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de Souza W, Gemini-Piperni S, Ruivo C, Bastos N, Almeida S, Lopes D, Cardoso P, Oliveira MJ, Sumner DR, Ross RD, Jacobs JJ, Granjeiro JM, Fernandes MH, Rocha LA, Melo S, Ribeiro AR. Osteoblasts-derived exosomes as potential novel communicators in particle-induced periprosthetic osteolysis. Mater Today Bio 2024; 28:101189. [PMID: 39221219 PMCID: PMC11364904 DOI: 10.1016/j.mtbio.2024.101189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 07/12/2024] [Accepted: 08/05/2024] [Indexed: 09/04/2024] Open
Abstract
The inflammatory response to wear particles derived from hip prothesis is considered a hallmark of periprosthetic osteolysis, which can ultimately lead to the need for revision surgery. Exosomes (Exos) have been associated with various bone pathologies, and there is increasing recognition in the literature that they actively transport molecules throughout the body. The role of wear particles in osteoblast-derived Exos is unknown, and the potential contribution of Exos to osteoimmune communication and periprosthetic osteolysis niche is still in its infancy. Given this, we investigate how titanium dioxide nanoparticles (TiO2 NPs), similar in size and composition to prosthetic wear particles, affect Exos biogenesis. Two osteoblastic cell models commonly used to study the response of osteoblasts to wear particles were selected as a proof of concept. The contribution of Exos to periprosthetic osteolysis was assessed by functional assays in which primary human macrophages were stimulated with bone-derived Exos. We demonstrated that TiO2 NPs enter multivesicular bodies, the nascent of Exos, altering osteoblast-derived Exos secretion and molecular cargo. No significant differences were observed in Exos morphology and size. However, functional assays reveal that Exos cargo enriched in uPA stimulates macrophages to a mixed M1 and M2 phenotype, inducing the release of pro- and anti-inflammatory signals characteristic of periprosthetic osteolysis. In addition, we demonstrated the expression of uPA in exosomes derived from the urine of patients with osteolysis. These results suggest that uPA can be a potential biomarker of osteolysis. In the future, uPa may serve as a possible non-invasive biomarker to identify patients at risk for peri-implant osteolysis.
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Affiliation(s)
- Wanderson de Souza
- Directory of Life Sciences Applied Metrology, National Institute of Metrology Quality and Technology, Rio de Janeiro, Brazil
- Postgraduate Program in Biotechnology, National Institute of Metrology Quality and Technology, Rio de Janeiro, Brazil
| | - S. Gemini-Piperni
- Postgraduate Program in Translational Biomedicine, University Grande Rio, Duque de Caxias, Brazil
- Labεn Group, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Carolina Ruivo
- I3S-Institute for Research and Innovation in Health, University of Porto, Portugal, Porto, Portugal
| | - Nuno Bastos
- I3S-Institute for Research and Innovation in Health, University of Porto, Portugal, Porto, Portugal
| | - Sofia Almeida
- I3S-Institute for Research and Innovation in Health, University of Porto, Portugal, Porto, Portugal
| | - Daniel Lopes
- I3S-Institute for Research and Innovation in Health, University of Porto, Portugal, Porto, Portugal
| | - Patricia Cardoso
- I3S-Institute for Research and Innovation in Health, University of Porto, Portugal, Porto, Portugal
| | - Maria Jose Oliveira
- I3S-Institute for Research and Innovation in Health, University of Porto, Portugal, Porto, Portugal
| | - D. Rick Sumner
- Department of Orthopedic Surgery of RUSH University, Chicago, USA
| | - Ryan D. Ross
- Department of Orthopedic Surgery of RUSH University, Chicago, USA
| | - Joshua J. Jacobs
- Department of Anatomy & Cell Biology of RUSH University, Chicago, USA
| | - Jose Mauro Granjeiro
- Directory of Life Sciences Applied Metrology, National Institute of Metrology Quality and Technology, Rio de Janeiro, Brazil
- Postgraduate Program in Biotechnology, National Institute of Metrology Quality and Technology, Rio de Janeiro, Brazil
- Postgraduate Program in Translational Biomedicine, University Grande Rio, Duque de Caxias, Brazil
- Dental School, Fluminense Federal University, Niterói, Brazil
| | - Maria Helena Fernandes
- Faculty of Dental Medicine, University of Porto, Porto, Portugal
- LAQV/REQUIMTE, University of Porto, Porto, Portugal
| | - Luis A. Rocha
- proMetheus, Escola Superior de Tecnologia e Gestão, Instituto Politécnico de Viana do Castelo, Viana do Castelo, Portugal
- IBTN/EURO – European Branch of the Institute of Biomaterials, Tribocorrosion and Nanomedicine, Izmir Institute of Technology, Izmir, Turkey
| | - Sonia Melo
- I3S-Institute for Research and Innovation in Health, University of Porto, Portugal, Porto, Portugal
| | - Ana R. Ribeiro
- IBTN/EURO – European Branch of the Institute of Biomaterials, Tribocorrosion and Nanomedicine, Izmir Institute of Technology, Izmir, Turkey
- Nanosafety group, International Iberian Nanotechnology Laboratory (INL), Braga, Portugal
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Kang SY, Ko YS, Kim HS, Yoo JJ. Outcome and complication rate of total hip arthroplasty in patients younger than twenty years: which bearing surface should be used? INTERNATIONAL ORTHOPAEDICS 2024; 48:1381-1390. [PMID: 38217722 PMCID: PMC11076316 DOI: 10.1007/s00264-023-06086-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 12/29/2023] [Indexed: 01/15/2024]
Abstract
PURPOSE Total hip arthroplasty (THA) in younger patients remains controversial due to concerns regarding long-term implant survival and potential complications. This study aimed to evaluate long-term clinical outcomes, complications, differences in complication and revision rates by bearing surfaces, and Kaplan-Meier survival curves for THA in patients under 20 years old. METHODS A retrospective review was conducted for 65 patients (78 hips) who underwent THA between 1991 and 2018. Their mean age was 18.9 years. Their clinical outcomes were assessed using the Harris Hip Score (HHS). Radiological outcomes were evaluated based on the presence of loosening, osteolysis, and heterotopic ossification. Complications such as dislocation, periprosthetic fractures, and infections were assessed. The mean follow-up period was 13.2 years (range, 5.0-31.2 years). RESULTS The mean HHS improved from 44.6 to 90.1. There were two cases of dislocation. However, no periprosthetic fracture, deep infection, or ceramic component fracture was noted. There were 19 revisions of implants. Eighteen of 19 hips were operated with hard-on-soft bearings in the index surgery (p < 0.01). The 23-year survivorship was 97.8% for THA using ceramic-on-ceramic bearings, while the 31-year survivorship was 36.7% using hard-on-soft bearings. CONCLUSION THA in patients under 20 years old yielded promising clinical and radiological outcomes, although polyethylene-bearing-related concerns persisted. Previously operated patients with hard-on-soft bearing should be meticulously examined during the follow-up. As ceramic-on-ceramic bearing showed excellent survivorship in this particular cohort, we recommend the use of this articulation as the bearing of choice.
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Affiliation(s)
- Sang Yoon Kang
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Young-Seung Ko
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Hong Seok Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
| | - Jeong Joon Yoo
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
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Costa MD, Donner S, Bertrand J, Pop OL, Lohmann CH. Hypersensitivity and lymphocyte activation after total hip arthroplasty. ORTHOPADIE (HEIDELBERG, GERMANY) 2023; 52:214-221. [PMID: 36820851 DOI: 10.1007/s00132-023-04349-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/16/2023] [Indexed: 02/24/2023]
Abstract
In the last decades total hip arthroplasty (THA) has become a standard procedure with many benefits but also a few still unsolved complications, which can lead to surgical revision in 19-23% of cases. Thus, aseptic loosening and metal hypersensitivity remain challenges. The phenomenon of wear debris causes chronic inflammation, which produces osteolysis and aseptic loosening. Wear debris promotes osteoclast production and inhibits osteoblasts by secretion of pro-inflammatory cytokines. Micro-abrasions can be induced by abrasive, adhesive and fatigue wear and cause a liberation of metal ions, which lead to another immune response elicited mostly by macrophages. Another reaction in the neocapsule can be a type IV hypersensitivity reaction to various alloys, containing metals such as nickel, cobalt and chromium. Patch testing and the lymphocyte transformation test (LTT) are not the best diagnostic possibilities to exclude a postoperative hypersensitivity reaction, because of the different alignment of the epicutaneous cells compared to the periprosthetic deep tissue. This hypersensitivity reaction is mostly induced by cytokines, which are secreted by macrophages rather than lymphocytes. In cell cultures and in animal studies, multipotent mesenchymal stem cells (MSC) have been shown to play a role in improving initial implant integration, to limit periprosthetic osteolysis and also to reconstitute peri-implant bone stock during implant revision. Thus, MSC might be used in the future to prolong the durability of THA. A better understanding of the interactions between primary chronic inflammation, corrosion, osteolysis and hypersensitivity is mandatory to develop new therapeutic strategies, aiming at the reduction of the incidence of implant failures. In this article the underlying immunological mechanisms to aseptic loosening are presented.
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Affiliation(s)
- Maximilian D Costa
- Department of Orthopaedic Surgery, Otto-von-Guericke University, Leipziger Str. 44, 39120, Magdeburg, Germany
- Department of Morphological Sciences, Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania
| | - Stefanie Donner
- Centre for Musculoskeletal Surgery, Charité-University Medicine, Berlin, Germany
| | - Jessica Bertrand
- Department of Orthopaedic Surgery, Otto-von-Guericke University, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Ovidiu-Laurean Pop
- Department of Morphological Sciences, Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania
| | - Christoph H Lohmann
- Department of Orthopaedic Surgery, Otto-von-Guericke University, Leipziger Str. 44, 39120, Magdeburg, Germany.
