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Kaplan LM, Siljander MP, Verner JJ, Baker KC, Gehrke CK, Salisbury MR, Baker EA. Analysis of Retrieved Unicompartmental Knee Implants and Tissue: Third-Body Wear as a Potential Contributor to Progression of Arthritis to Adjacent Compartments. Orthopedics 2019; 42:149-157. [PMID: 31099880 DOI: 10.3928/01477447-20190424-06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 04/03/2019] [Indexed: 02/03/2023]
Abstract
Unicompartmental knee arthroplasty (UKA) for the treatment of single-compartment osteoarthritis has been associated with polyethylene wear and progression of osteoarthritis into adjacent compartments, leading to revision. In this study, damage and clinical failure modes of retrieved UKA implants were investigated and protein expression profiles between articular cartilage adjacent to UKA and primary osteoarthritic cartilage were compared. Fifty retrieved UKA implants were analyzed for various damage. Records review and radiographic analysis were performed to collect clinical data and implant characteristics. Cartilage harvested from revision UKA and primary total knee arthroplasty surgeries was characterized with a proteome profiling array detecting levels of 36 different cytokines, chemokines, and acute phase inflammatory proteins. Progression of osteoarthritis (n=18, 36%) and component loosening (n=17, 34%) were the most common reasons for revision. Liners exhibited the highest frequency of damage modes. Progression of arthritis positively correlated with radiographic presence of extruded bone cement and burnishing of liner components. A protein-level profile between revision UKA and primary total knee arthroplasty cartilage showed 12 differentially expressed cytokines. Failure of UKA may be secondary to the effects of wear debris particulate migration into the adjacent compartment, suggesting an additional pathway of cartilage damage manifesting as traditional clinical symptoms. [Orthopedics. 2019; 42(3):149-157.].
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Su CY, Huang SS, Fang HW. Effects of Major Components of Synovial Fluid on the Morphology and Wear Rate of Polyetheretherketone (PEEK) Particles under an Accelerated Wear Process. Polymers (Basel) 2018; 10:polym10060635. [PMID: 30966669 PMCID: PMC6403845 DOI: 10.3390/polym10060635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 06/05/2018] [Accepted: 06/06/2018] [Indexed: 12/03/2022] Open
Abstract
Wear particle-induced biological responses are the major factors for the failure of total joint arthroplasties, but it is possible to improve the lubrication and reduce the wear of an artificial joint system. Polyetheretherketone (PEEK), with ultra-high molecular weight polyethylene, is a suitable bearing material due to its resistance to fatigue strain. However, the effects of major compositions of synovial fluid on the wear of PEEK are unclear. We characterized the effects of three major components of synovial fluid including albumin, globulin, and phospholipids on the morphology and wear rate of PEEK wear particles. Our results demonstrated that the concentrations of albumin and globulin could affect the morphology of PEEK wear particles. In addition, a higher concentration of globulin and phospholipids (12.5 mg/mL) resulted in an increase in the amount of wear particles by 2.8- and 1.7-fold, respectively. In contrast, increasing albumin caused a reduction of wear particle numbers. These results indicate increasing concentration of albumin or reducing concentration of globulin or phospholipids has a better effect on reducing the numbers of wear particles and provides a potential solution of reducing PEEK wear particles, thus it can be more effectively applied in other biomedical systems.
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Affiliation(s)
- Chen-Ying Su
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology, 1, Sec. 3, Zhongxiao E. Rd., Taipei 10608, Taiwan.
| | - Shih-Shuan Huang
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology, 1, Sec. 3, Zhongxiao E. Rd., Taipei 10608, Taiwan.
| | - Hsu-Wei Fang
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology, 1, Sec. 3, Zhongxiao E. Rd., Taipei 10608, Taiwan.
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, No. 35, Keyan Road, Zhunan Town, Miaoli County 35053, Taiwan.
