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Reynolds A, Doyle R, Boughton O, Cobb J, Muirhead-Allwood S, Jeffers J. Dynamics of manual impaction instruments during total hip arthroplasty. Bone Joint Res 2024; 13:193-200. [PMID: 38649151 DOI: 10.1302/2046-3758.134.bjr-2023-0224.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
Aims Manual impaction, with a mallet and introducer, remains the standard method of installing cementless acetabular cups during total hip arthroplasty (THA). This study aims to quantify the accuracy and precision of manual impaction strikes during the seating of an acetabular component. This understanding aims to help improve impaction surgical techniques and inform the development of future technologies. Methods Posterior approach THAs were carried out on three cadavers by an expert orthopaedic surgeon. An instrumented mallet and introducer were used to insert cementless acetabular cups. The motion of the mallet, relative to the introducer, was analyzed for a total of 110 strikes split into low-, medium-, and high-effort strikes. Three parameters were extracted from these data: strike vector, strike offset, and mallet face alignment. Results The force vector of the mallet strike, relative to the introducer axis, was misaligned by an average of 18.1°, resulting in an average wasted strike energy of 6.1%. Furthermore, the mean strike offset was 19.8 mm from the centre of the introducer axis and the mallet face, relative to the introducer strike face, was misaligned by a mean angle of 15.2° from the introducer strike face. Conclusion The direction of the impact vector in manual impaction lacks both accuracy and precision. There is an opportunity to improve this through more advanced impaction instruments or surgical training.
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Affiliation(s)
- Adam Reynolds
- Biomechanical Engineering, Imperial College London, London, UK
| | - Ruben Doyle
- Biomechanical Engineering, Imperial College London, London, UK
| | | | - Justin Cobb
- Orthopaedics, Imperial College London, London, UK
| | | | - Jonathan Jeffers
- Department of Mechanical Engineering, Imperial College London, London, UK
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2
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V A, Rajaraman V, Ariga P, Nallaswamy D. Maxillofacial Reconstruction With Three Dimensional Resin Bone Substitutes as an Alternative to Transition Group of Metals: A Structured Review. Cureus 2024; 16:e57396. [PMID: 38694639 PMCID: PMC11062478 DOI: 10.7759/cureus.57396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 04/01/2024] [Indexed: 05/04/2024] Open
Abstract
In recent years, novel technologies and techniques have allowed today the production of controlled architecture materials. Although autogenous bone graft substitutes remain the gold standard, enormous defects require supplementary alloplastic substitutes for reconstruction. Polymers have lately been explored for the same purpose and their biological performance has been under research since the last decade. The aim of this review is to analyse maxillofacial reconstruction with three-dimensional resin bone substitutes. A Problem Intervention Comparison Outcomes (PICO) analysis was done and a search was carried out in the Cochrane Database, PubMed, Google Scholar etc databases and a hand search was done to collect the related literature. All articles for maxillofacial reconstruction with three-dimensional resin bone substitutes were scrutinised. The manuscripts published from 1990 till May 2021, were included in this review. A total of 106 articles were obtained from a PICO-based keyword search, and 91 manuscripts were retrieved after excluding the duplicates. Out of these 57 manuscripts were excluded on the basis of title and abstract. From the remaining 34 studies, 17 were excluded after reading the full text based on the inclusion and exclusion criteria. During data extraction, four studies were removed and finally, 13 studies were included in this research. From this scoping review, we could conclude that polymethylmethacrylate and polylactic acid formulations are very promising resin bone substitutes for 3-dimensional reconstruction of maxillofacial defects. However, rigorous long-term clinical trials are needed to validate this conclusion.
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Affiliation(s)
- Ashok V
- Department of Prosthodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Vaishnavi Rajaraman
- Department of Prosthodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Padma Ariga
- Department of Prosthodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Deepak Nallaswamy
- Department of Prosthodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
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3
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Ferrao PNF, Saragas NP, Naude JJ. Outcomes of Total Ankle Arthroplasty After Periprosthetic Cyst Curettage and Bone Grafting. Foot Ankle Clin 2024; 29:123-143. [PMID: 38309797 DOI: 10.1016/j.fcl.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2024]
Abstract
Total ankle arthroplasty (TAA) has become a popular management option for ankle arthritis. Periprosthetic osteolysis is one of the most common causes for reoperation in TAA. A CT scan should be done in all suspected osteolysis cases to confirm location, quantify size and aid in surgical planning. These patients are often asymptomatic with limited evidence regarding appropriate management. Smaller lesions should be monitored for progression in size. Periprosthetic cysts measuring 10-15mm in all three axes should be considered for debridment and curettage with autogenous bone grafting. The authors believe that bone grafting of large asymptomatic periprosthetic cysts could prevent implant failure.
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Affiliation(s)
- Paulo N F Ferrao
- The Orthopaedic Foot & Ankle Unit, Netcare Linksfield Hospital, 303 Linksfield Medical Centre, 24 12th Avenue, Linksfield West, 2192, South Africa; Department of Orthopaedic Surgery, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa.
| | - Nikiforos P Saragas
- The Orthopaedic Foot & Ankle Unit, Netcare Linksfield Hospital, 303 Linksfield Medical Centre, 24 12th Avenue, Linksfield West, 2192, South Africa; Department of Orthopaedic Surgery, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa
| | - Jaco J Naude
- The Orthopaedic Foot & Ankle Unit, Netcare Linksfield Hospital, 303 Linksfield Medical Centre, 24 12th Avenue, Linksfield West, 2192, South Africa; Life Wilgers Hospital, Denneboom road, Wilgers ext 14, Pretoria, 0040, South Africa
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4
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Exploring the Usability of α-MSH-SM-Liposome as an Imaging Agent to Study Biodegradable Bone Implants In Vivo. Int J Mol Sci 2023; 24:ijms24021103. [PMID: 36674616 PMCID: PMC9866773 DOI: 10.3390/ijms24021103] [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: 11/30/2022] [Revised: 12/23/2022] [Accepted: 01/05/2023] [Indexed: 01/09/2023] Open
Abstract
Novel biodegradable metal alloys are increasingly used as implant materials. The implantation can be accompanied by an inflammatory response to a foreign object. For studying inflammation in the implantation area, non-invasive imaging methods are needed. In vivo imaging for the implanted area and its surroundings will provide beneficiary information to understand implant-related inflammation and help to monitor it. Therefore, inflammation-sensitive fluorescent liposomes in rats were tested in the presence of an implant to evaluate their usability in studying inflammation. The sphingomyelin-containing liposomes carrying alpha-melanocyte-stimulating hormone (α-MSH)-peptide were tested in a rat bone implant model. The liposome interaction with implant material (Mg-10Gd) was analyzed with Mg-based implant material (Mg-10Gd) in vitro. The liposome uptake process was studied in the bone-marrow-derived macrophages in vitro. Finally, this liposomal tracer was tested in vivo. It was found that α-MSH coupled sphingomyelin-containing liposomes and the Mg-10Gd implant did not have any disturbing influence on each other. The clearance of liposomes was observed in the presence of an inert and biodegradable implant. The degradable Mg-10Gd was used as an alloy example; however, the presented imaging system offers a new possible use of α-MSH-SM-liposomes as tools for investigating implant responses.
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5
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Cao H. Accuracy of radiostereometric analysis using a motorized Roentgen system in a pilot study for clinical simulation. Med Eng Phys 2023; 111:103929. [PMID: 36792244 DOI: 10.1016/j.medengphy.2022.103929] [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: 05/31/2022] [Revised: 10/26/2022] [Accepted: 11/21/2022] [Indexed: 11/25/2022]
Abstract
Radiostereometric analysis (RSA) is routinely implemented with two paired Roentgen tubes for three-dimensional (3D) implant migration measurements. A conventional set-up of one stationary tube and one mobile could be time-consuming. Utilizing two customized ceiling-mounted tubes is normally associated with investment costs. Thus, a pilot set-up of a motorized system (single Roentgen source) for radiostereometric image acquisition may be a time-saving and space-efficient alternative. RSA using the motorized system is feasible in this study as a non-synchronized image acquisition technique, however, patient motion may occur and influence the assessment of implant migration. The phantom study aimed to assess accuracy of RSA using the motorized Roentgen system in this in vitro study. Accuracy values of translations and rotations were ±0.29 mm and ±0.48° for the single Roentgen source RSA set-up and ±0.26 mm and ±0.48° for the conventional RSA set-up. This study was also performed to simulate potential patient motion during exposure intervals between paired image acquisition. RSA using the motorized system is able to implement RSA with acceptable accuracy. In general, RSA with synchronized image acquisition is the gold standard to access in vivo implant migration with the highest accuracy. Patient motion exists in non-synchronized image acquisition techniques and results in RSA-related motion artifacts. Then we introduced what RSA-related motion artifacts are. The uniplanar calibration cage applied in the study has a few fiducial and control markers, and some of the markers were occluded in radiographs. Whereas, the number of markers in the calibration cage is correlated with accuracy of 3D implant reconstruction.
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Affiliation(s)
- Han Cao
- Department of Orthopaedic Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; Department of Orthopaedic Surgery, Taizhou Second People's Hospital, 225599 Taizhou, China.
