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Mahri M, Shen N, Berrizbeitia F, Rodan R, Daer A, Faigan M, Taqi D, Wu KY, Ahmadi M, Ducret M, Emami E, Tamimi F. Osseointegration Pharmacology: A Systematic Mapping Using Artificial Intelligence. Acta Biomater 2021; 119:284-302. [PMID: 33181361 DOI: 10.1016/j.actbio.2020.11.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 11/04/2020] [Accepted: 11/05/2020] [Indexed: 12/25/2022]
Abstract
Clinical performance of osseointegrated implants could be compromised by the medications taken by patients. The effect of a specific medication on osseointegration can be easily investigated using traditional systematic reviews. However, assessment of all known medications requires the use of evidence mapping methods. These methods allow assessment of complex questions, but they are very resource intensive when done manually. The objective of this study was to develop a machine learning algorithm to automatically map the literature assessing the effect of medications on osseointegration. Datasets of articles classified manually were used to train a machine-learning algorithm based on Support Vector Machines. The algorithm was then validated and used to screen 599,604 articles identified with an extremely sensitive search strategy. The algorithm included 281 relevant articles that described the effect of 31 different drugs on osseointegration. This approach achieved an accuracy of 95%, and compared to manual screening, it reduced the workload by 93%. The systematic mapping revealed that the treatment outcomes of osseointegrated medical devices could be influenced by drugs affecting homeostasis, inflammation, cell proliferation and bone remodeling. The effect of all known medications on the performance of osseointegrated medical devices can be assessed using evidence mappings executed with highly accurate machine learning algorithms.
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Xie Y, Pan M, Gao Y, Zhang L, Ge W, Tang P. Dose-dependent roles of aspirin and other non-steroidal anti-inflammatory drugs in abnormal bone remodeling and skeletal regeneration. Cell Biosci 2019; 9:103. [PMID: 31890152 PMCID: PMC6929289 DOI: 10.1186/s13578-019-0369-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 12/20/2019] [Indexed: 01/10/2023] Open
Abstract
The failure of remodeling process that constantly regenerates effete, aged bone is highly associated with bone nonunion and degenerative bone diseases. Numerous studies have demonstrated that aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) activate cytokines and mediators on osteoclasts, osteoblasts and their constituent progenitor cells located around the remodeling area. These cells contribute to a complex metabolic scenario, resulting in degradative or synthetic functions for bone mineral tissues. The spatiotemporal effects of aspirin and NSAIDs in the bone remodeling are controversial according the specific therapeutic doses used for different clinical conditions. Herein, we review in vitro, in vivo, and clinical studies on the dose-dependent roles of aspirin and NSAIDs in bone remodeling. Our results show that low-dose aspirin (< 100 μg/mL), which is widely recommended for prevention of thrombosis, is very likely to be benefit for maintaining bone mass and qualities by activation of osteoblastic bone formation and inhibition of osteoclast activities via cyclooxygenase-independent manner. While, the roles of high-dose aspirin (150-300 μg/mL) and other NSAIDs in bone self-regeneration and fracture-healing process are difficult to elucidate owing to their dual effects on osteoclast activity and bone formation of osteoblast. In conclusion, this study highlighted the potential clinical applications of low-dose aspirin in abnormal bone remodeling as well as the risks of high-dose aspirin and other NSAIDs for relieving pain and anti-inflammation in fractures and orthopedic operations.
