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Sellin ML, Seyfarth-Sehlke A, Aziz M, Fabry C, Wenke K, Høl PJ, Rios-Mondragon I, Cimpan MR, Frank M, Bader R, Jonitz-Heincke A. Isolation of TiNbN wear particles from a coated metal-on-metal bearing: Morphological characterization and in vitro evaluation of cytotoxicity in human osteoblasts. J Biomed Mater Res B Appl Biomater 2024; 112:e35357. [PMID: 38247242 DOI: 10.1002/jbm.b.35357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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: 06/03/2023] [Revised: 10/18/2023] [Accepted: 11/15/2023] [Indexed: 01/23/2024]
Abstract
To improve the wear resistance of articulating metallic joint endoprostheses, the surfaces can be coated with titanium niobium nitride (TiNbN). Under poor tribological conditions or malalignment, wear can occur on these implant surfaces in situ. This study investigated the biological response of human osteoblasts to wear particles generated from TiNbN-coated hip implants. Abrasive particles were generated in a hip simulator according to ISO 14242-1/-2 and extracted with Proteinase K. Particle characteristics were evaluated by electron microscopy and energy dispersive x-ray spectroscopy (EDS), inductively coupled plasma mass spectrometry (ICP-MS) and dynamic light scattering (DLS) measurements. Human osteoblasts were exposed to different particle dilutions (1:20, 1:50, and 1:100), and cell viability and gene expression levels of osteogenic markers and inflammatory mediators were analyzed after 4 and 7 days. Using ICP-MS, EDS, and DLS measurements, ~70% of the particles were identified as TiNbN, ranging from 39 to 94 nm. The particles exhibited a flat and subangular morphology. Exposure to particles did not influence cell viability and osteoblastic differentiation capacity. Protein levels of collagen type 1, osteoprotegerin, and receptor activator of nuclear factor κB ligand were almost unaffected. Moreover, the pro-inflammatory response via interleukins 6 and 8 was minor induced after particle contact. A high number of TiNbN wear particles only slightly affected osteoblasts' differentiation ability and inflammatory response compared to metallic particles. Nevertheless, further studies should investigate the role of these particles in peri-implant bone tissue, especially concerning other cell types.
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Affiliation(s)
- Marie-Luise Sellin
- Department of Orthopaedics, Biomechanics and Implant Technology Research Laboratory, Rostock University Medical Center, Rostock, Germany
| | - Anika Seyfarth-Sehlke
- Department of Orthopaedics, Biomechanics and Implant Technology Research Laboratory, Rostock University Medical Center, Rostock, Germany
| | - Mahammad Aziz
- Department of Orthopaedics, Biomechanics and Implant Technology Research Laboratory, Rostock University Medical Center, Rostock, Germany
| | | | | | - Paul Johan Høl
- Department of Orthopaedic Surgery, Biomatlab, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, Biomaterials, University of Bergen, Bergen, Norway
| | - Ivan Rios-Mondragon
- Department for Clinical Dentistry Biomaterials, University of Bergen, Bergen, Norway
| | - Mihaela Roxana Cimpan
- Department for Clinical Dentistry Biomaterials, University of Bergen, Bergen, Norway
| | - Marcus Frank
- Medical Biology and Electron Microscopy Center, Rostock University Medical Center, Rostock, Germany
- Department Life, Light and Matter, University of Rostock, Rostock, Germany
| | - Rainer Bader
- Department of Orthopaedics, Biomechanics and Implant Technology Research Laboratory, Rostock University Medical Center, Rostock, Germany
- Department Life, Light and Matter, University of Rostock, Rostock, Germany
| | - Anika Jonitz-Heincke
- Department of Orthopaedics, Biomechanics and Implant Technology Research Laboratory, Rostock University Medical Center, Rostock, Germany
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Khan M, Gjertsen JE, Fenstad AM, Refsum A, Nguyen U, Hallan G, Høl PJ, Furnes O. Cementing techniques for total knee arthroplasty in Norwegian hospitals; a questionnaire-based study. BMC Musculoskelet Disord 2023; 24:900. [PMID: 37980481 PMCID: PMC10656824 DOI: 10.1186/s12891-023-07040-2] [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: 08/15/2023] [Accepted: 11/13/2023] [Indexed: 11/20/2023] Open
Abstract
BACKGROUND Cementing technique in total knee arthroplasty (TKA) may influence implant survival. There is limited knowledge about the results with clinically used techniques. The aim of this study was to investigate cementing techniques for TKA in Norwegian hospitals, to compare widely used techniques to recommendations from the literature, and to investigate variation within hospitals. METHODS A questionnaire requesting information about cementing techniques were distributed to all Norwegian orthopedic surgeons performing TKAs regularly in 2020. Data was analyzed using descriptive statistical methods. RESULTS We acquired 121 responses out of 257 surgeons. They were from 45 out of 56 hospitals, and at least half of the TKA surgeons from 20 hospitals, constituting 79 surgeons. All responders used pulsatile lavage. Cement application to both the tibial plateau and stem (full cementation) was practiced by 61%. Application of cement to both implant and bone was done by 70% of surgeons. Techniques to improve cement penetration were used by 86%. Only 35% of surgeons aimed to get a cement mantle thickness between 3-5 mm. Flexing the knee joint to remove excess cement was done by 82%. We found that in 55% of 20 hospitals the surgeons did not agree on the use of common guidelines in their ward. CONCLUSIONS The majority of the responders used recommended techniques from the literature when cementing TKA. At more than half of the eligible hospitals, surgeons disagreed about their hospitals' use of common guidelines. Focusing on developing evidence-based guidelines would be beneficial for TKA-quality.
