1
|
de Jong PA, Harlianto NI, Foppen W, Renkli NÖ, Spiering W, Weinans H, PThM Mali W, Mastbergen SC, Jansen MP. Prevalence and progression of arterial calcifications on computed tomography in humans with knee osteoarthritis. Rheumatology (Oxford) 2024:keae237. [PMID: 38648775 DOI: 10.1093/rheumatology/keae237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 03/12/2024] [Accepted: 04/15/2024] [Indexed: 04/25/2024] Open
Abstract
OBJECTIVES Ectopic bone deposition plays an important role in osteoarthritis (OA) and in arterial wall disease. We aimed to investigate the prevalence and progression of arterial calcifications on whole-body computed tomography (CT) in persons with knee OA. METHODS We included 118 (36 male) participants who satisfied the clinical American College of Rheumatology classification criteria for knee OA. Baseline investigations included Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Kellgren-Lawrence grading. At baseline and after two years, a whole-body CT was performed using the same scanner and protocol. Calcifications were quantified in the carotid, brachiocephalic, coronary, thoracic aortic, abdominal aortic, iliac, femoropopliteal and crural arteries. Multivariable linear and logistic regression modeling was used for analyses. RESULTS At baseline males were 66.9 ± 7.7 and females were 68.0 ± 5.6 years old. Calcifications were common, all participants except two females had some calcification, and prevalence ranged between 41.8% and 94.4% for various arterial beds. Baseline femoropopliteal calcifications were associated with a higher Kellgren-Lawrence grade (more severe knee OA). Median annual progression rate was 13.1% in males and 15.7% in females. Structural OA severity was not associated with progression, but a five points lower (worse) WOMAC was associated with 1% faster progression of arterial calcifications (p= 0.008). CONCLUSION Around age 70 nearly all persons with knee OA have arterial calcifications, which progress substantially. For further investigation into shared causality intervention studies are needed.
Collapse
Affiliation(s)
- Pim A de Jong
- Department of Radiology, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Netanja I Harlianto
- Department of Radiology, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Wouter Foppen
- Department of Radiology, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Nağme Ö Renkli
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Wilko Spiering
- Department of Vascular Medicine, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Harrie Weinans
- Department of Orthopedic Surgery, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Willem PThM Mali
- Department of Radiology, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Simon C Mastbergen
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| | - Mylène P Jansen
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
| |
Collapse
|
2
|
van Buuren MMA, Riedstra NS, van den Berg MA, Boel FDEM, Ahedi H, Arbabi V, Arden NK, Bierma-Zeinstra SMA, Boer CG, Cicuttini F, Cootes TF, Crossley K, Felson D, Gielis WP, Heerey J, Jones G, Kluzek S, Lane NE, Lindner C, Lynch JA, Van Meurs J, Mosler AB, Nelson AE, Nevitt M, Oei E, Runhaar J, Tang J, Weinans H, Agricola R. Cohort profile: Worldwide Collaboration on OsteoArthritis prediCtion for the Hip (World COACH) - an international consortium of prospective cohort studies with individual participant data on hip osteoarthritis. BMJ Open 2024; 14:e077907. [PMID: 38637130 PMCID: PMC11029301 DOI: 10.1136/bmjopen-2023-077907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 02/20/2024] [Indexed: 04/20/2024] Open
Abstract
PURPOSE Hip osteoarthritis (OA) is a major cause of pain and disability worldwide. Lack of effective therapies may reflect poor knowledge on its aetiology and risk factors, and result in the management of end-stage hip OA with costly joint replacement. The Worldwide Collaboration on OsteoArthritis prediCtion for the Hip (World COACH) consortium was established to pool and harmonise individual participant data from prospective cohort studies. The consortium aims to better understand determinants and risk factors for the development and progression of hip OA, to optimise and automate methods for (imaging) analysis, and to develop a personalised prediction model for hip OA. PARTICIPANTS World COACH aimed to include participants of prospective cohort studies with ≥200 participants, that have hip imaging data available from at least 2 time points at least 4 years apart. All individual participant data, including clinical data, imaging (data), biochemical markers, questionnaires and genetic data, were collected and pooled into a single, individual-level database. FINDINGS TO DATE World COACH currently consists of 9 cohorts, with 38 021 participants aged 18-80 years at baseline. Overall, 71% of the participants were women and mean baseline age was 65.3±8.6 years. Over 34 000 participants had baseline pelvic radiographs available, and over 22 000 had an additional pelvic radiograph after 8-12 years of follow-up. Even longer radiographic follow-up (15-25 years) is available for over 6000 of these participants. FUTURE PLANS The World COACH consortium offers unique opportunities for studies on the relationship between determinants/risk factors and the development or progression of hip OA, by using harmonised data on clinical findings, imaging, biomarkers, genetics and lifestyle. This provides a unique opportunity to develop a personalised hip OA risk prediction model and to optimise methods for imaging analysis of the hip.
Collapse
Affiliation(s)
- Michiel M A van Buuren
- Department of Orthopaedics and Sports Medicine, Erasmus Medical Center, Rotterdam, Zuid-Holland, Netherlands
| | - Noortje S Riedstra
- Department of Orthopaedics and Sports Medicine, Erasmus Medical Center, Rotterdam, Zuid-Holland, Netherlands
| | - Myrthe A van den Berg
- Department of Orthopaedics and Sports Medicine, Erasmus Medical Center, Rotterdam, Zuid-Holland, Netherlands
| | - Fleur D E M Boel
- Department of Orthopaedics and Sports Medicine, Erasmus Medical Center, Rotterdam, Zuid-Holland, Netherlands
| | - Harbeer Ahedi
- Institute for Medical Research, University of Tasmania Menzies, Hobart, Tasmania, Australia
| | - Vahid Arbabi
- Department of Orthopedics, UMC Utrecht, Utrecht, Netherlands
- Orthopaedic-Biomechanics Research Group, Department of Mechanical Engineering, Faculty of Engineering, University of Birjand, Birjand, Iran
| | - Nigel K Arden
- Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford Nuffield, Oxford, Oxfordshire, UK
| | | | - Cindy G Boer
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, Zuid-Holland, Netherlands
| | - Flavia Cicuttini
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Timothy F Cootes
- Centre for Imaging Sciences, The University of Manchester, Manchester, UK
| | - Kay Crossley
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University School of Allied Health Human Services and Sport, Melbourne, Victoria, Australia
| | - David Felson
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Willem Paul Gielis
- Department of Orthopedics, UMC Utrecht, Utrecht, Netherlands
- Department of Radiology, UMC Utrecht, Utrecht, Netherlands
| | - Joshua Heerey
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University School of Allied Health Human Services and Sport, Melbourne, Victoria, Australia
| | - Graeme Jones
- Institute for Medical Research, University of Tasmania Menzies, Hobart, Tasmania, Australia
| | - Stefan Kluzek
- Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford Nuffield, Oxford, Oxfordshire, UK
| | - Nancy E Lane
- Department of Medicine, University of California Davis School of Medicine, Sacramento, California, USA
| | - Claudia Lindner
- Centre for Imaging Sciences, The University of Manchester, Manchester, UK
| | - John A Lynch
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - J Van Meurs
- Department of Orthopaedics and Sports Medicine, Erasmus Medical Center, Rotterdam, Zuid-Holland, Netherlands
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, Zuid-Holland, Netherlands
| | - Andrea B Mosler
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University School of Allied Health Human Services and Sport, Melbourne, Victoria, Australia
| | - Amanda E Nelson
- Thurston Arthritis Research Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - M Nevitt
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Edwin Oei
- Department of Radiology & Nuclear Medicine, Erasmus Medical Center, Rotterdam, Zuid-Holland, Netherlands
| | - Jos Runhaar
- Department of General Practice, Erasmus Medical Center, Rotterdam, Zuid-Holland, Netherlands
| | - Jinchi Tang
- Department of Orthopaedics and Sports Medicine, Erasmus Medical Center, Rotterdam, Zuid-Holland, Netherlands
| | - Harrie Weinans
- Department of Orthopedics, UMC Utrecht, Utrecht, Netherlands
- Department of Biomechanical Engineering, TU Delft, Delft, Zuid-Holland, Netherlands
| | - Rintje Agricola
- Department of Orthopaedics and Sports Medicine, Erasmus Medical Center, Rotterdam, Zuid-Holland, Netherlands
| |
Collapse
|
3
|
van Dijk B, Oliveira S, Hooning van Duyvenbode JFF, Nurmohamed FRHA, Mashayekhi V, Hernández IB, van Strijp J, de Vor L, Aerts PC, Vogely HC, Weinans H, van der Wal BCH. Photoimmuno-antimicrobial therapy for Staphylococcus aureus implant infection. PLoS One 2024; 19:e0300069. [PMID: 38457402 PMCID: PMC10923484 DOI: 10.1371/journal.pone.0300069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 02/20/2024] [Indexed: 03/10/2024] Open
Abstract
INTRODUCTION Implant infections caused by Staphylococcus aureus are responsible for high mortality and morbidity worldwide. Treatment of these infections can be difficult especially when bacterial biofilms are involved. In this study we investigate the potential of infrared photoimmunotherapy to eradicate staphylococcal infection in a mouse model. METHODS A monoclonal antibody that targets Wall Teichoic Acid surface components of both S. aureus and its biofilm (4497-IgG1) was conjugated to a photosensitizer (IRDye700DX) and used as photoimmunotherapy in vitro and in vivo in mice with a subcutaneous implant pre-colonized with biofilm of Staphylococcus aureus. A dose of 400 μg and 200 μg of antibody-photosensitizer conjugate 4497-IgG-IRDye700DXwas administered intravenously to two groups of 5 mice. In addition, multiple control groups (vancomycin treated, unconjugated IRDye700DX and IRDye700DX conjugated to a non-specific antibody) were used to verify anti-microbial effects. RESULTS In vitro results of 4497-IgG-IRDye700DX on pre-colonized (biofilm) implants showed significant (p<0.01) colony-forming units (CFU) reduction at a concentration of 5 μg of the antibody-photosensitizer conjugate. In vivo, treatment with 4497-IgG-IRDye700DX showed no significant CFU reduction at the implant infection. However, tissue around the implant did show a significant CFU reduction with 400 μg 4497-IgG-IRDye700DX compared to control groups (p = 0.037). CONCLUSION This study demonstrated the antimicrobial potential of photoimmunotherapy for selectively eliminating S. aureus in vivo. However, using a solid implant instead of a catheter could result in an increased bactericidal effect of 4497-IgG-IRDye700DX and administration locally around an implant (per operative) could become valuable applications in patients that are difficult to treat with conventional methods. We conclude that photoimmunotherapy could be a potential additional therapy in the treatment of implant related infections, but requires further improvement.
Collapse
Affiliation(s)
- Bruce van Dijk
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sabrina Oliveira
- Department of Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
- Department of Biology, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | | | | | - Vida Mashayekhi
- Department of Biology, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Irati Beltrán Hernández
- Department of Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Jos van Strijp
- Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Lisanne de Vor
- Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Piet C. Aerts
- Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - H. Charles Vogely
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Harrie Weinans
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | | |
Collapse
|
4
|
Duits AAA, van Urk PR, Lehr AM, Nutzinger D, Reijnders MRL, Weinans H, Foppen W, Oner FC, van Gaalen SM, Kruyt MC. Radiologic Assessment of Interbody Fusion: A Systematic Review on the Use, Reliability, and Accuracy of Current Fusion Criteria. JBJS Rev 2024; 12:01874474-202401000-00005. [PMID: 38194599 DOI: 10.2106/jbjs.rvw.23.00065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
BACKGROUND Lumbar interbody fusion (IF) is a common procedure to fuse the anterior spine. However, a lack of consensus on image-based fusion assessment limits the validity and comparison of IF studies. This systematic review aims to (1) report on IF assessment strategies and definitions and (2) summarize available literature on the diagnostic reliability and accuracy of these assessments. METHODS Two searches were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Search 1 identified studies on adult lumbar IF that provided a detailed description of image-based fusion assessment. Search 2 analyzed studies on the reliability of specific fusion criteria/classifications and the accuracy assessed with surgical exploration. RESULTS A total of 442 studies were included for search 1 and 8 studies for search 2. Fusion assessment throughout the literature was highly variable. Eighteen definitions and more than 250 unique fusion assessment methods were identified. The criteria that showed most consistent use were continuity of bony bridging, radiolucency around the cage, and angular motion <5°. However, reliability and accuracy studies were scarce. CONCLUSION This review highlights the challenges in reaching consensus on IF assessment. The variability in IF assessment is very high, which limits the translatability of studies. Accuracy studies are needed to guide innovations of assessment. Future IF assessment strategies should focus on the standardization of computed tomography-based continuity of bony bridging. Knowledge from preclinical and imaging studies can add valuable information to this ongoing discussion. LEVEL OF EVIDENCE Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Anneli A A Duits
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Orthopedic surgery, Diakonessenhuis, Utrecht, Zeist, the Netherlands
- Department of Orthopedics, Clinical Orthopedic Research Center (CORC-mN), Diakonessenhuis Utrecht/Zeist, Utrecht, the Netherlands
| | - Paul R van Urk
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - A Mechteld Lehr
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Don Nutzinger
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Maarten R L Reijnders
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Harrie Weinans
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of biomechanical Engineering, Delft University of Technology, Delft, the Netherlands
| | - Wouter Foppen
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - F Cuhmur Oner
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Steven M van Gaalen
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Orthopedic Surgery, Acibadem Internal Medical Center, Amsterdam, the Netherlands
| | - Moyo C Kruyt
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Developmental BioEngineering, University of Twente, Enschede, the Netherlands
| |
Collapse
|
5
|
Widera P, Welsing PM, Danso SO, Peelen S, Kloppenburg M, Loef M, Marijnissen AC, van Helvoort EM, Blanco FJ, Magalhães J, Berenbaum F, Haugen IK, Bay-Jensen AC, Mobasheri A, Ladel C, Loughlin J, Lafeber FP, Lalande A, Larkin J, Weinans H, Bacardit J. Development and validation of a machine learning-supported strategy of patient selection for osteoarthritis clinical trials: the IMI-APPROACH study. Osteoarthr Cartil Open 2023; 5:100406. [PMID: 37649530 PMCID: PMC10463256 DOI: 10.1016/j.ocarto.2023.100406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 08/13/2023] [Indexed: 09/01/2023] Open
Abstract
Objectives To efficiently assess the disease-modifying potential of new osteoarthritis treatments, clinical trials need progression-enriched patient populations. To assess whether the application of machine learning results in patient selection enrichment, we developed a machine learning recruitment strategy targeting progressive patients and validated it in the IMI-APPROACH knee osteoarthritis prospective study. Design We designed a two-stage recruitment process supported by machine learning models trained to rank candidates by the likelihood of progression. First stage models used data from pre-existing cohorts to select patients for a screening visit. The second stage model used screening data to inform the final inclusion. The effectiveness of this process was evaluated using the actual 24-month progression. Results From 3500 candidate patients, 433 with knee osteoarthritis were screened, 297 were enrolled, and 247 completed the 2-year follow-up visit. We observed progression related to pain (P, 30%), structure (S, 13%), and combined pain and structure (P + S, 5%), and a proportion of non-progressors (N, 52%) ∼15% lower vs an unenriched population. Our model predicted these outcomes with AUC of 0.86 [95% CI, 0.81-0.90] for pain-related progression and AUC of 0.61 [95% CI, 0.52-0.70] for structure-related progression. Progressors were ranked higher than non-progressors for P + S (median rank 65 vs 143, AUC = 0.75), P (median rank 77 vs 143, AUC = 0.71), and S patients (median rank 107 vs 143, AUC = 0.57). Conclusions The machine learning-supported recruitment resulted in enriched selection of progressive patients. Further research is needed to improve structural progression prediction and assess this strategy in an interventional trial.
Collapse
Affiliation(s)
- Paweł Widera
- School of Computing, Newcastle University, Newcastle, UK
| | - Paco M.J. Welsing
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | | | | | - Margreet Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Marieke Loef
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Anne C. Marijnissen
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Eefje M. van Helvoort
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Francisco J. Blanco
- Institute of Biomedical Research, University Hospital of A Coruña, A Coruña, Spain
| | - Joana Magalhães
- Institute of Biomedical Research, University Hospital of A Coruña, A Coruña, Spain
| | | | - Ida K. Haugen
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | | | - Ali Mobasheri
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
- Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
- Department of Joint Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- World Health Organization Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liege, Belgium
| | | | - John Loughlin
- Bioscience Institute, Newcastle University, International Centre for Life, Newcastle, UK
| | - Floris P.J.G. Lafeber
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Agnès Lalande
- Servier International Research Institute, Suresnes, France
| | - Jonathan Larkin
- Novel Human Genetics Research Unit, GlaxoSmithKline, Collegeville, United States
| | - Harrie Weinans
- Department of Orthopedics, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Jaume Bacardit
- School of Computing, Newcastle University, Newcastle, UK
| |
Collapse
|
6
|
Kuiper RJA, Colaris JW, Stockmans F, van Es EM, Viergever MA, Seevinck PR, Weinans H, Sakkers RJB. Impact of bone and cartilage segmentation from CT and MRI on both bone forearm osteotomy planning. Int J Comput Assist Radiol Surg 2023; 18:2307-2318. [PMID: 37219804 PMCID: PMC10632286 DOI: 10.1007/s11548-023-02929-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 04/19/2023] [Indexed: 05/24/2023]
Abstract
INTRODUCTION The use of MRI scans for pre-operative surgical planning of forearm osteotomies provides additional information of joint cartilage and soft tissue structures and reduces radiation exposure in comparison with the use of CT scans. In this study, we investigated whether using 3D information obtained from MRI with and without cartilage information leads to a different outcome of pre-operative planning. METHODS Bilateral CT and MRI scans of the forearms of 10 adolescent and young adult patients with a unilateral bone deformation were acquired in a prospective study. The bones were segmented from CT and MRI, and cartilage only from MRI. The deformed bones were virtually reconstructed, by registering the joint ends to the healthy contralateral side. An optimal osteotomy plane was determined that minimized the distance between the resulting fragments. This process was performed in threefold: using the CT and MRI bone segmentations, and the MRI cartilage segmentations. RESULTS Comparison of bone segmentation from MRI and CT scan resulted in a 0.95 ± 0.02 Dice Similarity Coefficient and 0.42 ± 0.07 mm Mean Absolute Surface Distance. All realignment parameters showed excellent reliability across the different segmentations. However, the mean differences in translational realignment between CT and MRI bone segmentations (4.5 ± 2.1 mm) and between MRI bone and MRI bone and cartilage segmentations (2.8 ± 2.1 mm) were shown to be clinically and statistically significant. A significant positive correlation was found between the translational realignment and the relative amount of cartilage. CONCLUSION This study indicates that although bone realignment remained largely similar when using MRI with and without cartilage information compared to using CT, the small differences in segmentation could induce statistically and clinically significant differences in the osteotomy planning. We also showed that endochondral cartilage might be a non-negligible factor when planning osteotomies for young patients.
