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Mjöberg B. Hip prosthetic loosening and periprosthetic osteolysis: A commentary. World J Orthop 2022; 13:574-577. [PMID: 35949708 PMCID: PMC9244959 DOI: 10.5312/wjo.v13.i6.574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/02/2022] [Accepted: 06/14/2022] [Indexed: 02/06/2023] Open
Abstract
Prosthetic loosening and periprosthetic osteolysis have been debated for decades, both in terms of the timing and nature of the triggering events. The hypothesis of wear-particle-induced loosening states that wear particles cause a foreign-body response leading to periprosthetic osteolysis and ultimately to late prosthetic loosening, i.e., that the osteolysis precedes the loosening. The theory of early loosening, on the other hand, postulates that the loosening is already initiated during or shortly after surgery, i.e., that the osteolysis is secondary to the loosening. This commentary focuses on the causal relationship between prosthetic loosening and periprosthetic osteolysis.
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Affiliation(s)
- Bengt Mjöberg
- Department of Orthopedics, Lund University, Lund SE-221 00, Sweden
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2
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Lin J, Sofka CM, Demetracopoulos CA, Potter HG. The Utility of Isotropic 3D Magnetic Resonance Imaging in Assessing Painful Total Ankle Replacements. FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221094840. [PMID: 35520474 PMCID: PMC9067051 DOI: 10.1177/24730114221094840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Ji Lin
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - Carolyn M. Sofka
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | | | - Hollis G. Potter
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
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3
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Peng KT, Tsai MH, Lee CW, Chiang YC, Chen PC, Chen CC, Chang CH, Shih HN, Chang PJ. Dysregulated expression of antioxidant enzymes in polyethylene particle-induced periprosthetic inflammation and osteolysis. PLoS One 2018; 13:e0202501. [PMID: 30125327 PMCID: PMC6101395 DOI: 10.1371/journal.pone.0202501] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 08/03/2018] [Indexed: 01/01/2023] Open
Abstract
Small wear particles (0.1–10 μm) in total joint replacement are generally considered as the major causative agent leading to periprosthetic inflammation and osteolysis. However, little is known about the roles of larger wear particles (10–100 μm) in periprosthetic inflammation and osteolysis. Additionally, although ample studies demonstrated that increased oxidative stress is critically involved in particle-induced inflammation and osteolysis, detailed changes in antioxidant enzymes expression in the disease development remain largely unclear. Herein, we used a rat knee prosthesis model to assess effects of polyethylene (PE) particles (20–60 μm) on the levels of oxidative stress markers such as malondialdehyde (MDA) and total antioxidant capacity (TAC) in blood plasma, and on the expression profiles of antioxidant enzymes in knee joint tissues. In combination with a forced-exercise intervention for all surgical rats, we found that the rat groups treated with both artificial joint and PE particles exhibited higher MDA levels and lower TAC levels, together with lower levels of physical activity and higher levels of inflammatory markers, than the sham group and the groups receiving artificial joint or PE particles alone at weeks 20–24 post-operatively. Dose-response relationships between the exposure to PE particles and the induction of oxidative stress and inflammation were also observed in the artificial joint/PE groups. Under such conditions, we unexpectedly found that most of antioxidant enzymes displayed pronounced up-regulation, with concomitant induction of inflammatory and osteoclast-inducing factors (including IL-1β, NF-κB and RANKL), in the artificial joint/PE groups as compared to the sham, artificial joint only, or PE only group. Only a few antioxidant enzymes including SOD2 and GPx2 showed down-regulation. Collectively, our findings demonstrate that implantation of artificial joint along with large PE particles synergistically trigger the induction of oxidative stress; however, down-regulation of many antioxidant enzymes may not necessarily occur during the disease development.
