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Yan X, Zheng J, Ren W, Li S, Yang S, Zhi K, Gao L. O-GlcNAcylation: roles and potential therapeutic target for bone pathophysiology. Cell Commun Signal 2024; 22:279. [PMID: 38773637 PMCID: PMC11106977 DOI: 10.1186/s12964-024-01659-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 05/10/2024] [Indexed: 05/24/2024] Open
Abstract
O-linked N-acetylglucosamine (O-GlcNAc) protein modification (O-GlcNAcylation) is a critical post-translational modification (PTM) of cytoplasmic and nuclear proteins. O-GlcNAcylation levels are regulated by the activity of two enzymes, O-GlcNAc transferase (OGT) and O‑GlcNAcase (OGA). While OGT attaches O-GlcNAc to proteins, OGA removes O-GlcNAc from proteins. Since its discovery, researchers have demonstrated O-GlcNAcylation on thousands of proteins implicated in numerous different biological processes. Moreover, dysregulation of O-GlcNAcylation has been associated with several pathologies, including cancers, ischemia-reperfusion injury, and neurodegenerative diseases. In this review, we focus on progress in our understanding of the role of O-GlcNAcylation in bone pathophysiology, and we discuss the potential molecular mechanisms of O-GlcNAcylation modulation of bone-related diseases. In addition, we explore significant advances in the identification of O-GlcNAcylation-related regulators as potential therapeutic targets, providing novel therapeutic strategies for the treatment of bone-related disorders.
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Affiliation(s)
- Xiaohan Yan
- Department of Oral and Maxillofacial Reconstruction, the Affiliated Hospital of Qingdao University, Qingdao, 266555, China
- School of Stomatology, Qingdao University, Qingdao, 266003, China
- Department of Oral and Maxillofacial Surgery, the Affiliated Hospital of Qingdao University, 1677 Wutaishan Road, Huangdao District, Qingdao, 266555, Shandong, China
| | - Jingjing Zheng
- Department of Oral and Maxillofacial Reconstruction, the Affiliated Hospital of Qingdao University, Qingdao, 266555, China
- Department of Endodontics, the Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Wenhao Ren
- Department of Oral and Maxillofacial Reconstruction, the Affiliated Hospital of Qingdao University, Qingdao, 266555, China
- Department of Oral and Maxillofacial Surgery, the Affiliated Hospital of Qingdao University, 1677 Wutaishan Road, Huangdao District, Qingdao, 266555, Shandong, China
| | - Shaoming Li
- Department of Oral and Maxillofacial Reconstruction, the Affiliated Hospital of Qingdao University, Qingdao, 266555, China
- School of Stomatology, Qingdao University, Qingdao, 266003, China
- Department of Oral and Maxillofacial Surgery, the Affiliated Hospital of Qingdao University, 1677 Wutaishan Road, Huangdao District, Qingdao, 266555, Shandong, China
| | - Shuying Yang
- Department of Basic & Translational Sciences, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Keqian Zhi
- Department of Oral and Maxillofacial Reconstruction, the Affiliated Hospital of Qingdao University, Qingdao, 266555, China.
- School of Stomatology, Qingdao University, Qingdao, 266003, China.
- Key Lab of Oral Clinical Medicine, the Affiliated Hospital of Qingdao University, Qingdao, 266003, China.
- Department of Oral and Maxillofacial Surgery, the Affiliated Hospital of Qingdao University, 1677 Wutaishan Road, Huangdao District, Qingdao, 266555, Shandong, China.
| | - Ling Gao
- Department of Oral and Maxillofacial Reconstruction, the Affiliated Hospital of Qingdao University, Qingdao, 266555, China.
- School of Stomatology, Qingdao University, Qingdao, 266003, China.
- Key Lab of Oral Clinical Medicine, the Affiliated Hospital of Qingdao University, Qingdao, 266003, China.
- Department of Oral and Maxillofacial Surgery, the Affiliated Hospital of Qingdao University, 1677 Wutaishan Road, Huangdao District, Qingdao, 266555, Shandong, China.
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Sacher SE, Baral EC, Wright TM, Bauer TW, Li Q, Padgett DE, Potter HG, Koff MF. Association of Total Hip Arthroplasty Flexural Rigidity With Magnetic Resonance Imaging and Histological Findings. J Arthroplasty 2024:S0883-5403(24)00192-X. [PMID: 38428693 DOI: 10.1016/j.arth.2024.02.072] [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: 12/11/2023] [Revised: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Modular connections in total hip arthroplasty (THA) offer surgical advantages, but can contribute to implant fretting and corrosion due to micromotion at the head-stem interface. Previous studies implicated lower flexural rigidity as a key contributing factor to THA corrosion and fretting, but none associated flexural rigidity with direct histological evaluation or magnetic resonance imaging (MRI) outcomes. The purpose of this study was to determine how implant flexural rigidity is associated with MRI imaging metrics and histopathological outcomes in patients who have a failed THA. METHODS Patients requiring revision THA surgery underwent preoperative MRIs with 3-dimensional multispectral imaging techniques to suppress metal artifacts. The MRI images were graded for adverse local tissue reactions. For each hip, trunnion flexural rigidity was measured from the retrieved femoral stem, and a periprosthetic tissue sample was retrieved and evaluated using semiquantitative histology. Generalized linear models and analyses of variance were used to assess associations between flexural rigidity and MRI and histology outcomes. RESULTS A total of 106 THA stems were retrieved (46 women and 60 men, age: 68 years (range, 60 to 73 years). After adjustment for length of implantation, flexural rigidity was negatively correlated with histologic aseptic lymphocyte-dominant vasculitis-associated lesion severity (β = -26.27, P = .018), Fujishiro lymphocyte grading (β = -13.4, P = .039), perivascular lymphocyte layers (β = -17.8, P = .022), the grade of tissue organization (β = -22.5, P = .009), the presence of diffuse synovitis (β = -66.5, P = .003), and the presence of lymphoid aggregates (β = -75.9, P = .022). No association was found between MRI metrics and flexural rigidity. CONCLUSIONS Among these implants, decreased trunnion stiffness was associated with increased histologic features of adverse host-mediated soft tissue reactions.
