, UK
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Affatato S, Freccero N, Taddei P. The biomaterials challenge: A comparison of polyethylene wear using a hip joint simulator. J Mech Behav Biomed Mater 2016; 53:40-48. [DOI: 10.1016/j.jmbbm.2015.08.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 07/31/2015] [Accepted: 08/04/2015] [Indexed: 10/23/2022]
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BIANCHI MICHELE, BOI MARCO, LOPOMO NICOLA, MALTARELLO MARIACRISTINA, LISCIO FABIOLA, MILITA SILVIA, VISANI ANDREA, RUSSO ALESSANDRO, MARCACCI MAURILIO. NANOMECHANICAL CHARACTERIZATION OF ZIRCONIA THIN FILMS DEPOSITED ON UHMWPE BY PULSED PLASMA DEPOSITION. J MECH MED BIOL 2015. [DOI: 10.1142/s0219519415500700] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Plastic deformation and wear of the ultra-high molecular weight polyethylene (UHMWPE) insert have been pointed out as major issues relating to the long-term stability of an orthopaedic implant. The deposition of protective hard, tough and well-adhered zirconia ( ZrO 2) thin films directly on the surface of the UHMWPE component via the Pulsed Plasma Deposition (PPD) technique has been already demonstrated to be a feasible way to approach this problem. In the current study, the tribo-mechanical properties of ZrO 2-coated UHMWPE with respect to pristine UHMWPE were investigated in detail. Specifically, strength to local plastic deformation, indentation work portioning and creep behavior were evaluated through nanoindentation and micro-scratch tests. Further, preliminary wear data (i.e., rate and volume) were obtained by tribology tests mating coated and pristine UHMWPE with an alumina ball under dry conditions. The results of the mechanical tests evidenced a strong reduction of plastic deformation under both normal and tangential local loads and a drop of the 80% of the creep phenomenon for coated UHMWPE compared to pristine UHMWPE. Despite tribological tests showed similar wear data for coated and pristine UHMWPE, a different wear mechanism was detected between the two groups. The reported results supported the possibility to pursue this novel approach of depositing ZrO 2 thin film to protect the UHWMPE insert and enhance the long-term stability of the orthopaedic implants.
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Affiliation(s)
- MICHELE BIANCHI
- Laboratory of NanoBiotechnologies (NaBi), Rizzoli Orthopaedic Institute, via di Barbiano 1/10, 40136 Bologna, Italy
| | - MARCO BOI
- Laboratory of NanoBiotechnologies (NaBi), Rizzoli Orthopaedic Institute, via di Barbiano 1/10, 40136 Bologna, Italy
| | - NICOLA LOPOMO
- Laboratory of NanoBiotechnologies (NaBi), Rizzoli Orthopaedic Institute, via di Barbiano 1/10, 40136 Bologna, Italy
| | - MARIA CRISTINA MALTARELLO
- Laboratory of Musculoskeletal Cell Biology, Rizzoli Orthopaedic Institute, via di Barbiano 1/10, 40136 Bologna, Italy
| | - FABIOLA LISCIO
- Institute for Microelectronics and Microsystems (IMM), National Research Council, via Gobetti 101, 40129 Bologna, Italy
| | - SILVIA MILITA
- Institute for Microelectronics and Microsystems (IMM), National Research Council, via Gobetti 101, 40129 Bologna, Italy
| | - ANDREA VISANI
- Laboratory of Biomechanics and Technology, Innovation — Rizzoli Orthopaedic Institute, via di Barbiano 1/10, 40136 Bologna, Italy
| | - ALESSANDRO RUSSO
- Laboratory of Biomechanics and Technology, Innovation — Rizzoli Orthopaedic Institute, via di Barbiano 1/10, 40136 Bologna, Italy
| | - MAURILIO MARCACCI
- Laboratory of Biomechanics and Technology, Innovation — Rizzoli Orthopaedic Institute, via di Barbiano 1/10, 40136 Bologna, Italy
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Gigante A, Bottegoni C, Ragone V, Banci L. Effectiveness of Vitamin-E-Doped Polyethylene in Joint Replacement: A Literature Review. J Funct Biomater 2015; 6:889-900. [PMID: 26371052 PMCID: PMC4598683 DOI: 10.3390/jfb6030889] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 07/24/2015] [Accepted: 08/08/2015] [Indexed: 12/25/2022] Open
Abstract
Since polyethylene is one of the most frequently used biomaterials, such as in bearing components in joint arthroplasty, strong efforts have been made to improve the design and material properties over the last decades. Antioxidants, such as vitamin-E, seem to be a promising alternative to further increase durability and reduce polyethylene wear and degradation in the long-term. Nevertheless, even if several promising in vitro results are available, there is yet no clinical evidence that vitamin-E polyethylenes show these advantages in vivo. The aim of this paper was to provide a comprehensive overview on the current knowledge regarding the biological and mechanical proprieties of this biomaterial, underlying the in vitro and in vivo evidence for effectiveness of vitamin-E-doped polyethylene in joint arthroplasty.