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Affiliation(s)
- Yong Xie
- 1Department of Orthopedics, Chinese PLA General Hospital, Beijing, 100853 China
| | - Meng Pan
- 2State Key Laboratory of Medical Molecular Biology and Department of Immunology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Beijing, 100005 China
| | - Yanpan Gao
- 2State Key Laboratory of Medical Molecular Biology and Department of Immunology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Beijing, 100005 China
| | - Licheng Zhang
- 1Department of Orthopedics, Chinese PLA General Hospital, Beijing, 100853 China
| | - Wei Ge
- 2State Key Laboratory of Medical Molecular Biology and Department of Immunology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Beijing, 100005 China
| | - Peifu Tang
- 1Department of Orthopedics, Chinese PLA General Hospital, Beijing, 100853 China
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Apostu D, Lucaciu O, Lucaciu GDO, Crisan B, Crisan L, Baciut M, Onisor F, Baciut G, Câmpian RS, Bran S. Systemic drugs that influence titanium implant osseointegration. Drug Metab Rev 2017; 49:92-104. [PMID: 28030966 DOI: 10.1080/03602532.2016.1277737] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Titanium implants are widely used on an increasing number of patients in orthopedic and dental medicine. Despite the good survival rates of these implants, failures that lead to important socio-economic consequences still exist. Recently, research aimed at improving implant fixation, a process called osseointegration, has focused on a new, innovative field: systemic delivery of drugs. Following implant fixation, patients receive systemic drugs that could either impair or enhance osseointegration; these drugs include anabolic and anti-catabolic bone-acting agents in addition to new treatments. Anabolic bone-acting agents include parathyroid hormone (PTH) peptides, simvastatin, prostaglandin EP4 receptor antagonist, vitamin D and strontium ranelate; anti-catabolic bone-acting agents include compounds like calcitonin, biphosphonates, RANK/RANKL/OPG system and selective estrogen receptor modulators (SERM). Examples of the new therapies include DKK1- and anti-sclerostin antibodies. All classes of treatments have proven to possess positive impacts such as an increase in bone mineral density and on osseointegration. In order to prevent complications from occurring after surgery, some post-operative systemic drugs are administered; these can show an impairment in the osseointegration process. These include nonsteroidal anti-inflammatory drugs, proton pump inhibitors and selective serotonin reuptake inhibitors. The effects of aspirin, acetaminophen, opioids, adjuvants, anticoagulants and antibiotics in implant fixations are not fully understood, but studies are being carried out to investigate potential ramifications. It is currently accepted that systemic pharmacological agents can either enhance or impair implant osseointegration; therefore, proper drug selection is essential. This review aims to discuss the varying effects of three different classes of treatments on improving this process.
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Affiliation(s)
- Dragos Apostu
- a Department of Orthopaedics and Traumatology , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj-Napoca , Romania
| | - Ondine Lucaciu
- b Department of Oral Rehabilitation , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj-Napoca , Romania
| | | | - Bogdan Crisan
- d Department of Maxillofacial Surgery and Oral Implantology , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj-Napoca , Romania
| | - Liana Crisan
- e Department of Oral and Maxillofacial Surgery , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj-Napoca , Romania
| | - Mihaela Baciut
- d Department of Maxillofacial Surgery and Oral Implantology , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj-Napoca , Romania
| | - Florin Onisor
- e Department of Oral and Maxillofacial Surgery , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj-Napoca , Romania
| | - Grigore Baciut
- e Department of Oral and Maxillofacial Surgery , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj-Napoca , Romania
| | - Radu Septimiu Câmpian
- b Department of Oral Rehabilitation , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj-Napoca , Romania
| | - Simion Bran
- d Department of Maxillofacial Surgery and Oral Implantology , Iuliu Hatieganu University of Medicine and Pharmacy , Cluj-Napoca , Romania
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Salduz A, Dikici F, Kılıçoğlu ÖI, Balcı HI, Akgul T, Kürkçü M, Kurtoğlu C, Tözün R. Effects of NSAIDs and hydroxyapatite coating on osseointegration. J Orthop Surg (Hong Kong) 2017; 25:2309499016684410. [PMID: 28139193 DOI: 10.1177/2309499016684410] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The aim of our study is to investigate the bone ongrowth of two different alternative surfaces and the effect of nonsteroidal anti-inflammatory drugs (NSAIDs) on osseointegration. METHODS Hips of 40 New Zealand white rabbits were operated bilaterally. Hydroxyapatite (HA)-coated titanium rods were implanted into the right femur, and grit-blasted titanium rods were implanted into the left femur. They were divided into three groups. At the end of 8 weeks, both femora of the rabbits were removed and investigated biomechanically and histologically. RESULTS HA-coated implants had a significantly better failure load and "percentage of bone-implant contact" than grit-blasted implants. There was no significant difference between the medication groups as a result of the biomechanical and histologic investigations. CONCLUSIONS Our results indicate that NSAIDs did not have any negative effect on the osseointegration. HA-coated implants may provide more tensile strength and greater bone-implant contact rate in comparison with grit-blasted implants.
