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S. AD, P. SPA, Naveen J, Khan T, Khahro SH. Advancement in biomedical implant materials-a mini review. Front Bioeng Biotechnol 2024; 12:1400918. [PMID: 39021364 PMCID: PMC11252025 DOI: 10.3389/fbioe.2024.1400918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 05/31/2024] [Indexed: 07/20/2024] Open
Abstract
Metal alloys like stainless steel, titanium, and cobalt-chromium alloys are preferable for bio-implants due to their exceptional strength, tribological properties, and biocompatibility. However, long-term implantation of metal alloys can lead to inflammation, swelling, and itching because of ion leaching. To address this issue, polymers are increasingly being utilized in orthopedic applications, replacing metallic components such as bone fixation plates, screws, and scaffolds, as well as minimizing metal-on-metal contact in total hip and knee joint replacements. Ceramics, known for their hardness, thermal barrier, wear, and corrosion resistance, find extensive application in electrochemical, fuel, and biomedical industries. This review delves into a variety of biocompatible materials engineered to seamlessly integrate with the body, reducing adverse reactions like inflammation, toxicity, or immune responses. Additionally, this review examines the potential of various biomaterials including metals, polymers, and ceramics for implant applications. While metallic biomaterials remain indispensable, polymers and ceramics show promise as alternative options. However, surface-modified metallic materials offer a hybrid effect, combining the strengths of different constituents. The future of biomedical implant materials lies in advanced fabrication techniques and personalized designs, facilitating tailored solutions for complex medical needs.
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Affiliation(s)
- Ashish Daniel S.
- School of Mechanical Engineering, Vellore Institute of Technology, Vellore, India
| | - Suya Prem Anand P.
- School of Mechanical Engineering, Vellore Institute of Technology, Vellore, India
| | - Jesuarockiam Naveen
- School of Mechanical Engineering, Vellore Institute of Technology, Vellore, India
| | - Tabrej Khan
- Department of Engineering Management, Faculty of Engineering, Prince Sultan University, Riyadh, Saudi Arabia
| | - Shabir Hussain Khahro
- Department of Engineering Management, Faculty of Engineering, Prince Sultan University, Riyadh, Saudi Arabia
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Mizuno K, Boschetto F, Yamamoto K, Honma T, Miyamoto N, Adachi T, Kanamura N, Yamamoto T, Wenliang Z, Marin E, Pezzotti G. Cytotoxicity and osteogenic effects of aluminum ions. J Inorg Biochem 2022; 234:111884. [DOI: 10.1016/j.jinorgbio.2022.111884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 05/19/2022] [Accepted: 05/29/2022] [Indexed: 11/17/2022]
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Tresgallo-Parés R, Torres-Lugo NJ, Rosado-Hernández E, Olivella G, Ramírez N, Otero-López A. Adverse Soft-Tissue Reaction After Ceramic-On-Ceramic Bearing Fracture Mimicking a Periprosthetic Joint Infection. Arthroplast Today 2022; 13:93-97. [PMID: 35106343 PMCID: PMC8784301 DOI: 10.1016/j.artd.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/29/2021] [Accepted: 12/02/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Ruben Tresgallo-Parés
- Department of Orthopaedic Surgery, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Norberto J. Torres-Lugo
- Department of Orthopaedic Surgery, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
- Corresponding author. Department of Orthopaedic Surgery, University of Puerto Rico, PO Box 365067, San Juan, Puerto Rico 00936. Tel.: 1-787-764-5095.
