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Sun R, Vats K, Jn Baptiste J, Adeeb S, Jomha N, Westover L. Comparison of wear on articular cartilage by titanium alloy, ultra-high-molecular-weight polyethylene, and carbon fibre reinforced polyether-ether-ketone: A pilot study. Med Eng Phys 2023; 120:104042. [PMID: 37838396 DOI: 10.1016/j.medengphy.2023.104042] [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: 09/24/2021] [Revised: 08/15/2023] [Accepted: 08/25/2023] [Indexed: 10/16/2023]
Abstract
Artificial implant materials may articulate against native articular cartilage in certain clinical scenarios and the selection of an implant material that results in the least wear on articular cartilage is preferred to maintain normal joint architecture and function. This project compared the wear on porcine femoral condyles induced by articulation against porcine patellae, titanium alloy (Ti6Al4V), ultra high molecular weight polyethylene (UHMWPE), and carbon fibre reinforced polyether-ether-ketone (CFR-PEEK) through an ex vivo experimental setup. A sinusoidal compressive load of 30-160 N, representing an approximate joint pressure of 0.19-1 MPa at a frequency of 3 Hz coupled with a rotational displacement of +/- 10⁰ at 3 Hz was used to simulate physiological joint motion. Wear was characterized via gross examination and histologically using the OARSI scoring system after 43,200 cycles. CFR-PEEK resulted in the most significant wear on articular cartilage compared to titanium alloy and UHMWPE whereas titanium alloy and UHMWPE resulted in similar levels of wear. All materials caused more wear compared to cartilage-on-cartilage testing. The wear mechanism was characterized by progressive loss of proteoglycan content in cartilage in histology samples.
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Affiliation(s)
- Ruixiang Sun
- Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton AB Canada
| | - Karan Vats
- Department of Biomedical Engineering, Faculty of Engineering, University of Alberta, Edmonton AB Canada
| | - Jonelle Jn Baptiste
- Department of Civil and Environmental Engineering, Faculty of Engineering, University of Alberta, Edmonton AB Canada
| | - Samer Adeeb
- Department of Civil and Environmental Engineering, Faculty of Engineering, University of Alberta, Edmonton AB Canada
| | - Nadr Jomha
- Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton AB Canada
| | - Lindsey Westover
- Department of Biomedical Engineering, Faculty of Engineering, University of Alberta, Edmonton AB Canada; Department of Mechanical Engineering, Faculty of Engineering, University of Alberta, Edmonton AB Canada.
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Bauer C, Moser LB, Kern D, Jeyakumar V, Nehrer S. The Combination of Glucocorticoids and Hyaluronic Acid Enhances Efficacy in IL-1β/IL-17-Treated Bovine Osteochondral Grafts Compared with Individual Application. Int J Mol Sci 2023; 24:14338. [PMID: 37762639 PMCID: PMC10531904 DOI: 10.3390/ijms241814338] [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: 08/17/2023] [Revised: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
Patients with knee osteoarthritis often receive glucocorticoid (GC) or hyaluronic acid (HA) injections to alleviate symptoms. This study evaluated the impact of Triamcinolone Hexacetonide (a GC), HA, and a combination of both on bovine osteochondral grafts exposed to IL-1β and IL-17 in an ex vivo culture. Metabolic activity increased with GC treatment. GCs and GCs/HA counteracted cytokine effects, with gene expressions similar to untreated controls, while HA alone did not. However, HA improved the coefficient of friction after two weeks. The highest friction values were observed in GC-containing and cytokine-treated groups. Cytokine treatment reduced tissue proteoglycan content, which HA could mitigate, especially in the GC/HA combination. This combo also effectively controlled proteoglycan release, supported by reduced sGAG release. Cytokine treatment led to surface cell death, while GCs, HA, or their combination showed protective effects against inflammation. The GC/HA combination had the best overall results, suggesting its potential as a superior treatment option for osteoarthritis.
