1
|
Zhou C, Wang Y, Meng J, Yao M, Xu H, Wang C, Bi F, Zhu H, Yang G, Shi M, Yan S, Wu H. Additive Effect of Parathyroid Hormone and Zoledronate Acid on Prevention Particle Wears-Induced Implant Loosening by Promoting Periprosthetic Bone Architecture and Strength in an Ovariectomized Rat Model. Front Endocrinol (Lausanne) 2022; 13:871380. [PMID: 35546997 PMCID: PMC9084285 DOI: 10.3389/fendo.2022.871380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/16/2022] [Indexed: 11/13/2022] Open
Abstract
Implant-generated particle wears are considered as the major cause for the induction of implant loosening, which is more susceptible to patients with osteoporosis. Monotherapy with parathyroid hormone (PTH) or zoledronate acid (ZOL) has been proven efficient for preventing early-stage periprosthetic osteolysis, while the combination therapy with PTH and ZOL has exerted beneficial effects on the treatment of posterior lumbar vertebral fusion and disuse osteopenia. However, PTH and ZOL still have not been licensed for the treatment of implant loosening to date clinically. In this study, we have explored the effect of single or combined administration with PTH and ZOL on implant loosening in a rat model of osteoporosis. After 12 weeks of ovariectomized surgery, a femoral particle-induced periprosthetic osteolysis model was established. Vehicle, PTH (5 days per week), ZOL (100 mg/kg per week), or combination therapy was utilized for another 6 weeks before sacrifice, followed by micro-CT, histology, mechanical testing, and bone turnover examination. PTH monotherapy or combined PTH with ZOL exerted a protective effect on maintaining implant stability by elevating periprosthetic bone mass and inhibiting pseudomembrane formation. Moreover, an additive effect was observed when combining PTH with ZOL, resulting in better fixation strength, higher periprosthetic bone mass, and less pseudomembrane than PTH monotherapy. Taken together, our results suggested that a combination therapy of PTH and ZOL might be a promising approach for the intervention of early-stage implant loosening in patients with osteoporosis.
Collapse
Affiliation(s)
- Chenhe Zhou
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Orthopedic Research Institute of Zhejiang University, Hangzhou, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, The Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Yangxin Wang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Orthopedic Research Institute of Zhejiang University, Hangzhou, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, The Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Jiahong Meng
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Orthopedic Research Institute of Zhejiang University, Hangzhou, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, The Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Minjun Yao
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Orthopedic Research Institute of Zhejiang University, Hangzhou, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, The Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Huikang Xu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Cong Wang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Orthopedic Research Institute of Zhejiang University, Hangzhou, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, The Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Fanggang Bi
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hanxiao Zhu
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Orthopedic Research Institute of Zhejiang University, Hangzhou, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, The Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Guang Yang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Orthopedic Research Institute of Zhejiang University, Hangzhou, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, The Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Mingmin Shi
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Orthopedic Research Institute of Zhejiang University, Hangzhou, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, The Second Affiliated Hospital, Zhejiang University, Hangzhou, China
- *Correspondence: Haobo Wu, ; Shigui Yan, ; Mingmin Shi,
| | - Shigui Yan
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Orthopedic Research Institute of Zhejiang University, Hangzhou, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, The Second Affiliated Hospital, Zhejiang University, Hangzhou, China
- *Correspondence: Haobo Wu, ; Shigui Yan, ; Mingmin Shi,
| | - Haobo Wu
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Orthopedic Research Institute of Zhejiang University, Hangzhou, China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, The Second Affiliated Hospital, Zhejiang University, Hangzhou, China
- *Correspondence: Haobo Wu, ; Shigui Yan, ; Mingmin Shi,
| |
Collapse
|
2
|
Jummaat F, Yahya EB, Khalil H.P.S. A, Adnan AS, Alqadhi AM, Abdullah CK, A.K. AS, Olaiya NG, Abdat M. The Role of Biopolymer-Based Materials in Obstetrics and Gynecology Applications: A Review. Polymers (Basel) 2021; 13:633. [PMID: 33672526 PMCID: PMC7923797 DOI: 10.3390/polym13040633] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/11/2021] [Accepted: 02/17/2021] [Indexed: 12/17/2022] Open
Abstract
Biopolymers have gained tremendous attention in many daily life applications, including medical applications, in the past few years. Obstetrics and gynecology are two fields dealing with sensitive parts of the woman's body and her newborn baby, which are normally associated with many issues such as toxicity, infections, and even gene alterations. Medical professions that use screening, examination, pre, and post-operation materials should benefit from a better understanding of each type of material's characteristics, health, and even environmental effects. The underlying principles of biopolymer-based materials for different obstetric and gynecologic applications may discover various advantages and benefits of using such materials. This review presents the health impact of conventional polymer-based materials on pregnant women's health and highlights the potential use of biopolymers as a safer option. The recent works on utilizing different biopolymer-based materials in obstetric and gynecologic are presented in this review, which includes suture materials in obstetric and gynecologic surgeries, cosmetic and personal care products, vaginal health, and drug delivery; as well as a wound dressing and healing materials. This review highlights the main issues and challenges of biopolymers in obstetric and gynecologic applications.
Collapse
Affiliation(s)
- Fauziah Jummaat
- Management & Science University Medical Centre, University Drive, Off Persiaran Olahraga, Section 13, Shah Alam 40100, Malaysia
| | - Esam Bashir Yahya
- School of Industrial Technology, Universiti Sains Malaysia, Penang 11800, Malaysia; (E.B.Y.); (C.K.A.); (N.G.O.)
| | - Abdul Khalil H.P.S.
- School of Industrial Technology, Universiti Sains Malaysia, Penang 11800, Malaysia; (E.B.Y.); (C.K.A.); (N.G.O.)
| | - A. S. Adnan
- Management & Science University Medical Centre, University Drive, Off Persiaran Olahraga, Section 13, Shah Alam 40100, Malaysia
| | | | - C. K. Abdullah
- School of Industrial Technology, Universiti Sains Malaysia, Penang 11800, Malaysia; (E.B.Y.); (C.K.A.); (N.G.O.)
| | - Atty Sofea A.K.
- Hospital Seberang Jaya, Jalan Tun Hussein Onn, Seberang Jaya, Permatang Pauh 13700, Malaysia;
| | - N. G. Olaiya
- School of Industrial Technology, Universiti Sains Malaysia, Penang 11800, Malaysia; (E.B.Y.); (C.K.A.); (N.G.O.)
| | - Munifah Abdat
- Department of Preventive and Public Health Dentistry, Faculty of Dentistry, Universitas Syiah Kuala, Banda Aceh 23111, Indonesia;
| |
Collapse
|
3
|
Investigation of Cytotoxicity, Oxidative Stress, and Inflammatory Responses of Tantalum Nanoparticles in THP-1-Derived Macrophages. Mediators Inflamm 2020; 2020:3824593. [PMID: 33343230 PMCID: PMC7732397 DOI: 10.1155/2020/3824593] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/29/2020] [Accepted: 11/02/2020] [Indexed: 12/23/2022] Open
Abstract
Tantalum (Ta) is gaining attention as a biomaterial in bone tissue engineering. Although the clinical advantage of Ta-based implants for primary and revision total joint replacement (TJA) has been well documented, few studies investigated the effect of wear products of Ta implants on peri-implant cells, and their potential contribution to aseptic implant loosening. This study is aimed at examining the cytotoxicity, oxidative stress, and proinflammatory potential of Ta and TiO2 nanoparticles (NPs) on macrophages in vitro. NPs were characterized using scanning electron microscopy, dynamic light scattering, and energy-dispersive X-ray. To test the NP-mediated cellular response in macrophages, THP-1-derived macrophages were challenged with both NPs, and cytotoxicity was analyzed using CCK-8 and LDH assays. Flow cytometry was used to investigate particle uptake and their internalization routes. NP-mediated oxidative stress was investigated by measuring the production of reactive oxygen species, and their proinflammatory potential was determined by quantifying the production of TNFα and IL-1β in cell culture supernatants using ELISA. We found that both Ta and TiO2 NPs were taken up through actin-dependent phagocytosis, although TiO2 NPs did also show some involvement of macropinocytosis and clathrin-mediated endocytosis. Ta NPs caused no apparent toxicity, while TiO2 NPs demonstrated significant cytotoxicity at a concentration of over 100μg/mL at 24 h. Ta NPs induced negligible ROS generation and proinflammatory cytokines (TNFα, IL-1β) in macrophages. In contrast, TiO2 NPs markedly induced these effects in a dose-dependent manner. Our findings indicate that Ta NPs are inert, nontoxic, and noninflammatory. Therefore, Ta could be considered an excellent biomaterial in primary and revision joint arthroplasty implants.
Collapse
|
4
|
Zhang L, Haddouti EM, Welle K, Burger C, Kabir K, Schildberg FA. Local Cellular Responses to Metallic and Ceramic Nanoparticles from Orthopedic Joint Arthroplasty Implants. Int J Nanomedicine 2020; 15:6705-6720. [PMID: 32982228 PMCID: PMC7494401 DOI: 10.2147/ijn.s248848] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 07/08/2020] [Indexed: 12/27/2022] Open
Abstract
Over the last decades, joint arthroplasty has become a successful treatment for joint disease. Nowadays, with a growing demand and increasingly younger and active patients accepting these approaches, orthopedic surgeons are seeking implants with improved mechanical behavior and longer life span. However, aseptic loosening as a result of wear debris from implants is considered to be the main cause of long-term implant failure. Previous studies have neatly illustrated the role of micrometric wear particles in the pathological mechanisms underlying aseptic loosening. Recent osteoimmunologic insights into aseptic loosening highlight the important and heretofore underrepresented contribution of nanometric orthopedic wear particles. The present review updates the characteristics of metallic and ceramic nanoparticles generated after prosthesis implantation and summarizes the current understanding of their hazardous effects on peri-prosthetic cells.