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Affiliation(s)
- Sara E Sacher
- Hospital for Special Surgery, Department of Radiology, New York, New York
| | - Elexis C Baral
- Hospital for Special Surgery, Department of Biomechanics, New York, New York
| | - Timothy M Wright
- Hospital for Special Surgery, Department of Biomechanics, New York, New York
| | - Thomas W Bauer
- Hospital for Special Surgery, Department of Pathology and Laboratory Medicine, New York, New York
| | - Qian Li
- Hospital for Special Surgery, Department of Radiology, New York, New York
| | - Douglas E Padgett
- Hospital for Special Surgery, Adult Reconstruction and Joint Replacement, New York, New York
| | - Hollis G Potter
- Hospital for Special Surgery, Department of Radiology, New York, New York
| | - Matthew F Koff
- Hospital for Special Surgery, Department of Radiology, New York, New York
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Ngo D, Todd M, Accadbled F, Foster B, Jellesen MS, Rölfing JD, Rawat J. Corrosion of a Fassier-Duval Telescopic Nail Causing Pain and Osteolysis: A Case Report. JBJS Case Connect 2024; 14:01709767-202403000-00003. [PMID: 38181104 DOI: 10.2106/jbjs.cc.23.00424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Abstract
CASE A 15-year-old girl known with osteogenesis imperfecta presented with left femoral pain. She had been treated with multiple Fassier-Duval intramedullary nails, which were still in situ. Radiographic imaging demonstrated focal osteolysis and periosteal reaction at the telescopic junction of the rod in the distal femur. She underwent implant removal. Intraoperative sampling demonstrating acute sterile inflammation and presence of brownish colored particles consistent with metal debris and osteolysis. Explant analysis confirmed corrosion of the stainless-steel telescopic nail as the underlying cause. CONCLUSION Osteolysis and periosteal reaction because of corrosion should be considered in conjunction with other more common causes of pain, such as fracture or infection, in patients treated with telescopic intramedullary nails.
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Affiliation(s)
- David Ngo
- Flinders Medical Centre, Bedford Park, Australia
| | - Maya Todd
- Flinders Medical Centre, Bedford Park, Australia
| | | | - Bruce Foster
- Flinders Medical Centre, Bedford Park, Australia
| | - Morten Stendahl Jellesen
- Department of Civil and Mechanical Engineering, Technical University of Denmark, Lyngby, Denmark
| | - Jan Duedal Rölfing
- Children's Orthopaedics and Reconstruction, Aarhus University Hospital, Aarhus, Denmark
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Ganz R, Ulrich G, Kamineni S. Reinforcement Ring-Augmented Hip Arthroplasty: A 35-Year Follow-up. Arthroplast Today 2023; 24:101248. [PMID: 37964918 PMCID: PMC10641149 DOI: 10.1016/j.artd.2023.101248] [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] [Received: 05/08/2023] [Revised: 09/09/2023] [Accepted: 09/13/2023] [Indexed: 11/16/2023] Open
Abstract
During the late 1980s, techniques were evolving to prevent acetabular component loosening. Inadequate acetabular bone stock further complicated this concern, which was traditionally addressed with cementation and bone grafting during this time period. However, one evolving tactic to address acetabular component loosening in the setting of inadequate acetabular bone stock was to augment bone graft with an acetabular reinforcement ring. In 1963, a 26-year-old, active male sustained a right-sided femoral neck fracture following a skiing accident. He ultimately developed a collapsed femoral head and varus deformity of the femoral neck requiring a total hip arthroplasty with a cemented monoblock femoral component and a polyethylene acetabular component cemented into a reinforcement ring. The initial procedure was performed in 1988, and this prosthesis is still functioning 35 years later and represents one of the longest follow-ups of a patient with a primary total hip arthroplasty with a reinforcement ring.
