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Szczęsny G, Kopec M, Politis DJ, Kowalewski ZL, Łazarski A, Szolc T. A Review on Biomaterials for Orthopaedic Surgery and Traumatology: From Past to Present. MATERIALS 2022; 15:ma15103622. [PMID: 35629649 PMCID: PMC9145924 DOI: 10.3390/ma15103622] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/16/2022] [Accepted: 05/18/2022] [Indexed: 02/04/2023]
Abstract
The principal features essential for the success of an orthopaedic implant are its shape, dimensional accuracy, and adequate mechanical properties. Unlike other manufactured products, chemical stability and toxicity are of increased importance due to the need for biocompatibility over an implants life which could span several years. Thus, the combination of mechanical and biological properties determines the clinical usefulness of biomaterials in orthopaedic and musculoskeletal trauma surgery. Materials commonly used for these applications include stainless steel, cobalt-chromium and titanium alloys, ceramics, polyethylene, and poly(methyl methacrylate) (PMMA) bone cement. This study reviews the properties of commonly used materials and the advantages and disadvantages of each, with special emphasis on the sensitivity, toxicity, irritancy, and possible mutagenic and teratogenic capabilities. In addition, the production and final finishing processes of implants are discussed. Finally, potential directions for future implant development are discussed, with an emphasis on developing advanced personalised implants, according to a patient’s stature and physical requirements.
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Affiliation(s)
- Grzegorz Szczęsny
- Department of Orthopaedic Surgery and Traumatology, Medical University, 4 Lindleya Str., 02-005 Warsaw, Poland; (G.S.); (A.Ł.)
| | - Mateusz Kopec
- Institute of Fundamental Technological Research, Polish Academy of Sciences, 5B Pawińskiego Str., 02-106 Warsaw, Poland; (Z.L.K.); (T.S.)
- Correspondence:
| | - Denis J. Politis
- Department of Mechanical and Manufacturing Engineering, University of Cyprus, Nicosia 20537, Cyprus;
| | - Zbigniew L. Kowalewski
- Institute of Fundamental Technological Research, Polish Academy of Sciences, 5B Pawińskiego Str., 02-106 Warsaw, Poland; (Z.L.K.); (T.S.)
| | - Adam Łazarski
- Department of Orthopaedic Surgery and Traumatology, Medical University, 4 Lindleya Str., 02-005 Warsaw, Poland; (G.S.); (A.Ł.)
| | - Tomasz Szolc
- Institute of Fundamental Technological Research, Polish Academy of Sciences, 5B Pawińskiego Str., 02-106 Warsaw, Poland; (Z.L.K.); (T.S.)
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Stratton‐Powell AA, Williams S, Tipper JL, Redmond AC, Brockett CL. Mixed material wear particle isolation from periprosthetic tissue surrounding total joint replacements. J Biomed Mater Res B Appl Biomater 2022; 110:2276-2289. [PMID: 35532138 PMCID: PMC9540445 DOI: 10.1002/jbm.b.35076] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 11/05/2021] [Accepted: 04/18/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Ashley A. Stratton‐Powell
- Institute of Medical and Biological Engineering, School of Mechanical Engineering University of Leeds Leeds UK
| | - Sophie Williams
- Institute of Medical and Biological Engineering, School of Mechanical Engineering University of Leeds Leeds UK
| | - Joanne L. Tipper
- Institute of Medical and Biological Engineering, School of Mechanical Engineering University of Leeds Leeds UK
- School of Biomedical Engineering University of Technology Sydney Ultimo New South Wales Australia
| | - Anthony C. Redmond
- NIHR Leeds Biomedical Research Centre Leeds Teaching Hospitals NHS Trust Leeds UK
- Leeds Institute for Rheumatic and Musculoskeletal Medicine, School of Medicine University of Leeds Leeds UK
| | - Claire L. Brockett
- Institute of Medical and Biological Engineering, School of Mechanical Engineering University of Leeds Leeds UK
- NIHR Leeds Biomedical Research Centre Leeds Teaching Hospitals NHS Trust Leeds UK
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Othman YA, Verma R, Qureshi SA. Artificial disc replacement in spine surgery. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:S170. [PMID: 31624736 DOI: 10.21037/atm.2019.08.26] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Total disc replacement (TDR) is an innovative procedure that has gained traction in spine surgery. A large amount of data in the literature report on the short-term outcomes of TDR surgery favorably. However, surgeons remain reluctant to opt for TDR surgery due to uncertainty of long-term outcomes. Recently, long term data regarding TDR surgery has become available, with some studies showing superior outcomes to fusion surgery. The goal of this review is to synthesize and clinically contextualize the recent literature on TDR surgery. This article also provides brief discussion of the biggest challenges currently facing disc arthroplasties and the ways in which they are being tackled.