Collapse
Affiliation(s)
- Li Zhang
- Clinic for Orthopedics and Trauma Surgery, University Hospital Bonn, Venusberg-Campus 1, Bonn 53127, Germany
| | - El-Mustapha Haddouti
- Clinic for Orthopedics and Trauma Surgery, University Hospital Bonn, Venusberg-Campus 1, Bonn 53127, Germany
| | - Kristian Welle
- Clinic for Orthopedics and Trauma Surgery, University Hospital Bonn, Venusberg-Campus 1, Bonn 53127, Germany
| | - Christof Burger
- Clinic for Orthopedics and Trauma Surgery, University Hospital Bonn, Venusberg-Campus 1, Bonn 53127, Germany
| | - Koroush Kabir
- Clinic for Orthopedics and Trauma Surgery, University Hospital Bonn, Venusberg-Campus 1, Bonn 53127, Germany
| | - Frank A Schildberg
- Clinic for Orthopedics and Trauma Surgery, University Hospital Bonn, Venusberg-Campus 1, Bonn 53127, Germany
| |
Collapse
|
5
|
Liao L, Lin Y, Liu Q, Zhang Z, Hong Y, Ni J, Yu S, Zhong Y. Cepharanthine ameliorates titanium particle-induced osteolysis by inhibiting osteoclastogenesis and modulating OPG/RANKL ratio in a murine model. Biochem Biophys Res Commun 2019; 517:407-412. [DOI: 10.1016/j.bbrc.2019.07.115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 07/29/2019] [Indexed: 01/09/2023]
|
6
|
Inflammatory Responses Reprogram T REGS Through Impairment of Neuropilin-1. Sci Rep 2019; 9:10429. [PMID: 31320680 PMCID: PMC6639378 DOI: 10.1038/s41598-019-46934-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 07/08/2019] [Indexed: 01/23/2023] Open
Abstract
Chronic inflammatory insults compromise immune cell responses and ultimately contribute to pathologic outcomes. Clinically, it has been suggested that bone debris and implant particles, such as polymethylmethacrylate (PMMA), which are persistently released following implant surgery evoke heightened immune, inflammatory, and osteolytic responses that contribute to implant failure. However, the precise mechanism underlying this pathologic response remains vague. TREGS, the chief immune-suppressive cells, express the transcription factor Foxp3 and are potent inhibitors of osteoclasts. Using an intra-tibial injection model, we show that PMMA particles abrogate the osteoclast suppressive function of TREGS. Mechanistically, PMMA particles induce TREG instability evident by reduced expression of Foxp3. Importantly, intra-tibial injection of PMMA initiates an acute innate immune and inflammatory response, yet the negative impact on TREGS by PMMA remains persistent. We further show that PMMA enhance TH17 response at the expense of other T effector cells (TEFF), particularly TH1. At the molecular level, gene expression analysis showed that PMMA particles negatively regulate Nrp-1/Foxo3a axis to induce TREG instability, to dampen TREG activity and to promote phenotypic switch of TREGS to TH17 cells. Taken together, inflammatory cues and danger signals, such as bone and implant particles exacerbate inflammatory osteolysis in part through reprogramming TREGS.
Collapse
|
7
|
Pan C, Shan H, Wu T, Liu W, Lin Y, Xia W, Wang F, Zhou Z, Yu X. 20(S)-Protopanaxadiol Inhibits Titanium Particle-Induced Inflammatory Osteolysis and RANKL-Mediated Osteoclastogenesis via MAPK and NF-κB Signaling Pathways. Front Pharmacol 2019; 9:1538. [PMID: 30713497 PMCID: PMC6345703 DOI: 10.3389/fphar.2018.01538] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 12/17/2018] [Indexed: 01/17/2023] Open
Abstract
Osteolysis is a principal reason for arthroplasty failure like aseptic loosening induced by Titanium (Ti) particle. It is a challenge for orthopedic surgeons. Recent researches show that 20(S)-protopanaxadiol can inhibit inflammatory cytokine release in vitro. This study aims to assess the effect of 20(S)-protopanaxadiol on Ti particle-induced osteolysis and RANKL-mediated osteoclastogenesis. Micro-CT and histological analysis in vivo indicated the inhibitory effects of 20(S)-protopanaxadiol on osteoclastogenesis and the excretion of inflammatory cytokines. Next, we demonstrated that 20(S)-protopanaxadiol inhibited osteoclast differentiation, bone resorption area, and F-actin ring formation in a dose-dependent manner. Moreover, mechanistic studies suggested that the suppression of MAPK and NF-κB signaling pathways were found to mediate the inhibitory effects of 20(S)-protopanaxadiol. In conclusion, 20(S)-protopanaxadiol may suppress osteoclastogenesis in a dose- dependent manner and it could be a potential treatment of Ti particle-induced osteolysis.
Collapse
Affiliation(s)
- Chenhao Pan
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Haojie Shan
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Tianyi Wu
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Wei Liu
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yiwei Lin
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Wenyang Xia
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Feng Wang
- Department of Orthopedic Surgery, Shanghai Sixth People's Hospital East Campus Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Zubin Zhou
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Xiaowei Yu
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Department of Orthopedic Surgery, Shanghai Sixth People's Hospital East Campus Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China
| |
Collapse
|
8
|
Biomechanics and Biotribology of UHMWPE Artificial Hip Joints. SPRINGER SERIES IN BIOMATERIALS SCIENCE AND ENGINEERING 2019. [DOI: 10.1007/978-981-13-6924-7_8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
|
9
|
Jatrorrhizine Hydrochloride Suppresses RANKL-Induced Osteoclastogenesis and Protects against Wear Particle-Induced Osteolysis. Int J Mol Sci 2018; 19:ijms19113698. [PMID: 30469456 PMCID: PMC6275021 DOI: 10.3390/ijms19113698] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 11/12/2018] [Accepted: 11/15/2018] [Indexed: 01/22/2023] Open
Abstract
Wear particle-induced aseptic prosthetic loosening is a major complication associated with total joint arthroplasty (TJA). A growing body of evidence suggests that receptor activator of nuclear factor κ-B ligand (RANKL)-stimulated osteoclastogenesis and bone resorption are responsible for peri-implant loosening. Thus, agents which attenuate excessive osteoclast differentiation and function have been considered to offer therapeutic potential for prolonging the life of TJA implants. Jatrorrhizine hydrochloride (JH), a major protoberberine alkaloid isolated from the traditional Chinese herb Coptis chinensis, has been reported to have antimicrobial, antitumor, and antihypercholesterolemic and neuroprotective activities. However, its effects on osteoclast biology remain unknown. Here, we found that JH inhibited RANKL-induced osteoclast formation and bone resorption in vitro and exerted protection against titanium (Ti) particle-induced osteolysis in vivo. Biochemical analysis demonstrated that JH suppressed RANKL-induced activation of MAPKs (p38 and ERK) which down-regulated the production of NFATc1 and NFATc1-regulated osteoclastic marker genes, such as TRAP, CTR and CTSK. Collectively, our findings suggest that JH may be a promising anti-osteoclastogenesis agent for treating periprosthetic osteolysis or other osteoclast-related osteolytic diseases.
Collapse
|
10
|
Wu C, Liu X, Sun R, Qin Y, Liu Z, Yang S, Tang T, Zhu Z, Yu D, Liu F. Targeting Anion Exchange of Osteoclast, a New Strategy for Preventing Wear Particles Induced- Osteolysis. Front Pharmacol 2018; 9:1291. [PMID: 30459624 PMCID: PMC6232501 DOI: 10.3389/fphar.2018.01291] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 10/22/2018] [Indexed: 12/30/2022] Open
Abstract
Joint replacement is essential for the treatment of serious joint disease. However, prosthetic failure remains an important clinical issue, with periprosthesis osteolysis (PO), caused by osteoclastic bone resorption induced by wear particles, being the leading cause of failure. Nuclear factor of activated T cells c1 (NFATc1) appears to play an important role in wear particle-induced osteoclastogenesis, with bicarbonate/chloride exchanger, solute carrier family 4, anion exchanger, member 2, (SLC4A2) being upregulated during osteoclastogenesis in an NFATc1-dependent manner. Anion exchange mediated by SLC4A2 in osteoclasts could affect the bone resorption activity by regulating pHi. This study investigated the role and mechanism of SLC4A2 in wear particle-induced osteoclast differentiation and function in vitro. The use of 4, 4'-diisothiocyano-2,2'-stilbenedisulfonic acid (DIDS), an anion exchange inhibitor, suppressed wear particle-induced PO in vivo. Furthermore, controlled release of DIDS from chitosan microspheres can strengthen the PO therapy effect. Therefore, anion exchange mediated by osteoclastic SLC4A2 may be a potential therapeutic target for the treatment of aseptic loosening of artificial joints.
