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Deng Y, Phillips K, Feng ZP, Smith PN, Li RW. Aseptic loosening around total joint replacement in humans is regulated by miR-1246 and miR-6089 via the Wnt signalling pathway. J Orthop Surg Res 2024; 19:94. [PMID: 38287447 PMCID: PMC10823634 DOI: 10.1186/s13018-024-04578-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 01/23/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Total joint replacement for osteoarthritis is one of the most successful surgical procedures in modern medicine. However, aseptic loosening continues to be a leading cause of revision arthroplasty. The diagnosis of aseptic loosening remains a challenge as patients are often asymptomatic until the late stages. MicroRNA (miRNA) has been demonstrated to be a useful diagnostic tool and has been successfully used in the diagnosis of other diseases. We aimed to identify differentially expressed miRNA in the plasma of patients with aseptic loosening. METHODS Adult patients undergoing revision arthroplasty for aseptic loosening and age- and gender-matched controls were recruited. Samples of bone, tissue and blood were collected, and RNA sequencing was performed in 24 patients with aseptic loosening and 26 controls. Differentially expressed miRNA in plasma was matched to differentially expressed mRNA in periprosthetic bone and tissue. Western blot was used to validate protein expression. RESULTS Seven miRNA was differentially expressed in the plasma of patients with osteolysis (logFC >|2|, adj-P < 0.05). Three thousand six hundred and eighty mRNA genes in bone and 427 mRNA genes in tissue samples of osteolysis patients were differentially expressed (logFC >|2|, adj-P < 0.05). Gene enrichment analysis and pathway analysis revealed two miRNA (miR-1246 and miR-6089) had multiple gene targets in the Wnt signalling pathway in the local bone and tissues which regulate bone metabolism. CONCLUSION These results suggest that aseptic loosening may be regulated by miR-1246 and miR-6089 via the Wnt signalling pathway.
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Affiliation(s)
- Yi Deng
- Australian National University Medical School, Canberra, Australia.
- Department of Orthopaedic Surgery, Canberra Hospital, Canberra, Australia.
| | - Kate Phillips
- Australian National University Medical School, Canberra, Australia
| | - Zhi-Ping Feng
- John Curtin School of Medical Research, Australian National University, Canberra, Australia
| | - Paul N Smith
- Australian National University Medical School, Canberra, Australia
- Department of Orthopaedic Surgery, Canberra Hospital, Canberra, Australia
| | - Rachel W Li
- Australian National University Medical School, Canberra, Australia
- John Curtin School of Medical Research, Australian National University, Canberra, Australia
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2
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Li Z, Liang Y, Wan J, Zhu W, Wang Y, Chen Y, Lu B, Zhu J, Zhu C, Zhang X. Physically cross-linked organo-hydrogels for friction interfaces in joint replacements: design, evaluation and potential clinical applications. J Mater Chem B 2023; 11:11150-11163. [PMID: 37971358 DOI: 10.1039/d3tb01830j] [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: 11/19/2023]
Abstract
This paper investigates physically crosslinked organo-hydrogels for total hip replacement surgery. Current materials in artificial joints have limitations in mechanical performance and biocompatibility. To overcome these issues, a new approach based on hydrogen bonds between polyvinyl alcohol, poly(2-hydroxyethyl methacrylate), and glycerin is proposed to develop bioactive organo-hydrogels with improved mechanical properties and biocompatibility. This study analyzes local pathological characteristics, systemic toxicity, and mechanical properties of the gels. The results show that the gels possess excellent biocompatibility and mechanical strength, suggesting their potential as an alternative material for total hip replacement surgery. These findings contribute to improving patient outcomes in joint replacement procedures.
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Affiliation(s)
- Zheng Li
- Department of Pharmacy, the First Affiliated Hospital of Anhui Medical University, Hefei, P. R. China
| | - Yongzhi Liang
- Department of Orthopedics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, P. R. China.
- School of Science, Harbin Institute of Technology, Shenzhen, P. R. China
| | - Jia Wan
- Department of Burns, the First Affiliated Hospital of Anhui Medical University, Hefei, P. R. China
| | - Wanbo Zhu
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, P. R. China
| | - Yingjie Wang
- Department of Orthopedics, The Second Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, P. R. China.
| | - Yuan Chen
- Department of Orthopedics, The Second Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, P. R. China.
| | - Baoliang Lu
- Graduate School of Bengbu Medical College, Bengbu, P. R. China
| | - Junchen Zhu
- Department of Orthopedics, The Second Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, P. R. China.
| | - Chen Zhu
- Department of Orthopedics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, P. R. China.
| | - Xianzuo Zhang
- Department of Orthopedics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, P. R. China.
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Kinoshita S, Kinoshita K, Sakamoto T, Seo H, Suzuki M, Yamamoto T. Sequential Intraoperative Evaluation of Rotational Stability of Cementless Stem in Total Hip Arthroplasty: A Broach-Based Study. J Clin Med 2023; 12:5444. [PMID: 37685511 PMCID: PMC10487492 DOI: 10.3390/jcm12175444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/05/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
In cementless total hip arthroplasty, the rotational stability of the stem is generally confirmed in a one-time manual evaluation by the surgeon. This study was performed to evaluate the sequential intraoperative changes in rotational stability using a torque wrench. Primary total hip arthroplasty was performed on 52 consecutive hips using a single wedge stem design. Intraoperative evaluation of rotational stability was uniformly performed using a torque wrench. Evaluations were performed immediately after broach insertion and immediately before the final insertion of the stem (after placement of the acetabular cup). Immediately after the insertion of the broach, rotational stability was checked and confirmed to be fully stabilized using a torque wrench in all cases, and the stability was maintained in 17 of 52 (33%) hips immediately before the final insertion of the stem. Among the hips showing instability, 11 of 35 (31%) broaches were upsized, while the remaining 24 hips achieved stabilization through deeper insertion of the broach. In conclusion, the rotational stability achieved immediately after the insertion of the broach was not necessarily maintained during surgery, indicating that rotational stability may need to be checked at multiple time points intraoperatively.
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Affiliation(s)
| | | | | | | | | | - Takuaki Yamamoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan; (S.K.); (K.K.); (T.S.); (H.S.); (M.S.)
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Li Z, Lu M, Zhou Y, Min L, Tu C. Three-dimensional design custom-made uncemented stem for revision of cemented distal femoral endoprosthesis due to aseptic loosening. J Orthop Surg Res 2023; 18:506. [PMID: 37461032 DOI: 10.1186/s13018-023-03994-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/10/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Revision of cemented distal femoral replacement (DFR) due to aseptic loosening is challenging because of the resultant femoral bone loss. This paper aims to examine the outcomes of three-dimensional (3D) design custom-made uncemented stems for revision. METHODS Between January 2014 and December 2020, 17 patients received 3D design uncemented stems for revision of loosed cemented DFR. The femoral bone loss was classified into four Grades, and four types of uncemented stems were designed correspondingly. The revision stems were custom-made for each patient by measuring the diameter of the medullary cavity and the anterior curvature of the femur. RESULTS The patient counts with their corresponding Grades of femoral bone loss were as follows: Grade I, 8 patients; Grade II, 5 patients; Grade III, 3 patients; and Grade IV, 1 patient. During the mean follow-up of 80 months, no revision failure was detected. The postoperative radiographic showed that the stem matched the femoral anterior curvature well. The femoral bone defect was completely filled by the 3D design stem in 10 of the 17 cases postoperatively. In the remaining cases, the persistent peri-stem defect was filled or partially restored during the follow-up. CONCLUSION 3D design custom-made uncemented stem created precise, stable, and durable fixation and provided satisfactory clinical outcomes, which seems to be a viable method for cemented DFR revision.
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Affiliation(s)
- Zhuangzhuang Li
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Minxun Lu
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yong Zhou
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Li Min
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China.
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
| | - Chongqi Tu
- Department of Orthopedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China.
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
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Xu R, Jin Y, Tang S, Wang W, Sun YE, Liu Y, Zhang W, Hou B, Huang Y, Ma Z. Association between single nucleotide variants and severe chronic pain in older adult patients after lower extremity arthroplasty. J Orthop Surg Res 2023; 18:184. [PMID: 36895017 PMCID: PMC9999576 DOI: 10.1186/s13018-023-03683-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 03/06/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Hip or knee osteoarthritis (OA) is one of the main causes of disability worldwide and occurs mostly in the older adults. Total hip or knee arthroplasty is the most effective method to treat OA. However, severe postsurgical pain leading to a poor prognosis. So, investigating the population genetics and genes related to severe chronic pain in older adult patients after lower extremity arthroplasty is helpful to improve the quality of treatment. METHODS We collected blood samples from elderly patients who underwent lower extremity arthroplasty from September 2020 to February 2021 at the Drum Tower Hospital Affiliated to Nanjing University Medical School. The enrolled patients provided measures of pain intensity using the numerical rating scale on the 90th day after surgery. Patients were divided into the case group (Group A) and the control group (Group B) including 10 patients respectively by the numerical rating scale. DNA was isolated from the blood samples of the two groups for whole-exome sequencing. RESULTS In total, 661 variants were identified in the 507 gene regions that were significantly different between both groups (P < 0.05), including CASP5, RASGEF1A, CYP4B1, etc. These genes are mainly involved in biological processes, including cell-cell adhesion, ECM-receptor interaction, metabolism, secretion of bioactive substances, ion binding and transport, regulation of DNA methylation, and chromatin assembly. CONCLUSIONS The current study shows some variants within genes are significantly associated with severe postsurgical chronic pain in older adult patients after lower extremity arthroplasty, indicating a genetic predisposition for chronic postsurgical pain. The study was registered according to ICMJE guidelines. The trial registration number is ChiCTR2000031655 and registration date is April 6th, 2020.
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Affiliation(s)
- Rui Xu
- Department of Anesthesiology, Affiliated Drum Tower Hospital, Medical School, Nanjing University, No. 321 of Zhongshan Road, Nanjing, 210008, China
| | - Yinan Jin
- Department of Anesthesiology, Affiliated Drum Tower Hospital, Medical School, Nanjing University, No. 321 of Zhongshan Road, Nanjing, 210008, China
| | - Suhong Tang
- Department of Anesthesiology, Affiliated Drum Tower Hospital, Medical School, Nanjing University, No. 321 of Zhongshan Road, Nanjing, 210008, China
| | - Wenwen Wang
- Department of Anesthesiology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, 210008, China
| | - Yu-E Sun
- Department of Anesthesiology, Affiliated Drum Tower Hospital, Medical School, Nanjing University, No. 321 of Zhongshan Road, Nanjing, 210008, China
| | - Yue Liu
- Department of Anesthesiology, Affiliated Drum Tower Hospital, Medical School, Nanjing University, No. 321 of Zhongshan Road, Nanjing, 210008, China
| | - Wei Zhang
- Department of Anesthesiology, Affiliated Drum Tower Hospital, Medical School, Nanjing University, No. 321 of Zhongshan Road, Nanjing, 210008, China
| | - Bailing Hou
- Department of Anesthesiology, Affiliated Drum Tower Hospital, Medical School, Nanjing University, No. 321 of Zhongshan Road, Nanjing, 210008, China
| | - Yulin Huang
- Department of Anesthesiology, Affiliated Drum Tower Hospital, Medical School, Nanjing University, No. 321 of Zhongshan Road, Nanjing, 210008, China.
| | - Zhengliang Ma
- Department of Anesthesiology, Affiliated Drum Tower Hospital, Medical School, Nanjing University, No. 321 of Zhongshan Road, Nanjing, 210008, China.