Collapse
Affiliation(s)
- Ruurd J A Kuiper
- Department of Orthopaedics, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Joost W Colaris
- Department of Orthopaedics and Sports Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Filip Stockmans
- Muscles & Movement, Department of Development and Regeneration, KU Leuven Campus Kulak, Kortrijk, Belgium
| | - Eline M van Es
- Department of Orthopaedics and Sports Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Max A Viergever
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Peter R Seevinck
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Harrie Weinans
- Department of Orthopaedics, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Ralph J B Sakkers
- Department of Orthopaedics, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| |
Collapse
|
7
|
Rayegan H, Nguyen H, Weinans H, Gielis W, Ahmadi Brooghani S, Custers R, van Egmond N, Lindner C, Arbabi V. Automated Radiographic Measurements of Knee Osteoarthritis. Cartilage 2023; 14:413-423. [PMID: 37265053 PMCID: PMC10807738 DOI: 10.1177/19476035231166126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/27/2022] [Accepted: 03/12/2023] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVE Herewith, we report the development of Orthopedic Digital Image Analysis (ODIA) software that is developed to obtain quantitative measurements of knee osteoarthritis (OA) radiographs automatically. Manual segmentation and measurement of OA parameters currently hamper large-cohort analyses, and therefore, automated and reproducible methods are a valuable addition in OA research. This study aims to test the automated ODIA measurements and compare them with available manual Knee Imaging Digital Analysis (KIDA) measurements as comparison. DESIGN This study included data from the CHECK (Cohort Hip and Cohort Knee) initiative, a prospective multicentre cohort study in the Netherlands with 1,002 participants. Knee radiographs obtained at baseline of the CHECK cohort were included and mean medial/lateral joint space width (JSW), minimal JSW, joint line convergence angle (JLCA), eminence heights, and subchondral bone intensities were compared between ODIA and KIDA. RESULTS Of the potential 2,004 radiographs, 1,743 were included for analyses. Poor intraclass correlation coefficients (ICCs) were reported for the JLCA (0.422) and minimal JSW (0.299). The mean medial and lateral JSW, eminence height, and subchondral bone intensities reported a moderate to good ICC (0.7 or higher). Discrepancies in JLCA and minimal JSW between the 2 methods were mostly a problem in the lateral tibia plateau. CONCLUSIONS The current ODIA tool provides important measurements of OA parameters in an automated manner from standard radiographs of the knee. Given the automated and computerized methodology that has very high reproducibility, ODIA is suitable for large epidemiological cohorts with various follow-up time points to investigate structural progression, such as CHECK or the Osteoarthritis Initiative (OAI).
Collapse
Affiliation(s)
- H. Rayegan
- Orthopaedic-BioMechanics Research Group, University of Birjand, Birjand, Iran
- Department of Mechanical Engineering, Faculty of Engineering, University of Birjand, Birjand, Iran
| | - H.C. Nguyen
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- 3D Lab, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - H. Weinans
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering (3mE), Delft University of Technology, Delft, The Netherlands
| | - W.P. Gielis
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - S.Y. Ahmadi Brooghani
- Department of Mechanical Engineering, Faculty of Engineering, University of Birjand, Birjand, Iran
| | - R.J.H. Custers
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - N. van Egmond
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - C. Lindner
- Division of Informatics, Imaging & Data Sciences, The University of Manchester, Manchester, UK
| | - V. Arbabi
- Orthopaedic-BioMechanics Research Group, University of Birjand, Birjand, Iran
- Department of Mechanical Engineering, Faculty of Engineering, University of Birjand, Birjand, Iran
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
8
|
Arbabi S, Foppen W, Gielis WP, van Stralen M, Jansen M, Arbabi V, de Jong PA, Weinans H, Seevinck P. MRI-based synthetic CT in the detection of knee osteoarthritis: Comparison with CT. J Orthop Res 2023; 41:2530-2539. [PMID: 36922347 DOI: 10.1002/jor.25557] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 03/01/2023] [Accepted: 03/11/2023] [Indexed: 03/18/2023]
Abstract
Magnetic resonance Imaging is the gold standard for assessment of soft tissues; however, X-ray-based techniques are required for evaluating bone-related pathologies. This study evaluated the performance of synthetic computed tomography (sCT), a novel MRI-based bone visualization technique, compared with CT, for the scoring of knee osteoarthritis. sCT images were generated from the 3T T1-weighted gradient-echo MR images using a trained machine learning algorithm. Two readers scored the severity of osteoarthritis in tibiofemoral and patellofemoral joints according to OACT, which enables the evaluation of osteoarthritis, from its characteristics of joint space narrowing, osteophytes, cysts and sclerosis in CT (and sCT) images. Cohen's κ was used to assess the interreader agreement for each modality, and intermodality agreement of CT- and sCT-based scores for each reader. We also compared the confidence level of readers for grading CT and sCT images using confidence scores collected during grading. Inter-reader agreement for tibiofemoral and patellofemoral joints were almost-perfect for both modalities (κ = 0.83-0.88). The intermodality agreement of osteoarthritis scores between CT and sCT was substantial to almost-perfect for tibiofemoral (κ = 0.63 and 0.84 for the two readers) and patellofemoral joints (κ = 0.78 and 0.81 for the two readers). The analysis of diagnosis confidence scores showed comparable visual quality of the two modalities, where both are showing acceptable confidence levels for scoring OA. In conclusion, in this single-center study, sCT and CT were comparable for the scoring of knee OA.
Collapse
Affiliation(s)
- Saeed Arbabi
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Wouter Foppen
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Willem Paul Gielis
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Mylène Jansen
- Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Vahid Arbabi
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Mechanical Engineering, Faculty of Engineering, Orthopaedic-Biomechanics Research Group, Birjand, Iran
| | - Pim A de Jong
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Harrie Weinans
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Biomechanical Engineering, Delft University of Technology (TU Delft), Delft, The Netherlands
| | - Peter Seevinck
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
- MRIguidance B.V., Utrecht, The Netherlands
| |
Collapse
|
9
|
van Erp JH, Gielis WP, Arbabi V, de Gast A, Weinans H, Kaas L, Castelein RM, Schlösser TP. Unravelling the hip-spine dilemma from the CHECK-cohort: is sagittal pelvic morphology linked to radiographic signs of femoroacetabular impingement? Hip Int 2023; 33:1079-1085. [PMID: 36571206 DOI: 10.1177/11207000221145670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION To date the aetiology of femoroacetabular impingement (FAI) is still not completely understood. There are mechanical theories that suggest symptomatic FAI is linked to sagittal pelvic morphology and spinopelvic-femoral dynamics. The aim of this study is to evaluate the relation of sagittal pelvic morphology and orientation to radiographic signs of FAI. Additionally, we test whether the relation between FAI and spinopelvic parameters differs in osteoarthritic hips. METHODS From a prospective, observational cohort study, 1002 patients between 45 and 65 years old with a first episode of knee or hip pain were followed for 8 years. All patients who had lateral lumbar radiographs and clinical and radiographic follow-up of the hips were included in the present study. Range of internal rotation of the hip as well as radiographic signs of FAI (alpha and Wiberg angle) and presence of hip osteoarthritis (Kellgren and Lawrence) were systematically measured at baseline. Pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS)) were measured at 8-year follow-up. Associations between PI, PT, SS and FAI parameters were tested using generalised estimating equations. RESULTS 421 subjects, 842 hips, were included. No significant relations between PI, PT or SS and alpha or Wiberg angle were found. Comparison of hips with and without radiological sign(s) of FAI showed no differences in PI, PT or SS. There was no relation between range of internal rotation of the hip and spinopelvic parameters. CONCLUSION Sagittal pelvic morphology and orientation are not related to the presence of radiological signs of FAI in this study population.
Collapse
Affiliation(s)
- Joost Hj van Erp
- Clinical Orthopaedic Research Center - mN, Zeist, The Netherlands
- Department of Orthopaedics, Diakonessenhuis, Utrecht, The Netherlands
- Department of Orthopaedic Surgery, University Medical Centre Utrecht, The Netherlands
| | - Willem-Paul Gielis
- Department of Orthopaedic Surgery, University Medical Centre Utrecht, The Netherlands
| | - Vahid Arbabi
- Department of Orthopaedic Surgery, University Medical Centre Utrecht, The Netherlands
- Orthopedic-BioMechanics Research Group, Department of Mechanical Engineering, Faculty of Engineering, University of Birjand, Iran
| | - Arthur de Gast
- Clinical Orthopaedic Research Center - mN, Zeist, The Netherlands
- Department of Orthopaedics, Diakonessenhuis, Utrecht, The Netherlands
| | - Harrie Weinans
- Department of Orthopaedic Surgery, University Medical Centre Utrecht, The Netherlands
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - Laurens Kaas
- Department of Orthopaedic Surgery, St. Antonius hospital, Utrecht, The Netherlands
| | - René M Castelein
- Department of Orthopaedic Surgery, University Medical Centre Utrecht, The Netherlands
| | - Tom Pc Schlösser
- Department of Orthopaedic Surgery, University Medical Centre Utrecht, The Netherlands
| |
Collapse
|
10
|
van Hengel IAJ, van Dijk B, Modaresifar K, Hooning van Duyvenbode JFF, Nurmohamed FRHA, Leeflang MA, Fluit AC, Fratila-Apachitei LE, Apachitei I, Weinans H, Zadpoor AA. In Vivo Prevention of Implant-Associated Infections Caused by Antibiotic-Resistant Bacteria through Biofunctionalization of Additively Manufactured Porous Titanium. J Funct Biomater 2023; 14:520. [PMID: 37888185 PMCID: PMC10607138 DOI: 10.3390/jfb14100520] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/09/2023] [Accepted: 10/14/2023] [Indexed: 10/28/2023] Open
Abstract
Additively manufactured (AM) porous titanium implants may have an increased risk of implant-associated infection (IAI) due to their huge internal surfaces. However, the same surface, when biofunctionalized, can be used to prevent IAI. Here, we used a rat implant infection model to evaluate the biocompatibility and infection prevention performance of AM porous titanium against bioluminescent methicillin-resistant Staphylococcus aureus (MRSA). The specimens were biofunctionalized with Ag nanoparticles (NPs) using plasma electrolytic oxidation (PEO). Infection was initiated using either intramedullary injection in vivo or with in vitro inoculation of the implant prior to implantation. Nontreated (NT) implants were compared with PEO-treated implants with Ag NPs (PT-Ag), without Ag NPs (PT) and infection without an implant. After 7 days, the bacterial load and bone morphological changes were evaluated. When infection was initiated through in vivo injection, the presence of the implant did not enhance the infection, indicating that this technique may not assess the prevention but rather the treatment of IAIs. Following in vitro inoculation, the bacterial load on the implant and in the peri-implant bony tissue was reduced by over 90% for the PT-Ag implants compared to the PT and NT implants. All infected groups had enhanced osteomyelitis scores compared to the noninfected controls.
Collapse
Affiliation(s)
- Ingmar Aeneas Jan van Hengel
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands (I.A.); (H.W.); (A.A.Z.)
| | - Bruce van Dijk
- Department of Orthopedics, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Khashayar Modaresifar
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands (I.A.); (H.W.); (A.A.Z.)
| | | | | | - Marius Alexander Leeflang
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands (I.A.); (H.W.); (A.A.Z.)
| | - Adriaan Camille Fluit
- Department of Medical Microbiology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Lidy Elena Fratila-Apachitei
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands (I.A.); (H.W.); (A.A.Z.)
| | - Iulian Apachitei
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands (I.A.); (H.W.); (A.A.Z.)
| | - Harrie Weinans
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands (I.A.); (H.W.); (A.A.Z.)
- Department of Orthopedics, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Amir Abbas Zadpoor
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands (I.A.); (H.W.); (A.A.Z.)
| |
Collapse
|
11
|
Florkow MC, Nguyen CH, Sakkers RJB, Weinans H, Jansen MP, Custers RJH, van Stralen M, Seevinck PR. Magnetic resonance imaging-based bone imaging of the lower limb: Strategies for generating high-resolution synthetic computed tomography. J Orthop Res 2023. [PMID: 37807082 DOI: 10.1002/jor.25707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 09/13/2023] [Accepted: 10/05/2023] [Indexed: 10/10/2023]
Abstract
This study aims at assessing approaches for generating high-resolution magnetic resonance imaging- (MRI-) based synthetic computed tomography (sCT) images suitable for orthopedic care using a deep learning model trained on low-resolution computed tomography (CT) data. To that end, paired MRI and CT data of three anatomical regions were used: high-resolution knee and ankle data, and low-resolution hip data. Four experiments were conducted to investigate the impact of low-resolution training CT data on sCT generation and to find ways to train models on low-resolution data while providing high-resolution sCT images. Experiments included resampling of the training data or augmentation of the low-resolution data with high-resolution data. Training sCT generation models using low-resolution CT data resulted in blurry sCT images. By resampling the MRI/CT pairs before the training, models generated sharper images, presumably through an increase in the MRI/CT mutual information. Alternatively, augmenting the low-resolution with high-resolution data improved sCT in terms of mean absolute error proportionally to the amount of high-resolution data. Overall, the morphological accuracy was satisfactory as assessed by an average intermodal distance between joint centers ranging from 0.7 to 1.2 mm and by an average intermodal root-mean-squared distances between bone surfaces under 0.7 mm. Average dice scores ranged from 79.8% to 87.3% for bony structures. To conclude, this paper proposed approaches to generate high-resolution sCT suitable for orthopedic care using low-resolution data. This can generalize the use of sCT for imaging the musculoskeletal system, paving the way for an MR-only imaging with simplified logistics and no ionizing radiation.
Collapse
Affiliation(s)
- Mateusz C Florkow
- Image Sciences Institute, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Chien H Nguyen
- Department of Orthopaedics, University Medical Centre Utrecht, Utrecht, The Netherlands
- 3D Lab, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Ralph J B Sakkers
- Department of Orthopaedics, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Harrie Weinans
- Department of Orthopaedics, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Mylene P Jansen
- Department of Rheumatology & Clinical Immunology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Roel J H Custers
- Department of Orthopaedics, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | - Peter R Seevinck
- Image Sciences Institute, University Medical Centre Utrecht, Utrecht, The Netherlands
- MRIguidance B.V., Utrecht, The Netherlands
| |
Collapse
|
12
|
Johnbosco C, Karbaat L, Korthagen NM, Warmink K, Koerselman M, Coeleveld K, Becker M, van Loo B, Zoetebier B, Both S, Weinans H, Karperien M, Leijten J. Microencapsulated stem cells reduce cartilage damage in a material dependent manner following minimally invasive intra-articular injection in an OA rat model. Mater Today Bio 2023; 22:100791. [PMID: 37731960 PMCID: PMC10507156 DOI: 10.1016/j.mtbio.2023.100791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/05/2023] [Accepted: 09/04/2023] [Indexed: 09/22/2023] Open
Abstract
Osteoarthritis (OA) is a degenerative disease of the joints for which no curative treatment exists. Intra-articular injection of stem cells is explored as a regenerative approach, but rapid clearance of cells from the injection site limits the therapeutic outcome. Microencapsulation of mesenchymal stem cells (MSCs) can extend the retention time of MSCs, but the outcomes of the few studies currently performed are conflicting. We hypothesize that the composition of the micromaterial's shell plays a deciding factor in the treatment outcome of intra-articular MSC injection. To this end, we microencapsulate MSCs using droplet microfluidic generators in flow-focus mode using various polymers and polymer concentrations. We demonstrate that polymer composition and concentration potently alter the metabolic activity as well as the secretome of MSCs. Moreover, while microencapsulation consistently prolongs the retention time of MSC injected in rat joints, distinct biodistribution within the joint is demonstrated for the various microgel formulations. Furthermore, intra-articular injections of pristine and microencapsulated MSC in OA rat joints show a strong material-dependent effect on the reduction of cartilage degradation and matrix loss. Collectively, this study highlights that micromaterial composition and concentration are key deciding factors for the therapeutic outcome of intra-articular injections of microencapsulated stem cells to treat degenerative joint diseases.