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6
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Kunze KN, Krivicich LM, Brusalis C, Taylor SA, Gulotta LV, Dines JS, Fu MC. Pathogenesis, Evaluation, and Management of Osteolysis After Total Shoulder Arthroplasty. Clin Shoulder Elb 2022; 25:244-254. [PMID: 35971608 PMCID: PMC9471816 DOI: 10.5397/cise.2021.00738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/22/2022] [Indexed: 11/25/2022] Open
Abstract
Radiographic osteolysis after total shoulder arthroplasty (TSA) remains a challenging clinical entity, as it may not initially manifest clinically apparent symptoms but can lead to clinically important complications, such as aseptic loosening. A thorough consideration of medical history and physical examination is essential to rule out other causes of symptomatic TSA—namely, periprosthetic joint infection—as symptoms often progress to vague pain or discomfort due to subtle component loosening. Once confirmed, nonoperative treatment of osteolysis should first be pursued given the potential to avoid surgery-associated risks. If needed, the current surgical options include glenoid polyethylene revision and conversion to reverse shoulder arthroplasty. The current article provides a comprehensive review of the evaluation and management of osteolysis after TSA through an evidence-based discussion of current concepts.
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Gupta R, Schmidt EC, Namdari S, Stone MA, Hast MW. The addition of cerclage wiring does not improve proximal bicortical fixation of locking plates for Type C periprosthetic fractures in synthetic humeri. Clin Biomech (Bristol, Avon) 2022; 97:105709. [PMID: 35780699 PMCID: PMC10096358 DOI: 10.1016/j.clinbiomech.2022.105709] [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: 02/10/2022] [Revised: 06/05/2022] [Accepted: 06/14/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Treatment of proximal humerus periprosthetic fractures is challenging. It remains difficult to achieve robust fixation of the proximal fragment to the locking plate using cerclage wiring and/or unicortical screws. Use of polyaxial tangentially directed bicortical locking screws increases screw purchase, but it is unclear if this option provides robust fixation. This biomechanical study compares fixation of constructs using cerclage wires, bicortical locking screws, and a hybrid method utilizing both methods. METHODS Uncemented humeral stems were implanted into synthetic humeri and Type C periprosthetic fractures were simulated with a 1 cm transverse osteotomy. Distal ends of locking plates were secured with bicortical non-locking screws. The proximal ends were supported by either isolated cerclage wires, polyaxial locking screws, or a hybrid combination of both (n = 6 for each group). A universal test frame was used for non-destructive torsion and cyclic axial compression tests. 3-D motion tracking was employed to determine stiffnesses and relative interfragmentary motions. FINDINGS Isolated screw constructs showed significantly increased resistance against torsional movement, bending, and shear, (p < 0.05) in comparison to cerclage constructs. The hybrid construct provided no significant changes in stability over the isolated screw construct. INTERPRETATION Addition of cerclage wires in this synthetic bone model of Type C periprosthetic humerus fractures did not add significant stability to proximal bicortical locking plate fixation. Considering risks of tissue stripping and nerve injury, usage of cerclage wires in a similar clinical setting should be chosen carefully, especially when bicortical fixation around the prosthetic stem can be achieved.
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Affiliation(s)
- Richa Gupta
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA.
| | - Elaine C Schmidt
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Surena Namdari
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Michael A Stone
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Michael W Hast
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA.
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8
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Stuart B, Stan G, Popa A, Carrington M, Zgura I, Necsulescu M, Grant D. New solutions for combatting implant bacterial infection based on silver nano-dispersed and gallium incorporated phosphate bioactive glass sputtered films: A preliminary study. Bioact Mater 2022; 8:325-340. [PMID: 34541404 PMCID: PMC8427212 DOI: 10.1016/j.bioactmat.2021.05.055] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 05/29/2021] [Accepted: 05/29/2021] [Indexed: 12/26/2022] Open
Abstract
Ag/Ga were incorporated into resorbable orthopaedic phosphate bioactive glasses (PBG, containing P, Ca, Mg, Na, and Fe) thin films to demonstrate their potential to limit growth of Staphylococcus aureus and Escherichia coli in post-operative prosthetic implantation. Dual target consecutive co-sputtering was uniquely employed to produce a 46 nm Ag:PBG composite observed by high resolution TEM to consist of uniformly dispersed ~5 nm metallic Ag nano-particles in a glass matrix. Ga3+ was integrated into a phosphate glass preform target which was magnetron sputtered to film thicknesses of ~400 or 1400 nm. All coatings exhibited high surface energy of 75.4-77.3 mN/m, attributed to the presence of hydrolytic P-O-P structural surface bonds. Degradation profiles obtained in deionized water, nutrient broth and cell culture medium showed varying ion release profiles, whereby Ga release was measured in 1400 nm coating by ICP-MS to be ~6, 27, and 4 ppm respectively, fully dissolving by 24 h. Solubility of Ag nanoparticles was only observed in nutrient broth (~9 ppm by 24 h). Quantification of colony forming units after 24 h showed encouraging antibacterial efficacy towards both S. aureus (4-log reduction for Ag:PBG and 6-log reduction for Ga-PBG≈1400 nm) and E. coli (5-log reduction for all physical vapour deposited layers) strains. Human Hs27 fibroblast and mesenchymal stem cell line in vitro tests indicated good cytocompatibility for all sputtered layers, with a marginal cell proliferation inertia in the case of the Ag:PBG composite thin film. The study therefore highlights the (i) significant manufacturing development via the controlled inclusion of metallic nanoparticles into a PBG glass matrix by dual consecutive target co-sputtering and (ii) potential of PBG resorbable thin-film structures to incorporate and release cytocompatible/antibacterial oxides. Both architectures showed prospective bio-functional performance for a future generation of endo-osseous implant-type coatings.
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Affiliation(s)
- B.W. Stuart
- Advanced Materials Research Group, Faculty of Engineering, University of Nottingham, Nottingham, NG7 2RD, UK
| | - G.E. Stan
- National Institute of Materials Physics, Magurele, RO, 077125, Romania
| | - A.C. Popa
- National Institute of Materials Physics, Magurele, RO, 077125, Romania
- Army Centre for Medical Research, Bucharest, RO, 010195, Romania
| | - M.J. Carrington
- Advanced Materials Research Group, Faculty of Engineering, University of Nottingham, Nottingham, NG7 2RD, UK
| | - I. Zgura
- National Institute of Materials Physics, Magurele, RO, 077125, Romania
| | - M. Necsulescu
- Army Centre for Medical Research, Bucharest, RO, 010195, Romania
| | - D.M. Grant
- Advanced Materials Research Group, Faculty of Engineering, University of Nottingham, Nottingham, NG7 2RD, UK
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9
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Lu X, Wu Z, Xu K, Wang X, Wang S, Qiu H, Li X, Chen J. Multifunctional Coatings of Titanium Implants Toward Promoting Osseointegration and Preventing Infection: Recent Developments. Front Bioeng Biotechnol 2021; 9:783816. [PMID: 34950645 PMCID: PMC8691702 DOI: 10.3389/fbioe.2021.783816] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 10/25/2021] [Indexed: 01/27/2023] Open
Abstract
Titanium and its alloys are dominant material for orthopedic/dental implants due to their stable chemical properties and good biocompatibility. However, aseptic loosening and peri-implant infection remain problems that may lead to implant removal eventually. The ideal orthopedic implant should possess both osteogenic and antibacterial properties and do proper assistance to in situ inflammatory cells for anti-microbe and tissue repair. Recent advances in surface modification have provided various strategies to procure the harmonious relationship between implant and its microenvironment. In this review, we provide an overview of the latest strategies to endow titanium implants with bio-function and anti-infection properties. We state the methods they use to preparing these efficient surfaces and offer further insight into the interaction between these devices and the local biological environment. Finally, we discuss the unmet needs and current challenges in the development of ideal materials for bone implantation.
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Affiliation(s)
- Xiaoxuan Lu
- Key Laboratory of Oral Diseases Research of Anhui Province, Stomatologic Hospital and College, Anhui Medical University, Hefei, China
| | - Zichen Wu
- Key Laboratory of Oral Diseases Research of Anhui Province, Stomatologic Hospital and College, Anhui Medical University, Hefei, China
| | - Kehui Xu
- Key Laboratory of Oral Diseases Research of Anhui Province, Stomatologic Hospital and College, Anhui Medical University, Hefei, China
| | - Xiaowei Wang
- Key Laboratory of Oral Diseases Research of Anhui Province, Stomatologic Hospital and College, Anhui Medical University, Hefei, China
| | - Shuang Wang
- Key Laboratory of Oral Diseases Research of Anhui Province, Stomatologic Hospital and College, Anhui Medical University, Hefei, China
| | - Hua Qiu
- Key Laboratory of Oral Diseases Research of Anhui Province, Stomatologic Hospital and College, Anhui Medical University, Hefei, China
| | - Xiangyang Li
- Key Laboratory of Oral Diseases Research of Anhui Province, Stomatologic Hospital and College, Anhui Medical University, Hefei, China
| | - Jialong Chen
- Key Laboratory of Oral Diseases Research of Anhui Province, Stomatologic Hospital and College, Anhui Medical University, Hefei, China
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10
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Wuestemann T, Hoare SG, Petersik A, Hofstaetter B, Fehily M, Matsubara M, Markel DC. Bone morphology of the proximal femoral canal: ethnicity related differences and the influence on cementless tapered wedge stem designs. Hip Int 2021; 31:482-491. [PMID: 31868035 DOI: 10.1177/1120700019895458] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Differences in proximal femoral morphology between ethnicities may have implications on the design of cementless tapered wedge stems. This study analyses the differences in Asian and Caucasian bone morphology as well as the related fit of various cementless tapered wedge stem designs. METHODS A computed tomography database and modelling software was used to retrospectively analyse a total of 1345 femora. Ethnicity related comparisons as well as the fit of the stem designs were analysed. RESULTS Statistically significant differences between canal shape of Caucasian and Japanese as well as non-Japanese Asians were observed. The fit of the stems within the femoral canal was highly dependent on the respective stem shape. CONCLUSIONS The shape differences in stem designs had a larger influence on the fit within the femoral canal than the differences in ethnicity related to bone morphology.