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Summer B, Lill D, Remmel K, Schraml A, Schopf C, Banke IJ, Kuechenhoff H, Maierhofer T, Endres S, Thomas P. An interleukin-1 polymorphism additionally intensified by atopy as prognostic factor for aseptic non-mechanical complications in metal knee and hip arthroplasty. Front Immunol 2022; 13:1050315. [PMID: 36518750 PMCID: PMC9742593 DOI: 10.3389/fimmu.2022.1050315] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/15/2022] [Indexed: 11/29/2022] Open
Abstract
Background In contrast to infection or mechanical issues joint replacement failure following inflammatory adverse reactions is poorly understood. Objective To assess the association of IL-1β polymorphisms and history of allergy with aseptic non-mechanical complications following arthroplasty. Methods In 102 patients with aseptic non-mechanically caused symptomatic knee or hip arthroplasty (SA) and 93 patients with asymptomatic arthroplasty (AA) questionnaire-based history, patch test with at least standard series, lymphocyte transformation test (LTT) with nickel, cobalt and chromium and interleukin-1 polymorphism analysis were done. Three polymorphisms of the IL1B gene [IL-1b -3954 (rs1143634), IL-1b -511 (rs16944) and IL-1b -31 (rs1143627)] and one polymorphism of the IL1RN gene [IL1RN intron 2, variable number of tandem repeats, VNTR (rs2234663)] were assessed by PCR and gel electrophoresis. Results We found no significant difference in smoking history and atopy but 25% versus 10% of self-reported metal allergy in SA versus AA; the patch test (respective, LTT) for metal sensitivity was more often positive in SA patients. The allele 498 bp of the IL1RN polymorphism occurred significantly more often in the SA group (37% versus 11%; p < 0.0001). Upon additional presence of atopy, the difference was even greater (60% vs 10%) (p < 0.000001). There was no association of IL-1 polymorphisms with metal allergy. Conclusion The IL1RN VNTR allele 498 bp was strongly associated with SA. In patients with a history of atopy, presence of the IL1RN VNTR allele 498 bp led to a four-fold higher SA prevalence compared to patients without this allele.
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Affiliation(s)
- B. Summer
- Department of Dermatology and Allergology, University Hospital, Munich, Germany,*Correspondence: B. Summer,
| | - D. Lill
- Department of Dermatology and Allergology, University Hospital, Munich, Germany
| | - K. Remmel
- Department of Orthopedic Surgery, Clinic Rummelsberg and Nürnberg, Rummelsberg, Germany
| | - A. Schraml
- Department of Orthopedic Surgery, Clinic Rummelsberg and Nürnberg, Rummelsberg, Germany
| | - C. Schopf
- Department of Orthopaedics, Physical Medicine and Rehabiliation University Hospital, Munich, Germany
| | - I. J. Banke
- Clinic of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - H. Kuechenhoff
- Statistical Consulting Unit StaBLab, Department of Statistics, LMU, Munich, Germany
| | - T. Maierhofer
- Department of Statistics, University of California, Los Angeles (UCLA), Los Angeles, CA, United States
| | - S. Endres
- Division of Clinical Pharmacology, University Hospital, Munich, Germany
| | - P. Thomas
- Department of Dermatology and Allergology, University Hospital, Munich, Germany
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López-Anglada E, Collazos J, Montes AH, Pérez-Is L, Pérez-Hevia I, Jiménez-Tostado S, Suárez-Zarracina T, Alvarez V, Valle-Garay E, Asensi V. IL-1 β gene (+3954 C/T, exon 5, rs1143634) and NOS2 (exon 22) polymorphisms associate with early aseptic loosening of arthroplasties. Sci Rep 2022; 12:18382. [PMID: 36319725 PMCID: PMC9626623 DOI: 10.1038/s41598-022-22693-0] [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: 04/19/2022] [Accepted: 10/18/2022] [Indexed: 12/15/2022] Open
Abstract
Aseptic prosthetic loosening (APL) and prosthetic joint infections (PJI) are frequent complications of hip and knee implants. Polymorphisms of cytokines and nitric oxide (NO), key inflammatory molecules in APL and PJI pathogenesis, could explain individual susceptibility to these complications. Three cytokines (IL-1-a, IL-1-β, TNF-α) and two nitric oxide synthase (NOS2, NOS3) genes polymorphisms were genotyped in 77 APL and 117 PJI patients and 145 controls with aseptic hip or knee implants that were implanted for > 16 years. Plasma cytokines and nitrate-nitrite (NOx) levels also were measured. The TT genotype and T allele of (+3954 C/T, exon 5, rs1143634) IL-1β polymorphism were more frequent in APL patients compared to controls (P = 0.03 and P = 0.02, respectively). No genotypic associations in PJI patients were observed. Plasma IL-6, TNF-α and NOx were significantly different between APL and controls (P < 0.0001). Plasma IL-1β and IL-6 were significantly higher in APL T allele carriers vs. non-carriers (P < 0.03). Knee implant (HR 2.488, 95% CI 1.307-4.739, P = 0.005), male gender (HR 2.252, 95% CI 1.121-4.525, P = 0.023), carriages of the TT genotype of the (+3954 C/T) IL-1β polymorphism (HR 3.704, 95% CI 1.274-10.753, P = 0.016) and AA genotype of the (exon 22) NOS2 polymorphism (HR 3.509, 95% CI 1.266-9.709, P = 0.016) were independently associated with a shorter implant survival by Cox regression. No genotypic associations in PJI patients were observed. Genotyping of IL-1β (+3954 C/T, exon 5, rs1143634) and NOS2 (exon 22) polymorphisms could be useful as predictors of early hip or knee APL.
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Affiliation(s)
- Esteban López-Anglada
- grid.411052.30000 0001 2176 9028Traumatology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Julio Collazos
- grid.414476.40000 0001 0403 1371Infectious Diseases Section, Hospital de Galdacano, Vizcaya, Spain
| | - A. Hugo Montes
- grid.10863.3c0000 0001 2164 6351Biochemistry and Molecular Biology Department, University of Oviedo School of Medicine, Oviedo, Spain ,grid.511562.4Group of Translational Research in Infectious Diseases, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA)., Oviedo, Spain
| | - Laura Pérez-Is
- grid.10863.3c0000 0001 2164 6351Biochemistry and Molecular Biology Department, University of Oviedo School of Medicine, Oviedo, Spain ,grid.511562.4Group of Translational Research in Infectious Diseases, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA)., Oviedo, Spain
| | - Imanol Pérez-Hevia
- grid.411052.30000 0001 2176 9028Traumatology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Sergio Jiménez-Tostado
- grid.411052.30000 0001 2176 9028Traumatology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Tomás Suárez-Zarracina
- grid.411052.30000 0001 2176 9028Infectious Diseases Unit, Infectious Diseases Section, Hospital Universitario Central de Asturias, University of Oviedo School of Medicine, Avda Roma s/n, 33011 Oviedo, Spain ,grid.511562.4Group of Translational Research in Infectious Diseases, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA)., Oviedo, Spain
| | - Victoria Alvarez
- grid.411052.30000 0001 2176 9028Molecular Genetics Section, Hospital Universitario Central de Asturias, Oviedo, Spain ,grid.511562.4Group of Translational Research in Infectious Diseases, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA)., Oviedo, Spain
| | - Eulalia Valle-Garay
- grid.10863.3c0000 0001 2164 6351Biochemistry and Molecular Biology Department, University of Oviedo School of Medicine, Oviedo, Spain ,grid.511562.4Group of Translational Research in Infectious Diseases, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA)., Oviedo, Spain
| | - Víctor Asensi
- grid.411052.30000 0001 2176 9028Infectious Diseases Unit, Infectious Diseases Section, Hospital Universitario Central de Asturias, University of Oviedo School of Medicine, Avda Roma s/n, 33011 Oviedo, Spain ,grid.511562.4Group of Translational Research in Infectious Diseases, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA)., Oviedo, Spain
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8
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How to Prevent Aseptic Loosening in Cementless Arthroplasty: A Review. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12031571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aseptic loosening is the main late postoperative complication of cementless total hip arthroplasties (THAs), leading to pain and functional impairment. This article aims to update the orthopedic surgeon on the various methods by which the aseptic loosening rate can be reduced. We performed a systematic review by searching the PubMed database for hip aseptic loosening. We included meta-analysis, randomized controlled trials, reviews, and systematic reviews in the last 10 years, which provided information on techniques that can prevent aseptic loosening in total hip arthroplasty. From a total of 3205 articles identified, 69 articles (2%) met the inclusion criteria, leading to a total of 36 recommendations. A lot of research has been conducted in terms of septic loosening in the last decade. Currently, we have various techniques by which we can reduce the rate of aseptic loosening. Nevertheless, further randomized clinical trials are needed to expand the recommendations for aseptic loosening prevention.
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9
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McElvenny DM, Davis A, Dixon K, Alexander C, Gupta G, Nixon I, Crawford JO. Systematic review of the epidemiology of a single physical trauma and cancer. TRAUMA-ENGLAND 2021. [DOI: 10.1177/1460408621993757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background A systematic review of single physical trauma and cancer was carried out, with a meta-analysis where deemed appropriate. Methods A comprehensive search of the literature including databases such as Medline and Embase identified 1529 potentially relevant papers for inclusion. A further 89 potentially relevant studies were identified from bibliographies. After review of titles and abstracts and then full papers, a total of 77 studies were included in the broader review of trauma and cancer, and 31 of these studies considered single physical trauma and cancer. The searches were carried out in June 2016. Results Although physical trauma as a cause of cancer has been an issue of clinical interest for decades, the epidemiological evidence was sparse. Only for traumatic brain injury and brain cancer was there considered a sufficient number of epidemiological studies for a meta-analysis. A random effects meta-relative risk for glioma from cohort studies was 0.96 (95% CI: 0.49 to 1.88) and 1.53 (95% CI: 1.02 to 2.27) for case-control studies. The equivalent results for meningioma were 1.22 (95% CI: 0.85 to 1.76) and 1.88 (95% CI: 0.84 to 1.49) respectively. Conclusions Further work is required to clarify whether physical trauma has a role in cancer development, perhaps by exploiting trauma registries.