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Affiliation(s)
- Reinhold Ganz
- Department of Orthopedic Surgery, University of Bern, Bern, Switzerland
| | - Gary Ulrich
- Department of Orthopedic Surgery, Elbow Shoulder Research Center, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Srinath Kamineni
- Department of Orthopedic Surgery, Elbow Shoulder Research Center, University of Kentucky College of Medicine, Lexington, KY, USA
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Corbaz J, Barimani B, Vauclair F. Early aseptic loosening of a press-fit radial head prosthesis - A case series of 6 patients. J Int Med Res 2023; 51:3000605221135881. [PMID: 37082909 PMCID: PMC10126620 DOI: 10.1177/03000605221135881] [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: 04/22/2023] Open
Abstract
OBJECTIVE Radial head arthroplasty (RHA) is the principal treatment option for comminuted radial head (RH) fractures. Here, we present six cases of failed RHA using a modular monopolar press-fit RHA that was subsequently withdrawn from the market because it was associated with a high incidence of loosening. METHODS We retrospectively collected data from six patients who had received Radial Head Prothesis SystemTM at our centre between July 2015 and June 2016. The average follow-up was 40 months. RESULTS Aseptic loosening of the stem affected five (83%) of the six RHA. Four of these were symptomatic and RHA removal was performed. For these patients, the pain subsided and their elbow range of motion (ROM) improved. CONCLUSION While the ideal design for an RHA is still debatable, RHA is an efficient treatment option that restores elbow stability and function after a comminuted RH fracture. Importantly, removal of the prosthesis is an effective remedy following RHA associated elbow pain and decreased ROM.
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Affiliation(s)
- J Corbaz
- Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland
| | - B Barimani
- Department of Orthopaedic Surgery, McGill University, Montreal, Quebec, Canada
| | - F Vauclair
- Bone and Motion Center - Hirslanden, 1006 Lausanne, Switzerland
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6
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Berlinberg EJ, Kavian JA, Roof MA, Shichman I, Frykberg B, Lutes WB, Schnaser EA, Jones SA, McCalden RW, Schwarzkopf R. Minimum 2-Year Outcomes of a Novel 3D-printed Fully Porous Titanium Acetabular Shell in Revision Total Hip Arthroplasty. Arthroplast Today 2022; 18:39-44. [PMID: 36267391 PMCID: PMC9576483 DOI: 10.1016/j.artd.2022.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 08/09/2022] [Indexed: 11/27/2022] Open
Abstract
Background Fully porous acetabular shells are an appealing choice for patients with extensive acetabular defects undergoing revision total hip arthroplasty (rTHA). This study reports on the early outcomes of a novel 3-D printed fully porous titanium acetabular shell in revision acetabular reconstruction. Methods A multicenter retrospective study of patients who received a fully porous titanium acetabular shell for rTHA with a minimum of 2 years of follow-up was conducted. The primary outcome was rate of acetabular revision. Results The final study cohort comprised 68 patients with a mean age of 67.6 years (standard deviation 10.4) and body mass index of 29.5 kg/m2 (standard deviation 5.9). Ninety-four percent had a preoperative Paprosky defect grade of 2A or higher. The average follow-up duration was 3.0 years (range 2.0-5.1). Revision-free survivorship at 2 years was 81% for all causes, 88% for acetabular revisions, and 90% for acetabular revision for aseptic acetabular shell failure. Eight shells were explanted within 2 years (12%): 3 for failure of osseointegration/aseptic loosening (4%) after 15, 17, and 20 months; 3 for infection (4%) after 1, 3, and 6 months; and 2 for instability (3%). At the latest postoperative follow-up, all unrevised shells showed radiographic signs of osseointegration, and none had migrated. Conclusions This novel 3-D printed fully porous titanium shell in rTHA demonstrated good survivorship and osseointegration when used in complex acetabular reconstruction at a minimum of 2 years. Level of evidence IV, case series.
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Affiliation(s)
| | | | | | | | - Brett Frykberg
- Jacksonville Orthopaedic Institute, Baptist Health, Jacksonville, FL, USA
| | - William B. Lutes
- Aurora Orthopedics, Aurora Medical Center-Kenosha, Racine, WI, USA
| | | | | | - Richard W. McCalden
- University of Western Ontario, London Health Sciences Centre, London, ON, Canada
| | - Ran Schwarzkopf
- NYU Langone Health, New York, NY, USA,Corresponding author. NYU Langone Health, 301 East 17th Street, 15th Fl Suite 1518, New York, NY 10003, Tel.: +1 646 501 7300.
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7
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Xing D, Li R, Li JJ, Tao K, Lin J, Yan T, Zhou D. Catastrophic Periprosthetic Osteolysis in Total Hip Arthroplasty at 20 Years: A Case Report and Literature Review. Orthop Surg 2022; 14:1918-1926. [PMID: 35819098 PMCID: PMC9363776 DOI: 10.1111/os.13322] [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] [Received: 12/06/2021] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Periprosthetic osteolysis is a serious complication following total hip arthroplasty (THA). However, most orthopedic surgeons only focus on bone loss and hip reconstruction. Thus, it was required to understand the treatment algorithm for periprosthetic osteolysis integrally. CASE PRESENTATION A 52-year-old Asian male presented with chronic hip pain. A mass appeared on the medial side of the proximal left thigh at more than 20 years after bilateral THA. Radiographs revealed catastrophic periprosthetic osteolysis, especially on the acetabular side. Large amounts of necrotic tissue and bloody fluids were thoroughly debrided during revision THA. A modular hemipelvic prosthesis was used for revision of the left hip. Four years later, the patient presented with right hip pain, where a mass appeared on the medial side of the proximal right thigh. A primary acetabular implant with augment was used for revision of the right hip. Laboratory evaluation of bloody fluid retrieved from surgery revealed elevated levels of inflammatory markers. CONCLUSION Inflammatory responses to polyethylene wear debris can lead to severe bone resorption and aseptic loosening in the long-term following THA. Therefore, in spite of revision THA, interrupting the cascade inflammatory might be the treatment principle for periprosthetic osteolysis.