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Affiliation(s)
- Michelle Khan
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Jonas Lies Vei 87, 5021, Bergen, Norway.
| | - Jan-Erik Gjertsen
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Jonas Lies Vei 87, 5021, Bergen, Norway
- Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Anne Marie Fenstad
- Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Anders Refsum
- Orthopaedic Department, Bærum Hospital, Vestre Viken Hospital Trust, Bærum, Norway
| | - Uy Nguyen
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Jonas Lies Vei 87, 5021, Bergen, Norway
| | - Geir Hallan
- Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Paul Johan Høl
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Jonas Lies Vei 87, 5021, Bergen, Norway
| | - Ove Furnes
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Jonas Lies Vei 87, 5021, Bergen, Norway
- Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
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Høl PJ, Hallan G, Furnes O, Fenstad AM, Indrekvam K, Kadar T. Similarly low blood metal ion levels at 10-years follow-up of total hip arthroplasties with Oxinium, CoCrMo, and stainless steel femoral heads. Data from a randomized clinical trial. J Biomed Mater Res B Appl Biomater 2023; 111:821-828. [PMID: 36356214 PMCID: PMC10099800 DOI: 10.1002/jbm.b.35193] [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: 04/27/2022] [Revised: 09/21/2022] [Accepted: 10/29/2022] [Indexed: 11/12/2022]
Abstract
The use of inert head materials such as ceramic heads has been proposed as a method of reducing wear and corrosion products from the articulating surfaces in total hip arthroplasty, as well as from the stem-head taper connection. The aim of the present study was to compare the blood metal ion levels in patients with Oxinium and CoCrMo modular femoral heads, as well as monoblock stainless steel Charnley prostheses at 10 years postoperatively. The 150 patients with osteoarthritis of the hip joint included in a randomized clinical trial were grouped according to femoral head material. One group (n = 30) had received the Charnley monoblock stainless steel stem (DePuy, UK). The other patients (n = 120) received a Spectron EF CoCrMo stem with either a 28 mm CoCrMo or Oxinium modular head (Smith & Nephew, USA). After 10 years, 38 patients had withdrawn, 19 deceased, 7 revised due to aseptic loosening and 5 revised due to infection. The 81 patients with median age of 79 years (70-91) were available for whole blood metal ion analysis. The levels of Co, Cr, Ni and Zr in the blood were generally low with all the head materials (medians <0.3 micrograms/L) and no statistical difference between the groups were found (p = .2-.8). Based on the low blood metal ion values in our study groups, no indication of severe trunnion corrosion in patients with CoCrMo heads was observed, neither was there any beneficial reduction in metal ion exposure with the Oxinium femoral heads.
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Affiliation(s)
- Paul Johan Høl
- Biomatlab, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Geir Hallan
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway.,The Coastal Hospital at Hagevik, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Ove Furnes
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Anne Marie Fenstad
- The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Kari Indrekvam
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,The Coastal Hospital at Hagevik, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Thomas Kadar
- Physical Medicine and Rehabilitation, Clinic of Habilitation and Rehabilitation, Haukeland University Hospital, Bergen, Norway
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Wolf S, Johannessen AC, Ellison P, Furnes O, Hallan G, Rogg K, Skarstein K, Høl PJ. Inflammatory tissue reactions around aseptically loose cemented hip prostheses: A retrieval study of the Spectron EF stem with Reflection All-Poly acetabular cup. J Biomed Mater Res B Appl Biomater 2022; 110:1624-1636. [PMID: 35099116 PMCID: PMC9303329 DOI: 10.1002/jbm.b.35023] [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] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 11/09/2021] [Accepted: 01/15/2022] [Indexed: 12/27/2022]
Abstract
The cemented Spectron EF stem in combination with the cemented non‐crosslinked Reflection All‐Poly cup showed a high rate of mid‐term aseptic loosening. However, the failure mechanisms are not fully known. We assessed the inflammatory tissue reactions and wear particles in periprosthetic tissues, implant wear and blood metal ion levels in 28 patients with failed implants. Histological analysis showed a macrophage pre‐dominant pattern with randomly distributed lymphocytes, with various amounts of neutrophils and giant cells. The number of different cell types in the tissue samples from patients in the cup group and in the stem group was similar. Wear particles, mainly ZrO2, CoCrMo, and polyethylene particles of different sizes and shapes, were associated with macrophages/giant cells, and total particle load/mm2 was higher in cases of stem loosening. The Spectron EF stems were heavily worn, abraded, and polished. Stem abrasion correlated with metal ion concentrations in blood. The median polyethylene wear rate of the Reflection cups was 0.23 mm/year. The high proximal roughness of the Spectron EF stem resulted in excessive cement wear during loosening. The resulting inflammatory tissue responses to the degradation products both from the cup and the stem led to massive osteolysis and subsequent implant loosening.