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Affiliation(s)
- Damien M McElvenny
- Research Division, Institute of Occupational Medicine, Edinburgh, UK
- Centre for Occupational and Environmental Health, University of Manchester, Manchester, UK
| | - Alice Davis
- Research Division, Institute of Occupational Medicine, Edinburgh, UK
| | - Ken Dixon
- Research Division, Institute of Occupational Medicine, Edinburgh, UK
| | - Carla Alexander
- Research Division, Institute of Occupational Medicine, Edinburgh, UK
| | - Girish Gupta
- University Department of Dermatology, NHS Lothian, Edinburgh, UK
| | - Ioanna Nixon
- NHS Greater Glasgow & Clyde, Glasgow, UK
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Joanne O Crawford
- Research Division, Institute of Occupational Medicine, Edinburgh, UK
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10
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Yang Q, Wang J, Xu Y, Chen Y, Lian Q, Zhang Y. Incidence and risk factors of in-hospital prosthesis-related complications following total hip arthroplasty: a retrospective Nationwide Inpatient Sample database study. INTERNATIONAL ORTHOPAEDICS 2020; 44:2243-2252. [DOI: 10.1007/s00264-020-04682-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/22/2020] [Indexed: 12/14/2022]
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11
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Fu GT, Lin LJ, Sheng PY, Li CC, Zhang JX, Shen J, Liu S, Xue YL, Lin SP, Wang K, Zheng QJ, Ding Y. Efficiency of Zoledronic Acid in Inhibiting Accelerated Periprosthetic Bone Loss After Cementless Total Hip Arthroplasty in Osteoporotic Patients: A Prospective, Cohort Study. Orthop Surg 2020; 11:653-663. [PMID: 31456320 PMCID: PMC6712387 DOI: 10.1111/os.12513] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 07/09/2019] [Accepted: 07/10/2019] [Indexed: 11/30/2022] Open
Abstract
Objective To investigate the influence of preoperative osteopenia/osteoporosis on periprosthetic bone loss after total hip arthroplasty (THA) and the efficiency of zoledronate (ZOL) treatment in periprosthetic bone preservation. Methods This multicenter, prospective cohort study was conducted in four centers between April 2015 and October 2017. Patients were assigned to Normal BMD, Osteopenia, and Osteoporosis+ZOL groups. Patients with osteopenia received daily oral calcium (600 mg/d) and vitamin D (0.5 μg/d), while patients in the Osteoporosis+ZOL group received additional ZOL annually (5 mg/year). Periprosthetic bone mineral density (BMD) in seven Gruen zones, radiographic parameters, Harris hip score, EuroQol 5‐Dimensions (EQ‐5D) score, and BMD in hip and spine were measured within 7 days, 3 months, 12 months postoperation and annually thereafter. Results A total of 266 patients were enrolled, while 81 patients that completed the first year follow‐up were involved in the statistical analysis. The mean follow‐up time was 1.3 years. There were significant decreases of mean BMD in total Gruen zones (−4.55%, P < 0.05) and Gruen zone 1 (−10.22%, P < 0.01) in patients with osteopenia during the first postoperative year. Patients in the Osteoporosis+ZOL group experienced a marked increase in BMD in Gruen zone 1 (+16%) at the first postoperative year, which had a significant difference when compared with the Normal BMD group (P < 0.05) and the Osteopenia Group (P < 0.001). Low preoperative BMD in hip and spine was predictive of bone loss in Gruen zone 1 at 12 months after THA in patients with normal BMD (R2 = 0.40, P < 0.05). Conclusions Patients with osteopenia are prone to higher bone loss in the proximal femur after cementless total hip arthroplasty (THA). ZOL, not solely calcium and vitamin D, could prevent the accelerated periprosthetic bone loss after THA in patients with osteopenia and osteoporosis.
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Affiliation(s)
- Guang-Tao Fu
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China.,Division of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China
| | - Li-Jun Lin
- Department of Orthopaedics, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong Province, China
| | - Pu-Yi Sheng
- Department of Orthopaedics, the First affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Chang-Chuan Li
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Jin-Xin Zhang
- Public Health College, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Jun Shen
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Sheng Liu
- Department of Nuclear Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yun-Lian Xue
- Division of Statistics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China
| | - Si-Peng Lin
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Kun Wang
- Department of Orthopaedics, The Third affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Qiu-Jian Zheng
- Division of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China
| | - Yue Ding
- Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
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12
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Mavčič B, Antolič V, Dolžan V. Association of NLRP3 and CARD8 Inflammasome Polymorphisms With Aseptic Loosening After Primary Total Hip Arthroplasty. J Orthop Res 2020; 38:417-421. [PMID: 31529732 DOI: 10.1002/jor.24474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 09/10/2019] [Indexed: 02/06/2023]
Abstract
Our aim was to investigate the association of inflammasome polymorphisms NLRP3 rs35829419 (p. Q705K) and CARD8 rs2043211 (p. C10X) with aseptic loosening of total hip endoprostheses. We asked whether patients with the loosening of total hip arthroplasty earlier than 15 years after primary implantation had a higher proportion of the polymorphisms Q705K and C10X in comparison to subjects without loosening. A retrospective case-control study compared 36 patients with total hip endoprosthesis loosening earlier than 15 years after primary implantation and 51 control subjects with unloosened total hip endoprostheses, matched for gender, age, and follow-up period. Buccal mucosa samples were used for genomic DNA analysis and genotyped for NLRP3 rs35829419 and CARD8 rs2043211 using a fluorescence-based competitive allele-specific real-time polymerase chain reaction. The proportion of subjects with both wild-type NLRP3 and CARD8 (i.e., without Q705K or C10X) was considerably higher in the control group when compared with patients with early total hip arthroplasty loosening (49% vs. 28%; p = 0.05). After adjustment for gender, age, and follow-up, patients with combined wild type of both NLRP3 and CARD8 had significantly smaller odds for early implant loosening (odds ratio 0.33, p = 0.02). Investigated polymorphisms may influence several inflammatory pathways and contribute to the loosening of artificial implants with potential clinical significance for the appropriate selection of patients and endoprostheses when planning elective total hip arthroplasty. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:417-421, 2020.
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Affiliation(s)
- Blaž Mavčič
- Department of Orthopaedic Surgery, University Medical Centre Ljubljana, Faculty of Medicine, University of Ljubljana, Zaloška 9, SI-1000, Ljubljana, Slovenia
| | - Vane Antolič
- Department of Orthopaedic Surgery, University Medical Centre Ljubljana, Faculty of Medicine, University of Ljubljana, Zaloška 9, SI-1000, Ljubljana, Slovenia
| | - Vita Dolžan
- Institute of Biochemistry, Faculty of Medicine, University of Ljubljana, Vrazov trg 2, SI-1000, Ljubljana, Slovenia
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13
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Fu G, Ma Y, Liao J, Xue Y, Li M, Li Q, Deng Z, Zheng Q. High periprosthetic bone mineral density measured in immediate postoperative period may not guarantee less periprosthetic bone loss in the proximal femur after cementless total hip arthroplasty - A retrospective study. ARTHROPLASTY 2020; 2:2. [PMID: 35236466 PMCID: PMC8796644 DOI: 10.1186/s42836-020-0023-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 01/12/2020] [Indexed: 11/12/2022] Open
Abstract
Background Total hip arthroplasty is the most common orthopaedic procedure for the end-stage hip diseases. Periprosthetic bone loss is closely related to the increased risk of implant loosening and periprosthetic fractures, but the predictive value of periprosthetic bone mineral density (BMD) measured immediately after surgery has not yet been investigated. Methods From April 2015 to October 2017, 64 patients with femoral neck fracture, hip osteoarthritis, femoral head necrosis, or developmental dysplasia of the hip underwent unilateral total hip arthroplasty. Demographic data, bone mineral density of the hip and spine, periprosthetic BMD of 7 Gruen zones, and radiographic parameters measured preoperatively, 1 week, 3 months, and 12 months after surgery were collected. A p value < 0.05 was considered to be statistically significant. Results Significant decreases of the periprosthetic BMD were found in Gruen zone 1 (− 8.0%; p < 0.05), Gruen zone 2 (− 6.3%; p < 0.05), Gruen zone 7 (− 8.6%; p < 0.05), and total Gruen zone (− 4.7%; p < 0.05) in the first postoperative year, compared with the values measured 1 week after surgery. The relationship between the preoperative BMD of the hip/spine and the BMD of Gruen zone 1 and Gruen zone 7 measured 1 week after surgery did not reach statistical significance. The multiple linear regression analysis illustrated that the bone loss in Gruen zone 7 at the end of the follow-up period was negatively affected (β = − 0.703) by the BMD of Gruen zone 7 measured 1 week after surgery, with a R2 of 0.486 (p < 0.05). Similar results were also found in Gruen zone 1 (β = − 0.448, R2 = 0.186; p < 0.05). Conclusion There were marked decreases in periprosthetic BMD of the proximal femur in the first postoperative year. The predictive values of preoperative BMD of hip and spine on periprosthetic bone loss after THA were limited. Higher periprosthetic BMD measured in immediate postoperative period may not guarantee less periprosthetic bone loss in the proximal femur after cementless THA.
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Affiliation(s)
- Guangtao Fu
- Division of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106, Zhongshaner Road, Yuexiu District, Guangzhou, Guangdong Province, People's Republic of China
| | - Yuanchen Ma
- Division of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106, Zhongshaner Road, Yuexiu District, Guangzhou, Guangdong Province, People's Republic of China
| | - Junxing Liao
- Division of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106, Zhongshaner Road, Yuexiu District, Guangzhou, Guangdong Province, People's Republic of China
| | - Yunlian Xue
- Division of Statistics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, People's Republic of China
| | - Mengyuan Li
- Division of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106, Zhongshaner Road, Yuexiu District, Guangzhou, Guangdong Province, People's Republic of China
| | - Qingtian Li
- Division of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106, Zhongshaner Road, Yuexiu District, Guangzhou, Guangdong Province, People's Republic of China
| | - Zhantao Deng
- Division of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106, Zhongshaner Road, Yuexiu District, Guangzhou, Guangdong Province, People's Republic of China
| | - Qiujian Zheng
- Division of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106, Zhongshaner Road, Yuexiu District, Guangzhou, Guangdong Province, People's Republic of China.
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14
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Goodman SB, Gallo J, Gibon E, Takagi M. Diagnosis and management of implant debris-associated inflammation. Expert Rev Med Devices 2020; 17:41-56. [PMID: 31810395 PMCID: PMC7254884 DOI: 10.1080/17434440.2020.1702024] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 12/04/2019] [Indexed: 02/07/2023]
Abstract
Introduction: Total joint replacement is one of the most common, safe, and efficacious operations in all of surgery. However, one major long-standing and unresolved issue is the adverse biological reaction to byproducts of wear from the bearing surfaces and modular articulations. These inflammatory reactions are mediated by the innate and adaptive immune systems.Areas covered: We review the etiology and pathophysiology of implant debris-associated inflammation, the clinical presentation and detailed work-up of these cases, and the principles and outcomes of non-operative and operative management. Furthermore, we suggest future strategies for prevention and novel treatments of implant-related adverse biological reactions.Expert opinion: The generation of byproducts from joint replacements is inevitable, due to repetitive loading of the implants. A clear understanding of the relevant biological principles, clinical presentations, investigative measures and treatments for implant-associated inflammatory reactions and periprosthetic osteolysis will help identify and treat patients with this issue earlier and more effectively. Although progressive implant-associated osteolysis is currently a condition that is treated surgically, with further research, it is hoped that non-operative biological interventions could prolong the lifetime of joint replacements that are otherwise functional and still salvageable.
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Affiliation(s)
- Stuart B. Goodman
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA, USA
- Department of Bioengineering, Stanford University, Stanford, CA, USA
| | - Jiri Gallo
- Department of Orthopaedics, Palacký University Olomouc, Olomouc, Czech Republic
| | - Emmanuel Gibon
- Department of Orthopaedic Surgery, University of Florida, Gainesville, FL, USA
| | - Michiaki Takagi
- Department of Orthopaedic Surgery, Yamagata University, Yamagata, Japan
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15
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Christopher ZK, Deckey DG, Chung AS, Spangehl MJ. Patellar osteolysis after total knee arthroplasty with patellar resurfacing: a potentially underappreciated problem. Arthroplast Today 2019; 5:435-441. [PMID: 31886386 PMCID: PMC6921183 DOI: 10.1016/j.artd.2019.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 09/02/2019] [Accepted: 09/17/2019] [Indexed: 11/30/2022] Open
Abstract
Osteolysis of the patella following total knee arthroplasty is both uncommon and poorly described in the literature. We describe 3 cases of total knee arthroplasty with patella resurfacing that later presented with anterior knee pain with patellar osteolysis without evidence of patellar implant failure: 2 males and 1 female patient, all with bilateral knee osteoarthritis. Osteolysis of the patella was identified radiographically between 2 and 16 years from the index procedure. We theorize that high pressures across the patella-femoral joint, in obese or muscular patients, may play a role in the formation of these patellar osteolytic lesions. We suspect that the prevalence of this phenomenon is under-recognized in the literature and may increase with longer term follow-up and awareness.