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Affiliation(s)
- Yahya A Othman
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Ravi Verma
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Sheeraz A Qureshi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
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Li C, Wu Z, Yuan G, Fang Z, Lin X, Pu R, Kang Y, Li L, Shao S, Ding J, Zhao J, Liu Q, Qin A. Vx-11e protects against titanium-particle-induced osteolysis and osteoclastogenesis by supressing ERK activity. Biochem Biophys Res Commun 2019; 514:1244-1250. [PMID: 31109651 DOI: 10.1016/j.bbrc.2019.05.054] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 05/06/2019] [Indexed: 02/05/2023]
Abstract
Wear particle-induced osteolysis around the prosthesis is the most common long-term complication after total joint replacement surgery which often leads to aseptic loosening of the prosthesis. Osteoclasts play key roles in the osteolytic process. Currently there is a lack of clinically effective measures to prevent or treat peri-prosthetic osteolysis and thus identification of new agents that can inhibit the enhanced osteoclastic bone resorption is warranted. Through this study, we discovered that the specific and potent ERK1/2 inhibitor, Vx-11e, can protect against calvarial osteolysis caused by titanium (Ti) particles in vivo. Low doses of Vx-11e mildly reduced osteoclast resorption whilst no calvarial osteolysis was observed with high dose Vx-11e treatment. Histological examination showed fewer osteoclasts and reduced bone erosion in the Vx-11e treated groups. In vitro cellular analyses showed that Vx-11e inhibited osteoclast formation from BMM precursors in response to RANKL, as well as bone resorption by mature osteoclasts. Mechanistically, Vx-11e impaired RANKL-induced ERK1/2 signaling by inhibiting its kinase activity thereby blocking the phosphorylation of downstream substrates. Moreover, Vx-11e significantly reduced the expression of RANKL-mediated genes such as ACP5/TRAcP, CTR, MMP-9, CTSK. Collectively, our data provides evidence for the potential therapeutic use of Vx-11e for the treatment of osteolysis diseases caused by extremely actived osteoclastogenesis.
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Affiliation(s)
- Chen Li
- Guangxi Collaborative Innovation Center for Biomedicine, Guangxi Key Laboratory of Regenerative Medicine, Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Zuoxing Wu
- Guangxi Collaborative Innovation Center for Biomedicine, Guangxi Key Laboratory of Regenerative Medicine, Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Guixin Yuan
- Department of Orthopedics, The Second Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, 515041, China
| | - Zhanfei Fang
- Department of Orthopedics, The Second Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, 515041, China
| | - Xixi Lin
- Guangxi Collaborative Innovation Center for Biomedicine, Guangxi Key Laboratory of Regenerative Medicine, Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Ruoyu Pu
- Department of Obstetrics and Gynaecology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Yanbin Kang
- Research Centre for Regenerative Medicine, Department of Trauma Orthopedic and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi, 530021, China
| | - Li Li
- Pharmaceutic College, Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Siyuan Shao
- Guangxi Collaborative Innovation Center for Biomedicine, Guangxi Key Laboratory of Regenerative Medicine, Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Jiaxin Ding
- Guangxi Collaborative Innovation Center for Biomedicine, Guangxi Key Laboratory of Regenerative Medicine, Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Jinmin Zhao
- Research Centre for Regenerative Medicine, Department of Trauma Orthopedic and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi, 530021, China
| | - Qian Liu
- Research Centre for Regenerative Medicine, Department of Trauma Orthopedic and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi, 530021, China.
| | - An Qin
- Guangxi Collaborative Innovation Center for Biomedicine, Guangxi Key Laboratory of Regenerative Medicine, Guangxi Medical University, Nanning, Guangxi, 530021, China; Department of Orthopaedics, Shanghai Key Laboratory of Orthopaedic Implant, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200011, China.
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Werner JH, Rosenberg JH, Keeley KL, Agrawal DK. Immunobiology of periprosthetic inflammation and pain following ultra-high-molecular-weight-polyethylene wear debris in the lumbar spine. Expert Rev Clin Immunol 2018; 14:695-706. [PMID: 30099915 DOI: 10.1080/1744666x.2018.1511428] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Wear debris-induced osteolysis is a common cause of arthroplasty failure in several joints including the knee, hip and intervertebral disc. Debris from the prosthesis can trigger an inflammatory response that leads to aseptic loosening and prosthesis failure. In the spine, periprosthetic pain also occurs following accumulation of wear debris through neovascularization of the disc. The role of the immune system in the pathobiology of periprosthetic osteolysis of joint replacements is debatable. Areas covered: We discussed the stimulation of pro-inflammatory and pro-protective and pro-regenerative pathways due to debris from the prosthetics. The balance between the two pathways may determine the outcome results. Also, the role of cytokines and immune cells in periprosthetic inflammation in the etiology of osteolysis is critically reviewed. Expert commentary: Therapies targeting the inflammatory process associated with ultra-high-molecular-weight polyethylene wear debris could reduce implant failure. Additionally, therapies targeting neovascularization of discs following arthroplasty could mitigate periprosthetic pain.