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Affiliation(s)
| | | | | | | | | | | | - David C Markel
- The CORE Institute, Wayne State University and Providence Hospital, Detroit, MI, USA
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11
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Baghdadite coating formed by hybrid water-stabilized plasma spray for bioceramic applications: Mechanical and biological evaluations. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2021; 122:111873. [PMID: 33641891 DOI: 10.1016/j.msec.2021.111873] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 12/02/2020] [Accepted: 01/02/2021] [Indexed: 02/01/2023]
Abstract
This work studies the mechanical and biological properties of Baghdadite (BAG, Ca3ZrSi2O9) coating manufactured on Ti6Al4V substrates by hybrid water-stabilized plasma spray (WSP-H). Hydroxyapatite (HAp, Ca10(PO4)6(OH)2) coating was produced by gas-stabilized atmospheric plasma spray and used as a reference material. Upon spraying, the BAG coating exhibited lower crystallinity than the HAp coating. Mechanical testing demonstrated superior properties of the BAG coating: its higher hardness, elastic modulus as well as a better resistance to scratch and wear. In the cell viability study, the BAG coating presented better human osteoblast attachment and proliferation on the coating surface after three days and seven days compared to the HAp counterpart. Furthermore, the gene expression study of human osteoblasts indicated that the BAG coating surface showed higher expression levels of osteogenic genes than those on the HAp coating. Overall, this study indicates that enhanced mechanical and bioactive properties can be achieved for the BAG coating compared to the benchmark HAp coating. It is therefore concluded here that the BAG coating is a potential candidate for coating orthopedic implants.
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12
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Mehta N, Serino J, Hur ES, Smith S, Hamid KS, Lee S, Bohl DD. Pathogenesis, Evaluation, and Management of Osteolysis Following Total Ankle Arthroplasty. Foot Ankle Int 2021; 42:230-242. [PMID: 33345610 DOI: 10.1177/1071100720978426] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Periprosthetic osteolysis is a common occurrence after total ankle arthroplasty (TAA) and poses many challenges for the foot and ankle surgeon. Osteolysis may be asymptomatic and remain benign, or it may lead to component instability and require revision or arthrodesis. In this article, we present a current and comprehensive review of osteolysis in TAA with illustrative cases. We examine the basic science principles behind the etiology of osteolysis, discuss the workup of a patient with suspected osteolysis, and present a review of the evidence of various management strategies, including grafting of cysts, revision TAA, and arthrodesis.Level of Evidence: Level V, expert opinion.
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Affiliation(s)
- Nabil Mehta
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Joseph Serino
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Edward S Hur
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Shelby Smith
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kamran S Hamid
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Simon Lee
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Daniel D Bohl
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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13
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A multifaceted biomimetic interface to improve the longevity of orthopedic implants. Acta Biomater 2020; 110:266-279. [PMID: 32344174 DOI: 10.1016/j.actbio.2020.04.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/23/2020] [Accepted: 04/09/2020] [Indexed: 01/22/2023]
Abstract
The rise of additive manufacturing has provided a paradigm shift in the fabrication of precise, patient-specific implants that replicate the physical properties of native bone. However, eliciting an optimal biological response from such materials for rapid bone integration remains a challenge. Here we propose for the first time a one-step ion-assisted plasma polymerization process to create bio-functional 3D printed titanium (Ti) implants that offer rapid bone integration. Using selective laser melting, porous Ti implants with enhanced bone-mimicking mechanical properties were fabricated. The implants were functionalized uniformly with a highly reactive, radical-rich polymeric coating generated using a unique combination of plasma polymerization and plasma immersion ion implantation. We demonstrated the performance of such activated Ti implants with a focus on the coating's homogeneity, stability, and biological functionality. It was shown that the optimized coating was highly robust and possessed superb physico-chemical stability in a corrosive physiological solution. The plasma activated coating was cytocompatible and non-immunogenic; and through its high reactivity, it allowed for easy, one-step covalent immobilization of functional biomolecules in the absence of solvents or chemicals. The activated Ti implants bio-functionalized with bone morphogenetic protein 2 (BMP-2) showed a reduced protein desorption and a more sustained osteoblast response both in vitro and in vivo compared to implants modified through conventional physisorption of BMP-2. The versatile new approach presented here will enable the development of bio-functionalized additively manufactured implants that are patient-specific and offer improved integration with host tissue. STATEMENT OF SIGNIFICANCE: Additive manufacturing has revolutionized the fabrication of patient-specific orthopedic implants. Although such 3D printed implants can show desirable mechanical and mass transport properties, they often require surface bio-functionalities to enable control over the biological response. Surface covalent immobilization of bioactive molecules is a viable approach to achieve this. Here we report the development of additively manufactured titanium implants that precisely replicate the physical properties of native bone and are bio-functionalized in a simple, reagent-free step. Our results show that covalent attachment of bone-related growth factors through ion-assisted plasma polymerized interlayers circumvents their desorption in physiological solution and significantly improves the bone induction by the implants both in vitro and in vivo.
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14
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Doyle R, van Arkel RJ, Jeffers JRT. Effect of impaction energy on dynamic bone strains, fixation strength, and seating of cementless acetabular cups. J Orthop Res 2019; 37:2367-2375. [PMID: 31317554 PMCID: PMC6851739 DOI: 10.1002/jor.24418] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 07/02/2019] [Indexed: 02/04/2023]
Abstract
Seating a cementless acetabular cup via impaction is a balancing act; good cup fixation must be obtained to ensure adequate bone in-growth and cup apposition, while acetabular fracture must be avoided. Good impaction technique is essential to the success of hip arthroplasty. Yet little guidance exists in the literature to inform surgeons on "how hard" to hit. A drop rig and synthetic bone model were used to vary the energy of impaction strikes in low and high-density synthetic bone, while key parameters such as dynamic strain (quantifying fracture risk), implant fixation, and polar gap were measured. For high energy impaction (15 J) in low-density synthetic bone, a peak tensile strain was observed during impaction that was up to 3.4× as large as post-strike strain, indicating a high fracture risk. Diminishing returns were observed for pushout fixation with increasing energy. Eighty-five percent of the pushout fixation achieved using a 15 J impaction strike was attained by using a 7.5 J strike energy. Similarly, polar gap was only minimally reduced at high impaction energies. Therefore it is suggested that higher energy strikes increase fracture risk, but do not offer large improvements to fixation or implant-bone apposition. It may difficult be for surgeons to accurately deliver specific impaction energies, suggesting there is scope for operative tools to manage implant seating. © 2019 The Authors. Journal of Orthopaedic Research® published by Wiley Periodicals, Inc. on behalf of Orthopaedic Research Society. J Orthop Res 37:2367-2375, 2019.
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Affiliation(s)
- Ruben Doyle
- Department of Mechanical EngineeringImperial College LondonLondonSW7 2AZUnited Kingdom
| | - Richard J. van Arkel
- Department of Mechanical EngineeringImperial College LondonLondonSW7 2AZUnited Kingdom
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15
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Goodman SB, Pajarinen J, Yao Z, Lin T. Inflammation and Bone Repair: From Particle Disease to Tissue Regeneration. Front Bioeng Biotechnol 2019; 7:230. [PMID: 31608274 PMCID: PMC6761220 DOI: 10.3389/fbioe.2019.00230] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 09/06/2019] [Indexed: 12/17/2022] Open
Abstract
When presented with an adverse stimulus, organisms evoke an immediate, pre-programmed, non-specific innate immune response. The purpose of this reaction is to maintain the organism's biological integrity and function, mitigate or eradicate the injurious source, and re-establish tissue homeostasis. The initial stage of this protective reaction is acute inflammation, which normally reduces or terminates the offending stimulus. As the inflammatory reaction recedes, the stage of tissue repair and regeneration follows. If the above sequence of events is perturbed, reconstitution of normal biological form and function will not be achieved. Dysregulation of these activities may result in incomplete healing, fibrosis, or chronic inflammation. Our laboratory has studied the reaction to wear particles from joint replacements as a paradigm for understanding the biological pathways of acute and chronic inflammation, and potential translational treatments to reconstitute lost bone. As inflammation is the cornerstone for healing in all anatomical locations, the concepts developed have relevance to tissue engineering and regenerative medicine in all organ systems. To accomplish our goal, we developed novel in vitro and in vivo models (including the murine femoral continuous intramedullary particle infusion model), translational strategies including modulation of macrophage chemotaxis and polarization, and methods to interfere with key transcription factors NFκB and MyD88. We purposefully modified MSCs to facilitate bone healing in inflammatory scenarios: by preconditioning the MSCs, and by genetically modifying MSCs to first sense NFκB activation and then overexpress the anti-inflammatory pro-regenerative cytokine IL-4. These advancements provide significant translational opportunities to enhance healing in bone and other organs.