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Affiliation(s)
| | | | | | - Mark J. Spangehl
- Corresponding author. Department of Orthopedics, Mayo Clinic Arizona, 5777 E. Mayo Blvd, Phoenix, AZ 85054, USA. Tel.: +1 480 342 6202.
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16
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Dabic S, Azarbaijani Y, Karapetyan T, Loyo-Berrios N, Simonyan V, Kitchner T, Brilliant M, Torosyan Y. Development of an Integrated Platform Using Multidisciplinary Real-World Data to Facilitate Biomarker Discovery for Medical Products. Clin Transl Sci 2019; 13:98-109. [PMID: 31386280 PMCID: PMC6951466 DOI: 10.1111/cts.12685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 06/26/2019] [Indexed: 12/16/2022] Open
Abstract
Translational multidisciplinary research is important for the Center for Devices and Radiological Health's efforts for utilizing real‐world data (RWD) to enhance predictive evaluation of medical device performance in patient subpopulations. As part of our efforts for developing new RWD‐based evidentiary approaches, including in silico discovery of device‐related risk predictors and biomarkers, this study aims to characterize the sex/race‐related trends in hip replacement outcomes and identify corresponding candidate single nucleotide polymorphisms (SNPs). Adverse outcomes were assessed by deriving RWD from a retrospective analysis of hip replacement hospital discharge data from the National Inpatient Sample (NIS). Candidate SNPs were explored using pre‐existing data from the Personalized Medicine Research Project (PMRP). High‐Performance Integrated Virtual Environment was used for analyzing and visualizing putative associations between SNPs and adverse outcomes. Ingenuity Pathway Analysis (IPA) was used for exploring plausibility of the sex‐related candidate SNPs and characterizing gene networks associated with the variants of interest. The NIS‐based epidemiologic evidence showed that periprosthetic osteolysis (PO) was most prevalent among white men. The PMRP‐based genetic evidence associated the PO‐related male predominance with rs7121 (odds ratio = 4.89; 95% confidence interval = 1.41−17.05) and other candidate SNPs. SNP‐based IPA analysis of the expected gene expression alterations and corresponding signaling pathways suggested possible role of sex‐related metabolic factors in development of PO, which was substantiated by ad hoc epidemiologic analysis identifying the sex‐related differences in metabolic comorbidities in men vs. women with hip replacement‐related PO. Thus, our in silico study illustrates RWD‐based evidentiary approaches that may facilitate cost/time‐efficient discovery of biomarkers for informing use of medical products.
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Affiliation(s)
- Stefan Dabic
- Center for Devices and Radiological Health, US Food and Drug Administration (CDRH/FDA), Silver Spring, Maryland, USA.,High-Performance Integrated Virtual Environment (HIVE), US Food and Drug Administration (FDA), Silver Spring, Maryland, USA
| | - Yasameen Azarbaijani
- Center for Devices and Radiological Health, US Food and Drug Administration (CDRH/FDA), Silver Spring, Maryland, USA
| | - Tigran Karapetyan
- Center for Devices and Radiological Health, US Food and Drug Administration (CDRH/FDA), Silver Spring, Maryland, USA
| | - Nilsa Loyo-Berrios
- Center for Devices and Radiological Health, US Food and Drug Administration (CDRH/FDA), Silver Spring, Maryland, USA
| | - Vahan Simonyan
- High-Performance Integrated Virtual Environment (HIVE), US Food and Drug Administration (FDA), Silver Spring, Maryland, USA
| | - Terrie Kitchner
- Center for Human Genetics, Marshfield Clinic Research Institute (MCRI), Marshfield, Wisconsin, USA
| | - Murray Brilliant
- Center for Human Genetics, Marshfield Clinic Research Institute (MCRI), Marshfield, Wisconsin, USA
| | - Yelizaveta Torosyan
- Center for Devices and Radiological Health, US Food and Drug Administration (CDRH/FDA), Silver Spring, Maryland, USA
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17
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Dyskova T, Kriegova E, Slobodova Z, Zehnalova S, Kudelka M, Schneiderova P, Fillerova R, Gallo J. Inflammation time-axis in aseptic loosening of total knee arthroplasty: A preliminary study. PLoS One 2019; 14:e0221056. [PMID: 31469844 PMCID: PMC6716666 DOI: 10.1371/journal.pone.0221056] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 07/29/2019] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Aseptic loosening (AL) is the most frequent long-term reason for revision of total knee arthroplasty (TKA) affecting about 15-20% patients within 20 years after the surgery. Although there is a solid body of evidence about the crucial role of inflammation in the AL pathogenesis, scared information on inflammation signature and its time-axis in tissues around TKA exists. DESIGN The inflammation protein signatures in pseudosynovial tissues collected at revision surgery from patients with AL (AL, n = 12) and those with no clinical/radiographic signs of AL (non-AL, n = 9) were investigated by Proximity Extension Assay (PEA)-Immunoassay and immunohistochemistry. RESULTS AL tissues had elevated levels of TNF-family members sTNFR2, TNFSF14, sFasL, sBAFF, cytokines/chemokines IL8, CCL2, IL1RA/IL36, sIL6R, and growth factors sAREG, CSF1, comparing to non-AL. High interindividual variability in protein levels was evident particularly in non-AL. Levels of sTNFR2, sBAFF, IL8, sIL6R, and MPO discriminated between AL and non-AL and were associated with the time from index surgery, suggesting the cumulative character of inflammatory osteolytic response to prosthetic byproducts. The source of elevated inflammatory molecules was macrophages and multinucleated osteoclast-like cells in AL and histiocytes and osteoclast-like cells in non-AL tissues, respectively. All proteins were present in higher levels in osteoclast-like cells than in macrophages. CONCLUSIONS Our study revealed a differential inflammation signature between AL and non-AL stages of TKA. It also highlighted the unique patient's response to TKA in non-AL stages. Further confirmation of our preliminary results on a larger cohort is needed. Analysis of the time-axis of processes ongoing around TKA implantation may help to understand the mechanisms driving periprosthetic bone resorption needed for diagnostic/preventative strategies.
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Affiliation(s)
- Tereza Dyskova
- Department of Immunology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - Eva Kriegova
- Department of Immunology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - Zuzana Slobodova
- Department of Clinical and Molecular Pathology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - Sarka Zehnalova
- Department of Computer Science, Faculty of Electrical Engineering and Computer Science, VSB-Technical University of Ostrava, Ostrava, Czech Republic
| | - Milos Kudelka
- Department of Computer Science, Faculty of Electrical Engineering and Computer Science, VSB-Technical University of Ostrava, Ostrava, Czech Republic
| | - Petra Schneiderova
- Department of Immunology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - Regina Fillerova
- Department of Immunology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - Jiri Gallo
- Department of Orthopaedics, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
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18
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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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19
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Ross RD, Deng Y, Fang R, Frisch NB, Jacobs JJ, Sumner DR. Discovery of biomarkers to identify peri-implant osteolysis before radiographic diagnosis. J Orthop Res 2018; 36:2754-2761. [PMID: 29873110 PMCID: PMC6482967 DOI: 10.1002/jor.24044] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 05/07/2018] [Indexed: 02/04/2023]
Abstract
Peri-implant osteolysis is commonly diagnosed after substantial bone loss has occurred, making revision surgery more challenging. The goal of the current study was to identify urinary biomarkers that differentiate total hip replacement patients who eventually develop osteolysis from patients who do not. We used a repository of 24-h urine samples collected prior to surgery and annually thereafter in 26 patients, 16 who developed osteolysis, and 10 who did not. We examined the markers at radiographic diagnosis, annually for 6 years preceding diagnosis, at the first post-operative sampling point, and pre-operatively. Patients in the osteolysis and non-osteolysis groups were matched according to time post-surgery and did not differ in the male:female ratio or age at surgery. Seven candidate biomarkers were measured, including free deoxypyridinoline (DPD), cross-linked N-telopeptides (NTX), interleukin-6 (IL-6), interleukin-8 (IL-8), osteoprotegerin (OPG), α-crosslaps (α-CTX), and β-crosslaps (β-CTX). As an individual biomarker, DPD demonstrated the highest ability to predict osteolysis, with an area under the curve (AUC) in Receiver Operating Characteristic (ROC) analyses of 0.844 at 6 years prior to diagnosis. A panel of α-CTX and IL-6 was able to identify at-risk patients with an AUC of 0.941 or greater at all post-operative time points and an AUC of 1.000 pre-operatively. The results demonstrate the potential of using non-invasive biomarkers to identify patients at risk for peri-implant osteolysis long before the emergence of radiographic signs. Further, the high accuracy of the pre-operative biomarker levels demonstrates the potential importance of pre-existing, patient-specific factors driving subsequent osteolysis. Study Design © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2754-2761, 2018.
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Affiliation(s)
- Ryan D. Ross
- Department of Cell & Molecular Medicine, Rush University Medical Center, Chicago, IL 60612,Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612
| | - Youping Deng
- Department of Complementary & Integrative Medicine, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii 96813, USA
| | - Rui Fang
- Department of Complementary & Integrative Medicine, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii 96813, USA
| | - Nicholas B. Frisch
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612
| | - Joshua J. Jacobs
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612
| | - D. Rick Sumner
- Department of Cell & Molecular Medicine, Rush University Medical Center, Chicago, IL 60612,Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612
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20
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Pacheco-Martelo V, Roldán-Vasco S. Enzymes and cytokines disease in total hip arthroplasty: promoters of immune loosening. REVISTA DE LA FACULTAD DE MEDICINA 2018. [DOI: 10.15446/revfacmed.v66n3.61525] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Introducción. Una de las causas más importantes de falla de la prótesis de cadera lo constituye el fenómeno de aflojamiento, el cual se relaciona con la liberación de enzimas mediada por citocinas y produce la lisis del hueso que soporta el implante.Objetivo. Describir los mecanismos de interacción biológica de las moléculas promotoras del aflojamiento de la prótesis total de cadera que con mayor frecuencia están presentes en el proceso.Materiales y métodos. Se realizó una búsqueda de artículos originales y casos clínicos en las bases de datos PubMed y Scopus, sin límite de fecha de publicación, utilizando los términos MeSH “hip prosthesis loosening”, “aseptic loosening”, “cytokines” y “hip arthroplasty failure”. La extracción de datos se hizo mediante la lectura de 250 estudios, de los cuales se seleccionaron 66 para fines de redacción.Resultados. Los autores describen las moléculas más representativas implicadas en el aflojamiento de la prótesis de cadera, además se presentan las interacciones entre ellas.Conclusiones. Enzimas y citocinas han sido ampliamente estudiadas por cuatro décadas, aunque sus mecanismos de interacción son poco conocidos. Los autores proponen un mecanismo de interacción, proceso que podría denominarse “enfermedad de las enzimas y citocinas” o “aflojamiento inmunológico”.
