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Bendtsen MAF, Odgaard A, Madsen F, Mosegaard SB, Thomsen JS, Hauge EM, Søballe K, Stilling M. Preoperative proximal tibial bone density, bone microarchitecture, and bone turnover are not associated with postoperative tibial component migration in cemented and cementless medial unicompartmental knee replacements: secondary analyses from a randomized controlled trial. Acta Orthop 2024; 95:121-129. [PMID: 38391197 PMCID: PMC10885816 DOI: 10.2340/17453674.2024.39917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 11/16/2023] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND AND PURPOSE Cementless arthroplasty fixation relies on early bone ingrowth and may be poor in patients with low proximal tibial bone density or abnormal bone turnover. We aimed first to describe the baseline bone properties in patients undergoing medial unicompartmental knee replacement (UKR), and second to investigate its association with cemented and cementless tibial component migration until 2 years. METHODS A subset investigation of 2 patient groups from a 3-armed randomized controlled trial was conducted. There were 26 cemented and 25 cementless medial UKRs with twin-pegged femoral components. Volumetric bone mineral density (vBMD) and microstructure of the excised medial tibial plateau were ascertained with µCT. Bone turnover was estimated using dynamic histomorphometry (eroded surface/bone surface = ES/BS, osteoid surface/bone surface = OS/BS, mineralizing surface/bone surface = MS/BS). Tibial component migration in 4 feature points was followed for 2 years with radiostereometry. RESULTS At the 2-year follow-up, the cementless tibial components migrated 0.38 mm (95% confidence interval [CI] 0.14-0.62) total translation more than the cemented components at the posterior feature point. The greatest migration in the cementless group was subsidence at the posterior feature point of 0.66 mm (CI 0.48-0.84) until 6 weeks, and from 3 months the components were stable. Cemented tibial components subsided very little. Between 1- and 2-year follow-ups, no cementless but 4 cemented tibial components revealed continuous migration. OS/BS was half of the ES/BS. No µCT or histomorphometric parameters showed any clinically relevant correlation with tibial component migration at the posterior feature point for either cemented or cementless UKR at 6 weeks' or 2 years' follow-up after adjustment for age, BMI, and sex. CONCLUSION Preoperative vBMD, bone turnover, and microstructure were not associated with postoperative tibial component migration of cemented and cementless medial UKR.
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Affiliation(s)
- Mathias Alrø Fichtner Bendtsen
- Department of Clinical Medicine, Aarhus University, Aarhus; AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus.
| | - Anders Odgaard
- Department of Orthopaedic Surgery, Rigshospitalet-Copenhagen University Hospital, Copenhagen; Department of Clinical Medicine, University of Copenhagen, Copenhagen
| | - Frank Madsen
- Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus
| | | | | | | | - Kjeld Søballe
- Department of Clinical Medicine, Aarhus University, Aarhus; Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus
| | - Maiken Stilling
- Department of Clinical Medicine, Aarhus University, Aarhus; AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus; Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus
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Sellin ML, Seyfarth-Sehlke A, Aziz M, Fabry C, Wenke K, Høl PJ, Rios-Mondragon I, Cimpan MR, Frank M, Bader R, Jonitz-Heincke A. Isolation of TiNbN wear particles from a coated metal-on-metal bearing: Morphological characterization and in vitro evaluation of cytotoxicity in human osteoblasts. J Biomed Mater Res B Appl Biomater 2024; 112:e35357. [PMID: 38247242 DOI: 10.1002/jbm.b.35357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 10/18/2023] [Accepted: 11/15/2023] [Indexed: 01/23/2024]
Abstract
To improve the wear resistance of articulating metallic joint endoprostheses, the surfaces can be coated with titanium niobium nitride (TiNbN). Under poor tribological conditions or malalignment, wear can occur on these implant surfaces in situ. This study investigated the biological response of human osteoblasts to wear particles generated from TiNbN-coated hip implants. Abrasive particles were generated in a hip simulator according to ISO 14242-1/-2 and extracted with Proteinase K. Particle characteristics were evaluated by electron microscopy and energy dispersive x-ray spectroscopy (EDS), inductively coupled plasma mass spectrometry (ICP-MS) and dynamic light scattering (DLS) measurements. Human osteoblasts were exposed to different particle dilutions (1:20, 1:50, and 1:100), and cell viability and gene expression levels of osteogenic markers and inflammatory mediators were analyzed after 4 and 7 days. Using ICP-MS, EDS, and DLS measurements, ~70% of the particles were identified as TiNbN, ranging from 39 to 94 nm. The particles exhibited a flat and subangular morphology. Exposure to particles did not influence cell viability and osteoblastic differentiation capacity. Protein levels of collagen type 1, osteoprotegerin, and receptor activator of nuclear factor κB ligand were almost unaffected. Moreover, the pro-inflammatory response via interleukins 6 and 8 was minor induced after particle contact. A high number of TiNbN wear particles only slightly affected osteoblasts' differentiation ability and inflammatory response compared to metallic particles. Nevertheless, further studies should investigate the role of these particles in peri-implant bone tissue, especially concerning other cell types.