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Affiliation(s)
- Christoph Bauer
- Center for Regenerative Medicine, University for Continuing Education Krems, 3500 Krems, Austria
| | - Lukas B. Moser
- Department of Orthopedics, University Hospital Krems, 3500 Krems, Austria
| | - Daniela Kern
- Center for Regenerative Medicine, University for Continuing Education Krems, 3500 Krems, Austria
| | - Vivek Jeyakumar
- Center for Regenerative Medicine, University for Continuing Education Krems, 3500 Krems, Austria
| | - Stefan Nehrer
- Center for Regenerative Medicine, University for Continuing Education Krems, 3500 Krems, Austria
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3
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Annapareddy A, Mulpur P, Jayakumar T, Kikkuri RR, Suhas Masilamani AB, V R, Vaishya R, Reddy AVG. Patella non-resurfacing in primary total knee arthroplasty provides good functional results-a retrospective review of nine thousand three hundred forty six knees. INTERNATIONAL ORTHOPAEDICS 2023:10.1007/s00264-023-05819-5. [PMID: 37186286 DOI: 10.1007/s00264-023-05819-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 04/18/2023] [Indexed: 05/17/2023]
Abstract
PURPOSE Patellar resurfacing has long been a contentious subject in TKA with no consensus and the literature yielding disparate results. The aim of this study was to evaluate the long-term functional outcomes and complications of patients undergoing primary TKA without patellar resurfacing (non-resurfacing). METHODS This study retrospectively analysed 9346 patients who underwent primary manual jig-based TKA without patellar resurfacing at a single high-volume arthroplasty centre between 2010 and 2018. Patients with a minimum three year follow-up irrespective of disease etiology and implant manufacturer were included in the study. Primary outcome was measured using Oxford knee score and patellofemoral Feller score. Secondary outcomes included determining the incidence of patellofemoral complications and re-operation rates following TKA. RESULTS A total of 8695 knees were eligible for final evaluation having a mean follow-up of 6.6 years. Mean age of the patients was 62.6 (SD-7.5) years with female predominance of (N-6619, 70.8%). The majority of the patients had primary OA (N-8792, 94.1%) with varus deformity (N-8642, 92.46%). Depuy was the most used manufacturer (n = 2592, 26.4%) with the posterior stabilised (N-4127, 44.2%) design being the most predominant. The mean Feller score of the study population was 24.5 (SD = 3) with a majority of patients having good to excellent outcomes (86.95%, N-8424) and mean Oxford knee score was 36.9 (SD-6.9) with a majority of the patients having an OKS greater than 30 (87.1%, N-8133) with anterior knee pain (AKP) reported in only 4.8% patients (N-418). Most common complications included patellar clunk (N-56, 0.7%), traumatic patellar fractures (N-62, 0.8%), quadriceps tendon tear (N-54, 0.7%) and patellar dislocation (N-4, 0.05%) CONCLUSION: Patellar non-resurfacing has no detrimental impact on functional outcomes and incidence of AKP. We conclude that it is a safe, cost-effective and satisfactory approach in primary TKA with no significant complications.
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Affiliation(s)
- Adarsh Annapareddy
- Sunshine Bone and Joint Institute, KIMS-Sunshine Hospitals, Hyderabad, India
| | - Praharsha Mulpur
- Sunshine Bone and Joint Institute, KIMS-Sunshine Hospitals, Hyderabad, India
| | - Tarun Jayakumar
- Sunshine Bone and Joint Institute, KIMS-Sunshine Hospitals, Hyderabad, India.
| | | | | | - Ratnakar V
- Sunshine Bone and Joint Institute, KIMS-Sunshine Hospitals, Hyderabad, India
| | | | - A V Gurava Reddy
- Sunshine Bone and Joint Institute, KIMS-Sunshine Hospitals, Hyderabad, India
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4
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Thampi P, Tabbaa SM, Johnstone B, Wimmer MA, Laurent MP, Wayne McIlwraith C, Frisbie DD. Surface topography as a tool to detect early changes in a posttraumatic equine model of osteoarthritis. J Orthop Res 2022; 40:1349-1357. [PMID: 34449916 DOI: 10.1002/jor.25175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 08/04/2021] [Accepted: 08/16/2021] [Indexed: 02/04/2023]
Abstract
The equine model of posttraumatic osteoarthritis (OA) mimics certain aspects of the naturally occurring disease, both in horses and humans. The objective of this study was to assess articular cartilage degeneration in a posttraumatic OA model using the established macroscopic and microscopic scoring systems and compare them with a novel surface topography analysis. OA was induced in the carpal joint of 15 (n = 15) mixed breed horses. Surface changes on the articular cartilage were characterized using osteochondral blocks from the third carpal bone (C3) and radial carpal bone using surface topography, standard histological grading, and gross evaluation of the joints. Significant differences were observed between OA and non-OA joints for gross evaluation scores. Microscopic scores of hematoxylin and eosin and Safranin O and Fast Green-stained sections demonstrated no differences between OA and non-OA joints. However, articular cartilage from the induced OA joint had significantly greater surface topography measurements compared with the sham treatment group, consistent with the changes seen on gross evaluation of joints. No significant correlations were noted between surface roughness measurements, histological assessment, and gross evaluation scores. The results suggest that surface topography analysis may provide a reliable objective approach to assess early changes in the cartilage surface in OA.