| | - Edwin Rosado-Hernández
- Department of Orthopaedic Surgery, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Gerardo Olivella
- Department of Orthopaedic Surgery, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Norman Ramírez
- Department of Pediatric Orthopaedic Surgery, Mayaguez Medical Center, Mayaguez, Puerto Rico
| | - Antonio Otero-López
- Department of Orthopaedic Surgery, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
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Rony L, Pascaretti-Grizon F, Hubert L, Chappard D. Histochemical identification of wear debris released by alumina-on-alumina hip prostheses in the periprosthetic tissues. Orthop Traumatol Surg Res 2021; 107:102636. [PMID: 33023845 DOI: 10.1016/j.otsr.2020.03.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 03/09/2020] [Accepted: 03/18/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Tribological studies have shown that the most used couples for hip prostheses consist of metal-on-polyethylene and alumina-on-alumina prostheses. Over time, wear products accumulate in the joint cavity and in the periprosthetic tissues. Although polyethylene and metal are easily identifiable by microscopy in periprosthetic tissues, alumina particles are very difficult to identify. HYPOTHESIS The fluorescent azo-dye lumogallion was evaluated as a suitable histochemical stain for alumina particles in periprosthetic tissues. MATERIAL AND METHOD In 28 patients who had a prosthetic revision of an alumina-on-alumina prosthesis, periprosthetic tissues were removed and embedded in paraffin; sections were stained with HPS (for conventional diagnosis) or with lumogallion. Sections were examined for wear particles in light and fluorescence microscopy. Some sections were counter-stained using DAPI for visualization of cell nuclei. RESULTS The wear particles of the alumina-alumina prostheses were very difficult to identify on the HPS stained sections; they were clearly evidenced by lumogallion staining with a bright orange fluorescence. The stain revealed large quantities of particles (of the order of several thousand per section). Only two patients had no particles. The staining technique identified numerous particles that were not visible on HPS-stained sections in macrophages, synoviocytes and fibroblasts. CONCLUSION This staining, which has been validated in neuromuscular pathology for the identification of alumina used as a vaccine adjuvant, gave successful results in the present study. Alumina particles are modified when they are phagocytized by macrophages. lumogallion staining easily shows the presence of thousands of wear particles released by alumina-on-alumina prostheses in periprosthetic tissues. LEVEL OF EVIDENCE V expert opinion study.
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Affiliation(s)
- Louis Rony
- Groupe Etudes Remodelage Osseux et bioMatériaux, GEROM, EA-4658, SFR-4208, Univ-Angers, IRIS-IBS Institut de Biologie en Santé, CHU-Angers, 49933 Angers, France; Département de chirurgie osseuse, CHU-Angers, 49033 Angers, France
| | - Florence Pascaretti-Grizon
- Groupe Etudes Remodelage Osseux et bioMatériaux, GEROM, EA-4658, SFR-4208, Univ-Angers, IRIS-IBS Institut de Biologie en Santé, CHU-Angers, 49933 Angers, France
| | - Laurent Hubert
- Groupe Etudes Remodelage Osseux et bioMatériaux, GEROM, EA-4658, SFR-4208, Univ-Angers, IRIS-IBS Institut de Biologie en Santé, CHU-Angers, 49933 Angers, France; Département de chirurgie osseuse, CHU-Angers, 49033 Angers, France
| | - Daniel Chappard
- Département de chirurgie osseuse, CHU-Angers, 49033 Angers, France.
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Chappard D, Rony L, Ducellier F, Steiger V, Hubert L. Wear debris released by hip prosthesis analysed by microcomputed tomography. J Microsc 2020; 282:13-20. [PMID: 33118633 DOI: 10.1111/jmi.12971] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/30/2020] [Accepted: 10/18/2020] [Indexed: 11/28/2022]
Abstract
Total hip arthroplasty uses commercial devices that combine different types of biomaterials. Among them, metals, ceramics and metal oxides can be used either in the prosthesis itself or in the cement used to anchor them in the bone. Over time, all of these materials can wear out and release particles that accumulate in the periprosthetic tissues or can migrate away. We used histology blocks from 15 patients (5 titanium metallosis, 5 alumina prostheses, 5 with altered methacrylic cement) to perform a microCT study and compare it with conventional histology data. An EDS-SEM analysis was done to characterise the atomic nature of the materials involved. A morphometric analysis was also performed in 3D to count the particles and assess their density and size. The metallic particles appeared to be the largest and the ceramic particles the finest. However, microCT could not reveal the wear particles of radiolucent biomaterials such as polyethylene and the very fine zirconia particles from cement fragmentation. MicroCT analysis can reveal the extent of the accumulation of these debris in the periprosthetic tissues. LAYOUT DESCRIPTION: Hip prostheses progressively degrade in the body by releasing wear debris. They accumulate in the periprosthetic tissues. Microcomputed tomography was used to image three types of radio-opaque wear debris: metal, ceramic and zirconia used in the bone cements.