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Micrometer-Sized Titanium Particles Induce Aseptic Loosening in Rabbit Knee. BIOMED RESEARCH INTERNATIONAL 2018; 2018:5410875. [PMID: 29651439 PMCID: PMC5831897 DOI: 10.1155/2018/5410875] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 01/06/2018] [Accepted: 01/14/2018] [Indexed: 11/26/2022]
Abstract
Wear debris induced aseptic loosening is the leading cause of total knee arthroplasty (TKA) failure. The complex mechanism of aseptic loosening has been a major issue for introducing effective prevention and treatment methods, so a simplified yet efficient rabbit model was established to address this concern with the use of micrometer-sized titanium particles. 20 New Zealand white rabbits were selected and divided into two groups (control = 10, study = 10). A TKA surgery was then performed for each of them, with implantation of a titanium rod prosthesis which was coated evenly with micrometer-sized titanium in the study group and nothing in the control group, into right femoral medullary cavity. After 12 weeks, all the animals were euthanized and X-ray analyses, H&E staining, Goldner Masson trichrome staining, Von Kossa staining, PCR, and Western blotting of some specific mRNAs and proteins in the interface membrane tissues around the prosthesis were carried out. The implantation of a titanium rod prosthesis coated with 20 μm titanium particles into the femoral medullary cavity of rabbits caused continuous titanium particle stimulation around the prosthesis, effectively inducing osteolysis and aseptic loosening. Titanium particle-induced macrophages produce multiple inflammatory factors able to activate osteoclast differentiation through the OPG/RANKL/RANK signaling pathway, resulting in osteolysis while suppressing the function of osteoblasts and reducing bone ingrowth around the prosthesis. This model simulated the implantation and loosening process of an artificial prosthesis, which is an ideal etiological model to study the aseptic prosthetic loosening.
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22
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Zhang Y, Jiang P, Li W, Liu X, Lu Y, Huang Z, Song K. Calcineurin/NFAT signaling pathway mediates titanium particle-induced inflammation and osteoclast formation by inhibiting RANKL and M-CSF in vitro. Mol Med Rep 2017; 16:8223-8230. [DOI: 10.3892/mmr.2017.7670] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 08/17/2017] [Indexed: 11/06/2022] Open
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23
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Stelmach P, Kauther MD, Fuest L, Kurscheid G, Gehrke T, Klenke S, Jäger M, Wedemeyer C, Bachmann HS. Relationship between GNAS1 T393C polymorphism and aseptic loosening after total hip arthroplasty. Eur J Med Res 2017; 22:29. [PMID: 28830502 PMCID: PMC5568317 DOI: 10.1186/s40001-017-0271-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 08/18/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Aseptic loosening is a main cause for revision surgery after total hip arthroplasty (THA) and there is no reliable marker for the early detection of patients at high risk. This study has been performed to validate association of the T393C polymorphism (rs7121) in the GNAS1 gene, encoding for the alpha-subunit of heterotrimeric G-protein Gs, with risk for and time to aseptic loosening after THA, which has been demonstrated in our previous study. METHODS 231 patients with primary THA and 234 patients suffering from aseptic loosening were genotyped for dependency on GNAS1 genotypes and analyzed. RESULTS Genotyping revealed almost similar minor allele frequencies of 0.49 and 0.46, respectively. Consistently, genotype distributions of both groups were not significantly different (p = 0.572). Neither gender nor GNAS1 genotype showed a statistically significant association with time to loosening (p = 0.501 and p = 0.840). Stratification by gender, as performed in our previous study, was not able to show a significant genotype-dependent difference in time (female p = 0.313; male p = 0.584) as well as median time to aseptic loosening (female p = 0.353; male p = 0.868). CONCLUSION This study was not able to confirm the results of our preliminary study. An association of the GNAS1 T393C polymorphisms with risk for and time to aseptic loosening after THA is unlikely.
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Affiliation(s)
- Patrick Stelmach
- Institute of Pharmacogenetics, University Hospital Essen, 45147, Essen, Germany
| | - Max D Kauther
- Department of Orthopaedics and Trauma Surgery, University Hospital Essen, Essen, Germany
| | - Lena Fuest
- Institute of Pharmacogenetics, University Hospital Essen, 45147, Essen, Germany.,Department of Orthopaedics and Trauma Surgery, University Hospital Essen, Essen, Germany
| | - Gina Kurscheid
- Institute of Pharmacogenetics, University Hospital Essen, 45147, Essen, Germany.,Department of Orthopaedics and Trauma Surgery, University Hospital Essen, Essen, Germany
| | - Thorsten Gehrke
- Department of Joint Surgery, Helios ENDO-Klinik, Hamburg, Germany
| | - Stefanie Klenke
- Institute of Pharmacogenetics, University Hospital Essen, 45147, Essen, Germany.,Department of Anaesthesiology and Intensive Care, University Hospital Essen, Essen, Germany
| | - Marcus Jäger
- Department of Orthopaedics and Trauma Surgery, University Hospital Essen, Essen, Germany
| | - Christian Wedemeyer
- Department of Orthopaedics and Trauma Surgery, University Hospital Essen, Essen, Germany
| | - Hagen S Bachmann
- Institute of Pharmacogenetics, University Hospital Essen, 45147, Essen, Germany. .,Department of Health, School of Medicine, Institute of Pharmacology and Toxicology, Center for Biomedical Education and Research (ZBAF), Witten/Herdecke University, Witten, Germany.
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Blockade of NF-κB and MAPK pathways by ulinastatin attenuates wear particle-stimulated osteoclast differentiation in vitro and in vivo. Biosci Rep 2016; 36:BSR20160234. [PMID: 27638499 PMCID: PMC5091469 DOI: 10.1042/bsr20160234] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 09/15/2016] [Indexed: 11/17/2022] Open
Abstract
Ulinastatin, a urinary trypsin inhibitor (UTI), is widely used to clinically treat lipopolysaccharide (LPS)-related inflammatory disorders recently. Adherent pathogen-associated molecular patterns (PAMPs), of which LPS is the best-studied and classical endotoxin produced by Gram-negative bacteria, act to increase the biological activity of osteopedic wear particles such as polymethyl-methacrylate (PMMA) and titanium particles in cell culture and animal models of implant loosening. The present study was designed to explore the inhibitory effect of UTI on osteoclastogenesis and inflammatory osteolysis in LPS/PMMA-mediated Raw264.7 cells and murine osteolysis models, and investigate the potential mechanism. The in vitro study was divided into the control group, LPS-induced group, PMMA-stimulated group and UTI-pretreated group. UTI (500 or 5000 units/ml) pretreatment was followed by PMMA (0.5 mg/ml) with adherent LPS. The levels of inflammatory mediators including tumour necrosis factor-α (TNF-α), matrixmetallo-proteinases-9 (MMP-9) and interleukin-6 (IL-6), receptor activation of nuclear factor NF-κB (RANK), and cathepsin K were examined and the amounts of phosphorylated I-κB, MEK, JNK and p38 were measured. In vivo study, murine osteolysis models were divided into the control group, PMMA-induced group and UTI-treated group. UTI (500 or 5000 units/kg per day) was injected intraperitoneally followed by PMMA suspension with adherent LPS (2×108 particles/25 μl) in the UTI-treated group. The thickness of interfacial membrane and the number of infiltrated inflammatory cells around the implants were assessed, and bone mineral density (BMD), trabecular number (Tb.N.), trabecular thickness (Tb.Th.), trabecular separation (Tb.Sp.), relative bone volume over total volume (BV/TV) of distal femur around the implants were calculated. Our results showed that UTI pretreatment suppressed the secretion of proinflammatory cytokines including MMP-9, IL-6, TNF-α, RANK and cathepsin K through down-regulating the activity of nuclear factor kappa B (NF-κB) and MAPKs partly in LPS/PMMA-mediated Raw264.7 cells. Finally, UTI treatment decreased the inflammatory osteolysis reaction in PMMA-induced murine osteolysis models. In conclusion, these results confirm the anti-inflammatory potential of UTI in the prevention of particle disease.
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Vasconcelos DM, Ribeiro-da-Silva M, Mateus A, Alves CJ, Machado GC, Machado-Santos J, Paramos-de-Carvalho D, Alencastre IS, Henrique R, Costa G, Barbosa MA, Lamghari M. Immune response and innervation signatures in aseptic hip implant loosening. J Transl Med 2016; 14:205. [PMID: 27387445 PMCID: PMC4937545 DOI: 10.1186/s12967-016-0950-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 06/21/2016] [Indexed: 01/09/2023] Open
Abstract
Background Aseptic loosening (AL) of hip prosthesis presents inflammation and pain as sign and symptom similarly to arthritis pathologies. Still, the immune and innervation profiles in hip AL remain unclear and their interplay is poorly explored. Herein, local tissue inflammatory response, sensory and sympathetic innervation as well as associated local mediators were assessed in hip joint microenvironment underlying AL and compared to osteoarthritis (OA). Methods Histopathological analysis, immune cells (macrophages, T, B cells and PMNs) as well as sensory and sympathetic nerve fibers (SP+, CGRP+, TH+) distribution and profiles were analyzed on tissues retrieved from patients with failed hip prostheses due to AL (n = 20) and hip OA (n = 15) by immunohistochemistry. Additionally, transcriptional levels of pro-inflammatory cytokines (TNF-α, IL-1β, IL-6, IL-12a, iNOS), anti-inflammatory cytokine (IL-10), osteoclastic factor (RANKL) and bone remodeling factor (TGF-β1) were locally evaluated by qRT-PCR. Serum TGF-β1 levels were assessed preoperatively by ELISA. Results Histopathological analysis revealed that tissues, aseptic interface membranes of AL patients had distinct tissue architecture and immune cells profile when compared to OA synovial tissues. Macrophages, T cells and B cells showed significant differences in tissue distribution. In OA, inflammation is mostly confined to the vicinity of synovial membrane while in AL macrophages infiltrated throughout the tissue. This differential immune profile is also accompanied with a distinct pattern of sensory and sympathetic innervation. Importantly, in AL patients, a lack of sympathetic innervation aseptic interface membranes without compensation mechanisms at cellular levels was observed with simultaneous reorganization of sensorial innervation. Despite the different histopathological portrait, AL and OA patients exhibited similar transcriptional levels of genes encoding key proteins in local immune response. Nevertheless, in both pathologies, TGF-β1 expression was prominent in sites where the inflammation is occurring. However, at systemic level no differences were found. Conclusion These findings indicate that AL patients exhibit different local inflammatory response and innervation signatures from OA patients in hip joint. These insights shed the light on neuro-immune interplay in AL and highlight the need to better understand this crosstalk to unravel potential mechanisms for targeted-therapies to improve hip joint lifetime and treatment. Electronic supplementary material The online version of this article (doi:10.1186/s12967-016-0950-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Daniel M Vasconcelos
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal.,ICBAS - Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Manuel Ribeiro-da-Silva
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal.,Serviço de Ortopedia e Traumatologia, Centro Hospitalar São João, Porto, Portugal.,Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - António Mateus
- Serviço de Ortopedia e Traumatologia, Centro Hospitalar São João, Porto, Portugal.,Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Cecília Juliana Alves
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal
| | - Gil Costa Machado
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal
| | - Joana Machado-Santos
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal
| | - Diogo Paramos-de-Carvalho
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal
| | - Inês S Alencastre
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal
| | - Rui Henrique
- ICBAS - Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal.,Instituto Português de Oncologia do Porto, Porto, Portugal
| | - Gilberto Costa
- Serviço de Ortopedia e Traumatologia, Centro Hospitalar São João, Porto, Portugal.,Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Mário A Barbosa
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal.,ICBAS - Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Meriem Lamghari
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal. .,INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Porto, Portugal. .,ICBAS - Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal.