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Affiliation(s)
- Parvathy Thampi
- Department of Clinical Sciences, Orthopaedic Research Center & C. Wayne McIlwraith Translational Medicine Institute, Colorado State University, Fort Collins, Colorado, USA
| | - Suzanne M Tabbaa
- Department of Clinical Sciences, Orthopaedic Research Center & C. Wayne McIlwraith Translational Medicine Institute, Colorado State University, Fort Collins, Colorado, USA
| | - Brian Johnstone
- Department of Clinical Sciences, Orthopaedic Research Center & C. Wayne McIlwraith Translational Medicine Institute, Colorado State University, Fort Collins, Colorado, USA.,Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, Oregon, USA
| | - Marcus A Wimmer
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Michel P Laurent
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - C Wayne McIlwraith
- Department of Clinical Sciences, Orthopaedic Research Center & C. Wayne McIlwraith Translational Medicine Institute, Colorado State University, Fort Collins, Colorado, USA
| | - David D Frisbie
- Department of Clinical Sciences, Orthopaedic Research Center & C. Wayne McIlwraith Translational Medicine Institute, Colorado State University, Fort Collins, Colorado, USA
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5
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Bauer C, Göçerler H, Niculescu-Morzsa E, Jeyakumar V, Stotter C, Klestil T, Franek F, Nehrer S. Biotribological Tests of Osteochondral Grafts after Treatment with Pro-Inflammatory Cytokines. Cartilage 2021; 13:496S-508S. [PMID: 33596661 PMCID: PMC8808939 DOI: 10.1177/1947603521994900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE During osteoarthritis progression, cartilage degrades in a manner that influences its biomechanical and biotribological properties, while chondrocytes reduce the synthesis of extracellular matrix components and become apoptotic. This study investigates the effects of inflammation on cartilage under biomechanical stress using biotribological tests. METHODS Bovine osteochondral grafts from five animals were punched out from the medial condyle and treated with or without pro-inflammatory cytokines (interleukin-1β [IL-1β], tumor necrosis factor-α [TNF-α], IL-6) for 2 weeks. After incubation, biotribological tests were performed for 2 hours (alternating 10 minutes test and pause respectively at 39°C, 180 N, 1 Hz, and 2 mm stroke). Before and after testing, the cartilage surface was imaged with a 3-dimensional microscope. During testing, the coefficient of friction (COF) was measured, while gene expression analysis and investigation of metabolic activity of chondrocytes were carried out after testing. Histological sections of the tissue and wear debris from the test fluid were also analyzed. RESULTS After biotribological tests, surface cracks were found in both treated and untreated osteochondral grafts. In treated grafts, the COF increased, and the proteoglycan content in the cartilage tissue decreased, leading to structural changes. Chondrocytes from treated grafts showed increased expression of genes encoding for degradative enzymes, while cartilage-specific gene expression and metabolic activity exhibited no significant differences between treated and untreated groups. No measurable difference in the wear debris in the test fluid was found. CONCLUSIONS Treatment of osteochondral grafts with cytokines results in a significantly increased COF, while also leading to significant changes in cartilage proteoglycan content and cartilage matrix compression during biotribological tests.
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Affiliation(s)
- Christoph Bauer
- Department for Health Sciences, Medicine
and Research, Center for Regenerative Medicine, Danube University Krems, Krems,
Austria,Christoph Bauer, Center for Regenerative
Medicine, Department for Health Sciences, Medicine and Research, Danube
University Krems, Dr. Karl Dorrek Straße 30, Krems, 3500, Austria.
| | | | - Eugenia Niculescu-Morzsa
- Department for Health Sciences, Medicine
and Research, Center for Regenerative Medicine, Danube University Krems, Krems,
Austria
| | - Vivek Jeyakumar
- Department for Health Sciences, Medicine
and Research, Center for Regenerative Medicine, Danube University Krems, Krems,
Austria
| | - Christoph Stotter
- Department for Health Sciences, Medicine
and Research, Center for Regenerative Medicine, Danube University Krems, Krems,
Austria,LK Baden-Mödling-Hainburg, Department of
Orthopedics and Traumatology, Baden, Austria
| | - Thomas Klestil
- LK Baden-Mödling-Hainburg, Department of
Orthopedics and Traumatology, Baden, Austria,Center for Medical Specializations,
Department for Health Sciences, Medicine and Research, Danube University Krems,
Krems, Austria
| | | | - Stefan Nehrer
- Department for Health Sciences, Medicine
and Research, Center for Regenerative Medicine, Danube University Krems, Krems,
Austria
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Engelhardt JP, Schütte A, Hetjens S, Reisig G, Schwarz ML. Resilience to height loss of articular cartilage of osteoarthritic stifle joints of old pigs, compared with healthy cartilage from young pigs in a tribological pin-on-plate exposure, revealing similar friction forces. PLoS One 2021; 16:e0250244. [PMID: 33891624 PMCID: PMC8064609 DOI: 10.1371/journal.pone.0250244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 04/04/2021] [Indexed: 12/04/2022] Open
Abstract
Introduction We saw a lack of data on the biomechanical behavior of degenerated articular cartilage (OA) compared with that of healthy cartilage, even though the susceptibility to wear and tear of articular cartilage plays a key role in the progression of osteoarthritis (OA). Therefore, we performed a comparison between naturally occurring OA and healthy cartilage from pigs, before and after tribological stress. Aim The aim of the study was to compare OA-cartilage with healthy cartilage and to analyze the resilience to tribological shear stress, which will be measured as height loss (HL), and to friction forces of the cartilage layers. The findings will be substantiated in macro- and microscopical evaluations before and after tribological exposure. Methods We assessed stifle joints of fifteen old and sixteen young pigs from the local abattoir radiologically, macroscopically and histologically to determine possible OA alterations. We put pins from the femoral part of the joints and plates from the corresponding tibial plateaus in a pin-on-plate tribometer under stress for about two hours with about 1108 reciprocating cycles under a pressure of approximately 1 MPa. As a surrogate criterion of wear and tear, the HL was recorded in the tribometer. The heights of the cartilage layers measured before and after the tribological exposure were compared histologically. The condition of the cartilage before and after the tribological exposure was analyzed both macroscopically with an adapted ICRS score and microscopically according to Little et al. (2010). We assessed the friction forces acting between the surfaces of the cartilage pair–specimens. Results Articular cartilage taken from old pigs showed significant degenerative changes compared to that taken from the young animals. The macroscopic and microscopic scores showed strong alterations of the cartilage after the tribological exposure. There was a noticeable HL of the cartilage specimens after the first 100 to 300 cycles. The HL after tribological exposure was lower in the group of the old animals with 0.52 mm ± 0.23 mm than in the group of the young animals with 0.86 mm ± 0.26 mm (p < 0.0001). The data for the HL was validated by the histological height measurements with 0.50 mm ± 0.82 mm for the old and 0.79 mm ±0.53 mm for the young animals (p = 0.133). The friction forces measured at the cartilage of the old animals were 2.25 N ± 1.15 N and 1.89 N ± 1.45 N of the young animals (p = 0.3225). Conclusion Unlike articular cartilage from young pigs, articular cartilage from old pigs showed OA alterations. Tribological shear stress exposure revealed that OA cartilage showed less HL than healthy articular cartilage. Tribological stress exposure in a pin–on–plate tribometer seemed to be an appropriate way to analyze the mechanical stability of articular cartilage, and the applied protocol could reveal weaknesses of the assessed cartilage tissue. Friction and HL seemed to be independent parameters when degenerated and healthy articular cartilage were assessed under tribological exposure in a pin–on- plate tribometer.
