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Liang R, Li R, Mo W, Zhang X, Ye J, Xie C, Li W, Peng Z, Gu Y, Huang Y, Zhang S, Wang X, Ouyang H. Engineering biomimetic silk fibroin hydrogel scaffolds with "organic-inorganic assembly" strategy for rapid bone regeneration. Bioact Mater 2024; 40:541-556. [PMID: 39055734 PMCID: PMC11269296 DOI: 10.1016/j.bioactmat.2024.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 06/15/2024] [Accepted: 06/15/2024] [Indexed: 07/27/2024] Open
Abstract
Although natural polymers have been widely used in constructing bone scaffolds, it still remains challenging to fabricate natural polymer-derived bone scaffolds with biomimetic mechanical properties as well as outstanding osteogenic properties for large-size and weight-bearing bone defects regeneration. Herein, an "organic-inorganic assembly" strategy is developed to construct silk fibroin (SF)-based bone scaffolds with the aforementioned merits. After secondary structure reshuffling, the 3.3-fold increment of β-sheet structures in SF hydrogel resulted in a 100-fold improvement of mineral-assembly efficacy via influencing the ion adsorption process and providing templates for mineral growth. Notably, abundant minerals were deposited within the hydrogel and also on the surface, which indicated entire mineral-assembly, which ensured the biomimetic mechanical properties of the digital light processing 3D printed SF hydrogel scaffolds with haversian-mimicking structure. In vitro experiments proved that the assembly between the mineral and SF results in rapid adhesion and enhanced osteogenic differentiation of human bone marrow-derived mesenchymal stem cells. In vivo experiments further proved that the mineral-assembled SF hydrogel scaffold could significantly enhance integration and bone regeneration at the weight-bearing site within one month. This SF-based "organic-inorganic assembly" strategy sheds light on constructing cell-free, growth factor-free and natural polymer-derived bone scaffolds with biomimetic 3D structure, mechanical properties and excellent osteogenic properties.
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Affiliation(s)
- Renjie Liang
- Department of Sports Medicine of the Second Affiliated Hospital, and Liangzhu Laboratory, Zhejiang University School of Medicine, Hangzhou, China
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China
- Zhejiang University-University of Edinburgh Institute, Zhejiang University School of Medicine, Haining, China
| | - Rui Li
- Department of Sports Medicine of the Second Affiliated Hospital, and Liangzhu Laboratory, Zhejiang University School of Medicine, Hangzhou, China
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China
- Zhejiang University-University of Edinburgh Institute, Zhejiang University School of Medicine, Haining, China
| | - Weidong Mo
- Department of Sports Medicine of the Second Affiliated Hospital, and Liangzhu Laboratory, Zhejiang University School of Medicine, Hangzhou, China
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China
- Zhejiang University-University of Edinburgh Institute, Zhejiang University School of Medicine, Haining, China
| | - Xianzhu Zhang
- Department of Sports Medicine of the Second Affiliated Hospital, and Liangzhu Laboratory, Zhejiang University School of Medicine, Hangzhou, China
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China
- Zhejiang University-University of Edinburgh Institute, Zhejiang University School of Medicine, Haining, China
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Rd, Hangzhou, China
| | - Jinchun Ye
- Department of Sports Medicine of the Second Affiliated Hospital, and Liangzhu Laboratory, Zhejiang University School of Medicine, Hangzhou, China
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China
- Zhejiang University-University of Edinburgh Institute, Zhejiang University School of Medicine, Haining, China
| | - Chang Xie
- Department of Sports Medicine of the Second Affiliated Hospital, and Liangzhu Laboratory, Zhejiang University School of Medicine, Hangzhou, China
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China
- Zhejiang University-University of Edinburgh Institute, Zhejiang University School of Medicine, Haining, China
| | - Wenyue Li
- Department of Sports Medicine of the Second Affiliated Hospital, and Liangzhu Laboratory, Zhejiang University School of Medicine, Hangzhou, China
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China
- Zhejiang University-University of Edinburgh Institute, Zhejiang University School of Medicine, Haining, China
| | - Zhi Peng
- Department of Sports Medicine of the Second Affiliated Hospital, and Liangzhu Laboratory, Zhejiang University School of Medicine, Hangzhou, China
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China
- Zhejiang University-University of Edinburgh Institute, Zhejiang University School of Medicine, Haining, China
| | - Yuqing Gu
- Department of Sports Medicine of the Second Affiliated Hospital, and Liangzhu Laboratory, Zhejiang University School of Medicine, Hangzhou, China
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China
- Zhejiang University-University of Edinburgh Institute, Zhejiang University School of Medicine, Haining, China
| | - Yuxuan Huang
- Department of Sports Medicine of the Second Affiliated Hospital, and Liangzhu Laboratory, Zhejiang University School of Medicine, Hangzhou, China
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China
- Zhejiang University-University of Edinburgh Institute, Zhejiang University School of Medicine, Haining, China
| | - Shufang Zhang
- Department of Sports Medicine of the Second Affiliated Hospital, and Liangzhu Laboratory, Zhejiang University School of Medicine, Hangzhou, China
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China
- Zhejiang University-University of Edinburgh Institute, Zhejiang University School of Medicine, Haining, China
- China Orthopedic Regenerative Medicine Group (CORMed), Hangzhou, China
| | - Xiaozhao Wang
- Department of Sports Medicine of the Second Affiliated Hospital, and Liangzhu Laboratory, Zhejiang University School of Medicine, Hangzhou, China
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China
- Zhejiang University-University of Edinburgh Institute, Zhejiang University School of Medicine, Haining, China
| | - Hongwei Ouyang
- Department of Sports Medicine of the Second Affiliated Hospital, and Liangzhu Laboratory, Zhejiang University School of Medicine, Hangzhou, China
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China
- Zhejiang University-University of Edinburgh Institute, Zhejiang University School of Medicine, Haining, China
- China Orthopedic Regenerative Medicine Group (CORMed), Hangzhou, China
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Zhao C, Rong K, Liu P, Kong K, Li H, Zhang P, Chen X, Fu Q, Wang X. Preventing periprosthetic osteolysis in aging populations through lymphatic activation and stem cell-associated secretory phenotype inhibition. Commun Biol 2024; 7:962. [PMID: 39122919 PMCID: PMC11315686 DOI: 10.1038/s42003-024-06664-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 07/31/2024] [Indexed: 08/12/2024] Open
Abstract
With increases in life expectancy, the number of patients requiring joint replacement therapy and experiencing periprosthetic osteolysis, the most common complication leading to implant failure, is growing or underestimated. In this study, we found that osteolysis progression and osteoclast differentiation in the surface of the skull bone of adult mice were accompanied by significant expansion of lymphatic vessels within bones. Using recombinant VEGF-C protein to activate VEGFR3 and promote proliferation of lymphatic vessels in bone, we counteracted excessive differentiation of osteoclasts and osteolysis caused by titanium alloy particles or inflammatory cytokines LPS/TNF-α. However, this effect was not observed in aged mice because adipogenically differentiated mesenchymal stem cells (MSCs) inhibited the response of lymphatic endothelial cells to agonist proteins. The addition of the JAK inhibitor ruxolitinib restored the response of lymphatic vessels to external stimuli in aged mice to protect against osteolysis progression. These findings suggest that inhibiting SASP secretion by adipogenically differentiated MSCs while activating lymphatic vessels in bone offers a new method to prevent periprosthetic osteolysis during joint replacement follow-up.
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Affiliation(s)
- Chen Zhao
- Department of Orthopedics, Shanghai Key Laboratory of Orthopedics Implant, the Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kewei Rong
- Department of Orthopedics, Shanghai Key Laboratory of Orthopedics Implant, the Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Pengcheng Liu
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Keyu Kong
- Department of Orthopedics, Shanghai Key Laboratory of Orthopedics Implant, the Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haikuo Li
- Division of Biology & Biomedical Sciences, Washington University in St. Louis School of Medicine, St. Louis, USA
| | - Pu Zhang
- Department of Orthopedics, Shanghai Key Laboratory of Orthopedics Implant, the Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xuzhuo Chen
- Department of Oral Surgery, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiang Fu
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Xiaoqing Wang
- Department of Orthopedics, Shanghai Key Laboratory of Orthopedics Implant, the Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Mei F, Guo Y, Wang Y, Zhou Y, Heng BC, Xie M, Huang X, Zhang S, Ding S, Liu F, Deng X, Chen L, Yang C. Matrix stiffness regulates macrophage polarisation via the Piezo1-YAP signalling axis. Cell Prolif 2024; 57:e13640. [PMID: 38556840 PMCID: PMC11294424 DOI: 10.1111/cpr.13640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/29/2024] [Accepted: 03/18/2024] [Indexed: 04/02/2024] Open
Abstract
Macrophages play a pivotal role in the immunological cascade activated in response to biomedical implants, which predetermine acceptance or rejection of implants by the host via pro- and anti-inflammatory polarisation states. The role of chemical signals in macrophage polarisation is well-established, but how physical cues regulate macrophage function that may play a fundamental role in implant-bone interface, remains poorly understood. Here we find that bone marrow-derived macrophages (BMDM) cultured on polyacrylamide gels of varying stiffness exhibit different polarisation states. BMDM are 'primed' to a pro-inflammatory M1 phenotype on stiff substrates, while to an anti-inflammatory M2 phenotype on soft and medium stiffness substrates. It is further observed that matrix stiffening increases Piezo1 expression, as well as leads to subsequent activation of the mechanotransduction signalling effector YAP, thus favouring M1 polarisation whilst suppressing M2 polarisation. Moreover, upon treatment with YAP inhibitor, we successfully induce macrophage re-polarisation to the M2 state within the implant site microenvironment, which in turn promotes implant osseointegration. Collectively, our present study thus characterises the critical role of the Piezo1-YAP signalling axis in macrophage mechanosensing and stiffness-mediated macrophage polarisation and provides cues for the design of immuno-modulatory biomaterials that can regulate the macrophage phenotype.
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Affiliation(s)
- Feng Mei
- Department of Stomatology, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
- School of Stomatology, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
- Hubei Province Key Laboratory of Oral and Maxillofacial Development and RegenerationWuhanChina
| | - Yaru Guo
- Department of Geriatric DentistryPeking University School and Hospital of StomatologyBeijingChina
| | - Yu Wang
- Department of OrthodonticsPeking University School and Hospital of Stomatology, National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital StomatologyBeijingChina
| | - Yingying Zhou
- NMPA Key Laboratory for Dental Materials, Department of Dental Materials & Dental Medical Devices Testing CenterPeking University School and Hospital of StomatologyBeijingChina
| | - Boon Chin Heng
- Central LaboratoryPeking University School and Hospital of StomatologyBeijingChina
| | - Mengru Xie
- Department of Stomatology, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
- School of Stomatology, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
- Hubei Province Key Laboratory of Oral and Maxillofacial Development and RegenerationWuhanChina
| | - Xiaofei Huang
- Department of Stomatology, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
- School of Stomatology, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
- Hubei Province Key Laboratory of Oral and Maxillofacial Development and RegenerationWuhanChina
| | - Shihan Zhang
- Department of Geriatric DentistryPeking University School and Hospital of StomatologyBeijingChina
| | - Shuai Ding
- Department of OrthodonticsPeking University School and Hospital of Stomatology, National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital StomatologyBeijingChina
| | - Fangyong Liu
- NMPA Key Laboratory for Dental Materials, Department of Dental Materials & Dental Medical Devices Testing CenterPeking University School and Hospital of StomatologyBeijingChina
| | - Xuliang Deng
- Department of Geriatric DentistryPeking University School and Hospital of StomatologyBeijingChina
- NMPA Key Laboratory for Dental Materials, Department of Dental Materials & Dental Medical Devices Testing CenterPeking University School and Hospital of StomatologyBeijingChina
| | - Lili Chen
- Department of Stomatology, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
- School of Stomatology, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
- Hubei Province Key Laboratory of Oral and Maxillofacial Development and RegenerationWuhanChina
| | - Cheng Yang
- Department of Stomatology, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
- School of Stomatology, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
- Hubei Province Key Laboratory of Oral and Maxillofacial Development and RegenerationWuhanChina
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Carvalho EO, Marques-Almeida T, Cruz BDD, Correia DM, Esperança JMSS, Irastorza I, Silvan U, Fernandes MM, Lanceros-Mendez S, Ribeiro C. Piezoelectric biomaterials with embedded ionic liquids for improved orthopedic interfaces through osseointegration and antibacterial dual characteristics. BIOMATERIALS ADVANCES 2024; 164:213970. [PMID: 39106539 DOI: 10.1016/j.bioadv.2024.213970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 07/03/2024] [Accepted: 07/25/2024] [Indexed: 08/09/2024]
Abstract
Orthopedic implant failures, primarily attributed to aseptic loosening and implant site infections, pose significant challenges to patient recovery and lead to revision surgeries. Combining piezoelectric materials with ionic liquids as interfaces for orthopedic implants presents an innovative approach to addressing both issues simultaneously. In this study, films of poly(vinylidene fluoride-trifluoroethylene) (P(VDF-TrFE)) incorporated with 1-ethyl-3-methylimidazolium hydrogen sulfate ([Emim][HSO4]) ionic liquid were developed. These films exhibited strong antibacterial properties, effectively reducing biofilm formation, thereby addressing implant-related infections. Furthermore, stem cell-based differentiation assays exposed the potential of the composite materials to induce osteogenesis. Interestingly, our findings also revealed the upregulation of calcium channel expression as a result of electromechanical stimulation, pointing to a mechanistic basis for the observed biological effects. This work highlights the potential of piezoelectric materials with ionic liquids to improve the longevity and biocompatibility of orthopedic implants. Offering dual-functionality for infection prevention and bone integration, these advancements hold significant potential for advancing orthopedic implant technologies and improving patient outcomes.
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Affiliation(s)
- E O Carvalho
- Physics Centre of Minho and Porto Universities (CF-UM-UP), LaPMET - Laboratory of Physics for Materials and Emergent Technologies, University of Minho, 4710-057 Braga, Portugal; IB-S - Institute for Research and Innovation on Bio-Sustainability, University of Minho, 4710-057 Braga, Portugal
| | - T Marques-Almeida
- Physics Centre of Minho and Porto Universities (CF-UM-UP), LaPMET - Laboratory of Physics for Materials and Emergent Technologies, University of Minho, 4710-057 Braga, Portugal; IB-S - Institute for Research and Innovation on Bio-Sustainability, University of Minho, 4710-057 Braga, Portugal
| | - B D D Cruz
- Physics Centre of Minho and Porto Universities (CF-UM-UP), LaPMET - Laboratory of Physics for Materials and Emergent Technologies, University of Minho, 4710-057 Braga, Portugal; Centre of Chemistry, University of Minho, Braga 4710-057, Portugal; Centre of Molecular and Environmental Biology, University of Minho, 4710-057 Braga, Portugal
| | - D M Correia
- Centre of Chemistry, University of Minho, Braga 4710-057, Portugal
| | - J M S S Esperança
- LAQV/REQUIMTE, Department of Chemistry, NOVA School of Science and Technology, FCT NOVA, 2829-516 Caparica, Portugal
| | - I Irastorza
- Physics Centre of Minho and Porto Universities (CF-UM-UP), LaPMET - Laboratory of Physics for Materials and Emergent Technologies, University of Minho, 4710-057 Braga, Portugal; BCMaterials, Basque Center Centre for Materials, Applications, and Nanostructures, UPV/EHU Science Park, 48940 Leioa, Spain
| | - U Silvan
- BCMaterials, Basque Center Centre for Materials, Applications, and Nanostructures, UPV/EHU Science Park, 48940 Leioa, Spain; Ikerbasque, Basque Foundation for Science, 48009 Bilbao, Spain
| | - M M Fernandes
- Physics Centre of Minho and Porto Universities (CF-UM-UP), LaPMET - Laboratory of Physics for Materials and Emergent Technologies, University of Minho, 4710-057 Braga, Portugal; Centre for MicroElectroMechanics Systems (CMEMS), University of Minho, 4710-057 Guimarães, Portugal; LABBELS-Associate Laboratory, Braga, Guimarães, Portugal
| | - S Lanceros-Mendez
- Physics Centre of Minho and Porto Universities (CF-UM-UP), LaPMET - Laboratory of Physics for Materials and Emergent Technologies, University of Minho, 4710-057 Braga, Portugal; BCMaterials, Basque Center Centre for Materials, Applications, and Nanostructures, UPV/EHU Science Park, 48940 Leioa, Spain; Ikerbasque, Basque Foundation for Science, 48009 Bilbao, Spain.
| | - C Ribeiro
- Physics Centre of Minho and Porto Universities (CF-UM-UP), LaPMET - Laboratory of Physics for Materials and Emergent Technologies, University of Minho, 4710-057 Braga, Portugal; IB-S - Institute for Research and Innovation on Bio-Sustainability, University of Minho, 4710-057 Braga, Portugal.