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de Souza W, Gemini-Piperni S, Grenho L, Rocha LA, Granjeiro JM, Melo SA, Fernandes MH, Ribeiro AR. Titanium dioxide nanoparticles affect osteoblast-derived exosome cargos and impair osteogenic differentiation of human mesenchymal stem cells. Biomater Sci 2023; 11:2427-2444. [PMID: 36756939 DOI: 10.1039/d2bm01854c] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Titanium (Ti) and its alloys are the most widely used metallic biomaterials in total joint replacement; however, increasing evidence supports the degradation of its surface due to corrosion and wear processes releasing debris (ions, and micro and nanoparticles) and contribute to particle-induced osteolysis and implant loosening. Cell-to-cell communication involving several cell types is one of the major biological processes occurring during bone healing and regeneration at the implant-bone interface. In addition to the internal response of cells to the uptake and intracellular localization of wear debris, a red flag is the ability of titanium dioxide nanoparticles (mimicking wear debris) to alter cellular communication with the tissue background, disturbing the balance between osseous tissue integrity and bone regenerative processes. This study aims to understand whether titanium dioxide nanoparticles (TiO2 NPs) alter osteoblast-derived exosome (Exo) biogenesis and whether exosomal protein cargos affect the communication of osteoblasts with human mesenchymal stem/stromal cells (HMSCs). Osteoblasts are derived from mesenchymal stem cells coexisting in the bone microenvironment during development and remodelling. We observed that TiO2 NPs stimulate immature osteoblast- and mature osteoblast-derived Exo secretion that present a distinct proteomic cargo. Functional tests confirmed that Exos derived from both osteoblasts decrease the osteogenic differentiation of HMSCs. These findings are clinically relevant since wear debris alter extracellular communication in the bone periprosthetic niche, contributing to particle-induced osteolysis and consequent prosthetic joint failure.
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Affiliation(s)
- Wanderson de Souza
- Directory of Metrology Applied to Life Sciences, National Institute of Metrology Quality and Technology, Rio de Janeiro, Brazil.,Postgraduate Program in Biotechnology, National Institute of Metrology Quality and Technology, Rio de Janeiro, Brazil
| | - S Gemini-Piperni
- Postgraduate Program in Biotechnology, National Institute of Metrology Quality and Technology, Rio de Janeiro, Brazil.,Postgraduate Program in Translational Biomedicine, University Grande Rio, Duque de Caxias, Brazil.,Lab∈n Group, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-901, Brazil
| | - Liliana Grenho
- Faculty of Dental Medicine, University of Porto, Porto, Portugal.,LAQV/REQUIMTE, University of Porto, Porto, Portugal
| | - Luís A Rocha
- Physics Department, Paulista State University, São Paulo, Brazil.,IBTN/Br - Brazilian Branch of the Institute of Biomaterials, Tribocorrosion and Nanomedicine, São Paulo State University, Bauru, São Paulo, Brazil
| | - José M Granjeiro
- Directory of Metrology Applied to Life Sciences, National Institute of Metrology Quality and Technology, Rio de Janeiro, Brazil.,Postgraduate Program in Biotechnology, National Institute of Metrology Quality and Technology, Rio de Janeiro, Brazil.,Postgraduate Program in Translational Biomedicine, University Grande Rio, Duque de Caxias, Brazil.,Dental School, Fluminense Federal University, Niterói, Brazil
| | - Sonia A Melo
- i3S-Institute for Research and Innovation in Health, University of Porto, Porto, Portugal
| | - Maria H Fernandes
- Faculty of Dental Medicine, University of Porto, Porto, Portugal.,LAQV/REQUIMTE, University of Porto, Porto, Portugal
| | - Ana R Ribeiro
- Postgraduate Program in Biotechnology, National Institute of Metrology Quality and Technology, Rio de Janeiro, Brazil.,NanoSafety group, International Iberian Nanotechnology Laboratory - INL, 4715-330, Braga, Portugal.
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Yang D, Tan Y, Xie X, Xiao W, Kang J. Zingerone attenuates Ti particle-induced inflammatory osteolysis by suppressing the NF-κB signaling pathway in osteoclasts. Int Immunopharmacol 2023; 115:109720. [PMID: 37724956 DOI: 10.1016/j.intimp.2023.109720] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/31/2022] [Accepted: 01/08/2023] [Indexed: 01/22/2023]
Abstract
Aseptic loosening caused by inflammatory osteolysis is one of the most frequent and serious long-term complications after total joint arthroplasty (TJA). Development of a new therapeutic drug is required due to the lack of effective therapy and serious adverse effects. This study aimed to explore the pharmacological properties of zingerone (ZO) in attenuating osteoclast-mediated periprosthetic osteolysis and how ZO modulates osteoclastogenesis. The nontoxic concentration of ZO was clarified by the CCK-8 method. Then, we explored the efficacy of ZO on suppressing osteoclast differentiation, F-actin ring formation, bone resorption, and NF-κB luciferase activity in vitro as well as osteoprotection in vivo. Polymerase chain reaction and western blotting were applied to detect the underlying mechanisms involved in osteoclastogenesis. ZO showed an obvious inhibitory effect on osteoclastogenesis and bone resorption in a dose-dependent manner by mainly suppressing the activation of NF-κB signaling pathways. Furthermore, ZO administration successfully attenuated titanium (Ti) particle-stimulated periprosthetic osteolysis and osteoporosis by regulating osteoclast formation. Our findings demonstrated the pharmacological properties of ZO in inhibiting osteoclast formation and function by downregulation of NF-κB signaling activation. As a result, these findings could be expected to provide a novel reagent for regulating inflammatory osteolysis caused by prosthetic loosening.
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Affiliation(s)
- Daishui Yang
- The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, PR China
| | - Yejun Tan
- Department of Rheumatology and Immunology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, PR China; School of Mathematics, University of Minnesota Twin Cities, Minneapolis, MN 55455, US
| | - Xi Xie
- Department of Rheumatology and Immunology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, PR China
| | - Wenbiao Xiao
- Department of Geriatrics, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, PR China
| | - Jin Kang
- Department of Rheumatology and Immunology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, PR China.
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Duan J, Hu X, Li T, Wu G, Dou P, Ouyang Z. Cimifugin Suppresses NF-κB Signaling to Prevent Osteoclastogenesis and Periprosthetic Osteolysis. Front Pharmacol 2021; 12:724256. [PMID: 34658863 PMCID: PMC8511420 DOI: 10.3389/fphar.2021.724256] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 08/16/2021] [Indexed: 02/02/2023] Open
Abstract
Background: Aseptic loosening of prosthesis (ALP) is one of the most common long-term complications of knee and hip arthroplasty. Wear particle-induced osteoclastogenesis and subsequent periprosthetic osteolysis account for the morbidity of ALP. Here, we investigate the potential of cimifugin (CIM), a natural extract from Cimicifuga racemosa and Saposhnikovia divaricata, as a bone-protective drug in the treatment of ALP. Method: First, we performed cell viability and osteoclast formation assays to assess the effect of noncytotoxic CIM on osteoclast differentiation in vitro. Bone slice resorption and F-actin ring immunofluorescence assays were adopted to assess the effects of CIM on bone-resorption function. Then, quantitative real-time polymerase chain reaction (qRT–PCR) analysis was performed to further assess the repressive effects of CIM on osteoclastogenesis at the gene expression level. To elucidate the mechanisms underlying the above findings, Western blot and luciferase reporter gene assays were used to assess the regulatory effects of CIM on the NF-κB and MAPK signaling pathways. Moreover, a Ti particle-induced murine calvarial osteolysis model and subsequent histomorphometric analysis via micro-CT and immunohistochemical staining were used to elucidate the effect of CIM on periprosthetic osteolysis in vivo. Result: CIM dose-dependently inhibited both bone marrow-derived macrophage (BMM)- and RAW264.7 cell-derived osteoclastogenesis and bone resorption pit formation in vitro, which was further supported by the reduced expression of F-actin and osteoclast-specific genes. According to the Western blot analysis, inhibition of IκBα phosphorylation in the NF-κB signaling pathway, not the phosphorylation of MAPKs, was responsible for the suppressive effect of CIM on osteoclastogenesis. Animal experiments demonstrated that CIM alleviated Ti particle-induced bone erosion and osteoclast accumulation in murine calvaria. Conclusion: The current study suggested for the first time that CIM can inhibit RANKL-induced osetoclastogenesis by suppressing the NF-κB signaling pathway in vitro and prevent periprosthetic osteolysis in vivo. These findings suggest the potential of CIM as a therapeutic in ALP.
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Affiliation(s)
- Juan Duan
- Department of Geriatric Internal Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xuantao Hu
- Deparment of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Tao Li
- Deparment of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Gen Wu
- Deparment of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Pengcheng Dou
- Deparment of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhengxiao Ouyang
- Deparment of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, China
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Farhan-Alanie OMH, Hrycaiczuk A, Tinning C, Jones B, Stark A, Bryceland K. Alumina ceramic-on-ceramic hybrid total hip arthroplasty. A median of 15 years follow-up. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:1127-1136. [PMID: 34357474 DOI: 10.1007/s00590-021-03087-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 07/29/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The optimum choice of bearing surfaces in total hip replacement (THR) in the younger and active patient remains controversial. The aim of this study was to report the 10 year clinical outcomes, and a median of 15 year implant survival and incidence of complications in a series of Alumina ceramic-on-ceramic THRs utilising an uncemented shell and cemented stem. METHODS From January 2004 to December 2007, 175 consecutive patients (195 hips) underwent primary THR. The acetabular components was Trident Peripheral Self Locking (Stryker Orthopaedics) with a third-generation ceramic head and liner (Alumina ceramic, Stryker Orthopaedics). The stem utilised was an Exeter V-40 (Stryker Orthopaedics). Data were collated on demographics, surgical factors, clinical outcomes, radiographic outcomes and revision. RESULTS 23 patients (27 THRs) died during the follow-up period at a median of 7.8 (3.8 to 9.0) years post-operatively due to causes unrelated to the THR. Median age at time of surgery was 55 (interquartile range 48-60) years. Median follow-up for surviving patients was 15.2 years. Survivorship for all-cause revision was 97.2%. Increasing patient age at time of surgery was associated with a higher OHS at 10 years (p = 0.022). 32 mm head diameter had an improved OHS at 3 months (p = 0.014) and 10 years (p = 0.030). Posterior surgical approach had a statistically significant better OHS at 3 months (p = 0.015) and 1 year (p < 0.001), but the effect was not significant at 10 years (p = 0.440). CONCLUSION The findings of this study support excellent long-term outcomes and survivorship of Alumina ceramic-on-ceramic bearing in a hybrid THR in a younger population. Surgical factors leading to a more favourable outcome were the use of a 32 mm femoral head and a posterior approach. Increasing age at surgery demonstrated the most sustained improvement in 10 year clinical outcomes.