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Affiliation(s)
- Marie-Luise Sellin
- Department of Orthopaedics, Biomechanics and Implant Technology Research Laboratory, Rostock University Medical Center, Rostock, Germany
| | - Anika Seyfarth-Sehlke
- Department of Orthopaedics, Biomechanics and Implant Technology Research Laboratory, Rostock University Medical Center, Rostock, Germany
| | - Mahammad Aziz
- Department of Orthopaedics, Biomechanics and Implant Technology Research Laboratory, Rostock University Medical Center, Rostock, Germany
| | | | | | - Paul Johan Høl
- Department of Orthopaedic Surgery, Biomatlab, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, Biomaterials, University of Bergen, Bergen, Norway
| | - Ivan Rios-Mondragon
- Department for Clinical Dentistry Biomaterials, University of Bergen, Bergen, Norway
| | - Mihaela Roxana Cimpan
- Department for Clinical Dentistry Biomaterials, University of Bergen, Bergen, Norway
| | - Marcus Frank
- Medical Biology and Electron Microscopy Center, Rostock University Medical Center, Rostock, Germany
- Department Life, Light and Matter, University of Rostock, Rostock, Germany
| | - Rainer Bader
- Department of Orthopaedics, Biomechanics and Implant Technology Research Laboratory, Rostock University Medical Center, Rostock, Germany
- Department Life, Light and Matter, University of Rostock, Rostock, Germany
| | - Anika Jonitz-Heincke
- Department of Orthopaedics, Biomechanics and Implant Technology Research Laboratory, Rostock University Medical Center, Rostock, Germany
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Sokolova V, Loza K, Ebel JF, Buer J, Westendorf AM, Epple M. Barium sulphate microparticles are taken up by three different cell types: HeLa, THP-1, and hMSC. Acta Biomater 2023; 164:577-587. [PMID: 37019167 DOI: 10.1016/j.actbio.2023.03.043] [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: 12/11/2022] [Revised: 03/23/2023] [Accepted: 03/29/2023] [Indexed: 04/07/2023]
Abstract
Cytotoxicity and cellular uptake of spherical barium sulphate microparticles (diameter 1 µm) were studied with three different cell lines, i.e. THP-1 cells (monocytes; model for a phagocytosing cell line), HeLa cells (epithelial cells; model for a non-phagocytosing cell line), and human mesenchymal stem cells (hMSCs; model for non-phagocytosing primary cells). Barium sulphate is a chemically and biologically inert solid which allows to distinguish two different processes, e.g. the particle uptake and potential adverse biological reactions. Barium sulphate microparticles were surface-coated by carboxymethylcellulose (CMC) which gave the particles a negative charge. Fluorescence was added by conjugating 6-aminofluorescein to CMC. The cytotoxicity of these microparticles was studied by the MTT test and a live/dead assay. The uptake was visualized by confocal laser scanning microscopy (CLSM) and scanning electron microscopy (SEM). The particle uptake mechanism was quantified by flow cytometry with different endocytosis inhibitors in THP-1 and HeLa cells. The microparticles were easily taken up by all cell types, mostly by phagocytosis and micropinocytosis, within a few hours. STATEMENT OF SIGNIFICANCE: The interaction of particles and cells is of primary importance in nanomedicine, drug delivery, and nanotoxicology. It is commonly assumed that cells take up only nanoparticles unless they are able to phagocytosis. Here, we demonstrate with chemically and biologically inert microparticles of barium sulphate that even non-phagocytosing cells like HeLa and hMSCs take up microparticles to a considerable degree. This has considerable implication in biomaterials science, e.g. in case of abrasive debris and particulate degradation products from implants like endoprostheses.