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Chen W, Bichara DA, Suhardi J, Sheng P, Muratoglu OK. Effects of vitamin E-diffused highly cross-linked UHMWPE particles on inflammation, apoptosis and immune response against S. aureus. Biomaterials 2017; 143:46-56. [DOI: 10.1016/j.biomaterials.2017.07.028] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 07/17/2017] [Accepted: 07/20/2017] [Indexed: 01/31/2023]
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Silverstein AM, Stefani RM, Sobczak E, Tong EL, Attur MG, Shah RP, Bulinski JC, Ateshian GA, Hung CT. Toward understanding the role of cartilage particulates in synovial inflammation. Osteoarthritis Cartilage 2017; 25:1353-1361. [PMID: 28365462 PMCID: PMC5554538 DOI: 10.1016/j.joca.2017.03.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 03/03/2017] [Accepted: 03/23/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Arthroscopy with lavage and synovectomy can remove tissue debris from the joint space and the synovial lining to provide pain relief to patients with osteoarthritis (OA). Here, we developed an in vitro model to study the interaction of cartilage wear particles with fibroblast-like synoviocytes (FLS) to better understand the interplay of cartilage particulates with cytokines on cells of the synovium. METHOD In this study sub-10 μm cartilage particles or 1 μm latex particles were co-cultured with FLS ±10 ng/mL interleukin-1α (IL-1α) or tumor necrosis factor-α (TNF-α). Samples were analyzed for DNA, glycosaminoglycan (GAG), and collagen, and media samples were analyzed for media GAG, nitric oxide (NO) and prostaglandin-E2 (PGE2). The nature of the physical interaction between the particles and FLS was determined by microscopy. RESULTS Both latex and cartilage particles could be phagocytosed by FLS. Cartilage particles were internalized and attached to the surface of both dense monolayers and individual cells. Co-culture of FLS with cartilage particulates resulted in a significant increase in cell sheet DNA and collagen content as well as NO and PGE2 synthesis compared to control and latex treated groups. CONCLUSION The proliferative response of FLS to cartilage wear particles resulted in an overall increase in extracellular matrix (ECM) content, analogous to the thickening of the synovial lining observed in OA patients. Understanding how cartilage particles interface with the synovium may provide insight into how this interaction contributes to OA progression and may guide the role of lavage and synovectomy for degenerative disease.
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Affiliation(s)
- Amy M. Silverstein
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Robert M. Stefani
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Evie Sobczak
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Eric L. Tong
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Mukundan G. Attur
- Division of Rheumatology, Department of Medicine, New York University School of Medicine and NYU Langone Medical Center, New York, NY, USA
| | - Roshan P. Shah
- Department of Orthopedic Surgery, Columbia University, New York, NY, USA
| | - J. Chloe Bulinski
- Department of Biological Sciences, Columbia University, New York, NY, USA
| | - Gerard A. Ateshian
- Department of Biomedical Engineering, Columbia University, New York, NY, USA,Department of Mechanical Engineering, Columbia University, New York, NY, USA
| | - Clark T. Hung
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
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5
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Electrostatic field may regulate proliferation and immune responses of macrophages induced by polyethylene wear particles. J Taiwan Inst Chem Eng 2017. [DOI: 10.1016/j.jtice.2017.04.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Kurdziel MD, Salisbury M, Kaplan L, Maerz T, Baker KC. Exposure of articular chondrocytes to wear particles induces phagocytosis, differential inflammatory gene expression, and reduced proliferation. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2017; 28:106. [PMID: 28534289 DOI: 10.1007/s10856-017-5917-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 05/10/2017] [Indexed: 06/07/2023]
Abstract