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Affiliation(s)
- D Chappard
- Groupe Etudes Remodelage Osseux et bioMatériaux, Univ-Angers, IRIS-IBS Institut de Biologie en Santé, CHU-Angers, Angers, France
| | - L Rony
- Groupe Etudes Remodelage Osseux et bioMatériaux, Univ-Angers, IRIS-IBS Institut de Biologie en Santé, CHU-Angers, Angers, France.,Département de Chirurgie Osseuse, CHU-Angers, Angers, France
| | - F Ducellier
- Département de Chirurgie Osseuse, CHU-Angers, Angers, France
| | - V Steiger
- Département de Chirurgie Osseuse, CHU-Angers, Angers, France
| | - L Hubert
- Groupe Etudes Remodelage Osseux et bioMatériaux, Univ-Angers, IRIS-IBS Institut de Biologie en Santé, CHU-Angers, Angers, France.,Département de Chirurgie Osseuse, CHU-Angers, Angers, France
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Alumina Ceramic Exacerbates the Inflammatory Disease by Activation of Macrophages and T Cells. Int J Mol Sci 2020; 21:ijms21197114. [PMID: 32993182 PMCID: PMC7583733 DOI: 10.3390/ijms21197114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/15/2020] [Accepted: 09/24/2020] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Aluminum oxide (Al2O3) ceramic is one of the materials used for artificial joints, and it has been known that their fine particles (FPs) are provided by the wear of the ceramic. Al2O3 FPs have been shown to induce macrophage activation in vitro; however, the inflammatory effect in vivo has not been studied. (2) Methods: We examined the in vivo effect of Al2O3 FPs on the innate and adaptive immune cells in the mice. (3) Results: Al2O3 FPs promoted the activation of spleen macrophages; however, conventional dendritic cells (cDCs), plasmacytoid DCs (pDCs), and natural killer (NK) cells were not activated. In addition, increases in the CD4 and CD8 T cells was induced in the spleens of the mice treated with Al2O3 FPs, which differentiated into interferon-gamma (IFN-γ)-producing helper T1 (Th1) and cytotoxic T1 (Tc1) cells. Finally, the injection of Al2O3 FPs exacerbated dextran sulfate sodium (DSS)-induced inflammation in the colon, mediated by activated and increased number of CD4 and CD8 T cells. (4) Conclusions: These data demonstrate that FPs of Al2O3 ceramic may contribute to the exacerbation of inflammatory diseases in the patients.
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Kim YH, Park JW. Eighteen-Year Follow-Up Study of 2 Alternative Bearing Surfaces Used in Total Hip Arthroplasty in the Same Young Patients. J Arthroplasty 2020; 35:824-830. [PMID: 31672505 DOI: 10.1016/j.arth.2019.09.051] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/22/2019] [Accepted: 09/30/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND This study compares the long-term functional, radiographic, and computed tomography scan outcomes and implant survivorship of ceramic-on-ceramic total hip arthroplasty (C-O-C THA) and ceramic-on-highly cross-linked polyethylene total hip arthroplasty (C-O-HXLPE THA) in the same patients. METHODS In this randomized, prospective trial conducted between January 1999 and April 2003, 133 patients (266 hips) younger than 55 years were enrolled. Each patient received C-O-C THA in 1 hip and a C-O-HXLPE THA in the other. The mean follow-up was 17.1 years (range, 15-18 years); there were 84 men and 49 women with a mean age of 53 ± 7 years (range, 25-55 years). RESULTS At the latest follow-up, mean Harris hip scores (94 vs 93 points; P = .861), pain scores (43 vs 42 points; P = .651), and patient satisfaction scores (7.8 vs 7.6 points; P = .379) were not different between the 2 groups. Eight hips (3%) in the C-O-C THA had an audible squeaking sound. The mean annual penetration rate of HXLPE was 0.0162 ± 0.032 mm per year. No osteolysis was recorded on radiographs or computed tomography scans in either group. At 17.1 years, the survival rate of the acetabular component was 97% in the C-O-C bearing group and 98% in the C-O-HXLPE bearing group (P = .923). The survival rate of the femoral component was 99% in both groups. CONCLUSION Both C-O-C THA and C-O-HXLPE THA functioned well, with no osteolysis at mean of 17.1-year follow-up.