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Affiliation(s)
- Antonio Gigante
- Clinical Orthopaedics, Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, via Tronto 10/A, 60126 Ancona, Italy.
| | - Carlo Bottegoni
- Clinical Orthopaedics, Department of Clinical and Molecular Science, School of Medicine, Università Politecnica delle Marche, via Tronto 10/A, 60126 Ancona, Italy.
| | - Vincenza Ragone
- Research and Development Department, Permedica S.p.A., via Como 38, 23807 Merate (LC), Italy.
| | - Lorenzo Banci
- Research and Development Department, Permedica S.p.A., via Como 38, 23807 Merate (LC), Italy.
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Dion NT, Bragdon C, Muratoglu O, Freiberg AA. Durability of highly cross-linked polyethylene in total hip and total knee arthroplasty. Orthop Clin North Am 2015; 46:321-7, ix. [PMID: 26043046 DOI: 10.1016/j.ocl.2015.02.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This article reviews the history of the development of highly cross-linked polyethylene and provides an in-depth review of the clinical results regarding the durability of highly cross-linked polyethylene (HXLPE) used in total hip arthroplasty (THA) and total knee arthroplasty (TKA). The use of polyethylene as a bearing surface has contributed to the success of THA and TKA; however, polyethylene wear and osteolysis can lead to failure. Ongoing clinical and retrieval studies are required to analyze outcomes at longer-term follow-up.
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Affiliation(s)
- Neil T Dion
- Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit Street, Suite 3700, Boston, MA 02114, USA.
| | - Charles Bragdon
- Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit Street, Suite 3700, Boston, MA 02114, USA
| | - Orhun Muratoglu
- Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit Street, Suite 3700, Boston, MA 02114, USA
| | - Andrew A Freiberg
- Department of Orthopaedic Surgery, Massachusetts General Hospital, 55 Fruit Street, Suite 3700, Boston, MA 02114, USA
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38
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Rowell SL, Muratoglu OK. Investigation of surgically retrieved, vitamin E-stabilized, crosslinked UHMWPE implants after short-termin vivoservice. J Biomed Mater Res B Appl Biomater 2015; 104:1132-40. [DOI: 10.1002/jbm.b.33465] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 01/30/2015] [Accepted: 05/07/2015] [Indexed: 12/29/2022]
Affiliation(s)
- Shannon L. Rowell
- Harris Orthopaedics Laboratory; Massachusetts General Hospital; Boston MA
| | - Orhun K. Muratoglu
- Harris Orthopaedics Laboratory; Massachusetts General Hospital; Boston MA
- Department of Orthopaedic Surgery; Harvard Medical School; Boston MA
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39
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Analysis of UHMWPE wear particles produced in the simulation of hip and knee wear mechanisms with the RandomPOD system. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.biotri.2015.03.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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40
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[Possibilities and limits of modern polyethylenes. With respect to the application profile]. DER ORTHOPADE 2015; 43:515-21. [PMID: 24832377 DOI: 10.1007/s00132-014-2297-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Polyethylene is still one of the most important materials in the field of hip and knee arthroplasty. The clinical results of the last decades have helped to further develop polyethylene into a high-tech material. Progress in the development of new materials must be compared with the tried and tested ones to provide optimal and most individual patient care. OBJECTIVES This article gives an overview of the history and current application profile of the material ultra-high molecular weight polyethylene (UHMWPE) in hip and knee arthroplasty. MATERIAL AND METHODS With the aid of the current literature, new developments in the field of the material UHMWPE, also with respect to the biological activity of wear, the particular biomechanics of the knee joint as well as alternative hard-hard bearing surfaces in the hip, are represented in terms of implant safety. RESULTS The problems concerning polyethylene are now well recognized. The disadvantages of the material UHMWPE could be consistently reduced based on material research so that modern polyethylenes have gradually been shown in clinical trials that they can be reliably used. CONCLUSION Despite this the potential for improvement has still not yet been fully exploited. Any further development must be extensively tested both biomechanically and biologically before the material can be used in vivo. Long-term results are still necessary before a material can be accepted as being clinically safe.
