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Ali A, Paladhi A, Hira SK, Singh BN, Pyare R. Bioactive ZnO-assisted 1393 glass scaffold promotes osteogenic differentiation: Some studies. J Biomed Mater Res B Appl Biomater 2023; 111:1059-1073. [PMID: 36583285 DOI: 10.1002/jbm.b.35214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 12/01/2022] [Accepted: 12/08/2022] [Indexed: 12/31/2022]
Abstract
We developed ZnO-assisted 1393 bioactive glass-based scaffold with suitable mechanical properties through foam replica technique and observed to be suitable for bone tissue engineering application. However, the developed scaffolds' ability to facilitate cellular infiltration and integration was further assessed through in vivo studies in suitable animal model. Herein, the pure 1393 bioactive glass (BG) and ZnO-assisted 1393 bioactive glass- (ZnBGs; 1, 2, 4 mol% ZnO substitution for SiO2 in pure BG is named as Z1BG, Z2BG, Z3BG, respectively) based scaffolds were prepared through sol-gel route, followed by foam replica techniques and characterized by a series of in vitro and some in vivo tests. Different cell lines like normal mouse embryonic cells (NIH/3T3), mouse bone marrow stromal cells (mBMSc), peripheral blood mononuclear cells, that is, lymphocytes and monocytes (PBMC) and U2OS (carcinogenic human osteosarcoma cells) were used in determination and comparative analysis of the biological compatibility of the BG and ZnBGs. Also, the alkaline phosphatase (ALP) activity, and osteogenic gene expression by primer-specific osteopontin (OPN), osteocalcin (OCN), and glyceraldehyde-3-phosphate dehydrogenase (GAPDH) genes were performed to study osteogenic differentiability of the stromal cells in different BGs. Moreover, radiological and histopathological tests were performed in bone defect model of Wister rats to evaluate the in vivo bone regeneration and healing. Interestingly, these studies demonstrate augmented biological compatibility, and superior osteogenic differentiation in ZnBGs, in particular Z3BG than the pure BG in most cases.
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Affiliation(s)
- Akher Ali
- Department of Ceramic Engineering, Indian Institute of Technology (BHU), Varanasi, Uttar Pradesh, India
| | - Ankush Paladhi
- Cellular Immunology Laboratory, Department of Zoology, University of Burdwan, Purba Bardhaman, West Bengal, India
| | - Sumit Kumar Hira
- Cellular Immunology Laboratory, Department of Zoology, University of Burdwan, Purba Bardhaman, West Bengal, India
| | - Bhisham Narayan Singh
- Department of Ageing Research, Manipal School of Life Sciences, Manipal Academy of Higher Education, Udupi, Karnataka, India
| | - Ram Pyare
- Department of Ceramic Engineering, Indian Institute of Technology (BHU), Varanasi, Uttar Pradesh, India
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Wu D, Bhalekar RM, Marsh JS, Langton DJ, Stewart AJ. Periarticular metal hypersensitivity complications of hip bearings containing cobalt-chromium. EFORT Open Rev 2022; 7:758-771. [PMID: 36475551 PMCID: PMC9780614 DOI: 10.1530/eor-22-0036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Hip joints with bearings composed of cobalt-chromium alloy (metal-on-metal bearings) have been one of the most widely used implants in joint replacement arthroplasty. Unfortunately, these implants can contribute to a complication called aseptic lymphocyte-dominated vasculitis-associated lesion (ALVAL), a type IV metal hypersensitivity response around the joint. Consistent with such bearings, increased metal debris can be found in the surrounding fluids and in remote tissues and organs, due to wear and corrosion. It is hypothesized that metal ions released from the prosthesis (including Co2+) can potentially form haptens with proteins such as serum albumin in synovial fluid that in turn elicit ALVAL. Generally, elevated cobalt and chromium levels in synovial fluids may indicate implant failure. However, such measurements cannot be used as a reliable tool to predict the onset of ALVAL. To detect ALVAL, some diagnostic tests, questionnaires and imaging techniques have been used clinically with some success, but a standardized approach is lacking. At present, guidelines for implant usage and patient management are ambiguous and inconsistent across health care authorities. To reduce and better manage the development of ALVAL, further research into the precise molecular mechanism(s) by which ALVAL develops is urgently needed. Identification of diagnostic and prognostic biomarkers for ALVAL is required, as are more standardized guidelines for surgery and patient management.