The production of wear debris particulate remains a concern due to its association with implant failure through complex biologic interactions. In the setting of unicompartmental knee arthroplasty (UKA), damage and wear of the components may introduce debris particulate into the adjacent, otherwise, healthy compartment. The purpose of this study was to investigate the in vitro effect of polymeric and metallic wear debris particles on cell proliferation, extracellular matrix regulation, and phagocytosis index of normal human articular chondrocytes (nHACs). In culture, nHACs were exposed to both cobalt-chromium-molybdenum (CoCrMo) and polymethyl-methacrylate (PMMA) wear debris particulate for 3 and 10 days. At 3 days, no significant difference in cell proliferation was found between control cells and cells exposed to both CoCrMo or PMMA particles. However, cell proliferation was significantly decreased for CoCrMo exposed nHACs at both 6 (P < 0.001) and 10 days (P < 0.001) and PMMA at 10 days (P < 0.001). Target gene expression displayed both a time- and material-dependent response to CoCrMo and PMMA particles. Significant differences in COL10A1, ACAN, VCAN, IL-1β, TNF-α, MMP3, ADAMTS1, CASP3, and CASP9 regulation were found between CoCrMo and PMMA exposed nHACs at day 3 with gene regulation returning to near baseline at 10 days. Results from our study indicate a role of wear debris induced cartilage degeneration after exposure to polymeric and metallic wear debris particulate, suggesting an additional pathway of cartilage breakdown, potentially manifesting in traditional clinical symptoms.
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Affiliation(s)
- Michael D Kurdziel
- Department of Orthopaedic Research, Beaumont Health, Royal Oak, MI, USA
- Department of Orthopaedic Surgery, Oakland University-William Beaumont School of Medicine, Rochester, MI, USA
| | - Meagan Salisbury
- Department of Orthopaedic Research, Beaumont Health, Royal Oak, MI, USA
| | - Lige Kaplan
- Department of Orthopaedic Surgery, Oakland University-William Beaumont School of Medicine, Rochester, MI, USA
- Department of Orthopaedic Surgery, Beaumont Health, Royal Oak, MI, USA
| | - Tristan Maerz
- Department of Orthopaedic Research, Beaumont Health, Royal Oak, MI, USA
- Department of Orthopaedic Surgery, Oakland University-William Beaumont School of Medicine, Rochester, MI, USA
| | - Kevin C Baker
- Department of Orthopaedic Research, Beaumont Health, Royal Oak, MI, USA.
- Department of Orthopaedic Surgery, Oakland University-William Beaumont School of Medicine, Rochester, MI, USA.
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Utzschneider S, Lorber V, Dedic M, Paulus AC, Schröder C, Gottschalk O, Schmitt-Sody M, Jansson V. Biological activity and migration of wear particles in the knee joint: an in vivo comparison of six different polyethylene materials. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2014; 25:1599-1612. [PMID: 24562818 DOI: 10.1007/s10856-014-5176-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 02/10/2014] [Indexed: 06/03/2023]
Abstract
Wear of polyethylene causes loosening of joint prostheses because of the particle mediated activity of the host tissue. It was hypothesized that conventional and crosslinked polyethylene particles lead to similar biological effects around the knee joint in vivo as well as to a similar particle distribution in the surrounding tissues. To verify these hypotheses, particle suspensions of six different polyethylene materials were injected into knee joints of Balb/C mice and intravital microscopic, histological and immunohistochemical evaluations were done after 1 week. Whereas the biological effects on the synovial layer and the subchondral bone of femur and tibia were similar for all the polyethylenes, two crosslinked materials showed an elevated cytokine expression in the articular cartilage. Furthermore, the distribution of particles around the joint was dependent on the injected polyethylene material. Those crosslinked particles, which remained mainly in the joint space, showed an increased expression of TNF-alpha in articular cartilage. The data of this study support the use of crosslinked polyethylene in total knee arthroplasty. In contrast, the presence of certain crosslinked wear particles in the joint space can lead to an elevated inflammatory reaction in the remaining cartilage, which challenges the potential use of those crosslinked polyethylenes for unicondylar knee prostheses.