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Luptáková N, Dlouhý V, Sobola D, Fintová S, Weiser A, Beneš V, Dlouhý A. Interfaces between Cranial Bone and AISI 304 Steel after Long-Term Implantation: A Case Study of Cranial Screws. ACS Biomater Sci Eng 2024; 10:4297-4310. [PMID: 38900847 PMCID: PMC11234332 DOI: 10.1021/acsbiomaterials.4c00309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Abstract
Interfaces between AISI 304 stainless steel screws and cranial bone were investigated after long-term implantation lasting for 42 years. Samples containing the interface regions were analyzed using state-of-the-art analytical techniques including secondary ion mass, Fourier-transform infrared, Raman, and X-ray photoelectron spectroscopies. Local samples for scanning transmission electron microscopy were cut from the interface regions using the focused ion beam technique. A chemical composition across the interface was recorded in length scales covering micrometric and nanometric resolutions and relevant differences were found between peri-implant and the distant cranial bone, indicating generally younger bone tissue in the peri-implant area. Furthermore, the energy dispersive spectroscopy revealed an 80 nm thick steel surface layer enriched by oxygen suggesting that the AISI 304 material undergoes a corrosion attack. The attack is associated with transport of metallic ions, namely, ferrous and ferric iron, into the bone layer adjacent to the implant. The results comply with an anticipated interplay between released iron ions and osteoclast proliferation. The interplay gives rise to an autocatalytic process in which the iron ions stimulate the osteoclast activity while a formation of fresh bone resorption sites boosts the corrosion process through interactions between acidic osteoclast extracellular compartments and the implant surface. The autocatalytic process thus may account for an accelerated turnover of the peri-implant bone.
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Affiliation(s)
- Natália Luptáková
- Institute of Physics of Materials, AS CR, v. v. i., Žižkova 513/22, Brno 61662, Czech Republic
| | - Václav Dlouhý
- Department of Neurosurgery, Second Faculty of Medicine, Charles University and University Hospital Motol, V Úvalu 84, Prague 150 06, Czech Republic
| | - Dinara Sobola
- Institute of Physics of Materials, AS CR, v. v. i., Žižkova 513/22, Brno 61662, Czech Republic
| | - Stanislava Fintová
- Institute of Physics of Materials, AS CR, v. v. i., Žižkova 513/22, Brno 61662, Czech Republic
| | - Adam Weiser
- Institute of Physics of Materials, AS CR, v. v. i., Žižkova 513/22, Brno 61662, Czech Republic
| | - Vladimír Beneš
- Department of Neurosurgery, Second Faculty of Medicine, Charles University and University Hospital Motol, V Úvalu 84, Prague 150 06, Czech Republic
| | - Antonín Dlouhý
- Institute of Physics of Materials, AS CR, v. v. i., Žižkova 513/22, Brno 61662, Czech Republic
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Domingo MG, Kurtz M, Maglione G, Martin M, Brites F, Tasat DR, Olmedo DG. Chronic exposure to TiO 2 micro- and nano particles: A biochemical and histopathological experimental study. J Biomed Mater Res B Appl Biomater 2024; 112:e35443. [PMID: 38968028 DOI: 10.1002/jbm.b.35443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 04/08/2024] [Accepted: 06/09/2024] [Indexed: 07/07/2024]
Abstract
The aim of this work was to analyze the effects of long-term exposure to titanium dioxide (TiO2) micro- (MPs) and nanoparticles (NPs) (six and 12 months) on the biochemical and histopathological response of target organs using a murine model. Male Wistar rats were intraperitoneally injected with a suspension of TiO2 NPs (5 nm; TiO2-NP5 group) or MPs (45 μm; TiO2-NP5 group); the control group was injected with saline solution. Six and 12 months post-injection, titanium (Ti) concentration in plasma and target organs was determined spectrometrically (ICP-MS). Blood smears and organ tissue samples were evaluated by light microscopy. Liver and kidney function was evaluated using serum biochemical parameters. Oxidative metabolism was assessed 6 months post-injection (determination of superoxide anion by nitroblue tetrazolium (NBT) test, superoxide dismutase (SOD) and catalase (CAT), lipid peroxidation, and paraoxonase 1). Titanium (Ti) concentration in target organs and plasma was significantly higher in the TiO2-exposed groups than in the control group. Histological evaluation showed the presence of titanium-based particles in the target organs, which displayed no structural alterations, and in blood monocytes. Oxidative metabolism analysis showed that TiO2 NPs were more reactive over time than MPs (p < .05) and mobilization of antioxidant enzymes and membrane damage varied among the studied organs. Clearance of TiO2 micro and nanoparticles differed among the target organs, and lung clearance was more rapid than clearance from the lungs and kidneys (p < .05). Conversely, Ti concentration in plasma increased with time (p < .05). In conclusion, neither serum biochemical parameters nor oxidative metabolism markers appear to be useful as biomarkers of tissue damage in response to TiO2 micro- and nanoparticle deposits at chronic time points.
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Affiliation(s)
- Mariela Gisele Domingo
- Universidad de Buenos Aires, Facultad de Odontología, Cátedra de Anatomía Patológica, Buenos Aires, Argentina
- Becario de Investigación de la Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Melisa Kurtz
- CONICET, Buenos Aires, Argentina
- Instituto de Tecnologías Emergentes y Ciencias Aplicadas (ITECA), Escuela de Ciencia y Tecnología, Universidad Nacional de San Martín-CONICET, Buenos Aires, Argentina
| | - Guillermo Maglione
- Instituto de Tecnologías Emergentes y Ciencias Aplicadas (ITECA), Escuela de Ciencia y Tecnología, Universidad Nacional de San Martín-CONICET, Buenos Aires, Argentina
- Universidad de Buenos Aires, Facultad de Odontología, Cátedra de Histología y Embriología, Buenos Aires, Argentina
| | | | - Fernando Brites
- CONICET, Buenos Aires, Argentina
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Departamento de Bioquímica Clínica, Laboratorio de Lípidos y Lipoproteínas, Buenos Aires, Argentina
| | - Deborah Ruth Tasat
- Instituto de Tecnologías Emergentes y Ciencias Aplicadas (ITECA), Escuela de Ciencia y Tecnología, Universidad Nacional de San Martín-CONICET, Buenos Aires, Argentina
- Universidad de Buenos Aires, Facultad de Odontología, Cátedra de Histología y Embriología, Buenos Aires, Argentina
| | - Daniel Gustavo Olmedo
- Universidad de Buenos Aires, Facultad de Odontología, Cátedra de Anatomía Patológica, Buenos Aires, Argentina
- CONICET, Buenos Aires, Argentina
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7
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Kubsad S, Thenuwara S, Green W, Kurian S, Kishan A, Harris AB, Golladay GJ, Thakkar SC. 10-Year Cumulative Incidence and Indications for Revision Total Joint Arthroplasty for Patients Who Have Ehlers-Danlos Syndrome. J Arthroplasty 2024:S0883-5403(24)00638-7. [PMID: 38936437 DOI: 10.1016/j.arth.2024.06.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 06/16/2024] [Accepted: 06/17/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Long-term complications following total joint arthroplasty are not well established for patients who have Ehlers-Danlos syndrome (EDS), a group of connective tissue disorders. This study compared 10-year incidence of revision surgery after total hip arthroplasty (THA) and total knee arthroplasty (TKA) in patients who have and do not have EDS. METHODS A retrospective cohort analysis was conducted using a national all-payer claims database from 2010 to 2021 to identify patients who underwent primary TKA or THA. Patients who had and did not have EDS were propensity score-matched by age, sex, and a comorbidity index. Kaplan-Meier analyses and Cox proportional hazard models were used to determine the cumulative incidence and risks of revision experienced by patients who have and do not have EDS. RESULTS The EDS patients who underwent TKA had a higher risk of all-cause revision (hazard ratio [HR]: 1.50, 95% confidence interval [95% CI]: 1.09 to 2.07, P < .014) and risk of revision due to instability (HR = 2.49, 95% CI: 1.37 to 4.52, P < .003). The EDS patients who underwent THA had a higher risk of all-cause revision (HR = 2.32, 95% CI: 1.47 to 3.65, P < .001), revision due to instability (HR = 4.26, 95% CI: 2.17 to 8.36, P < .001), and mechanical loosening (HR = 3.63, 95% CI: 2.05 to 6.44, P < .001). CONCLUSIONS Patients who had EDS were found to have a higher incidence of revision within 10 years of undergoing TKA and THA compared to matched controls, especially for instability. Patients who have EDS should be counseled accordingly. Surgical technique and implant selection should include consideration for increased constraint in TKA and larger femoral heads or dual mobility articulations for THA.
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Affiliation(s)
- Sanjay Kubsad
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Orthopaedic Surgery, University of Washington School of Medicine, Seattle, Washington
| | - Samalya Thenuwara
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - William Green
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Shyam Kurian
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Arman Kishan
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Andrew B Harris
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Gregory J Golladay
- Department of Orthopaedic Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Savyasachi C Thakkar
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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8
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Thomson AL, Suhardi VJ, Niu Y, Oktarina A, Döring K, Chao C, Greenblatt MB, Ivashkiv LB, Bostrom MPG, Yang X. A translational murine model of aseptic loosening with osseointegration failure. J Orthop Res 2024. [PMID: 38899517 DOI: 10.1002/jor.25915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 05/19/2024] [Accepted: 05/25/2024] [Indexed: 06/21/2024]
Abstract
An in vivo animal model of a weight-bearing intra-articular implant is crucial to the study of implant osseointegration and aseptic loosening caused by osseointegration failure. Osseointegration, defined as a direct structural and functional attachment between living bone tissue and the surface of a load-carrying implant, is essential for implant stability and considered a prerequisite for the long-term clinical success of implants in total joint arthroplasty. Compared to large animal models, murine models offer extensive genetic tools for tracing cell differentiation and proliferation. The 18- to 22-week-old C57BL/6J background mice underwent either press-fitted or loose implantation of a titanium implant, achieving osseointegration or fibrous integration. A protocol was developed for both versions of the procedure, including a description of the relevant anatomy. Samples were subjected to microcomputed tomography and underwent biomechanical testing to access osseointegration. Lastly, samples were fixed and embedded for histological evaluation. The absence of mineralized tissue and weakened maximum pull-out force in loose implantation samples indicated that these implants were less mechanically stable compared to the control at 4 weeks postoperation. Histological analysis demonstrated extensive fibrotic tissue in the peri-implant area of loose implantation samples and excellent implant osseointegration in press-fitted samples at 4 weeks. Both mechanically stable and unstable hemiarthroplasty models with either osseous ingrowth or a robust periprosthetic fibrosis were achieved in mice. We hope that this model can help address current limitations for in vivo study of aseptic loosening and lead to necessary translational benefits.
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Affiliation(s)
- Andrew L Thomson
- Research Institute, Hospital for Special Surgery, New York, New York, USA
| | - Vincentius J Suhardi
- Research Institute, Hospital for Special Surgery, New York, New York, USA
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Yingzhen Niu
- Research Institute, Hospital for Special Surgery, New York, New York, USA
- Department of Joint Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Anastasia Oktarina
- Research Institute, Hospital for Special Surgery, New York, New York, USA
| | - Kevin Döring
- Research Institute, Hospital for Special Surgery, New York, New York, USA
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Christina Chao
- Research Institute, Hospital for Special Surgery, New York, New York, USA
| | - Matthew B Greenblatt
- Research Institute, Hospital for Special Surgery, New York, New York, USA
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Lionel B Ivashkiv
- Research Institute, Hospital for Special Surgery, New York, New York, USA
| | - Mathias P G Bostrom
- Research Institute, Hospital for Special Surgery, New York, New York, USA
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
- Department of Orthopedic Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Xu Yang
- Research Institute, Hospital for Special Surgery, New York, New York, USA
- Department of Orthopedic Surgery, Weill Cornell Medicine, New York, New York, USA
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9
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Shih JT, Tan TL, Shen PH, Yeh TT, Wu CC, Pan RY, Chien WC, Chung CH, Wang SH. Postoperative Bisphosphonates Use is Associated with Reduced Adverse Outcomes After Primary Total Joint Arthroplasty of Hip and Knee: A Nationwide Population-Based Cohort Study. Calcif Tissue Int 2024; 114:451-460. [PMID: 38492035 DOI: 10.1007/s00223-024-01192-6] [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: 10/19/2023] [Accepted: 02/06/2024] [Indexed: 03/18/2024]
Abstract
Bisphosphonates have been associated with a decreased risk of revision surgery after total joint arthroplasty of the hip or knee (TJA) because of their effects on decreased periprosthetic bone loss and prosthetic migration. However, the results in the early literature are inconsistent, and the influence of bisphosphonates on associated complications and subsequent TJA remains unknown. This study investigated the association between the use of bisphosphonates and the risk of adverse outcomes after primary TJA. This matched cohort study utilized the National Health Insurance Research Database in Taiwan to identify patients who underwent primary TJA over a 15-year period (January 2000-December 2015 inclusive). Study participants were further categorized into two groups, bisphosphonate users and nonusers, using propensity score matching. The Kaplan-Meier curve analysis and adjusted hazard ratios (aHRs) of revision surgery, adverse outcomes of primary surgery and subsequent TJA were calculated using Cox regression analysis. This study analyzed data from 6485 patients who underwent total hip arthroplasty (THA) and 20,920 patients who underwent total knee arthroplasty (TKA). The risk of revision hip and knee arthroplasty was significantly lower in the bisphosphonate users than in the nonusers (aHR, 0.54 and 0.53, respectively). Furthermore, the risk of a subsequent total joint arthroplasty, adverse events and all-cause mortality were also significantly reduced in the bisphosphonate users. This study, involving a large cohort of patients who underwent primary arthroplasties, revealed that bisphosphonate treatment may potentially reduce the risk of revision surgery and associated adverse outcomes. Furthermore, the use of bisphosphonates after TJA is also associated with a reduced need for subsequent arthroplasty.Research Registration Unique Identifying Number (UIN): ClinicalTrials.gov Identifier-NCT05623540 ( https://clinicaltrials.gov/show/NCT05623540 ).
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Affiliation(s)
- Jen-Ta Shih
- Department of Orthopedics, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Chenggong Rd., Neihu Dist., Taipei City, 11472, Taiwan
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei City, Taiwan
| | - Timothy L Tan
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Pei-Hung Shen
- Department of Orthopedics, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Chenggong Rd., Neihu Dist., Taipei City, 11472, Taiwan
| | - Tsu-Te Yeh
- Department of Orthopedics, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Chenggong Rd., Neihu Dist., Taipei City, 11472, Taiwan
| | - Chia-Chun Wu
- Department of Orthopedics, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Chenggong Rd., Neihu Dist., Taipei City, 11472, Taiwan
| | - Ru-Yu Pan
- Department of Orthopedics, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Chenggong Rd., Neihu Dist., Taipei City, 11472, Taiwan
| | - Wu-Chien Chien
- School of Public Health, National Defense Medical Center, Taipei City, Taiwan
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei City, Taiwan
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei City, Taiwan
| | - Chi-Hsiang Chung
- School of Public Health, National Defense Medical Center, Taipei City, Taiwan
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei City, Taiwan
| | - Sheng-Hao Wang
- Department of Orthopedics, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Chenggong Rd., Neihu Dist., Taipei City, 11472, Taiwan.