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Affiliation(s)
- Dongmei Wu
- School of Medicine, University of St. Andrews, St. Andrews, Fife, United Kingdom
| | - Rohan M Bhalekar
- ExplantLab, The Biosphere, Newcastle Helix, Newcastle-upon-Tyne, United Kingdom
| | - Jordan S Marsh
- School of Medicine, University of St. Andrews, St. Andrews, Fife, United Kingdom
| | - David J Langton
- ExplantLab, The Biosphere, Newcastle Helix, Newcastle-upon-Tyne, United Kingdom
| | - Alan J Stewart
- School of Medicine, University of St. Andrews, St. Andrews, Fife, United Kingdom,Correspondence should be addressed to A J Stewart;
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Suh LJ, Khan I, Kelley-Patteson C, Mohan G, Hassanein AH, Sinha M. Breast Implant-Associated Immunological Disorders. J Immunol Res 2022; 2022:8536149. [PMID: 35571560 PMCID: PMC9095406 DOI: 10.1155/2022/8536149] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 04/05/2022] [Accepted: 04/16/2022] [Indexed: 11/18/2022] Open
Abstract
Background Breast implants are commonly placed postbreast cancer reconstruction, cosmetic augmentation, and gender-affirming surgery. Breast implant illness (BII) is a systemic complication associated with breast implants. Patients with BII may experience autoimmune symptoms including fatigue, difficulty concentrating, hair loss, weight change, and depression. BII is poorly understood, and the etiology is unknown. The purpose of this literature review is to characterize BII autoimmune disorders and determine possible causes for its etiology. Methods The PubMed, Google Scholar, Embase, Web of Science, and OVID databases were interrogated from 2010 to 2020 using a query strategy including search term combinations of "implants," "breast implant illness," "autoimmune," and "systemic illness." Results BII includes a spectrum of autoimmune symptoms such as fatigue, myalgias/arthralgias, dry eyes/mouth, and rash. A review of epidemiological studies in the past ten years exhibited evidence affirming an association between breast implants and autoimmune diseases. The most commonly recognized were Sjogren's syndrome, rheumatoid arthritis, systemic sclerosis, chronic fatigue syndrome, and Raynaud's syndrome. Explantation resulted in alleviation of symptoms in over 50% of patients, strengthening the hypothesis linking breast implants to BII. Studies have shown that silicone is a biologically inert material and unlikely to be the cause of these symptoms. This is supported by the fact that increased risk of autoimmune disease was also reported in patients with other implantable biomaterials such as orthopedic implants. Recent studies shed light on a possible role of bacterial biofilm and subsequent host-pathogen interactions as a confounding factor to this problem. Conclusion BII could be dependent on biofilm infection and the microenvironment around the implants. The true pathophysiology behind these complaints must be further investigated so that alternative treatment regimens other than explantation can be developed. Translational significance of these studies is not limited to breast implants but extends to other implants as well.
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Affiliation(s)
- Lily J. Suh
- Department of Surgery, Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Imran Khan
- Department of Surgery, Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | | | - Ganesh Mohan
- Department of Surgery, Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Aladdin H. Hassanein
- Department of Surgery, Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Mithun Sinha
- Department of Surgery, Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, IN 46202, USA
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Postler A, Beyer F, Lützner C, Tille E, Lützner J. Similar outcome during short-term follow-up after coated and uncoated total knee arthroplasty: a randomized controlled study. Knee Surg Sports Traumatol Arthrosc 2018; 26:3459-3467. [PMID: 29616285 DOI: 10.1007/s00167-018-4928-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 03/28/2018] [Indexed: 12/27/2022]
Abstract
PURPOSE Patients with known hypersensitivity to metals often require hypoallergenic TKA implants. Coating of a standard implant is a common solution, and although in vitro tests have demonstrated reduction of polyethylene wear for these coatings, it is still unknown whether these implants have any clinical benefit. This study was initiated to investigate metal ion concentrations, knee function and patient-reported outcome (PRO) after coated and uncoated TKA. METHODS One hundred and twenty-two (122) patients were randomized to receive a coated or a standard TKA and, after exclusions, 59 patients were included in each group. Knee function and PRO were assessed with validated scores up to 3 years after surgery. Metal ion concentrations in blood samples were determined for chromium, cobalt, molybdenum and nickel, preoperatively and 1 year after surgery. RESULTS Chromium concentrations in patient plasma increased from a median of 0.25 to 1.30 µg/l in the standard TKA group, and from 0.25 to 0.75 µg/l in the coated TKA group (p = 0.012). Thirteen patients (3 coated, 10 standard TKA) had chromium concentrations above 2 µg/l. The concentrations of cobalt, molybdenum and nickel did not change. Patient-reported outcome measures (PROM) demonstrated a substantial improvement after TKA, without any differences between the groups. CONCLUSION The increase in chromium concentration in the standard group needs further investigation. If surgeons use coated implants, they can be confident that these implants perform as well as standard implants. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Anne Postler