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Affiliation(s)
- Susann Wolf
- Biomatlab, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway.,National Institute of Occupational Health, Oslo, Norway
| | - Anne Christine Johannessen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - Peter Ellison
- Biomatlab, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Ove Furnes
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Geir Hallan
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Katharina Rogg
- Biomatlab, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Kathrine Skarstein
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Pathology, Haukeland University Hospital, Bergen, Norway
| | - Paul Johan Høl
- Biomatlab, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Abstract
BACKGROUND A BHR (Birmingham hip resurfacing) prosthesis was implanted in 445 people in Norway. Adverse reactions can arise as a result of the release of metal ions from metal-on-metal joint surfaces made from cobalt-chromium alloy. The aim of the study was to analyse the release of metal ions during the first five years after surgery in patients with a BHR prosthesis and to investigate whether this was linked to clinical complications. MATERIAL AND METHOD Forty-four male patients (median age 53 years) implanted with a BHR prosthesis at the Coastal Hospital at Hagevik in the period October 2009 to May 2013 were monitored by means of blood samples before implantation and three months, one year, three years and five years afterwards. Analyses of cobalt and chromium in whole blood were performed. Function scoring was used to clinically assess the prosthetic joint. RESULTS Metal ion concentrations increased between the surgery date and one year later (p < 0.001), and subsequently remained stable. After five years, the median concentrations (min.- max.) of cobalt and chromium were 1.1 µg/L (0.4-6.3 µg/L) and 1.4 µg/L (0.4-11.7 µg/L) respectively for unilateral prostheses (n = 36), and 2.3 µg/L (1.6-28.5 µg/L) and 2.6 µg/L (1.7-14.1 µg/L) respectively for bilateral prostheses (n = 8). Five patients underwent revision surgery, while other patients had good hip function. INTERPRETATION Patients with a BHR prosthesis had a significant increase in cobalt and chromium in their blood one to five years after surgery, but the median levels were still well below the threshold value of 7 μg/L, which indicates an increased risk of complications.
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Høl PJ, Gjerdet NR, Jonung T. Corrosion and metal release from overlapping arterial stents under mechanical and electrochemical stress – An experimental study. J Mech Behav Biomed Mater 2019; 93:31-35. [DOI: 10.1016/j.jmbbm.2019.02.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 01/06/2019] [Accepted: 02/03/2019] [Indexed: 11/28/2022]
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Høl PJ, Kristoffersen EK, Gjerdet NR, Pellowe AS. Novel Nanoparticulate and Ionic Titanium Antigens for Hypersensitivity Testing. Int J Mol Sci 2018; 19:E1101. [PMID: 29642398 PMCID: PMC5979587 DOI: 10.3390/ijms19041101] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 03/26/2018] [Accepted: 04/03/2018] [Indexed: 02/06/2023] Open
Abstract
Titanium is used in a wide variety of materials ranging from medical devices to materials used in everyday life. Adverse biological reactions that could occur in patients, consumers, and workers should be monitored and prevented. There is a lack of available agents to test and predict titanium-related hypersensitivity. The aim of this study was to develop two bioavailable titanium substances in ionic and nanoparticulate form to serve as antigens for hypersensitivity testing in vitro. Peripheral blood mononuclear cells from 20 test subjects were stimulated with the antigens and secretion of monocytic and lymphatic cytokines and chemokines were measured by a multiplex bead assay. Lymphocyte stimulation indices were also determined in a subset of test subjects by measuring CD69 and HLA-DR expression by flow cytometry. Cytokine profiling revealed that both antigens increased production of typical monocyte and macrophage secreted cytokines after 24 h, with significant increases in IL-1β, IL-7, IL-10, IL-12, IL-2R, IL-6, GM-CSF, TNF-α, IL-1RA, MIP-1α, MIP-1β, IFN-α, and IL-15. Lymphatic cytokines and chemokines were not significantly induced by activation. After seven days of stimulation, ionic-Ti (2.5 μg/mL) caused proliferation (stimulation index > 2) of CD4+ cells and CD8+ cells in all persons tested (N = 6), while titanium dioxide nanoparticles (50 μg/mL) only caused significant proliferation of CD4+ cells. Our preliminary results show that the experimental titanium antigens, especially the ionic form, induce a general inflammatory response in vitro. A relevant cohort of test subjects is required to further elucidate their potential for predictive hypersensitivity testing.