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Affiliation(s)
- Stuart B Goodman
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, CA, United States.,Department of Bioengineering, Stanford University, Stanford, CA, United States.,Department of Medicine, Clinicum, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jukka Pajarinen
- Department of Medicine, Clinicum, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Zhenyu Yao
- Orthopaedic Research Laboratories, Stanford University, Stanford, CA, United States
| | - Tzuhua Lin
- Orthopaedic Research Laboratories, Stanford University, Stanford, CA, United States
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16
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The Inhibition of Radial and Axial Micromovement of Bone Scaffold with Gelfoam ® and Titanium Mesh Fixation and Its Effects on Osteointegration. Methods Protoc 2019; 2:mps2010020. [PMID: 31164601 PMCID: PMC6481059 DOI: 10.3390/mps2010020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 02/07/2019] [Accepted: 02/22/2019] [Indexed: 11/17/2022] Open
Abstract
A major drawback of nanocomposite scaffolds in bone tissue engineering is dimensional shrinkage after the fabrication process. Shrinkage yields gaps between the scaffold and host bone in the defect site and eventually causes failure in osteointegration by micromovement. The present study was conducted using titanium (Ti) mesh and Gelfoam® to prevent radial and axial micromovement, respectively. A critical-sized defect (CSD) was created in the center of the calvarium of Sprague Dawley rats to implant porous polydopamine-laced hydroxyapatite collagen calcium silicate (HCCS-PDA), a novel nanocomposite scaffold. Gelfoam® was applied around the edge of the defect, and then the HCCS-PDA scaffold was inserted in the defect area. Ti mesh was placed between the periosteum and skin right, above the inserted scaffold site. There were two test groups, with a fixture (Gelfoam® and Ti mesh) and without a fixture, each group contained five animals. The rats were sacrificed after three months post-operation. The explanted calvaria underwent micro-CT scanning and a push-out test to quantify osteointegration and mechanical strength between the scaffold and host bone. Histological analysis of undecalcified bone was performed by grinding resin infiltrated calvaria blocks to prepare 10 μm slices. Osteointegration was higher in the group with fixation than without fixation. Movement of the HCCS-PDA scaffold in the gap resulted in diminished osteointegration. With fixation, the movement was inhibited and osteointegration became prominent. Here we present a successful method of preventing axial and radial movement of scaffolds using Gelfoam® and Ti mesh. Applying this fixture, we expect that an HCCS-PDA scaffold can repair CSD more effectively.
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17
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Juboori MJA, Attas MAA, Gomes RZ, Alanbari BF. Using Resonance Frequency Analysis to Compare Delayed and Immediate Progressive Loading for Implants Placed in the Posterior Maxilla: A Pilot Study. Open Dent J 2018; 12:801-810. [PMID: 30450138 PMCID: PMC6198410 DOI: 10.2174/1745017901814010801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 09/05/2018] [Accepted: 09/25/2018] [Indexed: 11/24/2022] Open
Abstract
Objective: Implants placed in the posterior region of the maxilla have a high incidence of implant failure due to poor bone quality, especially when immediate implant loading is needed. Immediate Progressive Loading (IPL) can enhance bone quality and may offer an alternative solution when Immediate Implant loading is needed. Methods: Six patients (one male and five females; 34-62 years old) were included in this study. Twelve implants were inserted in the posterior region of the maxilla. Resonance Frequency Analysis (RFA) was performed at the time of implant placement and after 1, 2, 3 and 6 months. ISQ (Implant Stability Quotient) values were compared between the Delayed Loading (DL) group after 2 months and the Progressive Loading (PL) group and between different time points for each group. Results: At implant placement, the mean ISQ values for PL and DL implants were 63 and 57, respectively. One month after implant placement, the mean ISQ value for PL implants was 73. Two months after implant placement, the mean ISQ value for PL implants was 75. Three months after implant placement, the mean ISQ values for PL and DL implants were 76 and 69, respectively. Six months after implant placement, the mean ISQ values for PL and DL implants were 79 and 76, respectively. Conclusion: Despite its limitations, this pilot study indicated that compared to DL, PL can enhance bone density and implant stability, resulting in greater early functionality and fewer surgery sessions.
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Affiliation(s)
| | - Mohammed Ahmed Al Attas
- Department of Prosthodontic and Dental Implant, Riyadh Dental Center, King Saud Medical City, Riyadh, Saudi Arabia
| | - Raquel Zita Gomes
- Department of Oral Surgery, Faculty of Dental Medicine, University of Porto, Porto, Portugal
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18
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Kushaldeep, Tandan A, Upadhyaya V, Raghuvanshi M. Comparative evaluation of the influence of immediate versus delayed loading protocols of dental implants: A radiographic and clinical study. J Indian Prosthodont Soc 2018; 18:131-138. [PMID: 29692566 PMCID: PMC5903176 DOI: 10.4103/jips.jips_127_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 02/14/2018] [Indexed: 11/16/2022] Open
Abstract
Aim: Immediate loading protocol, in recent times, has gained popularity as it has not only shortened the treatment time but also resulted in enhanced patient satisfaction. The aim of this study was to evaluate and compare the effectiveness of immediate implant loading protocol over conventional implant loading protocol with respect to peri-implant bone loss. Materials and Methods: Twenty patients selected for this study were divided into two groups. In Group I patients, implants were immediately loaded, whereas in Group II, they were loaded with conventional loading protocol. Peri-implant bone loss was measured and compared using intraoral periapical radiographs with the grid at the time of implant loading, 1, 3, and 6 months after implant loading. Results: Change in radiographic bone loss in both the groups was found to be statistically significant when baseline was compared to 1, 3, and 6 months, but the difference in the bone loss between Group I and II was not found to be statistically significant. Conclusion: No statistically significant difference was observed in the crestal bone loss on comparison of immediate loading to delayed loading protocol. Clinical Significance: After achieving good primary stability, immediate-loaded implants can be used for the benefit of the patients as it reduces the period of edentulism.
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Affiliation(s)
- Kushaldeep
- Department of Prosthodontics, Private Practice, Delhi, India.,Department of Prosthodontics, BBDCODS, Lucknow, Uttar Pradesh, India
| | - Amrit Tandan
- Department of Prosthodontics, BBDCODS, Lucknow, Uttar Pradesh, India
| | - Viram Upadhyaya
- Department of Prosthodontics, DAV (C) Dental College Dental College, Yamuna Nagar, Haryana, India
| | - Mohit Raghuvanshi
- Department of Prosthodontics, BBDCODS, Lucknow, Uttar Pradesh, India
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19
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Pajarinen J, Lin TH, Nabeshima A, Jämsen E, Lu L, Nathan K, Yao Z, Goodman SB. Mesenchymal stem cells in the aseptic loosening of total joint replacements. J Biomed Mater Res A 2017; 105:1195-1207. [PMID: 27977880 DOI: 10.1002/jbm.a.35978] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 12/06/2016] [Indexed: 02/06/2023]
Abstract
Peri-prosthetic osteolysis remains as the main long-term complication of total joint replacement surgery. Research over four decades has established implant wear as the main culprit for chronic inflammation in the peri-implant tissues and macrophages as the key cells mediating the host reaction to implant-derived wear particles. Wear debris activated macrophages secrete inflammatory mediators that stimulate bone resorbing osteoclasts; thus bone loss in the peri-implant tissues is increased. However, the balance of bone turnover is not only dictated by osteoclast-mediated bone resorption but also by the formation of new bone by osteoblasts; under physiological conditions these two processes are tightly coupled. Increasing interest has been placed on the effects of wear debris on the cells of the bone-forming lineage. These cells are derived primarily from multipotent mesenchymal stem cells (MSCs) residing in bone marrow and the walls of the microvasculature. Accumulating evidence indicates that wear debris significantly impairs MSC-to-osteoblast differentiation and subsequent bone formation. In this review, we summarize the current understanding of the effects of biomaterial implant wear debris on MSCs. Emerging treatment options to improve initial implant integration and treat developing osteolytic lesions by utilizing or targeting MSCs are also discussed. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 105A: 1195-1207, 2017.
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Affiliation(s)
- Jukka Pajarinen
- Orthopaedic Research Laboratories, Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California
| | - Tzu-Hua Lin
- Orthopaedic Research Laboratories, Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California
| | - Akira Nabeshima
- Orthopaedic Research Laboratories, Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California
| | - Eemeli Jämsen
- Orthopaedic Research Laboratories, Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California.,Department of Medicine, Clinicum, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland
| | - Laura Lu
- Orthopaedic Research Laboratories, Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California
| | - Karthik Nathan
- Orthopaedic Research Laboratories, Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California
| | - Zhenyu Yao
- Orthopaedic Research Laboratories, Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California
| | - Stuart B Goodman
- Orthopaedic Research Laboratories, Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California
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20
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Raphel J, Holodniy M, Goodman SB, Heilshorn SC. Multifunctional coatings to simultaneously promote osseointegration and prevent infection of orthopaedic implants. Biomaterials 2016; 84:301-314. [PMID: 26851394 PMCID: PMC4883578 DOI: 10.1016/j.biomaterials.2016.01.016] [Citation(s) in RCA: 364] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 12/22/2015] [Accepted: 01/01/2016] [Indexed: 12/21/2022]
Abstract
The two leading causes of failure for joint arthroplasty prostheses are aseptic loosening and periprosthetic joint infection. With the number of primary and revision joint replacement surgeries on the rise, strategies to mitigate these failure modes have become increasingly important. Much of the recent work in this field has focused on the design of coatings either to prevent infection while ignoring bone mineralization or vice versa, to promote osseointegration while ignoring microbial susceptibility. However, both coating functions are required to achieve long-term success of the implant; therefore, these two modalities must be evaluated in parallel during the development of new orthopaedic coating strategies. In this review, we discuss recent progress and future directions for the design of multifunctional orthopaedic coatings that can inhibit microbial cells while still promoting osseointegration.
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Affiliation(s)
- Jordan Raphel
- Department of Materials Science and Engineering, Stanford University, Stanford, CA, USA
| | - Mark Holodniy
- Division of Infectious Diseases & Geographic Medicine, Stanford University, Stanford, CA, USA; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Stuart B Goodman
- Department of Orthopaedic Surgery and Bioengineering, Stanford University, Stanford, CA, USA
| | - Sarah C Heilshorn
- Department of Materials Science and Engineering, Stanford University, Stanford, CA, USA.