- University Center of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Franziska Beyer
- University Center of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Cornelia Lützner
- University Center of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Eric Tille
- University Center of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Jörg Lützner
- University Center of Orthopaedics and Traumatology, University Medicine Carl Gustav Carus Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
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Beyer F, Lützner C, Kirschner S, Lützner J. Midterm Results After Coated and Uncoated TKA: A Randomized Controlled Study. Orthopedics 2016; 39:S13-7. [PMID: 27219721 DOI: 10.3928/01477447-20160509-10] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 02/03/2016] [Indexed: 02/03/2023]
Abstract
Patients undergoing total knee arthroplasty (TKA) who have hypersensitivity to metals usually receive hypoallergenic TKA implants. Coating of a standard implant is a common solution. Although in vitro tests have demonstrated reduction in polyethylene wear for these coatings, it is unknown whether these costly implants have a clinical benefit for patients. One hundred twenty patients undergoing TKA were randomly assigned to receive a novel 7-layer-coating implant or a standard TKA implant. One revision occurred in the standard group, resulting in a calculated 5-year survival of 100% in the coated group and 98.1% in the standard group. The Oxford Knee Score improved substantially in both groups from a mean of 21.6 points preoperatively in the coated group and 21.9 points in the standard group to 39.2 points and 39.2 points, respectively. The current authors observed no adverse effects with the new coating during midterm follow-up. However, longer follow-up time is needed to evaluate possible advantages of this coating. [Orthopedics. 2016; 39(3):S13-S17.].
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Vasconcelos DM, Santos SG, Lamghari M, Barbosa MA. The two faces of metal ions: From implants rejection to tissue repair/regeneration. Biomaterials 2016; 84:262-275. [DOI: 10.1016/j.biomaterials.2016.01.046] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 01/20/2016] [Accepted: 01/21/2016] [Indexed: 12/20/2022]
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Revell PA, Matharu GS, Mittal S, Pynsent PB, Buckley CD, Revell MP. Increased expression of inducible co-stimulator on CD4+ T-cells in the peripheral blood and synovial fluid of patients with failed hip arthroplasties. Bone Joint Res 2016; 5:52-60. [PMID: 26868893 PMCID: PMC4852791 DOI: 10.1302/2046-3758.52.2000574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 12/09/2015] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES T-cells are considered to play an important role in the inflammatory response causing arthroplasty failure. The study objectives were to investigate the composition and distribution of CD4+ T-cell phenotypes in the peripheral blood (PB) and synovial fluid (SF) of patients undergoing revision surgery for failed metal-on-metal (MoM) and metal-on-polyethylene (MoP) hip arthroplasties, and in patients awaiting total hip arthroplasty. METHODS In this prospective case-control study, PB and SF were obtained from 22 patients (23 hips) undergoing revision of MoM (n = 14) and MoP (n = 9) hip arthroplasties, with eight controls provided from primary hip osteoarthritis cases awaiting arthroplasty. Lymphocyte subtypes in samples were analysed using flow cytometry. RESULTS The percentages of CD4+ T-cell subtypes in PB were not different between groups. The CD4+ T-cells in the SF of MoM hips showed a completely different distribution of phenotypes compared with that found in the PB in the same patients, including significantly decreased CD4+ T-central memory cells (p < 0.05) and increased T-effector memory cells (p < 0.0001) in the SF. Inducible co-stimulator (ICOS) was the only co-stimulatory molecule with different expression on CD4+ CD28+ cells between groups. In PB, ICOS expression was increased in MoM (p < 0.001) and MoP (p < 0.05) cases compared with the controls. In SF, ICOS expression was increased in MoM hips compared with MoP hips (p < 0.05). CONCLUSIONS Increased expression of ICOS on CD4+ T-cells in PB and SF of patients with failed arthroplasties suggests that these cells are activated and involved in generating immune responses. Variations in ICOS expression between MoM and MoP hips may indicate different modes of arthroplasty failure.Cite this article: Professor P. A. Revell. Increased expression of inducible co-stimulator on CD4+ T-cells in the peripheral blood and synovial fluid of patients with failed hip arthroplasties. Bone Joint Res 2016;5:52-60. doi: 10.1302/2046-3758.52.2000574.