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Affiliation(s)
- Omer M H Farhan-Alanie
- Department of Trauma and Orthopaedic Surgery, Glasgow Royal Infirmary, 84 Castle St, Glasgow, G4 0SF, UK.
| | - Alex Hrycaiczuk
- Department of Trauma and Orthopaedic Surgery, Glasgow Royal Infirmary, 84 Castle St, Glasgow, G4 0SF, UK
| | - Craig Tinning
- Department of Trauma and Orthopaedic Surgery, Forth Valley Royal Hospital, Stirling Rd, Larbert, FK5 4WR, UK
| | - Bryn Jones
- Department of Trauma and Orthopaedic Surgery, Glasgow Royal Infirmary, 84 Castle St, Glasgow, G4 0SF, UK
| | - Andrew Stark
- Department of Trauma and Orthopaedic Surgery, Glasgow Royal Infirmary, 84 Castle St, Glasgow, G4 0SF, UK
| | - Kevin Bryceland
- Department of Trauma and Orthopaedic Surgery, Glasgow Royal Infirmary, 84 Castle St, Glasgow, G4 0SF, UK
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Revealing Inflammatory Indications Induced by Titanium Alloy Wear Debris in Periprosthetic Tissue by Label-Free Correlative High-Resolution Ion, Electron and Optical Microspectroscopy. MATERIALS 2021; 14:ma14113048. [PMID: 34205030 PMCID: PMC8199876 DOI: 10.3390/ma14113048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/25/2021] [Accepted: 05/31/2021] [Indexed: 01/14/2023]
Abstract
The metallic-associated adverse local tissue reactions (ALTR) and events accompanying worn-broken implant materials are still poorly understood on the subcellular and molecular level. Current immunohistochemical techniques lack spatial resolution and chemical sensitivity to investigate causal relations between material and biological response on submicron and even nanoscale. In our study, new insights of titanium alloy debris-tissue interaction were revealed by the implementation of label-free high-resolution correlative microscopy approaches. We have successfully characterized its chemical and biological impact on the periprosthetic tissue obtained at revision surgery of a fractured titanium-alloy modular neck of a patient with hip osteoarthritis. We applied a combination of photon, electron and ion beam micro-spectroscopy techniques, including hybrid optical fluorescence and reflectance micro-spectroscopy, scanning electron microscopy (SEM), Energy-dispersive X-ray Spectroscopy (EDS), helium ion microscopy (HIM) and micro-particle-induced X-ray emission (micro-PIXE). Micron-sized wear debris were found as the main cause of the tissue oxidative stress exhibited through lipopigments accumulation in the nearby lysosome. This may explain the indications of chronic inflammation from prior histologic examination. Furthermore, insights on extensive fretting and corrosion of the debris on nm scale and a quantitative measure of significant Al and V release into the tissue together with hydroxyapatite-like layer formation particularly bound to the regions with the highest Al content were revealed. The functional and structural information obtained at molecular and subcellular level contributes to a better understanding of the macroscopic inflammatory processes observed in the tissue level. The established label-free correlative microscopy approach can efficiently be adopted to study any other clinical cases related to ALTR.
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Davis ET, Remes V, Virolainen P, Gebuhr P, Van Backlé B, Revell MP, Kopjar B. Mid-term outcomes of the R3™ delta ceramic acetabular system in total hip arthroplasty. J Orthop Surg Res 2021; 16:35. [PMID: 33422084 PMCID: PMC7797157 DOI: 10.1186/s13018-020-02192-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 12/28/2020] [Indexed: 11/10/2022] Open
Abstract
Background Whilst bony fixation of hip replacement has stable solutions, there remains controversy over which bearing best optimizes longevity and function. Ceramic-on-ceramic (CoC) bearing combinations are associated with lower risk of revision due to aseptic loosening and dislocation. Evidence for long-term functional outcomes of modern, 4th generation CoC bearings is limited. The aim of this study was to analyze outcomes and complications of the R3™ Acetabular System (Smith & Nephew, Inc., Cordova, TN, USA) in combination with BIOLOX® Delta ceramic femoral head in patients undergoing primary total hip arthroplasty (THA). Methods Between June 2009 and May 2011, 175 patients (178 hips) were enrolled into a prospective, study at 6 sites in Europe and prospectively followed-up at 3 months and 1, 3, 5, and 7 years postoperative. Results Total WOMAC score improved from 63 (range, 22–91) preoperative to 8 (range, 0–8) at 1-year follow-up and remained unchanged at 7-year follow-up. Modified Harris hip score improved from 45 (range, 10–87) preoperative to 83 (range, 25–100) at 3 months, 91 (range, 42–100) at 1 year, and 92 (range, 46, 100) at 7 years. UCLA Activity Rating Scale score improved from 3.3 (range, 1–8) preoperative to 6.2 (range, 2–8) at 1 year; it marginally declined to 5.8 (range, 3–8) at 7-year follow-up. There were 4 trochanteric fractures and 5 patients died of unrelated reasons. Three hips were revised (2 periprosthetic fractures and 1 subluxation). The 7-year cumulative survival rate was 98.3%. Conclusion Clinical and functional improvements of THA with CoC bearing are maintained at 7 years postoperative. Trial registration ClinicalTrials.Gov, NCT03566082, Registered 10 January 2018—retrospectively registered,
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Affiliation(s)
- Edward T Davis
- The Royal Orthopaedic Hospital, NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK.
| | - Ville Remes
- Department of Orthopedics, HUS Peijaksen sairaala, P.O. Box 900, 00029 HUS, Vantaa, Finland
| | - Petri Virolainen
- Turku University Hospital, Kiinamyllynkatu 4-8, P.O Box 52, 20521, Turku, Finland
| | - Peter Gebuhr
- Orthopaedic Surgeon, Department of Orthopaedics, Hvidovre University Hospital, Copenhagen, Denmark
| | - Bart Van Backlé
- AZ Nikolaas, Sint Niklaas, Regentiestraat, 60, 9100, Sint Niklaas, Belgium
| | - Matthew P Revell
- The Royal Orthopaedic Hospital, NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK
| | - Branko Kopjar
- Department of Health Services, University of Washington, H690C, Health Sciences Building, P.O. Box 357660, Seattle, WA, 98195-7660, USA
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10
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Deng W, Wang Z, Zhou Y, Shao H, Yang D, Li H. Does prior core decompression have detrimental effect on subsequent total hip arthroplasty for osteonecrosis of the femoral head: A systematic review and meta-analysis. Orthop Traumatol Surg Res 2020; 106:1553-1560. [PMID: 33189665 DOI: 10.1016/j.otsr.2020.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 07/23/2020] [Accepted: 07/31/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Core decompression (CD) is effective in relieving pain and delaying the progression to total hip arthroplasty (THA) for osteonecrosis of the femoral head (ONFH). However, the influence of CD on subsequent THA has not yet been established. Therefore, we performed this systematic review to answer: does prior CD have detrimental effect on subsequent THA for ONFH, especially with regards to survivorship and functional results, as well as perioperative and postoperative complications. PATIENTS AND METHODS After registration on PROSPERO (CRD42019118861), literature published up to and including November 2018 was searched in the PubMed, Embase and Cochrane library databases with predetermined terms. Comparative studies on the clinical outcomes between conversion to THA with prior CD (the Prior CD group) and primary THA (the Control group) for ONFH were included. The outcomes of interest included survivorship free from revision, the postoperative functional performance, perioperative and postoperative complications. Data was extracted systematically and a meta-analysis was performed. RESULTS Overall, 5 retrospective cohort studies with 110 hips were identified for the Prior CD group and 237 hips were identified for inclusion in the Control group. All of the studies were of high quality in terms of the Newcastle-Ottawa Scale. No difference in the rate of revision between the two groups (2/42 (4.8%) vs. 4/160 (2.5%); RR=1.92; 95% CI=0.34 to 10.75; p=0.46) was detected after a minimum two-year follow-up. The mean postoperative Harris Hip Score was similar between the two groups in all 5 studies. The two groups experienced similar blood loss (Mean difference=12.17ml; 95% CI= -15.28 to 39.61ml; p=0.38). Moreover, intraoperative fracture was increased in the Prior CD group, though this did not reach statistical significance (3/31 (9.7%) vs. 0/55 (0.0%); RR=7.05; 95% CI=0.82 to 60.78; p=0.08). Similarly, osteolysis or radiolucent lines were more likely to occur in the Prior CD group without statistical significance (9/81 (11.1%) vs. 6/200 (3.0%); RR=3.14, 95% CI=0.98 to 10.06; p=0.05). DISCUSSION The present evidence indicated that prior CD does not detrimentally affect the survivorship nor hip scores of subsequent THA. Attention should be paid, however, to the potential for intraoperative fracture, postoperative osteolysis or radiolucent lines. LEVEL OF EVIDENCE III; systematic review and meta-analysis of level III retrospective comparative studies.