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Affiliation(s)
- Kuo-Ti Peng
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
- College of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - Meng-Hsueh Tsai
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chiang-Wen Lee
- Division of Basic Medical Sciences, Department of Nursing, and Chronic Diseases and Health Promotion Research Center, Chang Gung Institute of Technology, Chiayi, Taiwan
| | - Yao-Chang Chiang
- Center for Drug Abuse and Addiction, China Medical University Hospital, Taichung, Taiwan
| | - Pei-Chun Chen
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chun-Chieh Chen
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chih-Hsiang Chang
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Hsin-Nung Shih
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
- * E-mail: (PJC); (HNS)
| | - Pey-Jium Chang
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang-Gung University, Taoyuan, Taiwan
- Department of Nephrology, Chang-Gung Memorial Hospital, Chiayi, Taiwan
- * E-mail: (PJC); (HNS)
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4
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Moran MM, Wilson BM, Ross RD, Virdi AS, Sumner DR. Arthrotomy-based preclinical models of particle-induced osteolysis: A systematic review. J Orthop Res 2017; 35:2595-2605. [PMID: 28548682 PMCID: PMC5702596 DOI: 10.1002/jor.23619] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 05/24/2017] [Indexed: 02/04/2023]
Abstract
We completed a systematic literature review of in vivo animal models that use arthrotomy-based methods to study particle-induced peri-implant osteolysis. The purpose of the review was to characterize the models developed to date, to determine the questions addressed, to assess scientific rigor and transparency, and to identify gaps in knowledge. We probed three literature databases (Medline, Embase, and Scopus) and found 77 manuscripts that fit the search parameters. In the most recent 10 years, researchers mainly used rat and mouse models, whereas in the previous 20 years, large animal, canine, and rabbit models were more common. The studies have demonstrated several pathophysiology pathways, including macrophage migration, particle phagocytosis, increased local production of cytokines and lysosomal enzymes, elevated bone resorption, and suppressed bone formation. The effect of variation in particle characteristics and concentration received limited attention with somewhat mixed findings. Particle contamination by endotoxin was shown to exacerbate peri-implant osteolysis. The possibility of early diagnosis was demonstrated through imaging and biomarker approaches. Several studies showed that both local and systemic delivery of bisphosphonates inhibits the development of particle-induced osteolysis. Other methods of inhibiting osteolysis include the use of anabolic agents and altering the implant design. Few studies examined non-surgical rescue of loosened implants, with conflicting results with alendronate. We found that the manuscripts often lacked the methodological detail now advocated by the ARRIVE guidelines, suggesting that improvement in reporting would be useful to maximize rigor and transparency. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2595-2605, 2017.
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Affiliation(s)
- Meghan M. Moran
- Department of Anatomy and Cell Biology, Rush University Medical Center
| | | | - Ryan D. Ross
- Department of Anatomy and Cell Biology, Rush University Medical Center
| | - Amarjit S. Virdi
- Department of Anatomy and Cell Biology, Rush University Medical Center
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5
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Abstract
Aseptic loosening of implants remains the most common reason for revision surgery for hip, knee, or ankle prostheses. Although a great scientific effort has been made to explain the underlying mechanisms it remains poorly understood, complex, and multifactorial. Many factors, including age, body weight, activity lesions, implant design, fixation methods, material proprieties, immunologic responses, and biomechanical adaptations to total ankle replacement all contribute to the development of periprosthetic osteolysis.
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Affiliation(s)
- Norman Espinosa
- Institute for Foot and Ankle Reconstruction Zurich, Kappelistrasse 7, Zurich 8002, Switzerland.
| | - Georg Klammer
- Institute for Foot and Ankle Reconstruction Zurich, Kappelistrasse 7, Zurich 8002, Switzerland
| | - Stephan H Wirth
- Department of Orthopaedics, University of Zurich, Forchstrasse 340, Zurich 8008, Switzerland
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6
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Langlois J, Hamadouche M. New animal models of wear-particle osteolysis. INTERNATIONAL ORTHOPAEDICS 2010; 35:245-51. [PMID: 21069525 DOI: 10.1007/s00264-010-1143-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Accepted: 10/15/2010] [Indexed: 12/22/2022]
Abstract
Particle debris resulting from in vivo degradation of total joint replacement components are recognised as the major factor limiting the longevity of joint reconstruction and the overall success of the procedure. Better understanding the complex cellular and tissue mechanisms and interactions resulting in wear-particle osteolysis requires a number of experimental approaches, including radiological monitoring and analysis of retrieved tissues from clinical cases, in vitro experiments, and also animal-model investigations. In consideration of both their advantages and drawbacks, this paper provides an historical overview of numerous animal models that have been developed over the last three decades to investigate the pathogenesis of wear-particle osteolysis and to facilitate the preclinical testing of new treatment options. The authors also focus on recent studies in order to provide a better understanding of the current state of the art on this subject and propose some perspectives regarding technical and fundamental questions.