Collapse
Affiliation(s)
- Chuanlong Wu
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedics, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xuqiang Liu
- Department of Orthopaedics, The First Affiliated Hospital, Nanchang University, Nanchang, China
| | - Ruixin Sun
- State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yunhao Qin
- Department of Orthopaedics, Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Zhiqing Liu
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedics, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shengbing Yang
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedics, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tingting Tang
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedics, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhenan Zhu
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedics, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Degang Yu
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedics, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fengxiang Liu
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedics, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
11
|
Meng J, Zhou C, Hu B, Luo M, Yang Y, Wang Y, Wang W, Jiang G, Hong J, Li S, Wu H, Yan S, Yan W. Stevioside Prevents Wear Particle-Induced Osteolysis by Inhibiting Osteoclastogenesis and Inflammatory Response via the Suppression of TAK1 Activation. Front Pharmacol 2018; 9:1053. [PMID: 30319406 PMCID: PMC6169369 DOI: 10.3389/fphar.2018.01053] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 08/31/2018] [Indexed: 12/28/2022] Open
Abstract
Aseptic loosening and periprosthetic osteolysis are the leading causes of total joint arthroplasty failure, which occurs as a result of chronic inflammatory response and enhanced osteoclast activity. Here we showed that stevioside, a natural compound isolated from Stevia rebaudiana, exhibited preventative effects on titanium particle-induced osteolysis in a mouse calvarial model. Further histological assessment and real-time PCR analysis indicated that stevioside prevented titanium particle-induced osteolysis by inhibiting osteoclast formation and inflammatory cytokine expression in vivo. In vitro, we found that stevioside could suppress RANKL-induced osteoclastogenesis and titanium particle-induced inflammatory response in a dose-dependent manner. Mechanistically, stevioside achieved these effects by disrupting the phosphorylation of TAK1 and subsequent activation of NF-κB/MAPKs signaling pathways. Collectively, our data suggest that stevioside effectively suppresses osteoclastogenesis and inflammatory response both in vitro and in vivo, and it might be a potential therapy for particle-induced osteolysis and other osteolytic diseases.
Collapse
Affiliation(s)
- Jiahong Meng
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedic Research Institute of Zhejiang University, Hangzhou, China
| | - Chenhe Zhou
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedic Research Institute of Zhejiang University, Hangzhou, China
| | - Bin Hu
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedic Research Institute of Zhejiang University, Hangzhou, China
| | - Mengmeng Luo
- Department of Plastic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yute Yang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedic Research Institute of Zhejiang University, Hangzhou, China
| | - Yangxin Wang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedic Research Institute of Zhejiang University, Hangzhou, China
| | - Wei Wang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedic Research Institute of Zhejiang University, Hangzhou, China
| | - Guangyao Jiang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedic Research Institute of Zhejiang University, Hangzhou, China
| | - Jianqiao Hong
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedic Research Institute of Zhejiang University, Hangzhou, China
| | - Sihao Li
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedic Research Institute of Zhejiang University, Hangzhou, China
| | - Haobo Wu
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedic Research Institute of Zhejiang University, Hangzhou, China
| | - Shigui Yan
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedic Research Institute of Zhejiang University, Hangzhou, China
| | - Weiqi Yan
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Orthopedic Research Institute of Zhejiang University, Hangzhou, China
| |
Collapse
|
12
|
Liao JC, Wei ZX, Zhao C, Ma ZP, Cai DZ. Inhibition of osteoclastogenesis for periprosthetic osteolysis therapy through the suppression of p38 signaling by fraxetin. Int J Mol Med 2018; 42:1257-1264. [PMID: 29786751 PMCID: PMC6089765 DOI: 10.3892/ijmm.2018.3698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 05/14/2018] [Indexed: 01/13/2023] Open
Abstract
Periprosthetic osteolysis belongs to osteolytic diseases, which often occur due to an imbalance between osteoclast and osteoblast number or activity. Fraxetin, a natural plant extract, inhibits osteoblast apoptosis and has therapeutic potential for treating osteolytic diseases. However, data pertaining to the effects of fraxetin on osteoclasts are limited. In the present study, it was demonstrated that the inhibition of osteoclastogenesis by fraxetin had an important role on the therapy of titanium particle-induced osteolysis in vivo. In addition, fraxetin was demonstrated to suppress receptor activator of nuclear factor-κB ligand (RANKL)-mediated osteoclast differentiation and bone resorption in vitro in a dose-dependent manner. Fraxetin inhibited osteoclast differentiation and function through the suppression of p38 signaling and subsequently, the suppression of osteoclast-specific gene expression, including tartrate-resistant acid phosphatase, nuclear factor of activated T-cells, cytoplasmic 1, and cathepsin K. In conclusion, fraxetin administration may have potential as a treatment method for periprosthetic osteolysis and other osteolytic diseases.
Collapse
Affiliation(s)
- Jia-Cheng Liao
- Department of Orthopedics, Southern Medical University Affiliated People's Hospital of Longhua District Shenzhen, Shenzhen, Guangdong 518109, P.R. China
| | - Zhao-Xia Wei
- Department of Neurology, Liwan Hospital of The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510000, P.R. China
| | - Chang Zhao
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong 510630, P.R. China
| | - Zhong-Ping Ma
- Department of Orthopedics, The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia 510030, P.R. China
| | - Dao-Zhang Cai
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong 510630, P.R. China
| |
Collapse
|
13
|
Li J, Li Y, Peng X, Li B, Yuan X, chen Y. Emodin attenuates titanium particle-induced osteolysis and RANKL-mediated osteoclastogenesis through the suppression of IKK phosphorylation. Mol Immunol 2018; 96:8-18. [DOI: 10.1016/j.molimm.2018.02.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 02/07/2018] [Indexed: 12/15/2022]
|
14
|
Zhou CH, Shi ZL, Meng JH, Hu B, Zhao CC, Yang YT, Yu W, Chen ZX, Heng BC, Parkman VJA, Jiang S, Zhu HX, Wu HB, Shen WL, Yan SG. Sophocarpine attenuates wear particle-induced implant loosening by inhibiting osteoclastogenesis and bone resorption via suppression of the NF-κB signalling pathway in a rat model. Br J Pharmacol 2018; 175:859-876. [PMID: 29130485 DOI: 10.1111/bph.14092] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 10/31/2017] [Accepted: 11/06/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND AND PURPOSE Aseptic prosthesis loosening, caused by wear particles, is one of the most common causes of arthroplasty failure. Extensive and over-activated osteoclast formation and physiological functioning are regarded as the mechanism of prosthesis loosening. Therapeutic modalities based on inhibiting osteoclast formation and bone resorption have been confirmed to be an effective way of preventing aseptic prosthesis loosening. In this study, we have investigated the effects of sophocarpine (SPC, derived from Sophora flavescens) on preventing implant loosening and further explored the underlying mechanisms. EXPERIMENTAL APPROACH The effects of SPC in inhibiting osteoclastogenesis and bone resorption were evaluated in osteoclast formation, induced in vitro by the receptor activator of NF-κB ligand (RANKL). A rat femoral particle-induced peri-implant osteolysis model was established. Subsequently, micro-CT, histology, mechanical testing and bone turnover were used to assess the effects of SPC in preventing implant loosening. KEY RESULTS In vitro, we found that SPC suppressed osteoclast formation, bone resorption, F-actin ring formation and osteoclast-associated gene expression by inhibiting NF-κB signalling, specifically by targeting IκB kinases. Our in vivo study showed that SPC prevented particle-induced prosthesis loosening by inhibiting osteoclast formation, resulting in reduced periprosthetic bone loss, diminished pseudomembrane formation, improved bone-implant contact, reduced bone resorption-related turnover and enhanced stability of implants. Inhibition of NF-κB signalling by SPC was confirmed in vivo. CONCLUSION AND IMPLICATIONS SPC can prevent implant loosening through inhibiting osteoclast formation and bone resorption. Thus, SPC might be a novel therapeutic agent to prevent prosthesis loosening and for osteolytic diseases.
Collapse
Affiliation(s)
- Chen-He Zhou
- Department of Orthopedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Orthopedic Research Institute of Zhejiang University, Hangzhou, China.,Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
| | - Zhong-Li Shi
- Department of Orthopedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Orthopedic Research Institute of Zhejiang University, Hangzhou, China
| | - Jia-Hong Meng
- Department of Orthopedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Orthopedic Research Institute of Zhejiang University, Hangzhou, China
| | - Bin Hu
- Department of Orthopedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Orthopedic Research Institute of Zhejiang University, Hangzhou, China
| | - Chen-Chen Zhao
- Department of Orthopedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Orthopedic Research Institute of Zhejiang University, Hangzhou, China
| | - Yu-Te Yang
- Department of Orthopedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Orthopedic Research Institute of Zhejiang University, Hangzhou, China
| | - Wei Yu
- Department of Orthopedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Orthopedic Research Institute of Zhejiang University, Hangzhou, China
| | - Ze-Xin Chen
- Center of Clinical Epidemiology & Biostatistics, Department of Science and Education, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Boon Chin Heng
- Faculty of Dentistry, The University of Hong Kong, Pokfulam, Hong Kong
| | | | - Shuai Jiang
- Department of Hand Surgery, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Han-Xiao Zhu
- Department of Orthopedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Orthopedic Research Institute of Zhejiang University, Hangzhou, China
| | - Hao-Bo Wu
- Department of Orthopedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Orthopedic Research Institute of Zhejiang University, Hangzhou, China
| | - Wei-Liang Shen
- Department of Orthopedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Orthopedic Research Institute of Zhejiang University, Hangzhou, China
| | - Shi-Gui Yan
- Department of Orthopedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Orthopedic Research Institute of Zhejiang University, Hangzhou, China
| |
Collapse
|
15
|
Pan C, Chen L, Wu R, Shan H, Zhou Z, Lin Y, Yu X, Yan L, Wu C. Lithium-containing biomaterials inhibit osteoclastogenesis of macrophagesin vitroand osteolysisin vivo. J Mater Chem B 2018; 6:8115-8126. [PMID: 32254931 DOI: 10.1039/c8tb02678e] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Li-containing bioceramics were promising biomaterials for inhibiting osteoclastogenesis of macrophages and osteolysisin vivo, potentially using for treating osteoporosis.