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Affiliation(s)
- John H Werner
- a Department of Clinical and Translational Science , Creighton University School of Medicine , Omaha , NE , USA
| | - John H Rosenberg
- a Department of Clinical and Translational Science , Creighton University School of Medicine , Omaha , NE , USA
| | - Kristen L Keeley
- a Department of Clinical and Translational Science , Creighton University School of Medicine , Omaha , NE , USA
| | - Devendra K Agrawal
- a Department of Clinical and Translational Science , Creighton University School of Medicine , Omaha , NE , USA
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Abstract
BACKGROUND Replacement of a diseased lumbar intervertebral disc with an artificial device, a procedure known as lumbar total disc replacement (LTDR), has been practiced since the 1980s. METHODS Comprehensive review of published literature germane to LTDR, but comment is restricted to high-quality evidence reporting implantation of lumbar artificial discs that have been commercially available for at least 15 years at the time of writing and which continue to be commercially available. RESULTS LTDR is shown to be a noninferior (and sometimes superior) alternative to lumbar fusion in patients with discogenic low back pain and/or radicular pain attributable to lumbar disc degenerative disease (LDDD). Further, LTDR is a motion-preserving procedure, and evidence is emerging that it may also result in risk reduction for subsequent development and/or progression of adjacent segment disease. CONCLUSIONS In spite of the substantial logistical challenges to the safe introduction of LTDR to a health care facility, the procedure continues to gain acceptance, albeit slowly. CLINICAL RELEVANCE Patients with LDDD who are considering an offer of spinal surgery can only provide valid and informed consent if they have been made aware of all reasonable surgical and nonsurgical options that may benefit them. Accordingly, and in those cases in which LTDR may have a role to play, patients under consideration for other forms of spinal surgery should be informed that this valid procedure exists.
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Affiliation(s)
- Stephen Beatty
- Institute of Health Sciences, Waterford Institute of Technology, Waterford, Republic of Ireland
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Veruva SY, Lanman TH, Isaza JE, Freeman TA, Kurtz SM, Steinbeck MJ. Periprosthetic UHMWPE Wear Debris Induces Inflammation, Vascularization, and Innervation After Total Disc Replacement in the Lumbar Spine. Clin Orthop Relat Res 2017; 475:1369-1381. [PMID: 27488379 PMCID: PMC5384906 DOI: 10.1007/s11999-016-4996-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The pathophysiology and mechanisms driving the generation of unintended pain after total disc replacement (TDR) remain unexplored. Ultrahigh-molecular-weight polyethylene (UHMWPE) wear debris from TDRs is known to induce inflammation, which may result in pain. QUESTIONS/PURPOSES The purpose of this study was to determine whether (1) periprosthetic UHMWPE wear debris induces immune responses that lead to the production of tumor necrosis factor-α (TNFα) and interleukin (IL)-1ß, the vascularization factors, vascular endothelial growth factor (VEGF) and platelet-derived growth factor-bb (PDGFbb), and the innervation/pain factors, nerve growth factor (NGF) and substance P; (2) the number of macrophages is associated with the production of the aforementioned factors; (3) the wear debris-induced inflammatory pathogenesis involves an increase in vascularization and associated innervation. METHODS Periprosthetic tissues from our collection of 11 patients with contemporary TDRs were evaluated using polarized light microscopy to quantify UHMWPE wear particles. The major reason for revision (mean implantation time of 3 years [range, 1-6 years]) was pain. For control subjects, biopsy samples from four patients with degenerative disc disease with severe pain and autopsy samples from three normal patients with no history of back pain were also investigated. Immunohistochemistry and histology were used to identify secretory factors, macrophages, and blood vessels. Immunostained serial sections were imaged at ×200 magnification and using MATLAB and NIH ImageJ, a threshold was determined for each factor and used to quantify positive staining normalized to tissue sectional area. The Mann-Whitney U test was used to compare results from different patient groups, whereas the Spearman Rho test was used to determine correlations. Significance was based on p < 0.05. RESULTS The mean percent area of all six inflammatory, vascularization, and innervation factors was higher in TDR tissues when compared with normal disc tissues. Based on nonparametric data analysis, those factors showing the most significant increase included TNFα (5.17 ± 1.76 versus 0.05 ± 0.03, p = 0.02), VEGF (3.02 ± 1.01 versus 0.02 ± 0.002, p = 0.02), and substance P (4.15 ± 1.01 versus 0.08 ± 0.04, p = 0.02). The mean percent area for IL-1ß (2.41 ± 0.66 versus 0.13 ± 0.13, p = 