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Affiliation(s)
- V Sokolova
- Inorganic Chemistry and Center for Nanointegration Duisburg-Essen (CeNIDE), University of Duisburg-Essen, Universitätsstr. 5-7, 45117 Essen, Germany.
| | - K Loza
- Inorganic Chemistry and Center for Nanointegration Duisburg-Essen (CeNIDE), University of Duisburg-Essen, Universitätsstr. 5-7, 45117 Essen, Germany.
| | - J F Ebel
- Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany.
| | - J Buer
- Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany.
| | - A M Westendorf
- Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany.
| | - M Epple
- Inorganic Chemistry and Center for Nanointegration Duisburg-Essen (CeNIDE), University of Duisburg-Essen, Universitätsstr. 5-7, 45117 Essen, Germany.
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Stratton-Powell AA, Williams S, Tipper JL, Redmond AC, Brockett CL. Isolation and characterisation of wear debris surrounding failed total ankle replacements. Acta Biomater 2023; 159:410-422. [PMID: 36736850 DOI: 10.1016/j.actbio.2023.01.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 02/04/2023]
Abstract
Aseptic loosening and osteolysis continue to be a short- to mid-term problem for total ankle replacement (TAR) devices. The production of wear particles may contribute to poor performance, but their characteristics are not well understood. This study aimed to determine the chemical composition, size and morphology of wear particles surrounding failed TARs. A recently developed wear particle isolation method capable of isolating both high- and low-density materials was applied to 20 retrieved periprosthetic tissue samples from 15 failed TARs of three different brands. Isolated particles were imaged using ultra-high-resolution imaging and characterised manually to determine their chemical composition, size, and morphology. Six different materials were identified, which included: UHMWPE, calcium phosphate (CaP), cobalt chromium alloy (CoCr), commercially pure titanium, titanium alloy and stainless steel. Eighteen of the 20 samples contained three or more different wear particle material types. In addition to sub-micron UHMWPE particles, which were present in all samples, elongated micron-sized shards of CaP and flakes of CoCr were commonly isolated from tissues surrounding AES TARs. The mixed particles identified in this study demonstrate the existence of a complex periprosthetic environment surrounding TAR devices. The presence of such particles suggests that early failure of devices may be due in part to the multifaceted biological cascade that ensues after particle release. This study could be used to support the validation of clinically-relevant wear simulator testing, pre-clinical assessment of fixation wear and biological response studies to improve the performance of next generation ankle replacement devices. STATEMENT OF SIGNIFICANCE: Total ankle replacement devices do not perform as well as total hip and knee replacements, which is in part due to the relatively poor scientific understanding of how they fail. The excessive production of certain types of wear debris is known to contribute to joint replacement failure. This is the first study to successfully isolate and characterise high- and low-density wear particles from tissues collected from patients with a failed total ankle replacement. This article includes the chemical composition and characteristics of the wear debris generated by ankle devices, all of which may affect their performance. This research provides clinically relevant reference values and images to support the development of pre-clinical testing for future total ankle replacement designs.