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10
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Srikrishnaraj A, Lanting BA, Burton JP, Teeter MG. The Microbial Revolution in the World of Joint Replacement Surgery. JB JS Open Access 2024; 9:e23.00153. [PMID: 38638595 PMCID: PMC11023614 DOI: 10.2106/jbjs.oa.23.00153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2024] Open
Abstract
Background The prevalence of revision surgery due to aseptic loosening and periprosthetic joint infection (PJI) following total hip and knee arthroplasty is growing. Strategies to prevent the need for revision surgery and its associated health-care costs and patient morbidity are needed. Therapies that modulate the gut microbiota to influence bone health and systemic inflammation are a novel area of research. Methods A literature review of preclinical and clinical peer-reviewed articles relating to the role of the gut microbiota in bone health and PJI was performed. Results There is evidence that the gut microbiota plays a role in maintaining bone mineral density, which can contribute to osseointegration, osteolysis, aseptic loosening, and periprosthetic fractures. Similarly, the gut microbiota influences gut permeability and the potential for bacterial translocation to the bloodstream, increasing susceptibility to PJI. Conclusions Emerging evidence supports the role of the gut microbiota in the development of complications such as aseptic loosening and PJI after total hip or knee arthroplasty. There is a potential for microbial therapies such as probiotics or fecal microbial transplantation to moderate the risk of developing these complications. However, further investigation is required. Clinical Relevance Modulation of the gut microbiota may influence patient outcomes following total joint arthroplasty.
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Affiliation(s)
- Arjuna Srikrishnaraj
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Brent A. Lanting
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Bone and Joint Institute, Western University, London, Ontario, Canada
| | - Jeremy P. Burton
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Bone and Joint Institute, Western University, London, Ontario, Canada
| | - Matthew G. Teeter
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Bone and Joint Institute, Western University, London, Ontario, Canada
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11
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Mirzaali MJ, Zadpoor AA. Orthopedic meta-implants. APL Bioeng 2024; 8:010901. [PMID: 38250670 PMCID: PMC10799688 DOI: 10.1063/5.0179908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
Meta-biomaterials, engineered materials with distinctive combinations of mechanical, physical, and biological properties stemming from their micro-architecture, have emerged as a promising domain within biomedical engineering. Correspondingly, meta-implants, which serve as the device counterparts of meta-biomaterials, offer exceptional functionalities, holding great potential for addressing complex skeletal diseases. This paper presents a comprehensive overview of the various types of meta-implants, including hybrid, shape-morphing, metallic clay, and deployable meta-implants, highlighting their unprecedented properties and recent achievement in the field. This paper also delves into the potential future developments of meta-implants, addressing the exploration of multi-functionalities in meta-biomaterials and their applications in diverse biomedical fields.
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Affiliation(s)
- Mohammad J. Mirzaali
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology (TU Delft), Delft 2628CD, The Netherlands
| | - Amir A. Zadpoor
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology (TU Delft), Delft 2628CD, The Netherlands
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12
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Thalody HS, Ponzio DY, Santoro AJ, Radack TM, Post ZD, Ong AC. Large Femoral Heads With Small Acetabular Components: An Examination of 10-Year Polyethylene Wear. Orthopedics 2024; 47:118-122. [PMID: 37561101 DOI: 10.3928/01477447-20230804-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
Highly cross-linked polyethylene (HXLPE) has improved polyethylene (PE) wear rates while decreasing osteolysis and aseptic loosening. However, concerns exist regarding the risk of mechanical failure with thin HXLPE liners in total hip arthroplasty (THA). Our purpose was to evaluate long-term outcomes and PE wear rates in primary THAs pairing large femoral heads with small acetabular components and thin HXLPE liners. We retrospectively reviewed 29 patients who underwent 33 primary THAs using large femoral heads (32 or 36 mm) with small acetabular components (48 or 50 mm) and thin HXLPE liners (3.9 or 5.9 mm) at minimum 10-year follow-up. PE liner wear was measured using a validated radiographic technique. Mean age was 66 years, 97% of the patients were women, and mean body mass index was 26.3 kg/m2. Thirty hips (90.9%) had ceramic femoral heads, and 13 hips (39%) had 36-mm femoral heads with 3.9-mm HXLPE liners. All cases used a neutral PE design. Mean linear wear rate and volumetric wear rate were 0.04 mm/year and 39.6 mm3/year, respectively, at mean 10.9-year follow-up. There were no instances of liner fracture, liner dissociation, or revision. Mean Hip disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS, JR) was 92.1. In the largest long-term study of primary THAs using large femoral heads with small acetabular components and thin HXLPE liners, we found low linear and volumetric wear rates and no cases of liner mechanical failures. Thin HXLPE liners are a safe and viable option for THA surgeons. [Orthopedics. 2024;47(2):118-122.].
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13
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Hawellek T, von Lewinski G, Lehmann W, Kühn KD. [Cement in revision arthroplasty-what about the "glacier effect"? : Case studies viewed from different perspectives]. ORTHOPADIE (HEIDELBERG, GERMANY) 2024; 53:185-194. [PMID: 37861705 DOI: 10.1007/s00132-023-04452-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND The number of operations concerning revision arthroplasty has been increasing continuously in recent years, and it can be assumed that they will continue to increase in the future. If an arthroplasty implant becomes loose, it must be changed. The question often arises as to how the new implant should be fixed in the bone. ADVANTAGES Revision implants can be inserted into the bone without cement. In the subsequent period, a secondary osseointegration of the implant takes place. Another possibility is to anchor the implant by using bone cement. The advantage of cemented anchorage is that the implant is firmly fixed in the bone, in principle, immediately, and it is possible to fully load the implant directly. Direct postoperative full weight bearing is helpful, especially for older and multimorbid patients, in order to achieve rapid mobilization. PREREQUISITES AND CHALLENGES When using cement in revision cases, however, there are a few prerequisites and challenges that the surgeon should definitely take into account. In the case of revision, the bone in the former implant bed is often deficient and appears thinned and sclerosed. It is, therefore, important to analyze the bone quality preoperatively on radiographic images and to include it in the planning of the anchoring strategy. In addition, the individual bone quality of the patient must also be taken into account intraoperatively. In any case, it must be clarified whether the basic prerequisites for the sufficient bond strength of the cement with the bone to be formed can still be met. Furthermore, the principles of cementing technique must be strictly observed, and the goal of a perfect cement mantle must be aimed for. If the indication for this is overstated, early loosening of the cemented revision arthroplasty is very likely.
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Affiliation(s)
- Thelonius Hawellek
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland.
| | - Gabriela von Lewinski
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
| | - Wolfgang Lehmann
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
| | - Klaus-Dieter Kühn
- Universitätsklinik für Orthopädie und Orthopädische Chirurgie, Medizinische Universität Graz, Graz, Österreich
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14
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Travnickova M, Filova E, Slepicka P, Slepickova Kasalkova N, Kocourek T, Zaloudkova M, Suchy T, Bacakova L. Titanium-Doped Diamond-like Carbon Layers as a Promising Coating for Joint Replacements Supporting Osteogenic Differentiation of Mesenchymal Stem Cells. Int J Mol Sci 2024; 25:2837. [PMID: 38474083 DOI: 10.3390/ijms25052837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 02/17/2024] [Accepted: 02/22/2024] [Indexed: 03/14/2024] Open
Abstract
Diamond-like carbon (DLC) layers are known for their high corrosion and wear resistance, low friction, and high biocompatibility. However, it is often necessary to dope DLC layers with additional chemical elements to strengthen their adhesion to the substrate. Ti-DLC layers (doped with 0.4, 2.1, 3.7, 6.6, and 12.8 at.% of Ti) were prepared by dual pulsed laser deposition, and pure DLC, glass, and polystyrene (PS) were used as controls. In vitro cell-material interactions were investigated with an emphasis on cell adhesion, proliferation, and osteogenic differentiation. We observed slightly increasing roughness and contact angle and decreasing surface free energy on Ti-DLC layers with increasing Ti content. Three-week biological experiments were performed using adipose tissue-derived stem cells (ADSCs) and bone marrow mesenchymal stem cells (bmMSCs) in vitro. The cell proliferation activity was similar or slightly higher on the Ti-doped materials than on glass and PS. Osteogenic cell differentiation on all materials was proved by collagen and osteocalcin production, ALP activity, and Ca deposition. The bmMSCs exhibited greater initial proliferation potential and an earlier onset of osteogenic differentiation than the ADSCs. The ADSCs showed a slightly higher formation of focal adhesions, higher metabolic activity, and Ca deposition with increasing Ti content.
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Affiliation(s)
- Martina Travnickova
- Laboratory of Biomaterials and Tissue Engineering, Institute of Physiology of the Czech Academy of Sciences, Videnska 1083, 142 00 Prague, Czech Republic
| | - Elena Filova
- Laboratory of Biomaterials and Tissue Engineering, Institute of Physiology of the Czech Academy of Sciences, Videnska 1083, 142 00 Prague, Czech Republic
- Faculty of Materials and Technology, VSB-Technical University of Ostrava, 17. Listopadu 2172/15, 708 00 Ostrava, Czech Republic
| | - Petr Slepicka
- Department of Solid State Engineering, University of Chemistry and Technology Prague, Technicka 5, 166 28 Prague, Czech Republic
| | - Nikola Slepickova Kasalkova
- Department of Solid State Engineering, University of Chemistry and Technology Prague, Technicka 5, 166 28 Prague, Czech Republic
| | - Tomas Kocourek
- Institute of Physics of the Czech Academy of Sciences, Na Slovance 2, 182 21 Prague, Czech Republic
- Faculty of Biomedical Engineering, Czech Technical University in Prague, Nam. Sitna 3105, 272 01 Kladno, Czech Republic
| | - Margit Zaloudkova
- Institute of Rock Structure and Mechanics, Czech Academy of Sciences, V Holesovickach 94/41, 182 09 Prague, Czech Republic
| | - Tomas Suchy
- Institute of Rock Structure and Mechanics, Czech Academy of Sciences, V Holesovickach 94/41, 182 09 Prague, Czech Republic
| | - Lucie Bacakova
- Laboratory of Biomaterials and Tissue Engineering, Institute of Physiology of the Czech Academy of Sciences, Videnska 1083, 142 00 Prague, Czech Republic
- Faculty of Materials and Technology, VSB-Technical University of Ostrava, 17. Listopadu 2172/15, 708 00 Ostrava, Czech Republic
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15
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Haitao X, Siyuan L, Sutong G, Yu G, Peirong X, Ling W, Yujian D, Dehong F. Preparation of Cu 2+/TA/HAP composite coating with anti-bacterial and osteogenic potential on 3D-printed porous Ti alloy scaffolds for orthopedic applications. Open Life Sci 2024; 19:20220826. [PMID: 38465344 PMCID: PMC10921476 DOI: 10.1515/biol-2022-0826] [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: 08/03/2023] [Revised: 12/16/2023] [Accepted: 12/20/2023] [Indexed: 03/12/2024] Open
Abstract
Because of stress shielding effects, traditional titanium (Ti) alloy scaffolds have a high elastic modulus, which might promote looseness and bone disintegration surrounding the implant, increasing the likelihood of a second surgery. In contrast, 3D-printed porous Ti alloy scaffolds can reduce the scaffold weight while enhancing biocompatibility. Further, these scaffolds' porous nature allows bone tissue ingrowth as well as strong pore connectivity, which can improve nutrient absorption. Nevertheless, bare Ti alloy implants may fail because of inadequate bone integration; hence, adding a coating on the implant surface is an effective technique for improving implant stability. In this study, a composite coating comprising hydroxyapatite (HAP), chitosan (CS), tannic acid (TA) and copper ions (Cu2+) (Cu2+/TA/HAP composite coating) was prepared on the surface of 3D printed porous Ti alloy scaffolds using electrophoretic deposition. Using the standard plate count method, Live/Dead bacteria staining assay, FITC Phalloidin and 4',6-diamidino-2-phenylindole staining assay, and live/dead staining of cells we determined that the composite coating has better antibacterial properties and cytocompatibility as well as lower cytotoxicity. The Alkaline Phosphatase assay revealed that the coating results showed good osteogenesis potential. Overall, the composite coatings produced in this investigation give new potential for the application of Ti alloys in clinics.
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Affiliation(s)
- Xu Haitao
- Wuxi People’s Hospital of Nanjing Medical University, Wuxi214000, Jiangsu, China
| | - Li Siyuan
- School of Chemical and Material Engineering, Jiangnan University, Wuxi214000, Jiangsu, China
| | - Guo Sutong
- Wuxi People’s Hospital of Nanjing Medical University, Wuxi214000, Jiangsu, China
| | - Guo Yu
- Wuxi People’s Hospital of Nanjing Medical University, Wuxi214000, Jiangsu, China
| | - Xu Peirong
- Wuxi No. 5 People’s Hospital, Wuxi214000, Jiangsu, China
| | - Wang Ling
- Wuxi People’s Hospital of Nanjing Medical University, Wuxi214000, Jiangsu, China
| | - Ding Yujian
- Wuxi People’s Hospital of Nanjing Medical University, Wuxi214000, Jiangsu, China
| | - Feng Dehong
- Wuxi People’s Hospital of Nanjing Medical University, Wuxi214000, Jiangsu, China
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16
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Ul Haq I, Khan TA, Krukiewicz K. Etiology, pathology, and host-impaired immunity in medical implant-associated infections. J Infect Public Health 2024; 17:189-203. [PMID: 38113816 DOI: 10.1016/j.jiph.2023.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/20/2023] [Accepted: 11/21/2023] [Indexed: 12/21/2023] Open
Abstract
Host impaired immunity and pathogens adhesion factors are the key elements in analyzing medical implant-associated infections (MIAI). The infection chances are further influenced by surface properties of implants. This review addresses the medical implant-associated pathogens and summarizes the etiology, pathology, and host-impaired immunity in MIAI. Several bacterial and fungal pathogens have been isolated from MIAI; together, they form cross-kingdom species biofilms and support each other in different ways. The adhesion factors initiate the pathogen's adherence on the implant's surface; however, implant-induced impaired immunity promotes the pathogen's colonization and biofilm formation. Depending on the implant's surface properties, immune cell functions get slow or get exaggerated and cause immunity-induced secondary complications resulting in resistant depression and immuno-incompetent fibro-inflammatory zone that compromise implant's performance. Such consequences lead to the unavoidable and straightforward conclusion for the downstream transformation of new ideas, such as the development of multifunctional implant coatings.
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Affiliation(s)
- Ihtisham Ul Haq
- Department of Physical Chemistry and Technology of Polymers, Silesian University of Technology, M. Strzody 9, 44-100 Gliwice, Poland; Joint Doctoral School, Silesian University of Technology, Akademicka 2A, 44-100 Gliwice, Poland; Programa de Pós-graduação em Inovação Tecnológica, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, MG, Brazil.
| | - Taj Ali Khan
- Division of Infectious Diseases & Global Medicine, Department of Medicine, University of Florida, Gainesville, FL, United States; Institute of Pathology and Diagnostic Medicine, Khyber Medical University, Peshawar, Pakistan.
| | - Katarzyna Krukiewicz
- Department of Physical Chemistry and Technology of Polymers, Silesian University of Technology, M. Strzody 9, 44-100 Gliwice, Poland; Centre for Organic and Nanohybrid Electronics, Silesian University of Technology, Konarskiego 22B, 44-100 Gliwice, Poland.