Collapse
Affiliation(s)
- Chenhao Pan
- Department of Orthopaedic
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital
- Shanghai
- China
- Institute of Microsurgery on Extremities
| | - Lei Chen
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure
- Shanghai Institute of Ceramics
- Chinese Academy of Sciences
- Shanghai
- China
| | - Ruoyu Wu
- Institute of Microsurgery on Extremities
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital
- Shanghai
- China
| | - Haojie Shan
- Department of Orthopaedic
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital
- Shanghai
- China
| | - Zubin Zhou
- Department of Orthopaedic
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital
- Shanghai
- China
- Institute of Microsurgery on Extremities
| | - Yiwei Lin
- Department of Orthopaedic
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital
- Shanghai
- China
| | - Xiaowei Yu
- Department of Orthopaedic
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital
- Shanghai
- China
- Institute of Microsurgery on Extremities
| | - Liang Yan
- Department of Ophthalmology
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital
- Shanghai
- China
| | - Chengtie Wu
- State Key Laboratory of High Performance Ceramics and Superfine Microstructure
- Shanghai Institute of Ceramics
- Chinese Academy of Sciences
- Shanghai
- China
| |
Collapse
|
16
|
Cyndari KI, Goodheart JR, Miller MA, Oest ME, Damron TA, Mann KA. Peri-Implant Distribution of Polyethylene Debris in Postmortem-Retrieved Knee Arthroplasties: Can Polyethylene Debris Explain Loss of Cement-Bone Interlock in Successful Total Knee Arthroplasties? J Arthroplasty 2017; 32:2289-2300. [PMID: 28285038 PMCID: PMC5469692 DOI: 10.1016/j.arth.2017.01.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 01/06/2017] [Accepted: 01/25/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Loss of mechanical interlock between cement and bone with in vivo service has been recently quantified for functioning, nonrevised, cemented total knee arthroplasties (TKAs). The cause of interlocking trabecular resorption is not known. The goal of this study is to quantify the distribution of PE debris at the cement-bone interface and determine if polyethylene (PE) debris is locally associated with loss of interlock. METHODS Fresh, nonrevised, postmortem-retrieved TKAs (n = 8) were obtained en bloc. Laboratory-prepared constructs (n = 2) served as negative controls. The intact cement-bone interface of each proximal tibia was embedded in Spurr's resin, sectioned, and imaged under polarized light to identify birefringent PE particles. PE wear particle number density was quantified at the cement-bone interface and distal to the interface, and then compared with local loss of cement-bone interlock. RESULTS The average PE particle number density for postmortem-retrieved TKAs ranged from 8.6 (1.3) to 24.9 (3.1) particles/mm2 (standard error) but was weakly correlated with years in service. The average particle number density was twice as high as distal (>5mm) to the interface compared to at the interface. The local loss of interlock at the interface was not related to the presence, absence, or particle density of PE. CONCLUSION PE debris can migrate extensively along the cement-bone interface of well-fixed tibial components. However, the amount of local bone loss at the cement-bone interface was not correlated with the amount of PE debris at the interface, suggesting that the observed loss of trabecular interlock in these well-fixed TKAs may be due to alternative factors.
Collapse
Affiliation(s)
- Karen I Cyndari
- Department of Orthopaedic Surgery, State University of New York Upstate Medical University, Syracuse, New York
| | - Jacklyn R Goodheart
- Department of Orthopaedic Surgery, State University of New York Upstate Medical University, Syracuse, New York
| | - Mark A Miller
- Department of Orthopaedic Surgery, State University of New York Upstate Medical University, Syracuse, New York
| | - Megan E Oest
- Department of Orthopaedic Surgery, State University of New York Upstate Medical University, Syracuse, New York
| | - Timothy A Damron
- Department of Orthopaedic Surgery, State University of New York Upstate Medical University, Syracuse, New York
| | - Kenneth A Mann
- Department of Orthopaedic Surgery, State University of New York Upstate Medical University, Syracuse, New York
| |
Collapse
|
17
|
Krenn S, Thomsen M, Usbeck S, Scheuber LF, Boettner F, Krukemeyer MG, Huber M, Kretzer JP, Gehrke T, Krenn V. Supramacroparticulate PE in 6 different joint endoprostheses localisations: An indicator for PE damage? Pathol Res Pract 2017; 213:987-996. [PMID: 28602486 DOI: 10.1016/j.prp.2017.03.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 03/27/2017] [Accepted: 03/29/2017] [Indexed: 10/19/2022]
Abstract
In the histopathological particle algorithm polyethylene (PE) particles with maximum lengths of more than 100μm - called PE supramacroparticles - are identified exclusively for knee joint and hip prostheses. However, a definitive characterisation, detection in all joint localisations and a causal clarification of the pathogenesis are lacking. In this study a total of 175 SLIM (synovial-like interface membrane) cases with PE supramacroparticles of knee joint prostheses (n=89), hip joint prostheses (n=44), ankle joint prostheses (n=36) and prostheses in three localisations of the upper extremities (n=6) were systematically investigated. The arithmetic mean of the particle length varied greatly within the prosthesis types. This had a significant positive correlation with the prosthesis lifetime and negative correlation with the date of implantation. It can be concluded that both the lifetime and the time of implantation have an influence on the particle length. The prostheses with supramacroparticulate damage moreover showed a clearly reduced survival rate compared with other data published on the prosthesis lifetime. The material wear therefore could not be attributed solely to the usual fatigue factors. Since loosening of the prostheses, decentring of the PE components or damage to the PE inlay existed in all cases, mechanical dysloading seems to be the most probable cause of PE supramacroparticle genesis. Due to the striking length and for demarcation from PE macroparticles, the term supramacroparticulate PE is proposed for a length of more than 100μm. In the extended histopathological particle algorithm supramacroparticulate PE has been included in the macroparticles category and should be taken into account and interpreted causally in histopathological diagnostics of joint prosthesis failure.
Collapse
Affiliation(s)
- Simon Krenn
- MVZ-Zentrum für Histologie, Zytologie und Molekulare Diagnostik, Trier, Germany; Danube Private University, Krems-Stein, Austria.
| | | | | | | | | | | | - Monika Huber
- Pathologisch-bakteriologisches Institut, Otto Wagner Spital, Wien, Austria
| | - Jan Philippe Kretzer
- Labor für Biomechanik und Implantat-Forschung, Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Heidelberg, Germany
| | | | - Veit Krenn
- MVZ-Zentrum für Histologie, Zytologie und Molekulare Diagnostik, Trier, Germany
| |
Collapse
|
18
|
|
19
|
Supramakropartikuläres Polyethylen bei Entzündungen periprothetischer Membranen. DER ORTHOPADE 2016; 45:256-64. [DOI: 10.1007/s00132-015-3194-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
20
|
[Histopathological particle algorithm. Particle identification in the synovia and the SLIM]. Z Rheumatol 2015; 73:639-49. [PMID: 24821089 DOI: 10.1007/s00393-013-1315-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND In the histopathological diagnostics of synovitis and the synovium-like interface membrane (SLIM) the identification of crystals and crystal-like deposits and the associated inflammatory reactions play an important role. The multitude of endogenous crystals, the range of implant materials and material combinations, and the variability in the formation process of different particles explain the high morphological particle heterogeneity which complicates the diagnostic identification of diagnostic particles. STUDY DESIGN AND METHODS A simple histopathological particle algorithm has been designed which allows methodological particle identification based on (1) conventional transmitted light microscopy with a guide to particle size, shape and color, (2) optical polarization criteria and (3) enzyme histochemical properties (oil red staining and Prussian blue reaction). These methods, the importance for particle identification and the differential diagnostics from non-prosthetic materials are summarized in the so-called histopathological particle algorithm. RESULTS A total of 35 cases of synovitis and SLIM were analyzed and validated according to these criteria. Based on these criteria and a dichotomous differentiation the complete spectrum of particles in the SLIM and synovia can be defined histopathologically. CONCLUSION For histopathological diagnosis a particle score for synovitis and SLIM is recommended to evaluate (1) the predominant type of prothetic wear debris with differentiation between microparticles, and macroparticles, (2) the presence of non-prosthesis material particles and (3) the quantification of particle-association necrosis and lymphocytosis. An open, continuously updated web-based particle algorithm would be helpful to address the issue of particle heterogeneity and include all new particle materials generated in a rapidly changing field.
Collapse
|
21
|
Analysis of UHMWPE wear particles produced in the simulation of hip and knee wear mechanisms with the RandomPOD system. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.biotri.2015.03.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
22
|
Wu C, Wang W, Tian B, Liu X, Qu X, Zhai Z, Li H, Liu F, Fan Q, Tang T, Qin A, Zhu Z. Myricetin prevents titanium particle-induced osteolysis in vivo and inhibits RANKL-induced osteoclastogenesis in vitro. Biochem Pharmacol 2015; 93:59-71. [DOI: 10.1016/j.bcp.2014.10.019] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Revised: 10/21/2014] [Accepted: 10/29/2014] [Indexed: 12/29/2022]
|
23
|
Ultrastructural analysis of nanoparticles and ions released in periprosthetic membranes. J Appl Biomater Funct Mater 2014; 12:210-7. [PMID: 24744234 DOI: 10.5301/jabfm.5000183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2013] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The distribution and relationship of hydroxyapatite debris, nanometric organic and metal wear particles and metal ions on periimplant interface membranes following aseptic and septic arthroplastic loosening were investigated. METHODS Scanning electron microscopy and X-ray spectroscopic analysis were used to analyze debris and ion distribution. RESULTS Hydroxyapatite debris appeared with different morphology in a particular distribution among several membranes. These differences may reflect the occurrence of different friction forces taking place between prosthesis and bone interface in the several types of prostheses studied. Metal wear particles were detected in greater numbers in membranes from noncemented prostheses compared with those from cemented ones. In contrast, more organic particles were present in membrane from cemented prosthesis. No differences were observed between aseptic and septic membranes. CONCLUSION Our findings support the need to evaluate the occurrence of friction forces that periprosthetic bone debris production may induce to exacerbate cellular reactivity. Furthermore, cellular engulfment of debris and the high level of different ions released indicate the occurrence of a toxic environment that may induce failure of any reparative pathways.
