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C PR, N B KB, A RK, Shanmugam V, N S B, Sahani R, Behera L, A P, Thansekhar MR. Progress in the Optimization of Compositional Design and Thermomechanical Processing of Metastable β Ti Alloys for Biomedical Applications. ACS Biomater Sci Eng 2024; 10:3528-3547. [PMID: 38722763 DOI: 10.1021/acsbiomaterials.3c01912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Over the past few years, significant research and development in the manufacturing industry related to the medical field has been done. The aim has been to improve existing biomaterials and bioimplants by exploring new methods and strategies. Beta titanium alloys, known for their exceptional strength-to-modulus ratio, corrosion resistance, biocompatibility, and ease of shaping, are expected to play a crucial role in manufacturing the next generation of biomedical equipment. To meet the specific requirements of human bone, researchers have employed key techniques like compositional design and thermomechanical processing routes to advance biomaterial development. These materials find extensive applications in orthopedic, orthodontic, and cardiovascular biomedical implants. Several studies have shown that precise material composition, with appropriate heat treatment and suitable mechanical approaches, can yield the desired mechanical properties for bone implants. In this review article, we explore the evolution of alloys at different stages, with a particular focus on their preparation for use in biomedical implants. The primary focus is on designing low-modulus β Ti alloy compositions and employing processing techniques to achieve high strength while maintaining a low young modulus suitable for biomedical applications.
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Affiliation(s)
- Pradeep Raja C
- School of Marine Engineering and Technology, Indian Maritime University, Kolkata 700088, India
| | - Karthik Babu N B
- Department of Mechanical Engineering, Assam Energy Institute, A Centre of Rajiv Gandhi Institute of Petroleum Technology, Sivasagar, Assam 785697, India
| | - Rajesh Kannan A
- Department of Mechanical Engineering, Hanyang University, Ansan, Gyeonggi-do 15588, Republic of Korea
| | - Vigneshwaran Shanmugam
- Department of Mechanical Engineering, Saveetha School of Engineering, Saveetha Institute of Medical and Technical Sciences, Chennai 602 105, Tamil Nadu, India
| | - Balaji N S
- Department of Mechanical Engineering, National Institute of Technology Andhra Pradesh, Tadepalligudem 534102, India
| | - Rishikant Sahani
- Department of Mechanical Engineering, National Institute of Technology, Rourkela 769008, India
| | - Laxmidhar Behera
- Department of Civil Engineering, Centurion University of Technology and Management, Odisha 761211, India
| | - Pugazhenthi A
- Department of Mechanical Engineering, University College of Engineering Dindigul, Dindigul 624622, India
| | - M R Thansekhar
- Department of Mechanical Engineering, K.L.N. College of Engineering, Madurai 630 612, India
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Atchuta A, Reddy A, Bhadauriya S, Beeravolu M, Vasudevan S. Characterization of Titanium Corrosion and Its Association With Peri-Implantitis Using Energy Dispersive X-ray Spectroscopy: A Case Report. Cureus 2024; 16:e60533. [PMID: 38887364 PMCID: PMC11181099 DOI: 10.7759/cureus.60533] [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] [Accepted: 05/17/2024] [Indexed: 06/20/2024] Open
Abstract
Dental implant corrosion is now being recognized as a contributing factor in the onset and advancement of peri-implantitis, posing significant challenges to both the durability of implants and the well-being of patients. The dissemination of titanium microparticles due to corrosion raises concerns about plausible toxicity and biological effects, especially for patients with long-standing implant prostheses. This case report focuses on the release of titanium particles in the peri-implant mucosa due to corrosion and its association with peri-implantitis. It emphasizes the critical need for strategies to minimize corrosion and alleviate its detrimental effects in order to optimize patient outcomes in the field of implant dentistry. Additionally, there is a call for research into the increasing biochemical effects of these microparticles on oral soft tissues surrounding metallic implants to enhance the longevity and clinical outcomes of implants.
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Affiliation(s)
- Abhinav Atchuta
- Periodontology, Army College of Dental Sciences, Secunderabad, IND
| | - Ajay Reddy
- Periodontology, Army College of Dental Sciences, Secunderabad, IND
| | | | - Mounika Beeravolu
- Periodontology, Kamineni Institute of Dental Sciences, Nalgonda, IND
| | - Sanjay Vasudevan
- Periodontology, Army College of Dental Sciences, Secunderabad, IND
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Dadkhahfar S, Chehrassan M, Faldini C. Hypersensitivity reactions to metals in spine surgery. Musculoskelet Surg 2023; 107:29-35. [PMID: 36344900 DOI: 10.1007/s12306-022-00765-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 10/05/2022] [Indexed: 11/09/2022]
Abstract
Hypersensitivity to orthopedic devices is a rare condition with an underestimated incidence due to the lack of diagnostic guideline and ambiguous clinical manifestations. Although hypersensitivity to metal is common, a few cases of hypersensitivity reactions have been reported after spinal instrumentation. Spinal fusion and stabilization require a wide range of devices such as screws, wires, bands, and artificial disk replacement devices. Spinal instrumented surgeries are different from total joint arthroplasty in several aspects such as degree and pattern of motion, loading environment, and adjacent tissues with distinct characteristics. The interval for hypersensitivity reactions to occur after spinal metallic implantation is usually weeks to months. The present review covers the topic of hypersensitivity reactions that have been reported after spinal surgeries with the focus on cutaneous presentations.
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Affiliation(s)
- S Dadkhahfar
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Chehrassan
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran.
| | - C Faldini
- Istituto Orthopedico Rizzoli, Bologna, Italy
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Wolford LM, Amaya P, Kesterke M, Pitombeira Pinto L, Franco P. Can Patients With Metal Hypersensitivity Requiring TMJ Total Joint Prostheses be Successfully Treated With All-Titanium Alloy Mandibular Components? J Oral Maxillofac Surg 2021; 80:599-613. [PMID: 34813761 DOI: 10.1016/j.joms.2021.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/28/2021] [Accepted: 10/06/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Patients with documented metal hypersensitivity to cobalt-chromium-molybdenum (CoCrMo) alloy with trace nickel requiring TMJ total joint prosthesis (TJP) may have adverse reactions to the metals in the standard TMJ Concepts TJP. This study aimed to determine if these patients can be successfully treated by eliminating CoCrMo alloy and constructing the mandibular components of all-titanium (Ti) alloy. PATIENTS AND METHODS This retrospective cohort study evaluated metal hypersensitive patients (MHG) that received the TMJ Concepts TJP modification of all-Ti alloy mandibular components with outcome results compared to a control group (CG) of non-metal-sensitive patients that received the standard TMJ Concepts prostheses. The primary predictor variables were the 2 groups, MHG and CG. Primary variables evaluated using Likert scales included TMJ pain, headache, jaw function, diet, and disability. Maximum incisal opening and quality of life were measured. Secondary variables included: age, gender, effect of the number and type of prior TMJ. Scores for pre- and postsurgery parameters (nonparametric variables) were analyzed using a Mann-Whitney U test (α = 0.05). RESULTS The MHG (n = 30) received the Ti alloy TJP and CG (n = 46) received the standard TJP, with statistically significant improvements in all variables in both groups and no statistically significant difference in outcome variables between the 2 groups. Patients with 0 to 1 previous TMJ surgeries had better outcomes in all parameters except maximum incisal opening compared to patients with 2 or more previous TMJ surgeries. CONCLUSIONS Patients with documented hypersensitivity to CoCrMo alloy, requiring TMJ Concepts TJP may experience improvement in TMJ pain, headache, jaw function, diet, disability, jaw opening, and quality of life when the mandibular components are manufactured from all-Ti alloy, eliminating the CoCrMo alloy. The larger the number of previous TMJ surgeries and exposure to failed alloplastic implants, the less improvement in treatment outcomes.