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17
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Bratengeier C, Johansson L, Liszka A, Bakker AD, Hallbeck M, Fahlgren A. Mechanical loading intensities affect the release of extracellular vesicles from mouse bone marrow-derived hematopoietic progenitor cells and change their osteoclast-modulating effect. FASEB J 2024; 38:e23323. [PMID: 38015031 DOI: 10.1096/fj.202301520r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/19/2023] [Accepted: 11/07/2023] [Indexed: 11/29/2023]
Abstract
Low-intensity loading maintains or increases bone mass, whereas lack of mechanical loading and high-intensity loading decreases bone mass, possibly via the release of extracellular vesicles by mechanosensitive bone cells. How different loading intensities alter the biological effect of these vesicles is not fully understood. Dynamic fluid shear stress at low intensity (0.7 ± 0.3 Pa, 5 Hz) or high intensity (2.9 ± 0.2 Pa, 1 Hz) was used on mouse hematopoietic progenitor cells for 2 min in the presence or absence of chemical compounds that inhibit release or biogenesis of extracellular vesicles. We used a Receptor activator of nuclear factor kappa-Β ligand-induced osteoclastogenesis assay to evaluate the biological effect of different fractions of extracellular vesicles obtained through centrifugation of medium from hematopoietic stem cells. Osteoclast formation was reduced by microvesicles (10 000× g) obtained after low-intensity loading and induced by exosomes (100 000× g) obtained after high-intensity loading. These osteoclast-modulating effects could be diminished or eliminated by depletion of extracellular vesicles from the conditioned medium, inhibition of general extracellular vesicle release, inhibition of microvesicle biogenesis (low intensity), inhibition of ESCRT-independent exosome biogenesis (high intensity), as well as by inhibition of dynamin-dependent vesicle uptake in osteoclast progenitor cells. Taken together, the intensity of mechanical loading affects the release of extracellular vesicles and change their osteoclast-modulating effect.
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Affiliation(s)
- C Bratengeier
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - L Johansson
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Clinical Pathology, Linköping University, Linköping, Sweden
| | - A Liszka
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - A D Bakker
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - M Hallbeck
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Clinical Pathology, Linköping University, Linköping, Sweden
| | - A Fahlgren
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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18
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Sellin ML, Seyfarth-Sehlke A, Aziz M, Fabry C, Wenke K, Høl PJ, Rios-Mondragon I, Cimpan MR, Frank M, Bader R, Jonitz-Heincke A. Isolation of TiNbN wear particles from a coated metal-on-metal bearing: Morphological characterization and in vitro evaluation of cytotoxicity in human osteoblasts. J Biomed Mater Res B Appl Biomater 2024; 112:e35357. [PMID: 38247242 DOI: 10.1002/jbm.b.35357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 10/18/2023] [Accepted: 11/15/2023] [Indexed: 01/23/2024]
Abstract
To improve the wear resistance of articulating metallic joint endoprostheses, the surfaces can be coated with titanium niobium nitride (TiNbN). Under poor tribological conditions or malalignment, wear can occur on these implant surfaces in situ. This study investigated the biological response of human osteoblasts to wear particles generated from TiNbN-coated hip implants. Abrasive particles were generated in a hip simulator according to ISO 14242-1/-2 and extracted with Proteinase K. Particle characteristics were evaluated by electron microscopy and energy dispersive x-ray spectroscopy (EDS), inductively coupled plasma mass spectrometry (ICP-MS) and dynamic light scattering (DLS) measurements. Human osteoblasts were exposed to different particle dilutions (1:20, 1:50, and 1:100), and cell viability and gene expression levels of osteogenic markers and inflammatory mediators were analyzed after 4 and 7 days. Using ICP-MS, EDS, and DLS measurements, ~70% of the particles were identified as TiNbN, ranging from 39 to 94 nm. The particles exhibited a flat and subangular morphology. Exposure to particles did not influence cell viability and osteoblastic differentiation capacity. Protein levels of collagen type 1, osteoprotegerin, and receptor activator of nuclear factor κB ligand were almost unaffected. Moreover, the pro-inflammatory response via interleukins 6 and 8 was minor induced after particle contact. A high number of TiNbN wear particles only slightly affected osteoblasts' differentiation ability and inflammatory response compared to metallic particles. Nevertheless, further studies should investigate the role of these particles in peri-implant bone tissue, especially concerning other cell types.
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Affiliation(s)
- Marie-Luise Sellin
- Department of Orthopaedics, Biomechanics and Implant Technology Research Laboratory, Rostock University Medical Center, Rostock, Germany
| | - Anika Seyfarth-Sehlke
- Department of Orthopaedics, Biomechanics and Implant Technology Research Laboratory, Rostock University Medical Center, Rostock, Germany
| | - Mahammad Aziz
- Department of Orthopaedics, Biomechanics and Implant Technology Research Laboratory, Rostock University Medical Center, Rostock, Germany
| | | | | | - Paul Johan Høl
- Department of Orthopaedic Surgery, Biomatlab, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, Biomaterials, University of Bergen, Bergen, Norway
| | - Ivan Rios-Mondragon
- Department for Clinical Dentistry Biomaterials, University of Bergen, Bergen, Norway
| | - Mihaela Roxana Cimpan
- Department for Clinical Dentistry Biomaterials, University of Bergen, Bergen, Norway
| | - Marcus Frank
- Medical Biology and Electron Microscopy Center, Rostock University Medical Center, Rostock, Germany
- Department Life, Light and Matter, University of Rostock, Rostock, Germany
| | - Rainer Bader
- Department of Orthopaedics, Biomechanics and Implant Technology Research Laboratory, Rostock University Medical Center, Rostock, Germany
- Department Life, Light and Matter, University of Rostock, Rostock, Germany
| | - Anika Jonitz-Heincke
- Department of Orthopaedics, Biomechanics and Implant Technology Research Laboratory, Rostock University Medical Center, Rostock, Germany
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Afghanyar Y, Möller JH, Wunderlich F, Dargel J, Rehbein P, Gercek E, Drees P, Kutzner KP. An isoelastic monoblock cup versus a modular metal-back cup: a matched-pair analysis of clinical and radiological results using Einzel-Bild-Röntgen-Analyse software. Arch Orthop Trauma Surg 2024; 144:493-500. [PMID: 37740060 PMCID: PMC10774207 DOI: 10.1007/s00402-023-05058-8] [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: 05/16/2023] [Accepted: 09/01/2023] [Indexed: 09/24/2023]
Abstract
INTRODUCTION Bone preservation and long-term survival are the main challenges in cementless total hip arthroplasty (THA). A good bone stock is especially important for adequate anchorage of the cup in revision cases. However, the optimal acetabular cup design for preserving good bone stock is still unclear. We aimed to compare clinical outcome, radiological alterations, migration, and wear at mid-term for two different cup types. MATERIALS AND METHODS This retrospective matched-pair study was performed using the data for 98 THA cases treated with a monoblock cup composed of vitamin E-blended highly cross-linked polyethylene (VEPE; monoblock group) or a modular cup composed of a highly cross-linked polyethylene (HXLPE) without an antioxidant (modular group). Clinical results were evaluated using the Harris Hip Score (HHS). The obtained radiographs were analyzed for radiological alterations, migration, and wear using Einzel-Bild-Röntgen-Analyse (EBRA) software. RESULTS The mean follow-up duration was 73.2 ± 19.2 months (range: 32-108 months) and 60.5 ± 12.2 months (range: 20-84 months) in the monoblock and modular groups, respectively. HHS improved to 95.7 points in the monoblock group and 97.6 points in the modular group, without significant differences (p = 0.425). EBRA measurements were obtained in all cases. Acetabular bone alterations were not detected on radiological assessments. Mean cup migration was 1.67 ± 0.92 mm (range: 0.46-3.94 mm) and 1.24 ± 0.87 mm (range: 0.22-3.62 mm) in the monoblock and modular groups. The mean wear rate was 0.21 ± 0.18 mm (range: 0.00-0.70 mm) and 0.20 ± 0.13 mm (range: 0.00-0.50 mm) in the monoblock and modular groups. Both migration and wear pattern showed no significant differences (p = 0.741 and 0.243). None of the cases required revision surgery, yielding an implant survival rate of 100% in both groups. CONCLUSION The isoelastic press-fit monoblock VEPE cup and modular metal-back HXLPE cup showed equivalent mid-term wear and cup migration. Long-term studies are required to determine the effects of modularity, isoelasticity, and polyethylene stabilization with vitamin E on cup loosening and survival rates.
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Affiliation(s)
- Yama Afghanyar
- Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Mainz, Germany.
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Wiesbaden, Germany.
| | - Jens Hendrik Möller
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Wiesbaden, Germany
| | - Felix Wunderlich
- Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - Jens Dargel
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Wiesbaden, Germany
| | - Philipp Rehbein
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Wiesbaden, Germany
| | - Erol Gercek
- Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - Philipp Drees
- Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - Karl Philipp Kutzner
- Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Mainz, Germany
- Department of Orthopaedics and Traumatology, St. Josefs Hospital Wiesbaden, Wiesbaden, Germany
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20
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Cheng KY, Gupta P, Kanniyappan H, Zahurullah H, Sun Y, Alhamad M, Mathew MT. Survivability of Titanium Implant Materials: In Vitro Simulated Inflammatory and Infectious Environment. Ann Biomed Eng 2023; 51:2749-2761. [PMID: 37530907 PMCID: PMC10834857 DOI: 10.1007/s10439-023-03330-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 07/22/2023] [Indexed: 08/03/2023]
Abstract
Titanium-based implants utilized in total joint arthroplasties could restore primary musculoskeletal function to patients suffering from osteoarthritis and other conditions. Implants are susceptible to failure stemming from aseptic loosening and infection at the joint site, eventually requiring revision surgery. We hypothesized that there might be a feedback loop by which metal degradation particles and ions released from the implant decrease cell viability and increase immune response, thereby creating biochemical conditions that increase the corrosion rate and release more metal ions. This study focused on the synergistic process through cell viability assays and electrochemical tests. From the results, inflammatory conditions from ion release resulting in cell death would further increase the corrosion rate at the metal implant site. The synergistic interaction in the implant surroundings in which infectious conditions produce Ti ions that contribute to more infection, creating a potential cycle of accelerating corrosion.
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Affiliation(s)
- Kai Yuan Cheng
- Regenerative Medicine and Disability Research Lab, University of Illinois College of Medicine, Rockford, IL, USA
| | - Puranjay Gupta
- Regenerative Medicine and Disability Research Lab, University of Illinois College of Medicine, Rockford, IL, USA
| | - Hemalatha Kanniyappan
- Regenerative Medicine and Disability Research Lab, University of Illinois College of Medicine, Rockford, IL, USA
| | - Hamza Zahurullah
- Regenerative Medicine and Disability Research Lab, University of Illinois College of Medicine, Rockford, IL, USA
| | - Yani Sun
- Department of Biomedical Engineering, College of Engineering, University of Illinois , Chicago, IL, USA
| | - Mostafa Alhamad
- Department of Restorative Dentistry, College of Dentistry, University of Illinois at Chicago, Chicago, IL, USA
- Department of Restorative Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Ad Dammām, Saudi Arabia
| | - Mathew T Mathew
- Regenerative Medicine and Disability Research Lab, University of Illinois College of Medicine, Rockford, IL, USA.
- Department of Restorative Dentistry, College of Dentistry, University of Illinois at Chicago, Chicago, IL, USA.
- Department of Biomedical Engineering, College of Engineering, University of Illinois , Chicago, IL, USA.
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21
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Schmerler J, Harris AB, Srikumaran U, Khanuja HS, Oni JK, Hegde V. Body Mass Index and Revision Total Knee Arthroplasty: Does Cause for Revision Vary by Underweight or Obese Status? J Arthroplasty 2023; 38:2504-2509.e1. [PMID: 37331444 DOI: 10.1016/j.arth.2023.06.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 06/06/2023] [Accepted: 06/09/2023] [Indexed: 06/20/2023] Open
Abstract
BACKGROUND Body mass index (BMI) impacts risk for revision total knee arthroplasty (rTKA), but the relationship between BMI and cause for revision remains unclear. We hypothesized that patients in different BMI classes would have disparate risk for causes of rTKA. METHODS There were 171,856 patients who underwent rTKA from 2006 to 2020 from a national database. Patients were classified as underweight (BMI < 19), normal-weight, overweight/obese (BMI 25 to 39.9), or morbidly obese (BMI > 40). Multivariable logistic regressions adjusted for age, sex, race/ethnicity, socioeconomic status, payer status, hospital geographic setting, and comorbidities were used to examine the effect of BMI on risk for different rTKA causes. RESULTS Compared to normal-weight controls, underweight patients were 62% less likely to undergo revision due to aseptic loosening, 40% less likely due to mechanical complications, 187% more likely due to periprosthetic fracture, 135% more likely due to periprosthetic joint infection (PJI). Overweight/obese patients were 25% more likely to undergo revision due to aseptic loosening, 9% more likely due to mechanical complications, 17% less likely due to periprosthetic fracture, and 24% less likely due to PJI. Morbidly obese patients were 20% more likely to undergo revision due to aseptic loosening, 5% more likely due to mechanical complications, and 6% less likely due to PJI. CONCLUSION Mechanical reasons were more likely to be the cause of rTKA in overweight/obese and morbidly obese patients, compared to underweight patients, for whom revision was more likely to be infection or fracture related. Increased awareness of these differences may promote patient-specific management to reduce complications. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Jessica Schmerler
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Andrew B Harris
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Uma Srikumaran
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Harpal S Khanuja
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Julius K Oni
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Vishal Hegde
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Anderson KD, Beckmann C, Heermant S, Ko FC, Dulion B, Tarhoni I, Borgia JA, Virdi AS, Wimmer MA, Sumner DR, Ross RD. Zucker Diabetic-Sprague Dawley Rats Have Impaired Peri-Implant Bone Formation, Matrix Composition, and Implant Fixation Strength. JBMR Plus 2023; 7:e10819. [PMID: 38025036 PMCID: PMC10652173 DOI: 10.1002/jbm4.10819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/14/2023] [Accepted: 08/31/2023] [Indexed: 12/01/2023] Open
Abstract
An increasing number of patients with type 2 diabetes (T2DM) will require total joint replacement (TJR) in the next decade. T2DM patients are at increased risk for TJR failure, but the mechanisms are not well understood. The current study used the Zucker Diabetic-Sprague Dawley (ZDSD) rat model of T2DM with Sprague Dawley (SPD) controls to investigate the effects of intramedullary implant placement on osseointegration, peri-implant bone structure and matrix composition, and fixation strength at 2 and 10 weeks post-implant placement. Postoperative inflammation was assessed with circulating MCP-1 and IL-10 2 days post-implant placement. In addition to comparing the two groups, stepwise linear regression modeling was performed to determine the relative contribution of glucose, cytokines, bone formation, bone structure, and bone matrix composition on osseointegration and implant fixation strength. ZDSD rats had decreased peri-implant bone formation and reduced trabecular bone volume per total volume compared with SPD controls. The osseointegrated bone matrix of ZDSD rats had decreased mineral-to-matrix and increased crystallinity compared with SPD controls. Osseointegrated bone volume per total volume was not different between the groups, whereas implant fixation was significantly decreased in ZDSD at 2 weeks but not at 10 weeks. A combination of trabecular mineral apposition rate and postoperative MCP-1 levels explained 55.6% of the variance in osseointegration, whereas cortical thickness, osseointegration mineral apposition rate, and matrix compositional parameters explained 69.2% of the variance in implant fixation strength. The results support the growing recognition that both peri-implant structure and matrix composition affect implant fixation and suggest that postoperative inflammation may contribute to poor outcomes after TJR surgeries in T2DM patients. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Kyle D Anderson
- Department of Anatomy and Cell BiologyRush University Medical CenterChicagoILUSA
| | - Christian Beckmann
- Department of Orthopedic SurgeryRush University Medical CenterChicagoILUSA
| | - Saskia Heermant
- Department of Orthopedic SurgeryRush University Medical CenterChicagoILUSA
| | - Frank C Ko
- Department of Anatomy and Cell BiologyRush University Medical CenterChicagoILUSA
- Department of Orthopedic SurgeryRush University Medical CenterChicagoILUSA
| | - Bryan Dulion
- Department of Anatomy and Cell BiologyRush University Medical CenterChicagoILUSA
| | - Imad Tarhoni
- Department of Anatomy and Cell BiologyRush University Medical CenterChicagoILUSA
| | - Jeffrey A Borgia
- Department of Anatomy and Cell BiologyRush University Medical CenterChicagoILUSA
| | - Amarjit S Virdi
- Department of Anatomy and Cell BiologyRush University Medical CenterChicagoILUSA
- Department of Orthopedic SurgeryRush University Medical CenterChicagoILUSA
| | - Markus A Wimmer
- Department of Orthopedic SurgeryRush University Medical CenterChicagoILUSA
| | - D Rick Sumner
- Department of Anatomy and Cell BiologyRush University Medical CenterChicagoILUSA
- Department of Orthopedic SurgeryRush University Medical CenterChicagoILUSA
| | - Ryan D Ross
- Department of Anatomy and Cell BiologyRush University Medical CenterChicagoILUSA
- Department of Orthopedic SurgeryRush University Medical CenterChicagoILUSA
- Department of Microbial Pathogens and ImmunityRush University Medical CenterChicagoILUSA
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23
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Wang Z, Tao H, Chu M, Yu L, Yang P, Wang Q, Lu J, Yang H, Wang Z, Zhang H, Geng D. Byakangelicol suppresses TiPs-stimulated osteoclastogenesis and bone destruction via COX-2/NF-κB signaling pathway. Regen Biomater 2023; 11:rbad092. [PMID: 38173778 PMCID: PMC10758544 DOI: 10.1093/rb/rbad092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 09/06/2023] [Accepted: 09/22/2023] [Indexed: 01/05/2024] Open
Abstract
Aseptic loosening (AL) is considered a significant cause of prosthesis revision after arthroplasty and a crucial factor in the longevity of an artificial joint prosthesis. The development of AL is primarily attributed to a series of biological reactions, such as peri-prosthetic osteolysis (PPO) induced by wear particles around the prosthesis. Chronic inflammation of the peri-prosthetic border tissue and hyperactivation of osteoclasts are key factors in this process, which are induced by metallic wear particles like Ti particles (TiPs). In our in vitro study, we observed that TiPs significantly enhanced the expression of inflammation-related genes, including COX-2, IL-1β and IL-6. Through screening a traditional Chinese medicine database, we identified byakangelicol, a traditional Chinese medicine molecule that targets COX-2. Our results demonstrated that byakangelicol effectively inhibited TiPs-stimulated osteoclast activation. Mechanistically, we found that byakangelicol suppressed the expression of COX-2 and related pro-inflammatory factors by modulating macrophage polarization status and NF-κB signaling pathway. The in vivo results also demonstrated that byakangelicol effectively inhibited the expression of inflammation-related factors, thereby significantly alleviating TiPs-induced cranial osteolysis. These findings suggested that byakangelicol could potentially be a promising therapeutic approach for preventing PPO.