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Affiliation(s)
- Wang Deng
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, 100035 Beijing, The People's Republic of China
| | - Zhaolun Wang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, 100035 Beijing, The People's Republic of China
| | - Yixin Zhou
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, 100035 Beijing, The People's Republic of China.
| | - Hongyi Shao
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, 100035 Beijing, The People's Republic of China
| | - Dejin Yang
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, 100035 Beijing, The People's Republic of China
| | - Hua Li
- Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No. 31 Xinjiekou East Street, Xicheng District, 100035 Beijing, The People's Republic of China
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11
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Prestat AJ, Dalili D, Rudel A, Torre F, Pavan LJ, Boileau P, Amoretti N. Percutaneous cementoplasty of periprosthetic loosening: can interventional radiologists offer an alternative to revision surgery? Eur Radiol 2020; 31:4221-4231. [PMID: 33201283 DOI: 10.1007/s00330-020-07463-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/16/2020] [Accepted: 11/03/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate feasibility and validate both safety and efficiency of radiological percutaneous periprosthetic bone cementoplasty (RPPBC) performed under local anesthesia as an alternative minimally invasive treatment of aseptic implant loosening. METHODS In this case series, seven patients (mean age 81 years, range 73 to 89 years, 2 men and 5 women) were enrolled between February 2011 and January 2020 with confirmed aseptic loosening of orthopedic implants. One patient presented with tibial component loosening of an unicompartmental knee arthroplasty, one with glenoid component loosening from a reverse shoulder arthroplasty, one femoral gamma nail, and four presented with pedicle screw loosening after staged posterior lumbar interbody fusion. All patients underwent clinical, biochemical, and imaging assessments to confirm the diagnosis of aseptic loosening. All benefited from RPPBC under dual CT and fluoroscopic guidance. All procedures were performed under local anesthesia by an experienced radiologist. Preprocedural, immediate and 6-month post-cementoplasty pain levels on a visual analogue scale (VAS), and functional outcomes were evaluated. Immediate and 6-month postprocedural CTs were performed to evaluate the treated region. RESULTS All RPPBC were well tolerated by patients throughout the procedure. None of the patients suffered from local or systemic infection post-RPPBC, or periprosthetic fractures. No recurrent implant loosening was observed. Six patients were pain free at 6 months. All patients expressed functional improvements during validated outcome score evaluations. CONCLUSION RPPBC appears to be an efficient and reliable treatment strategy for aseptic loosening of orthopedic implants in elderly patients deemed unfit for revision surgery. KEY POINTS • Radiological percutaneous periprosthetic bone cementoplasty offers immediate and long-lasting pain relief in elderly frail patients, or those deemed unfit for revision surgery despite presenting with symptomatic aseptic loosening of orthopedic implants. • Radiological percutaneous periprosthetic bone cementoplasty brings quick and long-lasting improvements in clinical functional outcomes and offer effective pain reduction, thereby improving the overall quality of life. • Radiological percutaneous periprosthetic bone cementoplasty is a safe, quick, reliable, and well-tolerated minimally invasive procedure which can be easily performed under simple locoregional anesthesia and requires short-term hospital stay.
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Affiliation(s)
- A J Prestat
- Department of MSK Radiology, CHU Pasteur 2, NICE University Hospital, Hospital PASTEUR 2, 30 Voie Romaine, 06002, Nice, France.
| | - D Dalili
- Nuffield Orthopedic Centre, Oxford University Hospitals NHS Foundation Trust, Windmill Rd, Oxford, OX3 7LD, UK.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - A Rudel
- Department of MSK Radiology, CHU Pasteur 2, NICE University Hospital, Hospital PASTEUR 2, 30 Voie Romaine, 06002, Nice, France.,Department of Orthopedic and Sports Surgery, Pasteur 2 Hospital, University Institute of Locomotion and Sports (IULS), 30, Voie Romaine, 06000, Nice, France
| | - F Torre
- Department of MSK Radiology, CHU Pasteur 2, NICE University Hospital, Hospital PASTEUR 2, 30 Voie Romaine, 06002, Nice, France
| | - L J Pavan
- Department of MSK Radiology, CHU Pasteur 2, NICE University Hospital, Hospital PASTEUR 2, 30 Voie Romaine, 06002, Nice, France
| | - P Boileau
- Department of Orthopedic and Sports Surgery, Pasteur 2 Hospital, University Institute of Locomotion and Sports (IULS), 30, Voie Romaine, 06000, Nice, France
| | - N Amoretti
- Department of MSK Radiology, CHU Pasteur 2, NICE University Hospital, Hospital PASTEUR 2, 30 Voie Romaine, 06002, Nice, France
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12
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Liao S, Feng W, Liu Y, Wang Z, Ding X, Song F, Lin X, Song H, Kc A, Su Y, Liang J, Xu J, Liu Q, Zhao J. Inhibitory effects of biochanin A on titanium particle-induced osteoclast activation and inflammatory bone resorption via NF-κB and MAPK pathways. J Cell Physiol 2020; 236:1432-1444. [PMID: 32853427 DOI: 10.1002/jcp.29948] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 06/24/2020] [Accepted: 07/06/2020] [Indexed: 01/11/2023]
Abstract
Revision operations have become a new issue after successful artificial joint replacements, and periprosthetic osteolysis leading to prosthetic loosening is the main cause of why the overactivation of osteoclasts (OCs) plays an important role. The effect of biochanin A (BCA) has been examined in osteoporosis, but no study on the role of BCA in prosthetic loosening osteolysis has been conducted yet. In this study, we utilised enzyme-linked immunosorbent assay, computed tomography imaging, and histological analysis. Results showed that BCA downregulated the secretion levels of tumor necrosis factor-α, interleukin-1α (IL-1α), and IL-1β to suppress inflammatory responses. The secretion levels of receptor-activated nuclear factor-κB ligand, CTX-1, and osteoclast-associated receptor as well as Ti-induced osteolysis were also reduced. BCA effectively inhibited osteoclastogenesis and suppressed hydroxyapatite resorption by downregulating OC-related genes in vitro. Analysis of mechanisms indicated that BCA inhibited the signalling pathways of mitogen-activated protein kinase (P38, extracellular signal-regulated kinase, and c-JUN N-terminal kinase) and nuclear factor-κB (inhibitor κB-α and P65), thereby downregulating the expression of nuclear factor of activated T cell 1 and c-Fos. In conclusion, BCA may be an alternative choice for the prevention of prosthetic loosening caused by OCs.
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Affiliation(s)
- Shijie Liao
- Department of Orthopaedics, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.,Research Centre for Regenerative Medicine, Guangxi Key Laboratory of Regenerative Medicine, Guangxi Medical University, Nanning, Guangxi, China
| | - Wenyu Feng
- Department of Orthopaedics, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.,Research Centre for Regenerative Medicine, Guangxi Key Laboratory of Regenerative Medicine, Guangxi Medical University, Nanning, Guangxi, China
| | - Yun Liu
- Department of Orthopaedics, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.,School of Biomedical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Ziyi Wang
- School of Biomedical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Xiaofei Ding
- Department of Orthopaedics, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.,Research Centre for Regenerative Medicine, Guangxi Key Laboratory of Regenerative Medicine, Guangxi Medical University, Nanning, Guangxi, China
| | - Fangming Song
- Research Centre for Regenerative Medicine, Guangxi Key Laboratory of Regenerative Medicine, Guangxi Medical University, Nanning, Guangxi, China.,School of Biomedical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Xixi Lin
- Research Centre for Regenerative Medicine, Guangxi Key Laboratory of Regenerative Medicine, Guangxi Medical University, Nanning, Guangxi, China
| | - Huijie Song
- Department of Anesthesiology, The First Affliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi, China
| | - Anil Kc
- Department of Orthopaedics, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Yuangang Su
- Research Centre for Regenerative Medicine, Guangxi Key Laboratory of Regenerative Medicine, Guangxi Medical University, Nanning, Guangxi, China
| | - Jiamin Liang
- Research Centre for Regenerative Medicine, Guangxi Key Laboratory of Regenerative Medicine, Guangxi Medical University, Nanning, Guangxi, China
| | - Jiake Xu
- Research Centre for Regenerative Medicine, Guangxi Key Laboratory of Regenerative Medicine, Guangxi Medical University, Nanning, Guangxi, China.,School of Biomedical Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Qian Liu
- Department of Orthopaedics, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.,Research Centre for Regenerative Medicine, Guangxi Key Laboratory of Regenerative Medicine, Guangxi Medical University, Nanning, Guangxi, China
| | - Jinmin Zhao
- Department of Orthopaedics, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.,Research Centre for Regenerative Medicine, Guangxi Key Laboratory of Regenerative Medicine, Guangxi Medical University, Nanning, Guangxi, China
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13
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Mancino F, Cacciola G, Di Matteo V, De Marco D, Greenberg A, Perisano C, MA M, Sculco PK, Maccauro G, De Martino I. Reconstruction options and outcomes for acetabular bone loss in revision hip arthroplasty. Orthop Rev (Pavia) 2020; 12:8655. [PMID: 32913591 PMCID: PMC7459368 DOI: 10.4081/or.2020.8655] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 06/17/2020] [Indexed: 12/20/2022] Open
Abstract
Revision total hip arthroplasty in the setting of acetabular bone loss is a challenging procedure and requires a solid understanding of current acetabular reconstruction options. Despite major developments in the field of revision hip surgery in recent decades, reconstruction of acetabular defects remains a major problem in order to achieve primary stability and durable fixation without sacrificing additional bone stock. Although there are several ways to classify acetabular bone defects, the Paprosky classification system is the most commonly used to describe the defects and guide treatment strategy. An understanding of the bone defects associated with detailed pre-operative assessment and planning are essential elements in order to achieve satisfactory outcomes. Multiple acetabular reconstructive options are currently available including impaction bone grafting with metal mesh, reinforcement rings and antiprotrusio cage, structural allografts, cementless hemispherical cups, extra-large "jumbo cups", oblong cups, modular porous metal augments, cup-cage constructs, custom- made triflange cups, and acetabular distraction. To date, debate continues as to which technique is most effective due to the lack of long-term studies of modern reconstruction systems. Further long-term studies are necessary to assess the longevity of the different implants. The purpose of this study was to review the current literature and provide a comprehensive understanding of the available reconstruction options with their clinical outcomes.