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Affiliation(s)
- Ashley A Stratton-Powell
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Woodhouse Lane, Leeds LS2 9JT, UK.
| | - Sophie Williams
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Woodhouse Lane, Leeds LS2 9JT, UK
| | - Joanne L Tipper
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Woodhouse Lane, Leeds LS2 9JT, UK; School of Biomedical Engineering, University of Technology Sydney, Ultimo 2007, Australia
| | - Anthony C Redmond
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, UK; Leeds Institute for Rheumatic and Musculoskeletal Medicine, School of Medicine, University of Leeds, UK
| | - Claire L Brockett
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Woodhouse Lane, Leeds LS2 9JT, UK; NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, UK
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Cong Y, Wang Y, Yuan T, Zhang Z, Ge J, Meng Q, Li Z, Sun S. Macrophages in aseptic loosening: Characteristics, functions, and mechanisms. Front Immunol 2023; 14:1122057. [PMID: 36969165 PMCID: PMC10030580 DOI: 10.3389/fimmu.2023.1122057] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 02/13/2023] [Indexed: 03/10/2023] Open
Abstract
Aseptic loosening (AL) is the most common complication of total joint arthroplasty (TJA). Both local inflammatory response and subsequent osteolysis around the prosthesis are the fundamental causes of disease pathology. As the earliest change of cell behavior, polarizations of macrophages play an essential role in the pathogenesis of AL, including regulating inflammatory responses and related pathological bone remodeling. The direction of macrophage polarization is closely dependent on the microenvironment of the periprosthetic tissue. When the classically activated macrophages (M1) are characterized by the augmented ability to produce proinflammatory cytokines, the primary functions of alternatively activated macrophages (M2) are related to inflammatory relief and tissue repair. Yet, both M1 macrophages and M2 macrophages are involved in the occurrence and development of AL, and a comprehensive understanding of polarized behaviors and inducing factors would help in identifying specific therapies. In recent years, studies have witnessed novel discoveries regarding the role of macrophages in AL pathology, the shifts between polarized phenotype during disease progression, as well as local mediators and signaling pathways responsible for regulations in macrophages and subsequent osteoclasts (OCs). In this review, we summarize recent progress on macrophage polarization and related mechanisms during the development of AL and discuss new findings and concepts in the context of existing work.
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Affiliation(s)
- Yehao Cong
- Department of Joint Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Orthopaedic Research Laboratory, Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Yi Wang
- Department of Joint Surgery, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Tao Yuan
- Department of Joint Surgery, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Zheng Zhang
- Department of Joint Surgery, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Jianxun Ge
- Department of Joint Surgery, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Qi Meng
- Department of Joint Surgery, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Ziqing Li
- Department of Joint Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Orthopaedic Research Laboratory, Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
- *Correspondence: Ziqing Li, ; Shui Sun,
| | - Shui Sun
- Department of Joint Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Orthopaedic Research Laboratory, Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
- Department of Joint Surgery, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
- *Correspondence: Ziqing Li, ; Shui Sun,
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Stratton‐Powell AA, Williams S, Tipper JL, Redmond AC, Brockett CL. Mixed material wear particle isolation from periprosthetic tissue surrounding total joint replacements. J Biomed Mater Res B Appl Biomater 2022; 110:2276-2289. [PMID: 35532138 PMCID: PMC9540445 DOI: 10.1002/jbm.b.35076] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 11/05/2021] [Accepted: 04/18/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Ashley A. Stratton‐Powell
- Institute of Medical and Biological Engineering, School of Mechanical Engineering University of Leeds Leeds UK
| | - Sophie Williams
- Institute of Medical and Biological Engineering, School of Mechanical Engineering University of Leeds Leeds UK
| | - Joanne L. Tipper
- Institute of Medical and Biological Engineering, School of Mechanical Engineering University of Leeds Leeds UK
- School of Biomedical Engineering University of Technology Sydney Ultimo New South Wales Australia
| | - Anthony C. Redmond
- NIHR Leeds Biomedical Research Centre Leeds Teaching Hospitals NHS Trust Leeds UK
- Leeds Institute for Rheumatic and Musculoskeletal Medicine, School of Medicine University of Leeds Leeds UK
| | - Claire L. Brockett
- Institute of Medical and Biological Engineering, School of Mechanical Engineering University of Leeds Leeds UK
- NIHR Leeds Biomedical Research Centre Leeds Teaching Hospitals NHS Trust Leeds UK
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