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Affiliation(s)
- Dan Xing
- Arthritis Clinic & Research Center, Peking University People's Hospital, Peking University, Beijing, China
| | - Rujun Li
- Arthritis Clinic & Research Center, Peking University People's Hospital, Peking University, Beijing, China
| | - Jiao Jiao Li
- School of Biomedical Engineering, Faculty of Engineering and IT, University of Technology Sydney, Ultimo, Australia
| | - Ke Tao
- Arthritis Clinic & Research Center, Peking University People's Hospital, Peking University, Beijing, China
| | - Jianhao Lin
- Arthritis Clinic & Research Center, Peking University People's Hospital, Peking University, Beijing, China
| | - Taiqiang Yan
- Musculoskeletal Tumor Center, Peking University People's Hospital, Peking University, Beijing, China
| | - Diange Zhou
- Arthritis Clinic & Research Center, Peking University People's Hospital, Peking University, Beijing, China
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Zhou R, Xue H, Wang J, Wang X, Wang Y, Zhang A, Zhang J, Han Q, Zhao X. Improving the Stability of a Hemipelvic Prosthesis Based on Bone Mineral Density Screw Channel and Prosthesis Optimization Design. Front Bioeng Biotechnol 2022; 10:892385. [PMID: 35706507 PMCID: PMC9189365 DOI: 10.3389/fbioe.2022.892385] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
In pelvic reconstruction surgery, the hemipelvic prosthesis can cause significant changes in stress distribution due to its high stiffness, and its solid structure is not suitable for osseointegration. The purpose of this study was to identify a novel bone mineral density screw channel and design the structure of the prosthesis so as to improve the distribution of stress, promote bone growth, and enhance the biomechanical properties of the prosthesis. The mechanical characteristics of bone mineral density screw and traditional screw were compared by finite element analysis method, and redesigned by topology optimization. The direction of the newly proposed screw channel was the posterolateral entrance of the auricular surface, ending at the contralateral sacral cape. Compared to the original group, the maximum stress of the optimized prosthesis was decreased by 24.39%, the maximum stress of the sacrum in the optimized group was decreased by 27.23%, and the average strain energy density of the sacrum in the optimized group was increased by 8.43%. On the surface of screw and connecting plate, the area with micromotion more than 28 μm is reduced by 12.17%. On the screw surface, the area with micromotion more than 28 μm is reduced by 22.9%. The newly determined screw channel and optimized prosthesis design can effectively improve the biomechanical properties of a prosthesis and the microenvironment of osseointegration. This method can provide a reference for the fixation of prostheses in clinical pelvic reconstruction.
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Zhao F, Cang D, Zhang J, Zheng L. Chemerin/ChemR23 signaling mediates the effects of ultra-high molecular weight polyethylene wear particles on the balance between osteoblast and osteoclast differentiation. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1149. [PMID: 34430590 PMCID: PMC8350637 DOI: 10.21037/atm-21-2945] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/15/2021] [Indexed: 02/02/2023]
Abstract
Background Ultra-high molecular weight polyethylene (UHMWPE) is one of the favored materials for total joint replacement, but its wear particles cause osteolysis. This study aims to elucidate the signaling that mediates the effects of UHMWPE particles on bone cells. Methods RAW264.7 and MC3T3-E1 cells were treated with UHMWPE particles. Chemerin/ChemR23 signaling was manipulated by either overexpressing Rarres2 and Cmklr1 or silencing Cmklr1. The osteoblast and osteoclast differentiation was evaluated by Alizarin red and TRAP staining, respectively. The expression of osteogenic and osteoclastogenic markers was assessed with quantitative real time PCR and western blot. Results UHMWPE particles upregulated the expression of Rarres2 and Cmklr1 in both osteoblast and osteoclast precursor cells. UHMWPE particles induced osteoclast differentiation while inhibited osteoblast differentiation, and this effect was abrogated by silencing Cmklr1 but augmented by the overexpression of Rarres2 and Cmklr1. Similarly, the expression of osteogenic marker genes was inhibited while that of osteoclastogenic marker genes was activated by UHMWPE particles, and this effect was abolished by silencing Cmklr1 and enhanced by Rarres2 and Cmklr1 overexpression. Conclusions These results demonstrated that chemerin/ChemR23 signaling plays a central role in the effects of UHMWPE particles on the balance of osteogenic and osteoclastogenic differentiation, which changes the course of bone remodeling and eventually results in osteolysis.