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Affiliation(s)
- Fabio Mancino
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head- Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giorgio Cacciola
- GIOMI Istituto Ortopedico del Mezzogiorno d’Italia Franco Scalabrino, Ganzirri, Messina, Italy
| | - Vincenzo Di Matteo
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head- Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Davide De Marco
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head- Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alexander Greenberg
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York NY, USA
| | - Carlo Perisano
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head- Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Malahias MA
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York NY, USA
| | - Peter K. Sculco
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York NY, USA
| | - Giulio Maccauro
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head- Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ivan De Martino
- Division of Orthopaedics and Traumatology, Department of Aging, Neurological, Orthopaedic and Head- Neck Studies, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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14
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Ormsby RT, Solomon LB, Stamenkov R, Findlay DM, Atkins GJ. Evidence for Gender-Specific Bone Loss Mechanisms in Periprosthetic Osteolysis. J Clin Med 2019; 9:jcm9010053. [PMID: 31878362 PMCID: PMC7019811 DOI: 10.3390/jcm9010053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 12/13/2019] [Accepted: 12/20/2019] [Indexed: 11/22/2022] Open
Abstract
Osteolysis adjacent to total hip replacement (THR) prostheses is a major cause of their eventual failure. Periprosthetic osteolysis is associated with the production of bioactive particles, produced by the wear of articulating prosthesis surfaces. Wear particles invade the periprosthetic tissue, inducing inflammation and bone resorption. Previous studies have shown that osteocytes, the most numerous cell type in mineralised bone, can respond to wear particles of multiple orthopaedic material types. Osteocytes play important roles in bone resorption, regulating bone resorption by osteoclasts and directly through osteocytic osteolysis, also known as perilacunar remodelling. In this study, we perform a histological analysis of bone biopsies obtained from cohorts of male and female patients undergoing either primary THR surgery or revision THR surgery for aseptic loosening. The osteocyte lacunae area (Ot.Lac.Ar) and percentage lacunar area/bone area (%Ot.Lac.Ar/B.Ar) were significantly larger overall in revision THR bone than bone from similar sites in primary THR. Analysis by patient gender showed that increased Ot.Lac.Ar, indicative of increased perilacunar remodelling, was restricted to female revision samples. No significant differences in osteoclast parameters were detectable between the cohorts. These findings suggest previously unrecognised gender-specific mechanisms of bone loss in orthopaedic wear particle-induced osteolysis in humans.
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Affiliation(s)
- Renee T. Ormsby
- Biomedical Orthopaedic Research Group, Centre for Orthopaedic & Trauma Research, The University of Adelaide, Adelaide, SA 5000, Australia;
| | - Lucian B. Solomon
- Centre for Orthopaedic & Trauma Research, The University of Adelaide, Adelaide, SA 5000, Australia; (L.B.S.); (D.M.F.)
- Department of Orthopaedics & Trauma, Royal Adelaide Hospital, Adelaide, SA 5000, Australia;
| | - Roumen Stamenkov
- Department of Orthopaedics & Trauma, Royal Adelaide Hospital, Adelaide, SA 5000, Australia;
| | - David M. Findlay
- Centre for Orthopaedic & Trauma Research, The University of Adelaide, Adelaide, SA 5000, Australia; (L.B.S.); (D.M.F.)
| | - Gerald J. Atkins
- Biomedical Orthopaedic Research Group, Centre for Orthopaedic & Trauma Research, The University of Adelaide, Adelaide, SA 5000, Australia;
- Correspondence: ; Tel.: +61 883137214
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15
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Goodman SB, Gallo J. Periprosthetic Osteolysis: Mechanisms, Prevention and Treatment. J Clin Med 2019; 8:E2091. [PMID: 31805704 PMCID: PMC6947309 DOI: 10.3390/jcm8122091] [Citation(s) in RCA: 127] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 11/28/2019] [Accepted: 11/29/2019] [Indexed: 02/06/2023] Open
Abstract
Clinical studies, as well as in vitro and in vivo experiments have demonstrated that byproducts from joint replacements induce an inflammatory reaction that can result in periprosthetic osteolysis (PPOL) and aseptic loosening (AL). Particle-stimulated macrophages and other cells release cytokines, chemokines, and other pro-inflammatory substances that perpetuate chronic inflammation, induce osteoclastic bone resorption and suppress bone formation. Differentiation, maturation, activation, and survival of osteoclasts at the bone-implant interface are under the control of the receptor activator of nuclear factor kappa-Β ligand (RANKL)-dependent pathways, and the transcription factors like nuclear factor κB (NF-κB) and activator protein-1 (AP-1). Mechanical factors such as prosthetic micromotion and oscillations in fluid pressures also contribute to PPOL. The treatment for progressive PPOL is only surgical. In order to mitigate ongoing loss of host bone, a number of non-operative approaches have been proposed. However, except for the use of bisphosphonates in selected cases, none are evidence based. To date, the most successful and effective approach to preventing PPOL is usage of wear-resistant bearing couples in combination with advanced implant designs, reducing the load of metallic and polymer particles. These innovations have significantly decreased the revision rate due to AL and PPOL in the last decade.
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Affiliation(s)
- Stuart B. Goodman
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway St. M/C 6342, Redwood City, CA 94063, USA
- Department of Bioengineering, Stanford University, Stanford, CA 94305, USA
| | - Jiri Gallo
- Department of Orthopaedics, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, I. P. Pavlova 6, 779 00 Olomouc, Czech Republic;
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16
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Braun S, Vardag S, Mueller U, Schroeder S, Sonntag R, Bormann T, Gotterbarm T, Kretzer JP. Backside wear, particle migration and effectiveness of screw hole plugs in acetabular hip joint replacement with cross-linked polyethylene. Acta Biomater 2019; 97:239-246. [PMID: 31374340 DOI: 10.1016/j.actbio.2019.07.050] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/17/2019] [Accepted: 07/26/2019] [Indexed: 11/26/2022]
Abstract
In total hip arthroplasty, osteolysis of the acetabulum often occurs at the backside of cups in the area of screw holes, indicating a clinically relevant amount of polyethylene (PE) wear particles in this area. In order to avoid a possible migration of wear particles to the acetabulum-bone, screw hole plugs are provided for some implant systems. The aims of this study were to quantitatively determine backside wear and to investigate the migration behaviour of articulation-related wear particles in a cup system with open and closed screw holes by plugs. Titanium cup systems with backside holes for screw fixations were sinusoidally loaded with 2.7 kN. The articulation area was separated from the backside area of the cup. A defined amount of articulation-generated particles was added to the fluid of the articulation chamber. The fluids in the two chambers were separately filtered after 2 × 106 cycles for a particle analysis. Backside wear with noticeably small (65.6 ± 4.2 nm) and round PE particles was identified. With both open and closed screw holes, a migration of the articulating wear particles from the articulation area behind the cup could be observed. Backside wear was estimated to be below 1% of the articulated wear. Screw hole plugs did not effectively prevent the migration of PE wear particles behind the investigated cups. STATEMENT OF SIGNIFICANCE: Backside wear occurs in a proven cup-system. Furthermore, it was quantitatively observed that articulation-generated wear products could migrate from the articulating area along the cup/liner-interface through the screw holes behind the cup. An almost unimpeded particle migration to the acetabulum-bone, in conjunction with very small backside wear particles, could produce a clinically relevant amount of PE with respect to pelvic lysis. These findings highlight the importance of management to avoid particle migration in artificial hip cups. Therefore, primarily the use of screw hole plugs, as far as available for the respective cup-system, is recommended. The aim of avoiding particle migration by plugs, but also by using a sophisticated anchoring mechanism between cup and PE liner should continue in future.
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17
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Yan Z, Zhu S, Tian X, Ye Z, Zhai D, Zhu Z, Wei D, Zhu Q, Lu Z, Cao X. Metformin protects bone mass in ultra-high-molecular-weight polyethylene particle-induced osteolysis by regulating osteocyte secretion. J Bone Miner Metab 2019; 37:399-410. [PMID: 30032440 DOI: 10.1007/s00774-018-0939-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 06/17/2018] [Indexed: 12/28/2022]
Abstract
Metformin, an anti-hyperglycemic agent used for type 2 diabetes, has recently been found to have more effects apart from glucose regulation. We found that, in ultra-high-molecular-weight polyethylene particle-induced osteolysis mouse models, metformin had bone protect property and reduced the negative regulator of bone formation sclerostin (SOST) and Dickkopf-related protein 1 (DKK1), and increased osteoprotegerin (OPG) secretion and the ratio of OPG/Receptor Activator for Nuclear Factor-κB Ligand (RANKL). In vitro, we established a 3D co-culture system in which metformin affects osteoblasts and osteoclasts through mature osteocytes secretion. Metformin (50 μM) significantly decreased SOST and DKK1 mRNA expression, stimulating alkaline phosphatase activity and proliferation of osteoblast, and increased OPG secretion and the ratio of OPG/RANKL, inhibiting osteoclastogenesis. Moreover, the effect on OPG was reversed by adenosine 5'-monophosphate-activated protein kinase inhibitor, Compound C. Our finding suggests that metformin induces differentiation and mineralization of osteoblasts, while inhibits osteoclastogenesis via mature osteocytes secretion. Therefore, the drug might be beneficial for not only diabetes but also in other bone disorders by acting on mature osteocytes.
