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Jaenisch M, Wirtz DC. Titanium - a Cementable Material for Endoarthroplasty. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2024; 162:296-302. [PMID: 36720242 DOI: 10.1055/a-1975-0687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
As materials for arthroplasty, titanium alloys exhibit the following advantages over conventional steel, cobalt chromium or chromium nickel alloys - good fatigue strength, excellent biocompatibility, low modulus of elasticity, and high corrosion resistance. The previous worse clinical outcome was most likely caused by crevice corrosion and led to reduced use. To warrant safe use, the design should be optimised (sufficient proximal diameter, proximal collar), in order to reduce unwanted deformation in the proximal part of the prosthesis. Additionally, a rough surface (Ra > 2.5 µm) should not be used. Further research in surface treatments (e. g. silicate-silane) could facilitate additional improvement.
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Affiliation(s)
- Max Jaenisch
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Dieter Christian Wirtz
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
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Leiss F, Goetz JS, Schindler M, Reinhard J, Müller K, Grifka J, Greimel F, Meyer M. Influence of bone mineral density on femoral stem subsidence after cementless THA. Arch Orthop Trauma Surg 2024; 144:451-458. [PMID: 37578658 DOI: 10.1007/s00402-023-05006-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 07/22/2023] [Indexed: 08/15/2023]
Abstract
INTRODUCTION Femoral stem subsidence can lead to aseptic loosening after total hip arthroplasty (THA). Low bone mineral density (BMD) is a risk factor for stem subsidence as it can affect the initial stability and osteointegration. We evaluated whether reduced bone mineral density is related to higher subsidence of the femoral stem after primary cementless THA with enhanced recovery rehabilitation. METHODS 79 patients who had undergone primary cementless THA with enhanced recovery rehabilitation were analyzed retrospectively. Subsidence of the femoral stem was measured on standing pelvic anterior-posterior radiographs after 4-6 weeks and one year. Patient individual risk factors for stem subsidence (stem size, canal flare index, canal fill ratio, body mass index (BMI), demographic data) were correlated. Dual X-ray absorptiometry (DXA) scans were performed of the formal neck and the lumbar spine including the calculation of T-score and Z-score. Patient-reported outcome measures were evaluated 12 months postoperatively. RESULTS Stem subsidence appeared regardless of BMD (overall collective 2.3 ± 1.64 mm). Measure of subsidence was even higher in patients with normal BMD (2.8 ± 1.7 mm vs. 2.0 ± 1.5 mm, p = 0.05). High BMI was correlated with increased stem subsidence (p = 0.015). Subsidence had no impact on improvement of patient-related outcome measures (WOMAC, EQ-5D-5L and EQ-VAS) after THA. Patients with low BMD reported lower quality of life 12 month postoperatively compared to patients with normal BMD (EQ-5D-5L 0.82 vs. 0.91, p = 0.03). CONCLUSION Stable fixation of a cementless stem succeeds also in patients with reduced BMD. Regarding stem subsidence, enhanced recovery rehabilitation can be safely applied in patients with low BMD.
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Affiliation(s)
- Franziska Leiss
- Department of Orthopedic Surgery, Asklepios Klinikum Bad Abbach, Regensburg University Medical Center, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Germany.