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21
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Raphel J, Karlsson J, Galli S, Wennerberg A, Lindsay C, Haugh MG, Pajarinen J, Goodman SB, Jimbo R, Andersson M, Heilshorn SC. Engineered protein coatings to improve the osseointegration of dental and orthopaedic implants. Biomaterials 2016; 83:269-82. [PMID: 26790146 PMCID: PMC4771523 DOI: 10.1016/j.biomaterials.2015.12.030] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 12/19/2015] [Accepted: 12/29/2015] [Indexed: 01/10/2023]
Abstract
Here we present the design of an engineered, elastin-like protein (ELP) that is chemically modified to enable stable coatings on the surfaces of titanium-based dental and orthopaedic implants by novel photocrosslinking and solution processing steps. The ELP includes an extended RGD sequence to confer bio-signaling and an elastin-like sequence for mechanical stability. ELP thin films were fabricated on cp-Ti and Ti6Al4V surfaces using scalable spin and dip coating processes with photoactive covalent crosslinking through a carbene insertion mechanism. The coatings withstood procedures mimicking dental screw and hip replacement stem implantations, a key metric for clinical translation. They promoted rapid adhesion of MG63 osteoblast-like cells, with over 80% adhesion after 24 h, compared to 38% adhesion on uncoated Ti6Al4V. MG63 cells produced significantly more mineralization on ELP coatings compared to uncoated Ti6Al4V. Human bone marrow mesenchymal stem cells (hMSCs) had an earlier increase in alkaline phosphatase activity, indicating more rapid osteogenic differentiation and mineral deposition on adhesive ELP coatings. Rat tibia and femur in vivo studies demonstrated that cell-adhesive ELP-coated implants increased bone-implant contact area and interfacial strength after one week. These results suggest that ELP coatings withstand surgical implantation and promote rapid osseointegration, enabling earlier implant loading and potentially preventing micromotion that leads to aseptic loosening and premature implant failure.
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Affiliation(s)
- Jordan Raphel
- Department of Materials Science and Engineering, Stanford University, Stanford, CA, USA
| | - Johan Karlsson
- Department of Chemistry and Chemical Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Silvia Galli
- Department of Prosthodontics, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Ann Wennerberg
- Department of Prosthodontics, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Christopher Lindsay
- Department of Materials Science and Engineering, Stanford University, Stanford, CA, USA
| | - Matthew G Haugh
- Department of Materials Science and Engineering, Stanford University, Stanford, CA, USA
| | - Jukka Pajarinen
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA
| | - Stuart B Goodman
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA
| | - Ryo Jimbo
- Department of Prosthodontics, Faculty of Odontology, Malmö University, Malmö, Sweden; Department of Oral and Maxillofacial Surgery and Oral Medicine, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Martin Andersson
- Department of Chemistry and Chemical Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Sarah C Heilshorn
- Department of Materials Science and Engineering, Stanford University, Stanford, CA, USA.
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22
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Chung EJ, Sugimoto MJ, Koh JL, Ameer GA. A biodegradable tri-component graft for anterior cruciate ligament reconstruction. J Tissue Eng Regen Med 2014; 11:704-712. [PMID: 25414080 DOI: 10.1002/term.1966] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 08/29/2014] [Accepted: 09/17/2014] [Indexed: 01/14/2023]
Abstract
Bone-patellar tendon-bone (BPTB) autografts are the gold standard for anterior cruciate ligament (ACL) reconstruction because the bony ends allow for superior healing and anchoring through bone-to-bone regeneration. However, the disadvantages of BPTB grafts include donor site morbidity and patellar rupture. In order to incorporate bone-to-bone healing without the risks associated with harvesting autogenous tissue, a biodegradable and synthetic tri-component graft was fabricated, consisting of porous poly(1,8-octanediol-co-citric acid)-hydroxyapatite nanocomposites (POC-HA) and poly(l-lactide) (PLL) braids. All regions of the tri-component graft were porous and the tensile properties were in the range of the native ACL. When these novel grafts were used to reconstruct the ACL of rabbits, all animals after 6 weeks were weight-bearing and showed good functionality. Histological assessment confirmed tissue infiltration throughout the entire scaffold and tissue ingrowth and interlocking within the bone tunnels, which is favourable for graft fixation. In conclusion, this pilot study suggests that a tri-component, biodegradable graft is a promising strategy to regenerate tissue types necessary for ACL tissue engineering, and provides a basis for developing an off-the-shelf graft for ACL repair. Copyright © 2014 John Wiley & Sons, Ltd.
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Affiliation(s)
- Eun Ji Chung
- Biomedical Engineering Department, Northwestern University, Evanston, IL, USA
| | - Matthew J Sugimoto
- Biomedical Engineering Department, Northwestern University, Evanston, IL, USA
| | - Jason L Koh
- Department of Orthopaedic Surgery, North Shore University Health System, Evanston, IL, USA
| | - Guillermo A Ameer
- Biomedical Engineering Department, Northwestern University, Evanston, IL, USA.,Department of Surgery, Northwestern University, Chicago, IL, USA.,Simpson-Querrey Institute for Bionanotechnology, Northwestern University, Chicago, IL, USA.,Chemistry of Life Processes Institute, Northwestern University, Evanston, IL, USA
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23
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Howard KI, Miller MA, Damron TA, Mann KA. The distribution of implant fixation for femoral components of TKA: a postmortem retrieval study. J Arthroplasty 2014; 29:1863-70. [PMID: 24845717 PMCID: PMC4164597 DOI: 10.1016/j.arth.2014.04.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 04/07/2014] [Accepted: 04/13/2014] [Indexed: 02/01/2023] Open
Abstract
Aseptic loosening of total knee arthroplasty (TKA) components is the foremost cause of implant failure in the long term. While tibial component loosening is of primary concern, femoral loosening may become a clinical problem due to younger, more active patients seeking TKA, and also high-flexion designs. In this study, we analyzed the fixation for 19 non-revised, postmortem retrieved, femoral components of TKA with time in service ranging from 1 to 22 years. We found that the average total contact fraction for cemented components was 9.5% and had a power law response (decrease) with years in service. The average initial interdigitation depth was 0.7mm, and the average current interdigitation depth was 0.13mm. Loss of interdigitation was 81%. Over all, minimal fixation seems necessary for long-term success of TKA femoral components.
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Ferreira MB, Barão VA, Delben JA, Faverani LP, Hipólito AC, Assunção WG. Non-linear 3D finite element analysis of full-arch implant-supported fixed dentures. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2014; 38:306-14. [DOI: 10.1016/j.msec.2014.02.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 01/14/2014] [Accepted: 02/16/2014] [Indexed: 12/01/2022]
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25
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Periprosthetic wear particle migration and distribution modelling and the implication for osteolysis in cementless total hip replacement. J Mech Behav Biomed Mater 2014; 32:225-244. [DOI: 10.1016/j.jmbbm.2014.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 01/03/2014] [Accepted: 01/08/2014] [Indexed: 11/19/2022]
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26
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The Role of Oxidative Stress in the Response of Endothelial Cells to Metals. SPRINGER SERIES IN BIOMATERIALS SCIENCE AND ENGINEERING 2013. [DOI: 10.1007/978-1-4614-4328-5_4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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27
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Overgaard S. Calcium phosphate coatings for fixation of bone implants. Evaluated mechanically and histologically by stereological methods. ACTA ACUST UNITED AC 2011. [DOI: 10.1080/000164702760300297] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Langlois J, Hamadouche M. New animal models of wear-particle osteolysis. INTERNATIONAL ORTHOPAEDICS 2010; 35:245-51. [PMID: 21069525 DOI: 10.1007/s00264-010-1143-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Accepted: 10/15/2010] [Indexed: 12/22/2022]
Abstract
Particle debris resulting from in vivo degradation of total joint replacement components are recognised as the major factor limiting the longevity of joint reconstruction and the overall success of the procedure. Better understanding the complex cellular and tissue mechanisms and interactions resulting in wear-particle osteolysis requires a number of experimental approaches, including radiological monitoring and analysis of retrieved tissues from clinical cases, in vitro experiments, and also animal-model investigations. In consideration of both their advantages and drawbacks, this paper provides an historical overview of numerous animal models that have been developed over the last three decades to investigate the pathogenesis of wear-particle osteolysis and to facilitate the preclinical testing of new treatment options. The authors also focus on recent studies in order to provide a better understanding of the current state of the art on this subject and propose some perspectives regarding technical and fundamental questions.
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Affiliation(s)
- Jean Langlois
- Department of Orthopaedic and Reconstructive Surgery Service A, Centre Hospitalo-Universitaire Cochin-Port Royal, 27 Rue du Faubourg St Jacques, 75014 Paris, France.
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29
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Cristofolini L, Schileo E, Juszczyk M, Taddei F, Martelli S, Viceconti M. Mechanical testing of bones: the positive synergy of finite-element models and in vitro experiments. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2010; 368:2725-2763. [PMID: 20439271 DOI: 10.1098/rsta.2010.0046] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Bone biomechanics have been extensively investigated in the past both with in vitro experiments and numerical models. In most cases either approach is chosen, without exploiting synergies. Both experiments and numerical models suffer from limitations relative to their accuracy and their respective fields of application. In vitro experiments can improve numerical models by: (i) preliminarily identifying the most relevant failure scenarios; (ii) improving the model identification with experimentally measured material properties; (iii) improving the model identification with accurately measured actual boundary conditions; and (iv) providing quantitative validation based on mechanical properties (strain, displacements) directly measured from physical specimens being tested in parallel with the modelling activity. Likewise, numerical models can improve in vitro experiments by: (i) identifying the most relevant loading configurations among a number of motor tasks that cannot be replicated in vitro; (ii) identifying acceptable simplifications for the in vitro simulation; (iii) optimizing the use of transducers to minimize errors and provide measurements at the most relevant locations; and (iv) exploring a variety of different conditions (material properties, interface, etc.) that would require enormous experimental effort. By reporting an example of successful investigation of the femur, we show how a combination of numerical modelling and controlled experiments within the same research team can be designed to create a virtuous circle where models are used to improve experiments, experiments are used to improve models and their combination synergistically provides more detailed and more reliable results than can be achieved with either approach singularly.