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Affiliation(s)
- Paul Johan Høl
- Department of Clinical Medicine, University of Bergen, N-5021 Bergen, Norway.
- Department of Orthopaedic Surgery, Haukeland University Hospital, Jonas Lies vei 87, N-5021 Bergen, Norway.
| | - Einar K Kristoffersen
- Department of Clinical Science, University of Bergen, N-5021 Bergen, Norway.
- Department of Immunology and Transfusion Medicine, Haukeland University Hospital, N-5021 Bergen, Norway.
| | - Nils Roar Gjerdet
- Department of Clinical Dentistry, University of Bergen, N-5009 Bergen, Norway.
| | - Amanda S Pellowe
- School of Engineering and Applied Sciences, Yale University, New Haven, CT 06511, USA.
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Kutzner I, Hallan G, Høl PJ, Furnes O, Gøthesen Ø, Figved W, Ellison P. Early aseptic loosening of a mobile-bearing total knee replacement. Acta Orthop 2018; 89:77-83. [PMID: 29105532 PMCID: PMC5810837 DOI: 10.1080/17453674.2017.1398012] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 09/29/2017] [Indexed: 01/31/2023] Open
Abstract
Background and purpose - Registry-based studies have reported an increased risk of aseptic tibial loosening for the cemented Low Contact Stress (LCS) total knee replacement compared with other cemented designs; however, the reasons for this have not been established. We made a retrieval analysis with the aim of identifying the failure mechanism. Patients and methods - We collected implants, cement, tissue, blood, and radiographs from 32 failed LCS Complete cases. Damage to the tibial baseplate and insert was assessed. Exposure to wear products was quantified in 11 cases through analysis of periprosthetic tissue and blood. Implant alignment and bone cement thickness was compared with a control group of 43 non-revised cases. Results - Loosening of the tibial baseplate was the reason for revision in 25 retrievals, occurring at the implant-cement interface in 16 cases. Polishing was observed on the lower surface of the baseplate and correlated to the level of cobalt, chromium, and zirconium in the blood. No evidence of abnormally high polyethylene wear was present. For each 1 mm increase in cement thickness the odds of failure due to aseptic loosening decreased by 61%. Greater varus alignment was associated with a shorter time to failure. The roughness, Ra, of a new LCS baseplate's lower surface was 3.7 (SD 0.7) µm. Interpretation - Debonding of the tibial component at the implant-cement interface was the predominant cause of tibial aseptic loosening. A thin cement layer may partly explain the poor performance. Furthermore, the comparatively low tibial surface roughness and the lack of a keeled stem may have played a role in the failures observed.
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Affiliation(s)
- Ines Kutzner
- Department of Clinical Medicine, University of Bergen, Norway
- Julius Wolff Institute, Charité—Universitätsmedizin Berlin, Germany
| | - Geir Hallan
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Paul Johan Høl
- Department of Clinical Medicine, University of Bergen, Norway
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Ove Furnes
- Department of Clinical Medicine, University of Bergen, Norway
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Øystein Gøthesen
- Department of Clinical Medicine, University of Bergen, Norway
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
- Haugesund Hospital, Haugesund, Norway
| | - Wender Figved
- Orthopedic Department, Baerum Hospital, Vestre Viken Hospital Trust, Norway
| | - Peter Ellison
- Department of Clinical Medicine, University of Bergen, Norway
- Department of Mechanical Engineering, Imperial College London, UK
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Jonitz-Heincke A, Tillmann J, Klinder A, Krueger S, Kretzer JP, Høl PJ, Paulus AC, Bader R. The Impact of Metal Ion Exposure on the Cellular Behavior of Human Osteoblasts and PBMCs: In Vitro Analyses of Osteolytic Processes. Materials (Basel) 2017; 10:ma10070734. [PMID: 28773099 PMCID: PMC5551777 DOI: 10.3390/ma10070734] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 06/16/2017] [Accepted: 06/27/2017] [Indexed: 01/30/2023]
Abstract
Osteolysis in the periprosthetic tissue can be caused by metallic wear particles and ions that can originate from implant surface corrosion. These products influence cellular behavior and stimulate the expression of proinflammatory cytokines. The purpose of this study was to evaluate the impact of CoCr29Mo6 ions on cell survival, differentiation, and cytokine expression in human osteoblasts and peripheral blood mononuclear cells (PBMCs). Thus, we exposed cells with a mixture of 200 µg/L ion solution and determined cell viability and apoptosis/necrosis. Gene expression analyses of osteoblastic and osteoclastic differentiation markers as well as pro-osteolytic mediators (IL-6, IL-8, TNF-α, MCP-1, MMP1, TIMP1) were performed. These markers were also investigated in mixed cultures of adherent and non-adherent PBMCs as well as in co-cultures of human osteoblasts and PBMCs. The ion solution induced necrosis in osteoblasts and PBMCs in single cultures. All examined mediators were highly expressed in the co-culture of osteoblasts and PBMCs whereas in the single cell cultures only IL-6, IL-8, and MMP1 were found to be stimulated. While the applied concentration of the CoCr29Mo6 ion solutions had only marginal effects on human osteoblasts and PBMCs alone, the co-culture may provide a comprehensive model to study osteolytic processes in response to Co and Cr ions.