Collapse
|
24
|
Revised histopathological consensus classification of joint implant related pathology. Pathol Res Pract 2014; 210:779-86. [DOI: 10.1016/j.prp.2014.09.017] [Citation(s) in RCA: 206] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 09/18/2014] [Indexed: 11/17/2022]
|
25
|
The inhibition of RANKL-induced osteoclastogenesis through the suppression of p38 signaling pathway by naringenin and attenuation of titanium-particle-induced osteolysis. Int J Mol Sci 2014; 15:21913-34. [PMID: 25464380 PMCID: PMC4284685 DOI: 10.3390/ijms151221913] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 10/30/2014] [Accepted: 11/24/2014] [Indexed: 12/25/2022] Open
Abstract
The aim of this study was to assess the effect of naringenin on osteoclastogenesis and titanium particle-induced osteolysis. Osteolysis from wear-induced particles and aseptic loosening are the most frequent late complications of total joint arthroplasty leading to revision of the prosthesis. Osteolysis during aseptic loosening is most likely due to increased bone resorption by osteoclasts. Through in vitro studies, we demonstrated that naringenin, a naturally occurring flavanone in grapefruit and tomatoes, exerts potent inhibitory effects on the ligand of the receptor activator of nuclear factor-κB (RANKL)-induced osteoclastogenesis and revealed that the mechanism of action of naringenin, which inhibited osteoclastogenesis by suppression of the p38 signaling pathway. Through in vivo studies, we proved that naringenin attenuated titanium particle-induced osteolysis in a mouse calvarial model. In general, we demonstrated that naringenin inhibited osteoclastogenesis via suppression of p38 signaling in vitro and attenuated titanium particle-induced osteolysis in vivo. This study also suggested that naringenin has significant potential for the treatment of osteolysis-related diseases caused by excessive osteoclast formation and activity.
Collapse
|
26
|
Krenn V, Morawietz L, Kienapfel H, Ascherl R, Matziolis G, Hassenpflug J, Thomsen M, Thomas P, Huber M, Schuh C, Kendoff D, Baumhoer D, Krukemeyer MG, Perino G, Zustin J, Berger I, Rüther W, Poremba C, Gehrke T. [Revised consensus classification. Histopathological classification of diseases associated with joint endoprostheses]. Z Rheumatol 2014; 72:383-92. [PMID: 23446461 DOI: 10.1007/s00393-012-1099-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The revised classification of the periprosthetic membrane (synovial-like interface membrane SLIM) encompasses all pathological alterations which can occur as a result of endoprosthetic replacement of major joints and lead to a reduction in durability of prostheses. This also includes the established consensus classification of SLIM by which aseptic and septic prosthetic loosening can be subdivided into four histological types and histopathological criteria for additional pathologies: endoprosthesis-associated arthrofibrosis, immunological/allergic alterations and osseous pathologies. This revision represents the foundation for the histopathological diagnostics of the total spectrum of diseases associated with joint prostheses, is a suitable basis for a standardized diagnostic procedure and etiological clarification of endoprosthesis failure and also as a data standard for endprosthesis registers, in particular for registers based on routine data (e.g. German endoprosthesis register).
Collapse
Affiliation(s)
- V Krenn
- MVZ-Zentrum für Histologie, Zytologie und Molekulare Diagnostik, Max-Planck-Str. 5, 54296 Trier.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Krenn V, Kretzer JP, Thomas P, Thomsen M, Usbeck S, Scheuber L, Boettner F, Rüther W, Schulz S, Zustin J, Huber M. Update on endoprosthesis pathology: Particle algorithm for particle identification in the SLIM. ACTA ACUST UNITED AC 2013. [DOI: 10.1053/j.sart.2014.01.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
28
|
Antonios JK, Yao Z, Li C, Rao AJ, Goodman SB. Macrophage polarization in response to wear particles in vitro. Cell Mol Immunol 2013; 10:471-82. [PMID: 24013843 PMCID: PMC3818297 DOI: 10.1038/cmi.2013.39] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Revised: 06/22/2013] [Accepted: 07/15/2013] [Indexed: 01/23/2023] Open
Abstract
Total joint replacement is a highly successful surgical procedure for treatment of patients with disabling arthritis and joint dysfunction. However, over time, with high levels of activity and usage of the joint, implant wear particles are generated from the articulating surfaces. These wear particles can lead to activation of an inflammatory reaction, and subsequent bone resorption around the implant (periprosthetic osteolysis). Cells of the monocyte/macrophage lineage orchestrate this chronic inflammatory response, which is dominated by a pro-inflammatory (M1) macrophage phenotype rather than an anti-inflammatory pro-tissue healing (M2) macrophage phenotype. While it has been shown that interleukin-4 (IL-4) selectively polarizes macrophages towards an M2 anti-inflammatory phenotype which promotes bone healing, rather than inflammation, little is known about the time course in which this occurs or conditions in which repolarization through IL-4 is most effective. The goal of this work was to study the time course of murine macrophage polarization and cytokine release in response to challenge with combinations of polymethyl methacrylate (PMMA) particles, lipopolysaccharide (LPS) and IL-4 in vitro. Treatment of particle-challenged monocyte/macrophages with IL-4 led to an initial suppression of pro-inflammatory cytokines and inducible nitric oxide synthase (iNOS) production and subsequent polarization into an M2 anti-inflammatory phenotype. This result was optimized when IL-4 was delivered before PMMA particle challenge, to an M1 phenotype rather than to uncommitted (M0) macrophages. The effects of this polarization were sustained over a 5-day time course. Polarization of M1 macrophages into an M2 phenotype may be a strategy to mitigate wear particle associated periprosthetic osteolysis.
Collapse
|
29
|
Total knee prosthesis polyethylene wear reduction by a new
metal part finishing method. J Appl Biomater Funct Mater 2013; 11:e99-e105. [PMID: 23728542 DOI: 10.5301/jabfm.5000153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2012] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The purpose of this study was to assess a new metal component finishing designed to improve total knee prosthesis durability. Wear of ultrahigh molecular-weight polyethylene (UHMWPE), with generation of submicrometer- and micrometer-sized particles, has been associated with osteolysis and artificial joint failure. Wear extent is influenced by several factors, some of which are related to manufacturing. METHODS UHMWPE wear was assessed in metal prosthesis components finished with the Microloy® technology and in traditionally finished components by wear simulation experiments (pin on disk and knee simulator tests) and analysis of wear debris. RESULTS Microloy®-finished prosthesis showed a 48.5% reduction in UHMWPE total weight loss compared with traditional components (P=0.002). A statistically significant (P<0.05) reduction of UHMWPE debris were detected from the Microloy®-finished compared with the traditionally finished components. CONCLUSIONS These findings suggest the Microloy® metal finishing may enhance the long-term performance of knee prostheses.
Collapse
|
30
|
Histopathologische Differenzialdiagnostik bei gelenkimplantatallergischen Fragestellungen. DER ORTHOPADE 2013; 42:614-21. [DOI: 10.1007/s00132-012-2034-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
31
|
Extracellular matrix degradation and tissue remodeling in periprosthetic loosening and osteolysis: focus on matrix metalloproteinases, their endogenous tissue inhibitors, and the proteasome. BIOMED RESEARCH INTERNATIONAL 2013; 2013:230805. [PMID: 23862137 PMCID: PMC3703793 DOI: 10.1155/2013/230805] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 05/31/2013] [Indexed: 12/18/2022]
Abstract
The leading complication of total joint replacement is periprosthetic osteolysis, which often results in aseptic loosening of the implant, leading to revision surgery. Extracellular matrix degradation and connective tissue remodeling around implants have been considered as major biological events in the periprosthetic loosening. Critical mediators of wear particle-induced inflammatory osteolysis released by periprosthetic synovial cells (mainly macrophages) are inflammatory cytokines, chemokines, and proteolytic enzymes, mainly matrix metalloproteinases (MMPs). Numerous studies reveal a strong interdependence of MMP expression and activity with the molecular mechanisms that control the composition and turnover of periprosthetic matrices. MMPs can either actively modulate or be modulated by the molecular mechanisms that determine the debris-induced remodeling of the periprosthetic microenvironment. In the present study, the molecular mechanisms that control the composition, turnover, and activity of matrix macromolecules within the periprosthetic microenvironment exposed to wear debris are summarized and presented. Special emphasis is given to MMPs and their endogenous tissue inhibitors (TIMPs), as well as to the proteasome pathway, which appears to be an elegant molecular regulator of specific matrix macromolecules (including specific MMPs and TIMPs). Furthermore, strong rationale for potential clinical applications of the described molecular mechanisms to the treatment of periprosthetic loosening and osteolysis is provided.
Collapse
|
32
|
Burton L, Paget D, Binder NB, Bohnert K, Nestor BJ, Sculco TP, Santambrogio L, Ross FP, Goldring SR, Purdue PE. Orthopedic wear debris mediated inflammatory osteolysis is mediated in part by NALP3 inflammasome activation. J Orthop Res 2013; 31:73-80. [PMID: 22933241 DOI: 10.1002/jor.22190] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 06/25/2012] [Indexed: 02/04/2023]
Abstract
Activation of myeloid cells by orthopedic particulate debris is a key event in the pathogenesis of periprosthetic osteolysis and implant loosening after total joint replacement (TJR). Several lines of evidence implicate NACHT, LRR, and PYD domains-containing protein 3 (NALP3) inflammasome-mediated production of interleukin 1 beta (IL-1β) in the pathogenesis of clinical disorders ascribable to foreign particulate materials, including asbestos, silica, and urate crystals. Recent reports indicate that orthopedic polymer products and metallic particulates and ions may activate the same pathway. Here, we investigated the contribution of the NALP3 inflammasome to the pathogenesis of peri-implant osteolysis. Pharmaceutical and genetic perturbations of caspase-1 and inflammasome components were used to assess the role of the NALP3 inflammasome in IL-1β production and osteoclast formation by human monocytes and mouse macrophages in response to polymethylmethacrylate (PMMA) particle phagocytosis. The role of caspase-1 in a mouse calvarial model of particle-mediated osteolysis was assessed using µCT. Phagocytosis of PMMA particles induces caspase-1 dependent release of IL-1β from human monocytes and mouse macrophages. Importantly, using macrophages from mice deficient in components of the NALP3 inflammasome, we show PMMA-induced IL-1β production is strictly dependent on these components. Mice lacking caspase-1, the sole effector of the NALP3 inflammasome, show reduced orthopedic wear particle-induced calvarial osteolysis compared to wild-type controls. Absence of NALP3 inflammasome components fails to alter osteoclast formation in vitro. Our findings identify the NALP3 inflammasome as a critical mediator of orthopedic wear-induced osteolysis and as a viable therapeutic target for the treatment of periprosthetic osteolysis.