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Affiliation(s)
- Larry M Wolford
- Clinical Professor, Departments of Oral and Maxillofacial Surgery and Orthodontics, Texas A&M University College of Dentistry, Private Practice Baylor University Medical Center, Dallas, TX.
| | - Pilar Amaya
- Resident, Oral and Maxillofacial Surgery, University of Bosque, Bogota, Columbia
| | - Matthew Kesterke
- Assistant Professor, Department of Biomedical Sciences, Texas A&M University College of Dentistry, Dallas, TX
| | - Lecio Pitombeira Pinto
- Chairman, Department of Oral and Maxillofacial Surgery, Fortaleza General Hospital, Fortaleza, Ceará, Brazil
| | - Pedro Franco
- Part-time Teaching Faculty, Texas A&M University College of Dentistry, Dallas, TX; Private practice, Irving, TX
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Xue R, Wang D, Yang D, Zhang L, Xu X, Liu L, Wu D. Novel Biocompatible Zr-Based Alloy with Low Young's Modulus and Magnetic Susceptibility for Biomedical Implants. MATERIALS (BASEL, SWITZERLAND) 2020; 13:E5130. [PMID: 33202987 PMCID: PMC7696516 DOI: 10.3390/ma13225130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 11/25/2022]
Abstract
The microstructure, mechanical properties, magnetic susceptibility, electrochemical corrosion performance, in vitro cell compatibility and blood consistency of Zr-16Nb-xTi (x = 0, 4, 8, 12 and 16 wt.%) materials were investigated as potential materials for biomedical implants. X-ray diffraction (XRD) and Transmission electron microscopy (TEM) analyses revealed the secondary phase martensite α' formed during the quenching process. The phase composition contained metastable β and martensite α', resulting from Ti addition. These phase constitutions were the main causes of a low Young's modulus and magnetic susceptibility. The in vitro cytocompatibility analysis illustrated that the MG63 cells maintained high activity (from 91% to 97%) after culturing in Zr-16Nb-xTi extraction media for 12 days due to the high internal biocompatibility of Zr, Nb and Ti elements, as well as the optimal corrosion resistance of Zr-16Nb-xTi. On the basis of Inductively coupled plasma optical emission spectrometry (ICP-OES) ion release studies, the concentration of Zr, Nb and Ti was noted to reach the equipment detective limit of 0.001 mg/L, which was much lower than pure Ti. With respect to the corrosion behavior in Hank's solution, Zr-16Nb-16Ti displayed superior properties, possessing the lowest corrosion current density and widest passivation region, attributed to the addition of Ti. The blood compatibility test illustrated that the Zr-16Nb-xTi materials were nonhemolytic, and the platelets maintained a spherical shape, with no aggregation or activation on Zr-16Nb-xTi. Overall, Ti addition has obvious effects on the developed Zr-16Nb-xTi alloys, and Zr-16Nb-4Ti exhibited low magnetic susceptibility, low modulus, good biocompatibility and proper corrosion properties, demonstrating the potential of use as implant biomaterials.
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Affiliation(s)
- Renhao Xue
- School of Material Science and Engineering, Central South University, Changsha 410083, China; (R.X.); (D.W.); (L.Z.); (X.X.)
- State Key Laboratory of Powder Metallurgy, Central South University, Changsha 410083, China
| | - Dong Wang
- School of Material Science and Engineering, Central South University, Changsha 410083, China; (R.X.); (D.W.); (L.Z.); (X.X.)
- State Key Laboratory of Powder Metallurgy, Central South University, Changsha 410083, China
| | - Dawei Yang
- Centre for Medical Genetics and School of Life Science, Central South University, Changsha 410008, China;
| | - Ligang Zhang
- School of Material Science and Engineering, Central South University, Changsha 410083, China; (R.X.); (D.W.); (L.Z.); (X.X.)
- State Key Laboratory of Powder Metallurgy, Central South University, Changsha 410083, China
| | - Xiaoning Xu
- School of Material Science and Engineering, Central South University, Changsha 410083, China; (R.X.); (D.W.); (L.Z.); (X.X.)
- State Key Laboratory of Powder Metallurgy, Central South University, Changsha 410083, China
| | - Libin Liu
- School of Material Science and Engineering, Central South University, Changsha 410083, China; (R.X.); (D.W.); (L.Z.); (X.X.)
- State Key Laboratory of Powder Metallurgy, Central South University, Changsha 410083, China
| | - Di Wu
- School of Material Science and Engineering, Central South University, Changsha 410083, China; (R.X.); (D.W.); (L.Z.); (X.X.)
- State Key Laboratory of Powder Metallurgy, Central South University, Changsha 410083, China
- School of Metallurgy and Environment, Central South University, Changsha 410083, China
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Biocompatibility of Materials for Biomedical Engineering. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1250:125-140. [PMID: 32601942 DOI: 10.1007/978-981-15-3262-7_9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
In the tissue engineering research field, nanobiomaterials highlight the impact of novel bioactive materials in both current applications and their potentials in future progress for tissue engineering and regenerative medicine. Tissue engineering is a well-investigated and challenging biomedical field, with promising perspectives to improve and support quality of life for the patient. To assess the response of those extracellular matrices (ECMs), induced by biomedical materials, this review will focus on cell response to natural biomaterials for biocompatibility.
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Kaur M, Singh K. Review on titanium and titanium based alloys as biomaterials for orthopaedic applications. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 102:844-862. [PMID: 31147056 DOI: 10.1016/j.msec.2019.04.064] [Citation(s) in RCA: 396] [Impact Index Per Article: 79.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 02/20/2019] [Accepted: 04/20/2019] [Indexed: 02/07/2023]
Abstract
Variety of implant materials have been employed in various disciplines of medical science depending on the requirement of a particular application. Metals, alloys, ceramics, and polymers are the commonly used biomaterials. The main focus of this study is to review the various structural and microstructural properties of titanium and titanium based alloys used as orthopaedic implants. Orthopaedic implants need to possess certain important qualities to ensure their safe and effective use. These properties like the biocompatibility, relevant mechanical properties, high corrosion and wear resistance and osseointegration are summarized in this review. Various attempts to improve upon these properties like different processing routes, surface modifications have also been inculcated in the paper to provide an insight into the extent of research and effort that has been put into developing a highly superior titanium orthopaedic implant.
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Affiliation(s)
- Manmeet Kaur
- School of Physics and Materials Science, Thapar Institute of Engineering and Technology, Patiala, Punjab 147004, India
| | - K Singh
- School of Physics and Materials Science, Thapar Institute of Engineering and Technology, Patiala, Punjab 147004, India.
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Alyafei HFSG, Fu W, Zalnezhad E, Jaber F, Hamouda AMS, Musharavati F, Bae S. Properties Investigation of GO/HA/Pt Composite Thin Film. BIOMED RESEARCH INTERNATIONAL 2019; 2019:4847932. [PMID: 31321236 PMCID: PMC6610737 DOI: 10.1155/2019/4847932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 04/23/2019] [Accepted: 05/22/2019] [Indexed: 11/24/2022]
Abstract
Hydroxyapatite/graphene oxide/platinum (HA/GO/Pt) nanocomposite was synthesized and electrodeposited on a pure zirconium substrate. The coated zirconium was annealed at 200, 300, 400, and 600°C in vacuum furnace in presence of argon gas. The structure and morphology of the coated samples were characterized. Biocompatibility and wear and corrosion resistances of specimens were examined. The result of corrosion tests shows that the graphene into HA/Pt composites significantly improves their corrosion resistance. The wear tests results of uncoated and coated samples before and after annealing show that coated samples annealed at 300°C had better wear resistance compared with uncoated and coated samples at other temperatures. Furthermore, the biocompatibility test shows that the coatings improved the cell attachment and proliferation compared to the pure zirconium substrate.
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Affiliation(s)
- Huda F. S. G. Alyafei
- Mechanical and Industrial Engineering Department, College of Engineering, Qatar University, 2713 Doha, Qatar
| | - W. Fu
- Department of Mechanical Engineering, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul 133-791, Republic of Korea
| | - E. Zalnezhad
- Department of Mechanical Engineering, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul 133-791, Republic of Korea
- Biomechacin LLC, San Antonio, TX 78251, USA
| | - F. Jaber
- Department of Biomedical Engineering, Ajman University, UAE
| | - A. M. S. Hamouda
- Mechanical and Industrial Engineering Department, College of Engineering, Qatar University, 2713 Doha, Qatar
| | - F. Musharavati
- Mechanical and Industrial Engineering Department, College of Engineering, Qatar University, 2713 Doha, Qatar
| | - S. Bae
- Department of Architectural Engineering, Hanyang University, Seoul 04763, Republic of Korea
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Liu Y, Hong H, Lu X, Wang W, Liu F, Yang H. L-Ascorbic Acid Protected Against Extrinsic and Intrinsic Apoptosis Induced by Cobalt Nanoparticles Through ROS Attenuation. Biol Trace Elem Res 2017; 175:428-439. [PMID: 27377067 DOI: 10.1007/s12011-016-0789-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 06/21/2016] [Indexed: 12/17/2022]
Abstract
Currently, tissue damage induced by cobalt nanoparticles (CoNPs) and cobalt ions (Co2+) are the most serious syndrome in the patients with metal-on-metal hip prostheses. Therefore, an urgent need exists for the identification of the mechanisms and the development of therapeutic strategies to limit it. The purpose of this study was to explore the mechanism of this damage and to demonstrate if L-ascorbic acid (L-AA) could protect against the cell toxicities induced by CoNPs and Co2+ in vitro. With CoNPs and Co2+ treatment, cell viability was significantly decreased; the ROS (reactive oxygen species) level in mitochondria was dramatically increased in CoNPs treated cells, but cobalt ions could barely induce the ROS. Consistently, the level of cell apoptosis was increased with the upregulation of pro-apoptotic factors (caspases 8, 9, and 3, and Bax) and the downregulation of anti-apoptotic factor Bcl-2. Besides that, the levels of cytochrome c and AIF were increased and released from mitochondria into the cytoplasm. After the cells were pretreated with L-AA, the cell viability decreased by CoNPs was reversed and the ROS induced by CoNPs was suppressed. The level of cell apoptosis induced by CoNPs was decreased as well. But it could not reverse the effects induced by Co2+. These studies demonstrated that CoNPs induce extrinsic and intrinsic apoptotic pathways via generation of ROS, and L-AA could prevent the cytotoxicity by reducing the level of ROS. While Co2+ may induce cytotoxicity through other signals, it could not be protected by L-AA treatment.