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Affiliation(s)
- Ahmet Salduz
- 1 Istanbul University, Istanbul Faculty of Medicine, Orthopedic and Traumatology Department, Istanbul, Turkey
| | - Fatih Dikici
- 1 Istanbul University, Istanbul Faculty of Medicine, Orthopedic and Traumatology Department, Istanbul, Turkey
| | - Önder Ismet Kılıçoğlu
- 1 Istanbul University, Istanbul Faculty of Medicine, Orthopedic and Traumatology Department, Istanbul, Turkey
| | - Halil Ibrahim Balcı
- 1 Istanbul University, Istanbul Faculty of Medicine, Orthopedic and Traumatology Department, Istanbul, Turkey
| | - Turgut Akgul
- 1 Istanbul University, Istanbul Faculty of Medicine, Orthopedic and Traumatology Department, Istanbul, Turkey
| | - Mehmet Kürkçü
- 2 Cukurova University, Faculty of Dentistry, Adana, Turkey
| | - Cem Kurtoğlu
- 2 Cukurova University, Faculty of Dentistry, Adana, Turkey
| | - Remzi Tözün
- 1 Istanbul University, Istanbul Faculty of Medicine, Orthopedic and Traumatology Department, Istanbul, Turkey
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Halawi MJ, Grant SA, Bolognesi MP. Multimodal Analgesia for Total Joint Arthroplasty. Orthopedics 2015; 38:e616-25. [PMID: 26186325 DOI: 10.3928/01477447-20150701-61] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 07/17/2014] [Indexed: 02/03/2023]
Abstract
Optimal perioperative pain control for total joint arthroplasty remains a challenge. Whereas traditional regimens have relied heavily on opioids, newer multimodal pathways are increasingly gaining popularity as safer and more effective alternatives. The main premise of multimodal analgesia is decreased consumption of opioids, and hence lesser opioid-related adverse events. Other reported advantages include lower pain scores, faster functional recovery, higher patient satisfaction, and shorter length of hospital stay. Unfortunately, despite the advent of numerous analgesic techniques, the multimodal approach has remained widely variable, making direct comparison between studies difficult to interpret. This article provides an extensive review of traditional and modern perioperative interventions in pain management for total joint arthroplasty, including intravenous patient-controlled analgesia, epidural infusion, oral opioids, nonsteroidal anti-inflammatory drugs, acetaminophen, peripheral nerve blocks, periarticular infiltration, steroids, anticonvulsants, and long-acting local anesthetics. Emphasis is placed on pathophysiology, clinical evidence, and timing. A standardized multimodal analgesia protocol is also proposed based on best available evidence. In addition to pharmacologic interventions, patient education and interdisciplinary collaboration among the care teams play an important role in the success of any treatment pathway. With a growing demand for total joint arthroplasty in an era of bundled payments and accountable care, there has never been a greater need for a standardized multimodal analgesia pathway.
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McKenzie JC, Goyal N, Hozack WJ. Multimodal pain management for total hip arthroplasty. ACTA ACUST UNITED AC 2013. [DOI: 10.1053/j.sart.2013.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
Although the long-term results following traditional total joint arthroplasty are excellent, postoperative pain management has been suboptimal. Under-treatment of pain is a focus of growing concern to the orthopedic community. Poorly controlled postoperative pain leads to undesirable outcomes, including immobility, stiffness, myocardial ischemia, atelectasis, pneumonia, deep venous thrombosis, anxiety, depression, and chronic pain. Over the past decade, the attempt to minimize postoperative complications, combined with the move toward minimally invasive surgery and early postoperative mobilization, has made pain management a critical aspect of joint replacement surgery. Effective protocols are currently available; all include a multimodal approach. Debate continues regarding the ideal approach; however, reliance on narcotic analgesia alone is suboptimal.
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Affiliation(s)
- Michael P Nett
- ISK Institute at Southside Hospital, Bay Shore, New York 11706, USA.
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