Collapse
Affiliation(s)
- Lyndsey Burton
- Hospital for Special Surgery, 535 East 70th Street, New York, New York 10021, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Dodgen E, Stratton E, Bowden A, Howell L. Spinal Implant Development, Modeling, and Testing to Achieve Customizable and Nonlinear Stiffness. J Med Device 2012. [DOI: 10.1115/1.4006543] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The spine naturally has a nonlinear force-deflection characteristic which facilitates passive stability, and thus there is a need for spinal implants that duplicate this behavior to provide stabilization when the spine loses stiffness through injury, degeneration, or surgery. Additionally, due to the complexity and variability in the mechanics of spinal dysfunction, implants could potentially benefit from incorporating a customizable stiffness into their design. This paper presents a spinal implant with contact-aided inserts that provide a customizable nonlinear stiffness. An analytical model was utilized to optimize the device design, and the model was then verified using a finite element model. Validation was performed on physical prototypes, first in isolation using a tensile tester and then using cadaveric testing on an in-house spine tester. Testing confirmed the performance of the implant and it was observed that the device increased mechanical stability to the spinal segment in flexion-extension and lateral-bending.
Collapse
Affiliation(s)
- Eric Dodgen
- Department of Mechanical Engineering, Brigham Young University, Provo, UT 84602
| | - Eric Stratton
- Department of Mechanical Engineering, Brigham Young University, Provo, UT 84602
| | - Anton Bowden
- Department of Mechanical Engineering, Brigham Young University, Provo, UT 84602
| | - Larry Howell
- Department of Mechanical Engineering, Brigham Young University, Provo, UT 84602
| |
Collapse
|
34
|
Are periprosthetic tissue reactions observed after revision of total disc replacement comparable to the reactions observed after total hip or knee revision surgery? Spine (Phila Pa 1976) 2012; 37:150-9. [PMID: 21336235 PMCID: PMC3145819 DOI: 10.1097/brs.0b013e3182154c22] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Comparative study. OBJECTIVE To compare periprosthetic tissue reactions observed after total disc replacement (TDR), total hip arthroplasty (THA), and total knee arthroplasty (TKA) revision surgery. SUMMARY OF BACKGROUND DATA Prosthetic wear debris leading to particle disease, followed by osteolysis, is often observed after THA and TKA. Although the presence of polyethylene (PE) particles and periprosthetic inflammation after TDR has been proven recently, osteolysis is rarely observed. The clinical relevance of PE wear debris in the spine remains poorly understood. METHODS The number, size, and shape of PE particles, as well as quantity and type of inflammatory cells in periprosthetic tissue retrieved during CHARITÉ TDR (n = 22), THA (n = 10), and TKA (n = 4) revision surgery were compared. Tissue samples were stained with hematoxylin/eosin and examined by using light microscopy with bright field and polarized light. RESULTS After THA, large numbers of PE particles of size less than 6 μm were observed, which were mainly phagocytosed by macrophages. The TKA group had a broad size range with many larger PE particles and more giant cells. In TDR, the size range was similar to that observed in TKA. However, the smallest particles were the most prevalent with 75% of the particles being less than 6 μm, as seen in revision THA. In TDR, both macrophages and giant cells were present with a higher number of macrophages. CONCLUSION Both small and large PE particles are present after TDR revision surgery compatible with both THA and TKA wear patterns. The similarities between periprosthetic tissue reactions in the different groups may give more insight into the clinical relevance of PE particles and inflammatory cells in the lumbar spine. The current findings may help to improve TDR design as applied from technologies previously developed in THA and TKA with the goal of a longer survival of TDR.
Collapse
|
35
|
[Joint endoprosthesis pathology. Histopathological diagnostics and classification]. DER PATHOLOGE 2011; 32:210-9. [PMID: 21526399 DOI: 10.1007/s00292-011-1418-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Prosthesis durability has steadily increased with high 10-year rates of 88-95%. However, four pathogenetic groups of diseases can decrease prosthesis durability: (1) periprosthetic wear particle disease (aseptic loosening) (2) bacterial infection (septic loosening) (3) periprosthetic ossification, and (4) arthrofibrosis. The histopathological "extended consensus classification of periprosthetic membranes" includes four types of membranes, arthrofibrosis, and osseous diseases of endoprosthetics: The four types of neosynovia are: wear particle-induced type (type I), mean prosthesis durability (MPD) in years 12.0; infectious type (type II), MPD 2.5; combined type (type III) MPD 4.2; and indeterminate type (type IV), MPD 5.5. Arthrofibrosis can be determined in three grades: grade 1 needs clinical information to be differentiated from a type IV membrane, and grades 2 & 3 can be diagnosed histopathologically. Periprosthetic ossification, osteopenia-induced fractures, and aseptic osteonecrosis can be histopathologically diagnosed safely with clinical information. The extended consensus classification of periprosthetic membranes may be a diagnostic groundwork for a future national endoprosthesis register.
Collapse
|
36
|
Punt I, Baxter R, Ooij AV, Willems P, Rhijn LV, Kurtz S, Steinbeck M. Submicron sized ultra-high molecular weight polyethylene wear particle analysis from revised SB Charité III total disc replacements. Acta Biomater 2011; 7:3404-11. [PMID: 21621656 DOI: 10.1016/j.actbio.2011.05.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Revised: 05/06/2011] [Accepted: 05/09/2011] [Indexed: 10/18/2022]
Abstract
Submicron sized particles are frequently observed in retrieved total hip and knee periprosthetic tissues and appear to be critical in the activation of the phagocytic inflammatory response. In this paper the concentration, size and shape of ultra-high molecular weight polyethylene (UHMWPE) wear particles between 0.05 and 2.00μm were determined after isolation from periprosthetic tissues from retrieved lumbar SB Charité III total disc replacements (TDR) using scanning electron microscopy (SEM). For comparison, UHMWPE wear particles were isolated from γ-radiation-air sterilized total hip arthroplasty (THA) revision tissues. The mean concentration of UHMWPE particles in TDR tissues was 1.6×10(9)g(-1)tissue (range 1.3-2.0), which was significantly lower than the concentration of 2.3×10(9)g(-1) THA revision tissue (range 1.8-3.2) (P=0.03). The mean particle size (equivalent circular diameter: TDR, 0.46μm; THA 0.53μm, P=0.60) and mean shape were comparable between TDR and THA (aspect ratio: TDR, 1.89; THA, 1.99, P=0.35; roundness: TDR, 0.58; THA, 0.56, P=0.35). However, the TDR particles tended to be smaller and more round. Although no correlations were found between visible damage to the UHMWPE core and the concentration or shape of the UHMWPE particles, a positive correlation was found between increasing particle size and increasing rim penetration of the TDR core (P=0.04). The presence of UHMWPE particles of similar size and shape in TDR tissue, albeit lower in concentration, might explain why, unlike THA, pain rather than osteolysis is the major reason for revision surgery.
Collapse
|
37
|
Langlois J, Hamadouche M. New animal models of wear-particle osteolysis. INTERNATIONAL ORTHOPAEDICS 2010; 35:245-51. [PMID: 21069525 DOI: 10.1007/s00264-010-1143-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Accepted: 10/15/2010] [Indexed: 12/22/2022]
Abstract
Particle debris resulting from in vivo degradation of total joint replacement components are recognised as the major factor limiting the longevity of joint reconstruction and the overall success of the procedure. Better understanding the complex cellular and tissue mechanisms and interactions resulting in wear-particle osteolysis requires a number of experimental approaches, including radiological monitoring and analysis of retrieved tissues from clinical cases, in vitro experiments, and also animal-model investigations. In consideration of both their advantages and drawbacks, this paper provides an historical overview of numerous animal models that have been developed over the last three decades to investigate the pathogenesis of wear-particle osteolysis and to facilitate the preclinical testing of new treatment options. The authors also focus on recent studies in order to provide a better understanding of the current state of the art on this subject and propose some perspectives regarding technical and fundamental questions.