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Affiliation(s)
- Yake Liu
- First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, People's Republic of China
| | - Hongxiang Hong
- Department of Orthopedics, The Affiliated Hospital to Nantong University, Nantong, Jiangsu Province, People's Republic of China
| | - Xu Lu
- Department of Pharmacology, School of Pharmacy, Nantong University, Nantong, Jiangsu Province, People's Republic of China
| | - Wei Wang
- Department of Orthopedics, The Affiliated Hospital to Nantong University, Nantong, Jiangsu Province, People's Republic of China
| | - Fan Liu
- Department of Orthopedics, The Affiliated Hospital to Nantong University, Nantong, Jiangsu Province, People's Republic of China
| | - Huilin Yang
- Department of Orthopedics, The First Affiliated Hospital to Soochow University, Shizi Street, Suzhou, 215006, Jiangsu Province, People's Republic of China.
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Zotti MG, Brumby-Rendell OP, McDonald B, Fisher T, Tsimiklis C, Yoon WW, Osti OL. The outcome of pedicle screw instrumentation removal for ongoing low back pain following posterolateral lumbar fusion. JOURNAL OF SPINE SURGERY (HONG KONG) 2016; 1:50-6. [PMID: 27683679 DOI: 10.3978/j.issn.2414-469x.2015.08.02] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Our aim was to determine whether patients derived benefit from removal of pedicle screw instrumentation for axial pain without other cause using our surgical technique and patient selection. A secondary aim was to investigate factors that were associated with poorer outcomes for this procedure as well as complication rate in this cohort. METHODS Theater records from a single spinal surgeon's practice were reviewed to identify patients that had undergone lumbar fusion for discogenic back pain with subsequent pedicle screw instrumentation removal (Expedium, DePuy Synthes) in the preceding 3 years with a minimum of 18 months follow-up. Inclusion criteria were persisting midline axial back pain with computed tomography (CT)-confirmed solid fusion with non-radicular symptoms and nil other potential causes found, e.g., infection. Case note review along with pre- and post-operative Oswestry disability index (ODI) questionnaires and visual analog scores (VAS) were assessed for all patients. Surgical technique included re-use of previous midline posterior incision and the Wiltse approach with removal of implants, confirmation of a solid fusion mass, washout and bone grafting of removal sites. RESULTS From 50 consecutive patients who underwent removal of posterolateral instrumentation for an index elective lumbar fusion for discogenic back pain, 34 patients were identified that met the criteria with a mean follow-up of 25 months (range, 18-36 months). The VAS and ODI improved in 22/34 (65%) of participants. The mean cohort VAS score was 6.6 pre-surgery and 4.3 post-surgery (P=0.04). Preoperative and postoperative mean Oswestry disability scores were 64 and 41, respectively (P=0.05). There was a statistically significant difference in the proportion of patients with poorer compared to satisfactory outcomes with regards to compensable status, preoperative grade II opioid use and shorter time between fusion and removal procedure. Complications were one postoperative hematoma and one superficial wound infection, both of which settled without re-operation. CONCLUSIONS Approximately two thirds of patients were satisfied with removal of instrumentation for treatment of residual low back pain (LBP) following elective lumbar fusion and recorded reduced VAS and grade II opioid use. A subset of patients remained that did not derive benefit and were associated with compensable status, preoperative grade II opioid use and a shorter time between fusion and removal procedure. A prospective cohort study with preoperative diagnostic injections and standardized imaging and microscopic techniques would strengthen future studies. However, this study suggests that removal of instrumentation is safe and provides modest benefit as a palliative procedure for a subset of patients with significant disability from chronic LBP without an underlying cause following lumbar fusion.
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Affiliation(s)
- Mario G Zotti
- Spinal Injuries Unit, Royal Adelaide Hospital, North Terrace, Adelaide SA 5001, Australia
| | - Oscar P Brumby-Rendell
- Spinal Injuries Unit, Royal Adelaide Hospital, North Terrace, Adelaide SA 5001, Australia
| | - Ben McDonald
- Spinal Injuries Unit, Royal Adelaide Hospital, North Terrace, Adelaide SA 5001, Australia
| | - Tom Fisher
- Calvary Healthcare, North Adelaide, SA 5006, Australia
| | | | - Wai Weng Yoon
- Spinal Injuries Unit, Royal Adelaide Hospital, North Terrace, Adelaide SA 5001, Australia
| | - Orso L Osti
- Calvary Healthcare, North Adelaide, SA 5006, Australia
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12
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Middleton S, Toms A. Allergy in total knee arthroplasty: a review of the facts. Bone Joint J 2016; 98-B:437-41. [PMID: 27037424 DOI: 10.1302/0301-620x.98b4.36767] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 10/21/2015] [Indexed: 12/18/2022]
Abstract
We explored the literature surrounding whether allergy and hypersensitivity has a clinical basis for implant selection in total knee arthroplasty (TKA). In error, the terms hypersensitivity and allergy are often used synonymously. Although a relationship is present, we could not find any evidence of implant failure due to allergy. There is however increasing basic science that suggests a link between loosening and metal ion production. This is not an allergic response but is a potential problem. With a lack of evidence logically there can be no justification to use 'hypoallergenic' implants in patients who have pre-existing skin sensitivity to the metals used in TKA.
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Affiliation(s)
- S Middleton
- Royal Devon and Exeter Hospitals Foundation Trust, Barrack Rd, Exeter, EX2 5DW, UK
| | - A Toms
- Royal Devon and Exeter Hospitals Foundation Trust, Barrack Rd, Exeter, EX2 5DW, UK
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Sheikh Z, Brooks PJ, Barzilay O, Fine N, Glogauer M. Macrophages, Foreign Body Giant Cells and Their Response to Implantable Biomaterials. MATERIALS (BASEL, SWITZERLAND) 2015; 8:5671-5701. [PMID: 28793529 PMCID: PMC5512621 DOI: 10.3390/ma8095269] [Citation(s) in RCA: 396] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 08/20/2015] [Accepted: 08/21/2015] [Indexed: 12/23/2022]
Abstract
All biomaterials, when implanted in vivo, elicit cellular and tissue responses. These responses include the inflammatory and wound healing responses, foreign body reactions, and fibrous encapsulation of the implanted materials. Macrophages are myeloid immune cells that are tactically situated throughout the tissues, where they ingest and degrade dead cells and foreign materials in addition to orchestrating inflammatory processes. Macrophages and their fused morphologic variants, the multinucleated giant cells, which include the foreign body giant cells (FBGCs) are the dominant early responders to biomaterial implantation and remain at biomaterial-tissue interfaces for the lifetime of the device. An essential aspect of macrophage function in the body is to mediate degradation of bio-resorbable materials including bone through extracellular degradation and phagocytosis. Biomaterial surface properties play a crucial role in modulating the foreign body reaction in the first couple of weeks following implantation. The foreign body reaction may impact biocompatibility of implantation devices and may considerably impact short- and long-term success in tissue engineering and regenerative medicine, necessitating a clear understanding of the foreign body reaction to different implantation materials. The focus of this review article is on the interactions of macrophages and foreign body giant cells with biomaterial surfaces, and the physical, chemical and morphological characteristics of biomaterial surfaces that play a role in regulating the foreign body response. Events in the foreign body response include protein adsorption, adhesion of monocytes/macrophages, fusion to form FBGCs, and the consequent modification of the biomaterial surface. The effect of physico-chemical cues on macrophages is not well known and there is a complex interplay between biomaterial properties and those that result from interactions with the local environment. By having a better understanding of the role of macrophages in the tissue healing processes, especially in events that follow biomaterial implantation, we can design novel biomaterials-based tissue-engineered constructs that elicit a favorable immune response upon implantation and perform for their intended applications.
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Affiliation(s)
- Zeeshan Sheikh
- Faculty of Dentistry, Matrix Dynamics Group, University of Toronto, 150 College Street, Toronto, ON M5S 3E2, Canada.
| | - Patricia J Brooks
- Faculty of Dentistry, Matrix Dynamics Group, University of Toronto, 150 College Street, Toronto, ON M5S 3E2, Canada.
| | - Oriyah Barzilay
- Faculty of Dentistry, Matrix Dynamics Group, University of Toronto, 150 College Street, Toronto, ON M5S 3E2, Canada.
| | - Noah Fine
- Faculty of Dentistry, Matrix Dynamics Group, University of Toronto, 150 College Street, Toronto, ON M5S 3E2, Canada.
| | - Michael Glogauer
- Faculty of Dentistry, Matrix Dynamics Group, University of Toronto, 150 College Street, Toronto, ON M5S 3E2, Canada.