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Affiliation(s)
- Anika Jonitz-Heincke
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopaedics, University Medical Center Rostock, 18057 Rostock, Germany.
| | - Jenny Tillmann
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopaedics, University Medical Center Rostock, 18057 Rostock, Germany.
| | - Annett Klinder
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopaedics, University Medical Center Rostock, 18057 Rostock, Germany.
| | - Simone Krueger
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopaedics, University Medical Center Rostock, 18057 Rostock, Germany.
| | - Jan Philippe Kretzer
- Clinic for Orthopaedics and Trauma Surgery, Heidelberg University Hospital, 69118 Heidelberg, Germany.
| | - Paul Johan Høl
- Department of Orthopaedic Clinic, Biomatlab, Haukeland University Hospital, 5021 Bergen, Norway.
- Department of Clinical Medicine, Biomaterials, University of Bergen, 5021 Bergen, Norway.
| | - Alexander C Paulus
- Department of Orthopaedic Surgery, University Hospital Munich (Campus Grosshadern), 81377 Munich, Germany.
| | - Rainer Bader
- Biomechanics and Implant Technology Research Laboratory, Department of Orthopaedics, University Medical Center Rostock, 18057 Rostock, Germany.
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Grosse S, Haugland HK, Lilleng P, Ellison P, Hallan G, Høl PJ. Wear particles and ions from cemented and uncemented titanium-based hip prostheses-a histological and chemical analysis of retrieval material. J Biomed Mater Res B Appl Biomater 2014; 103:709-17. [PMID: 25051953 PMCID: PMC4413358 DOI: 10.1002/jbm.b.33243] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [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: 03/05/2014] [Revised: 06/10/2014] [Accepted: 07/08/2014] [Indexed: 12/13/2022]
Abstract
Wear debris-induced inflammation is considered to be the main cause for periprosthetic osteolysis in total hip replacements (THR). The objective of this retrieval study was to examine the tissue reactions and exposure to metal ions and wear particles in periprosthetic tissues and blood samples from patients with titanium (Ti)-based hip prostheses that were revised due to wear, osteolysis, and/or aseptic loosening. Semiquantitative, histological tissue evaluations in 30 THR-patients revealed numerous wear debris-loaded macrophages, inflammatory cells, and necrosis in both groups. Particle load was highest in tissues adjacent to loosened cemented Ti stems that contained mainly submicron zirconium (Zr) dioxide particles. Particles containing pure Ti and Ti alloy elements were most abundant in tissues near retrieved uncemented cups. Polyethylene particles were also detected, but accounted only for a small portion of the total particle number. The blood concentrations of Ti and Zr were highly elevated in cases with high abrasive wear and osteolysis. Our findings indicate that wear particles of different chemical composition induced similar inflammatory responses, which suggests that particle size and load might be more important than the wear particle composition in periprosthetic inflammation and osteolysis. © 2014 The Authors. Journal of Biomedical Materials Research Part B: Applied Biomaterials Published by Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 103B:709–717, 2015.