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Affiliation(s)
- Fengchao Zhao
- Department of Orthopedic Surgery, the First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Dingwei Cang
- Department of Orthopedic Surgery, the First People's Hospital of Yancheng City, Yancheng, China
| | - Jianzhi Zhang
- Department of Central Laboratory, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Li Zheng
- Department of Orthopedic Surgery, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
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10
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Roedel GG, Kildow BJ, Sveom DS, Garvin KL. Total hip arthroplasty using highly cross-linked polyethylene in patients aged 50 years and younger : minimum 15-year follow-up. Bone Joint J 2021; 103-B:78-83. [PMID: 34192900 DOI: 10.1302/0301-620x.103b7.bjj-2020-2443.r1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Highly cross-linked polyethylene (HXLPE) has greatly improved the durability of total hip arthroplasty (THA) in young patients because of its improved wear characteristics. Few studies have followed this population into the second decade, and therefore the purpose of this investigation was to evaluate the clinical outcome for THA patients 50 years of age and younger at a minimum of 15 years postoperatively. The second purpose was to evaluate the radiological findings secondary to wear or mechanical failure of the implant. METHODS Between October 1999 and December 2005, 105 THAs were performed in 95 patients (53 female, 42 male) aged 50 years and younger (mean 42 years (20 to 50)). There were 87 patients (96 hips) that were followed for a minimum of 15 years (mean 17.3 years (15 to 21)) for analysis. Posterior approach was used with cementless fixation with a median head size of 28 mm. HXLPE was the acetabular bearing for all hips. Radiographs were evaluated for polyethylene wear, radiolucent lines, and osteolysis. RESULTS Clinical outcomes showed significant improvement of mean Harris Hip Scores from 52.8 (SD 13.5) preoperatively to 94.8 (SD 7.6) postoperatively. One hip was revised for recurrent instability, and there were no infections. No hips were revised for mechanical loosening or osteolysis. Mean polyethylene linear wear was 0.04 mm/year and volumetric wear was 6.22 mm3/year, with no significant differences between head size or material. Osteolysis was not present in any of the hips. CONCLUSION The use of HXLPE in THA for patients aged 50 years and younger has performed exceptionally well without evidence of significant wear causing mechanical loosening or necessitating revision. The radiolucent lines of the acetabular component must be followed to determine the prognostic significance. This investigation represents the longest clinical follow-up of a large, consecutive cohort of patients aged 50 years or younger with THA using HXLPE. This long-term analysis found negligible polyethylene wear, no incidence of aseptic loosening, and excellent clinical outcomes at and beyond 15 years of follow-up. Cite this article: Bone Joint J 2021;103-B(7 Supple B):78-83.
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Affiliation(s)
- Gordon G Roedel
- Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Beau J Kildow
- Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Daniel S Sveom
- Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Kevin L Garvin
- Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Mohan K, McGoldrick NP, O'Driscoll C, Quinlan JF. Mode I and II Wear in Ceramic on Ceramic Total Hip Arthroplasty: A Case Report. J Orthop Case Rep 2021; 11:16-20. [PMID: 34239822 PMCID: PMC8241264 DOI: 10.13107/jocr.2021.v11.i03.2068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Elective total hip arthroplasty (THA) is a common procedure and has been associated with favorable outcomes in both elderly and younger patients. A variety of implant and articular components exist so to allow surgeons to make a patient-specific choice with the intent of maximizing both patient outcomes and implant survival. The utilization of ceramic bearing surfaces during THA has become increasingly prevalent, with their tribological profile conveying favorable wear and osteolysis-resistant properties. Typically, ceramic articulating components are most susceptible to failure through brittle fracture or complications such as squeaking. Case Report: This case describes a 68-year-old Caucasian male who underwent revision of ceramic on ceramic THA due to pain, with intraoperative analysis revealing evidence of gross Mode I acetabular ceramic component wear with a resultant Mode II wear articulation between the ceramic femoral head and acetabular liner. Conclusion: Wear between ceramic implants in THA is infrequently reported, and as such awareness of this uncommon phenomena as well as its potential causative factors is important when considering either primary or revision THA involving ceramic bearing components.
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Affiliation(s)
- Kunal Mohan
- Department of Trauma and Orthopaedics, Tallaght University Hospital, Dublin D24NROA, Ireland
| | - Niall P McGoldrick
- Department of Trauma and Orthopaedics, Tallaght University Hospital, Dublin D24NROA, Ireland
| | - Conor O'Driscoll
- Department of Trauma and Orthopaedics, Tallaght University Hospital, Dublin D24NROA, Ireland
| | - John F Quinlan
- Department of Trauma and Orthopaedics, Tallaght University Hospital, Dublin D24NROA, Ireland
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12
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Zheng K, Li N, Zhang W, Zhu Y, Zhou J, Xu Y, Geng D. Mid- to Long-Term Outcomes of Cementless Modular, Fluted, Tapered Stem for Massive Femoral Bone Loss in Revision Total Hip Arthroplasty. Orthop Surg 2021; 13:989-1000. [PMID: 33821565 PMCID: PMC8126951 DOI: 10.1111/os.12936] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 12/12/2020] [Accepted: 12/27/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To evaluate mid- to long-term results of revision total hip arthroplasty for massive femoral bone loss using a cementless modular, fluted, tapered stem. METHODS This is a retrospective study performed at a single hospital. During the period of January 2007 to January 2015, 33 patients (34 hips) underwent primary revision surgery with cementless modular, fluted, tapered stems due to femoral bone loss. Sixteen men and 17 women were included in the study, with an average age of 63.9 ± 11.7 years (range, 27 to 88 years). Operative data including operative duration, length of incision, drainage volume and duration, blood loss and transfusion, cases of bone graft and extended trochanteric osteotomy were recorded. Clinical evaluation was performed using Harris hip score (HHS), visual analogue scale (VAS), and patients' satisfaction. Radiographic data including femoral stem fixation, subsidence, integrin of allograft bone, and leg length discrepancy were assessed. Complications and survivorship were evaluated using Kaplan-Meier survival rate. RESULTS The mean follow-up was 9.1 ± 2.5 years (range, 5-13 years). The Harris hip score was 43.6 ± 11.5 preoperatively and maintained at 86.5 ± 6.6 at the time of latest follow-up (P < 0. 05). The X-ray showed bone ingrowth fixation in 30 hips (88%), fibrous stable fixation in three hips (9%), and instability in one hip (3%). The average stem subsidence was 3.9 ± 2.2 mm (range, 1 to 10 mm). The mean difference in leg length in our study was 3.3 ± 2.7 mm (range, 0 to 10 mm), and the leg length discrepancy in 28 (82%) patients was within 5 mm. No case of junction fracture was observed. Seven (21%) intraoperative fractures occurred in our study. Three (9%) cases with infection were observed after revision. Six (18%) patients had lower limb vein thrombosis. The survivorship of prostheses with re-revision for any reason was 95% (95% CI, 12.0 to 13.0) at the 10-year follow-up. Three (9%) re-revisions were needed, including one for aseptic loosening, one for dislocation, and one for infection. CONCLUSION The mid- to long-term results of revision total hip arthroplasty with the cementless modular, fluted, tapered stems are encouraging for massive femoral bone loss.