Collapse
Affiliation(s)
- Jean Langlois
- Department of Orthopaedic and Reconstructive Surgery Service A, Centre Hospitalo-Universitaire Cochin-Port Royal, 27 Rue du Faubourg St Jacques, 75014 Paris, France.
| | | |
Collapse
|
38
|
Zhao DS, Ma GF, Selenius M, Salo J, Pikkarainen T, Konttinen YT. Ectopic expression of macrophage scavenger receptor MARCO in synovial membrane-like interface tissue in aseptic loosening of total hip replacement implants. J Biomed Mater Res A 2010; 92:641-9. [PMID: 19235220 DOI: 10.1002/jbm.a.32409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Macrophage receptor with collagenous structure (MARCO) is a scavenger receptor with a very limited expression in healthy tissues. It was hypothesized that foreign body wear debris induces it to participate in handling of implant-derived particles in human synovial membrane-like tissue around aseptically loosening total hip replacement implants. A DNA microarray study showed that MARCO was upregulated in human monocytes by polymethyl methacrylate particles in cell culture. MARCO mRNA and protein were strongly expressed in numerous CD68 positive macrophages and foreign body giant cells in interface membrane lining and stroma around cemented implants, but was only present in a few cells in synovial membrane from osteoarthritis patients. A 65-kDa MARCO-reactive band was only found in interface tissue extracts. This is the first work to show upregulation of MARCO mRNA by foreign bodies in vitro. This is paralleled in vivo as MARCO mRNA and protein were over-expressed in chronic foreign body synovitis. As scavenger receptor MARCO apparently participates in handling of wear particles, which due to their nondegradable, irritating nature initiate/perpetuate foreign body inflammation, and peri-implant osteolysis.
Collapse
Affiliation(s)
- De-Sheng Zhao
- Institute of Biomedicine/Medicine, University of Helsinki, P.O. Box 63, Haartmaninkatu 8, Biomedicum Helsinki, 00014 Helsinki, Finland
| | | | | | | | | | | |
Collapse
|
39
|
[Histopathologic diagnostics in endoprosthetics: periprosthetic neosynovialitis, hypersensitivity reaction, and arthrofibrosis]. DER ORTHOPADE 2009; 38:520-30. [PMID: 19448983 DOI: 10.1007/s00132-008-1400-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The durability of endoprosthetic implants of the large joints has increased over the last decades. North American studies have shown a 10-year durability of 94% for prosthetic hip implants, and European studies have shown 10-year durabilities of 88-95%. Pathologists differentiate three etiological disease patterns for the"pathology of endoprosthetics" that lead to reduction of implant durability: 1) periprosthetic particle disease (aseptic loosening), 2) infection, and 3) arthrofibrosis. Four types of neosynovitis/periprosthetic membrane have been determined in a consensus classification: particle-induced type (type I), with a mean prosthesis durability (MPD) of 12 years; infectious type (type II), MPD 2.5 years; combined type (type III), MPD 4.2 years; and indeterminate type (type IV), MPD 5.5 years. There are three histopathologic degrees of arthrofibrosis; grade 1 always needs clinical information for diagnosis, whereas grades 2 and 3 are distinct histopathologic entities.
Collapse
|
40
|
Baumann B, Rader CP, Seufert J, Nöth U, Rolf O, Eulert J, Jakob F. Effects of polyethylene and TiAIV wear particles on expression of RANK, RANKL and OPG mRNA. ACTA ACUST UNITED AC 2009; 75:295-302. [PMID: 15260421 DOI: 10.1080/00016470410001222] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Wear debris has been associated with periprosthetic osteolysis and loosening of total joint arthroplasties. RANKL (receptor activator of NF-kappaB ligand), RANK (receptor activator of NF-kappaB) and OPG (osteoprotegerin) are three key molecules which regulate differentiation, survival, fusion, and activation of osteoclasts. MATERIAL AND METHODS We evaluated the effect of TiAIV and polyethylene particles on expression of RANK, RANKL and OPG mRNA. We used a human monocytic leukemic cell line (THP-1) in this in vitro study. THP-1 monocytes were differentiated into macrophage-like cells and exposed to polyethylene particles and prosthesis-derived TiAIV particles. The supernantant was used for measurement of TNFalpha protein and total RNA was extracted from the cells. Expression of the genes coding for OPG, RANKL and RANK was analysed at the mRNA level using a semiquantitative RT-PCR method. RESULTS Both polyethylene and TiAIV particles induced a significant release of TNFalpha after 6 h of exposure and a significant upregulation of RANK mRNA. OPG mRNA expression was transiently upregulated after exposure to polyethylene and TiAIV particles. These effects were dependent on particle dose. RANKL mRNA was not detectable in our THP-1 model. In contrast, LPS exhibited a different pattern of RANK/ RANKL/OPG mRNA expression. INTERPRETATION Our findings provide evidence that both polyethylene and TiAIV particles induce upregulation of RANK expression in cells of the monocytic lineage, which may be important for periprosthetic osteoclastogenesis.
Collapse
Affiliation(s)
- Bernd Baumann
- Department of Orthopedic Surgery, König-Ludwig-Haus, Julius Maximilians University, Würzburg, Germany.
| | | | | | | | | | | | | |
Collapse
|
41
|
Han CD, Han CW, Yang IH. Femoral component fracture due to osteolysis after cemented mobile-bearing total knee arthroplasty. J Arthroplasty 2009; 24:323.e7-12. [PMID: 18534539 DOI: 10.1016/j.arth.2008.03.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2007] [Accepted: 03/13/2008] [Indexed: 02/01/2023] Open
Abstract
A 58-year-old man with osteoarthritis in the left knee underwent a total knee arthroplasty with a New Jersey anterior-posterior gliding low contact stress mobile-bearing implant. All femoral, tibial, and patellar components were implanted with bone cement. Pain developed at 43 months postsurgery, and plain radiography revealed a vertical crack in the femoral component and osteolysis at the medial femoral condyle. The femoral and tibial components were revised, and the bone defect at the medial femoral condyle was reconstructed using an allogeneic strut bone graft. Microscope examination identified polyethylene particles with foreign body granulomatous reaction, and scanning electron microscopy revealed fatigue failure of the femoral component. Osteolysis due to polyethylene particles can lead to fracture of the femoral component after cemented anterior-posterior gliding low contact stress mobile-bearing total knee arthroplasty.
Collapse
Affiliation(s)
- Chang Dong Han
- Department of Orthopedic Surgery, College of Medicine, Yonsei University, Seoul, South Korea
| | | | | |
Collapse
|
42
|
Lombardi AV, Ellison BS, Berend KR. Polyethylene wear is influenced by manufacturing technique in modular TKA. Clin Orthop Relat Res 2008; 466:2798-805. [PMID: 18791779 PMCID: PMC2565045 DOI: 10.1007/s11999-008-0470-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2007] [Accepted: 08/07/2008] [Indexed: 01/31/2023]
Abstract
Polyethylene insert backside surface wear is implicated in osteolysis and failure of total knee arthroplasty. Manufacturing and sterilization methods reduce articular-sided wear. We questioned whether manufacturing technique influences the severity of backside wear. We examined 39 explanted tibial bearings in a blinded fashion using visual, stereomicroscopic, and scanning electron microscopic techniques. We examined 26 direct compression molded components and 13 nondirect compression molded components and applied a new backside wear severity score. The score characterized the magnitude of the various modes of wear with severity ranging from 0 (no wear) to 27 (severe wear). Time in vivo, tibial baseplate material, and manufacturing technique were used as variables for comparison. Backside wear was related to polyethylene manufacturing process with direct compression molded implants having a wear score of 2.3 and nondirect compression molded a score of 5.7. Time in vivo influenced backside wear, although direct compression molded predicted decreased backside wear independent of time in vivo. The data suggest manufacturing technique influences backside wear in total knee arthroplasty polyethylene inserts.
Collapse
|
43
|
Nohynek GJ, Lademann J, Ribaud C, Roberts MS. Grey Gooon the Skin? Nanotechnology, Cosmetic and Sunscreen Safety. Crit Rev Toxicol 2008; 37:251-77. [PMID: 17453934 DOI: 10.1080/10408440601177780] [Citation(s) in RCA: 369] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Many modern cosmetic or sunscreen products contain nano-sized components. Nanoemulsions are transparent and have unique tactile and texture properties; nanocapsule, nanosome, noisome, or liposome formulations contain small vesicles (range: 50 to 5000 nm) consisting of traditional cosmetic materials that protect light-or oxygen-sensitive cosmetic ingredients. Transdermal delivery and cosmetic research suggests that vesicle materials may penetrate the stratum corneum (SC) of the human skin, but not into living skin. Depending on the physical/chemical properties of the ingredient and the formulation, nano-sized formulations may enhance or reduce skin penetration, albeit at a limited rate. Modern sunscreens contain insoluble titanium dioxide (TiO(2)) or zinc oxide (ZnO) nanoparticles (NP), which are colorless and reflect/scatter ultraviolet (UV) more efficiently than larger particles. Most available theoretical and experimental evidence suggests that insoluble NP do not penetrate into or through normal as well as compromised human skin. Oral and topical toxicity data suggest that TiO(2) and ZnO NP have low systemic toxicity and are well tolerated on the skin. In vitro cytotoxicity, genotoxicity, and photogenotoxicity studies on TiO(2) or other insoluble NP reporting uptake by cells, oxidative cell damage, or genotoxicity should be interpreted with caution, since such toxicities may be secondary to phagocytosis of mammalian cells exposed to high concentrations of insoluble particles. Caution needs to be exercised concerning topical exposure to other NP that either have characteristics enabling some skin penetration and/or have inherently toxic constituents. Studies on wear debris particles from surgical implants and other toxicity studies on insoluble particles support the traditional toxicology view that the hazard of small particles is mainly defined by the intrinsic toxicity of particles, as distinct from their particle size. There is little evidence supporting the principle that smaller particles have greater effects on the skin or other tissues or produce novel toxicities relative to micro-sized materials. Overall, the current weight of evidence suggests that nano-materials such as nano-sized vesicles or TiO(2) and ZnO nanoparticles currently used in cosmetic preparations or sunscreens pose no risk to human skin or human health, although other NP may have properties that warrant safety evaluation on a case-by-case basis before human use.