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41
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TURNER AC, SUGIMOTO T, UETSUKI K, HYON SH, TOMITA N. Mechanical and oxidative performance of high-dose electron-beam irradiated, dl- α-tocopherol (vitamin E) blended UHMWPE. ACTA ACUST UNITED AC 2015. [DOI: 10.1299/jbse.14-00238] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Alexander C. TURNER
- Department of Mechanical Engineering, Graduate School of Engineering, Kyoto University
| | | | | | - Suong-Hyu HYON
- Faculty of Textile Science, Kyoto Institute of Technology
| | - Naohide TOMITA
- Department of Mechanical Engineering, Graduate School of Engineering, Kyoto University
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Rodeo SA, Sugiguchi F, Fortier LA, Cunningham ME, Maher S. What's new in orthopaedic research. J Bone Joint Surg Am 2014; 96:2015-9. [PMID: 25471917 DOI: 10.2106/jbjs.n.01001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Scott A Rodeo
- The Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021
| | - Fumitaka Sugiguchi
- The Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021
| | - Lisa A Fortier
- Cornell University of Veterinary Medicine, 930 Campus Road, Room C3-181, Ithaca, NY 14853-6401
| | | | - Suzanne Maher
- The Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021
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George A, Ngo H, Bellare A. Influence of crystallization conditions on the tensile properties of radiation crosslinked, vitamin E stabilized UHMWPE. J Mech Behav Biomed Mater 2014; 40:406-412. [DOI: 10.1016/j.jmbbm.2014.09.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 09/01/2014] [Accepted: 09/08/2014] [Indexed: 11/26/2022]
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44
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Bichara DA, Malchau E, Sillesen NH, Cakmak S, Nielsen GP, Muratoglu OK. Vitamin E-diffused highly cross-linked UHMWPE particles induce less osteolysis compared to highly cross-linked virgin UHMWPE particles in vivo. J Arthroplasty 2014; 29:232-7. [PMID: 24998319 DOI: 10.1016/j.arth.2014.03.044] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 01/23/2014] [Accepted: 03/14/2014] [Indexed: 02/01/2023] Open
Abstract
Recent in vitro findings suggest that UHMWPE wear particles containing vitamin E (VE) may have reduced biologic activity and decreased osteolytic potential. We hypothesized that particles from VE-stabilized, radiation cross-linked UHMWPE would cause less osteolysis in a murine calvarial bone model when compared to virgin gamma irradiated cross-linked UHMWPE. Groups received equal amount of particulate debris overlaying the calvarium for 10 days. Calvarial bone was examined using high resolution micro-CT and histomorphometric analyses. There was a statistically significant difference between virgin (12.2%±8%) and VE-UHMWPE (3%±1.4%) groups in regards to bone resorption (P=0.005) and inflammatory fibrous tissue overlaying the calvaria (0.48 vs. 0.20, P<0.0001). These results suggest that VE-UHMWPE particles have reduced osteolytic potential in vivo when compared to virgin UHMWPE.
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Affiliation(s)
- David A Bichara
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Erik Malchau
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts
| | - Nanna H Sillesen
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts
| | - Selami Cakmak
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts
| | - G Petur Nielsen
- Harvard Medical School, Boston, Massachusetts; Bone and Soft Tissue Pathology, Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Orhun K Muratoglu
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
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Campoccia D, Visai L, Renò F, Cangini I, Rizzi M, Poggi A, Montanaro L, Rimondini L, Arciola CR. Bacterial adhesion to poly-(D,L)lactic acid blended with vitamin E: toward gentle anti-infective biomaterials. J Biomed Mater Res A 2014; 103:1447-58. [PMID: 25046271 DOI: 10.1002/jbm.a.35284] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Revised: 06/28/2014] [Accepted: 07/18/2014] [Indexed: 12/23/2022]
Abstract
Anti-infective properties of biomedical materials are often achieved by loading or coating them with powerful bactericides. Undesirably, these bioactive molecules can damage the host cells at the biomaterial-tissues interface and, sometimes, even determine systemic toxic effects. The search for biomaterials able to actively resist infection while displaying a safe cytocompatibility profile toward eukaryotic cells is being progressively developed. Poly-(D,L)lactic acid (PLA) is a broadly used resorbable material with established biocompatibility properties. The dissolving surfaces of a biodegradable material tend to be per se elusive for bacteria. Here, films of pristine PLA, of PLA blended with vitamin E (VitE) and PLA blended with vitamin E acetate (VitE ac) were challenged in vitro with the biofilm-producers Staphylococcus epidermidis RP62A and Staphylococcus aureus ATCC25923. The bacterial adhesion properties of the different materials were investigated on small film disc specimens by a method based on microtiter plates. Adherent bacteria were quantified by both CFU plating and bioluminescence. Significant decrease in bacterial adhesion and biofilm accumulation was found on the surface of both the enriched polymers. These findings, together with the favorable intrinsic properties of PLA and the desirable bioactivities conferred by VitE, point up the VitE-blended PLA polymers as gentle anti-infective biomaterials.