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Affiliation(s)
- Jean Langlois
- Department of Orthopaedic and Reconstructive Surgery Service A, Centre Hospitalo-Universitaire Cochin-Port Royal, 27 Rue du Faubourg St Jacques, 75014 Paris, France.
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7
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Yim ES, Zhao B, Myung D, Kourtis LC, Frank CW, Carter D, Smith RL, Goodman SB. Biocompatibility of poly(ethylene glycol)/poly(acrylic acid) interpenetrating polymer network hydrogel particles in RAW 264.7 macrophage and MG-63 osteoblast cell lines. J Biomed Mater Res A 2009; 91:894-902. [DOI: 10.1002/jbm.a.32311] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Ma T, Ortiz SG, Huang Z, Ren P, Smith RL, Goodman SB. In vivo murine model of continuous intramedullary infusion of particles--a preliminary study. J Biomed Mater Res B Appl Biomater 2009; 88:250-3. [PMID: 18777575 DOI: 10.1002/jbm.b.31175] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Continued production of wear debris affects both initial osseointegration and subsequent bone remodeling of total joint replacements (TJRs). However, continuous delivery of clinically relevant particles using a viable, cost effective, quantitative animal model to simulate the scenario in humans has been a challenge for orthopedic researchers. In this study, we successfully infused blue-dyed polystyrene particles, similar in size to wear debris in humans, to the intramedullary space of the mouse femur for 4 weeks using an osmotic pump. Approximately 40% of the original particle load (85 microL) was delivered into the intramedullary space, an estimate of 3 x 10(9) particles. The visible blue dye carried by the particles confirmed the delivery. This model demonstrated that continuous infusion of particles to the murine bone-implant interface is possible. In vivo biological processes associated using wear debris particles can be studied using this new animal model.
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Affiliation(s)
- Ting Ma
- The Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
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9
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Ortiz SG, Ma T, Regula D, Smith RL, Goodman SB. Continuous intramedullary polymer particle infusion using a murine femoral explant model. J Biomed Mater Res B Appl Biomater 2009; 87:440-6. [PMID: 18536041 DOI: 10.1002/jbm.b.31122] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In vitro models are important investigative tools in understanding the biological processes involved in wear-particle-induced chronic inflammation and periprosthetic osteolysis. In the clinical scenario, particles are produced and delivered continuously over extended periods of time. Previously, we quantified the delivery of both polystyrene and polyethylene particles over 2- and 4-week time periods using osmotic pumps and collection tubes. In the present study, we used explanted mice femora in organ culture and showed that continuous intramedullary delivery of submicron-sized polymer particles using osmotic pumps is feasible. Furthermore, infusion of 2.60 x 10(11) particles per mL (intermediate concentration) of ultrahigh molecular weight polyethylene (UHMWPE) for 2 weeks and 8.06 x 10(11) particles per mL (high concentration) UHMWPE for 4 weeks both yielded significantly higher scores for bone loss when compared with controls in which only mouse serum was infused.
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Affiliation(s)
- Steven G Ortiz
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
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10
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Hoenders CSM, Harmsen MC, van Luyn MJA. The local inflammatory environment and microorganisms in “aseptic” loosening of hip prostheses. J Biomed Mater Res B Appl Biomater 2008; 86:291-301. [DOI: 10.1002/jbm.b.30992] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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11
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Ma T, Huang Z, Ren PG, McCally R, Lindsey D, Smith RL, Goodman SB. An in vivo murine model of continuous intramedullary infusion of polyethylene particles. Biomaterials 2008; 29:3738-3742. [PMID: 18561997 DOI: 10.1016/j.biomaterials.2008.05.031] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2008] [Accepted: 05/20/2008] [Indexed: 12/20/2022]
Abstract
Wear debris affects both initial osseointegration and subsequent bone remodeling of total joint replacements (TJRs). To study the complex cascade associated with the continuous generation of particles, a robust animal model is essential. To date, an animal model that incorporates continuously delivered particles to an intramedullary orthopaedic implant has not been available. In this study, we successfully infused clinically relevant ultra high molecular weight polyethylene particles, previously isolated from joint simulator tests, to the intramedullary space of the mouse femur for 4 weeks using a subcutaneous osmotic pump. Reduction of bone volume following the 4-week infusion of UHMWPE was detected by microCT. UHMWPE particles also changed the level of Alkaline Phosphatase expression in the infused femurs. Continuous infusion of particles to the murine bone-implant interface simulated the clinical scenario of local polymer wear particle generation and delivery in humans and can be used to further study the biological processes associated with wear debris particles.