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Affiliation(s)
- Susann Grosse
- Department of Clinical Medicine, University of Bergen, N-5021, Norway
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11
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Abstract
BACKGROUND The relative risk of revision of the Titan(®) femoral stem due to aseptic loosening increased after 2000; however, the reasons for this have not been established. A retrieval analysis was initiated with the aim of delineating the failure mechanism. QUESTIONS/PURPOSES We asked whether aseptic loosening in stems after 2000 was associated with (1) appearance of osteolytic lesions, (2) wear particle exposure, (3) stem damage, or (4) changes to the implant or surgical instrumentation. METHODS Femoral stems, cement, tissue, and radiographs were collected from 28 patients. We assessed the development of osteolytic lesions in 17 patients. Exposure to wear particles was quantified in 18 patients. Stem damage was assessed in 15 patients. We observed differences in the implants by examination of 24 retrieved stems. Information concerning changes to instrumentation was requested from the manufacturer. RESULTS We found osteolysis in all patients receiving implants after 2000, which was associated with a median dose of cement and stem particles of 14,726/mm(2). Abrasion covered 59% of the surface of stems implanted from 1999. We identified geometric changes to the stem, the percent weight of aluminum in the stem's oxide layer decreased from 25% to 14% after 1997 and the rasp used to prepare the femoral cavity changed to a broach in 1999. CONCLUSIONS Stems implanted from 2000 failed through osteolysis induced by particles released from the cement and implant. Changes to implant geometry, surface oxide layer, and surgical tools occurred in the same time frame as the reduction in survivorship.
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Affiliation(s)
- Peter Ellison
- Biomaterials, Department of Surgical Sciences, University of Bergen, Bergen, Hordaland 5021 Norway
| | - Geir Hallan
- Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Paul Johan Høl
- Biomaterials, Department of Surgical Sciences, University of Bergen, Bergen, Hordaland 5021 Norway
| | - Nils Roar Gjerdet
- Biomaterials, Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - Leif I. Havelin
- Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
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Høl PJ, Mølster A, Gjerdet NR, Bell K, Saetersdal C, Gjertsen JE. Hip fracture implants increase serum metal levels. Scandinavian Journal of Clinical and Laboratory Investigation 2009; 66:705-16. [PMID: 17101563 DOI: 10.1080/00365510600939877] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Hip fractures are disabling accidents in the elderly. The purpose of this prospective study was to investigate systemic exposure to metals from hip implants used for fracture fixation. MATERIAL AND METHODS Serum levels of Cr, Ni and Mo in patients with compression hip screws (n = 22) or cervical fracture screws (n = 23) were measured by inductively coupled plasma mass spectrometry. Blood samples were collected before surgery and at 3 and 12 months postoperatively. RESULTS At 3 months, patients with compression hip screws showed higher concentrations of Cr and Ni than did those with cervical screws. Both types of screws led to a 2-fold increase in serum Mo, which was not expected for the freestanding cervical screws. After 12 months, the levels had decreased, but the compression hip screw was still associated with higher values for Cr and Mo. CONCLUSIONS The difference between the screws is most likely due to the potential for fretting and crevice corrosion between components in the compression hip screws. The apparent short-term systemic elevation of stainless steel elements in patients with hip screws does not support routine removal of asymptomatic hip fracture implants.
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Affiliation(s)
- P J Høl
- Orthopaedic Biomaterials-Innovest AS, Bergen, Norway.
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Høl PJ, Bell K, Mølster A, Gjerdet NR. Nickel contamination from an intravenous catheter used for infusion. Scandinavian Journal of Clinical and Laboratory Investigation 2009; 65:221-5. [PMID: 16095051 DOI: 10.1080/00365510510013578] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
At the outset of a clinical research project involving metal analyses on patients receiving metal devices in conjunction with hip fractures, unexpected high concentrations of nickel were discovered in serum samples taken before surgery. The median nickel concentration in 30 patients was 4.6 microg/l (highest 19.5 microg/l), while reference values in non-exposed persons are reported to be 0.05-1.2 microg/l. The sampling and analyzing procedures were scrutinized without positive identification of the source of contamination. A review of all relevant procedures was then undertaken. It was identified that the nickel contamination originated from the intravenous catheter which was always put in place immediately after the patient's admission to the hospital, and thus before the blood sampling. Close inspection of the intravenous catheter revealed that it contained a nickel-plated brass funnel inside the hub of the device which released nickel into the Ringer-acetate passing through the catheter. The present catheter has been the standard device used at Haukeland University Hospital for the past 6 years. Patients have consequently been exposed to small amounts of nickel. The clinical relevance of the exposure cannot be determined. For the patients included in the research project, a metal-free alternative was used. These findings show that the quality and properties of everyday medical devices should be scrutinized, at least before being used for special purposes.
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Affiliation(s)
- P J Høl
- Orthopedic Biomaterials, Innovest AS, Bergen, Norway.