Collapse
Affiliation(s)
- Castro Johnbosco
- Department of Developmental BioEngineering, TechMed Centre, University of Twente, the Netherlands
| | - Lisanne Karbaat
- Department of Developmental BioEngineering, TechMed Centre, University of Twente, the Netherlands
| | - Nicoline M. Korthagen
- Faculty of Veterinary Sciences Department of equine sciences, University of Utrecht, the Netherlands
- Department of Orthopaedics, University Medical Centre Utrecht, the Netherlands
| | - Kelly Warmink
- Department of Orthopaedics, University Medical Centre Utrecht, the Netherlands
| | - Michelle Koerselman
- Department of Developmental BioEngineering, TechMed Centre, University of Twente, the Netherlands
| | - Katja Coeleveld
- Department of Rheumatology & Clinical Immunology, University Medical Centre Utrecht, the Netherlands
| | - Malin Becker
- Department of Developmental BioEngineering, TechMed Centre, University of Twente, the Netherlands
| | - Bas van Loo
- Department of Developmental BioEngineering, TechMed Centre, University of Twente, the Netherlands
| | - Bram Zoetebier
- Department of Developmental BioEngineering, TechMed Centre, University of Twente, the Netherlands
| | - Sanne Both
- Department of Developmental BioEngineering, TechMed Centre, University of Twente, the Netherlands
| | - Harrie Weinans
- Department of Orthopaedics, University Medical Centre Utrecht, the Netherlands
| | - Marcel Karperien
- Department of Developmental BioEngineering, TechMed Centre, University of Twente, the Netherlands
| | - Jeroen Leijten
- Department of Developmental BioEngineering, TechMed Centre, University of Twente, the Netherlands
| |
Collapse
|
13
|
Warmink K, Rios JL, van Valkengoed DR, Vinod P, Korthagen NM, Weinans H. Effects of different obesogenic diets on joint integrity, inflammation and intermediate monocyte levels in a rat groove model of osteoarthritis. Front Physiol 2023; 14:1211972. [PMID: 37520829 PMCID: PMC10372350 DOI: 10.3389/fphys.2023.1211972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/05/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction: Obesogenic diets aggravate osteoarthritis (OA) by inducing low-grade systemic inflammation, and diet composition may affect OA severity. Here, we investigated the effect of diet on joint damage and inflammation in an OA rat model. Methods: Wistar-Han rats (n = 24) were fed a chow, a high-fat (HF) diet, or a high-fat/high-sucrose (HFS) for 24 weeks. OA was induced unilaterally 12 weeks after the diet onset by groove surgery, and compared to sham surgery or no surgical intervention (contralateral limb). Knee OA severity was determined by OARSI histopathology scoring system. At several timepoints monocyte populations were measured using flow cytometry, and joint macrophage response was determined via CD68 immunohistochemistry staining. Results: Groove surgery combined with HF or HFS diet resulted in higher OARSI scores, and both HF and HFS diet showed increased circulating intermediate monocytes compared to chow fed rats. Additionally, in the HFS group, minimal damage by sham surgery resulted in an increased OARSI score. HFS diet resulted in the largest metabolic dysregulation, synovial inflammation and increased CD68 staining in tibia epiphysis bone marrow. Conclusion: Obesogenic diets resulted in aggravated OA development, even with very minimal joint damage when combined with the sucrose/fat-rich diet. We hypothesize that diet-induced low-grade inflammation primes monocytes and macrophages in the blood, bone marrow, and synovium, resulting in joint damage when triggered by groove OA inducing surgery. When the metabolic dysregulation is larger, as observed here for the HFS diet, the surgical trigger required to induce joint damage may be smaller, or even redundant.
Collapse
Affiliation(s)
- K. Warmink
- Department of Orthopedics, University Medical Center Utrecht (UMCU), Utrecht, Netherlands
| | - J. L. Rios
- Department of Orthopedics, University Medical Center Utrecht (UMCU), Utrecht, Netherlands
| | - D. R. van Valkengoed
- Department of Orthopedics, University Medical Center Utrecht (UMCU), Utrecht, Netherlands
| | - P. Vinod
- Department of Orthopedics, University Medical Center Utrecht (UMCU), Utrecht, Netherlands
| | - N. M. Korthagen
- Department of Orthopedics, University Medical Center Utrecht (UMCU), Utrecht, Netherlands
- Department of Equine Sciences, Utrecht University, Utrecht, Netherlands
| | - H. Weinans
- Department of Orthopedics, University Medical Center Utrecht (UMCU), Utrecht, Netherlands
- Department of Biomechanical Engineering, TU Delft, Delft, Netherlands
| |
Collapse
|
14
|
Magré J, Willemsen K, Kolken HMA, Zadpoor AA, Vogely HC, van der Wal BCH, Weinans H. Deformable titanium for acetabular revision surgery: a proof of concept. 3D Print Med 2023; 9:16. [PMID: 37294496 DOI: 10.1186/s41205-023-00177-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/22/2023] [Indexed: 06/10/2023] Open
Abstract
Custom-made triflange acetabular implants are increasingly used in complex revision surgery where supporting bone stock is diminished. In most cases these triflange cups induce stress-shielding. A new concept for the triflange is introduced that uses deformable porous titanium to redirect forces from the acetabular rim to the bone stock behind the implant and thereby reduces further stress-shielding. This concept is tested for deformability and primary stability.Three different designs of highly porous titanium cylinders were tested under compression to determine their mechanical properties. The most promising design was used to design five acetabular implants either by incorporating a deformable layer at the back of the implant or by adding a separate generic deformable mesh behind the implant. All implants were inserted into sawbones with acetabular defects followed by a cyclic compression test of 1800N for 1000 cycles.The design with a cell size of 4 mm and 0.2 mm strut thickness performed the best and was applied for the design of the acetabular implants. An immediate primary fixation was realized in all three implants with an incorporated deformable layer. One of the two implants with a separate deformable mesh needed fixation with screws. Cyclic tests revealed an average additional implant subsidence of 0.25 mm that occurred in the first 1000 cycles with minimal further subsidence thereafter.It is possible to realize primary implant fixation and stability in simulated large acetabular revision surgery using a deformable titanium layer behind the cup. Additional research is needed for further implementation of such implants in the clinic.
Collapse
Affiliation(s)
- J Magré
- Department of Orthopedics, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
- 3D Lab, Division of Surgical Specialties, University Medical Center Utrecht, 3584 CX, Utrecht, The Netherlands.
| | - K Willemsen
- Department of Orthopedics, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
- 3D Lab, Division of Surgical Specialties, University Medical Center Utrecht, 3584 CX, Utrecht, The Netherlands
| | - H M A Kolken
- Department of Biomechanical Engineering, Delft University of Technology, 2628 CD, Delft, The Netherlands
| | - A A Zadpoor
- Department of Biomechanical Engineering, Delft University of Technology, 2628 CD, Delft, The Netherlands
| | - H C Vogely
- Department of Orthopedics, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - B C H van der Wal
- Department of Orthopedics, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - H Weinans
- Department of Orthopedics, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
- Department of Biomechanical Engineering, Delft University of Technology, 2628 CD, Delft, The Netherlands
| |
Collapse
|
15
|
Cecotto L, Stapels DAC, van Kessel KPM, Croes M, Lourens Z, Vogely HC, van der Wal BCH, van Strijp JAG, Weinans H, Amin Yavari S. Evaluation of silver bio-functionality in a multicellular in vitro model: towards reduced animal usage in implant-associated infection research. Front Cell Infect Microbiol 2023; 13:1186936. [PMID: 37342248 PMCID: PMC10277478 DOI: 10.3389/fcimb.2023.1186936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 05/16/2023] [Indexed: 06/22/2023] Open
Abstract
Background Despite the extensive use of silver ions or nanoparticles in research related to preventing implant-associated infections (IAI), their use in clinical practice has been debated. This is because the strong antibacterial properties of silver are counterbalanced by adverse effects on host cells. One of the reasons for this may be the lack of comprehensive in vitro models that are capable of analyzing host-bacteria and host-host interactions. Methods and results In this study, we tested silver efficacy through multicellular in vitro models involving macrophages (immune system), mesenchymal stem cells (MSCs, bone cells), and S. aureus (pathogen). Our model showed to be capable of identifying each element of culture as well as tracking the intracellular survival of bacteria. Furthermore, the model enabled to find a therapeutic window for silver ions (AgNO3) and silver nanoparticles (AgNPs) where the viability of host cells was not compromised, and the antibacterial properties of silver were maintained. While AgNO3 between 0.00017 and 0.017 µg/mL retained antibacterial properties, host cell viability was not affected. The multicellular model, however, demonstrated that those concentrations had no effect on the survival of S. aureus, inside or outside host cells. Similarly, treatment with 20 nm AgNPs did not influence the phagocytic and killing capacity of macrophages or prevent S. aureus from invading MSCs. Moreover, exposure to 100 nm AgNPs elicited an inflammatory response by host cells as detected by the increased production of TNF-α and IL-6. This was visible only when macrophages and MSCs were cultured together. Conclusions Multicellular in vitro models such as the one used here that simulate complex in vivo scenarios can be used to screen other therapeutic compounds or antibacterial biomaterials without the need to use animals.
Collapse
Affiliation(s)
- Leonardo Cecotto
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, Netherlands
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Daphne A. C. Stapels
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, Netherlands
- Infection Biology Group, Department of Biomolecular Health Sciences, Utrecht University, Utrecht, Netherlands
| | - Kok P. M. van Kessel
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Michiel Croes
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, Netherlands
| | - Zeldali Lourens
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - H. Charles Vogely
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Jos A. G. van Strijp
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Harrie Weinans
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, Netherlands
- Department of Biomechanical Engineering, Delft University of Technology, Delft, Netherlands
| | - Saber Amin Yavari
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, Netherlands
- Regenerative Medicine Centre Utrecht, Utrecht University, Utrecht, Netherlands
| |
Collapse
|
16
|
Warmink K, Rios JL, Varderidou-Minasian S, Torres-Torrillas M, van Valkengoed DR, Versteeg S, Eijkelkamp N, Weinans H, Korthagen NM, Lorenowicz MJ. Mesenchymal stem/stromal cells-derived extracellular vesicles as a potentially more beneficial therapeutic strategy than MSC-based treatment in a mild metabolic osteoarthritis model. Stem Cell Res Ther 2023; 14:137. [PMID: 37226203 DOI: 10.1186/s13287-023-03368-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 05/05/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Mesenchymal stromal/stem cells (MSCs) and MSC-derived extracellular vesicles (MSC-EVs) hold promise as a disease modifying treatment in osteoarthritis (OA). Obesity, and its associated inflammation, contribute to OA development and metabolic OA represents a specific and significant group of the OA patient population. Given their immunomodulatory properties, MSC and MSC-EVs are especially interesting for this group of patients as a therapeutic option. Here, we were the first to compare the therapeutic efficacy of MSCs and MSC-EVs in a mild OA model taking these metabolic aspects into consideration. METHODS Male Wistar-Han rats (Crl:WI(Han) (n = 36) were fed a high fat diet for 24 weeks, with unilateral induction of OA by groove surgery after 12 weeks. Eight days after surgery rats were randomized in three treatment groups receiving MSCs, MSC-EVs or vehicle injection. Pain-associated behavior, joint degeneration, and local and systemic inflammation were measured. RESULTS We demonstrated that despite not having a significant therapeutic effect, MSC-EV treatment results in lower cartilage degeneration, less pain behaviour, osteophytosis and joint inflammation, than MSC treatment. Suggesting that MSC-EVs could be a more promising therapeutic strategy than MSCs in this mild metabolic OA model. CONCLUSION In summary, we find that MSC treatment has negative effects on the joint in metabolic mild OA. This is an essential finding for the significant group of patients with metabolic OA phenotype, and might help to understand why clinical translation of MSC treatment shows varying therapeutic efficacy thus far. Our results also suggest that MSC-EV-based treatment might be a promising option for these patients, however MSC-EV therapeutic efficacy will need improvement.
Collapse
Affiliation(s)
- Kelly Warmink
- Regenerative Medicine Center, Uppsalalaan 8, 3584 CT, Utrecht, The Netherlands
- Department of Orthopedics, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Jaqueline L Rios
- Regenerative Medicine Center, Uppsalalaan 8, 3584 CT, Utrecht, The Netherlands
- Department of Orthopedics, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Suzy Varderidou-Minasian
- Regenerative Medicine Center, Uppsalalaan 8, 3584 CT, Utrecht, The Netherlands
- Center for Molecular Medicine, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands
| | - Marta Torres-Torrillas
- Bioregenerative Medicine and Applied Surgery Research Group, Department of Animal Medicine and Surgery, CEU Cardenal Herrera University, CEU Universities, Valencia, Spain
- García Cugat Foundation CEU-UCH Chair of Medicine and Regenerative Surgery, CEU Cardenal Herrera University, CEU Universities, Valencia, Spain
| | - Devin R van Valkengoed
- Regenerative Medicine Center, Uppsalalaan 8, 3584 CT, Utrecht, The Netherlands
- Department of Orthopedics, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Sabine Versteeg
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, PO Box 85090, 3508 AB, Utrecht, The Netherlands
| | - Niels Eijkelkamp
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, PO Box 85090, 3508 AB, Utrecht, The Netherlands
| | - Harrie Weinans
- Regenerative Medicine Center, Uppsalalaan 8, 3584 CT, Utrecht, The Netherlands
- Department of Orthopedics, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands
- Department of Biomechanical Engineering, TU Delft, Mekelweg 2, 2628 CD, Delft, The Netherlands
| | - Nicoline M Korthagen
- Regenerative Medicine Center, Uppsalalaan 8, 3584 CT, Utrecht, The Netherlands
- Department of Orthopedics, University Medical Center Utrecht, PO Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Magdalena J Lorenowicz
- Regenerative Medicine Center, Uppsalalaan 8, 3584 CT, Utrecht, The Netherlands.
- Center for Molecular Medicine, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands.
- Biomedical Primate Research Centre, Lange Kleiweg 161, 2288 GJ, Rijswijk, The Netherlands.
| |
Collapse
|
17
|
Jahanmard F, Khodaei A, Flapper J, Dogan O, Roohi K, Taheri P, Weinans H, Storm G, Croes M, Mastrobattista E, Yavari SA. Osteoimmunomodulatory GelMA/liposome coatings to promote bone regeneration of orthopedic implants. J Control Release 2023; 358:667-680. [PMID: 37207794 DOI: 10.1016/j.jconrel.2023.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 04/04/2023] [Accepted: 05/15/2023] [Indexed: 05/21/2023]
Abstract
Despite being the most widely used biomaterials in orthopedic surgery, metallic implants do not induce new bone growth because they are bioinert. Surface biofunctionalization of implants with immunomodulatory mediators is a recent approach to promote osteogenic factors that facilitate bone regeneration. Liposomes (Lip) can be used as a low-cost, efficient and simple immunomodulator to stimulate immune cells in favor of bone regeneration. Even though liposomal coating systems have been reported previously, their main disadvantage is their limited ability to preserve liposome integrity after drying. In order to address this issue, we developed a hybrid system in which liposomes could be embedded in a polymeric hydrogel namely gelatin methacryloyl (GelMA). Specifically, we have developed a novel versatile coating strategy using electrospray technology to coat implants with GelMA/Liposome without using adhesive intermediate layer. The two differently charged Lip (i.e., anionic and cationic) were blended with GelMA and coated via electrospray technology on the bone-implant surfaces. The results showed that the developed coating withstood mechanical stress during surgical replacement, and Lip inside GelMA coating stayed intact in different storage conditions for a minimum of 4 weeks. Surprisingly, bare Lip, either cationic or anionic, improved the osteogenesis of human Mesenchymal Stem Cells (MSCs) by inducing pro-inflammatory cytokines, even at a low dosage of Lip released from the GelMA coating. More importantly, we showed that the inflammatory response could be fine-tuned by selecting the Lip concentration, Lip/hydrogel ratio, and coating thickness to determine the timing of the release such that we can accommodate different clinical needs. These promising results pave the way to use these Lip coatings to load different types of therapeutic cargo for bone-implant applications.
Collapse
Affiliation(s)
- F Jahanmard
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands; Department of Orthopedics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - A Khodaei
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - J Flapper
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands; Department of Orthopedics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - O Dogan
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands; Department of Orthopedics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - K Roohi
- Department of Materials Engineering, Delft University of Technology, Delft, the Netherlands
| | - P Taheri
- Department of Materials Engineering, Delft University of Technology, Delft, the Netherlands
| | - H Weinans
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - G Storm
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands
| | - M Croes
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - E Mastrobattista
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands.
| | - S Amin Yavari
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, the Netherlands; Regenerative Medicine Utrecht, Utrecht University, Utrecht, the Netherlands
| |
Collapse
|
18
|
Warmink K, Vinod P, Korthagen NM, Weinans H, Rios JL. Macrophage-Driven Inflammation in Metabolic Osteoarthritis: Implications for Biomarker and Therapy Development. Int J Mol Sci 2023; 24:ijms24076112. [PMID: 37047082 PMCID: PMC10094694 DOI: 10.3390/ijms24076112] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/19/2023] [Accepted: 03/21/2023] [Indexed: 04/14/2023] Open
Abstract
Osteoarthritis (OA) is a common and debilitating joint disorder that leads to progressive joint breakdown and loss of articular cartilage. Accompanied by a state of low-grade inflammation, its etiology extends beyond that of a wear-and-tear disease, and the immune system might have a role in its initiation and progression. Obesity, which is directly associated with an increased incidence of OA, alters adipokine release, increases pro-inflammatory macrophage activity, and affects joint immune regulation. Studying inflammatory macrophage expression and strategies to inhibit inflammatory macrophage phenotype polarization might provide insights into disease pathogenesis and therapeutic applications. In pre-clinical studies, the detection of OA in its initial stages was shown to be possible using imaging techniques such as SPECT-CT, and advances are made to detect OA through blood-based biomarker analysis. In this review, obesity-induced osteoarthritis and its mechanisms in inducing joint degeneration are summarized, along with an analysis of the current developments in patient imaging and biomarker use for diagnostic and therapeutic strategies.