| | - Julia Sabrina Goetz
- Department of Orthopedic Surgery, Asklepios Klinikum Bad Abbach, Regensburg University Medical Center, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Germany
| | - Melanie Schindler
- Department of Orthopedic Surgery, Asklepios Klinikum Bad Abbach, Regensburg University Medical Center, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Germany
| | - Jan Reinhard
- Department of Orthopedic Surgery, Asklepios Klinikum Bad Abbach, Regensburg University Medical Center, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Germany
| | - Karolina Müller
- Center for Clinical Studies, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Joachim Grifka
- Department of Orthopedic Surgery, Asklepios Klinikum Bad Abbach, Regensburg University Medical Center, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Germany
| | - Felix Greimel
- Department of Orthopedic Surgery, Asklepios Klinikum Bad Abbach, Regensburg University Medical Center, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Germany
| | - Matthias Meyer
- Department of Orthopedic Surgery, Asklepios Klinikum Bad Abbach, Regensburg University Medical Center, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Germany
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Pius AK, Toya M, Gao Q, Ergul YS, Chow SKH, Goodman SB. Effects of Aging on Osteosynthesis at Bone-Implant Interfaces. Biomolecules 2023; 14:52. [PMID: 38254652 PMCID: PMC10813487 DOI: 10.3390/biom14010052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 12/23/2023] [Accepted: 12/27/2023] [Indexed: 01/24/2024] Open
Abstract
Joint replacement is a common surgery and is predominantly utilized for treatment of osteoarthritis in the aging population. The longevity of many of these implants depends on bony ingrowth. Here, we provide an overview of current techniques in osteogenesis (inducing bone growth onto an implant), which is affected by aging and inflammation. In this review we cover the biologic underpinnings of these processes as well as the clinical applications. Overall, aging has a significant effect at the cellular and macroscopic level that impacts osteosynthesis at bone-metal interfaces after joint arthroplasty; potential solutions include targeting prolonged inflammation, preventing microbial adhesion, and enhancing osteoinductive and osteoconductive properties.
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Affiliation(s)
- Alexa K. Pius
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Stanford, CA 94063, USA (Y.S.E.)
| | - Masakazu Toya
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Stanford, CA 94063, USA (Y.S.E.)
| | - Qi Gao
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Stanford, CA 94063, USA (Y.S.E.)
| | - Yasemin Sude Ergul
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Stanford, CA 94063, USA (Y.S.E.)
| | - Simon Kwoon-Ho Chow
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Stanford, CA 94063, USA (Y.S.E.)
| | - Stuart Barry Goodman
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Stanford, CA 94063, USA (Y.S.E.)
- Department of Bioengineering, Stanford University, Stanford, CA 94305, USA
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Berlinberg EJ, Kavian JA, Roof MA, Shichman I, Frykberg B, Lutes WB, Schnaser EA, Jones SA, McCalden RW, Schwarzkopf R. Minimum 2-Year Outcomes of a Novel 3D-printed Fully Porous Titanium Acetabular Shell in Revision Total Hip Arthroplasty. Arthroplast Today 2022; 18:39-44. [PMID: 36267391 PMCID: PMC9576483 DOI: 10.1016/j.artd.2022.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 08/09/2022] [Indexed: 11/27/2022] Open
Abstract
Background Fully porous acetabular shells are an appealing choice for patients with extensive acetabular defects undergoing revision total hip arthroplasty (rTHA). This study reports on the early outcomes of a novel 3-D printed fully porous titanium acetabular shell in revision acetabular reconstruction. Methods A multicenter retrospective study of patients who received a fully porous titanium acetabular shell for rTHA with a minimum of 2 years of follow-up was conducted. The primary outcome was rate of acetabular revision. Results The final study cohort comprised 68 patients with a mean age of 67.6 years (standard deviation 10.4) and body mass index of 29.5 kg/m2 (standard deviation 5.9). Ninety-four percent had a preoperative Paprosky defect grade of 2A or higher. The average follow-up duration was 3.0 years (range 2.0-5.1). Revision-free survivorship at 2 years was 81% for all causes, 88% for acetabular revisions, and 90% for acetabular revision for aseptic acetabular shell failure. Eight shells were explanted within 2 years (12%): 3 for failure of osseointegration/aseptic loosening (4%) after 15, 17, and 20 months; 3 for infection (4%) after 1, 3, and 6 months; and 2 for instability (3%). At the latest postoperative follow-up, all unrevised shells showed radiographic signs of osseointegration, and none had migrated. Conclusions This novel 3-D printed fully porous titanium shell in rTHA demonstrated good survivorship and osseointegration when used in complex acetabular reconstruction at a minimum of 2 years. Level of evidence IV, case series.