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Affiliation(s)
- S Utzschneider
- Department of Orthopedic Surgery, University Hospital of Munich (LMU), Campus Großhadern, Marchioninistraße 15, 81377, Munich, Germany,
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Chang CH, Hsu YM, Chen YC, Lin FH, Sadhasivam S, Loo ST, Savitha S. Anti-inflammatory effects of hydrophilic and lipophilic statins with hyaluronic acid against LPS-induced inflammation in porcine articular chondrocytes. J Orthop Res 2014; 32:557-65. [PMID: 24302463 DOI: 10.1002/jor.22536] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 11/14/2013] [Indexed: 02/04/2023]
Abstract
The objective of the study is to understand the therapeutic effects of lipophilic (simvastatin) and hydrophilic statins (pravastatin) combined with/without hyaluronic acid for osteoarthritis by an in vitro LPS-induced inflammatory model of articular chondrocytes. HA in combination with different doses of simvastatin or pravastatin were used. Beside cytotoxicity, the influence of statins on NO production, pro-inflammatory cytokine, inflammatory mediators, and NF-κB p50 protein were analyzed. Finally, TUNEL assay was performed to detect DNA strand breakage. Two statins were less able to lower NF-κB activity when they were administrated along without HA. The gene expression demonstrates that simvastatin and pravastatin had the ability to decrease pro-inflammatory and inflammatory mediator levels. High dose simvastatin with or without HA down regulated inflammatory cytokines, but resulted in higher cytotoxicity. TUNEL assay confirms the regulatory effect of statins with or without HA over the apoptosis of chondrocytes, especially in hydrophilic statins. The significant down-regulation of inflammatory mediators suggests that intra-articular injection of HA in combination with statins might feasibly slow the progress of osteoarthritis. Administration of simvastatin or pravastatin with hyaluronic acid may produce beneficial effects for OA treatment, but with better results when hydrophilic statin was used.
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Affiliation(s)
- Chih-Hung Chang
- Division of Orthopaedics, Department of Surgery, Far Eastern Memorial Hospital, No. 21, Nan-Ya South Road, Sec. 2 Pan-Chia Dict., New Taipei City, Taiwan; Graduate School of Biotechnology and Bioengineering, Yuan Ze University, Taoyuan, Taiwan; Department of Orthopaedics Surgery, National Taiwan University Hospital, Taipei, Taiwan
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Lorber V, Paulus AC, Buschmann A, Schmitt B, Grupp TM, Jansson V, Utzschneider S. Elevated cytokine expression of different PEEK wear particles compared to UHMWPE in vivo. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2014; 25:141-149. [PMID: 24068541 DOI: 10.1007/s10856-013-5037-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Accepted: 08/23/2013] [Indexed: 06/02/2023]
Abstract
Due to their mechanical properties, there has been growing interest in poly-ether-ether-ketone (PEEK) and its composites as bearing material in total and unicompartmental knee arthroplasty. The aim of this study was to analyze the biological activity of wear particles of two different (pitch and PAN) carbon-fiber-reinforced- (CFR-) PEEK varieties in comparison to ultra-high-molecular-weight-polyethylene (UHMWPE) in vivo. The authors hypothesized no difference between the used biomaterials. Wear particle suspensions of the particulate biomaterials were injected into knee joints of Balb/c mice, which were sacrificed after seven days. The cytokine expression (IL-1β, IL-6, TNF-α) was analyzed immunohistochemically in the synovial layer, the adjacent bone marrow and the articular cartilage. Especially in the bone marrow of the two CFR-PEEK varieties there were increased cytokine expressions compared to the control and UHMWPE group. Furthermore, in the articular cartilage the CFR-PEEK pitch group showed an enhanced cytokine expression, which could be a negative predictor for the use in unicondylar knee systems. As these data suggest an increased proinflammatory potential of CFR-PEEK and its composites in vivo, the initial hypothesis had to be refuted. Summarizing these results, CFR-PEEK seems not to be an attractive alternative to UHMWPE as a bearing material, especially in unicompartmental knee arthroplasty.