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Affiliation(s)
- Young-Hoo Kim
- The Joint Replacement Center, Seoul Metropolitan SeoNam Hospital, Seoul, Republic of Korea
| | - Jang-Won Park
- The Joint Replacement Center, Ewha Womans University Ewha Seoul Hospital, Seoul, Republic of Korea
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Degeratu CN, Mabilleau G, Aguado E, Mallet R, Chappard D, Cincu C, Stancu IC. Polyhydroxyalkanoate (PHBV) fibers obtained by a wet spinning method: Good in vitro cytocompatibility but absence of in vivo biocompatibility when used as a bone graft. Morphologie 2019; 103:94-102. [PMID: 30905592 DOI: 10.1016/j.morpho.2019.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 02/21/2019] [Accepted: 02/25/2019] [Indexed: 06/09/2023]
Abstract
Polyhydroxyalkanoates (PHAs) are biomaterials widely investigated for tissue-engineering applications. In this regard, we describe a method to prepare fibers of poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV) by a wet-spinning technique. Polymer fibers were used to test the cytocompatibility of the material in vitro. We have investigated their behavior in vitro in presence of the osteoblast-like (SaOs2) and macrophage (J774.2) cell lines. The PHBV fibers used were 100-200μm in diameter and offered a large surface for cell adhesion, similar to that they encounter when apposed onto a bone trabeculae. The fiber surface possessed a suitable roughness, a factor known to favor the adherence of cells, particularly osteoblasts. PHBV fibers were degraded in vitro by J774.2 cells as erosion pits were observable by transmission electron microscopy. The fibers were also colonisable by SaOs2 cells, which can spread and develop onto their surface. However, despite this good cytocompatibility observed in vitro, implantation in a bone defect drilled in rabbit femoral condyles showed that the material was only biotolerated without any sign of osteoconduction or degradation in vivo. We can conclude that PHBV is cytocompatible but is not suitable to be used as a bone graft as it does not favor osteoconduction and is not resorbed by bone marrow macrophages.
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Affiliation(s)
- C N Degeratu
- University Politehnica of Bucharest, Faculty of Applied Chemistry and Materials Science, Department of Bioresources and Polymer Science, 1-7 Gh Polizu, district 1, 011061 Bucharest, Romania; Groupe études remodelage osseux et biomatériaux, GEROM, EA-4658, SFR-4208, université d'Angers, IRIS-IBS institut de biologie en santé, CHU d'Angers, 49933 Angers, France
| | - G Mabilleau
- Groupe études remodelage osseux et biomatériaux, GEROM, EA-4658, SFR-4208, université d'Angers, IRIS-IBS institut de biologie en santé, CHU d'Angers, 49933 Angers, France; Service commun d'imagerie et analyses microscopiques, SCIAM, SFR-4208, université d'Angers, IRIS-IBS institut de biologie en santé, CHU d'Angers, 49933 Angers cedex, France
| | - E Aguado
- ONIRIS, École vétérinaire de Nantes, 44307 Nantes cedex 3, France
| | - R Mallet
- Groupe études remodelage osseux et biomatériaux, GEROM, EA-4658, SFR-4208, université d'Angers, IRIS-IBS institut de biologie en santé, CHU d'Angers, 49933 Angers, France; Service commun d'imagerie et analyses microscopiques, SCIAM, SFR-4208, université d'Angers, IRIS-IBS institut de biologie en santé, CHU d'Angers, 49933 Angers cedex, France
| | - D Chappard
- Groupe études remodelage osseux et biomatériaux, GEROM, EA-4658, SFR-4208, université d'Angers, IRIS-IBS institut de biologie en santé, CHU d'Angers, 49933 Angers, France; Service commun d'imagerie et analyses microscopiques, SCIAM, SFR-4208, université d'Angers, IRIS-IBS institut de biologie en santé, CHU d'Angers, 49933 Angers cedex, France.
| | - C Cincu
- University Politehnica of Bucharest, Faculty of Applied Chemistry and Materials Science, Department of Bioresources and Polymer Science, 1-7 Gh Polizu, district 1, 011061 Bucharest, Romania
| | - I C Stancu
- University Politehnica of Bucharest, Faculty of Applied Chemistry and Materials Science, Department of Bioresources and Polymer Science, 1-7 Gh Polizu, district 1, 011061 Bucharest, Romania
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Rony L, Lancigu R, Hubert L. Intraosseous metal implants in orthopedics: A review. Morphologie 2018; 102:231-242. [PMID: 30348489 DOI: 10.1016/j.morpho.2018.09.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 09/28/2018] [Accepted: 09/28/2018] [Indexed: 04/21/2023]
Abstract
Metal implants are biomaterials widely used in orthopedics. They are both used in osteosynthesis and arthroplasty. Their mechanical properties, biocompatibility and resistance to corrosion make them a widely used option in orthopedics. Alloys are the most commonly used metals in orthopedics. As far as physical traumas are concerned, implants such as screws, plates and/or nails are used for osteosynthesis as they ensure the stability of the fractured area and contribute to bone healing. Prostheses are used in arthroplasty to restore joint function for as long as possible. Contact between bone and the prosthesis induces bone remodeling at the interface between metal and bone even if the metal is recognized as biocompatible. Upon time, the interface between the metal implant and the bony tissue is continuously modified and adapted. Hip prosthesis is a typical example of intraosseous metal implant whose bone/implant interface has been extensively studied. Metal can be altered in vivo by different mechanisms including corrosion and fretting. An altered torque friction leads to wear debris that accumulate in the peri-prosthetic tissues causing metallosis.