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Høl PJ, Mølster A, Gjerdet NR. Should the galvanic combination of titanium and stainless steel surgical implants be avoided? Injury 2008; 39:161-9. [PMID: 18054018 DOI: 10.1016/j.injury.2007.07.015] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2007] [Revised: 06/13/2007] [Accepted: 07/16/2007] [Indexed: 02/02/2023]
Abstract
It is recommended that one should not combine different metals in orthopaedic devices. The least noble metal in such a galvanic coupling is more likely to corrode. However, some studies have failed to show increased corrosion when titanium and stainless steel are combined. The aim of this study was to determine the fretting corrosion of the contact areas between screws and plates made of these dissimilar metals used for internal fixation of bone fractures. The plates were fixed to a bone-simulating material and subjected to tensile and compressive forces in both human serum and Hank's solution. The outcome variables included in the analyses were weight loss, and release of Ti, Cr, Ni and Mo to the different media. Results from the multiple combinations were subjected to multivariate statistics. Principal component analysis visualised our findings and allowed classification of similar samples and separation of discrepant groups of samples. We found a significant effect of the test medium, but no dramatic effect due to mixing of metals. The titanium screws and plates corroded more in serum than in saline, while the opposite was true for stainless steel. Combination of dissimilar screws and plates did not cause higher weight loss or metal release than the single-material constructions, indicating comparable clinical safety.
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Affiliation(s)
- Paul Johan Høl
- Orthopedic Biomaterials, Helse Bergen Haukeland University Hospital, Aarstadveien 17, NO-5009 Bergen, Norway.
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Vamanu CI, Høl PJ, Allouni ZE, Elsayed S, Gjerdet NR. Formation of potential titanium antigens based on protein binding to titanium dioxide nanoparticles. Int J Nanomedicine 2008; 3:69-74. [PMID: 18488417 PMCID: PMC2526361 DOI: 10.2147/ijn.s1796] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Degradation products of titanium implants include free ions, organo-metallic complexes, and particles, ranging from nano to macro sizes. The biological effects, especially of nanoparticles, is yet unknown. The main objective of this study was to develop Ti-protein antigens in physiological solutions that can be used in testing of cellular responses. For this purpose, 0.1% TiO2 nanoparticles less than 100 nm were mixed with human serum albumin (HSA), 0.1% and 1%, in cell culture medium (DMEM, pH 7.2). The Ti concentrations in the resulting solutions were analyzed by inductively coupled plasma mass spectrometry. The stability of the nanoparticles in suspension was analyzed by UV-vis spectrophotometer and Dynamic Light Scattering. The concentration of Ti in suspension was dependent on the presence and concentration of HSA. Albumin prevented high aggregation rate of TiO2 nanoparticles in cell culture medium. It is shown that nano TiO2-protein stable aggregates can be produced under physiological conditions at high concentrations, and are candidates for use in cellular tests.
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Affiliation(s)
- Carmen Irina Vamanu
- Department of Oral Sciences, Faculty of Dentistry, University of Bergen, Bergen, Norway.
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Høl PJ, Vamnes JS, Gjerdet NR, Eide R, Isrenn R. Copper, zinc, and selenium in human blood and urine after injection of sodium 2,3-dimercaptopropane-1-sulfonate: a study on subjects with dental amalgam. Biol Trace Elem Res 2003; 91:19-31. [PMID: 12713026 DOI: 10.1385/bter:91:1:19] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This study investigated the effects of a single dose of intravenously administered sodium 2,3-dimercaptopropane-1-sulfonate (DMPS) on the essential elements copper, zinc, and selenium in human blood and urine. The possible role of dental amalgam was also addressed. Eighty individuals, divided in four groups according to the presence or absence of dental amalgam fillings and symptoms self-related to such fillings, were given DMPS (2 mg/kg body wt) and 500 mL Ringer's acetate intravenously. Urine and blood were collected prior to the injection, and thereafter at intervals over a 24-h period. Cu, Zn, and Se concentrations were determined by atomic absorption spectrometry methods. A statistically significant increase in the concentrations of Cu and Zn in urine was observed 30 and 120 min after the DMPS injection compared to the preinjection concentrations. The concentrations of Se were not affected. The cumulated excretion over 24 h after DMPS injection constitutes only from 0.1% to 0.7% of the body content of these elements. There was no effect of different amalgam statuses on Cu and Zn excretion. We found a temporary decrease (4-7%) in the concentrations of Cu, Zn, and Se in blood 15 and 30 min after DMPS, but this seems to be the result of dilution factors. Administration of a single dose of DMPS does not affect the body stores of the essential elements Cu, Zn, and Se.