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Affiliation(s)
- Jan P. Engelhardt
- Department of Experimental Orthopedics and Trauma Surgery, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Andy Schütte
- Department of Experimental Orthopedics and Trauma Surgery, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Svetlana Hetjens
- Department of Medical Statistics, University Medicine Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Gregor Reisig
- Department of Experimental Orthopedics and Trauma Surgery, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Markus L. Schwarz
- Department of Experimental Orthopedics and Trauma Surgery, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
- * E-mail:
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7
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Shekhawat VK, Hamilton JL, Pacione CA, Schmid TM, Wimmer MA. A MOVING CONTACT OF ARTICULATION ENHANCES THE BIOSYNTHETIC AND FUNCTIONAL RESPONSES OF ARTICULAR CARTILAGE. ACTA ACUST UNITED AC 2021; 26. [PMID: 33898693 DOI: 10.1016/j.biotri.2021.100180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Biomechanical influences play a fundamental role in the structural, functional, and biosynthetic properties of articular cartilage. During physiologic joint loading, the contact area between two surfaces migrates due to the primary and secondary motions of the joint. It has been demonstrated that a migratory contact area plays a critical role in reducing the coefficient of friction at the cartilage surface. However, a detailed analysis of the influences that a migratory contact area plays on the structural, functional, and biosynthetic properties remain to be explored. In this study, bovine cartilage explants were placed in a biotribometer. Explants were subjected to compression and shear forces of migratory contact area, namely moving contact (MC) articulation, or stationary contact area, namely stationary contact (SC) articulation. Free swelling explants were used as control. In a separate study, bovine cartilage-bone grafts were used for frictional testing. On histologic analysis, the SC group had evidence of surface fibrillations, which was not evident in the MC group. Compared to the SC group, the MC group cartilage explants had increased chondrocyte viability, increased lubricin synthesis, and comparable proteoglycan synthesis and release. MC articulation had reduced coefficient of friction as compared to SC articulation. MC articulation led to reduced surface roughness as compared to SC articulation. In conclusion, a migratory contact area can play an important role in maintaining the structural, function, and biosynthetic properties of articular cartilage. This study provides further evidence of the importance of migratory contact area and in vitro assessment of natural joint movement, which can be further evaluated in the context of cartilage homeostasis and disease.
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Affiliation(s)
- Vivek K Shekhawat
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL.,Department of Bioengineering, University of Illinois at Chicago, Chicago, IL
| | - John L Hamilton
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL
| | - Carol A Pacione
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL
| | - Thomas M Schmid
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL
| | - Markus A Wimmer
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL.,Department of Bioengineering, University of Illinois at Chicago, Chicago, IL
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8
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Parsons T, Al-Jabri T, Clement ND, Maffulli N, Kader DF. Patella resurfacing during total knee arthroplasty is cost-effective and has lower re-operation rates compared to non-resurfacing. J Orthop Surg Res 2021; 16:185. [PMID: 33706779 PMCID: PMC7948323 DOI: 10.1186/s13018-021-02295-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 02/10/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The decision to resurface the patella as part of total knee arthroplasty may be influenced by the surgeon's preference, education, training, tradition and geographic location. Advocates for non-resurfacing or selectively resurfacing may claim no difference in patient reported outcomes, and that resurfacing is associated with increased risks such as extensor mechanism injury or malalignment, problems with the design of the patella component and technical issues intraoperatively. AIMS To critically examine factors that should be considered in addition to patient reported outcomes in the decision process of resurfacing or non-resurfacing of the patella in total knee arthroplasty. METHOD A comprehensive literature search was conducted to identify factors that may influence decision making in addition to knee specific patient reported outcome measures such as surgical risks, patient quality of life, procedure cost, re-operation rate, implant design, surgeons learning curve and the fate of remaining cartilage in native patellae. RESULTS Patient-reported outcomes are equivocal for resurfacing and non-resurfacing. Critical analysis of the available literature suggests that the complications of resurfacing the patella are historic, which is now lower with improved implant design and surgical technique. Routine resurfacing was cost-effective in the long term (potential saving £104 per case) and has lower rates of revision (absolute risk reduction 4%). Finally, surgical judgment in selective resurfacing was prone to errors. CONCLUSION Patella resurfacing and non-resurfacing had similar patient-reported outcomes. However, patella resurfacing was cost-effective and was associated with a lower rate of re-operation compared to non-resurfacing.