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Affiliation(s)
- Zhidong Wang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou 215000, China
| | - Huaqiang Tao
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou 215000, China
| | - Miao Chu
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou 215000, China
| | - Lei Yu
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou 215000, China
| | - Peng Yang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou 215000, China
| | - Qiufei Wang
- Department of Orthopedics, Changshu Hospital Affiliated to Soochow University, First People’s Hospital of Changshu City, Changshu 215500, China
| | - Jun Lu
- Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, 321 Zhong Shan Road, Nanjing 210000, China
| | - Huilin Yang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou 215000, China
| | - Zhenheng Wang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou 215000, China
| | - Hailin Zhang
- Department of Orthopedics, Jiangyin People’s Hospital Affiliated to Nantong University, No. 163 Shoushan Road, Jiangyin 214400, China
| | - Dechun Geng
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou 215000, China
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Fritz J, Rashidi A, de Cesar Netto C. Magnetic Resonance Imaging of Total Ankle Arthroplasty: State-of-The-Art Assessment of Implant-Related Pain and Dysfunction. Foot Ankle Clin 2023; 28:463-492. [PMID: 37536814 DOI: 10.1016/j.fcl.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Total ankle arthroplasty (TAA) is an effective alternative for treating patients with end-stage ankle degeneration, improving mobility, and providing pain relief. Implant survivorship is constantly improving; however, complications occur. Many causes of pain and dysfunction after total ankle arthroplasty can be diagnosed accurately with clinical examination, laboratory, radiography, and computer tomography. However, when there are no or inconclusive imaging findings, magnetic resonance imaging (MRI) is highly accurate in identifying and characterizing bone resorption, osteolysis, infection, osseous stress reactions, nondisplaced fractures, polyethylene damage, nerve injuries and neuropathies, as well as tendon and ligament tears. Multiple vendors offer effective, clinically available MRI techniques for metal artifact reduction MRI of total ankle arthroplasty. This article reviews the MRI appearances of common TAA implant systems, clinically available techniques and protocols for metal artifact reduction MRI of TAA implants, and the MRI appearances of a broad spectrum of TAA-related complications.
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Affiliation(s)
- Jan Fritz
- Department of Orthopedic Surgery, Division of Foot and Ankle Surgery, Duke University, Durham, NC, USA.
| | - Ali Rashidi
- Division of Musculoskeletal Radiology, Department of Radiology, NYU Grossman School of Medicine, 660 1st Ave, 3rd Floor, Rm 313, New York, NY 10016, USA
| | - Cesar de Cesar Netto
- Department of Radiology, Molecular Imaging Program at StanDepartment of Radiology, Molecular Imaging Program at Stanford, Stanford University School of Medicine, Stanford, CA, USA
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Szymski D, Walter N, Krull P, Melsheimer O, Schindler M, Grimberg A, Alt V, Steinbrueck A, Rupp M. Comparison of mortality rate and septic and aseptic revisions in total hip arthroplasties for osteoarthritis and femoral neck fracture: an analysis of the German Arthroplasty Registry. J Orthop Traumatol 2023; 24:29. [PMID: 37329492 DOI: 10.1186/s10195-023-00711-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 06/02/2023] [Indexed: 06/19/2023] Open
Abstract
BACKGROUND Indications for total hip arthroplasties (THA) differ from primary osteoarthritis (OA), which allows elective surgery through femoral neck fractures (FNF), which require timely surgical care. The aim of this investigation was to compare mortality and revisions in THA for primary OA and FNF. METHODS Data collection for this study was performed using the German Arthroplasty Registry (EPRD) with analysis THA for the treatment of FNF and OA. Cases were matched 1:1 according to age, sex, body mass index (BMI), cementation, and the Elixhauser score using Mahalanobis distance matching. RESULTS Overall 43,436 cases of THA for the treatment of OA and FNF were analyzed in this study. Mortality was significantly increased in FNF, with 12.6% after 1 year and 36.5% after 5 years compared with 3.0% and 18.7% in OA, respectively (p < 0.0001). The proportion for septic and aseptic revisions was significantly increased in FNF (p < 0.0001). Main causes for an aseptic failure were mechanical complications (OA: 1.1%; FNF: 2.4%; p < 0.0001) and periprosthetic fractures (OA: 0.2%; FNF: 0.4%; p = 0.021). As influencing factors for male patients with septic failure (p < 0.002), increased BMI and Elixhauser comorbidity score and diagnosis of fracture (all p < 0.0001) were identified. For aseptic revision surgeries, BMI, Elixhauser score, and FNF were influencing factors (p < 0.0001), while all cemented and hybrid cemented THA were associated with a risk reduction for aseptic failure within 90 days after surgery (p < 0.0001). CONCLUSION In femoral neck fractures treated with THA, a significant higher mortality, as well as septic and aseptic failure rate, was demonstrated compared with prosthesis for the therapy of osteoarthritis. Increased Elixhauser comorbidity score and BMI are the main influencing factors for development of septic or aseptic failure and can represent a potential approach for prevention measures. LEVEL OF EVIDENCE Level III, Prognostic.
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Affiliation(s)
- Dominik Szymski
- Department for Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Nike Walter
- Department for Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Paula Krull
- Endoprothesenregister Deutschland gGmbH (EPRD), Berlin, Germany
| | | | - Melanie Schindler
- Department for Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | | | - Volker Alt
- Department for Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Arnd Steinbrueck
- Endoprothesenregister Deutschland gGmbH (EPRD), Berlin, Germany
- Orthopädisch Chirurgisches Kompetenzzentrum Augsburg (OCKA), Augsburg, Germany
| | - Markus Rupp
- Department for Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
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Hua Z, Hu M, Chen Y, Huang X, Gao L. Investigation of the Friction Properties of a New Artificial Imitation Cartilage Material: PHEMA/Glycerol Gel. MATERIALS (BASEL, SWITZERLAND) 2023; 16:ma16114023. [PMID: 37297157 DOI: 10.3390/ma16114023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/15/2023] [Accepted: 05/19/2023] [Indexed: 06/12/2023]
Abstract
The absence of artificial articular cartilage could cause the failure of artificial joints due to excessive material wear. There has been limited research on alternative materials for articular cartilage in joint prostheses, with few reducing the friction coefficient of artificial cartilage prostheses to the range of the natural cartilage friction coefficient (0.001-0.03). This work aimed to obtain and characterize mechanically and tribologically a new gel for potential application in articular replacement. Therefore, poly(hydroxyethyl methacrylate) (PHEMA)/glycerol synthetic gel was developed as a new type of artificial joint cartilage with a low friction coefficient, especially in calf serum. This glycerol material was developed via mixing HEMA and glycerin at a mass ratio of 1:1. The mechanical properties were studied, and it was found that the hardness of the synthetic gel was close to that of natural cartilage. The tribological performance of the synthetic gel was investigated using a reciprocating ball-on-plate rig. The ball samples were made of a cobalt-chromium-molybdenum (Co-Cr-Mo) alloy, and the plates were synthetic glycerol gel and two additional materials for comparison, which were ultra-high molecular polyethylene (UHMWPE) and 316L stainless steel. It was found that synthetic gel exhibited the lowest friction coefficient in both calf serum (0.018) and deionized water (0.039) compared to the other two conventional materials for knee prostheses. The surface roughness of the gel was found to be 4-5 μm through morphological analysis of wear. This newly proposed material provided a possible solution as a type of cartilage composite coating with hardness and tribological performance close to the nature of use in wear couples with artificial joints.
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Affiliation(s)
- Zikai Hua
- School of Mechatronic Engineering and Automation, Shanghai University, Shanghai 200444, China
| | - Mindie Hu
- School of Mechatronic Engineering and Automation, Shanghai University, Shanghai 200444, China
| | - Yiwen Chen
- School of Mechatronic Engineering and Automation, Shanghai University, Shanghai 200444, China
| | - Xiuling Huang
- School of Mechatronic Engineering and Automation, Shanghai University, Shanghai 200444, China
| | - Leiming Gao
- Department of Engineering, Nottingham Trent University, Nottingham NG1 4FQ, UK
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Murphy B, Martins C, Maggio M, Morris MA, Hoey DA. Nano sized gallium oxide surface features for enhanced antimicrobial and osteo-integrative responses. Colloids Surf B Biointerfaces 2023; 227:113378. [PMID: 37257301 DOI: 10.1016/j.colsurfb.2023.113378] [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: 03/28/2023] [Revised: 05/16/2023] [Accepted: 05/25/2023] [Indexed: 06/02/2023]
Abstract
Gallium oxide has known beneficial osteo-integrative properties. This may have importance for improving the osteointegration of orthopedic implants. At high concentrations gallium is cytotoxic. Therefore, integration of gallium into implant devices must be carefully controlled to limit its concentration and release. A strategy based on surface doping of gallium although challenging seems an appropriate approach to limit dose amounts to minimize cytotoxicity and maximize osteointegration benefits. In this work we develop a novel form of patterned surface doping via a block copolymer-based surface chemistry that enables very low gallium content but enhanced osteointegration as proven by comprehensive bioassays. Polystyrene-b-poly 4vinyl pyridine (PS-b-P4VP) BCP (block copolymer) films were produced on surfaces. Selective infiltration of the BCP pattern with a gallium salt precursor solution and subsequent UV-ozone treatment produced a surface pattern of gallium oxide nanodots as evidenced by atomic force and scanning electron microscopy. A comprehensive study of the bioactivity was carried out, including antimicrobial and sterility testing, gallium ion release kinetics and the interaction with human marrow mesenchymal stomal cells and mononuclear cells. Comparing the data from osteogenesis media assay tests with osteoclastogenesis tests demonstrated the potential for the gallium oxide nanodot doping to improve osteointegration properties of a surface.
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Affiliation(s)
- Bríd Murphy
- Advanced Materials and Bioengineering Research Centre (AMBER), Royal College of Surgeons in Ireland and Trinity College Dublin, Ireland; School of Chemistry, Trinity College Dublin, Dublin 2, Ireland.
| | - Carolina Martins
- Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland; Department of Mechanical, Manufacturing and Biomedical Engineering, School of Engineering, Trinity College Dublin, Ireland
| | - Mimma Maggio
- Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland; Department of Mechanical, Manufacturing and Biomedical Engineering, School of Engineering, Trinity College Dublin, Ireland
| | - Mick A Morris
- Advanced Materials and Bioengineering Research Centre (AMBER), Royal College of Surgeons in Ireland and Trinity College Dublin, Ireland; School of Chemistry, Trinity College Dublin, Dublin 2, Ireland.
| | - David A Hoey
- Advanced Materials and Bioengineering Research Centre (AMBER), Royal College of Surgeons in Ireland and Trinity College Dublin, Ireland; Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland; Department of Mechanical, Manufacturing and Biomedical Engineering, School of Engineering, Trinity College Dublin, Ireland
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Deng Y, Smith PN, Li RW. Diabetes mellitus is a potential risk factor for aseptic loosening around hip and knee arthroplasty. BMC Musculoskelet Disord 2023; 24:266. [PMID: 37020220 PMCID: PMC10074698 DOI: 10.1186/s12891-023-06376-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 03/27/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Aseptic loosening is a leading cause of revision following total hip and knee arthroplasty which is caused by chronic inflammation around the prosthesis. Diabetes mellitus causes systemic inflammatory changes which could increase the risk of aseptic loosening. This study investigated the association between diabetes mellitus and aseptic loosening around hip and knee arthroplasty. METHODS A case-control study was conducted at a single arthroplasty centre over the seven-year period of January 2015 to December 2021. Cases were defined as any adult patient undergoing revision hip or knee arthroplasty for aseptic loosening. Controls were randomly selected patients undergoing primary total hip or knee arthroplasty during the same period at a 1:4 ratio. Risk factors were compared between the two groups. RESULTS A total of 440 patients were included in our study - 88 in the aseptic loosening group and 352 patients in the control group. The odds of having diabetes mellitus in the aseptic loosening group was 2.78 (95%CI 1.31-5.92, P = 0.01). Other risk factors were not significantly different between the two groups. CONCLUSIONS The incidence of diabetes mellitus is significantly greater in patients undergoing revision arthroplasty for aseptic loosening. Further research is required to explore whether this association is indeed causative.
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Affiliation(s)
- Yi Deng
- Department of Orthopaedic Surgery, Canberra Hospital, Canberra, Australia.