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Affiliation(s)
- Kai Zheng
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ning Li
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Weicheng Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yi Zhu
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jun Zhou
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yaozeng Xu
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Dechun Geng
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China.,Orthopedics Institute, Soochow University, Suzhou, China
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Van Schie P, Van Bodegom-Vos L, Zijdeman TM, Nelissen RGHH, Marang-Van De Mheen PJ. Awareness of performance on outcomes after total hip and knee arthroplasty among Dutch orthopedic surgeons: how to improve feedback from arthroplasty registries. Acta Orthop 2021; 92:54-61. [PMID: 33019821 PMCID: PMC7919881 DOI: 10.1080/17453674.2020.1827523] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - The Netherlands Registry of Orthopedic Implants (LROI) uses audit and feedback (A&F) as the strategy to improve performance outcomes after total hip and knee arthroplasty (THA/TKA). Effectiveness of A&F depends on awareness of below-average performance to initiate improvement activities. We explored the awareness of Dutch orthopedic surgeons regarding their performance on outcomes after THA/TKA and factors associated with this awareness.Methods - An anonymous questionnaire was sent to all 445 eligible Dutch orthopedic surgeons performing THA/TKA. To assess awareness on own surgeon-group performance, they were asked whether their 1-year THA/TKA revision rates over the past 2 years were below average (negative outlier), average (non-outlier), above average (positive outlier) in the funnel plot on the LROI dashboard, or did not know. Associations were determined with (1) dashboard login at least once a year (yes/no); (2) correct funnel-plot interpretation (yes/no) and; (3) recall of their 1-year THA/TKA revision rate (yes/no).Results - 44% of respondents started the questionnaire, 158 THA and 156 TKA surgeons. 55% of THA surgeons and 55% of TKA surgeons were aware of their performance. Surgeons aware of their performance more often logged in on the LROI dashboard, more often interpreted funnel plots correctly, and more often recalled their revision rate. 38% of THA and 26% of TKA surgeons scored "good" on all 3 outcomes.Interpretation - Only half of the orthopedic surgeons were aware of their performance status regarding outcomes after THA/TKA. This suggests that to increase awareness, orthopedic surgeons need to be actively motivated to look at the dashboard more frequently and educated on interpretation of funnel plots for audit and feedback to be effective.