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Affiliation(s)
| | | | | | | | - Brett Frykberg
- Jacksonville Orthopaedic Institute, Baptist Health, Jacksonville, FL, USA
| | - William B. Lutes
- Aurora Orthopedics, Aurora Medical Center-Kenosha, Racine, WI, USA
| | | | | | - Richard W. McCalden
- University of Western Ontario, London Health Sciences Centre, London, ON, Canada
| | - Ran Schwarzkopf
- NYU Langone Health, New York, NY, USA,Corresponding author. NYU Langone Health, 301 East 17th Street, 15th Fl Suite 1518, New York, NY 10003, Tel.: +1 646 501 7300.
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Dyreborg K, Sørensen MS, Flivik G, Solgaard S, Petersen MM. Preoperative BMD does not influence femoral stem subsidence of uncemented THA when the femoral T-score is > -2.5. Acta Orthop 2021; 92:538-543. [PMID: 33977827 PMCID: PMC8522811 DOI: 10.1080/17453674.2021.1920163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - It is believed that in uncemented primary total hip arthroplasty (THA) the anchorage of the stem is dependent on the level of bone mineral density (BMD) of the femoral bone. This is one of the reasons for the widely accepted agreement that a cemented solution should be selected for people with osteoporosis or age > 75 years. We evaluated whether preoperative BMD of the femur bone is related to femoral stem migration in uncemented THA.Patients and methods - We enrolled 62 patients (mean age 64 years (range 49-74), 34 males) scheduled for an uncemented THA. Before surgery we undertook DEXA scans of the proximal femur including calculation of the T- and Z-scores for the femoral neck. Evaluation of stem migration by radiostereometric analysis (RSA) was performed with 24 months of follow-up. In 56 patients both preoperative DEXA data and RSA data were available with 24 months of follow-up.Results - None of the patients had a T-score below -2.5. We found no statistically significant relationship between preoperative BMD and femoral stem subsidence after 3 or 24 months. When comparing the average femoral stem subsidence between 2 groups with T-score > -1 and T-score ≤ -1, respectively, we found no statistically significant difference after either 3 or 24 months when measured with RSA.Interpretation - In a cohort of people ≤ 75 years of age and with local femur T-score > -2.5 we found no relationship between preoperative BMD and postoperative femoral stem subsidence of a cementless THA.
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Affiliation(s)
- Karen Dyreborg
- Department of Orthopaedic Surgery, Rigshospitalet, København, Denmark
- Department of Hip and Knee Surgery, Herlev-Gentofte Hospital, Hellerup, Denmark
| | | | - Gunnar Flivik
- Department of Orthopaedics, Skåne University Hospital, Lund, Sweden
| | - Søren Solgaard
- Department of Hip and Knee Surgery, Herlev-Gentofte Hospital, Hellerup, Denmark
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Dale H, Børsheim S, Kristensen TB, Fenstad AM, Gjertsen JE, Hallan G, Lie SA, Furnes O. Fixation, sex, and age: highest risk of revision for uncemented stems in elderly women - data from 66,995 primary total hip arthroplasties in the Norwegian Arthroplasty Register. Acta Orthop 2019; 91:33-41. [PMID: 31663413 PMCID: PMC7006785 DOI: 10.1080/17453674.2019.1682851] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - There is no consensus on best method of fixation in hip arthroplasty. We investigated different modes of fixation in primary total hip arthroplasty (THA) and the influence of age and sex, to assess need for a differentiated approach.Patients and methods - The study was based on data from the Norwegian Arthroplasty Register in the period 2005-2017. Included were all-cemented, all-uncemented, reverse hybrid (uncemented stem and cemented cup), and hybrid (cemented stem and uncemented cup) THA designs that were commonly used, contemporary and well documented, using different causes of revision as