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Affiliation(s)
- Ting Ma
- Department of Orthopaedic Surgery, Stanford University, School of Medicine, Stanford, CA, USA.
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12
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Ortiz SG, Ma T, Epstein NJ, Smith RL, Goodman SB. Validation and quantification of an in vitro model of continuous infusion of submicron-sized particles. J Biomed Mater Res B Appl Biomater 2008; 84:328-33. [PMID: 17595028 DOI: 10.1002/jbm.b.30875] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Wear particles produced from total joint replacements have been shown to stimulate a foreign body and chronic inflammatory reaction that results in periprosthetic osteolysis. Most animal models that simulate these events have used a single injection of particles, which is not representative of the clinical scenario, in which particles are continuously generated. The goal of this study was to evaluate the feasibility of an osmotic pump for the continuous delivery of clinically relevant submicron-sized particles over an extended period of time. Blue-dyed polystyrene particles and retrieved ultra-high molecular weight polyethylene (UHMWPE) particles, both suspended in mouse serum, were loaded into an Alzet mini-osmotic pump. Pumps were attached to vinyl tubing that ended with hollow titanium rods, simulating a metal implant, which was suspended in a collection vessel. The number of particles collected was evaluated over 2- and 4-week time periods. Delivery of both the polystyrene and UHMWPE particles was feasible over pump concentrations of 10(9) to 10(11) particles per pump. Furthermore, delivery efficiency of polystyrene particles decreased with increasing initial particle concentration, whereas delivery efficiency of UHMWPE particles increased slightly with increasing initial particle concentration. For UHMWPE, approximately one-third of the particles in the pump were collected at 4 weeks. This in vitro study has quantified the efficiency of a unique particle pumping system that may be used in future in vivo investigations to develop a murine model of continuous particle infusion.
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Affiliation(s)
- Steven G Ortiz
- The Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA
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13
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What experimental approaches (eg, in vivo, in vitro, tissue retrieval) are effective in investigating the biologic effects of particles? J Am Acad Orthop Surg 2008; 16 Suppl 1:S63-7. [PMID: 18612016 PMCID: PMC2735389 DOI: 10.5435/00124635-200800001-00013] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Understanding the complex cellular and tissue mechanisms and interactions resulting in periprosthetic osteolysis requires a number of experimental approaches, each of which has its own set of advantages and limitations. In vitro models allow for the isolation of individual cell populations and have furthered our understanding of particle-cell interactions; however, they are limited because they do not mimic the complex tissue environment in which multiple cell interactions occur. In vivo animal models investigate the tissue interactions associated with periprosthetic osteolysis, but the choice of species and whether the implant system is subjected to mechanical load or to unloaded conditions are critical in assessing whether these models can be extrapolated to the clinical condition. Rigid analysis of retrieved tissue from clinical cases of osteolysis offers a different approach to studying the biologic process of osteolysis, but it is limited in that the tissue analyzed represents the end-stage of this process and, thus, may not reflect this process adequately.
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14
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Nixon M, Taylor G, Sheldon P, Iqbal SJ, Harper W. Does bone quality predict loosening of cemented total hip replacements? ACTA ACUST UNITED AC 2007; 89:1303-8. [DOI: 10.1302/0301-620x.89b10.19038] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
We matched 78 patients with a loose cemented Charnley Elite Plus total hip replacement (THR) by age, gender, race, prosthesis and time from surgery with 49 patients with a well-fixed stable hip replacement, to determine if poor bone quality predisposes to loosening. Clinical, radiological, biomechanical and bone mineral density indicators of bone quality were assessed. Patients with loose replacements had more pain, were more likely to have presented with atrophic arthritis and to have a history of fragility fracture, narrower femoral cortices and lower peri-prosthetic or lumbar spine bone mineral density (all t-test, p < 0.01). They also tended to be smokers (chi-squared test, p = 0.08). Vitamin-D deficiency was common, but not significantly different between the two groups (t-test, p = 0.31) In this series of cemented hip replacements performed between 1994 and 1998, aseptic loosening was associated with poor bone quality. Patients with a THR should be screened for osteoporosis and have regular radiological surveillance.