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Affiliation(s)
- Paul Johan Høl
- Department of Odontology-Dental Biomaterials, University of Bergen, N-5009 Bergen, Norway
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Høl PJ, Vamnes JS, Gjerdet NR, Eide R, Isrenn R. Dental amalgam affects urinary selenium excretion. Biol Trace Elem Res 2002; 85:137-47. [PMID: 11899021 DOI: 10.1385/bter:85:2:137] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2001] [Revised: 08/20/2001] [Accepted: 09/18/2001] [Indexed: 11/11/2022]
Abstract
Selenium may have a protective effect against mercury toxicity. The aim of the present study was to investigate if selenium excretion in urine was affected in persons with dental amalgam fillings. The reason for this study is that dental amalgam is the most important source of inorganic mercury exposure in the general population, although the potential toxic effects of this exposure remain a subject for debate. The chelating agent 2,3 dimercaptopropane-1-sulfonate (DMPS) was injected intravenously (2 mg/kg) to provoke metal excretion. Urine samples were subsequently collected at intervals over a 24-h period. Selenium concentration was determined by hydride-generation atomic absorption spectrometry. The study was comprised of 20 persons who claimed symptoms from dental amalgam and 21 healthy persons with amalgam fillings. There were two control groups without amalgam. One control group had amalgam replaced because of concern about illness resulting from mercury release (n = 20), whereas the other control group never had amalgam (n = 19). Individuals with amalgam excreted less selenium (36.4 microg, median value) over 24 hours than those without amalgam (47.5 microg) (p = 0.016). There was no difference in selenium excretion between groups with (42.4 microg) and without (39.4 microg) amalgam-related symptoms (p = 0.15). The findings indicate that individuals exposed to low levels of elemental mercury from dental amalgam excrete less selenium to urine than unexposed individuals.
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Affiliation(s)
- Paul Johan Høl
- Department of Odontology--Dental Biomaterials, University of Bergen, Norway
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Abstract
It has been suggested that selenium (Se) exhibits protective effects against mercury (Hg) toxicity in humans due to formation of a Hg-Se complex bound to selenoprotein P in blood. The aim of the present study was to investigate Se concentrations in persons who had been examined with respect to general health problems associated with dental amalgam fillings. The Se concentrations were determined in whole-blood samples of 80 individuals by hydride generation atomic absorption spectrometry. The subjects comprised two main groups: 21 healthy controls with amalgam fillings and 20 patients who claimed symptoms from existing amalgam fillings. The median concentration of Se in blood (119.2 microg/L) was statistically significantly lower in subjects who claimed symptoms of mercury amalgam illness than in healthy subjects with amalgam (130.3 microg/L). The difference was more evident in individuals with more than 35 amalgam surfaces (P=0.003). Additional control groups without amalgam fillings comprised 19 healthy controls without amalgam experience and 20 subjects who have had amalgam fillings removed due to suspected symptoms associated with amalgam. The Se concentrations in these groups were not different from those with amalgam. It is indicated that persons with ill health self-related to dental amalgam might have a Se metabolism different from that of healthy people.
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Affiliation(s)
- P J Høl
- Department of Odontology-Dental Biomaterials, University of Bergen, Aarstadveien 17, Bergen, N-5009, Norway
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Abstract
The amount of mercury released into saliva from dental amalgam fillings is currently being debated. Mercury enters saliva as vapor, ions and particles of amalgam. The aim of the present study was to determine mercury and silver concentrations in saliva of persons with amalgam fillings. Moreover, it was the aim to investigate whether amalgam particles were present in samples of stimulated saliva in control subjects. In that case, we also wanted to determine the influence of these particles on the mercury concentrations found. Fifty-three patients with a wide range of complaints self-related to their amalgam fillings were examined by the Dental Biomaterials Adverse Reaction Unit of Norway. Among other tests, stimulated saliva was collected from each patient and analyzed for mercury and silver. Mercury and silver correlated with the amount of amalgam present. There was a strong correlation between mercury and silver concentrations. Amalgam particles were found by energy dispersive X-ray analysis. It appears that a considerable part of the mercury and silver were present as amalgam particles. The present study shows that amalgam particles in saliva have to be controlled for when analyzing mercury in saliva from subjects with amalgam fillings.
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Affiliation(s)
- G B Lygre
- Dental Biomaterials Adverse Reaction Unit, University of Bergen, Norway.
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Abstract
Results are reported from a study on the in vitro separation and identification of leachables from three different polymer-based dental filling materials by using a combined method of gas chromatography and mass spectrometry. The median number of separable organic leachables in these materials was between 14 and 22. Of these organic leachables the following were identified and quantified: DL-camphorquinone, 4-dimethylaminobenzoic acid ethyl ester (DMABEE), drometrizole, 1,7,7-trimethylbicyclo[2,2,1]heptane, 2,2-dimethoxy[1,2] diphenyletanone (DMBZ), ethyleneglycol dimethacrylate (EGDMA), and triethyleneglycol dimethacrylate (TEGDMA). Three of the leachables have previously been shown to provoke allergy. The range of log P(ow) values (representing the lipophilicity of these compounds) varied between 1.09 and 4.20. By multivariate data analysis, selected leachables from the tested materials were shown to separate into characteristic patterns. The results contribute to a characterization of potential hazardous compounds in polymer-based dental filling materials.
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Affiliation(s)
- H Lygre
- Department of Odontology-Dental Biomaterials, University of Bergen, Norway.
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