endpoints.Results - From the included 66,995 primary THAs, 2,242 (3.3%) were revised. Compared with all-cemented THAs, all-uncemented had a higher risk of revision due to any cause (RR 1.4; CI 1.2-1.6), mainly due to an increased risk of periprosthetic fracture (RR 5.2; CI 3.2-8.5) and dislocation (RR 2.2; CI 1.5-3.0). Women had considerably higher risk of revision due to periprosthetic fracture after all-uncemented THA (RR 12; CI 6-25), compared with cemented. All-uncemented THAs in women of age 55-75 years (RR 1.3; CI 1.0-1.7) and over 75 years of age (RR 1.8; CI 1.2-2.7), and reverse hybrid THAs in women over the age of 75 (RR 1.5; CI 1.1-1.9) had higher risk of revision compared with cemented. Hybrid THAs (RR 1.0; CI 0.9-1.2) and reverse hybrid THAs (RR 1.0; CI 0.7-1.3) had similar risk of revision due to any cause as cemented THAs.Interpretation - Uncemented stems (all-uncemented and reverse hybrid THAs) had increased risk of revision in women over 55 years of age, mainly due to periprosthetic fracture and dislocation, and should probably not be used in THA in these patients.
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Affiliation(s)
- Håvard Dale
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen; ,Department of Clinical Medicine, University of Bergen, Bergen; ,Correspondence:
| | | | - Torbjørn Berge Kristensen
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen;
| | - Anne Marie Fenstad
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen;
| | - Jan-Erik Gjertsen
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen; ,Department of Clinical Medicine, University of Bergen, Bergen;
| | - Geir Hallan
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen; ,Department of Clinical Medicine, University of Bergen, Bergen;
| | - Stein Atle Lie
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen; ,Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - Ove Furnes
- The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen; ,Department of Clinical Medicine, University of Bergen, Bergen;
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Freitag L, Günther C, Eberli U, Fürst A, Zeiter S, Stadelmann VA. Relative effects of age on implant integration in a rat model: A longitudinal in vivo microct study. J Orthop Res 2019; 37:541-552. [PMID: 30575124 DOI: 10.1002/jor.24210] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 12/11/2018] [Indexed: 02/04/2023]
Abstract
The effect of age on implant fixation in bone is not always considered during the design of preclinical models. The decision on animal's age is often related to practical or historical reasons, which ultimately may affect the reproducibility of results. This study aimed to quantify the effect of age by monitoring the fixation of contrast-enhanced PEEK screws in rats, hypothesizing that the kinetics of fixation is impaired in older animals but that age effects are less severe than osteoporotic effects. The time course of implant fixation was investigated in healthy rats at 24, 40, and 60 weeks of age; and in ovariectomized rats. Implant fixation was monitored using in-vivo microCT and dynamic histomorphometry during 1 month. The rats were euthanized 28 days post screw insertion. The data was analyzed both in absolute value and after normalization to baseline bone mass. In absolute terms, greater age had a detrimental effect on bone implant contact, bone fraction, implant stiffness, and bone remodeling but less than ovariectomy. Interestingly, once data was normalized to baseline bone mass this effect disappeared, suggesting that the physiologic response to implant placement was not affected by age. In conclusion, implant fixation kinetics is less affected by age than by baseline bone mass in this rat model. Animals of different ages can therefore be compared but data must be construed relatively to baseline bone mass and not in absolute terms. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 9999:1-12, 2018.