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Affiliation(s)
- M. Nixon
- Department of Orthopaedics, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK
| | - G. Taylor
- Department of Orthopaedics, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK
| | | | - S. J. Iqbal
- Leicester Royal Infirmary, Infirmary Square, Leicester LE1, UK
| | - W. Harper
- Department of Orthopaedics, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK
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15
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Carlsson LV, Albrektsson BEJ, Albrektsson BG, Albrektsson TO, Jacobsson CM, Macdonald W, Regnér L, Röstlund T, Weidenhielm LR. Stepwise introduction of a bone-conserving osseointegrated hip arthroplasty using RSA and a randomized study: I. Preliminary investigations--52 patients followed for 3 years. Acta Orthop 2006; 77:549-58. [PMID: 16929430 DOI: 10.1080/17453670610012601] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND We developed a total hip system using osseointegration guidelines, a metaphyseal-loading proximal femoral replacement in the retained neck and a dual-geometry titanium shell in the acetabulum. PATIENTS AND METHODS A randomized controlled clinical trial was undertaken in 52 patients (53 hips), using the cemented Spectron stem and cementless Harris-Galante II cup as control implants (24 patients in experimental group, 29 control patients). Clinical measures of Harris Hip Score (HHS), pain score and radiostereometric analysis (RSA) at regular intervals for up to three years were used to monitor progress. RESULTS No statistically significant differences were found in HHS and pain score; the stability of the cementless experimental implant was also comparable to that of the cemented controls by RSA. 3 revisions were required for migration in the experimental group and 1 was required for component dislocation in the control group. INTERPRETATION Our findings indicate the practicality of osseointegration of titanium implants, but suggest that current performance is inadequate for clinical introduction. However, the stable fixation achieved in the retained neck in the majority of patients is indicative of osseointegration. This finding will encourage technical and design improvements for enhancement of clinical osseointegration and should also encourage further study. Periprosthetic osteolysis might be avoided by the establishment and maintenance of direct implant-bone connection: "osseointegration".
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Affiliation(s)
- Lars V Carlsson
- Department of Biomaterials Research, Institute of Surgical Sciences, University of Gothenburg, Sweden.
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16
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Sundfeldt M, Carlsson LV, Johansson CB, Thomsen P, Gretzer C. Aseptic loosening, not only a question of wear: a review of different theories. Acta Orthop 2006; 77:177-97. [PMID: 16752278 DOI: 10.1080/17453670610045902] [Citation(s) in RCA: 384] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Today, aseptic loosening is the most common cause of revision of major arthroplasties. Aseptic loosening accounts for more than two-thirds of hip revisions and almost one-half of knee revisions in Sweden. Several theories on the cause of aseptic loosening have been proposed. Most of these theories, however, are based on empiric observations, experimental animal models or anecdotal cases. In this review, we discuss the most common theories concerning aseptic loosening. It emerges from this review that aseptic loosening has a multifactorial etiology and cannot be explained by a single theory.
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Affiliation(s)
- Mikael Sundfeldt
- Department of Biomaterials/Handicap Research, Sahlgrenska University Hospital, University of Gothenburg, Sweden.
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17
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DiResta GR, Brown H, Aiken S, Doty S, Schneider R, Wright T, Healey JH. Use of an absorbable membrane to position biologically inductive materials in the periprosthetic space of cemented joints. J Biomech 2006; 39:833-43. [PMID: 16488222 DOI: 10.1016/j.jbiomech.2005.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2004] [Accepted: 02/03/2005] [Indexed: 10/25/2022]
Abstract
A device is presented that positions ultrahigh molecular weight polyethylene (UHMWPE) debris against periprosthetic bone surfaces. This can facilitate the study of aseptic loosening associated with cemented joint prostheses by speeding the appearance of this debris within the periprosthetic space. The device, composed of a 100 microm thick bioabsorbable membrane impregnated with 1.4 x 10(9) sub-micron particles of UHMWPE debris, is positioned on the endosteum of the bone prior to the insertion of the cemented orthopedic implant. An in vitro pullout study and an in vivo canine pilot study were performed to investigate its potential to accelerate "time to aseptic loosening" of cemented prosthetic joints. Pullout studies characterized the influence of the membrane on initial implant fixation. The tensile stresses (mean+/-std.dev.) required to withdraw a prosthesis cemented into canine femurs with and without the membrane were 1.15+/-0.3 and 1.54+/-0.01 MPa, respectively; these findings were not significantly different (p > 0.4). The in vivo pilot study, involving five dogs, was performed to evaluate the efficacy of the debris to accelerate loosening in a canine cemented hip arthroplasty. Aseptic loosening and lameness occurred within 12 months, quicker than the 30 months reported in a retrospective clinical review of canine hip arthroplasty.