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Affiliation(s)
- P A Revell
- The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Birmingham B31 2AP, UK
| | - G S Matharu
- The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Birmingham B31 2AP, UK
| | - S Mittal
- University of Birmingham, Edgbaston, Birmingham B15 2WD, UK
| | - P B Pynsent
- The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Birmingham B31 2AP, UK
| | - C D Buckley
- University of Birmingham, Edgbaston, Birmingham B15 2WD, UK
| | - M P Revell
- The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Birmingham B31 2AP, UK
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Incidence of adverse wear reactions in hip resurfacing arthroplasty: a single surgeon series of 2,600 cases. Hip Int 2014; 23:250-8. [PMID: 23760745 DOI: 10.5301/hipint.5000030] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/04/2013] [Indexed: 02/04/2023]
Abstract
A single surgeon performed 2,559 metal-on-metal hip resurfacing arthroplasties in
2,109 patients. The Corin Cormet 2000 (393 cases) and Biomet Recap implants (2,166 cases) were used in our series. In this study, the adverse wear failure (AWF) rate was 0.27%. At 10 years postoperatively, our Kaplan-Meier cumulative revision rate for AWF was 1% for all patients, 0.2% for men, 2.6% for women, and 9% for patients with a diagnosis of dysplasia. All AWF failures had component sizes ≤48 mm. All had metal ion levels above 15 ug/ml. All had acetabular inclination angles (AIA) ≥50° on standing pelvis radiographs. All had severe metallosis found at the time of revision. Six of the seven AWF cases were in women. There were no failures from pseudotumours without AWF (metallosis) in this series.
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Lützner J, Hartmann A, Dinnebier G, Spornraft-Ragaller P, Hamann C, Kirschner S. Metal hypersensitivity and metal ion levels in patients with coated or uncoated total knee arthroplasty: a randomised controlled study. INTERNATIONAL ORTHOPAEDICS 2013; 37:1925-31. [PMID: 23860793 PMCID: PMC3779567 DOI: 10.1007/s00264-013-2010-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 06/24/2013] [Indexed: 12/23/2022]
Abstract
PURPOSE Metal ion release by orthopaedic implants may cause local and systemic effects and induce hypersensitivity reactions. Coated implants have been developed to prevent or reduce these effects. This study was initiated to investigate the safety of a novel coating for total knee arthroplasty (TKA) implants. METHODS A total of 120 patients undergoing primary TKA with no history of hypersensitivity and no other metal implant were randomised to receive either a coated or uncoated implant. Chromium (Cr), cobalt (Co), molybdenum (Mb) and nickel (Ni) hypersensitivity patch testing and plasma ion concentrations were evaluated pre-operatively and one year post-operatively. RESULTS At the one year follow-up both groups demonstrated significant improvement in knee function and quality of life. One new weakly positive reaction to Co in the TKA group with coated implant and two doubtful skin reactions to Ni (one in each group) were noted. Even with sensitisation to implant materials no skin reactions were observed. Plasma metal ion concentrations did not increase and were not elevated at the one year follow-up in either group. CONCLUSIONS Sensitisation after TKA was rare and had no influence on clinical results. TKA with coated implant and standard TKA demonstrated no plasma metal ion elevation.