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Mahmood B, Hammert WC. Metal implant allergy. J Hand Surg Am 2015; 40:831-3; quiz 834. [PMID: 25639842 DOI: 10.1016/j.jhsa.2014.11.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Revised: 11/11/2014] [Accepted: 11/14/2014] [Indexed: 02/02/2023]
Affiliation(s)
- Bilal Mahmood
- Department of Orthopaedic Surgery, University of Rochester Medical Center, Rochester, NY
| | - Warren C Hammert
- Department of Orthopaedic Surgery, University of Rochester Medical Center, Rochester, NY.
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Mercan S, Bölükbaşı N, Bölükbaşı MK, Yayla M, Cengiz S. Titanium Element Level in Peri-Implant Mucosa. BIOTECHNOL BIOTEC EQ 2014. [DOI: 10.5504/bbeq.2013.0007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Clark A, Milbrandt TA, Hilt JZ, Puleo DA. Retention of insulin-like growth factor I bioactivity during the fabrication of sintered polymeric scaffolds. Biomed Mater 2014; 9:025015. [PMID: 24565886 DOI: 10.1088/1748-6041/9/2/025015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The use of growth factors in tissue engineering offers an added benefit to cartilage regeneration. Growth factors, such as insulin-like growth factor I (IGF-I), increase cell proliferation and can therefore decrease the time it takes for cartilage tissue to regrow. In this study, IGF-I was released from poly(lactic-co-glycolic acid) (PLGA) scaffolds that were designed to have a decreased burst release often associated with tissue engineering scaffolds. The scaffolds were fabricated from IGF-I-loaded PLGA microspheres prepared by a double emulsion (W1/O/W2) technique. The microspheres were then compressed, sintered at 49 °C and salt leached. The bioactivity of soluble IGF-I was verified after being heat treated at 37, 43, 45, 49 and 60 °C. Additionally, the bioactivity of IGF-I was confirmed after being released from the sintered scaffolds. The triphasic release lasted 120 days resulting in 20%, 55% and 25% of the IGF-I being released during days 1-3, 4-58 and 59-120, respectively. Seeding bone marrow cells directly onto the IGF-I-loaded scaffolds showed an increase in cell proliferation, based on DNA content, leading to increased glycosaminoglycan production. The present results demonstrated that IGF-I remains active after being incorporated into heat-treated scaffolds, further enhancing tissue regeneration possibilities.
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Affiliation(s)
- Amanda Clark
- Department of Biomedical Engineering, University of Kentucky, Lexington, KY, USA
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Molecular and immune toxicity of CoCr nanoparticles in MoM hip arthroplasty. Trends Mol Med 2012; 18:145-55. [PMID: 22245020 DOI: 10.1016/j.molmed.2011.12.002] [Citation(s) in RCA: 123] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Revised: 12/04/2011] [Accepted: 12/08/2011] [Indexed: 12/29/2022]
Abstract
Theoretical, desirable features of second-generation metal-on-metal (MoM) hip prostheses have led to their widespread use. However, the bearing surfaces, consisting of complex cobalt-chromium alloys, are subject to wear and the release of cobalt and chromium (CoCr) nanoparticles. These nanoparticles can reduce cellular viability, induce DNA damage, lead to chromosomal aberrations, and possibly stimulate increased metal hypersensitivity. Clinically, the effects can be both local (soft-tissue reactions) and systemic (arthroprosthetic cobaltism). This review assesses the literature concerning the in vitro and in vivo cytotoxic, genotoxic, and immunotoxic effects of CoCr wear particles, which is increasingly important in view of the large number of MoM arthroplasties performed.
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Abstract
In joint reconstruction, the techniques and materials that provide the best outcomes for patients have been debated. The main points of controversy relate to the use of hemiarthroplasties versus total joint prostheses with metal-on-metal versus metal-on-polyethylene articulations. This article investigates these areas as well as the applicability of the techniques and materials and the complications that can occur. Hypersensitivity to materials used in joint prostheses is relatively common but often unrecognized. Although the discussion applies to all joints, the temporomandibular joint (TMJ) is emphasized. For TMJ reconstruction, metal-on-polyethylene articulation in total joint prostheses provides better treatment outcomes than metal-on-metal articulation.
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Affiliation(s)
- Larry M Wolford
- Department of Oral and Maxillofacial Surgery, Baylor University Medical Center, and Baylor College of Dentistry, Texas A&M University System, Dallas, Texas, USA.
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Ihaddadene R, Affatato S, Zavalloni M, Bouzid S, Viceconti M. Carbon composition effects on wear behaviour and wear mechanisms of metal-on-metal hip prosthesis. Comput Methods Biomech Biomed Engin 2011. [DOI: 10.1080/10255842.2011.591623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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21
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Adala R, Chakravarthy M, Srinivas V, Pai S. Orthopaedic surgery in a patient with metal sensitivity. J Cutan Aesthet Surg 2011; 4:67-8. [PMID: 21572690 PMCID: PMC3081493 DOI: 10.4103/0974-2077.79202] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Raviraj Adala
- Departments of Orthopedic Surgery and Anesthesia, Fortis hospitals, Bannerughatta Road, Bangalore. E-mail:
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Bondarenko A, Hewicker-Trautwein M, Erdmann N, Angrisani N, Reifenrath J, Meyer-Lindenberg A. Comparison of morphological changes in efferent lymph nodes after implantation of resorbable and non-resorbable implants in rabbits. Biomed Eng Online 2011; 10:32. [PMID: 21521497 PMCID: PMC3111424 DOI: 10.1186/1475-925x-10-32] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Accepted: 04/26/2011] [Indexed: 11/10/2022] Open
Abstract
Background Magnesium alloys as biodegradable implant materials received much interest in recent years. It is known that products of implant degradation can induce several types of immune response. Hence, the aim of this study was to examine the morphological changes of efferent lymph nodes after implantation of different resorbable magnesium alloys (MgCa0.8, LAE442) in comparison to commercially available resorbable (PLA) and non-resorbable (titanium) implant materials as well as control groups without implant material. Methods The different implant materials were inserted intramedullary into the rabbit tibia. After postoperative observation periods of three and six months, popliteal lymph nodes were examined histologically and immunhistologically and compared to lymph nodes of sham operated animals and animals without surgery. Haematoxylin and eosin staining was performed for cell differentiation. Mouse anti-CD79α and rat anti-CD3 monoclonal primary antibodies were used for B- and T-lymphocyte detection, mouse anti-CD68 primary antibodies for macrophage detection. Evaluation of all sections was performed applying a semi quantitative score. Results The histological evaluation demonstrated low and moderate levels of morphological changes for both magnesium alloys (LAE442 and MgCa0.8). Higher than moderate values were reached for titanium in sinus histiocytosis and histiocytic apoptosis (3 months) and for PLA in histiocytic apoptosis (3 and 6 months). The immune response to all investigated implants had a non-specific character and predominantly was a foreign-body reaction. LAE442 provoked the lowest changes which might be due to a lower degradation rate in comparison to MgCa0.8. Therewith it is a promising candidate for implants with low immunogenic potential. Conclusion Both examined magnesium alloys did not cause significantly increased morphological changes in efferent lymph nodes in comparison to the widely used implant materials titanium and PLA. LAE442 induced even lower immunological reactions. Therewith MgCa0.8 and especially LAE442 are appropriate candidates for biomedical use.
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Affiliation(s)
- Alexandr Bondarenko
- Department of Pathology, Dnipropetrovs’k State Medical Academy, str. Zhovtneva ploshcha 14, 49005 Dnipropetrovs’k, Ukraine
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Flatebø RS, Høl PJ, Leknes KN, Kosler J, Lie SA, Gjerdet NR. Mapping of titanium particles in peri-implant oral mucosa by Laser Ablation Inductively Coupled Plasma Mass Spectrometry and high-resolution optical darkfield microscopy. J Oral Pathol Med 2010; 40:412-20. [DOI: 10.1111/j.1600-0714.2010.00958.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Vendittoli PA, Roy A, Mottard S, Girard J, Lusignan D, Lavigne M. Metal ion release from bearing wear and corrosion with 28 mm and large-diameter metal-on-metal bearing articulations: a follow-up study. ACTA ACUST UNITED AC 2010; 92:12-9. [PMID: 20044673 DOI: 10.1302/0301-620x.92b1.22226] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We have updated our previous randomised controlled trial comparing release of chromium (Cr) and cobalt (Co) ions and included levels of titanium (Ti) ions. We have compared the findings from 28 mm metal-on-metal total hip replacement, performed using titanium CLS/Spotorno femoral components and titanium AlloFit acetabular components with Metasul bearings, with Durom hip resurfacing using a Metasul articulation or bearing and a titanium plasma-sprayed coating for fixation of the acetabular component. Although significantly higher blood ion levels of Cr and Co were observed at three months in the resurfaced group than in total hip replacement, no significant difference was found at two years post-operatively for Cr, 1.58 microg/L and 1.62 microg/L respectively (p = 0.819) and for Co, 0.67 microg/L and 0.94 microg/L respectively (p = 0.207). A steady state was reached at one year in the resurfaced group and after three months in the total hip replacement group. Interestingly, Ti, which is not part of the bearing surfaces with its release resulting from metal corrosion, had significantly elevated ion levels after implantation in both groups. The hip resurfacing group had significantly higher Ti levels than the total hip replacement group for all periods of follow-up. At two years the mean blood levels of Ti ions were 1.87 microg/L in hip resurfacing and and 1.30 microg/L in total hip replacement (p = 0.001). The study confirms even with different bearing diameters and clearances, hip replacement and 28 mm metal-on-metal total hip replacement produced similar Cr and Co metal ion levels in this randomised controlled trial study design, but apart from wear on bearing surfaces, passive corrosion of exposed metallic surfaces is a factor which influences ion concentrations. Ti plasma spray coating the acetabular components for hip resurfacing produces significantly higher release of Ti than Ti grit-blasted surfaces in total hip replacement.