Collapse
Affiliation(s)
- Kelly Warmink
- Department of Orthopedics, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Prateeksha Vinod
- Department of Orthopedics, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Nicoline M Korthagen
- Department of Orthopedics, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
- Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, 3584 CL Utrecht, The Netherlands
| | - Harrie Weinans
- Department of Orthopedics, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
- Department of Biomechanical Engineering, TU Delft, 2628 CD Delft, The Netherlands
| | - Jaqueline L Rios
- Department of Orthopedics, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| |
Collapse
|
19
|
Kuiper RJA, Seevinck PR, Viergever MA, Weinans H, Sakkers RJB. Automatic Assessment of Lower-Limb Alignment from Computed Tomography. J Bone Joint Surg Am 2023; 105:700-712. [PMID: 36947661 DOI: 10.2106/jbjs.22.00890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
BACKGROUND Preoperative planning of lower-limb realignment surgical procedures necessitates the quantification of alignment parameters by using landmarks placed on medical scans. Conventionally, alignment measurements are performed on 2-dimensional (2D) standing radiographs. To enable fast and accurate 3-dimensional (3D) planning of orthopaedic surgery, automatic calculation of the lower-limb alignment from 3D bone models is required. The goal of this study was to develop, validate, and apply a method that automatically quantifies the parameters defining lower-limb alignment from computed tomographic (CT) scans. METHODS CT scans of the lower extremities of 50 subjects were both manually and automatically segmented. Thirty-two manual landmarks were positioned twice on the bone segmentations to assess intraobserver reliability in a subset of 20 subjects. The landmarks were also positioned automatically using a shape-fitting algorithm. The landmarks were then used to calculate 25 angles describing the lower-limb alignment for all 50 subjects. RESULTS The mean absolute difference (and standard deviation) between repeat measurements using the manual method was 2.01 ± 1.64 mm for the landmark positions and 1.05° ± 1.48° for the landmark angles, whereas the mean absolute difference between the manual and fully automatic methods was 2.17 ± 1.37 mm for the landmark positions and 1.10° ± 1.16° for the landmark angles. The manual method required approximately 60 minutes of manual interaction, compared with 12 minutes of computation time for the fully automatic method. The intraclass correlation coefficient showed good to excellent reliability between the manual and automatic assessments for 23 of 25 angles, and the same was true for the intraobserver reliability in the manual method. The mean for the 50 subjects was within the expected range for 18 of the 25 automatically calculated angles. CONCLUSIONS We developed a method that automatically calculated a comprehensive range of 25 measurements that defined lower-limb alignment in considerably less time, and with differences relative to the manual method that were comparable to the differences between repeated manual assessments. This method could thus be used as an efficient alternative to manual assessment of alignment. LEVEL OF EVIDENCE Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Ruurd J A Kuiper
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, the Netherlands
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Peter R Seevinck
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
- MRIguidance B.V., Utrecht, the Netherlands
| | - Max A Viergever
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Harrie Weinans
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ralph J B Sakkers
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, the Netherlands
| |
Collapse
|
20
|
van Dijk B, Hooning van Duyvenbode JFF, de Vor L, Nurmohamed FRHA, Lam MGEH, Poot AJ, Ramakers RM, Koustoulidou S, Beekman FJ, van Strijp J, Rooijakkers SHM, Dadachova E, Vogely HC, Weinans H, van der Wal BCH. Evaluating the Targeting of a Staphylococcus-aureus-Infected Implant with a Radiolabeled Antibody In Vivo. Int J Mol Sci 2023; 24:ijms24054374. [PMID: 36901805 PMCID: PMC10002501 DOI: 10.3390/ijms24054374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/06/2023] [Accepted: 02/16/2023] [Indexed: 02/25/2023] Open
Abstract
Implant infections caused by Staphylococcus aureus are difficult to treat due to biofilm formation, which complicates surgical and antibiotic treatment. We introduce an alternative approach using monoclonal antibodies (mAbs) targeting S. aureus and provide evidence of the specificity and biodistribution of S.-aureus-targeting antibodies in a mouse implant infection model. The monoclonal antibody 4497-IgG1 targeting wall teichoic acid in S. aureus was labeled with indium-111 using CHX-A"-DTPA as a chelator. Single Photon Emission Computed Tomography/computed tomographyscans were performed at 24, 72 and 120 h after administration of the 111In-4497 mAb in Balb/cAnNCrl mice with a subcutaneous implant that was pre-colonized with S. aureus biofilm. The biodistribution of this labelled antibody over various organs was visualized and quantified using SPECT/CT imaging, and was compared to the uptake at the target tissue with the implanted infection. Uptake of the 111In-4497 mAbs at the infected implant gradually increased from 8.34 %ID/cm3 at 24 h to 9.22 %ID/cm3 at 120 h. Uptake at the heart/blood pool decreased over time from 11.60 to 7.58 %ID/cm3, whereas the uptake in the other organs decreased from 7.26 to less than 4.66 %ID/cm3 at 120 h. The effective half-life of 111In-4497 mAbs was determined to be 59 h. In conclusion, 111In-4497 mAbs were found to specifically detect S. aureus and its biofilm with excellent and prolonged accumulation at the site of the colonized implant. Therefore, it has the potential to serve as a drug delivery system for the diagnostic and bactericidal treatment of biofilm.
Collapse
Affiliation(s)
- Bruce van Dijk
- Department of Orthopedics, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
- Correspondence: ; Tel.: +31-88-75-569-71
| | | | - Lisanne de Vor
- Department of Medical Microbiology, University Medical Centre Utrecht, 3584 CX Utrecht, The Netherlands
| | | | - Marnix G. E. H. Lam
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Alex J. Poot
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Ruud M. Ramakers
- MILabs B.V., 3584 CX Utrecht, The Netherlands
- Department of Radiation Science and Technology, Delft University of Technology, 2628 CD Delft, The Netherlands
- Department of Translational Neuroscience, Brain Center Rudolf Magnus, University Medical Center, 3584 CX Utrecht, The Netherlands
| | - Sofia Koustoulidou
- MILabs B.V., 3584 CX Utrecht, The Netherlands
- Department of Translational Neuroscience, Brain Center Rudolf Magnus, University Medical Center, 3584 CX Utrecht, The Netherlands
| | - Freek J. Beekman
- MILabs B.V., 3584 CX Utrecht, The Netherlands
- Department of Radiation Science and Technology, Delft University of Technology, 2628 CD Delft, The Netherlands
- Department of Translational Neuroscience, Brain Center Rudolf Magnus, University Medical Center, 3584 CX Utrecht, The Netherlands
| | - Jos van Strijp
- Department of Medical Microbiology, University Medical Centre Utrecht, 3584 CX Utrecht, The Netherlands
| | - Suzan H. M. Rooijakkers
- Department of Medical Microbiology, University Medical Centre Utrecht, 3584 CX Utrecht, The Netherlands
| | - Ekaterina Dadachova
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK S7N 5A8, Canada
| | - H. Charles Vogely
- Department of Orthopedics, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Harrie Weinans
- Department of Orthopedics, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
- Department of BioMechanical Engineering, Delft University of Technology, 2628 CD Delft, The Netherlands
| | - Bart C. H. van der Wal
- Department of Orthopedics, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| |
Collapse
|
21
|
Kwananocha I, Magré J, Willemsen K, Weinans H, Sakkers RJB, How T, Verseijden F, Tryfonidou MA, van der Wal BCH, Meij BP. Acetabular rim extension using a personalized titanium implant for treatment of hip dysplasia in dogs: short-term results. Front Vet Sci 2023; 10:1160177. [PMID: 37152693 PMCID: PMC10157081 DOI: 10.3389/fvets.2023.1160177] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 03/27/2023] [Indexed: 05/09/2023] Open
Abstract
Hip dysplasia (HD) is a common orthopedic problem in young dogs. To decrease the laxity of the hip joint related to HD, the surgical treatments are recommended to increase femoral head coverage. ACEtabular rim eXtension (ACE-X) using a personalized 3-dimensional printed titanium shelf implant is a new surgical treatment to increase femoral head coverage and decrease laxity of the dysplastic hip joint, however, the efficacy is less know. Client-owned dogs older than 6 months with clinical signs of coxofemoral joint subluxation and radiographic evidence of HD with no or mild osteoarthritis (OA) were included. The Norberg angle (NA), linear percentage of femoral head overlap (LFO), and percentage of femoral head coverage (PC) were investigated radiographically and with computed tomography (CT) before and after surgery. OA was graded (scores 0-3) according to the maximum osteophyte size measured on CT. In addition, joint laxity (Ortolani) test results, gait analysis, and the Helsinki chronic pain index (HCPI) questionnaire were obtained at preoperative, immediately postoperative and at 1.5- and 3-month evaluations. Acetabular rim extension was performed in 61 hips of 34 dogs; NA, LFO, and PC were significantly higher immediately postoperatively and at the 1.5- and 3-month follow-up examinations compared with preoperative values (p < 0.05). Osteophyte size gradually increased over time (p < 0.05). The OA score significantly increased between preoperatively and directly postoperatively, and between preoperatively and at 3-month follow-up (p < 0.05). The laxity test normalized in 59 out of 61 hips after surgery, and the HCPI questionnaire showed that the pain score decreased significantly at 1.5 and 3 months, postoperatively. The force plate showed no significant improvement during the 3 months follow-up. Although pain reduction by the implant was unclear in short-term results, a personalized shelf implant significantly increased femoral head coverage and eliminated subluxation of the dysplastic hip joint. Further studies are required to study the long-term efficacy of gait, chronic pain, and progression of osteoarthritis.
Collapse
Affiliation(s)
- Irin Kwananocha
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
- Research and Academic Service, Faculty of Veterinary Medicine, Kasetsart University, Bangkok, Thailand
| | - Joëll Magré
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, Netherlands
- 3D Lab, Division of Surgical Specialties, University Medical Center Utrecht, Utrecht, Netherlands
| | - Koen Willemsen
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, Netherlands
- 3D Lab, Division of Surgical Specialties, University Medical Center Utrecht, Utrecht, Netherlands
| | - Harrie Weinans
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, Netherlands
| | - Ralph J. B. Sakkers
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, Netherlands
| | - Thijs How
- Diergeneeskundig Specialisten Centrum Den Haag, The Hague, Netherlands
| | - Femke Verseijden
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | - Marianna A. Tryfonidou
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | | | - Björn P. Meij
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
- *Correspondence: Björn P. Meij
| |
Collapse
|
22
|
Arbabi S, Seevinck P, Weinans H, de Jong PA, Sturkenboom J, van Hamersvelt RW, Foppen W, Arbabi V. Statistical shape model of the talus bone morphology: A comparison between impinged and nonimpinged ankles. J Orthop Res 2023; 41:183-195. [PMID: 35289957 PMCID: PMC10084311 DOI: 10.1002/jor.25328] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 02/14/2022] [Accepted: 03/13/2022] [Indexed: 02/04/2023]
Abstract
Diagnosis of ankle impingement is performed primarily by clinical examination, whereas medical imaging is used for severity staging and treatment guidance. The association of impingement symptoms with regional three-dimensional (3D) bone shape variaties visible in medical images has not been systematically explored, nor do we know the type and magnitude of this relation. In this cross-sectional case-control study, we hypothesized that 3D talus bone shape could be used to quantitatively formulate the discriminating shape variations between ankles with impingement from ankles without impingement, and we aimed to characterize and quantify these variations. We used statistical shape modeling (SSM) methods to determine the most prevalent modes of shape variations that discriminate between the impinged and nonimpinged ankles. Results of the compactness and parallel analysis test on the statistical shape model identify 8 prominent shape modes of variations (MoVs) representing approximately 78% of the total 3D variations in the population of shapes, among which two modes captured discriminating features between impinged and nonimpinged ankles (p value of 0.023 and 0.042). Visual inspection confirms that these two shape modes, capturing abnormalities in the anterior and posterior parts of talus, represent the two main bony risk factors in anterior and posterior ankle impingement. In conclusion, in this research using SSM we have identified shape MoVs that were found to correlate significantly with bony ankle impingement. We also illustrated potential guidance from SSMs for surgical planning.
Collapse
Affiliation(s)
- Saeed Arbabi
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Orthopedics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Peter Seevinck
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands.,MRIguidance B.V., Utrecht, The Netherlands
| | - Harrie Weinans
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Biomechanical Engineering, Delft University of Technology (TU Delft), Delft, The Netherlands
| | - Pim A de Jong
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Joran Sturkenboom
- Polikliniek Orthopedie, Central Military Hospital, Utrecht, The Netherlands
| | | | - Wouter Foppen
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Vahid Arbabi
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Mechanical Engineering, Faculty of Engineering, Orthopaedic-Biomechanics Research Group, Birjand, Iran
| |
Collapse
|
23
|
Nguyen HC, van Egmond N, de Visser HM, Weinans H, Sakkers RJ, Custers RJ. Visual Inspection for Lower Limb Malalignment Diagnosis Is Unreliable. Cartilage 2022; 13:59-65. [PMID: 36305650 PMCID: PMC9924985 DOI: 10.1177/19476035221113952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE Visual inspection of the lower limb is often part of standard clinical practice during a physical examination at the outpatient clinic. This study aims to investigate how reliable visual inspections are in terms of detecting lower limb malalignments without additional tools and physical examinations. DESIGN This study enrolled 50 patients. Each patient underwent a whole leg radiograph (WLR); in addition, a standardized digital photograph was taken of the lower limbs. Four persons (different experience levels) visually rated the digital photograph twice (unaware of the hip knee angle [HKA] on the WLR) and placed them in the category: severe valgus (>5°); moderate valgus (2°-5°); neutral, moderate varus (2°-5°); and severe varus (>5°). Visual ratings were compared with the measured HKA on WLRs for correlation using Spearman's rho. Linear ordinal regression models with significance when P < 0.05 were used to test whether body mass index (BMI), age, gender, and HKA were possible risk factors for incorrect visual HKA assessment. RESULTS Spearman's rho between the visual assessment and measured HKA on the WLR was moderate with 0.478 (P < 0.01). Women had an increased odds ratio of 3.7 (P = 0.001) for incorrect visual assessment. Higher HKA also increased the odds ratio for erroneous visual assessment with 1.4 (P = 0.003). BMI and age did not significantly increase the odds of erroneous visual leg axis assessments in this study. CONCLUSIONS Visual assessment of the lower limb alignment does not provide clinically relevant information. Lower limb malalignment diagnoses cannot be performed using only a visual inspection. Physical examination tests and radiographical assessments are advised. LEVEL OF EVIDENCE Diagnostic level II.
Collapse
Affiliation(s)
- H. Chien Nguyen
- Department of Orthopaedics, University
Medical Center Utrecht, Utrecht, The Netherlands
| | - Nienke van Egmond
- Department of Orthopaedics, University
Medical Center Utrecht, Utrecht, The Netherlands
| | - Huub M. de Visser
- Department of Orthopaedics, University
Medical Center Utrecht, Utrecht, The Netherlands
| | - Harrie Weinans
- Department of Orthopaedics, University
Medical Center Utrecht, Utrecht, The Netherlands
| | - Ralph J.B. Sakkers
- Department of Orthopaedics, University
Medical Center Utrecht, Utrecht, The Netherlands
| | - Roel J.H. Custers
- Department of Orthopaedics, University
Medical Center Utrecht, Utrecht, The Netherlands,Roel J.H. Custers, Department of
Orthopaedics, University Medical Center Utrecht, Heidelberglaan 100, 3584CX
Utrecht, The Netherlands.
| |
Collapse
|
24
|
Kuiper RJA, Sakkers RJB, van Stralen M, Arbabi V, Viergever MA, Weinans H, Seevinck PR. Efficient cascaded V-net optimization for lower extremity CT segmentation validated using bone morphology assessment. J Orthop Res 2022; 40:2894-2907. [PMID: 35239226 PMCID: PMC9790725 DOI: 10.1002/jor.25314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 01/13/2022] [Accepted: 02/02/2022] [Indexed: 02/04/2023]
Abstract
Semantic segmentation of bone from lower extremity computerized tomography (CT) scans can improve and accelerate the visualization, diagnosis, and surgical planning in orthopaedics. However, the large field of view of these scans makes automatic segmentation using deep learning based methods challenging, slow and graphical processing unit (GPU) memory intensive. We investigated methods to more efficiently represent anatomical context for accurate and fast segmentation and compared these with state-of-the-art methodology. Six lower extremity bones from patients of two different datasets were manually segmented from CT scans, and used to train and optimize a cascaded deep learning approach. We varied the number of resolution levels, receptive fields, patch sizes, and number of V-net blocks. The best performing network used a multi-stage, cascaded V-net approach with 1283 -643 -323 voxel patches as input. The average Dice coefficient over all bones was 0.98 ± 0.01, the mean surface distance was 0.26 ± 0.12 mm and the 95th percentile Hausdorff distance 0.65 ± 0.28 mm. This was a significant improvement over the results of the state-of-the-art nnU-net, with only approximately 1/12th of training time, 1/3th of inference time and 1/4th of GPU memory required. Comparison of the morphometric measurements performed on automatic and manual segmentations showed good correlation (Intraclass Correlation Coefficient [ICC] >0.8) for the alpha angle and excellent correlation (ICC >0.95) for the hip-knee-ankle angle, femoral inclination, femoral version, acetabular version, Lateral Centre-Edge angle, acetabular coverage. The segmentations were generally of sufficient quality for the tested clinical applications and were performed accurately and quickly compared to state-of-the-art methodology from the literature.