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Affiliation(s)
- Peter Van Schie
- Department of Orthopedics, Leiden University Medical Centre, Leiden;,Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands,Correspondence:
| | - Leti Van Bodegom-Vos
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands
| | - Tristan M Zijdeman
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands
| | | | - Perla J Marang-Van De Mheen
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands
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Wu T, Liu H, Wang B, Ding C, Meng Y, Rong X, Chen H, Yang Y, Hong Y, Huang K, He J. [Analysis of infuence factors of anterior bone loss after cervical disc arthroplasty and its effect on effectiveness]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:26-32. [PMID: 33448195 DOI: 10.7507/1002-1892.202008126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective To explore the influence factors of anterior bone loss (ABL) after cervical disc arthroplasty (CDA) and effects of ABL on the clinical and radiographic outcomes. Methods One hundred and fifty-five patients who underwent single-level Prestige-LP CDA between January 2008 and December 2017 and met the inclusive criteria were enrolled in the study. Perioperative data of patients were collected. The Japanese Orthopaedic Association (JOA) score, Neck Disability Index (NDI), and the visual analogue scale (VAS) score were used for clinical outcomes evaluation. Radiographic parameters including cervical lordosis, C 2-7 range of motion (ROM), disc angle, segmental ROM, and the lengths of the upper and lower endplates were assessed on the X-ray films. Device-related complications, including ABL, subsidence, radiographic adjacent segment pathology, and heterotopic ossification, were recorded. Univariate analysis was used to analyze the related factors, and logistic regression analysis was used to screen the influence factors. Patients were grouped according to whether ABL occurred after operation, and the differences in clinical and imaging evaluation parameters were compared. Results There were 94 cases (60.6%) in the ABL group and 61 cases (39.4%) in the non-ABL group. Univariate analysis showed the significant differences in age, body mass index (BMI), and intraoperative blood loss between the two groups ( P<0.05). However, there was no significant difference in gender, bone mineral density (T value), preoperative blood calcium level, preoperative blood phosphorus level, preoperative alkaline phosphatase level, operative segment, operative time, and follow-up time between the two groups ( P>0.05). Multivariate analysis showed that the age and BMI were influence factors for ABL after CDA ( P<0.05). The JOA score, NDI, and VAS score significantly improved in both groups at 3 months after operation ( P<0.05), and the scores were further improved at last follow-up ( P<0.05). There was no significant difference in JOA score, NDI, and VAS score between the two groups before and after operation ( P>0.05). The preoperative cervical lordosis was significantly smaller in the ABL group than in the non-ABL group ( t=-2.402, P=0.018). At last follow-up, the segmental ROM was significantly greater in the ABL group than in the non-ABL group ( P<0.05), and the lengths of the upper and lower endplates were less in the ABL group than in the non-ABL group ( P<0.05). No significant difference in the other radiographic parameters between the two groups were found ( P>0.05). Prosthesis subsidence occurred in 5 cases (3.2%), including 3 cases in the ABL group and 2 cases in the non-ABL group; the difference between the two groups was not significant ( P=1.000). Heterotopic ossification occurred in 67 cases (43.2%), including 32 cases in the ABL group and 35 cases in the non-ABL group; the difference between the two groups was significant ( χ 2=8.208, P=0.004). High-grade heterotopic ossification was detected in 26 cases (13 cases in the ABL group and 13 cases in the non-ABL group). Twenty-nine cases (18.7%) had radiographic adjacent segment pathology, including 15 cases in the ABL group and 14 cases in non-ABL group; the difference between the two groups was not significant ( χ 2=1.190, P=0.276). Conclusion The incidence of ABL after CDA was relatively high, which mainly occurred within 3 months after operation, and no longer progressing with stable radiographic features after the first 12 months. Age and BMI were independent influence factors for ABL. ABL does not affect the clinical outcomes but may preserve more ROM of prostheses.
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Affiliation(s)
- Tingkui Wu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Hao Liu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Beiyu Wang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Chen Ding
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Yang Meng
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Xin Rong
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Hua Chen
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Yi Yang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Ying Hong
- West China School of Nursing, Sichuan University/Department of Anesthesia Surgery Center, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Kangkang Huang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Junbo He
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
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Letter to the Editor concerning "Osteolysis after cervical disc arthroplasty" by Joaquim AF, et al. (Eur Spine J; [2020]: doi: 10.1007/s00586-020-06,578-2). EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:3248. [PMID: 32975631 DOI: 10.1007/s00586-020-06606-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 09/04/2020] [Accepted: 09/15/2020] [Indexed: 02/05/2023]
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Wu TK, Liu H, Wang BY, He JB, Ding C, Rong X, Yang Y, Huang KK, Hong Y. Incidence of bone loss after Prestige-LP cervical disc arthroplasty: a single-center retrospective study of 396 cases. Spine J 2020; 20:1219-1228. [PMID: 32445801 DOI: 10.1016/j.spinee.2020.05.102] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 05/08/2020] [Accepted: 05/08/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND CONTEXT The development of bone loss (BL) at the operated level after cervical disc arthroplasty (CDA) has not been well recognized. The incidence of BL may be correlated with the prosthesis type. Currently, no study has reported the incidence of BL after CDA with the Prestige-LP disc, and this remains an active area of research. PURPOSE To determine the incidence of BL after Prestige-LP CDA and evaluate the impact of BL on clinical and radiological outcomes. STUDY DESIGN This is an observational study. PATIENT SAMPLE A total of 396 patients were reviewed. OUTCOME MEASURES The Japanese Orthopedics Association (JOA), Visual Analogue Scale (VAS), and Neck Disability Index (NDI) scores were evaluated. Cervical lordosis, disc angle, global and segmental range of motion (ROM), heterotopic ossification (HO), and BL were measured. METHODS We retrospectively reviewed patients who underwent Prestige-LP disc from January 2008 to October 2018 at our institution. Clinical outcomes were evaluated using JOA, VAS, and NDI scores. Radiological variables, including cervical lordosis, disc angle, global and segmental ROM, HO, and BL, were retrieved. RESULTS A total of 396 patients and 483 CDAs were evaluated. BL occurred in 56.6% of patients and 52.8% of CDA segments. Mild BL occurred in 30.2%, moderate BL in 37.3%, and severe BL in 32.5% of CDA segments. Notably, 88.2% of CDA segments developed BL within the first 3 months, and 19.1% of them progressed at 6 months. However, no progressive BL after 12 months was seen. About 50.2% of CDAs showed superior and inferior endplates involvement. The incidence of BL was associated with age, surgery type, level distribution, and incidence and grade of HO. Patients with BL had a better segmental ROM, but no relationships between patients with or without BL were found in clinical outcomes. CONCLUSIONS BL was a common but self-limited phenomenon after CDA at the early postoperative stage. It occurred more often in relatively young age patients, two-level CDA, and C5/6 segment. However, patients suffering from BL showed no deterioration of the clinical outcomes, more exceptional motion preservation at the arthroplasty level, and lower incidence with a lower grade of HO.