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Tibial tunnel widening after bioresorbable poly-lactide calcium carbonate interference screw usage in ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2010; 18:79-84. [PMID: 19609505 DOI: 10.1007/s00167-009-0865-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2009] [Accepted: 06/18/2009] [Indexed: 01/23/2023]
Abstract
Developing bio-absorbable interference screws for anterior cruciate ligament (ACL) reconstruction has proven to be a challenging task. The aim of this study was to investigate the osteogenetic response of poly-lactide carbonate (PLC) interference screws in ACL reconstruction in humans. Ten patients (median age, 28 years) underwent arthroscopic ACL reconstruction with semitendinosus/gracilis tendon graft and a PLC interference screw. The patients were scanned with a multi-slice CT scanner 2 weeks and 1 year postoperatively. Fourteen days postoperatively a mean tunnel widening of 78% [52%; 110%] was observed. At 1-year follow-up, the mean tunnel widening was 128% [84%; 180%]. No sign of bone replacement or bone ingrowth was observed. Factors such as accelerated rehabilitation, micro-motions, and early screw degradation might be responsible for this large tunnel widening. Our results demonstrate the difficulty in translation of preclinical data. This study illustrates the need for extensive preclinical investigation of new materials for clinical purposes.
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Abstract
Currently, there are many options in cartilage repair. These cartilage repair techniques can generally be categorized into 3 groups: marrow stimulation-based techniques, osteochondral transfer techniques, and cell-based cartilage repair techniques. This review article presents an overview of these techniques, indications for usage, advantages and disadvantages of each, and a current review of applications in foot and ankle surgery.
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Affiliation(s)
- Benjamin L Clair
- Department of Orthopaedics, Hennepin County Medical Center, Minneapolis, Minnesota, USA.
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32
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Søballe K, Mouzin ORG, Kidder LA, Overgaard S, Bechtold JE. The effects of hydroxyapatite coating and bone allograft on fixation of loaded experimental primary and revision implants. ACTA ACUST UNITED AC 2009. [DOI: 10.1080/00016470308540836] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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34
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Ma T, Ren PG, Larsen DM, Suenaga E, Zilber S, Genovese M, Smith RL, Goodman SB. Efficacy of a p38 mitogen activated protein kinase inhibitor in mitigating an established inflammatory reaction to polyethylene particles in vivo. J Biomed Mater Res A 2008; 89:117-23. [PMID: 18431764 DOI: 10.1002/jbm.a.31957] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The inhibitor of p38 mitogen-activated protein kinase (MAPK) is of interest in the nonoperative treatment of periprosthetic osteolysis due to wear particles. Previous studies demonstrated that an oral p38 MAPK inhibitor did not suppress bone formation when given during the initial phase of tissue differentiation. However, the oral p38 MAPK inhibitor also did not curtail the foreign body and chronic inflammatory response to particles when given simultaneously. The purpose of the current study was to examine the efficacy of a p38 MAPK inhibitor, SCIO-323, on mitigating an established inflammatory reaction that parallels the clinical situation more closely. The Bone Harvest Chamber was implanted in rabbits and submicron polyethylene particles were placed in the chamber for 6 weeks. The contents of the chambers were harvested every 6 weeks. Oral treatment with the SCIO-323 included delivery for 3 weeks and stopping for 3 weeks, delivery for 3 weeks after an initial 3-week delay, and delivery for 6 weeks continuously. Administration of the SCIO-323 continuously for 6 weeks with/without the presence of particles, or for the initial 3 of 6 weeks had minor effects on bone ingrowth. After establishing a particle-induced chronic inflammatory reaction for 3 weeks, administration of SCIO-323 for a subsequent 3 weeks suppressed net bone formation. The activity of osteoclast-like cells remained low among all treatments when compared with the first control. Using the present model, the oral p38 MAPK inhibitor was ineffective in improving bone ingrowth in the presence of polyethylene particles.
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Affiliation(s)
- T Ma
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
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What experimental approaches (eg, in vivo, in vitro, tissue retrieval) are effective in investigating the biologic effects of particles? J Am Acad Orthop Surg 2008; 16 Suppl 1:S63-7. [PMID: 18612016 PMCID: PMC2735389 DOI: 10.5435/00124635-200800001-00013] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Understanding the complex cellular and tissue mechanisms and interactions resulting in periprosthetic osteolysis requires a number of experimental approaches, each of which has its own set of advantages and limitations. In vitro models allow for the isolation of individual cell populations and have furthered our understanding of particle-cell interactions; however, they are limited because they do not mimic the complex tissue environment in which multiple cell interactions occur. In vivo animal models investigate the tissue interactions associated with periprosthetic osteolysis, but the choice of species and whether the implant system is subjected to mechanical load or to unloaded conditions are critical in assessing whether these models can be extrapolated to the clinical condition. Rigid analysis of retrieved tissue from clinical cases of osteolysis offers a different approach to studying the biologic process of osteolysis, but it is limited in that the tissue analyzed represents the end-stage of this process and, thus, may not reflect this process adequately.
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Lannocca M, Varini E, Cappello A, Cristofolini L, Bialoblocka E. Intra-operative evaluation of cementless hip implant stability: A prototype device based on vibration analysis. Med Eng Phys 2007; 29:886-94. [PMID: 17101289 DOI: 10.1016/j.medengphy.2006.09.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2006] [Revised: 09/19/2006] [Accepted: 09/24/2006] [Indexed: 10/23/2022]
Abstract
Cementless implants are mechanically stabilized during surgery by a press-fitting procedure. Good initial stability is crucial to avoid stem loosening and bone cracking, therefore, the surgeon must achieve optimal press-fitting. A possible approach to solve this problem and assist the surgeon in achieving the optimal compromise, involves the use of vibration analysis. The present study aimed to design and test a prototype device able to evaluate the primary mechanical stability of a cementless prosthesis, based on vibration analysis. In particular, the goal was to discriminate between stable and quasi-stable implants; thus the stem-bone system was assumed to be linear in both cases. For that reason, it was decided to study the frequency responses of the system, instead of the harmonic distortion. The prototype developed consists of a piezoelectric exciter connected to the stem and an accelerometer attached to the femur. Preliminary tests were performed on four composite femurs implanted with a conventional stem. The results showed that the input signal was repeatable and the output could be recorded accurately. The most sensitive parameter to stability was the shift in resonance frequency of the stem-bone system, which was highly correlated with residual micromotion on all four specimens.
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Affiliation(s)
- Maurizio Lannocca
- University of Bologna, Engineering Faculty, DEIS, Viale Risorgimento 2, 40136 Bologna, Italy.
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Ma T, Gutnick J, Salazar B, Larsen MD, Suenaga E, Zilber S, Huang Z, Huddleston J, Smith RL, Goodman S. Modulation of allograft incorporation by continuous infusion of growth factors over a prolonged duration in vivo. Bone 2007; 41:386-92. [PMID: 17613298 DOI: 10.1016/j.bone.2007.05.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2007] [Revised: 04/30/2007] [Accepted: 05/02/2007] [Indexed: 11/16/2022]
Abstract
Morselized cancellous allograft bone is frequently used in the reconstruction of bone defects in cases of revision total joint replacement, trauma, spine fusion and treated infection. However, the initial lack of viable bone cells in morselized allograft bone significantly slows the process of graft incorporation compared to autograft bone. This study examined the effects of prolonged local infusion of the growth factors bone morphogenic protein-7 (BMP-7 or OP-1) and fibroblast growth factor-2 (FGF-2 or basic FGF) in the process of allograft incorporation using a rabbit tibial chamber model. New bone formation was evaluated by two indices, the activity of alkaline phosphatase and the level of birefringence. The markers of osteoclast-like cells were also measured. Without the infusion of the growth factors, lower levels of new bone formation were observed in the allograft group, compared to the autograft group. Infusion of growth factors FGF-2 and OP-1, singly or in combination, for 4 weeks, diminished this difference. The numbers of osteoclast-like cells were much higher in the allograft group before the growth factors were delivered. The infusion of FGF, singly, diminished this difference. However, the infusion of OP-1 or the combination of FGF and OP-1 did not decrease the number of osteoclast-like cells to a level comparable to autograft only. Local infusion of growth factors appears to be a useful adjunct to promote the incorporation of allograft bone in vivo.
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Affiliation(s)
- Ting Ma
- The Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA 94305-5326, USA
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Baumann B, Seufert J, Rolf O, Jakob F, Goebel S, Eulert J, Rader CP. Upregulation of LITAF mRNA expression upon exposure to TiAlV and polyethylene wear particles in THP-1 macrophages. BIOMED ENG-BIOMED TE 2007; 52:200-7. [PMID: 17408380 DOI: 10.1515/bmt.2007.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Tumor necrosis factor alpha (TNFalpha) plays a fundamental role in the pathogenesis of wear particle-induced periprosthetic osteolysis. However, particle-induced mechanisms that control TNFalpha gene expression are not yet well characterized. LITAF [lipopolysaccharide (LPS)-induced TNFalpha factor] is a novel transcription factor that regulates expression of the TNFalpha gene, but nothing is known about its role in wear particle-induced osteolysis. We evaluated the effect of titanium aluminum vanadium (TiAlV) and polyethylene particles on mRNA expression of LITAF. A human monocytic leukemia cell line (THP-1) was used in this in vitro study. THP-1 monocytes were differentiated to macrophage-like cells and exposed to LPS-detoxified polyethylene particles and prosthesis-derived TiAlV particles. Supernatant was used for TNFalpha protein measurement and total RNA was extracted from cells. LITAF was analyzed at the mRNA level using semiquantitative RT-PCR. Both polyethylene and TiAlV particles induced significant upregulation of LITAF mRNA that was followed by a significant TNFalpha response. These effects were dependent on the particle dose. Low particle concentrations exhibited no significant effect on expression of TNFalpha and LITAF mRNA. In comparison to exposure to polyethylene and TiAlV particles, LPS stimulation exhibited similar upregulation of LITAF mRNA, but led to an overwhelming TNFalpha response. Our findings provide evidence that LITAF is implicated in the pathogenesis of wear particle-induced osteolysis.