Collapse
Affiliation(s)
- Ruurd J. A. Kuiper
- Department of OrthopaedicsUniversity Medical Center UtrechtUtrechtThe Netherlands,Image Sciences InstituteUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Ralph J. B. Sakkers
- Department of OrthopaedicsUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Marijn van Stralen
- Image Sciences InstituteUniversity Medical Center UtrechtUtrechtThe Netherlands,MRIguidance B.V.UtrechtThe Netherlands
| | - Vahid Arbabi
- Department of OrthopaedicsUniversity Medical Center UtrechtUtrechtThe Netherlands,Department of Mechanical EngineeringUniversity of BirjandBirjandIran
| | - Max A. Viergever
- Image Sciences InstituteUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Harrie Weinans
- Department of OrthopaedicsUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Peter R. Seevinck
- Image Sciences InstituteUniversity Medical Center UtrechtUtrechtThe Netherlands,MRIguidance B.V.UtrechtThe Netherlands
| |
Collapse
|
25
|
van Buuren MMA, Heerey JJ, Smith A, Crossley KM, Kemp JL, Scholes MJ, Lawrenson PR, King MG, Gielis WP, Weinans H, Lindner C, Souza RB, Verhaar JAN, Agricola R. The association between statistical shape modeling-defined hip morphology and features of early hip osteoarthritis in young adult football players: Data from the femoroacetabular impingement and hip osteoarthritis cohort (FORCe) study. Osteoarthr Cartil Open 2022; 4:100275. [PMID: 36474944 PMCID: PMC9718108 DOI: 10.1016/j.ocarto.2022.100275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 04/28/2022] [Accepted: 05/16/2022] [Indexed: 11/20/2022] Open
Abstract
Objective To explore the relationship between radiographic hip shape and features of early hip osteoarthritis (OA) on magnetic resonance imaging (MRI) in young male and female football players without radiographic hip OA. Design We used baseline data from a cohort of symptomatic and asymptomatic football players aged 18-50 years. Hip shape was assessed on anteroposterior radiographs with statistical shape modeling (SSM) for men and women separately. Cartilage defects and labral tears were graded using the Scoring Hip Osteoarthritis with MRI (SHOMRI) system. We used logistic regression with generalized estimating equations to estimate associations between each hip shape variant, called shape modes, and cartilage defects or labral tears. Results We included 229 participants (446 hips, 77.4% male). For each sex, 15 shape modes were analyzed. In men, three shape modes were associated with cartilage defects: adjusted odds ratios (aOR) 0.75 (95%CI 0.58-0.97) per standard deviation (SD) for mode 1; 1.34 (95%CI 1.05-1.69) per SD for mode 12; and 0.61 (95%CI 0.48-0.78) per SD for mode 15; and one also with labral tears: aOR 1.30 (95%CI 1.01-1.69) per SD for mode 12. These modes generally represented variations in the femoral neck and subtypes of cam morphology, with and without pincer morphology. For women, there was no evidence for associations with the outcomes. Conclusions Several hip shape variants were associated with cartilage defects on MRI in young male football players. Specifically, one subtype of cam morphology was associated with both cartilage defects and labral tears. Hip shape was not associated with early OA features in women.
Collapse
Affiliation(s)
- M M A van Buuren
- Department of Orthopaedics and Sports Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - J J Heerey
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - A Smith
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - K M Crossley
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - J L Kemp
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - M J Scholes
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - P R Lawrenson
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - M G King
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - W P Gielis
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - H Weinans
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands
| | - C Lindner
- Division of Informatics, Imaging & Data Sciences, University of Manchester, Manchester, United Kingdom
| | - R B Souza
- Department of Physical Therapy and Rehabilitation Science, University of California San Francisco, San Francisco, CA, USA
| | - J A N Verhaar
- Department of Orthopaedics and Sports Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - R Agricola
- Department of Orthopaedics and Sports Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| |
Collapse
|
26
|
Cecotto L, van Kessel K, Wolfert MA, Vogely C, van der Wal B, Weinans H, van Strijp J, Yavari SA. Antibacterial and anti-inflammatory properties of host defense peptides against Staphylococcus aureus. iScience 2022; 25:105211. [PMID: 36248729 PMCID: PMC9563556 DOI: 10.1016/j.isci.2022.105211] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/05/2022] [Accepted: 09/22/2022] [Indexed: 12/03/2022] Open
Abstract
Cationic host defense peptides (HDPs) are a promising alternative to antibiotics in the fight against Staphylococcus aureus infections. In this study, we investigated the antibacterial and immunomodulatory properties of three HDPs namely IDR-1018, CATH-2, and LL-37. Although all three HDPs significantly inhibited LPS-induced activation of human macrophages, only CATH-2 prevented S. aureus growth. When applied to different infection models focused on intracellularly surviving bacteria, only IDR-1018 showed a consistent reduction in macrophage bacterial uptake. However, this observation did not correlate with an increase in killing the efficiency of intracellular S. aureus. Here, we conclude that despite the promising antibacterial and anti-inflammatory properties of the selected HDPs, macrophages’ intrinsic antibacterial functions were not improved. Future studies should either focus on combining different HDPs or using them synergistically with other antibacterial agents to improve immune cells’ efficacy against S. aureus pathogenesis. HDPs namely IDR-1018, CATH-2, and LL-37 inhibit macrophage LPS-mediated activation Only CATH-2 shows direct antibacterial properties against S. aureus Reduction in the number of phagocytosed bacteria is rendered by IDR-1018 HDPs fail to stimulate macrophage’s ability to kill intracellular S. aureus
Collapse
|
27
|
van der Gronde BATD, Schlösser TPC, van Erp JHJ, Snijders TE, Castelein RM, Weinans H, de Gast A. Current Evidence for Spinopelvic Characteristics Influencing Total Hip Arthroplasty Dislocation Risk. JBJS Rev 2022; 10:01874474-202208000-00004. [PMID: 36000764 DOI: 10.2106/jbjs.rvw.22.00038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Decreased pelvic mobility and pelvic retroversion may result from spinal degeneration and lead to changes in the orientation of the acetabular implant after total hip arthroplasty (THA). While multiple patient and surgery-related factors contribute to THA dislocations, there is increasing evidence that sagittal spinopelvic dynamics are relevant for THA stability. The aim of this systematic review was to assess the relationship between previously described sagittal spinopelvic characteristics and implant dislocations after primary THA. METHODS A comprehensive literature search in the PubMed and Embase databases was conducted for studies reporting on spinopelvic morphology, alignment, pathology, or surgery and THA dislocations. Risk of bias was assessed using the MINORS criteria. Because of high heterogeneity in study methodology, a synthesis of best evidence was performed. Odds ratios (ORs), relative risks (RRs), and effect sizes (g) were calculated. RESULTS Fifteen studies (1,007,900 THAs) with quality scores of 15 to 23 out of 24 were included. Nine different spinopelvic alignment parameters (8 studies, g = 0.14 to 2.02), spinal pathology (2 studies, OR = 1.9 to 29.2), and previous spinal fusion surgery (8 studies, OR = 1.59 to 23.7, RR = 3.0) were found to be related to THA dislocation. Conflicting results were found for another sagittal pelvic morphology parameter, pelvic incidence. CONCLUSIONS Several sagittal spinopelvic patient characteristics were found to be related to THA dislocation, and the associated risks were greater than for other patient and surgery-related factors. Future research is needed to determine which of those characteristics and parameters should be taken into account in patients undergoing primary THA. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- B A T D van der Gronde
- Clinical Orthopedic Research Center midden Nederland, Department of Orthopedic Surgery, Diakonessenhuis Hospital, Zeist, the Netherlands
| | - T P C Schlösser
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - J H J van Erp
- Clinical Orthopedic Research Center midden Nederland, Department of Orthopedic Surgery, Diakonessenhuis Hospital, Zeist, the Netherlands.,Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - T E Snijders
- Clinical Orthopedic Research Center midden Nederland, Department of Orthopedic Surgery, Diakonessenhuis Hospital, Zeist, the Netherlands
| | - R M Castelein
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - H Weinans
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.,Department of Biomechanical Engineering, Technical University Delft, Delft, the Netherlands
| | - A de Gast
- Clinical Orthopedic Research Center midden Nederland, Department of Orthopedic Surgery, Diakonessenhuis Hospital, Zeist, the Netherlands
| |
Collapse
|
28
|
Khokhani P, Belluomo R, Croes M, Gawlitta D, Kruyt MC, Weinans H. An in-vitro model to test the influence of immune cell secretome on MSC osteogenic differentiation. Tissue Eng Part C Methods 2022; 28:420-430. [PMID: 35770885 DOI: 10.1089/ten.tec.2022.0086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Immune cells and their soluble factors have an important role in the bone healing process. Modulation of the immune response, therefore, offers a potential strategy to enhance bone formation. To investigate the influence of the immune system on osteogenesis, we developed and applied an in-vitro model that incorporates both innate and adaptive immune cells. Human peripheral blood mononuclear cells (PBMCs) were isolated and cultured for 24 hours and subsequently stimulated with immune-modulatory agents; C-class CpG oligodeoxynucleotide (CpG ODN C), Polyinosinic acid-polycytidylic acid Poly(I:C), and lipopolysaccharide (LPS); all pathogen recognition receptor agonists, and that target Toll-like receptors TLR9, -3, and -4, respectively. The conditioned medium obtained from PBMCs after 24 hours was used to investigate its effects on the metabolic activity and osteogenic differentiation capacity of human bone marrow-derived mesenchymal stromal cells (MSCs). Conditioned media from unstimulated PBMCs did not affect the metabolic activity and osteogenic differentiation capacity of MSCs. The conditioned medium from CpG ODN C and LPS stimulated PBMCs increased alkaline phosphatase activity of MSCs by approximately 3-fold as compared to the unstimulated control, whereas Poly(I:C) conditioned medium did not enhance ALP activity of MSCs. Moreover, direct stimulation of MSCs with the immune-modulatory stimuli did not result in increased alkaline phosphatase activity. These results demonstrate that soluble factors present in conditioned medium from PBMCs stimulated with immune-modulatory factors enhance osteogenesis of MSCs. This in-vitro model can serve as a tool in screening immune-modulatory stimulants from a broad variety of immune cells for (indirect) effects on osteogenesis and also to identify soluble factors from multiple immune cell types that may modulate bone healing.
Collapse
Affiliation(s)
- Paree Khokhani
- University Medical Centre Utrecht, 8124, Orthopedics , UMC Utrecht, dept. Orthopedics, G5.203, Heidelberglaan 100, Utrecht, Utrecht, Drenthe, Netherlands, 3584CX.,University Medical Centre, Utrecht (UMCU), UMC Utrecht, dept. Orthopedics, G5.203, Heidelberglaan 100, Netherlands;
| | - Ruggero Belluomo
- University Medical Centre Utrecht, 8124, Orthopedics , Utrecht, Utrecht, Netherlands;
| | - Michiel Croes
- University Medical Centre Utrecht, 8124, Orthopedics , Utrecht, Utrecht, Netherlands;
| | - Debby Gawlitta
- University Medical Center Utrecht, Oral and Maxillofacial Surgery, Prosthodontics & Special Dental Care, Heidelberglaan 100, G05.129, PO Box 85500, Utrecht, Netherlands, 3508 GA;
| | - Moyo C Kruyt
- University medical center Utrecht, Orthopedics, HP G 05.228, PO Box 85500, Utrecht, Netherlands, 3508 GA;
| | - Harrie Weinans
- University Medical Centre Utrecht, 8124, Orthopedics, Utrecht, Utrecht, Netherlands;
| |
Collapse
|
29
|
Willemsen K, Tryfonidou M, Sakkers R, Castelein RM, Zadpoor AA, Seevinck P, Weinans H, Meij B, van der Wal BCH. Patient-specific 3D-printed shelf implant for the treatment of hip dysplasia: Anatomical and biomechanical outcomes in a canine model. J Orthop Res 2022; 40:1154-1162. [PMID: 34191341 PMCID: PMC9291530 DOI: 10.1002/jor.25133] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/19/2021] [Accepted: 06/09/2021] [Indexed: 02/04/2023]
Abstract
A solution for challenging hip dysplasia surgery could be a patient-specific 3D-printed shelf implant that is positioned extra-articular and restores the dysplastic acetabular rim to normal anatomical dimensions. The anatomical correction and biomechanical stability of this concept were tested in a canine model that, like humans, also suffers from hip dysplasia. Using 3D reconstructed computed tomography images the 3D shelf implant was designed to restore the radiological dysplastic hip parameters to healthy parameters. It was tested ex vivo on three dog cadavers (six hips) with hip dysplasia. Each hip was subjected to a biomechanical subluxation test, first without and then with the 3D shelf implant in place. Subsequently, an implant failure test was performed to test the primary implant fixation. At baseline, the dysplastic hips had an average Norberg angle of 88 ± 3° and acetabular coverage of 47 ± 2% and subluxated at an average of 83 ± 2° of femoral adduction. After adding the patient-specific shelf implants the dysplastic hips had an average Norberg angle of 122 ± 2° and acetabular coverage of 67 ± 3% and subluxated at an average of 117 ± 2° of femoral adduction. Implant failure after primary implant fixation occurred at an average of 1330 ± 320 Newton. This showed that the patient-specific shelf implants significantly improved the coverage and stability of dysplastic hips in a canine model with naturally occurring hip dysplasia. The 3D shelf is a promising concept for treating residual hip dysplasia with a straightforward technology-driven approach; however, the clinical safety needs to be further investigated in an experimental proof-of-concept animal study.
Collapse
Affiliation(s)
- Koen Willemsen
- Department of OrthopedicsUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Marianna Tryfonidou
- Department of Clinical Sciences, Faculty of Veterinary MedicineUtrecht UniversityUtrechtThe Netherlands
| | - Ralph Sakkers
- Department of OrthopedicsUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - René M. Castelein
- Department of OrthopedicsUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Amir A. Zadpoor
- Department of Biomechanical EngineeringDelft University of TechnologyDelftThe Netherlands
| | - Peter Seevinck
- Department of RadiologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Harrie Weinans
- Department of OrthopedicsUniversity Medical Center UtrechtUtrechtThe Netherlands,Department of Biomechanical EngineeringDelft University of TechnologyDelftThe Netherlands
| | - Björn Meij
- Department of Clinical Sciences, Faculty of Veterinary MedicineUtrecht UniversityUtrechtThe Netherlands
| | | |
Collapse
|
30
|
Taylor J, Dekker S, Jurg D, Skandsen J, Grossman M, Marijnissen AK, Ladel C, Mobasheri A, Larkin J, Weinans H, Kanter-Schlifke I. Correction to: Making the patient voice heard in a research consortium: experiences from an EU project (IMI-APPROACH). Res Involv Engagem 2022; 8:15. [PMID: 35440013 PMCID: PMC9019958 DOI: 10.1186/s40900-022-00348-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Jane Taylor
- The APPROACH Patient Council, Utrecht, The Netherlands
| | - Sjouke Dekker
- The APPROACH Patient Council, Utrecht, The Netherlands
| | - Diny Jurg
- The APPROACH Patient Council, Utrecht, The Netherlands
| | - Jon Skandsen
- The APPROACH Patient Council, Utrecht, The Netherlands
| | | | - Anne-Karien Marijnissen
- Rheumatology and Clinical Immunology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | | | - Ali Mobasheri
- University of Oulu, Oulu Finland State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
- University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Harrie Weinans
- Rheumatology and Clinical Immunology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | | |
Collapse
|
31
|
Florkow MC, Willemsen K, Zijlstra F, Foppen W, van der Wal BCH, van der Voort van Zyp JRN, Viergever MA, Castelein RM, Weinans H, van Stralen M, Sakkers RJB, Seevinck PR. MRI-based synthetic CT shows equivalence to conventional CT for the morphological assessment of the hip joint. J Orthop Res 2022; 40:954-964. [PMID: 34191351 PMCID: PMC9291600 DOI: 10.1002/jor.25127] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 05/05/2021] [Accepted: 06/09/2021] [Indexed: 02/04/2023]
Abstract
This study evaluated the accuracy of synthetic computed tomography (sCT), as compared to CT, for the 3D assessment of the hip morphology. Thirty male patients with asymptomatic hips, referred for magnetic resonance (MR) imaging and CT, were included in this retrospective study. sCT images were generated from three-dimensional radiofrequency-spoiled T1-weighted multi-echo gradient-echo MR images using a commercially available deep learning-enabled software and were compared with CT images through mean error and surface distance computation and by means of eight clinical morphometric parameters relevant for hip care. Parameters included center-edge angle (CEA), sharp angle, acetabular index, extrusion index, femoral head center-to-midline distance, acetabular version (AV), and anterior and posterior acetabular sector angles. They were measured by two senior orthopedic surgeons and a radiologist in-training on CT and sCT images. The reliability and agreement of CT- and sCT-based measurements were assessed using intraclass correlation coefficients (ICCs) for absolute agreement, Bland-Altman plots, and two one-sided tests for equivalence. The surface distance between CT- and sCT-based bone models were on average submillimeter. CT- and sCT-based measurements showed moderate to excellent interobserver and intraobserver correlation (0.56 < ICC < 0.99). In particular, the inter/intraobserver agreements were good for AV (ICC > 0.75). For CEA, the intraobserver agreement was good (ICC > 0.75) and the interobserver agreement was moderate (ICC > 0.69). Limits of agreements were similar between intraobserver CT and intermodal measurements. All measurements were found statistically equivalent, with average intermodal differences within the intraobserver limits of agreement. In conclusion, sCT and CT were equivalent for the assessment of the hip joint bone morphology.