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Affiliation(s)
- Thomas Parsons
- South West London Elective Orthopaedic Centre, Denbies Wing, Epsom General Hospital, Surrey, KT18 7EG UK
- Royal United Hospital Bath, Combe Park, Bath, Avon BA1 3NG UK
| | - Talal Al-Jabri
- Department of Surgery and Cancer, Imperial College London, London, SW7 2AZ England
| | - Nick D. Clement
- South West London Elective Orthopaedic Centre, Denbies Wing, Epsom General Hospital, Surrey, KT18 7EG UK
- Department of Orthopaedics, Royal Infirmary of Edinburgh, Little France, Edinburgh, EH16 4SA UK
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, SA Italy
- Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London, E1 4DG England
- School of Pharmacy and Bioengineering, Keele University School of Medicine, Stoke on Trent, ST5 5BG UK
| | - Deiary F. Kader
- South West London Elective Orthopaedic Centre, Denbies Wing, Epsom General Hospital, Surrey, KT18 7EG UK
- University of Kurdistan Hewler, Erbil, Iraq
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9
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Anisotropic properties of articular cartilage in an accelerated in vitro wear test. J Mech Behav Biomed Mater 2020; 109:103834. [PMID: 32543401 DOI: 10.1016/j.jmbbm.2020.103834] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 11/21/2022]
Abstract
Many material properties of articular cartilage are anisotropic, particularly in the superficial zone where collagen fibers have a preferential direction. However, the anisotropy of cartilage wear had not been previously investigated. The objective of this study was to evaluate the anisotropy of cartilage material behavior in an in vitro wear test. The wear and coefficient of friction of bovine condylar cartilage were measured with loading in directions parallel (longitudinal) and orthogonal (transverse) to the collagen fiber orientation at the articular surface. An accelerated cartilage wear test was performed against a T316 stainless-steel plate in a solution of phosphate buffered saline with protease inhibitors. A constant load of 160 N was maintained for 14000 cycles of reciprocal sliding motion at 4 mm/s velocity and a travel distance of 18 mm in each direction. The contact pressure during the wear test was approximately 2 MPa, which is in the range of that reported in the human knee and hip joint. Wear was measured by biochemically quantifying the glycosaminoglycans (GAGs) and collagen that was released from the tissue during the wear test. Collagen damage was evaluated with collagen hybridizing peptide (CHP), while visualization of the tissue composition after the wear test was provided with histologic analysis. Results demonstrated that wear in the transverse direction released about twice as many GAGs than in the longitudinal direction, but that no significant differences were seen in the amount of collagen released from the specimens. Specimens worn in the transverse direction had a higher intensity of CHP stain than those worn in the longitudinal direction, suggesting more collagen damage from wear in the transverse direction. No anisotropy in friction was detected at any point in the wear test. Histologic and CHP images demonstrate that the GAG loss and collagen damage extended through much of the depth of the cartilage tissue, particularly for wear in the transverse direction. These results highlight distinct differences between cartilage wear and the wear of traditional engineering materials, and suggest that further study on cartilage wear is warranted. A potential clinical implication of these results is that orienting osteochondral grafts such that the direction of wear is aligned with the primary fiber direction at the articular surface may optimize the life of the graft.
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10
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Stotter C, Stojanović B, Bauer C, Rodríguez Ripoll M, Franek F, Klestil T, Nehrer S. Effects of Loading Conditions on Articular Cartilage in a Metal-on-Cartilage Pairing. J Orthop Res 2019; 37:2531-2539. [PMID: 31334864 PMCID: PMC6899800 DOI: 10.1002/jor.24426] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 07/15/2019] [Indexed: 02/04/2023]
Abstract
The aim of this in vitro study was to investigate the response of articular cartilage to frictional load when sliding against a metal implant, and identify potential mechanisms of damage to articular cartilage in a metal-on-cartilage pairing. Bovine osteochondral cylinders were reciprocally slid against metal cylinders (cobalt-chromium-molybdenum alloy) with several variations of load and sliding velocity using a microtribometer. The effects of different loads and velocities, and the resulting friction coefficients on articular cartilage, were evaluated by measuring histological and metabolic outcomes. Moreover, the biotribocorrosion of the metal was determined. Chondrocytes stimulated with high load and velocity showed increased metabolic activity and cartilage-specific gene expression. In addition, higher load and velocity resulted in biotribocorrosion of the metal implant and damage to the surface of the articular cartilage, whereas low velocity and a high coefficient of friction increased the expression of catabolic genes. Articular cartilage showed particular responses to load and velocity when sliding against a metal implant. Moreover, metal implants showed tribocorrosion. Therefore, corrosion particles may play a role in the mechano-biochemical wear of articular cartilage after implantation of a metal implant. These findings may be useful to surgeons performing resurfacing procedures and total knee arthroplasty. © 2019 The Authors. Journal of Orthopaedic Research® published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society J Orthop Res 37:2531-2539, 2019.