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Affiliation(s)
- P-A Vendittoli
- Maisonneueve-Rosemont Hospital, University of Montreal, Quebec, Canada.
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Baroli B. From natural bone grafts to tissue engineering therapeutics: Brainstorming on pharmaceutical formulative requirements and challenges. J Pharm Sci 2009; 98:1317-75. [PMID: 18729202 DOI: 10.1002/jps.21528] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Tissue engineering is an emerging multidisciplinary field of investigation focused on the regeneration of diseased or injured tissues through the delivery of appropriate molecular and mechanical signals. Therefore, bone tissue engineering covers all the attempts to reestablish a normal physiology or to speed up healing of bone in all musculoskeletal disorders and injuries that are lashing modern societies. This article attempts to give a pharmaceutical perspective on the production of engineered man-made bone grafts that are described as implantable tissue engineering therapeutics, and to highlight the importance of understanding bone composition and structure, as well as osteogenesis and bone healing processes, to improve the design and development of such implants. In addition, special emphasis is given to pharmaceutical aspects that are frequently minimized, but that, instead, may be useful for formulation developments and in vitro/in vivo correlations.
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Affiliation(s)
- Biancamaria Baroli
- Dip. Farmaco Chimico Tecnologico, Università di Cagliari, Via Ospedale, 72, 09124 Cagliari, Italy
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Wear performance of large-diameter differential-hardness hip bearings. J Arthroplasty 2008; 23:56-60. [PMID: 18722303 DOI: 10.1016/j.arth.2008.05.021] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2008] [Accepted: 05/11/2008] [Indexed: 02/01/2023] Open
Abstract
We hypothesized that differential-hardness hard-on-hard bearings would generate less wear debris compared with like-hardness metal-on-metal (M-o-M) bearings. We conducted wear testing on 3 types of large-diameter hard hip bearings: (1) contemporary cast-on-cast ("like" hardness) M-o-M; (2) differential-hardness M-o-M; and (3) differential-hardness ceramic-on-metal. A simulated gait profile ranging from 200 to 2000 N was applied to the bearings at a frequency of 1 Hz for 5 Mc. All bearings were tested in an anatomically inverted position in 90% alpha calf serum. Both differential-hardness bearing systems produced lower run-in wear rates (90%-97%), steady-state wear rate (45%-84%), and total metal wear (68%-88%) compared with the like-hardness bearing system. The ceramic-on-metal bearings exhibited the least wear followed by differential-hardness M-o-M bearings; like-hardness M-o-M bearings exhibited the greatest amount of wear. These findings support our hypothesis that differential-hardness hip bearing systems produce less metallic wear debris than those with like hardness and may result in lower metal ion release in vivo.
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Hodgson AW, Mischler S, Von Rechenberg B, Virtanen S. An analysis of the in vivo deterioration of Co-Cr-Mo implants through wear and corrosion. Proc Inst Mech Eng H 2007; 221:291-303. [PMID: 17539584 DOI: 10.1243/09544119jeim208] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The degradation of Co-Cr-Mo ASTM F75-92 hip implants after a harvesting period of 81 months in sheep was investigated. Hip prostheses and tissue samples were obtained from a medical study involving total hip arthroplasty of the cemented type in 12 sheep. Upon euthanasia, the explants were retrieved for analyses of the surfaces and evidence of degradation, while tissue samples from the interface regions were harvested for chemical analysis and evidence of Co, Cr, and Mo contents. Clear evidence of wear and corrosion was detected. Results also indicated that the modes of metal transport through the poly(methyl methacrylate) bone cement play an important role as the surface degradation mechanisms of the metal. The results are being discussed in terms of electrochemical and triboelectrochemical behaviour of the Co-Cr-Mo alloy.
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Affiliation(s)
- A W Hodgson
- Institute of Materials Chemistry and Corrosion, Department of Materials, Swiss Federal Institute of Technology Zurich, Zurich, Switzerland
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29
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Mercuri LG. Total Joint Reconstruction—Autologous or Alloplastic. Oral Maxillofac Surg Clin North Am 2006; 18:399-410, vii. [PMID: 18088840 DOI: 10.1016/j.coms.2006.03.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Gatti AM, Montanari S. Retrieval analysis of clinical explanted vena cava filters. J Biomed Mater Res B Appl Biomater 2006; 77:307-14. [PMID: 16292760 DOI: 10.1002/jbm.b.30361] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Vena cava filters are the most commonly used mechanical devices to prevent pulmonary embolism. A retrievable permanent filter has been available since 1999. That has allowed the direct study of thrombi captured in humans and the punctual interaction of blood and device at long and short term. Through traditional histologic methods, captured thrombi and the tissues formed around the filter were observed. An innovative environmental scanning electron microscopy technique allowed detection of micro- and nanosized foreign bodies inside thrombi and tissues, and chemical analysis could be carried out by means of energy dispersive spectroscopy. All specimens contained different quantities of foreign debris ranging from few tens of microns to 50 nanometers; their chemistry was not homogeneous when patients were compared, and also differed considerably within the same filter. The constant presence of debris deeply embedded in all thrombi observed may mean that they are the cause that triggered the formation of those thrombi as a result of the interaction between foreign bodies and blood components.
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Affiliation(s)
- A M Gatti
- INFM, Department of Neurosciences, Head and Neck, Rehabilitation, Laboratory of Biomaterials, University of Modena and Reggio Emilia, Italy.
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Flatebø RS, Johannessen AC, Grønningsaeter AG, Bøe OE, Gjerdet NR, Grung B, Leknes KN. Host Response to Titanium Dental Implant Placement Evaluated in a Human Oral Model. J Periodontol 2006; 77:1201-10. [PMID: 16805683 DOI: 10.1902/jop.2006.050406] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Recent reports have questioned if metal sensitivity may arise from exposure to titanium. The objective of this study was to histologically evaluate non-perforated mucosa covering submerged maxillary titanium implants with regard to induced tissue reactions. METHODS Thirteen patients, 21 to 69 years of age, without previous implants were included. After initial examination, the bone crest areas destined for dental implant placement were exposed, and threaded external hex dental implants were inserted. Prior to wound closure, a full mucosal tissue slice was biopsied from the edge of the mucoperiosteal flap (baseline). The patients were monitored monthly for 6 months. At the abutment connection, biopsies were taken by a 6-mm punch, altogether yielding 26 specimens. Tissue reactions were analyzed by coded histometric analysis at four defined areas at increasing distance from the oral epithelium, including ratios of inflammatory cells (IC)/epithelial cells, IC/fibroblasts, and number of dense particles. RESULTS The stained sections portrayed gingival tissue with intact oral epithelium and connective tissue with variable accumulation of IC. Experimental biopsies demonstrated mineralized areas and dense particles of different sizes. Analysis of variance revealed a higher IC/fibroblast ratio for level 3 at baseline compared to level 3 at 6 months (P<0.01). Furthermore, a significant decrease in IC/fibroblast ratio was observed between levels 2 and 3 and 2 and 4 at 6 months (P<0.001). The connective tissue level facing the cover screw contained the highest number of dense particles (P<0.01). CONCLUSIONS Tissue sensitivity reactions to titanium implants were not disclosed. All 6-month biopsies contained dense particles that were most likely metals.