Collapse
Affiliation(s)
- Mateusz C. Florkow
- Image Sciences InstituteUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Koen Willemsen
- Department of OrthopedicsUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Frank Zijlstra
- Image Sciences InstituteUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Wouter Foppen
- Department of RadiologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | | | | | - Max A. Viergever
- Image Sciences InstituteUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - René M. Castelein
- Department of OrthopedicsUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Harrie Weinans
- Department of OrthopedicsUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Marijn van Stralen
- Image Sciences InstituteUniversity Medical Center UtrechtUtrechtThe Netherlands,MRIguidance B.V.UtrechtThe Netherlands
| | - Ralph J. B. Sakkers
- Department of OrthopedicsUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Peter R. Seevinck
- Image Sciences InstituteUniversity Medical Center UtrechtUtrechtThe Netherlands,MRIguidance B.V.UtrechtThe Netherlands
| |
Collapse
|
32
|
Warmink K, Siebelt M, Low PS, Riemers FM, Wang B, Plomp SGM, Tryfonidou MA, van Weeren PR, Weinans H, Korthagen NM. Folate Receptor Expression by Human Monocyte-Derived Macrophage Subtypes and Effects of Corticosteroids. Cartilage 2022; 13:19476035221081469. [PMID: 35255727 PMCID: PMC9137314 DOI: 10.1177/19476035221081469] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Folate receptor beta (FR-β) has been used as a clinical marker and target in multiple inflammatory diseases, including osteoarthritis (OA) and rheumatoid arthritis (RA). However, the conditions under which FR-β+ macrophages arise remain unclear and could be affected by corticosteroids. Therefore, we studied FR-β expression in vitro in macrophage subtypes and determined their response to triamcinolone acetonide (TA), a clinically often-used corticosteroid. DESIGN Human monocyte-derived macrophages were differentiated to the known M0, M1, or M2 macrophage phenotypes. The phenotype and FR-β expression and plasticity of the macrophage subtypes were determined using flow cytometry, reverse transcription-quantitative polymerase chain reaction (RT-qPCR), and enzyme-linked immunosorbent assay (ELISA). RESULTS FR-β expression was low in granulocyte-macrophage colony-stimulating factor (GM-CSF)-generated (M1-like) macrophages and high in macrophage colony-stimulating factor (M-CSF)-generated (M0 and M2-like) macrophages. FR-β expression remained high once the M0 or M2 macrophages were stimulated with pro-inflammatory stimuli (interferon-γ plus lipopolysaccharide) to induce M1-like macrophages. On the contrary, anti-inflammatory TA treatment skewed GM-CSF macrophage differentiation toward an M2 and FR-β+ phenotype. CONCLUSIONS As corticosteroids skewed monocytes toward an FR-β-expressing, anti-inflammatory phenotype, even in an M1 priming GM-CSF environment, FR-β has potential as a biomarker to monitor success of treatment with corticosteroids. Without corticosteroid treatment, M-CSF alone induces high FR-β expression which remains high under pro-inflammatory conditions. This explains why pro-inflammatory FR-β+ macrophages (exposed to M-CSF) are observed in arthritis patients and correlate with disease severity.
Collapse
Affiliation(s)
- Kelly Warmink
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, The Netherlands,Kelly Warmink, Department of Orthopedics, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
| | - Michiel Siebelt
- Department of Orthopedics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Philip S. Low
- Department of Chemistry, Purdue University, West Lafayette, IN, USA
| | - Frank M. Riemers
- Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Bingbing Wang
- Department of Chemistry, Purdue University, West Lafayette, IN, USA
| | - Saskia G. M. Plomp
- Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Marianna A. Tryfonidou
- Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - P. René van Weeren
- Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Harrie Weinans
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, The Netherlands,Department of Biomechanical Engineering, TU Delft, Delft, The Netherlands
| | - Nicoline M. Korthagen
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, The Netherlands,Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| |
Collapse
|
33
|
van Erp JHJ, Schlösser TPC, Baijense AW, Snijders TE, Stevenson R, Gielis WP, Castelein RM, Weinans H, de Gast A. Calculation of the 3-D femoral component's orientation in total hip arthroplasty using a trigonometric algorithm. Sci Rep 2022; 12:3499. [PMID: 35241700 PMCID: PMC8894411 DOI: 10.1038/s41598-022-07331-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 02/11/2022] [Indexed: 11/09/2022] Open
Abstract
Femoral component orientation plays a key role in implant stability and therefore the success rate of total hip arthroplasty. To date, this topic has been studied using various definitions and a variety of imaging modalities and protocols. The aim of this study is a proof of concept that a new algorithm can be used to describe the femoral component’s 3D orientation on the three orthogonal anatomical planes and relative to its mechanical axis using input from two orthogonal planes. CT scans of 18 patients with a total of 22 hip arthroplasties were collected. From these, orthogonal coronal and sagittal projections of the complete femur were acquired in the scanning position (MIPs) and relative to the femoral mechanical axis (corrected MIPs). On these images, the orientation of the neck of the femoral component in space and relative to the femoral axis, respectively, was measured by coronal inclination (CIF), sagittal inclination (SIF) and transverse version (TVF). With the algorithm, TVF was also calculated based on CIF and SIF. Differences between measured and calculated TVF and intra- and inter-observer reliability were evaluated using intra-class correlation coefficients (ICC). The error of non-orthogonal imaging (85° angle between the sagittal and coronal reconstructions) was tested on a third series of MIPs. The ICC between the calculated TVF and manually measured TVF, in space and relative to the femoral axis, was 0.98 for both with median absolute differences of 1.3 and 1.5°. For non-orthogonal images this was 0.70 with a median absolute difference of 5°. ICCs for intra-observer and inter-observer reliability for the calculated TVF values were 0.98 and 0.88, respectively. With this algorithm the transverse orientation of the neck of the femoral component can be assessed in space and relative to the mechanical femoral axis by combining its sagittal and coronal orientation. As long as the imaging visualizes two orthogonal planes, the orientation of an implant can be assessed in 3-D, regardless of the imaging modality.
Collapse
Affiliation(s)
- Joost H J van Erp
- Clinical Orthopedic Research Center-mN, Zeist, The Netherlands. .,Department of Orthopedic Surgery, Diakonessenhuis, Utrecht, The Netherlands. .,Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Tom P C Schlösser
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Thom E Snijders
- Clinical Orthopedic Research Center-mN, Zeist, The Netherlands.,Department of Orthopedic Surgery, Diakonessenhuis, Utrecht, The Netherlands
| | - Rob Stevenson
- Korteweg-de Vries Institute for Mathematics, University of Amsterdam, Amsterdam, The Netherlands
| | - Willem Paul Gielis
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - René M Castelein
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Harrie Weinans
- Department of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Biomechanical Engineering, TU Delft, Delft, The Netherlands
| | - Arthur de Gast
- Clinical Orthopedic Research Center-mN, Zeist, The Netherlands
| |
Collapse
|
34
|
Saukko AEA, Nykänen O, Sarin JK, Nissi MJ, Te Moller NCR, Weinans H, Mancini IAD, Visser J, Brommer H, van Weeren PR, Malda J, Grinstaff MW, Töyräs J. Dual-contrast computed tomography enables detection of equine posttraumatic osteoarthritis in vitro. J Orthop Res 2022; 40:703-711. [PMID: 33982283 DOI: 10.1002/jor.25066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 04/26/2021] [Indexed: 02/04/2023]
Abstract
To prevent the progression of posttraumatic osteoarthritis, assessment of cartilage composition is critical for effective treatment planning. Posttraumatic changes include proteoglycan (PG) loss and elevated water content. Quantitative dual-energy computed tomography (QDECT) provides a means to diagnose these changes. Here, we determine the potential of QDECT to evaluate tissue quality surrounding cartilage lesions in an equine model, hypothesizing that QDECT allows detection of posttraumatic degeneration by providing quantitative information on PG and water contents based on the partitions of cationic and nonionic agents in a contrast mixture. Posttraumatic osteoarthritic samples were obtained from a cartilage repair study in which full-thickness chondral defects were created surgically in both stifles of seven Shetland ponies. Control samples were collected from three nonoperated ponies. The experimental (n = 14) and control samples (n = 6) were immersed in the contrast agent mixture and the distributions of the agents were determined at various diffusion time points. As a reference, equilibrium moduli, dynamic moduli, and PG content were measured. Significant differences (p < 0.05) in partitions between the experimental and control samples were demonstrated with cationic contrast agent at 30 min, 60 min, and 20 h, and with non-ionic agent at 60 and 120 min. Significant Spearman's rank correlations were obtained at 20 and 24 h (ρ = 0.482-0.693) between the partition of cationic contrast agent, cartilage biomechanical properties, and PG content. QDECT enables evaluation of posttraumatic changes surrounding a lesion and quantification of PG content, thus advancing the diagnostics of the extent and severity of cartilage injuries.
Collapse
Affiliation(s)
- Annina E A Saukko
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Department of Medical Physics, Turku University Hospital, Turku, Finland
| | - Olli Nykänen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Research Unit of Medical Imaging Physics and Technology, University of Oulu, Oulu, Finland
| | - Jaakko K Sarin
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Mikko J Nissi
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Research Unit of Medical Imaging Physics and Technology, University of Oulu, Oulu, Finland
| | - Nikae C R Te Moller
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Harrie Weinans
- Department of Biomechanical Engineering, Delft University of Technology (TU Delft), Delft, The Netherlands.,Department of Orthopedics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Irina A D Mancini
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Jetze Visser
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Harold Brommer
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - P Réné van Weeren
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Jos Malda
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands.,Department of Orthopedics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mark W Grinstaff
- Departments of Biomedical Engineering, Chemistry, and Medicine, Boston University, Boston, Massachusetts, USA
| | - Juha Töyräs
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.,School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia.,Science Service Center, Kuopio University Hospital, Kuopio, Finland
| |
Collapse
|
35
|
de Vor L, van Dijk B, van Kessel K, Kavanaugh JS, de Haas C, Aerts PC, Viveen MC, Boel EC, Fluit AC, Kwiecinski JM, Krijger GC, Ramakers RM, Beekman FJ, Dadachova E, Lam MGEH, Vogely HC, van der Wal BCH, van Strijp JAG, Horswill AR, Weinans H, Rooijakkers SHM. Human monoclonal antibodies against Staphylococcus aureus surface antigens recognize in vitro and in vivo biofilm. eLife 2022; 11:e67301. [PMID: 34989676 PMCID: PMC8751199 DOI: 10.7554/elife.67301] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 12/06/2021] [Indexed: 12/22/2022] Open
Abstract
Implant-associated Staphylococcus aureus infections are difficult to treat because of biofilm formation. Bacteria in a biofilm are often insensitive to antibiotics and host immunity. Monoclonal antibodies (mAbs) could provide an alternative approach to improve the diagnosis and potential treatment of biofilm-related infections. Here, we show that mAbs targeting common surface components of S. aureus can recognize clinically relevant biofilm types. The mAbs were also shown to bind a collection of clinical isolates derived from different biofilm-associated infections (endocarditis, prosthetic joint, catheter). We identify two groups of antibodies: one group that uniquely binds S. aureus in biofilm state and one that recognizes S. aureus in both biofilm and planktonic state. Furthermore, we show that a mAb recognizing wall teichoic acid (clone 4497) specifically localizes to a subcutaneously implanted pre-colonized catheter in mice. In conclusion, we demonstrate the capacity of several human mAbs to detect S. aureus biofilms in vitro and in vivo.
Collapse
Affiliation(s)
- Lisanne de Vor
- Department of Medical Microbiology, University Medical Centre UtrechtUtrechtNetherlands
| | - Bruce van Dijk
- Department of Orthopedics, University Medical Centre UtrechtUtrechtNetherlands
| | - Kok van Kessel
- Department of Medical Microbiology, University Medical Centre UtrechtUtrechtNetherlands
| | - Jeffrey S Kavanaugh
- Department of Immunology and Microbiology, University of Colorado School of MedicineAuroraUnited States
| | - Carla de Haas
- Department of Medical Microbiology, University Medical Centre UtrechtUtrechtNetherlands
| | - Piet C Aerts
- Department of Medical Microbiology, University Medical Centre UtrechtUtrechtNetherlands
| | - Marco C Viveen
- Department of Medical Microbiology, University Medical Centre UtrechtUtrechtNetherlands
| | - Edwin C Boel
- Department of Medical Microbiology, University Medical Centre UtrechtUtrechtNetherlands
| | - Ad C Fluit
- Department of Medical Microbiology, University Medical Centre UtrechtUtrechtNetherlands
| | - Jakub M Kwiecinski
- Department of Immunology and Microbiology, University of Colorado School of MedicineAuroraUnited States
| | - Gerard C Krijger
- Department of Radiology and Nuclear Medicine, University Medical Centre UtrechtUtrechtNetherlands
| | - Ruud M Ramakers
- MILabs B.VUtrechtNetherlands
- Department of Translational Neuroscience, Brain Center Rudolf Magnus, University Medical CenterUtrechtNetherlands
- Department of Radiation Science and Technology, Delft University of TechnologyDelftNetherlands
| | - Freek J Beekman
- MILabs B.VUtrechtNetherlands
- Department of Translational Neuroscience, Brain Center Rudolf Magnus, University Medical CenterUtrechtNetherlands
- Department of Radiation Science and Technology, Delft University of TechnologyDelftNetherlands
| | - Ekaterina Dadachova
- College of Pharmacy and Nutrition, University of SaskatchewanSaskatoonCanada
| | - Marnix GEH Lam
- Department of Radiology and Nuclear Medicine, University Medical Centre UtrechtUtrechtNetherlands
| | - H Charles Vogely
- Department of Orthopedics, University Medical Centre UtrechtUtrechtNetherlands
| | - Bart CH van der Wal
- Department of Orthopedics, University Medical Centre UtrechtUtrechtNetherlands
| | - Jos AG van Strijp
- Department of Medical Microbiology, University Medical Centre UtrechtUtrechtNetherlands
| | - Alexander R Horswill
- Department of Immunology and Microbiology, University of Colorado School of MedicineAuroraUnited States
- Department of Veterans Affairs, Eastern Colorado Health Care SystemDenverUnited States
| | - Harrie Weinans
- Department of Orthopedics, University Medical Centre UtrechtUtrechtNetherlands
- Department of Biomechanical engineering, TU DelftDelftNetherlands
| | - Suzan HM Rooijakkers
- Department of Medical Microbiology, University Medical Centre UtrechtUtrechtNetherlands
| |
Collapse
|
36
|
Willemsen K, Möring MM, Harlianto NI, Tryfonidou MA, van der Wal BCH, Weinans H, Meij BP, Sakkers RJB. Comparing Hip Dysplasia in Dogs and Humans: A Review. Front Vet Sci 2022; 8:791434. [PMID: 34977223 PMCID: PMC8714762 DOI: 10.3389/fvets.2021.791434] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/17/2021] [Indexed: 11/13/2022] Open
Abstract
Hip dysplasia (HD) is common in both humans and dogs. This interconnection is because humans and dogs descended from a common ancestor and therefore have a similar anatomy at micro- and macroscopic levels. Furthermore, dogs are the animals of choice for testing new treatments for human hip dysplasia and orthopedic surgery in general. However, little literature exists comparing HD between the two species. Therefore, the aim of this review is to describe the anatomy, etiology, pathogenesis, diagnostics, and treatment of HD in humans and dogs. HD as an orthopedic condition has many common characteristics in terms of etiology and pathogenesis and most of the differences can be explained by the evolutionary differences between dogs and humans. Likewise, the treatment of HD shows many commonalities between humans and dogs. Conservative treatment and surgical interventions such as femoral osteotomy, pelvic osteotomy and total hip arthroplasty are very similar between humans and dogs. Therefore, future integration of knowledge and experiences for HD between dogs and humans could be beneficial for both species.
Collapse
Affiliation(s)
- Koen Willemsen
- 3D Lab, Division of Surgical Specialties, University Medical Center Utrecht, Utrecht, Netherlands.,Department of Orthopedics, University Medical Center Utrecht, Utrecht, Netherlands
| | - Michelle M Möring
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, Netherlands
| | - Netanja I Harlianto
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, Netherlands
| | - Marianna A Tryfonidou
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | - Bart C H van der Wal
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, Netherlands
| | - Harrie Weinans
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, Netherlands.,Department of Biomechanical Engineering, Delft University of Technology, Delft, Netherlands
| | - Björn P Meij
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | - Ralph J B Sakkers
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, Netherlands
| |
Collapse
|
37
|
van Erp JHJ, Snijders TE, Weinans H, Castelein RM, Schlösser TPC, de Gast A. The role of the femoral component orientation on dislocations in THA: a systematic review. Arch Orthop Trauma Surg 2022; 142:1253-1264. [PMID: 34101017 PMCID: PMC9110501 DOI: 10.1007/s00402-021-03982-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/26/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Dislocation remains a major complication in total hip arthroplasty (THA), in which femoral component orientation is considered a key parameter. New imaging modalities and definitions on femoral component orientation have been introduced, describing orientation in different planes. This study aims to systematically review the relevance of the different orientation parameters on implant stability. METHODS A systematic review was performed according to the PRISMA guidelines to identify articles in the PubMed and EMBASE databases that study the relation between any femoral component orientation parameters and implant stability in primary THA. RESULTS After screening for inclusion and exclusion criteria and quality assessment, nine articles were included. Definitions to describe the femoral component orientation and methodologies to assess its relevance for implant stability differed greatly, with lack of consensus. Seven retrospective case-control studies reported on the relevance of the transversal plane orientation: Low femoral- or low combined femoral and acetabular anteversion was statistical significantly related with more posterior dislocations, and high femoral- or combined femoral and acetabular anteversion with anterior dislocations in two studies. There were insufficient data on sagittal and coronal component orientation in relation to implant stability. CONCLUSION Because of incomparable definitions, limited quality and heterogeneity in methodology of the included studies, there is only weak evidence that the degree of transverse component version is related with implant stability in primary THA. Recommendations about the optimal orientation of the femoral component in all three anatomical planes cannot be provided. Future studies should uniformly define the three-dimensional orientation of the femoral component and systematically describe implant stability.