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Affiliation(s)
- Christoph Stotter
- Faculty of Health and Medicine, Department for Health Sciences, Medicine and Research, Center for Regenerative MedicineDanube University KremsDr. Karl‐Dorrek‐Str. 30KremsA‐3500Austria,Department of Orthopedics and TraumatologyLK Baden‐Mödling‐HainburgWaltersdorfer Straße 75A‐2500BadenAustria
| | - Bojana Stojanović
- AC2T Research GmbHViktor Kaplan‐Straße 2A‐2700Wiener NeustadtAustria
| | - Christoph Bauer
- Faculty of Health and Medicine, Department for Health Sciences, Medicine and Research, Center for Regenerative MedicineDanube University KremsDr. Karl‐Dorrek‐Str. 30KremsA‐3500Austria
| | | | - Friedrich Franek
- AC2T Research GmbHViktor Kaplan‐Straße 2A‐2700Wiener NeustadtAustria
| | - Thomas Klestil
- Department of Orthopedics and TraumatologyLK Baden‐Mödling‐HainburgWaltersdorfer Straße 75A‐2500BadenAustria,Faculty of Health and Medicine, Department for Health Sciences, Medicine and ResearchDanube University KremsDr. Karl‐Dorrek‐Str. 30KremsA‐3500Austria
| | - Stefan Nehrer
- Faculty of Health and Medicine, Department for Health Sciences, Medicine and Research, Center for Regenerative MedicineDanube University KremsDr. Karl‐Dorrek‐Str. 30KremsA‐3500Austria
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Stojanović B, Bauer C, Stotter C, Klestil T, Nehrer S, Franek F, Rodríguez Ripoll M. Tribocorrosion of a CoCrMo alloy sliding against articular cartilage and the impact of metal ion release on chondrocytes. Acta Biomater 2019; 94:597-609. [PMID: 31226479 DOI: 10.1016/j.actbio.2019.06.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 06/11/2019] [Accepted: 06/13/2019] [Indexed: 01/22/2023]
Abstract
Partial knee replacement and hemiarthroplasty are some of the orthopedic procedures resulting in a metal on cartilage interface. As metal implant material, CoCrMo based alloys are commonly used. The aim of the present study is to assess the role of biotribocorrosion on the CoCrMo-cartilage interface with an emphasis on metal release during sliding contact. The biotribocorrosion experiments were performed under controlled electrochemical conditions using a floating cell with a three electrode set up coupled to a microtribometer. Throughout the experiment the coefficient of friction and the open circuit potential were monitored. Analyses of the electrolyte after the experiment show that metal release can occur during sliding contact of CoCrMo alloy against articular cartilage despite the extraordinary low coefficient of friction measured. Metal release is attributed to changes in passive layer caused at the onset of sliding. The released metal was found to be forming compounds with potential cytotoxicity. Since the presence of metal ions in the cartilage matrix can potentially lead to cell apoptosis, the metabolic activity of human osteoarthritic chondrocytes (2D-cultures) was investigated in the presence of phosphate buffered saline containing metal ions using XTT-assay. The experiments indicate that critical concentrations of Co ions lead to a significant decrease in chondrocyte metabolic activity. Therefore, biotribocorrosion is a mechanism that can occur in partial replacements and lead to chondrocyte apoptosis thus playing a role in the observed accelerated degradation of the remaining cartilage tissue after the mentioned orthopedic procedures. STATEMENT OF SIGNIFICANCE: Partial replacements provide an alternative to total joint replacements. This procedure is less invasive, allows a faster rehabilitation and provides a better function of the joint. However, the remaining native cartilage experiences accelerated degradation when in contact with metallic implant components. This work investigates the role of tribocorrosion at the metal-cartilage interface during sliding. Tribocorrosion is a degradation process that can alter significantly the wear rates experienced by metallic implants and lead to the release of metal ions and particles. The released metal can form compounds with potential cytotoxicity on cartilage tissue. The knowledge gained in this work will serve to understand the mechanisms behind the failure of partial replacements and develop future biomaterials with an enhanced lifetime.