0.01), VEGF (3.02 ± 1.01 versus 0.34 ± 0.29, p = 0.04), and substance P (4.15 ± 1.01 versus 1.05 ± 0.46, p = 0.01) was also higher in TDR tissues when compared with disc tissues from patients with painful degenerative disc disease. Five of the factors, TNFα, IL-1ß, VEGF, NGF, and substance P, strongly correlated with the number of wear particles, macrophages, and blood vessels. The most notable correlations included TNFα with wear particles (p < 0.001, ρ = 0.63), VEGF with macrophages (p = 0.001, ρ = 0.71), and NGF with blood vessels (p < 0.001, ρ = 0.70). Of particular significance, the expression of PDGFbb, NGF, and substance P was predominantly localized to blood vessels/nerve fibers. CONCLUSIONS These findings indicate wear debris-induced inflammatory reactions can be linked to enhanced vascularization and associated innervation/pain factor production at periprosthetic sites around TDRs. Elucidating the pathogenesis of inflammatory particle disease will provide information needed to identify potential therapeutic targets and treatment strategies to mitigate pain and potentially avoid revision surgery. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Sai Y Veruva
- Implant Research Center, Drexel University, 3401 Market Street, Suite 345, Philadelphia, PA, 19104, USA
| | - Todd H Lanman
- Department of Neurosurgery, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | | | - Theresa A Freeman
- Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Steven M Kurtz
- Implant Research Center, Drexel University, 3401 Market Street, Suite 345, Philadelphia, PA, 19104, USA
- Exponent, Inc, Philadelphia, PA, USA
| | - Marla J Steinbeck
- Implant Research Center, Drexel University, 3401 Market Street, Suite 345, Philadelphia, PA, 19104, USA.
- Department of Orthopaedic Surgery, Drexel University College of Medicine, Philadelphia, PA, USA.
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Park CK. Total Disc Replacement in Lumbar Degenerative Disc Diseases. J Korean Neurosurg Soc 2015; 58:401-11. [PMID: 26713139 PMCID: PMC4688308 DOI: 10.3340/jkns.2015.58.5.401] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 08/11/2015] [Accepted: 08/12/2015] [Indexed: 02/07/2023] Open
Abstract
More than 10 years have passed since lumbar total disc replacement (LTDR) was introduced for the first time to the world market for the surgical management of lumbar degenerative disc disease (DDD). It seems like the right time to sum up the relevant results in order to understand where LTDR stands on now, and is heading forward to. The pathogenesis of DDD has been currently settled, but diagnosis and managements are still controversial. Fusion is recognized as golden standard of surgical managements but has various kinds of shortcomings. Lately, LTDR has been expected to replace fusion surgery. A great deal of LTDR reports has come out. Among them, more than 5-year follow-up prospective randomized controlled studies including USA IDE trials were expected to elucidate whether for LTDR to have therapeutic benefit compared to fusion. The results of these studies revealed that LTDR was not inferior to fusion. Most of clinical studies dealing with LTDR revealed that there was no strong evidence for preventive effect of LTDR against symptomatic degenerative changes of adjacent segment disease. LTDR does not have shortcomings associated with fusion. However, it has a potentiality of the new complications to occur, which surgeons have never experienced in fusion surgeries. Consequently, longer follow-up should be necessary as yet to confirm the maintenance of improved surgical outcome and to observe any very late complications. LTDR still may get a chance to establish itself as a substitute of fusion both nominally and virtually if it eases the concerns listed above.
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Affiliation(s)
- Chun Kun Park
- Department of Neurosurgery, The Catholic University of Korea College of Medicine, Seoul, Korea. ; Good Doctor Teun Teun Hospital, Anyang, Korea
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Abstract
PURPOSE The primary goal of this Policy Statement is to educate patients, physicians, medical providers, reviewers, adjustors, case managers, insurers, and all others involved or affected by insurance coverage decisions regarding lumbar disc replacement surgery. PROCEDURES This Policy Statement was developed by a panel of physicians selected by the Board of Directors of ISASS for their expertise and experience with lumbar TDR. The panel's recommendation was entirely based on the best evidence-based scientific research available regarding the safety and effectiveness of lumbar TDR.
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In vivo compatibility of Dynesys® spinal implants: a case series of five retrieved periprosthetic tissue samples and corresponding implants. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 24:1074-84. [DOI: 10.1007/s00586-014-3705-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 11/24/2014] [Accepted: 11/26/2014] [Indexed: 12/28/2022]
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