Collapse
Affiliation(s)
- Gerhard J Nohynek
- L'Oréal Research and Development, Worldwide Safety Department, Asnières, France.
| | | | | | | |
Collapse
|
44
|
Ito M, Tokunaga K, Endo N, Takano Y, Yuasa N. The effect of cup placement in cementless total hip arthroplasty on the wear rate of polyethylene. Orthopedics 2008; 31:225. [PMID: 19292250 DOI: 10.3928/01477447-20080301-19] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
There are many reports on cup placement, inclination, anteversion, and position. This article strictly defines the area of cup placement based on data from 185 healthy hip centers and Ranawat's triangle. Linear wear rate (LWR) was measured in 55 total hip arthroplasty (THA) cases and categorized as low or high. The relationships between these categories and cup size, inclination, anteversion, position, age, follow-up period, bone graft, cup osteolysis, and stem osteolysis were investigated.
Collapse
Affiliation(s)
- Masayuki Ito
- Department of Reconstructive and Transplant Medicine, Division of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | | | | | | | | |
Collapse
|
45
|
Nohynek G, Dufour E, Roberts M. Nanotechnology, Cosmetics and the Skin: Is There a Health Risk? Skin Pharmacol Physiol 2008; 21:136-49. [DOI: 10.1159/000131078] [Citation(s) in RCA: 215] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
46
|
How have wear testing and joint simulator studies helped to discriminate among materials and designs? J Am Acad Orthop Surg 2008; 16 Suppl 1:S111-9. [PMID: 18612005 DOI: 10.5435/00124635-200800001-00022] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Historically, hip joint simulators most often have been used to model wear of a bearing surface against a bearing surface. These simulators have provided highly accurate predictions of the in vivo wear of a broad spectrum of bearing materials, including cross-linked polyethylenes, metal-on-metal, ceramic-on-ceramic, and others in development. In recent years, more severe conditions have been successfully modeled, including jogging, stair climbing, ball-cup micro separation, third-body abrasion, and neck-socket impingement. These tests have served to identify improved materials and to eliminate some with inadequate wear resistance prior to their clinical use. Simulation of the knee joint is inherently more complex than it is for the hip. It is more difficult to compare the results of laboratory tests with actual clinical performance, due to the lack of accurate in vivo measures of wear. Nevertheless, knee simulators, based on force control or motion control, have successfully reproduced the type of surface damage that occurs in vivo (eg, burnishing, scratching, pitting) as well as the size and shapes of the resultant wear particles. Knee simulators have been used to compare molded versus machined polyethylene components, highly cross-linked polyethylenes, fixed versus mobile bearings, and oxidized zirconia and other materials, under optimal conditions as well as more severe wear modes, such as malalignment, higher loading and activity levels, and third-body roughening.
Collapse
|
47
|
Koulouvaris P, Ly K, Ivashkiv LB, Bostrom MP, Nestor BJ, Sculco TP, Purdue PE. Expression profiling reveals alternative macrophage activation and impaired osteogenesis in periprosthetic osteolysis. J Orthop Res 2008; 26:106-16. [PMID: 17729302 DOI: 10.1002/jor.20486] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Interactions between periprosthetic cells and prosthetic wear debris have been recognized as an important event in the development of osteolysis and aseptic loosening. Although the ability of wear debris to activate pro-inflammatory macrophage signaling has been documented, the full repertoire of macrophage responses to wear particles has not been established. Here, we examined the involvement of alternative macrophage activation and defective osteogenic signaling in osteolysis. Using real-time RT-PCR analysis of periprosthetic soft tissue from osteolysis patients, we detected elevated levels of expression of alternative macrophage activation markers (CHIT1, CCL18), chemokines (IL8, MIP1 alpha) and markers of osteoclast precursor cell differentiation and multinucleation (Cathepsin K, TRAP, DC-STAMP) relative to osteoarthritis controls. The presence of cathepsin K positive multinuclear cells was confirmed by immunohistochemistry. Reduced expression levels of the osteogenic signaling components BMP4 and FGF18 were detected. Expression levels of TNF-alpha, IL-6, and RANKL were unchanged, while the anti-osteoclastogenic cytokine OPG was reduced in osteolysis patients, resulting in elevated RANKL:OPG ratios. In vitro studies confirmed the role of particulate debris in alternative macrophage activation and inhibition of osteogenic signaling. Taken together, these results suggest involvement in osteolysis of alternative macrophage activation, accompanied by elevated levels of various chemokines. Increased recruitment and maturation of osteoclast precursors is also observed, as is reduced osteogenesis. These findings provide new insights into the molecular pathogenesis of osteolysis, and identify new potential candidate markers for disease progression and therapeutic targeting.
Collapse
Affiliation(s)
- Panagiotis Koulouvaris
- Osteolysis Research Laboratory, Hospital for Special Surgery, 535 East 70th Street, New York, New York 10021, USA
| | | | | | | | | | | | | |
Collapse
|
48
|
Syggelos SA, Giannopoulou E, Gouvousis PA, Andonopoulos AP, Aletras AJ, Panagiotopoulos E. In vitro effects of non-steroidal anti-inflammatory drugs on cytokine, prostanoid and matrix metalloproteinase production by interface membranes from loose hip or knee endoprostheses. Osteoarthritis Cartilage 2007; 15:531-42. [PMID: 17188523 DOI: 10.1016/j.joca.2006.11.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2006] [Accepted: 11/06/2006] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To study the effects of the non-steroidal anti-inflammatory drugs (NSAIDs) aceclofenac, piroxicam, tenoxicam and indomethacin on cytokine, matrix metalloproteinases (MMPs), tissue inhibitors of metalloproteinases (TIMPs) and prostaglandin E2 (PGE2) production, by interface membranes (IFT), obtained at revision surgery for aseptic loosening of total joint arthroplasty. Involvement of these soluble factors is well documented and probably, a pharmaceutically induced inhibition of them might retard loosening. METHODS IFTs from 10 patients with a loose hip or knee endoprosthesis were collected. The possibility of septic loosening was thoroughly excluded by histopathologic and microbiologic evaluation. IFTs were cultured in the absence or presence of the tested drugs and the levels of the soluble mediators were determined, using electrophoretic and enzyme-linked immunosorbent assay techniques. Paracetamol was used as neutral drug. RESULTS All NSAIDs exhibited a pronounced inhibitory effect upon the production of interleukin-6 (IL-6) and tumour necrosis factor-alpha (TNF-alpha). This specific effect on IL-6 is reported in the literature for the first time. The majority of NSAIDs also induced the production of IL-1beta in an adequate portion of samples. These drugs did not have a clear effect on MMP synthesis, but they had a stimulatory tendency on TIMP-1 production. Paracetamol, significantly decreased the synthesis of TNF-alpha and that of the gelatinases. CONCLUSION Our in vitro results are encouraging, since it appears that the action of NSAIDs, globally considered, may be beneficial upon the loosening process. The inhibitory effect of paracetamol upon TNF-alpha and gelatinases is intriguing. Our data, if supported by similar observations, probably justify performance of long-term clinical trials.
Collapse
Affiliation(s)
- S A Syggelos
- Department of Orthopaedics, School of Medicine, University of Patras, Rio, Patras, Greece
| | | | | | | | | | | |
Collapse
|
49
|
Baudriller H, Chabrand P, Moukoko D. Modeling UHMWPE wear debris generation. J Biomed Mater Res B Appl Biomater 2007; 80:479-85. [PMID: 16862559 DOI: 10.1002/jbm.b.30620] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
It is widely recognized that polyethylene wear debris is one of the main causes of long-term prosthesis loosening. The noxious bioreactivity associated with this debris is determined by its size, shape, and quantity. The aim of this study was to develop a numerical tool that can be used to investigate the primary polyethylene wear mechanisms involved. This model illustrates the formation of varying flow of polyethylene debris with various shapes and sizes caused by elementary mechanical processes. Instead of using the classical continuum mechanics formulation for this purpose, we used a divided materials approach to simulate debris production and release. This approach involves complex nonlinear bulk behaviors, frictional adhesive contact, and characterizes material damage as a loss of adhesion. All the associated models were validated with various benchmark tests. The examples given show the ability of the numerical model to generate debris of various shapes and sizes such as those observed in implant retrieval studies. Most of wear mechanisms such as abrasion, adhesion, and the shearing off of micro-asperities can be described using this approach. Furthermore, it could be applied to study the effects of friction couples, macroscopic geometries, and material processing (e.g. irradiation) on wear.
Collapse
Affiliation(s)
- H Baudriller
- Laboratoire de Mécanique et d'Acoustique, CNRS, Marseille, France
| | | | | |
Collapse
|
50
|
Niki Y, Matsumoto H, Otani T, Tomatsu T, Toyama Y. How much sterile saline should be used for efficient lavage during total knee arthroplasty? Effects of pulse lavage irrigation on removal of bone and cement debris. J Arthroplasty 2007; 22:95-9. [PMID: 17197315 DOI: 10.1016/j.arth.2006.02.078] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2005] [Accepted: 02/01/2006] [Indexed: 02/01/2023] Open
Abstract
Bone and polymethyl methacrylate (PMMA) debris particles generated during total knee arthroplasty (TKA) reportedly cause third-body wear. The present study investigated the volume of pulse lavage sufficient for removal of intraoperative PMMA and bone particles. Subjects comprised 8 patients who underwent cemented TKA. Pulse lavage with 8 L of sterile saline was performed using a pulsatile irrigator. During pulse lavage, aspirated fluid was collected in a 1-L aliquot, and the number and size of bone and PMMA particles in each fluid were measured. Image analysis revealed that the number of particles peaked at first lavage and gradually decreased until eighth lavage. Significant differences were found between the first vs second, second vs third, and third vs fourth lavage. However, no significant differences were found beyond the fourth lavage. This study indicated that 4 L of pulse lavage is effective for removing the particles during cemented TKA.
Collapse
Affiliation(s)
- Yasuo Niki
- Department of Orthopaedic Surgery, Keio University, Shinjuku-ku, Tokyo, Japan
| | | | | | | | | |
Collapse
|