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Affiliation(s)
- Ting-Kui Wu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu 610041, China.
| | - Hao Liu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu 610041, China.
| | - Bei-Yu Wang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu 610041, China.
| | - Jun-Bo He
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu 610041, China.
| | - Chen Ding
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu 610041, China.
| | - Xin Rong
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu 610041, China.
| | - Yi Yang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu 610041, China.
| | - Kang-Kang Huang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu 610041, China.
| | - Ying Hong
- Department of Operating Room, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu 610041, China.
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Periprosthetic Osteolysis: Mechanisms, Prevention and Treatment. J Clin Med 2019; 8:jcm8122091. [PMID: 31805704 PMCID: PMC6947309 DOI: 10.3390/jcm8122091] [Citation(s) in RCA: 127] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 11/28/2019] [Accepted: 11/29/2019] [Indexed: 02/06/2023] Open
Abstract
Clinical studies, as well as in vitro and in vivo experiments have demonstrated that byproducts from joint replacements induce an inflammatory reaction that can result in periprosthetic osteolysis (PPOL) and aseptic loosening (AL). Particle-stimulated macrophages and other cells release cytokines, chemokines, and other pro-inflammatory substances that perpetuate chronic inflammation, induce osteoclastic bone resorption and suppress bone formation. Differentiation, maturation, activation, and survival of osteoclasts at the bone-implant interface are under the control of the receptor activator of nuclear factor kappa-Β ligand (RANKL)-dependent pathways, and the transcription factors like nuclear factor κB (NF-κB) and activator protein-1 (AP-1). Mechanical factors such as prosthetic micromotion and oscillations in fluid pressures also contribute to PPOL. The treatment for progressive PPOL is only surgical. In order to mitigate ongoing loss of host bone, a number of non-operative approaches have been proposed. However, except for the use of bisphosphonates in selected cases, none are evidence based. To date, the most successful and effective approach to preventing PPOL is usage of wear-resistant bearing couples in combination with advanced implant designs, reducing the load of metallic and polymer particles. These innovations have significantly decreased the revision rate due to AL and PPOL in the last decade.
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Jagga S, Sharma AR, Bhattacharya M, Chakraborty C, Lee SS. Influence of single nucleotide polymorphisms (SNPs) in genetic susceptibility towards periprosthetic osteolysis. Genes Genomics 2019; 41:1113-1125. [PMID: 31313107 DOI: 10.1007/s13258-019-00845-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 06/26/2019] [Indexed: 12/13/2022]
Abstract
Wear debris-induced inflammatory osteolysis remains a significant limiting factor for implant replacement surgeries. Hence, a comprehensive understanding of the complex network of cellular and molecular signals leading to these inflammatory responses is required. Both macrophages and monocytes have a critical role in the instigation of the inflammatory reaction to wear debris but differ in the extent to which they induce cytokine expression in patients. Lately, single nucleotide polymorphisms (SNPs) have been associated with genetic susceptibility among individual patients with implant failure. Studies have shown that SNPs in key pro-inflammatory cytokines and their receptors are associated with osteolytic susceptibility. Likewise, SNPs within several genes involved in the regulation of bone turnover have also been found to be associated with wear debris induced osteolysis. It is presumed that SNP variance might play a decisive role in the activation and signaling of macrophages, osteoblasts, chondrocytes, fibroblasts and other cells involved in inflammatory bone loss. Understanding the extent to which SNPs exist among genes that are responsible for inflammatory bone loss may provide potential targets for developing future therapeutic interventions. Herein, we attempt to summarize the various susceptible genes with possible SNP variance that could contribute to the severity of periprosthetic osteolysis in patients with implants.
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Affiliation(s)
- Supriya Jagga
- Institute for Skeletal Aging and Orthopedic Surgery, Hallym University-Chuncheon Sacred Heart Hospital, Chuncheon-si, Gangwon-do, 24252, Republic of Korea
| | - Ashish Ranjan Sharma
- Institute for Skeletal Aging and Orthopedic Surgery, Hallym University-Chuncheon Sacred Heart Hospital, Chuncheon-si, Gangwon-do, 24252, Republic of Korea
| | - Manojit Bhattacharya
- Institute for Skeletal Aging and Orthopedic Surgery, Hallym University-Chuncheon Sacred Heart Hospital, Chuncheon-si, Gangwon-do, 24252, Republic of Korea
| | - Chiranjib Chakraborty
- Institute for Skeletal Aging and Orthopedic Surgery, Hallym University-Chuncheon Sacred Heart Hospital, Chuncheon-si, Gangwon-do, 24252, Republic of Korea. .,Department of Biotechnology, School of Life Science and Biotechnology, Adamas University, Barasat-Barrackpore Rd, Jagannathpur, Kolkata, West Bengal, 700126, India.
| | - Sang-Soo Lee
- Institute for Skeletal Aging and Orthopedic Surgery, Hallym University-Chuncheon Sacred Heart Hospital, Chuncheon-si, Gangwon-do, 24252, Republic of Korea.
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