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Affiliation(s)
- Davide Campoccia
- Research Unit on Implant Infections, Rizzoli Orthopaedic Institute, Bologna, Italy
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Kyomoto M, Moro T, Yamane S, Watanabe K, Hashimoto M, Takatori Y, Tanaka S, Ishihara K. Poly(2-methacryloyloxyethyl phosphorylcholine) grafting and vitamin E blending for high wear resistance and oxidative stability of orthopedic bearings. Biomaterials 2014; 35:6677-86. [DOI: 10.1016/j.biomaterials.2014.04.051] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 04/12/2014] [Indexed: 11/29/2022]
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Grupp TM, Holderied M, Mulliez MA, Streller R, Jäger M, Blömer W, Utzschneider S. Biotribology of a vitamin E-stabilized polyethylene for hip arthroplasty - Influence of artificial ageing and third-body particles on wear. Acta Biomater 2014; 10:3068-78. [PMID: 24631660 DOI: 10.1016/j.actbio.2014.02.052] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 02/25/2014] [Accepted: 02/28/2014] [Indexed: 12/28/2022]
Abstract
The objective of our study was to evaluate the influence of prolonged artificial ageing on oxidation resistance and the subsequent wear behaviour of vitamin E-stabilized, in comparison to standard and highly cross-linked remelted polyethylene (XLPE), and the degradation effect of third-body particles on highly cross-linked remelted polyethylene inlays in total hip arthroplasty. Hip wear simulation was performed with three different polyethylene inlay materials (standard: γ-irradiation 30 kGy, N2; highly cross-linked and remelted: γ-irradiation 75 kGy, EO; highly cross-linked and vitamin E (0.1%) blended: electron beam 80 kGy, EO) machined from GUR 1020 in articulation with ceramic and cobalt-chromium heads. All polyethylene inserts beneath the virgin references were subjected to prolonged artificial ageing (70°C, pure oxygen at 5 bar) with a duration of 2, 4, 5 or 6 weeks. In conclusion, after 2 weeks of artificial ageing, standard polyethylene shows substantially increased wear due to oxidative degradation, whereas highly cross-linked remelted polyethylene has a higher oxidation resistance. However, after enhanced artificial ageing for 5 weeks, remelted XLPE also starts oxidate, in correlation with increased wear. Vitamin E-stabilized polyethylene is effective in preventing oxidation after irradiation cross-linking even under prolonged artificial ageing for up to 6 weeks, resulting in a constant wear behaviour.
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Banche G, Allizond V, Bracco P, Bistolfi A, Boffano M, Cimino A, Brach del Prever EM, Cuffini AM. Interplay between surface properties of standard, vitamin E blended and oxidised ultra high molecular weight polyethylene used in total joint replacement and adhesion of Staphylococcus aureus and Escherichia coli. Bone Joint J 2014; 96-B:497-501. [PMID: 24692617 DOI: 10.1302/0301-620x.96b4.32895] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We have assessed the different adhesive properties of some of the most common bacteria associated with periprosthetic joint infection on various types of ultra high molecular Weight Polyethylene (UHMWPE). Quantitative in vitro analysis of the adhesion of biofilm producing strains of Staphylococcus aureus and Escherichia coli to physically and chemically characterised standard UHMWPE (PE), vitamin E blended UHMWPE (VE-PE) and oxidised UHMWPE (OX-PE) was performed using a sonication protocol. A significant decreased bacterial adhesion was registered for both strains on VE-PE, in comparison with that observed on PE, within 48 hours of observation (S. aureus p = 0.024 and E. coli p = 0.008). Since Vitamin E reduces bacterial adhesive ability, VE-stabilised UHMWPE could be valuable in joint replacement by presenting excellent mechanical properties, while reducing bacterial adhesiveness.
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Affiliation(s)
- G Banche
- University of Torino, Department of Public Health and Pediatrics, Via Santena 9, 10126 Turin, Italy
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