Collapse
Affiliation(s)
- Joost H. J. van Erp
- Department of Orthopedics, Diakonessenhuis, Utrecht, Zeist, The Netherlands ,Clinical Orthopedic Research Center m-N, Zeist, The Netherlands ,Department of Orthopedics, UMC Utrecht, Utrecht, The Netherlands
| | - Thom E. Snijders
- Department of Orthopedics, Diakonessenhuis, Utrecht, Zeist, The Netherlands ,Clinical Orthopedic Research Center m-N, Zeist, The Netherlands
| | - Harrie Weinans
- Department of Orthopedics, UMC Utrecht, Utrecht, The Netherlands ,Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | | | | | - Arthur de Gast
- Department of Orthopedics, Diakonessenhuis, Utrecht, Zeist, The Netherlands ,Clinical Orthopedic Research Center m-N, Zeist, The Netherlands
| |
Collapse
|
38
|
Khodaei A, Jahanmard F, Madaah Hosseini HR, Bagheri R, Dabbagh A, Weinans H, Amin Yavari S. Controlled temperature-mediated curcumin release from magneto-thermal nanocarriers to kill bone tumors. Bioact Mater 2021; 11:107-117. [PMID: 34938916 PMCID: PMC8665343 DOI: 10.1016/j.bioactmat.2021.09.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 08/11/2021] [Accepted: 09/23/2021] [Indexed: 01/10/2023] Open
Abstract
Systemic chemotherapy has lost its position to treat cancer over the past years mainly due to drug resistance, side effects, and limited survival ratio. Among a plethora of local drug delivery systems to solve this issue, the combinatorial strategy of chemo-hyperthermia has recently received attention. Herein we developed a magneto-thermal nanocarrier consisted of superparamagnetic iron oxide nanoparticles (SPIONs) coated by a blend formulation of a three-block copolymer Pluronic F127 and F68 on the oleic acid (OA) in which Curcumin as a natural and chemical anti-cancer agent was loaded. The subsequent nanocarrier SPION@OA-F127/F68-Cur was designed with a controlled gelation temperature of the shell, which could consequently control the release of curcumin. The release was systematically studied as a function of temperature and pH, via response surface methodology (RSM). The bone tumor killing efficacy of the released curcumin from the carrier in combination with the hyperthermia was studied on MG-63 osteosarcoma cells through Alamar blue assay, live-dead staining and apoptosis caspase 3/7 activation kit. It was found that the shrinkage of the F127/F68 layer stimulated by elevated temperature in an alternative magnetic field caused the curcumin release. Although the maximum release concentration and cell death took place at 45 °C, treatment at 41 °C was chosen as the optimum condition due to considerable cell apoptosis and lower side effects of mild hyperthermia. The cell metabolic activity results confirmed the synergistic effects of curcumin and hyperthermia in killing MG-63 osteosarcoma cells.
Collapse
Affiliation(s)
- A Khodaei
- Institute for Nanoscience and Nanotechnology, Sharif University of Technology, Tehran, Iran.,Department of Orthopedics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - F Jahanmard
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - H R Madaah Hosseini
- Department of Materials Science and Engineering, Sharif University of Technology, Tehran, Iran
| | - R Bagheri
- Department of Materials Science and Engineering, Sharif University of Technology, Tehran, Iran
| | - A Dabbagh
- School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Malaysia
| | - H Weinans
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - S Amin Yavari
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, the Netherlands.,Regenerative Medicine Utrecht, Utrecht University, Utrecht, the Netherlands
| |
Collapse
|
39
|
van Helvoort EM, Welsing PMJ, Jansen MP, Gielis WP, Loef M, Kloppenburg M, Blanco F, Haugen IK, Berenbaum F, Bay-Jensen AC, Ladel C, Lalande A, Larkin J, Loughlin J, Mobasheri A, Weinans H, Lafeber F, Eijkelkamp N, Mastbergen S. Neuropathic pain in the IMI-APPROACH knee osteoarthritis cohort: prevalence and phenotyping. RMD Open 2021; 7:rmdopen-2021-002025. [PMID: 34911812 PMCID: PMC8679113 DOI: 10.1136/rmdopen-2021-002025] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/28/2021] [Indexed: 12/11/2022] Open
Abstract
Objectives Osteoarthritis (OA) patients with a neuropathic pain (NP) component may represent a specific phenotype. This study compares joint damage, pain and functional disability between knee OA patients with a likely NP component, and those without a likely NP component. Methods Baseline data from the Innovative Medicines Initiative Applied Public-Private Research enabling OsteoArthritis Clinical Headway knee OA cohort study were used. Patients with a painDETECT score ≥19 (with likely NP component, n=24) were matched on a 1:2 ratio to patients with a painDETECT score ≤12 (without likely NP component), and similar knee and general pain (Knee Injury and Osteoarthritis Outcome Score pain and Short Form 36 pain). Pain, physical function and radiographic joint damage of multiple joints were determined and compared between OA patients with and without a likely NP component. Results OA patients with painDETECT scores ≥19 had statistically significant less radiographic joint damage (p≤0.04 for Knee Images Digital Analysis parameters and Kellgren and Lawrence grade), but an impaired physical function (p<0.003 for all tests) compared with patients with a painDETECT score ≤12. In addition, more severe pain was found in joints other than the index knee (p≤0.001 for hips and hands), while joint damage throughout the body was not different. Conclusions OA patients with a likely NP component, as determined with the painDETECT questionnaire, may represent a specific OA phenotype, where local and overall joint damage is not the main cause of pain and disability. Patients with this NP component will likely not benefit from general pain medication and/or disease-modifying OA drug (DMOAD) therapy. Reserved inclusion of these patients in DMOAD trials is advised in the quest for successful OA treatments. Trial registration number The study is registered under clinicaltrials.gov nr: NCT03883568.
Collapse
Affiliation(s)
| | - Paco M J Welsing
- Rheumatology & Clinical Immunology, UMC Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Mylène P Jansen
- Rheumatology & Clinical Immunology, UMC Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - Marieke Loef
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Margreet Kloppenburg
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.,Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Francisco Blanco
- Servicio de Reumatologia, INIBIC-Hospital Universitario A Coruña, A Coruña, Spain
| | - Ida K Haugen
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Francis Berenbaum
- Rheumatology, Sorbonne Université, Paris, France.,INSERM, Paris, France
| | | | | | - Agnes Lalande
- Institut de Recherches Internationales Servier, Suresnes, France
| | | | - John Loughlin
- Musculoskeletal Research Group, Newcastle University, Newcastle upon Tyne, UK
| | - Ali Mobasheri
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.,Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
| | - Harrie Weinans
- Orthopedics, UMC Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Floris Lafeber
- Rheumatology & Clinical Immunology, UMC Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Niels Eijkelkamp
- Center for Translational Immunology, UMC Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Simon Mastbergen
- Rheumatology & Clinical Immunology, UMC Utrecht, Utrecht University, Utrecht, The Netherlands
| |
Collapse
|
40
|
Golafshan N, Willemsen K, Kadumudi FB, Vorndran E, Dolatshahi‐Pirouz A, Weinans H, Wal BCH, Malda J, Castilho M. 3D-Printed Regenerative Magnesium Phosphate Implant Ensures Stability and Restoration of Hip Dysplasia. Adv Healthc Mater 2021; 10:e2101051. [PMID: 34561956 DOI: 10.1002/adhm.202101051] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 09/06/2021] [Indexed: 11/10/2022]
Abstract
Osteoarthritis of the hip is a painful and debilitating condition commonly occurring in humans and dogs. One of the main causes that leads to hip osteoarthritis is hip dysplasia. Although the current surgical methods to correct dysplasia work satisfactorily in many circumstances, these are associated with serious complications, tissue resorption, and degeneration. In this study, a one-step fabrication of a regenerative hip implant with a patient-specific design and load-bearing properties is reported. The regenerative hip implant is fabricated based on patient imaging files and by an extrusion assisted 3D printing process using a flexible, bone-inducing biomaterial. The novel implant can be fixed with metallic screws to host bone and can be loaded up to physiological loads without signs of critical permanent deformation or failure. Moreover, after exposing the hip implant to accelerated in vitro degradation, it is confirmed that it is still able to support physiological loads even after losing ≈40% of its initial mass. In addition, the osteopromotive properties of the novel hip implant is demonstrated as shown by an increased expression of osteonectin and osteocalcin by cultured human mesenchymal stem cells after 21 days. Overall, the proposed hip implant provides an innovative regenerative and mechanically stable solution for hip dysplasia treatment.
Collapse
Affiliation(s)
- Nasim Golafshan
- Department of Orthopaedics University Medical Center Utrecht Utrecht 3584 CX The Netherlands
- Regenerative Medicine Utrecht Utrecht University Utrecht 3584 CT The Netherlands
| | - Koen Willemsen
- Department of Orthopaedics University Medical Center Utrecht Utrecht 3584 CX The Netherlands
| | - Firoz Babu Kadumudi
- Department of Health Technology Technical University of Denmark Lyngby 2800 Denmark
| | - Elke Vorndran
- Department for Functional Materials in Medicine and Dentistry University of Würzburg Würzburg 97070 Germany
| | | | - Harrie Weinans
- Department of Orthopaedics University Medical Center Utrecht Utrecht 3584 CX The Netherlands
- Department of Biomechanical Engineering TU Delft Delft 2628 CD The Netherlands
| | - Bart C. H. Wal
- Department of Orthopaedics University Medical Center Utrecht Utrecht 3584 CX The Netherlands
| | - Jos Malda
- Department of Orthopaedics University Medical Center Utrecht Utrecht 3584 CX The Netherlands
- Regenerative Medicine Utrecht Utrecht University Utrecht 3584 CT The Netherlands
- Department of Clinical Sciences Faculty of Veterinary Medicine Utrecht University Utrecht 3584 CL The Netherlands
| | - Miguel Castilho
- Department of Orthopaedics University Medical Center Utrecht Utrecht 3584 CX The Netherlands
- Regenerative Medicine Utrecht Utrecht University Utrecht 3584 CT The Netherlands
- Orthopaedic Biomechanics Department of Biomedical Engineering Eindhoven University of Technology Eindhoven 5612 AZ The Netherlands
| |
Collapse
|
41
|
Eren ED, Nijhuis WH, van der Weel F, Dede Eren A, Ansari S, Bomans PHH, Friedrich H, Sakkers RJ, Weinans H, de With G. Multiscale characterization of pathological bone tissue. Microsc Res Tech 2021; 85:469-486. [PMID: 34490967 PMCID: PMC9290679 DOI: 10.1002/jemt.23920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/16/2021] [Accepted: 08/18/2021] [Indexed: 11/09/2022]
Abstract
Bone is a complex natural material with a complex hierarchical multiscale organization, crucial to perform its functions. Ultrastructural analysis of bone is crucial for our understanding of cell to cell communication, the healthy or pathological composition of bone tissue, and its three‐dimensional (3D) organization. A variety of techniques has been used to analyze bone tissue. This article describes a combined approach of optical, scanning electron, and transmission electron microscopy for the ultrastructural analysis of bone from the nanoscale to the macroscale, as illustrated by two pathological bone tissues. By following a top‐down approach to investigate the multiscale organization of pathological bones, quantitative estimates were made in terms of calcium content, nearest neighbor distances of osteocytes, canaliculi diameter, ordering, and D‐spacing of the collagen fibrils, and the orientation of intrafibrillar minerals which enable us to observe the fine structural details. We identify and discuss a series of two‐dimensional (2D) and 3D imaging techniques that can be used to characterize bone tissue. By doing so we demonstrate that, while 2D imaging techniques provide comparable information from pathological bone tissues, significantly different structural details are observed upon analyzing the pathological bone tissues in 3D. Finally, particular attention is paid to sample preparation for and quantitative processing of data from electron microscopic analysis.
Collapse
Affiliation(s)
- E Deniz Eren
- Laboratory of Physical Chemistry, Department of Chemical Engineering and Chemistry, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Wouter H Nijhuis
- Department of Orthopedic Surgery, University Medical Centre Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Freek van der Weel
- Laboratory of Physical Chemistry, Department of Chemical Engineering and Chemistry, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Aysegul Dede Eren
- Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, Eindhoven, The Netherlands.,Eindhoven University of Technology, Department of Biomedical Engineering, Biointerface Science, Eindhoven, The Netherlands
| | - Sana Ansari
- Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, Eindhoven, The Netherlands.,Orthopedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Paul H H Bomans
- Laboratory of Physical Chemistry, Department of Chemical Engineering and Chemistry, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Heiner Friedrich
- Laboratory of Physical Chemistry, Department of Chemical Engineering and Chemistry, Eindhoven University of Technology, Eindhoven, The Netherlands.,Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Ralph J Sakkers
- Department of Orthopedic Surgery, University Medical Centre Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Harrie Weinans
- Department of Orthopedic Surgery, University Medical Centre Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands.,TU Delft, Department of Biomechanical Engineering, Delft, The Netherlands
| | - Gijsbertus de With
- Laboratory of Physical Chemistry, Department of Chemical Engineering and Chemistry, Eindhoven University of Technology, Eindhoven, The Netherlands
| |
Collapse
|
42
|
van Gemert Y, Kozijn AE, Pouwer MG, Kruisbergen NNL, van den Bosch MHJ, Blom AB, Pieterman EJ, Weinans H, Stoop R, Princen HMG, van Lent PLEM. Novel high-intensive cholesterol-lowering therapies do not ameliorate knee OA development in humanized dyslipidemic mice. Osteoarthritis Cartilage 2021; 29:1314-1323. [PMID: 33722697 DOI: 10.1016/j.joca.2021.02.570] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 02/03/2021] [Accepted: 02/25/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE High systemic cholesterol levels have been associated with osteoarthritis (OA) development. Therefore, cholesterol lowering by statins has been suggested as a potential treatment for OA. We investigated whether therapeutic high-intensive cholesterol-lowering attenuated OA development in dyslipidemic APOE∗3Leiden.CETP mice. METHODS Female mice (n = 13-16 per group) were fed a Western-type diet (WTD) for 38 weeks. After 13 weeks, mice were divided into a baseline group and five groups receiving WTD alone or with treatment: atorvastatin alone, combined with PCSK9 inhibitor alirocumab and/or ANGPTL3 inhibitor evinacumab. Knee joints were analysed for cartilage degradation, synovial inflammation and ectopic bone formation using histology. Aggrecanase activity in articular cartilage and synovial S100A8 expression were determined as markers of cartilage degradation/regeneration and inflammation. RESULTS Cartilage degradation and active repair were significantly increased in WTD-fed mice, but cholesterol-lowering strategies did not ameliorate cartilage destruction. This was supported by comparable aggrecanase activity and S100A8 expression in all treatment groups. Ectopic bone formation was comparable between groups and independent of cholesterol levels. CONCLUSIONS Intensive therapeutic cholesterol lowering per se did not attenuate progression of cartilage degradation in dyslipidemic APOE∗3Leiden.CETP mice, with minor joint inflammation. We propose that inflammation is a key feature in the disease and therapeutic cholesterol-lowering strategies may still be promising for OA patients presenting both dyslipidemia and inflammation.
Collapse
Affiliation(s)
- Y van Gemert
- Experimental Rheumatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - A E Kozijn
- Metabolic Health Research, TNO, Leiden, the Netherlands; Department of Orthopaedics, UMC Utrecht, Utrecht University, Utrecht, the Netherlands; Department of Rheumatology & Clinical Immunology, UMC Utrecht, Utrecht University, Utrecht, the Netherlands
| | - M G Pouwer
- Metabolic Health Research, TNO, Leiden, the Netherlands; Department of Cardiology, Leiden UMC, Leiden, the Netherlands
| | - N N L Kruisbergen
- Experimental Rheumatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - M H J van den Bosch
- Experimental Rheumatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - A B Blom
- Experimental Rheumatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - E J Pieterman
- Metabolic Health Research, TNO, Leiden, the Netherlands
| | - H Weinans
- Department of Orthopaedics, UMC Utrecht, Utrecht University, Utrecht, the Netherlands; Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands
| | - R Stoop
- Metabolic Health Research, TNO, Leiden, the Netherlands
| | - H M G Princen
- Metabolic Health Research, TNO, Leiden, the Netherlands
| | - P L E M van Lent
- Experimental Rheumatology, Radboud University Medical Center, Nijmegen, the Netherlands.
| |
Collapse
|
43
|
Kuiper RJA, van Stralen M, Sakkers RJB, Bergmans RHJ, Zijlstra F, Viergever MA, Weinans H, Seevinck PR. CT to MR registration of complex deformations in the knee joint through dual quaternion interpolation of rigid transforms. Phys Med Biol 2021; 66. [PMID: 34298532 DOI: 10.1088/1361-6560/ac1769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 07/23/2021] [Indexed: 11/12/2022]
Abstract
Purpose.To develop a method that enables computed tomography (CT) to magnetic resonance (MR) image registration of complex deformations typically encountered in rotating joints such as the knee joint.Methods.We propose a workflow, denoted quaternion interpolated registration (QIR), consisting of three steps, which makes use of prior knowledge of tissue properties to initialise deformable registration. In the first step, the rigid skeletal components were individually registered. Next, the deformation of soft tissue was estimated using a dual quaternion-based interpolation method. In the final step, the registration was fine-tuned with a rigidity-constrained deformable registration step. The method was applied to paired, unregistered CT and MR images of the knee of 92 patients. It was compared to registration using B-Splines (BS) and B-Splines with a rigidity penalty (BSRP). Registration accuracy was evaluated using mutual information, and by calculating Dice similarity coefficient (DSC), mean absolute surface distance (MASD) and 95th percentile Hausdorff distance (HD95) on bone, and DSC on water and fat dominated tissue. To evaluate the rigidity of bone in the registration, the Jacobian determinant (JD) was calculated.Results.QIR achieved improved results with 0.93, 0.76 mm and 1.88 mm on the DSC, MASD and HD95 metrics on bone, compared to 0.87, 1.40 mm and 4.99 mm for method and 0.87, 1.40 mm and 3.56 mm for the BSRP method. The average DSC of water and fat was 0.77 and 0.86 for the QIR, 0.75 and 0.84 for BS and 0.74 and 0.84 for BSRP. Comparison of the median JD and median interquartile (IQR) ranges of the JD indicated that the QIR (1.00 median, 0.03 IQR) resulted in higher rigidity in the rigid skeletal tissues compared to the BS (0.98 median, 0.19 IQR) and BSRP (1.00 median, 0.05 IQR) methods.Conclusion.This study showed that QIR could improve the outcome of complex registration problems, encountered in joints involving rigid and non-rigid bodies such as occur in the knee, as compared to a conventional registration approach.