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Affiliation(s)
- Rigmor S Flatebø
- Department of Oral Sciences - Periodontology, Faculty of Dentistry, University of Bergen, Bergen, and Department of Oral and Maxillofacial Surgery, Stavanger University Hospital, Stavanger, Norway
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Isaac GH, Siebel T, Schmalzried TP, Cobb AG, O'Sullivan T, Oakeshott RD, Flett M, Vail TP. Development rationale for an articular surface replacement: a science-based evolution. Proc Inst Mech Eng H 2006; 220:253-68. [PMID: 16669392 DOI: 10.1243/095441105x69132] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Hip resurfacing has an enduring appeal because of the advantages of bone conservation and maximal joint stability. However, a far from satisfactory experience with earlier resurfacing designs led to its virtual disappearance in the 1980s. The concept was reintroduced in the late 1990s. The current generation of resurfacing devices generally consisted of a large-diameter metal-on-metal articulation, the femoral components being cemented and the acetabular components utilizing various forms of cementless fixation. The encouraging medium-term results, with a follow-up of up to 8 years using the current generation of surface replacement joints, combined with favourable reports related to long-term performance of some metal bearings have led to a rapid increase in the use of such components with these devices. This trend is most marked in younger, more active patients who have expectations of restoration of lifestyle in addition to improved mobility and pain relief and in whom failure with conventional total hip replacement is much higher than previously reported with more sedentary patients. The aim of this paper is, firstly, to highlight a number of areas of improvement and, secondly, to explain how these may be addressed by making modifications to the design of both implants and instrumentation and to the surgical technique. The areas identified for improvement were tissue preservation (thinner components, and reduced steps between sizes), acetabular cup issues (fixation, insertion, and positioning), femoral component issues (design, loading, and cementation), improved bearing surface characteristics, and simplified precise instrumentation with a low-trauma surgical technique.
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Affiliation(s)
- G H Isaac
- DePuy International Limited, Leeds, UK.
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Isaac GH, Thompson J, Williams S, Fisher J. Metal-on-metal bearings surfaces: Materials, manufacture, design, optimization, and alternatives. Proc Inst Mech Eng H 2006; 220:119-33. [PMID: 16669381 DOI: 10.1243/095441105x68953] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
When first introduced, total hip replacements offered pain relief and improved mobility in elderly patients. The success of this procedure in terms of long-term durability and restoration of function has led to its use in younger, more active patients. This has resulted in a commensurate increase in patient expectation regarding longevity and the degree to which function and lifestyle is restored. The bearing surface is a key feature of the performance of replacement joints. It is generally accepted that excessive amounts of wear debris preclude their long-term survivorship and hence there is an ongoing requirement for bearing surfaces which minimize debris generation. The purpose of this paper is to review the factors which affect the performance of so-called metal-on-metal bearings, to compare their performance with that of the other commonly used contemporary alternatives, metal and ceramic articulating against highly cross-linked polyethylene, and ceramic-on-ceramic, and finally to consider the potential solutions offered by new developments such as ceramic-on-metal and coatings applied to metal-on-metal bearings.
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Gatti AM, Montanari S, Gambarelli A, Capitani F, Salvatori R. In-vivo short- and long-term evaluation of the interaction material-blood. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2005; 16:1213-9. [PMID: 16362224 DOI: 10.1007/s10856-005-4731-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2005] [Accepted: 07/18/2005] [Indexed: 05/05/2023]
Abstract
Through an innovative electron microscopy technique, thrombi and fibrotic tissue taken from 14 explanted vena cava filters were observed. Twelve cases showed the presence of micro-and nano-sized inorganic, non biodegradable nor biocompatible particles which did not belong to the metal the device was made of and which could be the sole cause or, more likely, a pre-existing cause for thrombosis. In two cases, those debris activated immunological reactions typical of a foreign body. The presence of inorganic particles in the blood was never detected before and their effects on human health are hardly known. Their thrombogenicity should be added to the Virchow's Triad as a fourth factor and could be the explanation to many of the cases of pulmonary embolism where no thrombotic focus could be demonstrated.
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Affiliation(s)
- Antonietta M Gatti
- Laboratory of Biomaterials, University of Modena and ReggioEmilia, Italy.
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Abstract
Metal-on-metal bearings have wear rates that are 20 to 100 times lower than metal-on-conventional polyethylene. The amount of wear generally is the same order of magnitude for the head and the cup. There is an initial run-in period of higher wear followed by lower, steady-state wear. Wear rate is a function of the interplay of material(s), macrogeometry, microgeometry, and the resultant type and amount of lubrication. The wear resistance and clinical performance of a metal-on-metal bearing are more sensitive to macrogeometry and lubrication than a metal-on-polyethylene bearing. Metal wear particles are nanometers in linear dimension. They are much smaller and more numerous than the submicron polyethylene wear particles, but the volume of periprosthetic inflammatory tissue is less. Osteolysis seems to be relatively rare. Little is known about the systemic distribution of metal particles and ions. The significance of systemic distribution also is not known. The levels of serum and urine Co and Cr ions are elevated in patients with metal-on-metal bearings, but the long-term, steady-state levels are not much higher than those from corrosion of modular femoral components. Because of the elevated levels of Co and Cr ions, there is a greater risk of delayed type hypersensitivity. There also is concern about the potential for malignant degeneration secondary to prolonged exposure to these elements. The available data are insufficient to address this concern. Rigorous long-term studies are needed. It will take decades of close clinical observation to determine if the benefits of metal-on-metal bearings outweigh the associated risks.
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Affiliation(s)
- Mauricio Silva
- Joint Replacement Institute at Orthopaedic Hospital, Los Angeles, CA 90007, USA
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Lewis JB, Wataha JC, McCloud V, Lockwood PE, Messer RLW, Tseng WY. Au(III), Pd(II), Ni(II), and Hg(II) alter NFκB signaling in THP1 monocytic cells. J Biomed Mater Res A 2005; 74:474-81. [PMID: 15983993 DOI: 10.1002/jbm.a.30383] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The transcription factor NFkappaB plays a key role in the tissue inflammatory response. Metal ions released into tissues from biomaterials (e.g., Au, Pd, Ni, Hg) are known to alter the binding of NFkappaB proteins to DNA, thereby modulating the effect of NFkappaB on gene activation and, ultimately, the tissue response to biomaterials. Little is known about the effect of these metals on key signaling steps prior to NFkappaB-DNA binding such as transcription factor activation or nuclear translocation, yet these steps are equally important to modulation of the pathway. Oxidative stress is known to alter NFkappaB proteins and is suspected to play a role in metal-induced NFkappaB signaling modulation. Our aim in the current study was to assess the effects of sublethal levels of Ni, Hg, Pd, and Au ions on NFkappaB activation and nuclear translocation in the monocyte, which is acknowledged as an important orchestrator of the biological response to materials and the pathogenesis of chronic disease. Sublethal concentrations of Au(III), Ni(II), Hg(II), and Pd(II) were added to cultures of human THP1 monocytic cells for 72 h. In parallel cultures, lipopolysaccharide (LPS) was added for the last 30 min to activate the monocytic cells. Then cellular cytoplasmic and nuclear proteins were isolated, separated by electrophoresis, and probed for IkappaBalpha degradation (activation) and NFkappaB p65 translocation. Protein levels were digitally quantified and statistically compared. The levels of reactive oxygen species (ROS) in the monocytic cells were measured as a possible mechanism of metal-induced NFkappaB modulation. Only Au(III) activated IkappaBalpha degradation by itself. Au(III) and Pd(II) enhanced LPS-induced IkappaBalpha degradation, but Hg(II) and Ni(II) suppressed it. Au(III), Ni(II), and Pd(II) activated p65 nuclear translocation without LPS, and all but Ni(II) enhanced LPS-induced translocation. Collectively, the results suggest that these metal ions alter activation and translocation of NFkappaB, each in a unique way at unique concentrations. Furthermore, even when these metals had no overt effects on signaling by themselves, all altered activation of signaling by LPS, suggesting that the biological effects of these metals on monocytic function may only be manifest upon activation. None of the metal ions elevated levels of ROS at 72 h, indicating that ROS were probably not direct modulators of the NFkappaB activation or translocation at this late time point.
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Affiliation(s)
- J B Lewis
- School of Dentistry, Medical College of Georgia, Augusta, Georgia 30912-1126, USA
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Abstract
Pathological colonic tissues were investigated with an Environmental Scanning Electron Microscope technique to verify the presence of inorganic, non-biodegradable pollutants, i.e. micro- and nano-debris of exogenous origin, after debris in liver and kidney had been discovered. In all, 18 samples of colon tissues affected by cancer and Crohn's disease were evaluated and found in all the cases to contain micro- and nano-particles. Their chemistry, detected with an X-ray microprobe, indicated a heterogeneous nature, whereas the size of the particles was homogeneous. Three control samples of healthy, young, cadavers were analysed and showed the absence of debris within the normal, healthy colon mucosa. The study reveals the presence of particulate debris, generally considered as biocompatible, in pathological specimens of human colon. The findings suggest a possible link between the presence of such particles and the underlying pathology in the cases analysed.
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Affiliation(s)
- Antonietta M Gatti
- Laboratory of Biomaterials, INFM, Department of Surgery and Neurosciences, University of Modena and Reggio Emilia, Via del Pozzo 71, Modena 41100, Italy.