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Affiliation(s)
- Bernd Baumann
- Department of Orthopedic Surgery, Julius-Maximilians University Würzburg, Würzburg, Germany.
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Ma T, Nelson ER, Mawatari T, Oh KJ, Larsen DM, Smith RL, Goodman SB. Effects of local infusion of OP-1 on particle-induced and NSAID-induced inhibition of bone ingrowth in vivo. J Biomed Mater Res A 2007; 79:740-6. [PMID: 16988970 DOI: 10.1002/jbm.a.30949] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Excessive polyethylene wear particles from joint replacements may lead to periprosthetic osteolysis and loosening. Nonsteroidal anti-inflammatory drugs (NSAIDs) decrease fracture healing and bone ingrowth. We hypothesized that continuous local infusion of OP-1 (BMP-7) would increase local bone formation in the presence of two different adverse stimuli, polyethylene particles, and an oral NSAID. The Drug Test Chamber (DTC) was implanted in the proximal tibia of mature rabbits. The tissue growing into the chamber was exposed to OP-1 solution (110 ng/day), which was infused via an osmotic pump. Infusion of OP-1 alone for 6 weeks enhanced local bone formation in the chamber by 80% (p < 0.05) over infusion of carrier alone. In the presence of polyethylene particles, infusion of OP-1 increased local bone formation by 38% (p < 0.05) over treatment with particles and carrier. Oral administration of NSAID reduced local bone formation by 58% (p < 0.05); this suppressive effect caused by NSAIDS was completely reversed by the infusion of OP-1 (p < 0.05). These findings underline a potential role for local treatment with OP-1 to increase bone formation in the presence of potentially adverse stimuli such as polyethylene wear particles or NSAID use.
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Affiliation(s)
- T Ma
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
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Baumann B, Rolf O, Jakob F, Goebel S, Sterner T, Eulert J, Rader CP. Synergistic effects of mixed TiAlV and polyethylene wear particles on TNFα response in THP-1 macrophages / Synergistische Effekte gemischter TiAlV- und Polyethylen-Abriebpartikel auf die TNFα-Antwort in THP-1 Makrophagen. BIOMED ENG-BIOMED TE 2006; 51:360-6. [PMID: 17155873 DOI: 10.1515/bmt.2006.070] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
TNFalpha is a potent osteoclastogenic cytokine that has a fundamental role in the pathogenesis of wear particle-induced osteolysis. Wear particles of one composition and their biological effects are well characterised. In contrast, little is known about the effects of mixed particles with respect to mix ratio and particle concentration. We evaluated the effects of different mix ratios of polyethylene and TiAlV particles on TNFalpha response. We used a human monocytic cell line (THP-1) in this in vitro study. THP-1 monocytes were differentiated to macrophage-like cells and exposed to different mixtures of lipopolysaccharide-detoxified polyethylene and TiAlV particles. TNFalpha was analysed in culture supernatants using ELISAs. Both polyethylene and TiAlV particles induced a dose- and time-related release of TNFalpha, with maximum levels after 6 h. A PE/TiAlV mix ratio of 36:1 at 10(8) particles/ml induced significantly higher TNFalpha concentrations compared to equal particle concentrations of isolated TiAlV (p=0.047) or PE (p=0.044), indicating the synergistic effect of mixed particles. These results provide evidence that TiAlV and polyethylene particles have significant synergistic effects, depending on the mix ratio and particle concentrations. This supra-additive effect can contribute substantially to the pathogenesis of implant particle-induced osteolysis.
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Affiliation(s)
- Bernd Baumann
- Department of Orthopaedic Surgery, Julius-Maximilians University Würzburg, Würzburg, Germany.
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Wang J, Diaz J, Sabokbar A, Athanasou N, Kjellson F, Tanner K, McCarthy I, Lidgren L. In vitro and in vivo biological responses to a novel radiopacifying agent for bone cement. J R Soc Interface 2006; 2:71-8. [PMID: 16849166 PMCID: PMC1578263 DOI: 10.1098/rsif.2004.0009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Iodixanol (IDX) and iohexol (IHX) have been investigated as possible radiopacification agents for polymethylmethacrylate (PMMA) bone cement, to replace the currently used barium sulphate and zirconia. IDX and IHX are both water-soluble iodine-based contrast media and for the last 20 years have been used extensively in clinical diagnostic procedures such as contrast media enhanced computed tomography, angiography and urography. One of the major reasons to remove the current radiopacifying agents is their well-documented cytotoxicity and their potential to increase bone resorption. Using in vitro bone resorption assays, the effect of PMMA particles plus IDX or IHX to induce osteoclast formation and lacunar resorption on dentine slices has been investigated. These responses have been compared with the in vitro response to PMMA particles containing the conventional radiopacifying agents, that is, barium sulphate and zirconia. In parallel, the in vivo reaction, in terms of new bone formation, to particles of these materials has been tested using a bone harvest chamber in rabbit tibiae. In vitro cell culture showed that PMMA containing IHX resulted in significantly less bone resorption than PMMA containing the conventional opacifiers. In vivo testing, however, showed no significant differences between the amounts of new bone formed around cement samples containing the two iodine-based opacifying agents in particulate form, although both led to fewer inflammatory cells than particles of PMMA containing zirconia. Our results suggest that a non-ionic radiopacifier could be considered as an alternative to the conventional radiopacifying agents used in biomaterials in orthopaedic surgery.
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Affiliation(s)
- J.S Wang
- Department of Orthopaedics, Lund UniversityLund 22185, Sweden
| | - J Diaz
- Nuffield Orthopaedic CentreWindmill Road, Headington, Oxford OX3 7LD, UK
| | - A Sabokbar
- Nuffield Orthopaedic CentreWindmill Road, Headington, Oxford OX3 7LD, UK
| | - N Athanasou
- Nuffield Orthopaedic CentreWindmill Road, Headington, Oxford OX3 7LD, UK
| | - F Kjellson
- Department of Orthopaedics, Lund UniversityLund 22185, Sweden
| | - K.E Tanner
- Department of Materials, Queen Mary University of LondonMile End Road, London E1 4NS, UK
- Author for correspondence ()
| | - I.D McCarthy
- Department of Orthopaedics, Lund UniversityLund 22185, Sweden
| | - L Lidgren
- Department of Orthopaedics, Lund UniversityLund 22185, Sweden
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Cristofolini L, Varini E, Pelgreffi I, Cappello A, Toni A. Device to measure intra-operatively the primary stability of cementless hip stems. Med Eng Phys 2006; 28:475-82. [PMID: 16144768 DOI: 10.1016/j.medengphy.2005.07.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2005] [Revised: 07/18/2005] [Accepted: 07/19/2005] [Indexed: 11/29/2022]
Abstract
The primary stability of cementless prostheses is critical for the long-term outcome of the operation. Surgeons are currently driven only by their experience in evaluating the extent of stem stability achieved. The aim of the present work was to develop a new device that enables the stability of a cementless stem to be quantitatively assessed intraoperatively. The angle of the stem/femur rotation under torsion and the torque are acquired and compared in real-time to a pre-set threshold inferred from the literature. The device indicates whether the stem is stable or not. It was extensively tested and finally validated in vitro on cadaveric and composite femurs hosting different sizes of the same kind of prostheses, implanted with different levels of press-fitting. The overall accuracy (23%) takes into account not only the overall measurement error but also the variability due to differences in bone quality and stem press-fitting. This error was deemed sufficient to discriminate between stable and unstable implants.
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Affiliation(s)
- L Cristofolini
- Laboratorio di Tecnologia Medica, Istituti Ortopedici Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy.
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Sundfeldt M, Carlsson LV, Johansson CB, Thomsen P, Gretzer C. Aseptic loosening, not only a question of wear: a review of different theories. Acta Orthop 2006; 77:177-97. [PMID: 16752278 DOI: 10.1080/17453670610045902] [Citation(s) in RCA: 384] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Today, aseptic loosening is the most common cause of revision of major arthroplasties. Aseptic loosening accounts for more than two-thirds of hip revisions and almost one-half of knee revisions in Sweden. Several theories on the cause of aseptic loosening have been proposed. Most of these theories, however, are based on empiric observations, experimental animal models or anecdotal cases. In this review, we discuss the most common theories concerning aseptic loosening. It emerges from this review that aseptic loosening has a multifactorial etiology and cannot be explained by a single theory.
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Affiliation(s)
- Mikael Sundfeldt
- Department of Biomaterials/Handicap Research, Sahlgrenska University Hospital, University of Gothenburg, Sweden.
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Barker DS, Tanner KE, Ryd L. A Circumferentially Flanged Tibial Tray Minimizes Bone-Tray Shear Micromotion. Proc Inst Mech Eng H 2005; 219:449-56. [PMID: 16312104 DOI: 10.1243/095441105x34464] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Aseptic loosening of the tibial component is the major complication of total knee arthroplasty. There is an association between early excessive shear micromotion between the bone and the tray of the tibial component and late aseptic loosening. Using non-linear finite element analysis, whether a tibial tray with a circumferentially flanged rim and a mating cut in the proximal tibia could minimize bone-tray shear micromotion was considered. fifteen competing tray designs with various degrees of flange curvature were assessed with the aim of minimizing bone-tray shear micromotion. A trade-off was found between reducing micromotion and increasing peripheral cancellous bone stresses. It was found that, within the limitations of the study, there was a theoretical design that could virtually eliminate micromotion due to axial loads, with minimal bone removal and without the use of screws or pegs.