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Affiliation(s)
- Zhao Yan
- Department of Orthopaedics, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, People's Republic of China
| | - Shu Zhu
- Department of Orthopaedics, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, People's Republic of China
| | - Xiaoxi Tian
- Emergency Department of Tangdu Hospital, Fourth Military Medical University, Xi'an, 710032, People's Republic of China
| | - Zichen Ye
- State Key Laboratory of Cancer Biology, Department of Pharmacogenomics, Fourth Military Medical University, Xi'an, 710032, People's Republic of China
| | - Dongsheng Zhai
- State Key Laboratory of Cancer Biology, Department of Pharmacogenomics, Fourth Military Medical University, Xi'an, 710032, People's Republic of China
| | - Zheng Zhu
- Department of Urinary Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, People's Republic of China
| | - Di Wei
- Department of Urinary Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, People's Republic of China
| | - Qingsheng Zhu
- Department of Orthopaedics, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, People's Republic of China
| | - Zifan Lu
- State Key Laboratory of Cancer Biology, Department of Pharmacogenomics, Fourth Military Medical University, Xi'an, 710032, People's Republic of China.
| | - Xiaorui Cao
- Department of Orthopaedics, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, People's Republic of China.
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18
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Rysinska A, Sköldenberg O, Garland A, Rolfson O, Aspberg S, Eisler T, Garellick G, Stark A, Hailer N, Gordon M. Aseptic loosening after total hip arthroplasty and the risk of cardiovascular disease: A nested case-control study. PLoS One 2018; 13:e0204391. [PMID: 30427844 PMCID: PMC6235257 DOI: 10.1371/journal.pone.0204391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 09/07/2018] [Indexed: 11/18/2022] Open
Abstract
Background Patients with surgically treated osteoarthritis of the hip have an increased risk of cardiovascular morbidity and mortality many years after the operation compared with controls. Our hypothesis is that this increased risk after total hip arthroplasty (THA) is mediated by development of periprosthetic osteolysis leading to aseptic loosening of the implant. Methods We conducted a nation-wide, nested, case-control study consisting of patients receiving a cemented THA due to osteoarthritis between the years 1992 and 2005. Our study population included a total of 14,430 subjects identified in the Swedish hip arthroplasty register and linked to the Swedish National Patient Register. The case group consisted of patients (n = 2,886) who underwent reoperation of the treated hip due to osteolysis or aseptic loosening at any time within five years after the index surgery. Each case was matched with four controls (n = 11,544) who had not undergone reoperation. The main outcomes were cardiovascular events i.e. myocardial infarction, heart failure and cerebral infarction according to ICD-codes and time to the first cardiovascular event during the exposure period. Outcomes were subgrouped into cardiac and cerebral events. We used regression models to calculate the incidence rates and adjusted our results for confounders. Findings Overall, 5.1% of patients had cardiac events, with slightly more overall cardiovascular events occurring in the control group (8.1% vs. 6.7%, odds ratio 0.8, 95% confidence interval (CI) 0.7 to 1.0). After adjusting for confounders, the case group had an increased relative risk of 1.3 (95% confidence interval (CI) 1.1 to 1.3) for total number of cardiovascular events. Similar effect sizes were observed for time to first event. Interpretation Patients with osteoarthritis who received THA and subsequently underwent a revision operation due to loosening had a higher relative risk of developing cardiovascular events than controls. Thus there is an association which could be explained by a common inflammatory disease pathway that requires further experimental research.
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Affiliation(s)
- Agata Rysinska
- Karolinska Institutet, Department of Clinical Sciences at Danderyd Hospital, Stockholm, Stockholm, Sweden
- * E-mail:
| | - Olof Sköldenberg
- Karolinska Institutet, Department of Clinical Sciences at Danderyd Hospital, Stockholm, Stockholm, Sweden
| | - Anne Garland
- Department of Orthopaedics, Institute of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Ola Rolfson
- Swedish Hip Arthroplasty Register, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, University of Gothenburg, Gothenburg, Sweden
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston MA, United States of America, and Harvard Medical School, Boston, MA, United States of America
| | - Sara Aspberg
- Karolinska Institutet, Department of Clinical Sciences at Danderyd Hospital, Stockholm, Stockholm, Sweden
| | - Thomas Eisler
- Karolinska Institutet, Department of Clinical Sciences at Danderyd Hospital, Stockholm, Stockholm, Sweden
| | - Göran Garellick
- Swedish Hip Arthroplasty Register, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, University of Gothenburg, Gothenburg, Sweden
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston MA, United States of America, and Harvard Medical School, Boston, MA, United States of America
| | - Andreas Stark
- Karolinska Institutet, Department of Clinical Sciences at Danderyd Hospital, Stockholm, Stockholm, Sweden
| | - Nils Hailer
- Department of Orthopaedics, Institute of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Max Gordon
- Karolinska Institutet, Department of Clinical Sciences at Danderyd Hospital, Stockholm, Stockholm, Sweden
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Gong ZM, Tang ZY, Sun XL. LncRNA PRNCR1 regulates CXCR4 expression to affect osteogenic differentiation and contribute to osteolysis after hip replacement. Gene 2018; 673:251-261. [DOI: 10.1016/j.gene.2018.05.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 05/13/2018] [Indexed: 01/05/2023]
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21
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Gao XR, Ge J, Li WY, Zhou WC, Xu L, Geng DQ. NF-κB/let-7f-5p/IL-10 pathway involves in wear particle-induced osteolysis by inducing M1 macrophage polarization. Cell Cycle 2018; 17:2134-2145. [PMID: 30176162 DOI: 10.1080/15384101.2018.1515549] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
NF-κB signaling pathway shows significant influence on wear particle-induced osteolysis, and this study aims to explore the underlying mechanism and the role of let-7f-5p in this process. A mouse calvarial osteolysis model was constructed with PMMA particles, and the bone marrow-derived macrophages (BMMs) were isolated from the osteolysis area. The expression of miRNA and protein was determined by qRT-PCR and western blot, respectively. The level of cytokines was evaluated with ELISA. Recombinant plasmids were transfected into cells for the endogenous expression of related genes. Dual-luciferase reporter assay was performed to determine the interaction between let-7f-5p and IL-10 in macrophage RAW264.7 cells. M1 macrophage polarization and expression of let-7f-5p were promoted in BMMs of osteolysis mouse model, compared with that in sham group. The expression of let-7f-5p was increased in the process of M1 macrophage polarization that induced by PMMA. Let-7f-5p was involved in M1 polarization in macrophages that treated with PMMA. IL-10 was negatively regulated by let-7f-5p. NF-κB regulated the expression of IL-10 through let-7f-5p. NF-κB participated in the PMMA-induced M1 macrophage polarization through let-7f-5p. Let-7f-5p contributed to PMMA-induced osteolysis by promoting M1 polarization of macrophages. The NF-κB/let-7f-5p/IL-10 pathway induces M1 macrophage polarization, and thus contributing to wear particle-induced osteolysis.
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Affiliation(s)
- Xu-Ren Gao
- a Department of Orthopedics , the Affiliated Hospital of Xuzhou Medical University , Xuzhou , China
| | - Jian Ge
- a Department of Orthopedics , the Affiliated Hospital of Xuzhou Medical University , Xuzhou , China
| | - Wei-Yi Li
- a Department of Orthopedics , the Affiliated Hospital of Xuzhou Medical University , Xuzhou , China
| | - Wang-Chen Zhou
- a Department of Orthopedics , the Affiliated Hospital of Xuzhou Medical University , Xuzhou , China
| | - Lei Xu
- a Department of Orthopedics , the Affiliated Hospital of Xuzhou Medical University , Xuzhou , China
| | - De-Qin Geng
- b Department of Clinical Medicine , the Affiliated Hospital of Xuzhou Medical University , Xuzhou , China
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Mahon OR, Dunne A. Disease-Associated Particulates and Joint Inflammation; Mechanistic Insights and Potential Therapeutic Targets. Front Immunol 2018; 9:1145. [PMID: 29892292 PMCID: PMC5985611 DOI: 10.3389/fimmu.2018.01145] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 05/07/2018] [Indexed: 12/27/2022] Open
Abstract
It is now well established that intra-articular deposition of endogenous particulates, such as osteoarthritis-associated basic calcium phosphate crystals, gout-associated monosodium urate crystals, and calcium deposition disease-associated calcium pyrophosphate crystals, contributes to joint destruction through the production of cartilage-degrading enzymes and pro-inflammatory cytokines. Furthermore, exogenous wear-debris particles, generated from prosthetic implants, drive periprosthetic osteolysis which impacts on the longevity of total joint replacements. Over the last few years, significant insight has been gained into the mechanisms through which these particulates exert their effects. Not only has this increased our understanding of the pathological processes associated with crystal deposition but it has also led to the identification of a number of therapeutic targets to treat particulate-associated disease. In this review, we discuss recent developments regarding the cellular events triggered by joint-associated particulates, as well as future directions in therapy for particulate-related arthropathies.