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Wataha JC, Lewis JB, Volkmann KR, Lockwood PE, Messer RLW, Bouillaguet S. Sublethal concentrations of Au (III), Pd (II), and Ni(II) differentially alter inflammatory cytokine secretion from activated monocytes. ACTA ACUST UNITED AC 2004; 69:11-7. [PMID: 15015204 DOI: 10.1002/jbm.b.20029] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Many transition metals have been viewed collectively as nonspecific biological toxins in cells, which has limited investigation into their possible therapeutic effects. In the current study, the effects of Au(III), Ni(II), and Pd(II) on the differential secretion of cytokines from monocytes has been investigated. This is critical to understanding any therapeutic potential of these metals, their allergenicity, or the clinical effects of current metal therapies such as chrysotherapy. Lethal concentrations (defined as > 50% suppression of mitochondrial succinate dehydrogenase (SDH) activity) of metals were determined by dose-response curves with the use of 72 h exposures to human THP-1 monocytes. Then, secretion of TNFalpha, IL1beta, and IL6 were measured after the monocytes were exposed to sublethal concentrations of metals, with or without stimulation by lipopolysaccharide. The concentrations of Au(III), Pd(II), and Ni(II) required to suppress SDH activity by 50% were found to be 255, 270, and 90 microM, respectively. No sublethal concentration of any metal alone caused secretion of the cytokines. However, LPS-induced cytokine secretion was significantly and differentially altered by sublethal concentrations of each metal. Differential responses were highly dependent on metal concentration and involved both suppression and potentiation of the LPS activation. In the case of Ni(II), potentiation of TNFalpha, IL1beta, and IL6 ranged from 200% for TNFalpha to over 1200% for IL6. Metals such as Au(III), Pd(II), and Ni(II) differentially alter cytokine expression from monocytes. These results imply that metals have more specific effects on cell signaling than previously assumed. These results also are important in explaining multiple clinical effects often seen with chrysotherapy, identifying potential new avenues for metal therapy, and understanding the inflammatory effects of metals such as nickel.
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Affiliation(s)
- John C Wataha
- School of Dentistry, Medical College of Georgia, Augusta, Georgia 30912, USA.
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Adams JE, Jaffe KA, Lemons JE, Siegal GP. Prosthetic implant associated sarcomas: a case report emphasizing surface evaluation and spectroscopic trace metal analysis. Ann Diagn Pathol 2003; 7:35-46. [PMID: 12616473 DOI: 10.1053/adpa.2003.50006] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Advances with implantation of synthetic biomaterials in the setting of orthopedic surgery have clearly resulted in improvements in patient outcomes. However, all implants have been shown to have associated risks. For example, ionic and particulate debris from implants have been shown to engage in biological interactions with the native tissue, and have been associated with a wide range of metabolic, bacteriologic, immunologic, and oncogenic effects. The propensity of synthetic biomaterials to undergo degradation, producing an inflammatory reaction or other sequelae, has been well recognized. The use of porous implants, which allow for a greater interface area between native tissue and the prosthesis, may magnify the interaction between biologically active tissue and synthetic devices in some situations, giving rise to new and intriguing issues concerning biocorrosion and biocompatibility. In this article, we report the case of a high-grade conventional osteosarcoma occurring at the site of a modular porous-surfaced titanium and cobalt alloy total hip prosthesis 3 years after device implantation. Detailed spectroscopic trace metal analysis was performed and elevated levels of both vanadium and chromium, but not aluminum, nickel, or titanium were identified in the tumor.
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Affiliation(s)
- Julie E Adams
- Department of Pathology, and the Division of Orthopaedic Surgery, University of Alabama at Birmingham, 35233, USA
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Wataha JC, Nelson SK, Lockwood PE. Elemental release from dental casting alloys into biological media with and without protein. Dent Mater 2001; 17:409-14. [PMID: 11445208 DOI: 10.1016/s0109-5641(00)00099-3] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The objective of this study was to determine the role of proteins in affecting elemental release from a variety of clinically available dental casting alloys. An important role for proteins was suspected based on previous reports about the corrosion of stainless steel and the cytotoxicity of alloys after exposure to a saline-protein solution. METHODS Clinically available alloys with compositions ranging from 0 to 94at.% noble elements were exposed for 1 week to either saline, saline with 3% bovine serum albumin (BSA), or complete cell-culture medium with 3% serum. Atomic absorption spectrophotometry was used to measure the release of elements from the alloys. Elemental release was normalized for the exposed surface area of the alloys. RESULTS In general, more elemental release occurred into the saline-BSA solution compared to saline alone for all released elements (Ag, Cu, Pd, and Zn) except for Ni. Ni release from the NiCr alloy was lower in the presence of BSA. Each element responded somewhat differently with Pd being the least predictable in its behavior. Elemental release was less in the cell-culture medium than in the saline-BSA solution for most elements. For alloys which released multiple elements, all elements responded similarly but not identically to the presence of protein. A high elemental release during exposure to the saline-BSA solution correlated with a low alloy cytotoxicity post-exposure to the saline-BSA. SIGNIFICANCE This study demonstrates the importance of defining exactly the composition of biological solutions used to assess in vitro corrosion and biocompatibility of dental casting alloys. Other molecules in addition to proteins appeared to be critical to the corrosion of these alloys in vitro.
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Affiliation(s)
- J C Wataha
- Medical College of Georgia School of Dentistry, Augusta, GA 30912-1260, USA.
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Hung WS, Fang CL, Su CH, Lai WF, Chang YC, Tsai YH. Cytotoxicity and immunogenicity of SACCHACHITIN and its mechanism of action on skin wound healing. JOURNAL OF BIOMEDICAL MATERIALS RESEARCH 2001; 56:93-100. [PMID: 11309795 DOI: 10.1002/1097-4636(200107)56:1<93::aid-jbm1072>3.0.co;2-b] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
SACCHACHITIN membrane, a weavable skin substitute made from the residual fruiting body of Ganoderma tsugae, has been demonstrated to promote skin wound healing. Prior to its clinical application, it is critical to learn more about any possible cytotoxicity, immunogenicity, or allergy response, and at least some of its mechanism(s) of action(s). In the present studies, it has been found that SACCHACHITIN suspension at less than 0.05% shows no cytotoxicity to the primary culture of rat fibroblasts. However, at higher concentrations (> or = 0.1%), it does reduce the growth of fibroblasts, based on MTT assays. This might be caused by positive charges on chitin molecules that are too strong, and may be harmful to the cell membrane. SACCHACHITIN showed no immunogenicity after it was inoculated into rats three times; however, the unmodified, purified rabbit type I and type II collagens did. Subcutaneous injection of SACCHACHITIN suspension into rats showed no gross allergic responses on skin. Nevertheless, it did cause local acute inflammation, as observed by histological investigation. This is similar to what occurred in the wound site covered with SACCHACHITIN membrane. The chemotactic effect of SACCHACHITIN was exhibited in both intact and wounded skin tissues. This may be one of the initial beneficial effects of SACCHACHITIN membrane to wound healing. The rapid acute inflammatory process was followed by the appearance of angiogenesis and granulation tissue formation, which occurred earlier than it normally would. Coverage of the wound area with SACCHACHITIN membrane also induced an earlier formation of scar tissue to replace the granulation tissue. A 1.5 x 1.5 cm(2) wound area covered by SACCHACHITIN completely healed by 21 days, while that covered with cotton gauze did not. Therefore, SACCHACHITIN is a safe biomaterial for use as a wound dressing for skin healing. Its promoting action for wound healing might be due to its chemotactic effect for inflammatory cells. This, in turn, may facilitate subsequent angiogenesis, granulation tissue formation, and faster new tissue formation, leading to faster wound healing.
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Affiliation(s)
- W S Hung
- Graduate Institute of Cell and Molecular Biology, Taipei Medical University, 250 Wu-Hsing Street, Taipei, Taiwan 110
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42
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Abstract
All metals in contact with biological systems undergo corrosion. This electrochemical process leads to the formation of metal ions, which may activate the immune system by forming complexes with endogenous proteins. Implant degradation products have been shown to be associated with dermatitis, urticaria, and vasculitis. If cutaneous signs of an allergic response appear after implantation of a metal device, metal sensitivity should be considered. Currently, there is no generally accepted test for the clinical determination of metal hypersensitivity to implanted devices. The prevalence of dermal sensitivity in patients with a joint replacement device, particularly those with a failed implant, is substantially higher than that in the general population. Until the roles of delayed hypersensitivity and humoral immune responses to metallic orthopaedic implants are more clearly defined, the risk to patients may be considered minimal. It is currently unclear whether metal sensitivity is a contributing factor to implant failure.
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Affiliation(s)
- N Hallab
- Department of Orthopaedic Surgery, Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL 60612, USA.