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Affiliation(s)
- D S Barker
- Department of Orthopaedics, Lund University Hospital, Lund, Sweden.
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Terrier A, Büchler P, Farron A. Bone-cement interface of the glenoid component: stress analysis for varying cement thickness. Clin Biomech (Bristol, Avon) 2005; 20:710-7. [PMID: 15961203 DOI: 10.1016/j.clinbiomech.2005.03.010] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2004] [Revised: 03/03/2005] [Accepted: 03/30/2005] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although shoulder arthroplasty is an accepted treatment for osteoarthritis, loosening of the glenoid component, which mainly occurs at the bone-cement interface, remains a major concern. Presently, the mechanical effect of the cement mantel thickness on the bone-cement interface is still unclear. METHODS Finite element analysis of a prosthetic scapula was used to evaluate the effect of cement thickness on stresses and micromotions at the bone-cement interface. The glenoid component was all-polyethylene, keeled and flat back. Cement mantel thickness was gradually increased from 0.5 to 2.0 mm. Two glenohumeral contact forces were applied: concentric and eccentric. Two extreme cases were considered for the bone-cement interface: bonded and debonded. FINDINGS Within cement, stress increased as cement thickness decreased, reaching the fatigue limit below 1.0 mm. Bone stress was below its ultimate strength and was minimum between 1.0 and 1.5mm. Interface stress was close to the interface strength, and also minimum between 1.0 and 1.5 mm. Both the decentring of the load and the debonding of the interface increased the stress. INTERPRETATION A cement thinning weakens the cement, but also the bone-cement interface, along the back-keel edges. Conversely, a cement thickening rigidifies the cemented implant, consequently increasing interfacial stresses and micromotions. To avoid both excessive cement fatigue and interface failure, an ideal cement thickness has been identified between 1.0 and 1.5 mm.
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Affiliation(s)
- Alexandre Terrier
- Laboratoire de Recherche en Orthopédie, STI-IGBM-LRO, Bâtiment AA.B, Station 15, Ecole Polytechnique Fédérale de Lausanne (EPFL), 1015 Lausanne, Switzerland.
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Goodman SB, Ma T, Mitsunaga L, Miyanishi K, Genovese MC, Smith RL. Temporal effects of a COX-2-selective NSAID on bone ingrowth. J Biomed Mater Res A 2005; 72:279-87. [PMID: 15666361 DOI: 10.1002/jbm.a.30231] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The effects of a short course of a COX-2 inhibitor on bone healing when the drug is discontinued are unknown. We examined the effects of rofecoxib on bone ingrowth over a 6-week period using a well-defined animal model. The Bone Harvest Chamber was implanted bilaterally in mature rabbits. After osseointegration of the chamber, the following treatments were given for 6 weeks each, followed by a harvest in each case: control-no drug; oral rofecoxib (12.5 mg/day) for the first 2 of 6 weeks; washout period-no drug; oral rofecoxib for the last 2 of 6 weeks; washout period-no drug; rofecoxib given continuously for all 6 weeks. Harvested specimens were snap-frozen, cut into serial 6-microm sections, and stained with hematoxylin and eosin and alkaline phosphatase (osteoblast marker), and processed using immunohistochemistry to identify the vitronectin receptor (osteoclast-like cells). Rofecoxib given continuously for 6 weeks yielded statistically less bone ingrowth compared to the control treatment. Rofecoxib given during the initial or final 2 weeks of a 6-week treatment did not appear to interfere with bone ingrowth. This suggests that the effects of COX-2 inhibitors on bone are less profound when the drug is administered for a short period of time.
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Affiliation(s)
- Stuart B Goodman
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, California 94305-5341, USA.
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Abstract
Total joint replacements of the hip and knee are generally highly successful, with satisfactory longevity and clinical results. Using modern biocompatible materials, optimal component design, and meticulous surgical technique, survivorship of cemented or cementless joint replacements is approximately 15 years with more than a 90% probability. The host's biologic response is critical to implant longevity. Particulate disease refers to the host's adverse biologic response to wear debris and byproducts generated from the prosthesis. Initially, emphasis was placed on particulate polymethylmethacrylate (cement disease), but more recently polyethylene wear debris has been underscored. Debris from several materials in sufficient quantities and physicochemical forms, however, can generate an inflammatory cascade resulting in periprosthetic bone destruction (osteolysis), jeopardizing long-term success of the implant.
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Affiliation(s)
- Stuart Goodman
- Department of Orthopaedic Surgery, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94305, USA.
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Buma P, Schreurs W, Verdonschot N. Skeletal tissue engineering-from in vitro studies to large animal models. Biomaterials 2004; 25:1487-95. [PMID: 14697851 DOI: 10.1016/s0142-9612(03)00492-7] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Bone is a tissue with a strong regenerative potential. New strategies for tissue engineering of bone should therefore only focus on defects with a certain size that will not heal spontaneously. In the development of tissue-engineered constructs many variables may play a role, e.g. the source of the cells used, the design and mechanical properties of the scaffold and the concentration and mode of application of growth factor(s). Models for studying new strategies for tissue engineering of bone should be based on the target tissue to be restored. However, in light of the many potential variables, which may also interact if used in combination(s), there is also a large need for relatively simple models in which variables can be tested in a limited number of animals. Moreover, in compromised bone there may be a problem with the load-bearing capacity of the remaining healthy bone. In this light, an important prerequisite for tissue-engineering constructs is that they can be tested in loaded conditions. Particularly, this latter prerequisite is very difficult to achieve. Therefore, in vitro tests for mechanical stability are very useful for evaluating the mechanical consequences of a particular reconstruction procedure prior to the animal experiment. Before a tissue-engineered construct can be introduced into a clinical trial, a final test should be available in a large animal model that is as close and relevant to a particular problematic clinical situation as possible.In the past, a series of models were developed in our laboratory that are very useful for testing tissue-engineered constructs. In this paper, we focus on the use of relatively new simple in vitro and in vivo models for hip revision surgery, segmental bone defect restoration and tumour surgery.
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Affiliation(s)
- Pieter Buma
- Orthopaedic Research Laboratory, Department of Orthopaedics, University Medical Center Nijmegen, P.O. Box 9101, 6500 HB, Nijmegen, Netherlands.
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Proussaefs P, Lozada J. Immediate loading of hydroxyapatite-coated implants in the maxillary premolar area: Three-year results of a pilot study. J Prosthet Dent 2004; 91:228-33. [PMID: 15060491 DOI: 10.1016/j.prosdent.2003.12.016] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
STATEMENT OF THE PROBLEM Although immediate loading of implants in the edentulous mandible has been described in the literature, there is limited information regarding immediate loading of single implants. PURPOSE This prospective clinical study evaluated the clinical parameters of immediately loaded single-threaded hydroxyapatite-coated (HA) root form implants. MATERIAL AND METHODS Ten human subjects were included in this report. In all situations, a screw-retained provisional acrylic resin crown was placed in the maxillary premolar area immediately after implant surgery. Definitive screw-retained metal-ceramic prostheses were placed 6 months after surgery. Standardized periapical radiographs were made before implant surgery, immediately after surgery, and 1, 3, 6, 12, and 36 months after implant surgery. Mobility (measured with the Perio-Test), distance from implant platform to the gingival crevice, distance from the implant platform to the depth of the sulcus, peri-implant probing depth, and bleeding on probing index were recorded at 3, 6, 12, and 36 months after implant placement. For clinical measurements, a 5-mm healing abutment was placed. RESULTS All implants appeared clinically osseointegrated. Standardized radiographs demonstrated mean marginal bone loss of 0.6, 0.7, 0.8, 0.9, and 1.0 mm at 1, 3, 6, 12, and 36 months after implant surgery, respectively. Mean implant mobility was -3.3 at the day of surgery and -3.8, -3.4, -3.6, and -4.2 at 3, 6, 12, and 36 months, respectively. The distance from implant platform to the gingival crevice was 2.8, 2.4, 2.4, and 3.1 mm at 3, 6, 12, and 36 months, respectively. The distance from the implant platform to the depth of the sulcus was 0.8, 0.9, 0.9, and 1.1 mm at 3, 6, 12, and 36 months, respectively. The peri-implant probing depth was 3.6, 3.3, 3.2, and 4.3 mm at 3, 6, 12, and 36 months, respectively. The bleeding on probing index was 0.4, 0.4, 0.4, and 0.1 at 3, 6, 12, and 36 months, respectively. CONCLUSION The results of this prospective pilot study provide initial evidence that single root form implants may be immediately loaded when placed at the maxillary premolar area.
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Affiliation(s)
- Periklis Proussaefs
- Graduate Program in Implant Dentistry, School of Dentistry, Loma Linda University, 92350, USA.
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Coulthard P, Esposito M, Slater M, Worthington HV, Kay EJ. Prevention. Part 5: Preventive strategies for patients requiring osseointegrated oral implant treatment. Br Dent J 2003; 195:187-94. [PMID: 12970693 DOI: 10.1038/sj.bdj.4810435] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Prevention for patients requiring rehabilitation with oral implants is about preventing implant failure and biomechanical complications. This paper describes preventative strategies for the planning stage for implant treatment and the later maintenance period and indicates the level of scientific evidence supporting these strategies.
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Affiliation(s)
- P Coulthard
- Head of Oral and Maxillofacial Surgery, University Dental Hospital of Manchester.
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