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Affiliation(s)
- Gene R DiResta
- Orthopaedics Research Laboratory, Memorial Sloan Kettering Cancer Center, RRL 409, 430 E67th St., New York, NY 10021, USA.
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18
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Epstein NJ, Bragg WE, Ma T, Spanogle J, Smith RL, Goodman SB. UHMWPE wear debris upregulates mononuclear cell proinflammatory gene expression in a novel murine model of intramedullary particle disease. Acta Orthop 2005. [DOI: 10.1080/17453670510041321] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Affiliation(s)
- Noah J Epstein
- Department of Orthopedic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - William E Bragg
- Department of Orthopedic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Ting Ma
- Department of Orthopedic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Joshua Spanogle
- Department of Orthopedic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - R Lane Smith
- Department of Orthopedic Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Stuart B Goodman
- Department of Orthopedic Surgery, Stanford University School of Medicine, Stanford, California, USA
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19
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Warme BA, Epstein NJ, Trindade MCD, Miyanishi K, Ma T, Saket RR, Regula D, Goodman SB, Smith RL. Proinflammatory mediator expression in a novel murine model of titanium-particle-induced intramedullary inflammation. ACTA ACUST UNITED AC 2004; 71:360-6. [PMID: 15389497 DOI: 10.1002/jbm.b.30120] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Wear debris from total joint replacement prostheses is implicated in periprosthetic osteolysis and implant loosening. The pathophysiology of this biological process remains unclear. Animal models of particle-induced osteolysis have proven useful in the study of specific tissue responses to wear debris. However, existing in vivo murine models of particle-mediated inflammation do not permit analysis of cortical bone degradation. This study describes a murine model of particle disease using an intramedullary rod in the mouse femur to parallel the clinical situation. The model consists of placing a 10-mm-long Kirschner wire retrograde in both femurs of C57b1/6 male mice via a medial parapatellar arthrotomy. Phagocytosable titanium particles were also implanted unilaterally to replicate generation of wear debris. Mice were sacrificed at 2, 10, and 26 weeks and whole femurs were cultured for 72 h. Levels of interleukin-6, monocyte chemotactic protein-1, and macrophage colony stimulating factor were assayed by ELISA. Transverse histological sections, at the level of the implant, were taken and stained with hematoxylin and eosin (H&E). Results demonstrated increased expression of proinflammatory mediators at 2 weeks in femora with rod and particles compared to femora with rods alone. Destruction of the endosteum was evident at 2, 10, and 26 weeks in the femora with titanium. This novel murine model of particle-induced intramedullary inflammation may facilitate cost-effective genetic studies and offers investigators a simple, clinically relevant intramedullary model to readily examine the pathogenesis of particle-mediated periprosthetic osteolysis.
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Affiliation(s)
- Bryan A Warme
- Department of Orthopaedic Surgery, Stanford University School of Medicine, California, USA
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O'Hara LJ, Nivbrant B, Röhrl S. Cross-linked polyethylene and bisphosphonate therapy for osteolysis in total hip arthroplasty: a case report. J Orthop Surg (Hong Kong) 2004; 12:114-21. [PMID: 15237133 DOI: 10.1177/230949900401200121] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A 39-year-old woman underwent bilateral total hip arthroplasty with conventional, ethylene oxide-sterilised liners when she was a subject in a radiostereometric analysis study. Within 2 years she had rapid polyethylene wear with aggressive, asymptomatic, and periprosthetic osteolysis on both sides. Oral alendronate therapy halted the progression of osteolysis over a year and revision to cross-linked polyethylene liners was then undertaken while one stem was curettaged and the other revised. Radiostereometric analysis revealed a 96% reduction in wear rate over 2 years with the cross-linked liners. On stopping alendronate treatment, aggressive osteolysis recurred on the curretaged but not on the revised femur.
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Affiliation(s)
- L J O'Hara
- Perth Orthopaedic Institute, Western Australia, Australia.
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