- Trauma and Orthopaedic Research Unit, Australian National University School of Medicine and Psychology, Canberra, ACT, 2601, Australia.
| | - Paul N Smith
- Department of Orthopaedic Surgery, Canberra Hospital, Canberra, Australia
- Trauma and Orthopaedic Research Unit, Australian National University School of Medicine and Psychology, Canberra, ACT, 2601, Australia
| | - Rachel W Li
- Trauma and Orthopaedic Research Unit, Australian National University School of Medicine and Psychology, Canberra, ACT, 2601, Australia
- John Curtin School of Medical Research, Australian National University, Acton, ACT, Australia
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Cong Y, Wang Y, Yuan T, Zhang Z, Ge J, Meng Q, Li Z, Sun S. Macrophages in aseptic loosening: Characteristics, functions, and mechanisms. Front Immunol 2023; 14:1122057. [PMID: 36969165 PMCID: PMC10030580 DOI: 10.3389/fimmu.2023.1122057] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 02/13/2023] [Indexed: 03/10/2023] Open
Abstract
Aseptic loosening (AL) is the most common complication of total joint arthroplasty (TJA). Both local inflammatory response and subsequent osteolysis around the prosthesis are the fundamental causes of disease pathology. As the earliest change of cell behavior, polarizations of macrophages play an essential role in the pathogenesis of AL, including regulating inflammatory responses and related pathological bone remodeling. The direction of macrophage polarization is closely dependent on the microenvironment of the periprosthetic tissue. When the classically activated macrophages (M1) are characterized by the augmented ability to produce proinflammatory cytokines, the primary functions of alternatively activated macrophages (M2) are related to inflammatory relief and tissue repair. Yet, both M1 macrophages and M2 macrophages are involved in the occurrence and development of AL, and a comprehensive understanding of polarized behaviors and inducing factors would help in identifying specific therapies. In recent years, studies have witnessed novel discoveries regarding the role of macrophages in AL pathology, the shifts between polarized phenotype during disease progression, as well as local mediators and signaling pathways responsible for regulations in macrophages and subsequent osteoclasts (OCs). In this review, we summarize recent progress on macrophage polarization and related mechanisms during the development of AL and discuss new findings and concepts in the context of existing work.
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Affiliation(s)
- Yehao Cong
- Department of Joint Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Orthopaedic Research Laboratory, Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Yi Wang
- Department of Joint Surgery, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Tao Yuan
- Department of Joint Surgery, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Zheng Zhang
- Department of Joint Surgery, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Jianxun Ge
- Department of Joint Surgery, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Qi Meng
- Department of Joint Surgery, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Ziqing Li
- Department of Joint Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Orthopaedic Research Laboratory, Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
- *Correspondence: Ziqing Li, ; Shui Sun,
| | - Shui Sun
- Department of Joint Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Orthopaedic Research Laboratory, Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, China
- Department of Joint Surgery, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
- *Correspondence: Ziqing Li, ; Shui Sun,
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Di Martino A, Ursini F, Bordini B, Ancarani C, Ciaffi J, Brunello M, D'Agostino C, Faldini C. Perioperative treatment with TNF inhibitors does not affect survival of total hip arthroplasty in inflammatory arthritis: a registry-based cohort study. Semin Arthritis Rheum 2023; 60:152201. [PMID: 37028127 DOI: 10.1016/j.semarthrit.2023.152201] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 03/04/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVES Aim of this study was to investigate the effect of perioperative exposure to TNF inhibitors (TNFi) on the long-term survival of total hip arthroplasty (THA) in inflammatory arthritis patients from a large regional register of arthroplasty procedures (RIPO). METHODS This study is a retrospective analysis of data from RIPO for THAs performed between 2008 and 2019. After extraction of the procedures of interest from the RIPO dataset, cross-matching with administrative databases were used to identify patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), ankylosing spondylitis (AS), primary osteoarthritis (OA), and treatments of interest. Three different cohorts of patients were identified: perioperative TNFi-treated patients (6 months before or after the surgery), perioperative non-bDMARD/tsDMARD (biologic or targeted-synthetic disease modifying antirheumatic drugs), and OA. RESULTS At an average follow-up of 5 years, survival rates (using any revision surgery as an endpoint) were not significantly different when perioperative TNFi users and non-bDMARD/tsDMARD patients were compared (p = 0.713), and between TNFi-treated and OA controls (p = 0.123). At the latest available follow-up, 2.5% patients in the TNFi cohort, 3% in the non-bDMARD/tsDMARD cohort, and 0.8% in the OA cohort underwent revision surgery. No significant differences were found comparing the risk of postoperative infection or aseptic loosening among groups. CONCLUSION Risk of revision surgery is not increased in patients with inflammatory arthritis perioperatively exposed to TNFi. Our results support the long-term safety of this class of molecules on survival of prosthetic implants.
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Affiliation(s)
- Alberto Di Martino
- 1st Orthopedic and Traumatology Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Francesco Ursini
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy; Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Barbara Bordini
- Medical Technology Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Cristina Ancarani
- Medical Technology Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Jacopo Ciaffi
- Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Matteo Brunello
- 1st Orthopedic and Traumatology Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Claudio D'Agostino
- 1st Orthopedic and Traumatology Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Cesare Faldini
- 1st Orthopedic and Traumatology Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
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Eckert JA, Bitsch RG, Schroeder S, Schwarze M, Jaeger S. Pulsatile Lavage Improves Tibial Cement Penetration and Implant Stability in Medial Unicompartmental Arthroplasty: A Cadaveric Study. J Knee Surg 2023; 36:417-423. [PMID: 34507360 DOI: 10.1055/s-0041-1735310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cemented unicompartmental knee arthroplasty (UKA) shows good survivorship and function. However, implant failure, causing the need for revision, can occur. Aseptic loosening is still among the most common reasons for revision. The purpose of this study was to assess the influence of preimplantation lavage technique on tibial cement penetration depth, tibial cement volume, and load to fracture in the tibial component of mobile-bearing UKA. In 10 pairs of fresh frozen human tibiae, cemented UKA was implanted by an experienced surgeon. Tibial components were then implanted, left and right tibiae were randomly allocated to group A or B. Prior to implantation, irrigation was performed with either syringe lavage or pulsatile jet lavage in a standardized manner. Cement surface was 4170.2 mm2 (3271.6-5497.8 mm2) in the syringe lavage group, whereas the jet lavage group showed 4499.3 mm2 (3354.3-5809.1 mm2); cement volume was significantly higher as well (4143.4 mm3 (2956.6-6198.6 mm3) compared with 5936.9 mm3 (3077.5-8183.1 mm3)). Cement penetration depth was 2.5 mm (1.7-3.2 mm) for the jet lavage, and 1.8 mm (1.2-2.4 mm) for the syringe lavage. The mean fracture load was 4680 N in the jet lavage group and 3800 N in the syringe lavage group (p = 0.001). Subsidence was significantly higher for syringe lavage. This study suggests a correlation of cement penetration depth and cement volume to implant failure in the tibial component of a UKA using a cadaveric model. The type of bone lavage most likely influences these two key parameters.
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Affiliation(s)
- Johannes A Eckert
- Laboratory of Biomechanics and Implant Research, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
| | - Rudi G Bitsch
- Laboratory of Biomechanics and Implant Research, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany.,Deutsches Gelenkzentrum in der ATOS Klinik Heidelberg GmbH & Co. KG, Heidelberg, Germany
| | - Stefan Schroeder
- Laboratory of Biomechanics and Implant Research, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
| | - Martin Schwarze
- Laboratory of Biomechanics and Implant Research, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
| | - Sebastian Jaeger
- Laboratory of Biomechanics and Implant Research, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Heidelberg, Germany
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BMP-2 functional polypeptides relieve osteolysis via bi-regulating bone formation and resorption coupled with macrophage polarization. NPJ Regen Med 2023; 8:6. [PMID: 36759627 PMCID: PMC9911742 DOI: 10.1038/s41536-023-00279-2] [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: 06/01/2022] [Accepted: 01/25/2023] [Indexed: 02/11/2023] Open
Abstract
Osteolysis caused by wear debris around the prosthesis is the main reason for aseptic loosening. Extending prosthetic service life is still challenging. In this study, we first synthesized a bone morphogenetic protein-2 (BMP-2) functional polypeptide (BMP2pp), and evaluated the effects of BMP2pp on macrophage polarization and impaired osteogenesis caused by titanium (Ti) particles in vitro. Then, we delineated the impact of BMP2pp on bone formation and resorption in a mouse calvarial bone osteolysis model induced by Ti particles. The results showed that BMP2pp not only alleviated the Ti-induced inhibition of osteoblastic differentiation in human placenta-derived mesenchymal stem cells (hPMSCs) but also prevented Ti-induced M1 macrophage polarization and promoted M2 macrophage differentiation in mice. Conditioned medium from BMP2pp-activated macrophages increased the osteogenesis of hPMSCs. The western blot results indicated a significant decrease in the expression of NF-κB inducing kinase (NIK) and phospho-NF-κB p65 in bone marrow-derived macrophages treated with BMP2pp. Furthermore, we clarified the protective effect of BMP2pp on bone formation and the reduction in bone resorption coupled with the immunomodulatory properties of calvarial osteolysis in mice. In summary, BMP2pp ameliorated the Ti-mediated impairment in osteogenic potential of hPMSCs, suppressed the M1 polarization of macrophages by inhibiting the activation of the NF-κB signaling pathway, and ameliorated Ti-induced bone osteolysis. Our research suggests that BMP2pp may be a potential option for treating prosthetic loosening induced by wear debris from prostheses.
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Farhadi F, Barnes MR, Sugito HR, Sin JM, Henderson ER, Levy JJ. Applications of artificial intelligence in orthopaedic surgery. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 4:995526. [PMID: 36590152 PMCID: PMC9797865 DOI: 10.3389/fmedt.2022.995526] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
The practice of medicine is rapidly transforming as a result of technological breakthroughs. Artificial intelligence (AI) systems are becoming more and more relevant in medicine and orthopaedic surgery as a result of the nearly exponential growth in computer processing power, cloud based computing, and development, and refining of medical-task specific software algorithms. Because of the extensive role of technologies such as medical imaging that bring high sensitivity, specificity, and positive/negative prognostic value to management of orthopaedic disorders, the field is particularly ripe for the application of machine-based integration of imaging studies, among other applications. Through this review, we seek to promote awareness in the orthopaedics community of the current accomplishments and projected uses of AI and ML as described in the literature. We summarize the current state of the art in the use of ML and AI in five key orthopaedic disciplines: joint reconstruction, spine, orthopaedic oncology, trauma, and sports medicine.
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Affiliation(s)
- Faraz Farhadi
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States,Radiology and Imaging Sciences, National Institutes of Health (NIH), Bethesda, United States,Correspondence: Faraz Farhadi Joshua J. Levy
| | - Matthew R. Barnes
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Harun R. Sugito
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Jessica M. Sin
- Department of Radiology, Dartmouth Health, Lebanon, United States
| | - Eric R. Henderson
- Department of Orthopaedics, Dartmouth Health, Lebanon, United States
| | - Joshua J. Levy
- Department of Pathology and Laboratory Medicine, Dartmouth Health, Lebanon, NH, United States,Correspondence: Faraz Farhadi Joshua J. Levy
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The Role of the Innate Immune System in Wear Debris-Induced Inflammatory Peri-Implant Osteolysis in Total Joint Arthroplasty. BIOENGINEERING (BASEL, SWITZERLAND) 2022; 9:bioengineering9120764. [PMID: 36550970 PMCID: PMC9774505 DOI: 10.3390/bioengineering9120764] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/23/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
Periprosthetic osteolysis remains a leading complication of total hip and knee arthroplasty, often resulting in aseptic loosening of the implant and necessitating revision surgery. Wear-induced particulate debris is the main cause initiating this destructive process. The purpose of this article is to review recent advances in understanding of how wear debris causes osteolysis, and emergent strategies for the avoidance and treatment of this disease. A strong activator of the peri-implant innate immune this debris-induced inflammatory cascade is dictated by macrophage secretion of TNF-α, IL-1, IL-6, and IL-8, and PGE2, leading to peri-implant bone resorption through activation of osteoclasts and inhibition of osteoblasts through several mechanisms, including the RANK/RANKL/OPG pathway. Therapeutic agents against proinflammatory mediators, such as those targeting tumor necrosis factor (TNF), osteoclasts, and sclerostin, have shown promise in reducing peri-implant osteolysis in vitro and in vivo; however, radiographic changes and clinical diagnosis often lag considerably behind the initiation of osteolysis, making timely treatment difficult. Considerable efforts are underway to develop such diagnostic tools, therapies, and identify novel targets for therapeutic intervention.
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Wahl P, Mossu-Haas C, Dommann-Scherrer C, Wei K, Eschbach L, Gehr P, Benninger E. Early failure of a highly cross-linked polyethylene inlay after total hip arthroplasty probably due to insufficient irradiation. Proc Inst Mech Eng H 2022; 236:1711-1719. [DOI: 10.1177/09544119221130673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Highly cross-linked polyethylene (XLPE) is a major advance in total hip arthroplasty (THA), as it suffers from less wear and thus is associated with lower revision rates than standard ultra-high molecular weight polyethylene. Early failures are reported rarely, and associated with specific design or manufacturing issues. We report a case requiring early revision due to adverse reaction to polyethylene particles. Investigations identified insufficient irradiation as the most probable cause of failure. Here are reported the features of a clinical case with determination of the material properties of the retrieved XLPE liner and establishment of the appropriate calibration curves as reference. Periprosthetic joint infection could be ruled out with appropriate sampling as cause for the inflammatory periarticular tumour. Histology identified a massive macrophagic reaction to micrometric polyethylene particles. No component malposition was present, nor any third-body wear. The trans-vinylene index (TVI) indicated insufficient and potentially detrimental irradiation of the polyethylene, while gel content, crystallinity, melting temperature and oxidation index remained within expected ranges. Histologically proven failure of a XLPE THA liner was identifiable despite correct implantation of the components. The cause of failure most probably was an inadequate irradiation, as indicated by determination of the TVI. This case underscores the importance of histologic workup even in aseptic revisions, and of detailed analysis of retrievals. The calibration curves provided are essential for analysis of other retrievals.
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Affiliation(s)
- Peter Wahl
- Division of Orthopaedics and Traumatology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | | | | | - Kongchang Wei
- Laboratory for Biomimetic Membranes and Textiles, Empa, Swiss Federal Laboratories for Materials Science and Technology, St. Gallen, Switzerland
| | | | - Peter Gehr
- Institute of Anatomy, University of Berne, Berne, Switzerland
| | - Emanuel Benninger
- Division of Orthopaedics and Traumatology, Cantonal Hospital Winterthur, Winterthur, Switzerland
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Ekhtiari S, Gazendam A, Saidahmed A, Petruccelli D, Winemaker MJ, de Beer JD, Shah V, Wood TJ. Risk factors for recurrence of periprosthetic joint infection following operative management: a cohort study with average 5-year follow-up. ANNALS OF JOINT 2022; 8:2. [PMID: 38529229 PMCID: PMC10929461 DOI: 10.21037/aoj-22-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 09/08/2022] [Indexed: 03/27/2024]
Abstract
Background Periprosthetic joint infections (PJIs) remain challenging to eradicate even after surgical management, which in most cases involves either debridement, antibiotics and implant retention (DAIR) or single- or two-staged revision. The purpose of this study is to determine predictors of PJI recurrence after operative management for PJI, and to determine differences in recurrence-free survival between DAIR and staged revision. Methods This is a retrospective analysis of prospectively collected data of revision hip and knee arthroplasty surgeries due to PJI between 2011 and 2018 at an academic hospital. Any patient undergoing revision surgery for PJI was included except if the index surgery information was unknown. The primary outcome was confirmed PJI recurrence. Multivariable logistic regression analysis was utilized to determine the relationship between the predictor variables and outcome variable. Log rank testing was used to compare recurrence-free survival between DAIR and staged revision. Results A total of 89 patients (91 joints) underwent revision surgery due to PJI. Younger age and presence of a sinus tract were statistically significant for risk of PJI recurrence. A multivariable logistic regression model including both variables was significant for predicting recurrence of PJI (χ2=10.2, P=0.006). Survival was not significantly different between patients who underwent DAIR versus a staged revision. Conclusions Younger patients and those with a chronic sinus tract are at significantly higher risk of recurrent PJI. This study also demonstrated that PJI can be successfully managed in the majority of cases with DAIR or staged revision.