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Affiliation(s)
- B Stojanović
- AC2T research GmbH, Viktor Kaplan-Straße 2/C, A-2700 Wiener Neustadt, Austria
| | - C Bauer
- Danube University Krems, Faculty of Health and Medicine, Department for Health Sciences and Biomedicine, Center for Regenerative Medicine and Orthopedics, Dr. Karl-Dorrek-Str. 30, A-3500 Krems, Austria
| | - C Stotter
- Danube University Krems, Faculty of Health and Medicine, Department for Health Sciences and Biomedicine, Center for Regenerative Medicine and Orthopedics, Dr. Karl-Dorrek-Str. 30, A-3500 Krems, Austria; LK Baden-Mödling-Hainburg, Department of Orthopedics and Traumatology, Waltersdorferstraße 75, A-2500 Baden, Austria
| | - T Klestil
- LK Baden-Mödling-Hainburg, Department of Orthopedics and Traumatology, Waltersdorferstraße 75, A-2500 Baden, Austria; Danube University Krems, Faculty of Health and Medicine, Department for Health Sciences and Biomedicine, Center for Medical Specializations, Dr. Karl-Dorrek-Str. 30, A-3500 Krems, Austria
| | - S Nehrer
- Danube University Krems, Faculty of Health and Medicine, Department for Health Sciences and Biomedicine, Center for Regenerative Medicine and Orthopedics, Dr. Karl-Dorrek-Str. 30, A-3500 Krems, Austria
| | - F Franek
- AC2T research GmbH, Viktor Kaplan-Straße 2/C, A-2700 Wiener Neustadt, Austria
| | - M Rodríguez Ripoll
- AC2T research GmbH, Viktor Kaplan-Straße 2/C, A-2700 Wiener Neustadt, Austria.
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Bauer C, Göçerler H, Niculescu‐Morzsa E, Jeyakumar V, Stotter C, Tóth I, Klestil T, Franek F, Nehrer S. Effect of osteochondral graft orientation in a biotribological test system. J Orthop Res 2019; 37:583-592. [PMID: 30690777 PMCID: PMC6594111 DOI: 10.1002/jor.24236] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 01/11/2019] [Indexed: 02/04/2023]
Abstract
Autologous osteochondral transplantation (AOT) utilizing autografts is a widely used technique for the treatment of small-to-medium cartilage defects occurring in knee and ankle joints. The application of viable cartilage and bone ensures proper integration, early weight bearing, as well as restoration of biomechanical and biotribological properties. However, alignment of the autografts onto the defect site remains a pivotal aspect of reinstating the properties of the joint toward successful autograft integration. This is the first study to perform tests with different orientations of osteochondral grafts in a cartilage-on-cartilage test system. The objective was to estimate if there are differences between aligned and 90°-rotated grafts concerning molecular biological and biomechanical parameters. Tissue viability, assessed by XTT assay indicated lower metabolic activity in tested osteochondral grafts (aligned, p = 0.0148 and 90°-rotated, p = 0.0760) in favor of a higher anabolic gene expression (aligned, p = 0.0030 and 90°-rotated, 0.0027). Tissue structure was evaluated by Safranin O histology and microscopic images of the surface. Aligned and 90°-rotated grafts revealed no apparent differences between proteoglycan content or cracks and fissures on the cartilage surface. Test medium analyzed after tribological tests for their sulfated glycosaminoglycan content revealed no differences (p = 0.3282). During the tests, both the friction coefficient and the relative displacement between the two cartilage surfaces were measured, with no significant difference in both parameters (COF, p = 0.2232 and relative displacement, p = 0.3185). From the methods we deployed, this study can infer that there are no differences between aligned and 90°-rotated osteochondral grafts after tribological tests in the used ex vivo tissue model. © 2019 The Authors. Journal of Orthopaedic Research® Published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res.
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Affiliation(s)
- Christoph Bauer
- Danube University Krems, Department for Health Sciences, Medicine and ResearchCenter for Regenerative Medicine and OrthopedicsDr.‐Karl‐Dorrek‐Strasse 303500KremsAustria
| | | | - Eugenia Niculescu‐Morzsa
- Danube University Krems, Department for Health Sciences, Medicine and ResearchCenter for Regenerative Medicine and OrthopedicsDr.‐Karl‐Dorrek‐Strasse 303500KremsAustria
| | - Vivek Jeyakumar
- Danube University Krems, Department for Health Sciences, Medicine and ResearchCenter for Regenerative Medicine and OrthopedicsDr.‐Karl‐Dorrek‐Strasse 303500KremsAustria
| | - Christoph Stotter
- Danube University Krems, Department for Health Sciences, Medicine and ResearchCenter for Regenerative Medicine and OrthopedicsDr.‐Karl‐Dorrek‐Strasse 303500KremsAustria,LK Baden‐Mödling‐HainburgDepartment of Orthopedics and TraumatologyBadenAustria
| | | | - Thomas Klestil
- LK Baden‐Mödling‐HainburgDepartment of Orthopedics and TraumatologyBadenAustria,Danube University Krems, Department for Health Sciences, Medicine and ResearchCenter for Health Sciences and MedicineKremsAustria
| | | | - Stefan Nehrer
- Danube University Krems, Department for Health Sciences, Medicine and ResearchCenter for Regenerative Medicine and OrthopedicsDr.‐Karl‐Dorrek‐Strasse 303500KremsAustria
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Vainieri M, Wahl D, Alini M, van Osch G, Grad S. Mechanically stimulated osteochondral organ culture for evaluation of biomaterials in cartilage repair studies. Acta Biomater 2018; 81:256-266. [PMID: 30273741 DOI: 10.1016/j.actbio.2018.09.058] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 08/15/2018] [Accepted: 09/27/2018] [Indexed: 10/28/2022]
Abstract