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Abstract
STATEMENT OF PROBLEM Dental casting alloys are widely used in applications that place them into contact with oral tissues for many years. With the development of new dental alloys over the past 15 years, many questions remain about their biologic safety. Practitioners must choose among hundreds of alloy compositions, often without regard to biologic properties. PURPOSE This article is an evidence-based tutorial for clinicians. Concepts and current issues relevant to the biologic effects of dental casting alloys are presented. SUMMARY The single most relevant property of a casting alloy to its biologic safety is its corrosion. Systemic and local toxicity, allergy, and carcinogenicity all result from elements in the alloy being released into the mouth during corrosion. Little evidence supports concerns of casting alloys causing systemic toxicity. The occurrence of local toxic effects (adjacent to the alloy) is not well documented, but is a higher risk, primarily because local tissues are exposed to much higher concentrations of released metal ions. Several elements such as nickel and cobalt have relatively high potential to cause allergy, but the true risk of using alloys containing these elements remains undefined. Prudence dictates that alloys containing these elements be avoided if possible. Several elements in casting alloys are known mutagens, and a few such as beryllium and cadmium are known carcinogens in different chemical forms. Despite these facts, carcinogenic effects from dental casting alloys have not been demonstrated. Prudent practitioners should avoid alloys containing these known carcinogens. CONCLUSION To minimize biologic risks, dentists should select alloys that have the lowest release of elements (lowest corrosion). This goal can be achieved by using high-noble or noble alloys with single-phase microstructures. However, there are exceptions to this generality, and selection of an alloy should be made on a case-by-case basis using corrosion and biologic data from dental manufacturers.
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Affiliation(s)
- J C Wataha
- Medical College of Georgia, School of Dentistry, Augusta, Ga., USA.
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Wataha JC, Lockwood PE, Frazier KB, Khajotia SS. Effect of toothbrushing on elemental release from dental casting alloys. J Prosthodont 1999; 8:245-51. [PMID: 10895676 DOI: 10.1111/j.1532-849x.1999.tb00046.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
PURPOSE This study assessed the effect of toothbrushing on the elemental release from common dental casting alloys. MATERIALS AND METHODS A Au-Pt high-noble alloy, a Au-Pd high-noble alloy, a Pd-Cu-Ga noble alloy, and a Ni-Cr base-metal alloy were placed into a biological medium for 1 week to allow equilibration of elemental release, then brushed for 30 minutes at 90 strokes/min under 200 g of force with a soft toothbrush. The brushing was performed in neutral saline or lactic acid at pH 4 with or without toothpaste. The alloys were then transferred back into a biological medium for 1 week. Atomic absorption spectroscopy was used to measure the mass lost from each alloy during and in the week after brushing. Mass loss was expressed as micrograms per square centimeter of alloy surface, and the various brushing conditions were compared by analysis of variance and Tukey multiple comparison intervals (alpha = 0.05). RESULTS During brushing, element release increased significantly over nonbrushed controls for all alloys except the Ni-Cr. Toothpastes, acidic solutions, or combinations of these conditions with toothbrushing further enhanced elemental release, but Ni release from the Ni-Cr alloy increased the most (30-fold). In the week after brushing, brushing alone increased elemental release only from the Ni-Cr alloy. However, toothpastes and acidic solutions increased elemental release for all alloys significantly, except for the Au-Pd alloy. In general, elemental release during brushing was far greater than in the week after brushing. CONCLUSIONS Under the conditions of this study, toothbrushing increased the elemental release from dental casting alloys.
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Affiliation(s)
- J C Wataha
- Department of Oral Rehabilitation, Medical College of Georgia, Augusta 30912-1260, USA.
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Hing KA, Best SM, Tanner KE, Revell PA, Bonfield W. Histomorphological and biomechanical characterization of calcium phosphates in the osseous environment. Proc Inst Mech Eng H 1998; 212:437-51. [PMID: 9852739 DOI: 10.1243/0954411981534204] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The standardization of characterization techniques is becoming increasingly important for bone replacement materials as it becomes apparent that, for the field to advance, testing must be developed to allow the biocompatibility or bioactivity of a new material to be assessed and directly compared with existing materials. Currently there are many forms of biocompatibility test for materials destined for the osseous environment, ranging from immersion in simulated body fluid to implantation into living bone. However, the variety of ways in which the data from these tests may be acquired and interpreted, as a result of changes in parameters such as surgical technique and mechanical test conditions, means that much of the published data within the field is not comparable. This paper will introduce the concept of biocompatibility by considering calcium phosphate bioceramics, and discusses some aspects of in vivo experimental design, including simple histomorphometry techniques, in addition to considering practical methods for the assessment of the biomechanical characteristics of an osseointegrated implant.
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Affiliation(s)
- K A Hing
- IRC in Biomedical Materials, Queen Mary and Westfield College, London
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Saad B, Hirt TD, Welti M, Uhlschmid GK, Neuenschwander P, Suter UW. Development of degradable polyesterurethanes for medical applications: in vitro and in vivo evaluations. JOURNAL OF BIOMEDICAL MATERIALS RESEARCH 1997; 36:65-74. [PMID: 9212390 DOI: 10.1002/(sici)1097-4636(199707)36:1<65::aid-jbm8>3.0.co;2-j] [Citation(s) in RCA: 112] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
To evaluate the biocompatibility of a newly developed degradable class of polyesterurethanes and their possible use as biomaterials, we investigated the cell and tissue interactions with these polymers using a small number of chemical base entities. The polymers were prepared by chain extension with diisocyanates of PHB/HV-diol and either PCL-diol or Diorez, another aliphatic polyester-diol. Regardless of the chemical composition of the four tested polyesterurethanes used as substrates, no morphological difference was observed either in the macrophages (macrophage cell line J774) or in the fibroblasts (fibroblast cell line 3T3) cultured on the polymers. In contrast, however, cell adhesion and growth of macrophages and fibroblasts were affected by the polymer properties. Compared to macrophages cultured on tissue culture polystyrene (TCPS), cells cultured on the test polymers exhibited levels of cell adhesion that varied from 65-100% of TCPS, and the doubling time was 25-43% higher on the polymers than on TCPS. Likewise, fibroblasts adhered to the polymers at lower rates (50-85% of TCPS) and grew at higher doubling times (125-140% of TCPS). Furthermore, cells cultured on the test polymers preserved their phenotypes: fibroblasts produced high amounts (up to 280% of control cells) of collagens Type I and Type IV and fibronectin; and macrophages produced nitric oxide (NO) and tumor necrosis factor alpha (TNF-alpha) in the same concentrations as control cells and responded to lipopolysaccharide treatment by the elevation of the production of NO and TNF-alpha, indicating that the cell-to-polymer interactions allow fibroblasts and macrophages to maintain their phenotypes. In vivo investigations showed that all four test polymers exhibit favorable tissue compatibility. The formed capsule was 60-250 microns thick. In addition, the polymers are degradable. After one year's subcutaneous implantation in rats, the molecular weight of the test polymers were reduced to about 50%, depending on the composition. Taken collectively, the present data demonstrate that the newly developed polyesterurethanes are cell and tissue compatible and biodegradable.
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Affiliation(s)
- B Saad
- Department of Materials, Institute of Polymers, ETH, Zurich, Switzerland
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Lewold S, Olsson H, Gustafson P, Rydholm A, Lidgren L. Overall cancer incidence not increased after prosthetic knee replacement: 14,551 patients followed for 66,622 person-years. Int J Cancer 1996; 68:30-3. [PMID: 8895536 DOI: 10.1002/(sici)1097-0215(19960927)68:1<30::aid-ijc6>3.0.co;2-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
It is unknown whether patients as a consequence of prosthetic joint replacement are at a higher risk of developing cancer. We therefore analyzed cancer incidence following prosthetic knee replacement (TKR). The observed cancer incidence in 14,551 patients from the population-based Swedish Knee Arthroplasty Register who have undergone TKR because of osteoarthrosis (OA, n = 10,120) or rheumatoid arthritis (RA, n = 4431) were compared with the expected cancer incidence for a Swedish reference population. The cohort was followed for a total of 66,622 person-years. We followed 33% of the patients with OA and 59% of those with RA for more than 5 years. All patients who underwent TKR, whether for OA or for RA, had lower than expected total cancer incidence. We found a markedly low incidence of colorectal carcinoma, especially in patients with RA. Our results do not indicate an increased incidence of cancer following TKR.
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Affiliation(s)
- S Lewold
- Department of Orthopedics, University Hospital, Lund, Sweden
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Maurin N, Guernier C, Daty N. Delayed in vitro immune response to long-term intraperitoneal polymer implant in mice. JOURNAL OF BIOMEDICAL MATERIALS RESEARCH 1995; 29:1493-8. [PMID: 8600139 DOI: 10.1002/jbm.820291205] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
This paper presents an original experimental procedure designed to evaluate, by a two step in vivo/in vitro combination, the long-term biocompatibility of synthetic materials developed for clinical applications. The efficacy of the test is illustrated by the experimental results obtained with various materials currently used in medicine (Dacron, RCH) and also with three recently synthesized compounds. In the first step of the procedure, the sample was grafted for at least 5 months in the peritoneal cavity of mice, allowing the possible development of delayed sensitization. In the second step, this sensitization was detected by an in vitro test, the Lymphoblastic Transformation Test (LTT), adapted for this new purpose. On the basis of this experiment, the 5 polymers tested were classified into 2 groups: one group did not significantly differ from the control, and the other had a significantly higher incidence of sensitization. As these results were in agreement with the known biocompatibility of these polymers, they demonstrate the validity of the test to classify new polymers.
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Affiliation(s)
- N Maurin
- Laboratoire d'Histologie Faculté de Médecine Saint-Antoine, Paris, France
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