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26
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Translating Genomic Advances to Physical Therapist Practice: A Closer Look at the Nature and Nurture of Common Diseases. Phys Ther 2016; 96:570-80. [PMID: 26637647 DOI: 10.2522/ptj.20150112] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 11/23/2015] [Indexed: 02/09/2023]
Abstract
The Human Genome Project and the International HapMap Project have yielded new understanding of the influence of the human genome on health and disease, advancing health care in significant ways. In personalized medicine, genetic factors are used to identify disease risk and tailor preventive and therapeutic regimens. Insight into the genetic bases of cellular processes is revealing the causes of disease and effects of exercise. Many diseases known to have a major lifestyle contribution are highly influenced by common genetic variants. Genetic variants are associated with increased risk for common diseases such as cardiovascular disease and osteoarthritis. Exercise response also is influenced by genetic factors. Knowledge of genetic factors can help clinicians better understand interindividual differences in disease presentation, pain experience, and exercise response. Family health history is an important genetic tool and encourages clinicians to consider the wider client-family unit. Clinicians in this new era need to be prepared to guide patients and their families on a variety of genomics-related concerns, including genetic testing and other ethical, legal, or social issues. Thus, it is essential that clinicians reconsider the role of genetics in the preservation of wellness and risk for disease to identify ways to best optimize fitness, health, or recovery. Clinicians with knowledge of the influence of genetic variants on health and disease will be uniquely positioned to institute individualized lifestyle interventions, thereby fulfilling roles in prevention and wellness. This article describes how discoveries in genomics are rapidly evolving the understanding of health and disease by highlighting 2 conditions: cardiovascular disease and osteoarthritis. Genetic factors related to exercise effects also are considered.
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Bechtel CP, Gebhart JJ, Tatro JM, Kiss-Toth E, Wilkinson JM, Greenfield EM. Particle-Induced Osteolysis Is Mediated by TIRAP/Mal in Vitro and in Vivo: Dependence on Adherent Pathogen-Associated Molecular Patterns. J Bone Joint Surg Am 2016; 98:285-94. [PMID: 26888676 DOI: 10.2106/jbjs.o.00736] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Proinflammatory signaling by toll-like receptors (TLRs) likely contributes to biologic responses to wear particles causing aseptic loosening. We recently reported associations with aseptic loosening in patients with polymorphisms in the locus encoding an adapter protein specific for TLR-2 and TLR-4 known as toll/interleukin-1 receptor domain-containing adapter protein/MyD88 adapter-like (TIRAP/Mal). To directly examine the contribution of TIRAP/Mal, we tested the hypothesis that TIRAP/Mal deficiency reduces the activity of wear particles. Signaling by TLR-2 and TLR-4 through TIRAP/Mal can be activated by bacterial pathogen-associated molecular patterns (PAMPs) such as lipopolysaccharide or endogenous alarmins. To distinguish between those possibilities, we tested the hypothesis that the effects of TIRAP/Mal depend on the adherence of bacterial PAMPs to the particles. METHODS In vitro mRNA levels and secretion of tumor necrosis factor-α, interleukin (IL)-1β, and IL-6 were measured after incubating wild-type and TIRAP/Mal(-/-) macrophages in the presence or absence of titanium particles with adherent bacterial debris, so-called endotoxin-free particles, or particles with adherent lipopolysaccharide. In vivo osteolysis was measured after implanting titanium particles on the calvaria of wild-type and TIRAP/Mal(-/-) mice. RESULTS TIRAP/Mal deficiency significantly inhibited the activity of titanium particles with adherent bacterial debris to stimulate in vivo osteolysis and in vitro cytokine mRNAs and secretion. Those effects are dependent on adherent PAMPs because removal of >99% of the adherent bacterial debris from the particles significantly reduced their activity and the remaining activity was not dependent on TIRAP/Mal. Moreover, adherence of highly purified lipopolysaccharide to the endotoxin-free particles reconstituted the activity and the dependence on TIRAP/Mal. CONCLUSIONS TIRAP/Mal deficiency reduces inflammatory responses and osteolysis induced by particles with adherent PAMPs. CLINICAL RELEVANCE Our results, coupled with the genetic associations between aseptic loosening and polymorphisms within the TIRAP/Mal locus, support TLR signaling through TIRAP/Mal as one of the factors that enhances the activity of wear particles and further support the hypothesis that bacterial PAMPs likely contribute to aseptic loosening in a subset of patients.
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Affiliation(s)
- Christopher P Bechtel
- Departments of Orthopaedics (C.P.B., J.J.G., J.M.T., and E.M.G.) and Pathology (E.M.G.), University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Jeremy J Gebhart
- Departments of Orthopaedics (C.P.B., J.J.G., J.M.T., and E.M.G.) and Pathology (E.M.G.), University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Joscelyn M Tatro
- Departments of Orthopaedics (C.P.B., J.J.G., J.M.T., and E.M.G.) and Pathology (E.M.G.), University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Endre Kiss-Toth
- Departments of Cardiovascular Science (E.K.-T.) and Human Metabolism (J.M.W.), University of Sheffield, Sheffield, United Kingdom
| | - J Mark Wilkinson
- Departments of Cardiovascular Science (E.K.-T.) and Human Metabolism (J.M.W.), University of Sheffield, Sheffield, United Kingdom
| | - Edward M Greenfield
- Departments of Orthopaedics (C.P.B., J.J.G., J.M.T., and E.M.G.) and Pathology (E.M.G.), University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio
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28
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Stelmach P, Wedemeyer C, Fuest L, Kurscheid G, Gehrke T, Klenke S, Jäger M, Kauther MD, Bachmann HS. The BCL2 -938C>A Promoter Polymorphism Is Associated with Risk for and Time to Aseptic Loosening of Total Hip Arthroplasty. PLoS One 2016; 11:e0149528. [PMID: 26881923 PMCID: PMC4755546 DOI: 10.1371/journal.pone.0149528] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 02/02/2016] [Indexed: 01/15/2023] Open
Abstract
Aseptic loosening is a major cause of revision surgery of total hip arthroplasty (THA). Only few host factors affecting aseptic loosening have been identified until now, although they are urgently needed to identify and possibly treat those patients at higher risk for aseptic loosening. To determine whether the functional single nucleotide polymorphism (SNP) c.-938C>A (rs2279115), located in the promoter region of the BCL2 gene has an impact on aseptic loosening of THA we genotyped and analyzed 234 patients suffering from aseptic loosening and 231 patients after primary THA. The polymorphism is associated with risk for aseptic loosening with the CC genotype at highest risk for aseptic loosening, Odds Ratio CC vs. AA 1.93, 95%CI 1.15-3.25, p = 0.013. In contrast, low risk AA genotype carriers that still developed aseptic loosening showed a significantly shorter time to aseptic loosening than patients carrying the C allele (p = 0.004). These results indicate that the BCL2 -938C>A polymorphism influences the occurrence and course of aseptic loosening and suggests this polymorphism as an interesting candidate for prospective studies and analyses in THA registers.
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Affiliation(s)
- Patrick Stelmach
- Institute of Pharmacogenetics, University Hospital Essen, Essen, Germany
| | - Christian Wedemeyer
- Department of Orthopaedics and Trauma Surgery, University Hospital Essen, Essen, Germany
| | - Lena Fuest
- Institute of Pharmacogenetics, University Hospital Essen, Essen, Germany
- Department of Orthopaedics and Trauma Surgery, University Hospital Essen, Essen, Germany
| | - Gina Kurscheid
- Institute of Pharmacogenetics, University Hospital Essen, Essen, Germany
- Department of Orthopaedics and Trauma Surgery, University Hospital Essen, Essen, Germany
| | - Thorsten Gehrke
- Department of Joint Surgery, Helios ENDO-Klinik, Hamburg, Germany
| | - Stefanie Klenke
- Institute of Pharmacogenetics, University Hospital Essen, Essen, Germany
- Department of Anaesthesiology and Intensive Care, University Hospital Essen, Essen, Germany
| | - Marcus Jäger
- Department of Orthopaedics and Trauma Surgery, University Hospital Essen, Essen, Germany
| | - Max D. Kauther
- Department of Orthopaedics and Trauma Surgery, University Hospital Essen, Essen, Germany
| | - Hagen S. Bachmann
- Institute of Pharmacogenetics, University Hospital Essen, Essen, Germany
- * E-mail:
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29
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Schoeman MAE, Pijls BG, Oostlander AE, Keurentjes JC, Valstar ER, Nelissen RGHH, Meulenbelt I. Innate immune response and implant loosening: Interferon gamma is inversely associated with early migration of total knee prostheses. J Orthop Res 2016. [PMID: 26212694 DOI: 10.1002/jor.22988] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
To allow prediction of the risk of loosening prior to surgery, we investigated the relationship between innate immune cytokine response via TLR2 stimulation and early migration of six different knee prostheses using RSA (radiostereometry). This study included 114 patients of a prospective RSA-cohort who received a total knee arthroplasty. Whole blood cytokine responses were obtained by ex vivo stimulation with tripalmitoyl-S-glycerylcysteine (Pam3Cys-SK4) for assessment of the TLR2 immune response. Early migration was calculated using the maximum total point motion (MTPM) 1 year post surgery. Principal component analysis (PCA) was applied to the cytokine data to reduce the correlated data of individual cytokines and identified two components. Subsequently, linear mixed model analyses were applied with adjustments for gender, age, BMI, time-to-blood sampling, and prosthesis type. Component 1, consisting of IFNγ, IL-12p40, IL-10, IL-1β, TNFα, and IL-6, showed a significant inverse association (β = -0.128; p = 0.041) with MTPM. Further analysis showed that IFNγ (β = -0.161, p = 0.008) had the highest contribution to this association and is particularly found in patients receiving another prosthesis than Nexgen (β = -0.239; p < 0.001). In conclusion, patients with high levels of IFNγ upon stimulation of TLR2 are at lower risk of early migration of their knee prosthesis.
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Affiliation(s)
- Monique A E Schoeman
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Bart G Pijls
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Angela E Oostlander
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Johan C Keurentjes
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Edward R Valstar
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands.,Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology, Delft, The Netherlands
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Ingrid Meulenbelt
- Department of Molecular Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
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30
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Genetic susceptibility to prosthetic joint infection following total joint arthroplasty: A systematic review. Gene 2015; 563:76-82. [PMID: 25747542 DOI: 10.1016/j.gene.2015.03.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 03/03/2015] [Accepted: 03/04/2015] [Indexed: 12/28/2022]
Abstract
BACKGROUND Prosthetic joint infection (PJI) is the most common cause of total joint arthroplasty failure and revision surgery. Genetic polymorphisms could be determinant factors for PJI. METHODS We performed a systematic research of Medline, Pubmed, Embase, Cochrane Library, and Google Scholar, and identified 11 studies with 34 kinds of gene polymorphisms, were included in the synthesis. RESULTS Our data suggest that the C allele and genotype C/C for MBL-550 SNP, genotype A/A for MBL-54 SNP and G allele for MBL-221 SNP increase the risk of PJI, while G allele and genotype G/G for MBL-550 SNP decrease the risk of PJI in Caucasian populations. Several other genes reported by single-center studies also contribute to the genetic susceptibility to septic PJI. No definitive conclusions could be achieved due to the small amount of data in the included studies. CONCLUSION Several genes contribute to the genetic susceptibility to PJI following total joint arthroplasty. Further studies will enhance the understanding of PJI, and may inform and direct early interventions.