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Affiliation(s)
- Olwyn R Mahon
- School of Biochemistry and Immunology, School of Medicine, Trinity College Dublin, Trinity Biomedical Sciences Institute, The University of Dublin, Dublin, Ireland
| | - Aisling Dunne
- School of Biochemistry and Immunology, School of Medicine, Trinity College Dublin, Trinity Biomedical Sciences Institute, The University of Dublin, Dublin, Ireland
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Atrey A, Ward SE, Khoshbin A, Hussain N, Bogoch E, Schemitsch EH, Waddell JP. Ten-year follow-up study of three alternative bearing surfaces used in total hip arthroplasty in young patients. Bone Joint J 2017; 99-B:1590-1595. [DOI: 10.1302/0301-620x.99b12.bjj-2017-0353.r1] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 08/29/2017] [Indexed: 11/05/2022]
Abstract
Aims We present the ten-year data of a cohort of patients, aged between 18 and 65 years (mean age 52.7 years; 19 to 64), who underwent total hip arthroplasty. Patients were randomised to be treated with a cobalt-chrome (CoCr) femoral head with an ultra-high molecular weight polyethylene (UHMWPE), highly cross-linked polyethylene (XLPE) or ceramic-on-ceramic (CoC) bearing surface. Patients and Methods A total of 102 hips (91 patients) were randomised into the three groups. At ten years, 97 hips were available for radiological and functional follow-up. Two hips (two patients) had been revised (one with deep infection and one for periprosthetic fracture) and three were lost to follow-up. Radiological analysis was performed using a validated digital assessment programme to give linear, directional and volumetric wear of the two polyethylene groups. Results There was a significantly reduced rate of steady-state linear wear with XLPE (0.07 mm/yr) compared with UHMWPE (0.37 mm/yr) (p = 0.001). Volumetric wear was also significantly reduced in the XLPE group (29.29 mm3/yr) compared with the UHMWPE group (100.75mm3/yr) (p = 0.0001). There were six patients with UHMWPE who had non-progressive osteolysis and none in the XLPE group. All three bearing groups had significant improvements in 12-item short form health survey scores, Western Ontario and McMaster Universities Osteoarthritis Index score and Harris Hip Score. However, the improvement in HSS was significantly less in the UHMWPE group (p = 0.0188) than in the other two groups. At ten years, the rates of volumetric and linear wear in the XLPE group remain low and predominantly below the estimated threshold for osteolysis (1 mm/yr). The rate of linear wear in the XLPE group was three times less than in the UHMWPE group at five-year follow-up and five times less at ten years. The rate of volumetric wear was also three times less in the XLPE group at ten years. Conclusion While CoC also performs well, XLPE at ten years remains a safe and excellent bearing option in young patients, with low rates of wear and no evidence of osteolysis. Cite this article: Bone Joint J 2017;99-B:1590–5.
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Affiliation(s)
- A. Atrey
- University of Toronto and St Michael’s
Hospital, 55 Queen Street E, Level
8, Toronto, Ontario M5C
1R6, Canada
| | - S. E. Ward
- University of Toronto and St Michael’s
Hospital, 55 Queen Street E, Level
8, Toronto, Ontario M5C
1R6, Canada
| | - A. Khoshbin
- University of Toronto and St Michael’s
Hospital, 55 Queen Street E, Level
8, Toronto, Ontario M5C
1R6, Canada
| | - N. Hussain
- The Ohio State University, Wexner
Medical Center, 410 W 10th Ave, Columbus, OH 43210, USA
| | - E. Bogoch
- University of Toronto and St Michael’s
Hospital, 55 Queen Street E, Level
8, Toronto, Ontario M5C
1R6, Canada
| | - E. H. Schemitsch
- University of Western Ontario, 268
Grosvenor Street, Room E3-116, London, Ontario, N6A
4V2, Canada
| | - J. P. Waddell
- University of Toronto and St Michael’s
Hospital, 55 Queen Street E, Level
8, Toronto, Ontario M5C
1R6, Canada
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Zhang Y, Jiang P, Li W, Liu X, Lu Y, Huang Z, Song K. Calcineurin/NFAT signaling pathway mediates titanium particle-induced inflammation and osteoclast formation by inhibiting RANKL and M-CSF in vitro. Mol Med Rep 2017; 16:8223-8230. [DOI: 10.3892/mmr.2017.7670] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 08/17/2017] [Indexed: 11/06/2022] Open
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Bu YM, Zheng DZ, Wang L, Liu J. Abrasive Endoprosthetic Wear Particles Inhibit IFN-γ Secretion in Human Monocytes Via Upregulating TNF-α-Induced miR-29b. Inflammation 2017; 40:166-173. [PMID: 27812842 DOI: 10.1007/s10753-016-0465-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The adverse biological responses to prostheses wear particles commonly led to the failure of total hip arthroplasty. Among the released cytokines, interferon-γ (IFN-γ) has been found to be a critical functional factor during osteoclast differentiation. However, the molecular mechanism underlying the regulation of IFN-γ in wear particles-induced cells still needs to be determined. Four kinds of abrasive endoprosthetic wear particle were used to treat THP-1 cells, including polymethylmethacrylate (PMMA), zirconiumoxide (ZrO2), commercially pure titanium (cpTi), and titanium alloy (Ti-6Al-7Nb), with a concentration of 0.01, 0.05, 0.1, or 0.2 mg/ml for 48 h. The expression of IFN-γ and miR-29b was detected by real-time RT-PCR or ELISA. Luciferase reporter assay was performed to determine the regulation of miR-29b on IFN-γ. The effect of miR-29b inhibitor on the expression of wear particle-induced IFN-γ was detected. The expression of miR-29b was examined in THP-1 cells treated with tumor necrosis factor-alpha (TNF-α). The expression of IFN-γ was downregulated and the level of miR-29b was increased in THP-1 cells pretreated with wear particles. IFN-γ was a target of miR-29b. Wear particles inhibited the expression of IFN-γ through miR-29b. The expression of miR-29b was significantly reduced in THP-1 cells treated with TNF-α neutralizing antibody and particles comparing to that in the cells treated with particles alone. Wear particles inhibit the IFN-γ secretion in human monocytes, which was associated with the upregulating TNF-α-induced miR-29b.
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Affiliation(s)
- Yan-Min Bu
- Department of Orthopedics, Tianjin Hospital, No. 406, Jie Fang South Rd, Tianjin, 300211, People's Republic of China
| | - De-Zhi Zheng
- Department of Orthopedics, Tianjin Hospital, No. 406, Jie Fang South Rd, Tianjin, 300211, People's Republic of China
| | - Lei Wang
- Department of Orthopedics, Tianjin Hospital, No. 406, Jie Fang South Rd, Tianjin, 300211, People's Republic of China
| | - Jun Liu
- Department of Orthopedics, Tianjin Hospital, No. 406, Jie Fang South Rd, Tianjin, 300211, People's Republic of China.
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Liu G, Guo T, Zhang Y, Liu N, Chen J, Chen J, Zhang J, Zhao J. Apoptotic pathways of macrophages within osteolytic interface membrane in periprosthestic osteolysis after total hip replacement. APMIS 2017; 125:565-578. [PMID: 28345781 DOI: 10.1111/apm.12679] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 01/10/2017] [Indexed: 12/27/2022]
Abstract
Macrophage apoptosis in interface membrane, which occurs through either death receptor, mitochondrion, or endoplasmic reticulum (ER) stress pathways, has been suggested to play an important role in promoting osteolysis. However, how and why macrophage apoptosis originates and the correlation among these apoptotic pathways is not yet clear. The objective of this study was to identify the apoptotic mechanism of macrophages, and to explore the relationship between the apoptotic pathways and progression of osteolysis. Transmission electron microscopy (TEM) was utilized to analyze the tissue ultrastructure of wear particles, and in situ apoptotic macrophage identification was performed by TUNEL staining. We analyzed the expression of the key biomarkers of apoptotic pathways via immunohistochemistry and Western blotting. Our results demonstrated that the majority of wear particles within osteolytic interface membrane was in the 30-60 nm range, and that macrophage apoptotic ratio increased along with osteolysis progression. Normal hip dysplasia and mechanical loosening of tissues showed low expression levels of biomarkers for ER stress (Ca2+ , JNK, cleaved Caspase-4, IRE1-α, Grp78/Bip, and CHOP), mitochondrion (Bcl-2, Bax, and Cytochrome c), and death receptor (Fas and cleaved Caspase-8) pathways, while osteolytic interface membrane tissues expressed high levels of these biomarkers. In addition, we found that the ER stress intensity was in complete conformity with mitochondrial dysfunction and was consistent with the results of death receptor activation. Thus, our findings suggested that wear particles generated at implant interface can accelerate macrophage apoptosis through changes in apoptotic pathways and ultimately aggravate the symptom of osteolysis. These data represent a preferential apoptotic signaling pathway of macrophages as specific target points for the prevention and therapeutic modulation of periprosthetic osteolysis.