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Affiliation(s)
- Seper Ekhtiari
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Aaron Gazendam
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Ahmed Saidahmed
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Danielle Petruccelli
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Mitchell J. Winemaker
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Justin D. de Beer
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Vivek Shah
- Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA
| | - Thomas J. Wood
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
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Biocompatibility of 3D-printed PLA, PEEK and PETG: Adhesion of Bone Marrow and Peritoneal Lavage Cells. Polymers (Basel) 2022; 14:polym14193958. [PMID: 36235903 PMCID: PMC9571806 DOI: 10.3390/polym14193958] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/11/2022] [Accepted: 09/17/2022] [Indexed: 11/28/2022] Open
Abstract
Samples in the form of cylindrical plates, additively manufactured using the fused deposition modelling (or filament freeform fabrication, FDM/FFF) technology from polylactide (PLA), polyethylene terephthalate glycol (PETG) and polyetheretherketone (PEEK), were studied in series of in-vitro experiments on the adhesion of rat bone-marrow cells and rat peritoneal cells. Methods of estimation of the absolute number of cells and polymer samples’ mass change were used for the evaluation of cells adhesion, followed by the evaluation of cell-culture supernatants. The results of experiments for both types of cells demonstrated a statistically significant change in the absolute number of cells (variation from 44 to 119%) and the weight of the polymer samples (variation from 0.61 to 2.18%), depending on roughness of sample surface, controlled by a nozzle diameter of a 3D printer as well as printing layer height. It was found that more cells adhere to PLA samples with a larger nozzle diameter and layer height. For PETG samples, the results did not show a clear relationship between cell adhesion and printing parameters. For PEEK samples, on the contrary, adhesion to samples printed with a lower nozzle diameter (higher resolution) is better than to samples printed with a larger nozzle diameter (lower resolution). The difference in results for various polymers can be explained by their chemical structure.
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Abu El Afieh J, Gray M, Seah M, Khan W. Endoprosthetic Reconstruction in Ewing's Sarcoma Patients: A Systematic Review of Postoperative Complications and Functional Outcomes. J Clin Med 2022; 11:jcm11154612. [PMID: 35956228 PMCID: PMC9370018 DOI: 10.3390/jcm11154612] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 08/05/2022] [Accepted: 08/05/2022] [Indexed: 11/16/2022] Open
Abstract
Ewing's sarcoma (ES) is a rare primary bone cancer managed by radiotherapy, chemotherapy and surgical resection. The existing literature on limb salvage surgery with endoprostheses combines data for ES patients with osteosarcoma. This review aimed to evaluate surgical and functional outcomes of endoprosthetic reconstruction in exclusively Ewing's patients. We believe that this is the first comprehensive review to evaluate the outcomes of limb salvage surgery with endoprostheses exclusively in Ewing's sarcoma patients. Clinical data and outcomes were collected from PubMed, Embase, Medline and Scopus. The inclusion criteria were studies on limb salvage surgery in ES patients, where individual patient data was available. Seventeen studies with a total of 57 Ewing's patients were included in this review. Fifty-three of the ES patients preserved the limb after limb salvage with endoprostheses. The average five-year implant survivorship was 85.9% based on four studies in this review. Postoperative complications were categorised by Henderson's failure modes. Soft tissue failure was the most common, occurring in 35.1% of patients, followed by deep infection in 15.7% of patients. There was a suggestion of 'good' functional outcomes with limb salvage surgery. The salient limitation of this review is the variability and rarity of the patient population. Homogenous data in a larger population is necessary to provide more insight into outcomes of limb reconstruction in ES.
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Anil U, Singh V, Schwarzkopf R. Diagnosis and Detection of Subtle Aseptic Loosening in Total Hip Arthroplasty. J Arthroplasty 2022; 37:1494-1500. [PMID: 35189292 DOI: 10.1016/j.arth.2022.02.060] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/10/2022] [Accepted: 02/14/2022] [Indexed: 02/02/2023] Open
Abstract
Aseptic loosening is a common cause of revision total hip arthroplasty (rTHA), and with the rising number of primary THAs, revisions for aseptic loosening represent a significant burden for arthroplasty surgeons. Aseptic loosening remains a diagnostic and management challenge. Loosening can occur as a result of inadequate initial fixation, mechanical loss of fixation over time, or a biological loss of fixation over time. However, in most cases, etiology is multifactorial, involving all 3 factors. The diagnosis of aseptic loosening involves a careful history, focused clinical exam, and thorough evaluation of imaging using several diagnostic modalities. The careful evaluation of serial radiographs remains the cornerstone of diagnosis with additional input from advanced imaging modalities such as FDG-PET, DEXA, MRI, and several others, each offering unique advantages and disadvantages. In certain patients, history and physical exam might be the only initial obvious signs of loosening, and thus, unexplained continuous pain augmented by imaging findings serves as an indication for revision surgery.
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Affiliation(s)
- Utkarsh Anil
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Vivek Singh
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
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Sharma AR, Lee YH, Gankhuyag B, Chakraborty C, Lee SS. Effect of Alumina Particles on the Osteogenic Ability of Osteoblasts. J Funct Biomater 2022; 13:jfb13030105. [PMID: 35997443 PMCID: PMC9397023 DOI: 10.3390/jfb13030105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/26/2022] [Accepted: 07/26/2022] [Indexed: 02/01/2023] Open
Abstract
Biomaterials are used as implants for bone and dental disabilities. However, wear particles from the implants cause osteolysis following total joint arthroplasty (TJA). Ceramic implants are considered safe and elicit a minimal response to cause periprosthetic osteolysis. However, few reports have highlighted the adverse effect of ceramic particles such as alumina (Al2O3) on various cell types. Hence, we aimed to investigate the effect of Al2O3 particles on osteoprogenitors. A comparative treatment of Al2O3, Ti, and UHMWPE particles to osteoprogenitors at a similar concentration of 200 μg/mL showed that only Al2O3 particles were able to suppress the early and late differentiation markers of osteoprogenitors, including collagen synthesis, alkaline phosphatase (ALP) activity and mRNA expression of Runx2, OSX, Col1α, and OCN. Al2O3 particles even induced inflammation and activated the NFkB signaling pathway in osteoprogenitors. Moreover, bone-forming signals such as the WNT/β-catenin signaling pathway were inhibited by the Al2O3 particles. Al2O3 particles were found to induce the mRNA expression of WNT/β-catenin signaling antagonists such as DKK2, WIF, and sFRP1 several times in osteoprogenitors. Taken together, this study highlights a mechanistic view of the effect of Al2O3 particles on osteoprogenitors and suggests therapeutic targets such as NFĸB and WNT signaling pathways for ceramic particle-induced osteolysis.
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Affiliation(s)
- Ashish Ranjan Sharma
- Institute for Skeletal Aging & Orthopedic Surgery, Hallym University-Chuncheon Sacred Heart Hospital, Chuncheon 24252, Korea; (A.R.S.); (Y.-H.L.); (B.G.)
| | - Yeon-Hee Lee
- Institute for Skeletal Aging & Orthopedic Surgery, Hallym University-Chuncheon Sacred Heart Hospital, Chuncheon 24252, Korea; (A.R.S.); (Y.-H.L.); (B.G.)
| | - Buyankhishig Gankhuyag
- Institute for Skeletal Aging & Orthopedic Surgery, Hallym University-Chuncheon Sacred Heart Hospital, Chuncheon 24252, Korea; (A.R.S.); (Y.-H.L.); (B.G.)
| | - Chiranjib Chakraborty
- Department of Biotechnology, School of Life Science and Biotechnology, Adamas University, Barasat-Barrackpore Rd, Kolkata 700126, India;
| | - Sang-Soo Lee
- Institute for Skeletal Aging & Orthopedic Surgery, Hallym University-Chuncheon Sacred Heart Hospital, Chuncheon 24252, Korea; (A.R.S.); (Y.-H.L.); (B.G.)
- Correspondence:
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George SM, Nayak C, Singh I, Balani K. Multifunctional Hydroxyapatite Composites for Orthopedic Applications: A Review. ACS Biomater Sci Eng 2022; 8:3162-3186. [PMID: 35838237 DOI: 10.1021/acsbiomaterials.2c00140] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Being a bioactive material, hydroxyapatite (HAp) is regarded as one of the most attractive ceramic biomaterials for bone and hard-tissue replacement and regeneration. Despite its substantial biocompatibility, osteoconductivity, and compositional similarity to that of bone, the employment of HAp is still limited in orthopedic applications due to its poor mechanical (low fracture toughness and bending strength) and antibacterial properties. These significant challenges lead to the notion of developing novel HAp-based composites via different fabrication routes. HAp, when efficaciously combined with functionally graded materials and antibacterial agents, like Ag, ZnO, Co, etc., form composites that render remarkable crack resistance and toughening, as well as enhance its bactericidal efficacy. The addition of different materials and a fabrication method, like 3D printing, greatly influence the porosity of the structure and, in turn, control cell adhesion, thereby enabling biological fixation of the material. This article encompasses an elaborate discussion on different multifunctional HAp composites developed for orthopedic applications with particular emphasis on the incorporation of functionally graded materials and antibacterial agents. The influence of 3D printing on the fabrication of HAp-based scaffolds, and the different in vitro and in vivo studies conducted on these, have all been included here. Furthermore, the present review not only provides insights and broad understanding by elucidating recent advancements toward 4D printing but also directs the reader to future research directions in design and application of HAp-based composite coatings and scaffolds.
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Affiliation(s)
- Suchi Mercy George
- Department of Materials Science and Engineering, Indian Institute of Technology Kanpur, Kanpur 208016, India
| | - Chinmayee Nayak
- Department of Materials Science and Engineering, Indian Institute of Technology Kanpur, Kanpur 208016, India
| | - Indrajeet Singh
- Department of Materials Science and Engineering, Indian Institute of Technology Kanpur, Kanpur 208016, India
| | - Kantesh Balani
- Department of Materials Science and Engineering, Indian Institute of Technology Kanpur, Kanpur 208016, India.,Advanced Centre for Materials Science, Indian Institute of Technology Kanpur, Kanpur 208016, India
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Xing D, Li R, Li JJ, Tao K, Lin J, Yan T, Zhou D. Catastrophic Periprosthetic Osteolysis in Total Hip Arthroplasty at 20 Years: A Case Report and Literature Review. Orthop Surg 2022; 14:1918-1926. [PMID: 35819098 PMCID: PMC9363776 DOI: 10.1111/os.13322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Periprosthetic osteolysis is a serious complication following total hip arthroplasty (THA). However, most orthopedic surgeons only focus on bone loss and hip reconstruction. Thus, it was required to understand the treatment algorithm for periprosthetic osteolysis integrally. CASE PRESENTATION A 52-year-old Asian male presented with chronic hip pain. A mass appeared on the medial side of the proximal left thigh at more than 20 years after bilateral THA. Radiographs revealed catastrophic periprosthetic osteolysis, especially on the acetabular side. Large amounts of necrotic tissue and bloody fluids were thoroughly debrided during revision THA. A modular hemipelvic prosthesis was used for revision of the left hip. Four years later, the patient presented with right hip pain, where a mass appeared on the medial side of the proximal right thigh. A primary acetabular implant with augment was used for revision of the right hip. Laboratory evaluation of bloody fluid retrieved from surgery revealed elevated levels of inflammatory markers. CONCLUSION Inflammatory responses to polyethylene wear debris can lead to severe bone resorption and aseptic loosening in the long-term following THA. Therefore, in spite of revision THA, interrupting the cascade inflammatory might be the treatment principle for periprosthetic osteolysis.
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Affiliation(s)
- Dan Xing
- Arthritis Clinic & Research Center, Peking University People's Hospital, Peking University, Beijing, China
| | - Rujun Li
- Arthritis Clinic & Research Center, Peking University People's Hospital, Peking University, Beijing, China
| | - Jiao Jiao Li
- School of Biomedical Engineering, Faculty of Engineering and IT, University of Technology Sydney, Ultimo, Australia
| | - Ke Tao
- Arthritis Clinic & Research Center, Peking University People's Hospital, Peking University, Beijing, China
| | - Jianhao Lin
- Arthritis Clinic & Research Center, Peking University People's Hospital, Peking University, Beijing, China
| | - Taiqiang Yan
- Musculoskeletal Tumor Center, Peking University People's Hospital, Peking University, Beijing, China
| | - Diange Zhou
- Arthritis Clinic & Research Center, Peking University People's Hospital, Peking University, Beijing, China
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Bone Tissue Engineering through 3D Bioprinting of Bioceramic Scaffolds: A Review and Update. LIFE (BASEL, SWITZERLAND) 2022; 12:life12060903. [PMID: 35743934 PMCID: PMC9225502 DOI: 10.3390/life12060903] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/10/2022] [Accepted: 06/11/2022] [Indexed: 12/11/2022]
Abstract
Trauma and bone loss from infections, tumors, and congenital diseases make bone repair and regeneration the greatest challenges in orthopedic, craniofacial, and plastic surgeries. The shortage of donors, intrinsic limitations, and complications in transplantation have led to more focus and interest in regenerative medicine. Structures that closely mimic bone tissue can be produced by this unique technology. The steady development of three-dimensional (3D)-printed bone tissue engineering scaffold therapy has played an important role in achieving the desired goal. Bioceramic scaffolds are widely studied and appear to be the most promising solution. In addition, 3D printing technology can simulate mechanical and biological surface properties and print with high precision complex internal and external structures to match their functional properties. Inkjet, extrusion, and light-based 3D printing are among the rapidly advancing bone bioprinting technologies. Furthermore, stem cell therapy has recently shown an important role in this field, although large tissue defects are difficult to fill by injection alone. The combination of 3D-printed bone tissue engineering scaffolds with stem cells has shown very promising results. Therefore, biocompatible artificial tissue engineering with living cells is the key element required for clinical applications where there is a high demand for bone defect repair. Furthermore, the emergence of various advanced manufacturing technologies has made the form of biomaterials and their functions, composition, and structure more diversified, and manifold. The importance of this article lies in that it aims to briefly review the main principles and characteristics of the currently available methods in orthopedic bioprinting technology to prepare bioceramic scaffolds, and finally discuss the challenges and prospects for applications in this promising and vital field.
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Bobe K, Willbold E, Haupt M, Reebmann M, Morgenthal I, Andersen O, Studnitzky T, Nellesen J, Tillmann W, Vogt C, Vano-Herrera K, Witte F. Biodegradable open-porous scaffolds made of sintered magnesium W4 and WZ21 short fibres show biocompatibility in vitro and in long-term in vivo evaluation. Acta Biomater 2022; 148:389-404. [PMID: 35691561 DOI: 10.1016/j.actbio.2022.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 05/27/2022] [Accepted: 06/01/2022] [Indexed: 11/26/2022]
Abstract
Open-porous scaffolds made of W4 and WZ21 fibres were evaluated to analyse their potential as an implant material. WZ21 scaffolds without any surface modification or coating, showed promising mechanical properties which were comparable to the W4 scaffolds tested in previous studies. Eudiometric testing results were dependent on the experimental setup, with corrosion rates differing by a factor of 3. Cytotoxicity testing of WZ21 showed sufficient cytocompatibility. The corrosion behavior of the WZ21 scaffolds in different cell culture media are indicating a selective dealloying of elements from the magnesium scaffold by different solutions. Long term in-vivo studies were using 24 W4 scaffolds and 12 WZ21 scaffolds, both implanted in rabbit femoral condyles. The condyles and important inner organs were explanted after 6, 12 and 24 weeks and analyzed. The in-vivo corrosion rate of the WZ21 scaffolds calculated by microCT-based volume loss was up to 49 times slower than the in-vitro corrosion rate based on weight loss. Intramembranous bone formation within the scaffolds of both alloys was revealed, however a low corrosion rate and formation of gas cavities at initial time points were also detected. No systemic or local toxicity could be observed. Investigations by μ-XRF did not reveal accumulation of yttrium in the neighboring tissue. In summary, the magnesium scaffold´s performance is biocompatible, but would benefit from a surface modification, such as a coating to obtain lower the initial corrosion rates, and hereby establish a promising open-porous implant material for load-bearing applications. STATEMENT OF SIGNIFICANCE: Magnesium is an ideal temporary implant material for non-load bearing applications like bigger bone defects, since it degrades in the body over time. Here we developed and tested in vitro and in a rabbit model in vivo degradable open porous scaffolds made of sintered magnesium W4 and WZ21 short fibres. These scaffolds allow the ingrowth of cells and blood vessels to promote bone healing and regeneration. Both fibre types showed in vitro sufficient cytocompatibility and proliferation rates and in vivo, no systemic toxicity could be detected. At the implantation site, intramembranous bone formation accompanied by ingrowth of supplying blood vessels within the scaffolds of both alloys could be detected.