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Do genetic susceptibility, Toll-like receptors, and pathogen-associated molecular patterns modulate the effects of wear? Clin Orthop Relat Res 2014; 472:3709-17. [PMID: 25034980 PMCID: PMC4397765 DOI: 10.1007/s11999-014-3786-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Overwhelming evidence supports the concept that wear particles are the primary initiator of aseptic loosening of orthopaedic implants. It is likely, however, that other factors modulate the biologic response to wear particles. This review focuses on three potential other factors: genetic susceptibility, Toll-like receptors (TLRs), and bacterial pathogen-associated molecular patterns (PAMPs). WHERE ARE WE NOW?: Considerable evidence is emerging that both genetic susceptibility and TLR activation are important factors that modulate the biologic response to wear particles, but it remains controversial whether bacterial PAMPs also do so. WHERE DO WE NEED TO GO?: Detailed understanding of the roles of these other factors may lead to identification of novel therapeutic targets for patients with aseptic loosening. HOW DO WE GET THERE?: Highest priority should be given to polymorphism replication studies with large numbers of patients and studies to replicate the reported correlation between bacterial biofilms and the severity of aseptic loosening.
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Sumner DR, Ross R, Purdue E. Are there biological markers for wear or corrosion? A systematic review. Clin Orthop Relat Res 2014; 472:3728-39. [PMID: 24668073 PMCID: PMC4397751 DOI: 10.1007/s11999-014-3580-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Identification of biomarkers associated with wear and tribocorrosion in joint arthroplasty would be helpful to enhance early detection of aseptic loosening and/or osteolysis and to improve understanding of disease progression. There have been several new reports since the last systematic review (which covered research through mid-2008) justifying a new assessment. QUESTIONS/PURPOSES We sought to determine which biomarkers have the most promise for early diagnosis and monitoring of aseptic loosening and/or osteolysis related to wear or corrosion in total joint arthroplasty. METHODS We performed a systematic review using MEDLINE and EMBASE databases, covering the period through December 2013, and identified 1050 articles. We restricted the definition of biomarker to biomolecules and imaging parameters useful for diagnosis and monitoring of disease progression, only including articles in English. We chose 65 articles for full review, including 44 from the original search and 21 from subsequent hand searches. We used the 22 articles in which patients with total joint arthroplasty who had aseptic loosening and/or periimplant osteolysis unrelated to sepsis had been compared with patients with total joint arthroplasty with stable implants. There were 90 comparisons of these two patient populations involving 35 different biomarkers. RESULTS Diagnostic accuracy was assessed in nine of the 90 comparisons with the highest accuracy found for tartrate-resistant acid phosphatase 5b (0.96), although a separate comparison for this biomarker found a lower accuracy (0.76). Accuracy of > 0.80 was also found for crosslinked n-telopeptide of type I collagen, osteoprotegerin, and deoxypyridinoline. The most studied markers, tumor necrosis factor-α and interleukin-1β, were found to differ in the affected and control groups in < 30% of the comparisons. Thirty of the 35 biomarkers were studied in four or fewer separate comparisons with nearly half of the biomarkers (17) studied in only one comparison. Many of the comparisons were not able to eliminate a number of confounding variables, and there was only one prospective study. CONCLUSIONS Currently, there are no validated biomarkers for early diagnosis and monitoring of the biological sequelae of wear or tribocorrosion, although there are some promising leads, including markers of bone turnover.
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Affiliation(s)
- D. Rick Sumner
- Department of Anatomy and Cell Biology, Rush University Medical Center, 600 South Paulina, Suite 507, Chicago, IL 60612 USA ,Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL USA
| | - Ryan Ross
- Department of Anatomy and Cell Biology, Rush University Medical Center, 600 South Paulina, Suite 507, Chicago, IL 60612 USA
| | - Ed Purdue
- Hospital for Special Surgery, New York, NY USA
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Pajarinen J, Lin TH, Sato T, Yao Z, Goodman SB. Interaction of Materials and Biology in Total Joint Replacement - Successes, Challenges and Future Directions. J Mater Chem B 2014; 2:7094-7108. [PMID: 25541591 PMCID: PMC4273175 DOI: 10.1039/c4tb01005a] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Total joint replacement (TJR) has revolutionized the treatment of end-stage arthritic disorders. This success is due, in large part, to a clear understanding of the important interaction between the artificial implant and the biology of the host. All surgical procedures in which implants are placed in the body evoke an initial inflammatory reaction, which generally subsides over several weeks. Thereafter, a series of homeostatic events occur leading to progressive integration of the implant within bone and the surrounding musculoskeletal tissues. The eventual outcome of the operation is dependent on the characteristics of the implant, the precision of the surgical technique and operative environment, and the biological milieu of the host. If these factors and events are not optimal, adverse events can occur such as the development of chronic inflammation, progressive bone loss due to increased production of degradation products from the implant (periprosthetic osteolysis), implant loosening or infection. These complications can lead to chronic pain and poor function of the joint reconstruction, and may necessitate revision surgery or removal of the prosthesis entirely. Recent advances in engineering, materials science, and the immunological aspects associated with orthopaedic implants have fostered intense research with the hope that joint replacements will last a lifetime, and facilitate pain-free, normal function.
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Affiliation(s)
- J Pajarinen
- Department of Orthopaedic Surgery, Orthopaedic Surgery Laboratories, Stanford University, Stanford, CA, USA
| | - T-H Lin
- Department of Orthopaedic Surgery, Orthopaedic Surgery Laboratories, Stanford University, Stanford, CA, USA
| | - T Sato
- Department of Orthopaedic Surgery, Orthopaedic Surgery Laboratories, Stanford University, Stanford, CA, USA
| | - Z Yao
- Department of Orthopaedic Surgery, Orthopaedic Surgery Laboratories, Stanford University, Stanford, CA, USA
| | - S B Goodman
- Department of Orthopaedic Surgery, Orthopaedic Surgery Laboratories, Stanford University, Stanford, CA, USA
- Department of Bioengineering, Orthopaedic Surgery Laboratories, Stanford University, Stanford, CA, USA
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Navratilova Z, Gallo J, Smizansky M, Mrazek F, Petrek M. Osteoprotegerin gene polymorphism is not associated with prosthetic joint infection after total joint arthroplasty in the Czech population. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2014; 158:273-6. [DOI: 10.5507/bp.2012.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 02/15/2012] [Indexed: 11/23/2022] Open
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Xie J, Zhang Q, Zhu T, Zhang Y, Liu B, Xu J, Zhao H. Substrate stiffness-regulated matrix metalloproteinase output in myocardial cells and cardiac fibroblasts: implications for myocardial fibrosis. Acta Biomater 2014; 10:2463-72. [PMID: 24508540 DOI: 10.1016/j.actbio.2014.01.031] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 12/08/2013] [Accepted: 01/29/2014] [Indexed: 11/16/2022]
Abstract
Cardiac fibrosis, an important pathological feature of structural remodeling, contributes to ventricular stiffness, diastolic dysfunction, arrhythmia and may even lead to sudden death. Matrix stiffness, one of the many mechanical factors acting on cells, is increasingly appreciated as an important mediator of myocardial cell behavior. Polydimethylsiloxane (PDMS) substrates were fabricated with different stiffnesses to mimic physiological and pathological heart tissues, and the way in which the elastic modulus of the substrate regulated matrix-degrading gelatinases in myocardial cells and cardiac fibroblasts was explored. Initially, an increase in cell spreading area was observed, concomitant with the increase in PDMS stiffness in both cells. Later, it was demonstrated that the MMP-2 gene expression and protein activity in myocardial cells and cardiac fibroblasts can be enhanced with an increase in PDMS substrate stiffness and, moreover, such gene- and protein-related increases had a significant linear correlation with the elastic modulus. In comparison, the MMP-9 gene and protein expressions were up-regulated in cardiac fibroblasts only, not in myocardial cells. These results implied that myocardial cells and cardiac fibroblasts in the myocardium could sense the stiffness in pathological fibrosis and showed a differential but positive response in the expression of matrix-degrading gelatinases when exposed to an increased stiffening of the matrix in the microenvironment. The phenomenon of cells sensing pathological matrix stiffness can help to increase understanding of the mechanism underlying myocardial fibrosis and may ultimately lead to planning cure strategies.
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Affiliation(s)
- Jing Xie
- Institute of Biomechanics and Medical Engineering, Department of Engineering Mechanics, Tsinghua University, Beijing 100084, People's Republic of China
| | - Quanyou Zhang
- Institute of Biomechanics and Medical Engineering, Department of Engineering Mechanics, Tsinghua University, Beijing 100084, People's Republic of China; Department of Engineering Mechanics, Taiyuan University of Technology, Taiyuan 030024, People's Republic of China
| | - Ting Zhu
- School of Life Science, Tsinghua University, Beijing 100084, People's Republic of China
| | - Yanyan Zhang
- Institute of Biomechanics and Medical Engineering, Department of Engineering Mechanics, Tsinghua University, Beijing 100084, People's Republic of China
| | - Bailin Liu
- Institute of Biomechanics and Medical Engineering, Department of Engineering Mechanics, Tsinghua University, Beijing 100084, People's Republic of China
| | - Jianwen Xu
- The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning 530023, People's Republic of China
| | - Hucheng Zhao
- Institute of Biomechanics and Medical Engineering, Department of Engineering Mechanics, Tsinghua University, Beijing 100084, People's Republic of China.
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Orthopaedic implant failure: aseptic implant loosening–the contribution and future challenges of mouse models in translational research. Clin Sci (Lond) 2014; 127:277-93. [DOI: 10.1042/cs20130338] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Aseptic loosening as a result of wear debris is considered to be the main cause of long-term implant failure in orthopaedic surgery and improved biomaterials for bearing surfaces decreases significantly the release of micrometric wear particles. Increasingly, in-depth knowledge of osteoimmunology highlights the role of nanoparticles and ions released from some of these new bearing couples, opening up a new era in the comprehension of aseptic loosening. Mouse models have been essential in the progress made in the early comprehension of pathophysiology and in testing new therapeutic agents for particle-induced osteolysis. However, despite this encouraging progress, there is still no valid clinical alternative to revision surgery. The present review provides an update of the most commonly used bearing couples, the current concepts regarding particle–cell interactions and the approaches used to study the biology of periprosthetic osteolysis. It also discusses the contribution and future challenges of mouse models for successful translation of the preclinical progress into clinical applications.