Collapse
Affiliation(s)
- Ruurd J A Kuiper
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands.,Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marijn van Stralen
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands.,MRIguidance B.V., Utrecht, The Netherlands
| | - Ralph J B Sakkers
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rick H J Bergmans
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands.,MRIguidance B.V., Utrecht, The Netherlands
| | - Frank Zijlstra
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Max A Viergever
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Harrie Weinans
- Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Peter R Seevinck
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands.,MRIguidance B.V., Utrecht, The Netherlands
| |
Collapse
|
44
|
Snijders TE, Schlösser TPC, van Straalen M, Castelein RM, Stevenson RP, Weinans H, de Gast A. Erratum to: The Effect of Postural Pelvic Dynamics on the Three-dimensional Orientation of the Acetabular Cup in THA Is Patient Specific. Clin Orthop Relat Res 2021; 479:1878-1879. [PMID: 34242203 PMCID: PMC8277286 DOI: 10.1097/corr.0000000000001887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 06/08/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Thom E. Snijders
- Clinical Orthopedic Research Center midden-Nederland, Diakonessenhuis, Zeist, the Netherlands
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Tom P. C. Schlösser
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marijn van Straalen
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
| | - René M. Castelein
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Rob P. Stevenson
- Korteweg-de Vries Institute for Mathematics, University of Amsterdam, Amsterdam, the Netherlands
| | - Harrie Weinans
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Biomechanical Engineering, TU Delft, Delft, the Netherlands
| | - Arthur de Gast
- Clinical Orthopedic Research Center midden-Nederland, Diakonessenhuis, Zeist, the Netherlands
- Department of Orthopaedic Surgery, Diakonessenhuis, Utrecht, the Netherlands
| |
Collapse
|
45
|
Snijders TE, Schlösser TPC, van Straalen M, Castelein RM, Stevenson RP, Weinans H, de Gast A. Reply to the Letters to the Editor: The Effect of Postural Pelvic Dynamics on the Three-dimensional Orientation of the Acetabular Cup in THA Is Patient Specific. Clin Orthop Relat Res 2021; 479:1876-1877. [PMID: 34213503 PMCID: PMC8277261 DOI: 10.1097/corr.0000000000001872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Thom E. Snijders
- Clinical Orthopedic Research Center midden-Nederland, Diakonessenhuis, Zeist, the Netherlands
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Tom P. C. Schlösser
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marijn van Straalen
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
| | - René M. Castelein
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Rob P. Stevenson
- Korteweg-de Vries Institute for Mathematics, University of Amsterdam, Amsterdam, the Netherlands
| | - Harrie Weinans
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Biomechanical Engineering, TU Delft, Delft, the Netherlands
| | - Arthur de Gast
- Clinical Orthopedic Research Center midden-Nederland, Diakonessenhuis, Zeist, the Netherlands
- Department of Orthopaedic Surgery, Diakonessenhuis, Utrecht, the Netherlands
| |
Collapse
|
46
|
Taylor J, Dekker S, Jurg D, Skandsen J, Grossman M, Marijnissen AK, Ladel C, Mobasheri A, Larkin J, Weinans H, Kanter-Schlifke I. Making the patient voice heard in a research consortium: experiences from an EU project (IMI-APPROACH). Res Involv Engagem 2021; 7:24. [PMID: 33971982 PMCID: PMC8107424 DOI: 10.1186/s40900-021-00267-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/31/2021] [Indexed: 05/12/2023]
Abstract
APPROACH is an EU-wide research consortium with the goal to identify different subgroups of knee osteoarthritis to enable future differential diagnosis and treatment. During a 2-year clinical study images, biomarkers and clinical data are collected from people living with knee osteoarthritis and data are analyzed to confirm patterns that can indicate such different subgroups. A Patient Council (PC) has been set up at project initiation and consists of five people from Norway, The Netherlands and UK. Initially, this group of individuals had to learn how to effectively work with each other and with the researchers. Today, the PC is a strong team that is fully integrated in the consortium and acknowledged by researchers as an important sounding board. The article describes this journey looking at formal processes of involvement - organizational structure, budget, meetings - and more informal processes such as building relationships and changing researcher perceptions. It describes how the PC helped improve the experience and engagement of study participants by providing input to the clinical protocol and ensuring effective communication (e.g. through direct interactions with participants and newsletters). Furthermore, the PC is helping with dissemination of results and project advocacy, and overall provides the patient perspective to researchers. Additionally, the authors experienced and describe the intangible benefits such as a shift in researcher attitudes and a sense of community and purpose for PC members. Importantly, learnings reported in this article also include the challenges, such as effective integration of the PC with researchers' work in the early phase of the project. TRIAL REGISTRATION: US National Library of Medicine, NCT03883568 , retrospectively registered 21 March 2019.
Collapse
Affiliation(s)
- Jane Taylor
- The APPROACH Patient Council, Utrecht, The Netherlands
| | - Sjouke Dekker
- The APPROACH Patient Council, Utrecht, The Netherlands
| | - Diny Jurg
- The APPROACH Patient Council, Utrecht, The Netherlands
| | - Jon Skandsen
- The APPROACH Patient Council, Utrecht, The Netherlands
| | | | - Anne-Karien Marijnissen
- Rheumatology & Clinical Immunology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584 CX The Netherlands
| | | | - Ali Mobasheri
- University of Oulu, Oulu Finland State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
- University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Harrie Weinans
- Rheumatology & Clinical Immunology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584 CX The Netherlands
| | | |
Collapse
|
47
|
van Buuren MMA, Arden NK, Bierma-Zeinstra SMA, Bramer WM, Casartelli NC, Felson DT, Jones G, Lane NE, Lindner C, Maffiuletti NA, van Meurs JBJ, Nelson AE, Nevitt MC, Valenzuela PL, Verhaar JAN, Weinans H, Agricola R. Statistical shape modeling of the hip and the association with hip osteoarthritis: a systematic review. Osteoarthritis Cartilage 2021; 29:607-618. [PMID: 33338641 DOI: 10.1016/j.joca.2020.12.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/30/2020] [Accepted: 12/08/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To summarize available evidence on the association between hip shape as quantified by statistical shape modeling (SSM) and the incidence or progression of hip osteoarthritis. DESIGN We conducted a systematic search of five electronic databases, based on a registered protocol (available: PROSPERO CRD42020145411). Articles presenting original data on the longitudinal relationship between radiographic hip shape (quantified by SSM) and hip OA were eligible. Quantitative meta-analysis was precluded because of the use of different SSM models across studies. We used the Newcastle-Ottawa Scale (NOS) for risk of bias assessment. RESULTS Nine studies (6,483 hips analyzed with SSM) were included in this review. The SSM models used to describe hip shape ranged from 16 points on the femoral head to 85 points on the proximal femur and hemipelvis. Multiple hip shape features and combinations thereof were associated with incident or progressive hip OA. Shape variants that seemed to be consistently associated with hip OA across studies were acetabular dysplasia, cam morphology, and deviations in acetabular version (either excessive anteversion or retroversion). CONCLUSIONS Various radiographic, SSM-defined hip shape features are associated with hip OA. Some hip shape features only seem to increase the risk for hip OA when combined together. The heterogeneity of the used SSM models across studies precludes the estimation of pooled effect sizes. Further studies using the same SSM model and definition of hip OA are needed to allow for the comparison of outcomes across studies, and to validate the found associations.
Collapse
Affiliation(s)
- M M A van Buuren
- Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - N K Arden
- Nuffield Department of Orthopedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; NIHR Musculoskeletal Biomedical Research Unit, Arthritis Research UK Centre for Sport, Exercise, and Osteoarthritis, University of Oxford, Oxford, UK
| | - S M A Bierma-Zeinstra
- Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of General Practice and Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - W M Bramer
- Medical Library, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - N C Casartelli
- Human Performance Lab, Schulthess Clinic, Zürich, Switzerland; Laboratory of Exercise and Health, ETH Zürich, Schwerzenbach, Switzerland
| | - D T Felson
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK; NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Department of Rheumatology, Boston University School of Medicine, Boston, MA, USA
| | - G Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - N E Lane
- Department of Medicine, University of California, Davis, CA, USA
| | - C Lindner
- Division of Informatics, Imaging & Data Sciences, University of Manchester, Manchester, UK
| | - N A Maffiuletti
- Human Performance Lab, Schulthess Clinic, Zürich, Switzerland
| | - J B J van Meurs
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - A E Nelson
- Thurston Arthritis Research Center and Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - M C Nevitt
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - P L Valenzuela
- Department of Systems Biology, University of Alcalá, Madrid, Spain
| | - J A N Verhaar
- Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - H Weinans
- Department of Orthopedics, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands
| | - R Agricola
- Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| |
Collapse
|
48
|
Willemsen K, Ketel MHM, Zijlstra F, Florkow MC, Kuiper RJA, van der Wal BCH, Weinans H, Pouran B, Beekman FJ, Seevinck PR, Sakkers RJB. 3D-printed saw guides for lower arm osteotomy, a comparison between a synthetic CT and CT-based workflow. 3D Print Med 2021; 7:13. [PMID: 33914209 PMCID: PMC8082893 DOI: 10.1186/s41205-021-00103-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 04/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Three-dimensional (3D)-printed saw guides are frequently used to optimize osteotomy results and are usually designed based on computed tomography (CT), despite the radiation burden, as radiation-less alternatives like magnetic resonance imaging (MRI) have inferior bone visualization capabilities. This study investigated the usability of MR-based synthetic-CT (sCT), a novel radiation-less bone visualization technique for 3D planning and design of patient-specific saw guides. METHODS Eight human cadaveric lower arms (mean age: 78y) received MRI and CT scans as well as high-resolution micro-CT. From the MRI scans, sCT were generated using a conditional generative adversarial network. Digital 3D bone surface models based on the sCT and general CT were compared to the surface model from the micro-CT that was used as ground truth for image resolution. From both the sCT and CT digital bone models saw guides were designed and 3D-printed in nylon for one proximal and one distal bone position for each radius and ulna. Six blinded observers placed these saw guides as accurately as possible on dissected bones. The position of each guide was assessed by optical 3D-scanning of each bone with positioned saw guide and compared to the preplanning. Eight placement errors were evaluated: three translational errors (along each axis), three rotational errors (around each axis), a total translation (∆T) and a total rotation error (∆R). RESULTS Surface models derived from micro-CT were on average smaller than sCT and CT-based models with average differences of 0.27 ± 0.30 mm for sCT and 0.24 ± 0.12 mm for CT. No statistically significant positioning differences on the bones were found between sCT- and CT-based saw guides for any axis specific translational or rotational errors nor between the ∆T (p = .284) and ∆R (p = .216). On Bland-Altman plots, the ∆T and ∆R limits of agreement (LoA) were within the inter-observer variability LoA. CONCLUSIONS This research showed a similar error for sCT and CT digital surface models when comparing to ground truth micro-CT models. Additionally, the saw guide study showed equivalent CT- and sCT-based saw guide placement errors. Therefore, MRI-based synthetic CT is a promising radiation-less alternative to CT for the creation of patient-specific osteotomy surgical saw guides.
Collapse
Affiliation(s)
- Koen Willemsen
- Department of Orthopedics, University Medical Center Utrecht, HP:05-228, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands. .,3D Lab, Division of Surgical Specialties, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Mirte H M Ketel
- Department of Orthopedics, University Medical Center Utrecht, HP:05-228, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Frank Zijlstra
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mateusz C Florkow
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ruurd J A Kuiper
- Department of Orthopedics, University Medical Center Utrecht, HP:05-228, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Bart C H van der Wal
- Department of Orthopedics, University Medical Center Utrecht, HP:05-228, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Harrie Weinans
- Department of Orthopedics, University Medical Center Utrecht, HP:05-228, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.,3D Lab, Division of Surgical Specialties, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - Behdad Pouran
- MILabs B.V, Houten, The Netherlands.,Department of Translational Neuroscience, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Freek J Beekman
- MILabs B.V, Houten, The Netherlands.,Department of Translational Neuroscience, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands.,Department Radiation Science & Technology, Delft University of Technology, Delft, The Netherlands
| | - Peter R Seevinck
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ralph J B Sakkers
- Department of Orthopedics, University Medical Center Utrecht, HP:05-228, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| |
Collapse
|
49
|
Kolken H, de Jonge C, van der Sloten T, Garcia AF, Pouran B, Willemsen K, Weinans H, Zadpoor A. Additively manufactured space-filling meta-implants. Acta Biomater 2021; 125:345-357. [PMID: 33618018 DOI: 10.1016/j.actbio.2021.02.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/10/2021] [Accepted: 02/14/2021] [Indexed: 12/30/2022]
Abstract
The unprecedented properties of meta-biomaterials could pave the way for the development of life-lasting orthopedic implants. Here, we used non-auxetic meta-biomaterials to address the shortcomings of the current treatment options in acetabular revision surgery. Due to the severe bone deficiencies and poor bone quality, it can be very challenging to acquire adequate initial implant stability and long-term fixation. More advanced treatments, such as patient-specific implants, do guarantee the initial stability, but are formidably expensive and may eventually fail due to stress shielding. We, therefore, developed meta-implants furnished with a deformable porous outer layer. Upon implantation, this layer plastically deforms into the defects, thereby improving the initial stability and homogeneously stimulating the surrounding bone. We first studied the space-filling behavior of additively manufactured pure titanium lattices, based on six different unit cells, in a compression test complemented with full-field strain measurements. The diamond, body-centered cubic, and rhombic dodecahedron unit cells were eventually selected for the design of the deformable porous outer layer. Each design came in three different relative density profiles, namely maximum (MAX), functionally graded (FG), and minimum (MIN). After their compression in bone-mimicking molds with simulated acetabular defects, the space-filling behavior of the implants was evaluated using load-displacement curves, micro-CT images, and 3D reconstructions. The meta-implants with an FG diamond infill exhibited the most promising space-filling behavior. However, the required push-in forces exceed the impact forces currently applied in surgery. Future research should, therefore, focus on design optimization, to improve the space-filling behavior and to facilitate the implantation process for orthopedic surgeons. STATEMENT OF SIGNIFICANCE: Ideally, orthopedic implants would last for the entire lifetime of the patient. Unfortunately, they rarely do. Critically sized defects are a common sight in the revision of acetabular cups, and rather difficult to treat. The permanent deformation of lattice structures can be used to create shape-morphing implants that would fill up the defect site, and thereby restore the physiological loading conditions. Bending-dominated structures were incorporated in the porous outer layer of the space-filling meta-implants for their considerable lateral expansion in response to axial compression. A functionally graded density offered structural integrity at the joint while enhancing the deformability at the bone-implant interface. With the use of a more ductile metal, CP-Ti, these meta-implants could be deformed without strut failure.
Collapse
|
50
|
Bhattarai A, Mäkelä JTA, Pouran B, Kröger H, Weinans H, Grinstaff MW, Töyräs J, Turunen MJ. Effects of human articular cartilage constituents on simultaneous diffusion of cationic and nonionic contrast agents. J Orthop Res 2021; 39:771-779. [PMID: 32767676 PMCID: PMC8048551 DOI: 10.1002/jor.24824] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 07/03/2020] [Accepted: 08/05/2020] [Indexed: 02/04/2023]
Abstract
Contrast-enhanced computed tomography is an emerging diagnostic technique for osteoarthritis. However, the effects of increased water content, as well as decreased collagen and proteoglycan concentrations due to cartilage degeneration, on the diffusion of cationic and nonionic agents, are not fully understood. We hypothesize that for a cationic agent, these variations increase the diffusion rate while decreasing partition, whereas, for a nonionic agent, these changes increase both the rate of diffusion and partition. Thus, we examine the diffusion of cationic and nonionic contrast agents within degraded tissue in time- and depth-dependent manners. Osteochondral plugs (N = 15, d = 8 mm) were extracted from human cadaver knee joints, immersed in a mixture of cationic CA4+ and nonionic gadoteridol contrast agents, and imaged at multiple time-points, using the dual-contrast method. Water content, and collagen and proteoglycan concentrations were determined using lyophilization, infrared spectroscopy, and digital densitometry, respectively. Superficial to mid (0%-60% depth) cartilage CA4+ partitions correlated with water content (R < -0.521, P < .05), whereas in deeper (40%-100%) cartilage, CA4+ correlated only with proteoglycans (R > 0.671, P < .01). Gadoteridol partition correlated inversely with collagen concentration (0%-100%, R < -0.514, P < .05). Cartilage degeneration substantially increased the time for CA4+ compared with healthy tissue (248 ± 171 vs 175 ± 95 minute) to reach the bone-cartilage interface, whereas for gadoteridol the time (111 ± 63 vs 179 ± 163 minute) decreased. The work clarifies the diffusion mechanisms of two different contrast agents and presents depth and time-dependent effects resulting from articular cartilage constituents. The results will inform the development of new contrast agents and optimal timing between agent administration and joint imaging.
Collapse
Affiliation(s)
- Abhisek Bhattarai
- Department of Applied PhysicsUniversity of Eastern FinlandKuopioFinland,Diagnostic Imaging CenterKuopio University HospitalKuopioFinland
| | | | - Behdad Pouran
- Department of OrthopaedicsUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Heikki Kröger
- Department of Orthopedics, Traumatology and Hand SurgeryKuopio University HospitalKuopioFinland
| | - Harrie Weinans
- Department of OrthopaedicsUniversity Medical Center UtrechtUtrechtThe Netherlands,Department of Biomechanical Engineering, Faculty of Mechanical, Maritime, and Materials EngineeringDelft University of Technology (TU Delft)DelftThe Netherlands
| | - Mark W. Grinstaff
- Departments of Biomedical Engineering, Chemistry, and MedicineBoston UniversityBostonMassachusetts
| | - Juha Töyräs
- Department of Applied PhysicsUniversity of Eastern FinlandKuopioFinland,Diagnostic Imaging CenterKuopio University HospitalKuopioFinland,School of Information Technology and Electrical EngineeringThe University of QueenslandBrisbaneAustralia
| | - Mikael J. Turunen
- Department of Applied PhysicsUniversity of Eastern FinlandKuopioFinland,SIB LabsUniversity of Eastern FinlandKuopioFinland
| |
Collapse
|