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Affiliation(s)
- Katharina Bobe
- Laboratory for Biomechanics and Biomaterials, Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Straße 1-7, Hannover 30625, Germany
| | - Elmar Willbold
- Laboratory for Biomechanics and Biomaterials, Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Straße 1-7, Hannover 30625, Germany.
| | - Maike Haupt
- Laboratory for Biomechanics and Biomaterials, Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Straße 1-7, Hannover 30625, Germany
| | - Mattias Reebmann
- Laboratory for Biomechanics and Biomaterials, Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Straße 1-7, Hannover 30625, Germany
| | - Ingrid Morgenthal
- Fraunhofer Institute for Manufacturing Technology and Advanced Materials IFAM, Branch Lab Dresden, Winterbergstraße 28, Dresden 01277, Germany
| | - Olaf Andersen
- Fraunhofer Institute for Manufacturing Technology and Advanced Materials IFAM, Branch Lab Dresden, Winterbergstraße 28, Dresden 01277, Germany
| | - Thomas Studnitzky
- Fraunhofer Institute for Manufacturing Technology and Advanced Materials IFAM, Branch Lab Dresden, Winterbergstraße 28, Dresden 01277, Germany
| | - Jens Nellesen
- Institute of Materials Engineering, Technische Universität Dortmund, Leonhard-Euler-Straße 2, Dortmund 44227, Germany
| | - Wolfgang Tillmann
- Institute of Materials Engineering, Technische Universität Dortmund, Leonhard-Euler-Straße 2, Dortmund 44227, Germany
| | - Carla Vogt
- Institute for Analytical Chemistry, University of Mining and Technology, Leipziger Straße 29, Freiberg 09599, Germany
| | - Kelim Vano-Herrera
- Deutsches Institut für Kautschuktechnologie, Eupener Straße 33, Hannover 30519, Germany
| | - Frank Witte
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Dental Materials and Biomaterial Research, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Aßmannshauser Straße 4-6, Berlin 14197, Germany
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Xu T, Zeng Y, Yang X, Liu G, Lv T, Yang H, Jiang F, Chen Y. Application of 68Ga-citrate PET/CT for differentiating periprosthetic joint infection from aseptic loosening after joint replacement surgery. Bone Joint Res 2022; 11:398-408. [PMID: 35731211 PMCID: PMC9233412 DOI: 10.1302/2046-3758.116.bjr-2021-0464.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIMS We aimed to evaluate the utility of 68Ga-citrate positron emission tomography (PET)/CT in the differentiation of periprosthetic joint infection (PJI) and aseptic loosening (AL), and compare it with 99mTc-methylene bisphosphonates (99mTc-MDP) bone scan. METHODS We studied 39 patients with suspected PJI or AL. These patients underwent 68Ga-citrate PET/CT, 99mTc-MDP three-phase bone scan and single-photon emission CT (SPECT)/CT. PET/CT was performed at ten minutes and 60 minutes after injection, respectively. Images were evaluated by three nuclear medicine doctors based on: 1) visual analysis of the three methods based on tracer uptake model, and PET images attenuation-corrected with CT and those not attenuation-corrected with CT were analyzed, respectively; and 2) semi-quantitative analysis of PET/CT: maximum standardized uptake value (SUVmax) of lesions, SUVmax of the lesion/SUVmean of the normal bone, and SUVmax of the lesion/SUVmean of the normal muscle. The final diagnosis was based on the clinical and intraoperative findings, and histopathological and microbiological examinations. RESULTS Overall, 23 and 16 patients were diagnosed with PJI and AL, respectively. The sensitivity and specificity of three-phase bone scan and SPECT/CT were 100% and 62.5%, 82.6%, and 100%, respectively. Attenuation correction (AC) at 60 minutes and non-AC at 60 minutes of PET/CT had the same highest sensitivity and specificity (91.3% and 100%), and AC at 60 minutes combined with SPECT/CT could improve the diagnostic efficiency (sensitivity = 95.7%). Diagnostic efficacy of the SUVmax was low (area under the curve (AUC) of ten minutes and 60 minutes was 0.814 and 0.806, respectively), and SUVmax of the lesion/SUVmean of the normal bone at 60 minutes was the best semi-quantitative parameter (AUC = 0.969). CONCLUSION 68Ga-citrate showed the potential to differentiate PJI from AL, and visual analysis based on uptake pattern of tracer was reliable. The visual analysis method of AC at 60 minutes, combined with 99mTc-MDP SPECT/CT, could improve the sensitivity from 91.3% to 95.7%. In addition, a major limitation of our study was that it had a limited sample size, and more detailed studies with a larger sample size are warranted. Cite this article: Bone Joint Res 2022;11(6):398-408.
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Affiliation(s)
- Tingting Xu
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China.,Institute of Nuclear Medicine, Southwest Medical University, Luzhou, Sichuan, China
| | - Yalan Zeng
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Xiao Yang
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China.,Institute of Nuclear Medicine, Southwest Medical University, Luzhou, Sichuan, China
| | - Guangfu Liu
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China.,Institute of Nuclear Medicine, Southwest Medical University, Luzhou, Sichuan, China
| | - Taiyong Lv
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China.,Institute of Nuclear Medicine, Southwest Medical University, Luzhou, Sichuan, China
| | - Hongbin Yang
- Department of Orthopedics, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Fei Jiang
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China.,Institute of Nuclear Medicine, Southwest Medical University, Luzhou, Sichuan, China
| | - Yue Chen
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, China.,Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China.,Institute of Nuclear Medicine, Southwest Medical University, Luzhou, Sichuan, China
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Revision Risk of Total Hip Arthroplasty With Vitamin E Doped Liners: Results From the Danish Hip Arthroplasty Register. J Arthroplasty 2022; 37:1136-1142. [PMID: 35149169 DOI: 10.1016/j.arth.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/03/2022] [Accepted: 02/03/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Vitamin E-doped cross-linked polyethylene (VEPE) liners were introduced in total hip arthroplasty (THA) to reduce wear and risk of aseptic loosening and liner fracture. We report this nationwide population-based study to investigate the safety of VEPE liners for THA compared to cross-linked annealed or remelted polyethylene (XLPE). METHODS We included THAs from The Danish Hip Arthroplasty Register from January 1, 2008 to June 30, 2019, with uncemented cup, VEPE or XLPE liner, and metal or ceramic head. The outcome was revision due to (1) polyethylene-related endpoints (aseptic loosening, granuloma, osteolysis, or liner fractures) and (2) other endpoints. RESULTS A total of 110,803 THAs were assessed for eligibility and 53,842 THAs (46,645 patients) were included in the study: 5069 (9.4%) THAs with a VEPE liner and 48,773 (91.6%) with a XLPE liner. Median observation time was 5.48 (interquartile range 3.80-7.15) years for VEPE and 4.85 (interquartile range 2.68-7.76) for XLPE. VEPE had a lower risk of revision for polyethylene-related endpoints compared to XLPE (hazard ratio [HR] 0.60, 95% confidence interval 0.36-0.98) during complete follow-up. THAs with VEPE liners were associated with increased risk of any revision within the first 3 months (HR 1.62, 1.36-1.94), revision recorded as aseptic loosening within 3 months (HR 4.46, 2.26-8.80), and periprosthetic fracture within 3 months (HR 2.57, 1.98, 3.33). CONCLUSION VEPE liners had a lower risk of revision due to polyethylene-related endpoints, but a higher risk of all-cause revision within 3 months.
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Rial R, Liu Z, Messina P, Ruso JM. Role of nanostructured materials in hard tissue engineering. Adv Colloid Interface Sci 2022; 304:102682. [PMID: 35489142 DOI: 10.1016/j.cis.2022.102682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 04/11/2022] [Accepted: 04/19/2022] [Indexed: 01/05/2023]
Abstract
The rise in the use of biomaterials in bone regeneration in the last decade has exponentially multiplied the number of publications, methods, and approaches to improve and optimize their functionalities and applications. In particular, biomimetic strategies based on the self-assembly of molecules to design, create and characterize nanostructured materials have played a very relevant role. We address this idea on four different but related points: self-setting bone cements based on calcium phosphate, as stable tissue support and regeneration induction; metallic prosthesis coatings for cell adhesion optimization and prevention of inflammatory response exacerbation; bio-adhesive hybrid materials as multiple drug delivery localized platforms and finally bio-inks. The effect of the physical, chemical, and biological properties of the newest biomedical devices on their bone tissue regenerative capacity are summarized, described, and analyzed in detail. The roles of experimental conditions, characterization methods and synthesis routes are emphasized. Finally, the future opportunities and challenges of nanostructured biomaterials with their advantages and shortcomings are proposed in order to forecast the future directions of this field of research.
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Gkiatas I, Karasavvidis T, Sharma AK, Xiang W, Malahias MA, Chalmers BP, Sculco PK. Highly cross-linked polyethylene in primary total knee arthroplasty is associated with a lower rate of revision for aseptic loosening: a meta-analysis of 962,467 cases. Arch Orthop Trauma Surg 2022; 142:1177-1184. [PMID: 33847797 DOI: 10.1007/s00402-021-03887-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/27/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The evolution in total knee arthroplasty (TKA) includes the highly cross-linked polyethylene (HXLPE) which has been reported as an effective manner to reduce the wear of the polyethylene and the osteolysis. The purpose of the present study is to synthesize the results of comparative studies between HXLPE and conventional polyethylenes and determine their effect in primary TKA. METHODS The US National Library of Medicine (PubMed/MEDLINE) and the Cochrane Database of Systematic Reviews were queried for publications utilizing the following keywords: "cross-linked", "polyethylene", "HXLPE", "conventional", "total knee arthroplasty", "TKA", "total knee replacement" and "TKR" combined with Boolean operators AND and OR. RESULTS Ten studies met the inclusion criteria and were included in the present meta-analysis with 962,467 patients. No significant difference was found regarding the revision rate for any reason between the patients who received HXLPE and those with conventional liner (OR 0.67; 95% CI 0.39-1.18; I2: 97.7%). In addition, there was no difference regarding the radiolucent lines between the two types of liners (OR 0.54; 95% CI 0.20-1.49; I2: 69.4%). However, with data coming from seven studies enrolling a total of 411,543 patients, it was demonstrated that patients who received HXLPE were less likely to be revised due to aseptic loosening compared to the patients with conventional liners (OR 0.35; 95% CI 0.31-0.39; I2: 0.0%). CONCLUSION The present meta-analysis showed that regarding the overall revision rate and radiographic outcomes there was no significant difference between the two types of liners. On the other hand, the significantly less revision rate due to loosening supports the routine continued use of HXLPE in primary TKA.
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Affiliation(s)
- Ioannis Gkiatas
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, 10022, USA.
| | - Theofilos Karasavvidis
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Abhinav K Sharma
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, 10022, USA
| | - William Xiang
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, 10022, USA
| | - Michael-Alexander Malahias
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, 10022, USA
| | - Brian P Chalmers
- Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY, 10022, USA
| | - Peter K Sculco
- Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, 10022, USA
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Cold Spraying of Thick Biomimetic and Stoichiometric Apatite Coatings for Orthopaedic Implants. COATINGS 2022. [DOI: 10.3390/coatings12060722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Ceramic coatings have a long history in the orthopaedic field, with plasma sprayed coatings of hydroxyapatite as leading standard in the manufacturing process; however, these coatings can contain secondary phases resulting from the decomposition of hydroxyapatite at high temperatures, which limit the lifetime of implants and their osseointegration. This work aims to produce coatings that can maximize bone osseointegration of metallic implants. In order to preserve the raw characteristics of hydroxyapatite powders that are thermally unstable, coatings were deposited by cold spray onto Ti6Al4V alloy substrates. In contrast with other thermal spray technologies, this process presents the advantage of spraying particles through a supersonic gas jet at a low temperature. On top of hydroxyapatite, carbonated nanocrystalline apatite was synthesized and sprayed. This biomimetic apatite is similar to bone minerals due to the presence of carbonates and its poor crystallinity. FTIR and XRD analyses proved that the biomimetic characteristics and the non-stoichiometric of the apatite were preserved in the cold spray coatings. The cold spray process did not affect the chemistry of the raw material. The adhesion of the coatings as well as their thicknesses were evaluated, showing values comparable to conventional process. Cold spraying appears as a promising method to preserve the characteristics of calcium phosphate ceramics and to produce coatings that offer potentially improved osseointegration.
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Gao X, Ge J, Zhou W, Xu L, Geng D. IL-10 inhibits osteoclast differentiation and osteolysis through MEG3/IRF8 pathway. Cell Signal 2022; 95:110353. [PMID: 35525407 DOI: 10.1016/j.cellsig.2022.110353] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 04/28/2022] [Accepted: 05/01/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Osteolysis caused by wear particles is the main reason for joint replacement failure. Inhibition of osteoclast differentiation relieves wear particle-induced osteolysis. Our study aimed to explore the effect of lncRNA maternally expressed gene 3 (MEG3) on osteoclast differentiation and wear particle-induced osteolysis, and to improve the potential mechanism of interleukin-10 (IL-10) inhibition on osteoclast differentiation. METHODS Polymethylmethacrylate (PMMA) -induced osteolysis mice model and receptor activator of nuclear factor-B ligand (RANKL) -induced osteoclast differentiation model were constructed. Tartrate-resistant acidic phosphatase (TRAP) staining, hematoxylin-eosin (HE) staining, immunohistochemical staining, bone resorption assay, dual-luciferase assay, RNA pull-down assay, RNA immunoprecipitation, and chromatin immunoprecipitation were executed. RESULTS MEG3 levels were increased and interferon regulatory factor 8 (IRF8) levels were decreased in PMMA-induced osteolysis mice. IL-10 inhibited RANKL-induced osteoclast differentiation, promoted MEG3 methylation, and inhibited MEG3 expression. Moreover, knockdown of MEG3 inhibited osteoclast differentiation and increased IRF8 levels. Meanwhile, MEG3 combined with signal transducer and activator of transcription 1 (STAT1), STAT1 combined with IRF8, and overexpression of MEG3 inhibited STAT1 binding to IRF8. Further studies have shown that knockdown of MEG3 inhibited osteoclast differentiation and alleviated osteolysis, but knockdown of IRF8 weakened these results. CONCLUSION MEG3 regulated the expression of IRF8 by binding to STAT1, thereby affecting osteoclast differentiation and wear particle-induced osteolysis. IL-10 might inhibit osteoclast differentiation by MEG3/IRF8.
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Affiliation(s)
- Xuren Gao
- Department of Orthopedics, the Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China.
| | - Jian Ge
- Department of Orthopedics, the Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China
| | - Wangchen Zhou
- Department of Orthopedics, the Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China
| | - Lei Xu
- Department of Orthopedics, the Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China
| | - Deqin Geng
- Department of Clinical Medicine, the Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China
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