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Nich C, Takakubo Y, Pajarinen J, Ainola M, Salem A, Sillat T, Rao AJ, Raska M, Tamaki Y, Takagi M, Konttinen YT, Goodman SB, Gallo J. Macrophages-Key cells in the response to wear debris from joint replacements. J Biomed Mater Res A 2013; 101:3033-45. [PMID: 23568608 PMCID: PMC3775910 DOI: 10.1002/jbm.a.34599] [Citation(s) in RCA: 162] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 11/16/2012] [Accepted: 01/12/2013] [Indexed: 12/14/2022]
Abstract
The generation of wear debris is an inevitable result of normal usage of joint replacements. Wear debris particles stimulate local and systemic biological reactions resulting in chronic inflammation, periprosthetic bone destruction, and eventually, implant loosening, and revision surgery. The latter may be indicated in up to 15% patients in the decade following the arthroplasty using conventional polyethylene. Macrophages play multiple roles in both inflammation and in maintaining tissue homeostasis. As sentinels of the innate immune system, they are central to the initiation of this inflammatory cascade, characterized by the release of proinflammatory and pro-osteoclastic factors. Similar to the response to pathogens, wear particles elicit a macrophage response, based on the unique properties of the cells belonging to this lineage, including sensing, chemotaxis, phagocytosis, and adaptive stimulation. The biological processes involved are complex, redundant, both local and systemic, and highly adaptive. Cells of the monocyte/macrophage lineage are implicated in this phenomenon, ultimately resulting in differentiation and activation of bone resorbing osteoclasts. Simultaneously, other distinct macrophage populations inhibit inflammation and protect the bone-implant interface from osteolysis. Here, the current knowledge about the physiology of monocyte/macrophage lineage cells is reviewed. In addition, the pattern and consequences of their interaction with wear debris and the recent developments in this field are presented.
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Affiliation(s)
- Christophe Nich
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California; Laboratoire de Biomécanique et Biomatériaux Ostéo-Articulaires-UMR CNRS 7052, Faculté de Médecine-Université Paris 7, Paris, France; Department of Orthopaedic Surgery, European Teaching Hospital, Assistance Publique-Hôpitaux de Paris-Université Paris 5, Paris, France
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Zhou X, Qian W, Li J, Zhang P, Yang Z, Chen W, Wu L. Who are at risk for thromboembolism after arthroplasty? A systematic review and meta-analysis. Thromb Res 2013; 132:531-6. [PMID: 24074702 DOI: 10.1016/j.thromres.2013.09.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Revised: 08/29/2013] [Accepted: 09/03/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND Thromboembolism, including deep venous thrombosis and pulmonary embolism, is a grave threat to patients undergoing total joint replacement. Using a systematic review and meta-analysis we asked whether gene mutations or polymorphisms could be risk factors for thrombosis after arthroplasty. METHODS We performed a comprehensive search of Medline, PubMed, Embase, Cochrane databases, China National Knowledge Infrastructure (CNKI), and Google Scholar, and identified 19 studies detailing genetic investigations of patients with thromboembolism following joint replacement. RESULTS Our meta-analyses included 5149 patients who underwent arthroplasty surgery. Significant associations with venous thromboembolism were identified for factor G1691A (odds ratio (OR) 1.41, 95% confidence interval (CI) 1.03 - 1.94, p=0.03), prothrombin G20210A (OR 2.16, 95% CI, 1.27- 3.69, p=0.005), and MTHFR/C677T/TT (OR 2.36, 95% CI 1.03 - 5.42, p=0.04) in Caucasian populations. No significant gene mutation was identified in Asian populations. CONCLUSION This study suggests a way to identify patients scheduled for arthroplasty who are at higher risk of thrombosis, enabling individualized treatment.
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Affiliation(s)
- Xindie Zhou
- Department of Orthopedics Surgery, The Second Affiliated Hospital of Medical College, Zhejiang University, Hangzhou, China
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39
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Abstract
Matrix metalloproteinases (MMP) are involved in the development of tendinopathy. These potent enzymes completely degrade all components of the connective tissue, modify the extracellular matrix (ECM), and mediate the development of painful tendinopathy. To control the local activity of activated proteinases, the same cells produce tissue inhibitors of metalloproteinases (TIMP). These latter bind to the enzyme and prevent degradation. The balance between the activities of MMPs and TIMPs regulates tendon remodeling, whereas an imbalance produces a collagen dis-regulation and disturbances in tendons. ADAMs (a disintegrin and metalloproteinase) are cell membrane-linked enzymes with proteolytic and cell signaling functions. ADAMTSs (ADAM with thrombospondin motifs) are secreted into the circulation and constitute a heterogenous family of proteases with both anabolic and catabolic functions. Further studies are needed to better define the mechanism of action, and whether these new strategies are safe and effective in larger models.
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Affiliation(s)
- Angelo Del Buono
- Department of Orthopaedic and Trauma Surgery, Campus Biomedico University of Rome, Italy
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40
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Navratilova Z, Gallo J, Mrazek F, Lostak J, Petrek M. MBL2gene variation affecting serum MBL is associated with prosthetic joint infection in Czech patients after total joint arthroplasty. ACTA ACUST UNITED AC 2012; 80:444-51. [DOI: 10.1111/tan.12001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 07/25/2012] [Accepted: 08/21/2012] [Indexed: 02/01/2023]
Affiliation(s)
- Z. Navratilova
- Laboratory of Immunogenomics and Immunoproteomics, Faculty of Medicine and Dentistry; Palacky University; Olomouc; Czech Republic
| | - J. Gallo
- Department of Orthopaedics, Faculty of Medicine and Dentistry and University Hospital Olomouc; Olomouc; Czech Republic
| | - F. Mrazek
- Laboratory of Immunogenomics and Immunoproteomics, Faculty of Medicine and Dentistry; Palacky University; Olomouc; Czech Republic
| | - J. Lostak
- Department of Orthopaedics, Faculty of Medicine and Dentistry and University Hospital Olomouc; Olomouc; Czech Republic
| | - M. Petrek
- Laboratory of Immunogenomics and Immunoproteomics, Faculty of Medicine and Dentistry; Palacky University; Olomouc; Czech Republic
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Gallo J, Goodman SB, Konttinen YT, Raska M. Particle disease: biologic mechanisms of periprosthetic osteolysis in total hip arthroplasty. Innate Immun 2012; 19:213-24. [PMID: 22751380 DOI: 10.1177/1753425912451779] [Citation(s) in RCA: 162] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Numerous studies provide detailed insight into the triggering and amplification mechanisms of the inflammatory response associated with prosthetic wear particles, promoting final dominance of bone resorption over bone formation in multiple bone multicellular units around an implant. In fact, inflammation is a highly regulated process tightly linked to simultaneous stimulation of tissue protective and regenerative mechanisms in order to prevent collateral damage of periprosthetic tissues. A variety of cytokines, chemokines, hormones and specific cell populations, including macrophages, dendritic and stem cells, attempt to balance tissue architecture and minimize inflammation. Based on this fact, we postulate that the local tissue homeostatic mechanisms more effectively regulate the pro-inflammatory/pro-osteolytic cells/pathways in patients with none/mild periprosthetic osteolysis (PPOL) than in patients with severe PPOL. In this line of thinking, 'particle disease theory' can be understood, at least partially, in terms of the failure of local tissue homeostatic mechanisms. As a result, we envision focusing current research on homeostatic mechanisms in addition to traditional efforts to elucidate details of pro-inflammatory/pro-osteolytic pathways. We believe this approach could open new avenues for research and potential therapeutic strategies.
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Affiliation(s)
- Jiri Gallo
- Department of Orthopaedics, University Hospital, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic.
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Stahelova A, Mrazek F, Smizansky M, Petrek M, Gallo J. Variation in the IL1B, TNF and IL6 genes and individual susceptibility to prosthetic joint infection. BMC Immunol 2012; 13:25. [PMID: 22568934 PMCID: PMC3475038 DOI: 10.1186/1471-2172-13-25] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 04/17/2012] [Indexed: 12/28/2022] Open
Abstract
Background Prosthetic joint infection (PJI) is an important failure mechanism of total joint arthroplasty (TJA). Here we examine whether the particular genetic variants can lead to increased susceptibility to PJI development. Results We conducted a genetic-association study to determine whether PJI could be associated with functional cytokine gene polymorphisms (CGP) influencing on innate immunity response. A case–control design was utilized and previously published criteria for PJI were included to distinguish between cases and control subjects with/without TJA. Six single nucleotide polymorphisms (SNPs) located in the genes for interleukin-1beta (SNP: IL1B-511, +3962), tumour necrosis factor alpha (TNF-308, -238) and interleukin-6 (IL6-174, nt565) were genotyped in 303 Caucasian (Czech) patients with TJA (89 with PJI / 214 without PJI), and 168 unrelated healthy Czech individuals without TJA. The results showed that carriers of the less common IL1B−511*T allele were overrepresented in the group of TJA patients with PJI (69%) in comparison with those that did not develop PJI (51%, p = 0.006, pcorr = 0.037) and with healthy controls (55%, p = 0.04, pcorr = N.S.). There was no significant difference in the distribution of the remaining five investigated CGPs and their haplotypes between groups. Conclusion A functional variant of the gene encoding for IL-1beta was preliminarily nominated as a genetic factor contributing to the susceptibility to PJI. Our results should be independently replicated; studies on the functional relevance of IL1B gene variants in PJI are also needed.
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Affiliation(s)
- Anna Stahelova
- Laboratory of Immunogenomics and Immunoproteomics, Faculty of Medicine and Dentistry, Palacky University Olomouc, IP Pavlova 6, Olomouc 77520, Czech Republic
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Abstract
The most frequent cause of failure after total hip replacement in all reported arthroplasty registries is peri-prosthetic osteolysis. Osteolysis is an active biological process initiated in response to wear debris. The eventual response to this process is the activation of macrophages and loss of bone. Activation of macrophages initiates a complex biological cascade resulting in the final common pathway of an increase in osteolytic activity. The biological initiators, mechanisms for and regulation of this process are beginning to be understood. This article explores current concepts in the causes of, and underlying biological mechanism resulting in peri-prosthetic osteolysis, reviewing the current basic science and clinical literature surrounding the topic.
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Affiliation(s)
- B Ollivere
- Norfolk & Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK.
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44
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Del Buono A, Oliva F, Longo UG, Rodeo SA, Orchard J, Denaro V, Maffulli N. Metalloproteases and rotator cuff disease. J Shoulder Elbow Surg 2012; 21:200-8. [PMID: 22244063 DOI: 10.1016/j.jse.2011.10.020] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Revised: 10/22/2011] [Accepted: 10/24/2011] [Indexed: 02/07/2023]
Abstract
The molecular changes occurring in rotator cuff tears are still unknown, but much attention has been paid to better understand the role of matrix metalloproteinases (MMP) in the development of tendinopathy. These are potent enzymes that, once activated, can completely degrade all components of the connective tissue, modify the extracellular matrix (ECM), and mediatethe development of painful tendinopathy and tendon rupture. To control the local activity of activated proteinases, the same cells produce tissue inhibitors of metalloproteinases (TIMP) that bind to the enzymes and prevent degradation. The balance between the activities of MMPs and TIMPs regulates tendon remodeling, whereas an imbalance produces a collagen dis-regulation and disturbances intendons. ADAMs (a disintegrin and metalloproteinase) are cell membrane-linked enzymes with proteolytic and cell signaling functions. ADAMTSs (ADAM with thrombospondin motifs) are secreted into the circulation, and constitute a heterogenous family of proteases with both anabolic and catabolic functions. Biologic modulation of endogenous MMP activity to basal levels may reduce pathologic tissue degradation and favorably influence healing after rotator cuff repair. Further studies are needed to better define the mechanism of action, and whether these new strategies are safe and effective in larger models.
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Affiliation(s)
- Angelo Del Buono
- Department of Orthopaedic and Trauma Surgery, Campus Biomedico, University of Rome, Rome, Italy
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