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Affiliation(s)
- L Rony
- Groupe Études Remodelage Osseux et bioMatériaux (GEROM), LabCom NextBone, SFR 42 08, université d'Angers, CHU d'Angers, IRIS-IBS institut de biologie en santé, 49933 Angers cedex, France; Département de chirurgie osseuse, CHU d'Angers, 49033 Angers cedex, France.
| | - R Lancigu
- Département de chirurgie osseuse, CHU d'Angers, 49033 Angers cedex, France
| | - L Hubert
- Département de chirurgie osseuse, CHU d'Angers, 49033 Angers cedex, France
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Bertrand J, Delfosse D, Mai V, Awiszus F, Harnisch K, Lohmann CH. Ceramic prosthesis surfaces induce an inflammatory cell response and fibrotic tissue changes. Bone Joint J 2018; 100-B:882-890. [DOI: 10.1302/0301-620x.100b7.bjj-2017-1590.r2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims Early evidence has emerged suggesting that ceramic-on-ceramic articulations induce a different tissue reaction to ceramic-on-polyethylene and metal-on-metal bearings. Therefore, the aim of this study was to investigate the tissue reaction and cellular response to ceramic total hip arthroplasty (THA) materials in vitro, as well as the tissue reaction in capsular tissue after revision surgery of ceramic-on-ceramic THAs. Patients and Methods We investigated tissue collected at revision surgery from nine ceramic-on-ceramic articulations. we compared our findings with tissue obtained from five metal-on-metal THA revisions, four ceramic-on-polyethylene THAs, and four primary osteoarthritis synovial membranes. The latter were analyzed to assess the amount of tissue fibrosis that might have been present at the time of implantation to enable evaluation, in relation to implantation time, of any subsequent response in the tissues. Results There was a significant increase in tissue fibrosis with implantation time for all implant types tested. Interestingly, the tissue fibrosis in ceramic-on-ceramic THAs was significantly increased compared with metal-on-metal and ceramic-on-polyethylene. Additionally, we found ceramic wear particles in the periprosthetic tissue of ceramic implants. Fibroblasts responded with expression of cytokines when cultured on alumina-toughened zirconia (ATZ) and zirconia-toughened alumina (ZTA) ceramic surfaces. This response was more pronounced on ATZ ceramics compared with ZTA ceramics. The same inflammatory response was observed with peripheral blood mononuclear cells (PBMCs) cultured on ZTA and ATZ. Conclusion Our findings therefore, corroborate the previous findings that ceramic-on-ceramic periprosthetic revision tissue is fibrous and offer an explanation for this observation. We detected a long-term inflammatory response of PBMCs and an inflammatory response of fibroblasts to ATZ and ZTA ceramic. These findings partially explain the fibrotic tissue change in periprosthetic tissue of ceramic-on-ceramic bearings. Cite this article: Bone Joint J 2018;100-B:882–90.
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Affiliation(s)
- J. Bertrand
- Department of Orthopaedic Surgery, Otto-von-Guericke
University, Magdeburg, Germany
| | | | - V. Mai
- Mathys AG Bettlach, Bettlach, Switzerland
| | - F. Awiszus
- Department of Orthopaedic Surgery, Otto-von-Guericke
University, Magdeburg, Germany
| | - K. Harnisch
- Institute for Materials and Joining Technology,
Otto-von-Guericke University, Magdeburg, Germany
| | - C. H. Lohmann
- Department of Orthopaedic Surgery, Otto-von-Guericke
University, Magdeburg, Germany
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