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Affiliation(s)
- Guoyin Liu
- Department of Orthopaedics, Jinling Hospital affiliated to School of Medicine, Nanjing University and State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, Nanjing, China.,Department of Orthopaedics, Bayi Hospital Affiliated Nanjing University of Chinese Medicine, Nanjing, China
| | - Ting Guo
- Department of Orthopaedics, Jinling Hospital affiliated to School of Medicine, Nanjing University and State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, Nanjing, China
| | - Yong Zhang
- Department of Orthopaedics, Bayi Hospital Affiliated Nanjing University of Chinese Medicine, Nanjing, China
| | - Naicheng Liu
- Department of Orthopaedics, Jinling Hospital affiliated to School of Medicine, Nanjing University and State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, Nanjing, China
| | - Jiangning Chen
- Department of Orthopaedics, Jinling Hospital affiliated to School of Medicine, Nanjing University and State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, Nanjing, China
| | - Jianmin Chen
- Department of Orthopaedics, Bayi Hospital Affiliated Nanjing University of Chinese Medicine, Nanjing, China
| | - Junfeng Zhang
- Department of Orthopaedics, Jinling Hospital affiliated to School of Medicine, Nanjing University and State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, Nanjing, China
| | - Jianning Zhao
- Department of Orthopaedics, Jinling Hospital affiliated to School of Medicine, Nanjing University and State Key Laboratory of Pharmaceutical Biotechnology, School of Life Sciences, Nanjing University, Nanjing, China
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Howie DW, Holubowycz OT, Callary SA. The Wear Rate of Highly Cross-Linked Polyethylene in Total Hip Replacement Is Not Increased by Large Articulations: A Randomized Controlled Trial. J Bone Joint Surg Am 2016; 98:1786-1793. [PMID: 27807110 DOI: 10.2106/jbjs.15.01248] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Larger articulations reduce the risk of dislocation following primary total hip arthroplasty, leading to increased use of these articulations. The wear rate of highly cross-linked polyethylene (XLPE) is low in standard-diameter articulations but remains unclear in larger articulations. The aim of this randomized controlled trial was to compare the mean wear rates of 36-mm and 28-mm metal-on-XLPE articulations between 1 and 3 years postoperatively. METHODS Fifty-six elderly patients undergoing primary total hip arthroplasty were randomized intraoperatively to receive either a 36-mm or 28-mm metal-on-XLPE articulation. Factors that may affect wear were controlled by study design. Wear was measured using radiostereometric analysis. RESULTS Mean annual proximal wear rates between 1 and 3 years were 0.00 and 0.01 mm/yr for the 36 and 28-mm articulation cohorts, respectively. No patient had a proximal wear rate of >0.1 mm/yr. Mean wear was very low in all directions, and the wear rate of 36-mm articulations was not significantly greater than that of 28-mm articulations on the basis of proximal, medial 2-dimensional, and 3-dimensional wear. CONCLUSIONS The wear rate of a larger 36-mm metal-on-XLPE articulation between 1 and 3 years following primary total hip arthroplasty was low and no greater than that of a 28-mm articulation. However, before a 36-mm metal-on-XLPE articulation is widely recommended, particularly in young active patients, long-term wear rates and association between wear and periprosthetic osteolysis should be determined. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Donald W Howie
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Oksana T Holubowycz
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Stuart A Callary
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA, Australia
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Ormsby RT, Cantley M, Kogawa M, Solomon LB, Haynes DR, Findlay DM, Atkins GJ. Evidence that osteocyte perilacunar remodelling contributes to polyethylene wear particle induced osteolysis. Acta Biomater 2016; 33:242-51. [PMID: 26796208 DOI: 10.1016/j.actbio.2016.01.016] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 01/12/2016] [Accepted: 01/16/2016] [Indexed: 01/04/2023]
Abstract
Periprosthetic osteolysis (PO) leading to aseptic loosening, is the most common cause of failure of total hip replacement (THR) in the mid- to long-term. Polyethylene (PE) particulates from the wear of prosthesis liners are bioactive and are implicated in the initiation and or progression of osteolysis. Evidence exists that cells of the osteoblast/osteocyte lineage are affected by PE particles and contribute to the catabolic response by promoting osteoclastic bone resorption. In this study, we hypothesised that osteocytes contribute directly to PO by removing bone from their perilacunar matrix. Osteocyte responses to ultra-high molecular weight PE (UHMWPE) particles were examined in vitro in human primary osteocyte-like cultures, in vivo in the mouse calvarial osteolysis model, and in the acetabulum of patients undergoing revision total hip replacement (THR) surgery for PO. Osteocytes exposed to UHMWPE particles showed upregulated expression of catabolic markers, MMP-13, carbonic anhydrase 2 (CA2), cathepsin K (CTSK) and tartrate resistant acid phosphatase (TRAP), with no effect on cell viability, as assessed by Caspase 3 activity. Consistent with this catabolic activity causing perilacunar bone loss, histological analysis of calvarial sections from mice exposed to UHMWPE revealed a significant (p<0.001) increase in osteocyte lacunar area (Lac.Ar) compared to sham-operated animals. Furthermore, acetabular biopsies from patients with PO also showed significantly (p<0.001) increased osteocyte lacunar size in trabecular bone adjacent to PE particles, compared with osteocyte lacunar size in bone from primary THR patients. Together, these findings suggest a previously unrecognised action of UHMWPE wear particles on osteocytes, which directly results in a loss of osteocyte perilacunar bone. This action may exacerbate the indirect pro-osteoclastic action of UHMWPE-affected osteocytes, previously shown to contribute to aseptic loosening of orthopaedic implants. STATEMENT OF SIGNIFICANCE This study addresses the clinical problem of periprosthetic osteolysis, bone loss in response to polyethylene wear particles derived from materials used in orthopaedic implants. Periprosthetic osteolysis has been thought to be due largely to wear particles stimulating the activity of bone resorbing osteoclasts. However, in this study we demonstrate for the first time that polyethylene particles stimulate another type of bone loss, mediated by the direct activity of bone mineral embedded osteocytes, termed osteocytic osteolysis or osteocyte perilacunar remodelling. This study provides new mechanistic insight into wear-particle mediated bone loss and represents a new paradigm for the way in which bone cells, namely osteocytes, the key controlling cell type in bone, react to biomaterials.
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Saad S, Dharmapatni AASSK, Crotti TN, Cantley MD, Algate K, Findlay DM, Atkins GJ, Haynes DR. Semaphorin-3a, neuropilin-1 and plexin-A1 in prosthetic-particle induced bone loss. Acta Biomater 2016; 30:311-318. [PMID: 26602825 DOI: 10.1016/j.actbio.2015.11.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 11/13/2015] [Accepted: 11/16/2015] [Indexed: 12/30/2022]
Abstract
Peri-prosthetic osteolysis (PPO) occurs in response to prosthetic wear particles causing an inflammatory reaction in the surrounding tissue that leads to subsequent bone loss. Semaphorin-3a (SEM3A), neuropilin-1 (NRP1) and plexin-A1 (PLEXA1) are axonal guidance molecules that have been recently implicated in regulating bone metabolism. This study investigated SEM3A, NRP1 and PLEXA1 protein and mRNA expression in human PPO tissue and polyethylene (PE) particle-stimulated human peripheral blood mononuclear cell (PBMC)-derived osteoclasts in vitro. In addition, the effects of tumour necrosis factor alpha (TNFα) on cultured osteoclasts was assessed. In PPO tissues, a granular staining pattern of SEM3A and NRP1 was observed within large multi-nucleated cells that contained prosthetic wear particles. Immunofluorescent staining confirmed the expression of SEM3A, NRP1 and PLEXA1 in large multi-nucleated human osteoclasts in vitro. Furthermore, SEM3A, NRP1 and PLEXA1 mRNA levels progressively increased throughout osteoclast differentiation induced by receptor activator of nuclear factor κB ligand (RANKL), and the presence of PE particles further increased mRNA expression of all three molecules. Soluble SEM3A was detected in human osteoclast culture supernatant at days 7 and 17 of culture, as assessed by ELISA. TNFα treatment for 72h markedly decreased the mRNA expression of SEM3A, NRP1 and PLEXA1 by human osteoclasts in vitro. Our findings suggest that SEM3A, NRP1 and PLEXA1 may have important roles in PPO, and their interactions, alone or as a complex, may have a role in pathological bone loss progression. STATEMENT OF SIGNIFICANCE Peri-prosthetic osteolysis occurs in response to prosthetic wear particles causing an inflammatory reaction in the surrounding tissue that leads to subsequent bone loss. The rate of hip and knee arthroplasty is increasing by at least 5% per year. However, these joint replacements have a finite lifespan, with data from the National Joint Replacement Registry (Australia) showing that the major cause of failure of total hip replacements is aseptic loosening. In aseptic loosening, wear particles liberated from prostheses are phagocytosed by macrophages, leading to release of inflammatory cytokines and up-regulation of osteoclast formation and activity. Semaphorin-3a, neuropilin-1 and plexin-A1 are axonal guidance molecules that have been recently implicated in regulating bone metabolism. This is the first report to show that these molecules may be involved in the implant failure.
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Affiliation(s)
- S Saad
- Discipline of Anatomy and Pathology, School of Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - A A S S K Dharmapatni
- Discipline of Anatomy and Pathology, School of Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - T N Crotti
- Discipline of Anatomy and Pathology, School of Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - M D Cantley
- Discipline of Anatomy and Pathology, School of Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - K Algate
- Discipline of Anatomy and Pathology, School of Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - D M Findlay
- Centre for Orthopedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia
| | - G J Atkins
- Centre for Orthopedic and Trauma Research, The University of Adelaide, Adelaide, South Australia, Australia
| | - D R Haynes
- Discipline of Anatomy and Pathology, School of Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.
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Gallo G, Caudal A, Bronsard N, Hauger O, Amoretti N. Stabilisation of a loosened femoral gamma nail by percutaneous cement injection (cementoplasty): a new technique. Skeletal Radiol 2015; 44:1535-9. [PMID: 26138339 DOI: 10.1007/s00256-015-2193-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 06/03/2015] [Accepted: 06/08/2015] [Indexed: 02/02/2023]
Abstract
Surgical repair of pertrochanteric and subtrochanteric fractures in the elderly is usually achieved using an endomedullary nail. Unfortunately, even today, some of the patients who undergo this intervention develop periprosthetic bone absorption over time that can lead to loosening of the prosthesis, resulting in pain, joint instability and the need for revision surgery. Surgical revision is hindered by potential complications related to patients' existing underlying medical conditions. It is often the case that these patients are weak and present comorbidities, which can lead to an absolute contraindication to surgery. An interesting alternative could be the stabilisation by percutaneous injection of cement (cementoplasty) in the periprosthetic space under CT and fluoroscopic guidance. In patients with absolute contraindication we performed percutaneous cementoplasty as treatment for femoral prosthesis loosening. Our procedure was technically a success following the end of the intervention period (follow-up: 6 months). The patient no longer experienced significant pain and showed stability of the prosthesis, as demonstrated by CT.
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Affiliation(s)
- Giacomo Gallo
- Service of Radiology, Centre Hospitalier Universitaire Archet 2, 151 route de Saint-Antoine-de-Ginestière, Nice, France
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