Surgical procedures such as microfracture or autologous chondrocyte implantation have been used to treat articular cartilage lesions; however, repair often fails in terms of matrix organization and mechanical behaviour. Advanced biomaterials and tissue engineered constructs have been developed to improve cartilage repair; nevertheless, their clinical translation has been hampered by the lack of reliable in vitro models suitable for pre-clinical screening of new implants and compounds. In this study, an osteochondral defect model in a bioreactor that mimics the multi-axial motion of an articulating joint, was developed. Osteochondral explants were obtained from bovine stifle joints, and cartilage defects of 4 mm diameter were created. The explants were used as an interface against a ceramic ball applying dynamic compressive and shear loading. Osteochondral defects were filled with chondrocytes-seeded fibrin-polyurethane constructs and subjected to mechanical stimulation. Cartilage viability, proteoglycan accumulation and gene expression of seeded chondrocytes were compared to free swelling controls. Cells within both cartilage and bone remained viable throughout the 10-day culture period. Loading did not wear the cartilage, as indicated by histological evaluation and glycosaminoglycan release. The gene expression of seeded chondrocytes indicated a chondrogenic response to the mechanical stimulation. Proteoglycan 4 and cartilage oligomeric matrix protein were markedly increased, while mRNA ratios of collagen type II to type I and aggrecan to versican were also enhanced. This mechanically stimulated osteochondral defect culture model provides a viable microenvironment and will be a useful pre-clinical tool to screen new biomaterials and biological regenerative therapies under relevant complex mechanical stimuli. STATEMENT OF SIGNIFICANCE: Articular cartilage lesions have a poor healing capacity and reflect one of the most challenging problems in orthopedic clinical practice. The aim of current research is to develop a testing system to assess biomaterials for implants, that can permanently replace damaged cartilage with the original hyaline structure and can withstand the mechanical forces long term. Here, we present an osteochondral ex vivo culture model within a cartilage bioreactor, which mimics the complex motion of an articulating joint in vivo. The implementation of mechanical forces is essential for pre-clinical testing of novel technologies in the field of cartilage repair, biomaterial engineering and regenerative medicine. Our model provides a unique opportunity to investigate healing of articular cartilage defects in a physiological joint-like environment.
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Winkeljann B, Bussmann AB, Bauer MG, Lieleg O. Oscillatory Tribology Performed With a Commercial Shear Rheometer. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.biotri.2018.04.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Quantification of cartilage wear morphologies in unidirectional sliding experiments: Influence of different macromolecular lubricants. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.biotri.2017.06.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Trevino RL, Pacione CA, Malfait AM, Chubinskaya S, Wimmer MA. Development of a Cartilage Shear-Damage Model to Investigate the Impact of Surface Injury on Chondrocytes and Extracellular Matrix Wear. Cartilage 2017; 8:444-455. [PMID: 28934882 PMCID: PMC5613899 DOI: 10.1177/1947603516681133] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Many i n vitro damage models investigate progression of cartilage degradation after a supraphysiologic, compressive impact at the surface and do not model shear-induced damage processes. Models also neglect the response to uninterrupted tribological stress after damage. It was hypothesized that shear-induced removal of the superficial zone would accelerate matrix degradation when damage was followed by continued load and articulation. Methods Bovine cartilage underwent a 5-day test. Shear-damaged samples experienced 2 days of damage induction with articulation against polyethylene and then continued articulation against cartilage (CoC), articulation against metal (MoC), or rest as free-swelling control (FSC). Surface-intact samples were randomized to CoC, MoC, or FSC for the entire 5-day test. Samples were evaluated for chondrocyte viability, GAG (glycosaminoglycan) release (matrix wear surrogate), and histological integrity. Results Shear induction wore away the superficial zone. Damaged samples began continued articulation with collagen matrix disruption and increased cell death compared to intact samples. In spite of the damaged surface, these samples did not exhibit higher GAG release than intact samples articulating against the same counterface ( P = 0.782), contrary to our hypothesis. Differences in GAG release were found to be due to tribological testing against metal ( P = 0.003). Conclusion Shear-induced damage lowers chondrocyte viability and affects extracellular matrix integrity. Continued motion of either cartilage or metal against damaged surfaces did not increase wear compared with intact samples. We conjecture that favorable reorganization of the surface collagen fibers during articulation protected the underlying matrix. This finding suggests a potential window for clinical interventions to slow matrix degradation after traumatic incidents.
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Affiliation(s)
- Robert L. Trevino
- Department of Anatomy and Cell Biology, Rush University Medical Center, Chicago, IL, USA
| | - Carol A. Pacione
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Anne-Marie Malfait
- Department of Internal Medicine (Rheumatology), Rush University Medical Center, Chicago, IL, USA
| | - Susan Chubinskaya
- Department of Pediatrics, Rush University Medical Center, Chicago, IL, USA
| | - Markus A. Wimmer
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
- Markus A. Wimmer, Department of Orthopedic Surgery, Rush University Medical Center, 1611 West Harrison Street, Chicago, IL 60612, USA.
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