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Affiliation(s)
- Jörg Lützner
- Department of Orthopaedic Surgery, University Hospital Carl Gustav Carus, Medical Faculty of the Technical University of Dresden, Fetscherstr. 74, 01307, Dresden, Germany,
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Liu F, Chen Z, Gu Y, Wang Q, Cui W, Fan W. Deformation of the Durom acetabular component and its impact on tribology in a cadaveric model--a simulator study. PLoS One 2012; 7:e45786. [PMID: 23144694 PMCID: PMC3483233 DOI: 10.1371/journal.pone.0045786] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 08/22/2012] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Recent studies have shown that the acetabular component frequently becomes deformed during press-fit insertion. The aim of this study was to explore the deformation of the Durom cup after implantation and to clarify the impact of deformation on wear and ion release of the Durom large head metal-on-metal (MOM) total hips in simulators. METHODS Six Durom cups impacted into reamed acetabula of fresh cadavers were used as the experimental group and another 6 size-paired intact Durom cups constituted the control group. All 12 Durom MOM total hips were put through a 3 million cycle (MC) wear test in simulators. RESULTS The 6 cups in the experimental group were all deformed, with a mean deformation of 41.78 ± 8.86 µm. The average volumetric wear rate in the experimental group and in the control group in the first million cycle was 6.65 ± 0.29 mm(3)/MC and 0.89 ± 0.04 mm(3)/MC (t = 48.43, p = 0.000). The ion levels of Cr and Co in the experimental group were also higher than those in the control group before 2.0 MC. However there was no difference in the ion levels between 2.0 and 3.0 MC. CONCLUSIONS This finding implies that the non-modular acetabular component of Durom total hip prosthesis is likely to become deformed during press-fit insertion, and that the deformation will result in increased volumetric wear and increased ion release. CLINICAL RELEVANCE This study was determined to explore the deformation of the Durom cup after implantation and to clarify the impact of deformation on wear and ion release of the prosthesis. Deformation of the cup after implantation increases the wear of MOM bearings and the resulting ion levels. The clinical use of the Durom large head prosthesis should be with great care.
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Affiliation(s)
- Feng Liu
- Department of Orthopedics, the First Affiliated Hospital with Nanjing Medical University, Nanjing, China
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Metal-on-metal bearings, inflammatory pseudotumours and their neurological manifestations. Hip Int 2012; 22:129-36. [PMID: 22476931 DOI: 10.5301/hip.2012.9185] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/17/2012] [Indexed: 02/04/2023]
Abstract
Metal-on-metal bearings have become more popular for hip arthroplasty in younger patients in the last 15 years. We present a review of the neurological consequences relating to such bearing surfaces illustrated by an appropriate case report. The mechanisms of increased metal ion production and pseudotumour formation are discussed. If unexplained neurology, hip/groin pain or a localised mass around the hip are present with a metal bearing hip then urgent referral to a specialist orthopaedic surgeon is warranted for consideration of exchange arthroplasty.
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Sampson B, Hart A. Clinical usefulness of blood metal measurements to assess the failure of metal-on-metal hip implants. Ann Clin Biochem 2012; 49:118-31. [PMID: 22155921 PMCID: PMC4527411 DOI: 10.1258/acb.2011.011141] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2011] [Indexed: 02/06/2023]
Abstract
In April 2010, a Medicines and Healthcare Products Regulatory Agency safety alert concerning all metal-on-metal (MOM) hip replacements recommended measuring chromium and cobalt concentrations when managing patients with painful prostheses. The need for this review is illustrated by the recent surge in requests for these blood tests from orthopaedic surgeons following this alert. The aim is to provide guidance to laboratories in assessing these requests and advising clinicians on interpretation. First, we summarize the basic terminology regarding the types of hip replacements, with emphasis on the MOM type. Second, we describe the clinical concerns over implant-derived wear debris in the local tissues and distant sites. Analytical aspects of the measurement of the relevant metal ions and what factors affect the levels measured are discussed. The application of inductively coupled plasma mass spectrometry techniques to the measurement of these metals is considered in detail. The biological effects of metal wear products are summarized with local toxicity and systemic biological effects considered, including carcinogenicity, genotoxicity and systemic toxicity. Clinical cases are used to illustrate pertinent points.
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Affiliation(s)
- Barry Sampson
- Department of Clinical Biochemistry, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Road, London, UK.
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Lein T, Schlee J, Kothe M, Moritz F, Wubtaye D. Periprothetische intertrochantäre Femurfraktur nach Oberflächenersatz des Hüftgelenks. Unfallchirurg 2010; 113:944-50. [DOI: 10.1007/s00113-009-1714-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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