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Affiliation(s)
- V Lorber
- Department of Orthopedic Surgery, University Hospital of Munich (LMU), Campus Großhadern, Marchioninistraße 15, 81377, Munich, Germany
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Park DY, Min BH, Kim DW, Song BR, Kim M, Kim YJ. Polyethylene wear particles play a role in development of osteoarthritis via detrimental effects on cartilage, meniscus, and synovium. Osteoarthritis Cartilage 2013; 21:2021-9. [PMID: 24161707 DOI: 10.1016/j.joca.2013.09.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 08/31/2013] [Accepted: 09/28/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE While ultra-high molecular weight polyethylene (UHMWPE) wear particles are known to cause periprosthetic osteolysis, its interaction with other intra-articular tissues in the case of partial joint arthroplasties is not well understood. We hypothesized that UHMWPE particles per se would interact with intra-articular tissue, which by acting as inflammatory reservoirs, would subsequently induce osteoarthritic (OA) changes. Our goal was to assess the inflammatory response, phagocytic activity, as well as apoptosis of intra-articular cells in the presence of UHMWPE particles in vitro, and the in vivo response of those tissues after intra-articular injection of particles in a murine model. DESIGN Three cell types were used for the in vitro study; chondrocytes, meniscal fibrochondrocytes, and synoviocytes. Each cell type was cultured with two different concentrations of UHMWPE particles. Pro-inflammatory cytokine production, phagocytosis, and apoptosis were analyzed. In vivo experiments were done by injecting two concentrations of UHMWPE particles into normal and murine OA model knee joints. RESULTS In vitro experiments showed that UHMWPE particles increase pro-inflammatory cytokine and mediator (IL-1β, IL-6, TNF-α, Nitric Oxide, and Prostaglandin E2) production, phagocytosis of particles, and apoptosis in all cell types. In vivo experiment showed degeneration of cartilage and meniscus, as well as synovitis after particle injection. CONCLUSIONS UHMWPE wear particles per se exert detrimental effects in cartilage, synovium, and meniscus of the knee joint resulting in pro-inflammatory cytokine release, phagocytosis of particles and apoptosis. Particles induced and exacerbated OA changes in a murine model.
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Affiliation(s)
- D Y Park
- Department of Anatomy, Ajou University School of Medicine, San 5 Wonchon-dong, Youngtong-gu, Suwon, Kyounggi-do 443-721, Republic of Korea.
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Kretzer JP, Zietz C, Schröder C, Reinders J, Middelborg L, Paulus A, Sonntag R, Bader R, Utzschneider S. [Principles of tribological analysis of endoprostheses]. DER ORTHOPADE 2013; 41:844-52. [PMID: 23052851 DOI: 10.1007/s00132-012-1948-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
For the tribological characterization of artificial joints, various experimental methods are currently available. However, the in vitro test conditions applied are only comparable in a limited way and transferability to the in vivo situation is also restricted. This is due to the different wear simulation concepts used and partly insufficient simulation of clinical worst case situations. In the present paper current scientific methods and procedures for tribological testing of artificial joints are presented. In addition, the biological effects of wear products are described enabling clinicians to challenge tribological studies and to facilitate specific interpretation of scientific results taking the clinical situation into account.
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Affiliation(s)
- J P Kretzer
- Labor für Biomechanik und Implantatforschung, Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Heidelberg, 69120, Heidelberg, Deutschland.
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Stanek A, Cieślar G, Romuk E, Kasperczyk S, Sieroń-Stołtny K, Birkner E, Sieroń A. Decrease in antioxidant status of plasma and erythrocytes from patients with ankylosing spondylitis. Clin Biochem 2010; 43:566-70. [DOI: 10.1016/j.clinbiochem.2009.12.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Revised: 12/12/2009] [Accepted: 12/14/2009] [Indexed: 02/04/2023]
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