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Affiliation(s)
| | - Christian Günther
- AO Research Institute Davos, Davos, Switzerland.,Klinik für Pferdechirurgie, Vetsuisse-Fakultät der Universität Zürich, Zürich, Switzerland
| | | | - Anton Fürst
- Klinik für Pferdechirurgie, Vetsuisse-Fakultät der Universität Zürich, Zürich, Switzerland
| | | | - Vincent A Stadelmann
- AO Research Institute Davos, Davos, Switzerland.,Schulthess Clinic, Department of Research and Development, Zürich, Switzerland
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Liu F, Li Y, Liang J, Sui W, Bellare A, Kong L. Effects of micro/nano strontium‐loaded surface implants on osseointegration in ovariectomized sheep. Clin Implant Dent Relat Res 2019; 21:377-385. [DOI: 10.1111/cid.12719] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 01/04/2019] [Indexed: 12/25/2022]
Affiliation(s)
- Fuwei Liu
- State Key Laboratory of Military Stomatology and National Clinical Research Center for Oral Diseases and Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial SurgerySchool of Stomatology, The Fourth Military Medical University Xi'an People's Republic of China
| | - Yongfeng Li
- Department of StomatologyPLA 301 Hospital Beijing People's Republic of China
| | - Jianfei Liang
- State Key Laboratory of Military Stomatology and National Clinical Research Center for Oral Diseases and Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial SurgerySchool of Stomatology, The Fourth Military Medical University Xi'an People's Republic of China
| | - Wen Sui
- Department of StomatologyShenzhen Hospital of Southern Medical University Shenzhen People's Republic of China
| | - Anuj Bellare
- Department of Orthopedic SurgeryBrigham and Women's Hospital Boston Massachusetts
| | - Liang Kong
- State Key Laboratory of Military Stomatology and National Clinical Research Center for Oral Diseases and Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial SurgerySchool of Stomatology, The Fourth Military Medical University Xi'an People's Republic of China
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Vertesich K, Puchner SE, Staats K, Schreiner M, Hipfl C, Kubista B, Holinka J, Windhager R. Distal femoral reconstruction following failed total knee arthroplasty is accompanied with risk for complication and reduced joint function. BMC Musculoskelet Disord 2019; 20:47. [PMID: 30704448 PMCID: PMC6357401 DOI: 10.1186/s12891-019-2432-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 01/22/2019] [Indexed: 12/02/2022] Open
Abstract
Background Substantial bone loss following failed total knee arthroplasty (TKA) represents a major challenge in revision arthroplasty, that can require distal femoral reconstruction (DFR). In this study, we aimed to assess the clinical outcome and the complication frequencies of individuals who underwent DFR with modular megaprostheses. Additionally, we aimed to compare functional outcome measures after DFR in these sophisticated cases to an age-matched control group of total knee prostheses to quantify the potential loss of function. Methods A retrospective chart review of 30 consecutive patients after DFR from 1997 to 2017 with a mean age of 74.38 years (± 10.1) was performed. Complications were classified according to the Henderson classification. Knee Society Score (KSS) was calculated and range of motion (ROM) was assessed. Results Thirteen (43.3%) patients had at least one complication requiring revision surgery. Revision-free survival was 74.8% at one year, 62.5% at three and 40.9% at 10 years post-op. Soft-tissue failure complications were found in three (10.0%) patients, aseptic loosening in four (13.3%) patients, structural failure in one (3.3%) patient and infection in eight (26.6%) patients. Of those with infection, five (16.6%) experienced ongoing prosthetic joint infection and three (10.0%) developed new infection after distal femur reconstruction. Patients with DFR achieved 69.3% of KSS pain score, 23.1% KSS function score and 76.2% of ROM compared to patients with primary TKA. Conclusions DFR after failed TKA represents a treatment procedure with high risk for complication in this particular group. Despite the prospect of rapid postoperative mobilization, reduced functionality, range of motion and mobilization have to be considered when choosing this treatment option.
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Affiliation(s)
- Klemens Vertesich
- Department of Orthopedics and Trauma-Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Stephan E Puchner
- Department of Orthopedics and Trauma-Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Kevin Staats
- Department of Orthopedics and Trauma-Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Markus Schreiner
- Department of Orthopedics and Trauma-Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Christian Hipfl
- Department of Orthopedics and Trauma-Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Bernd Kubista
- Department of Orthopedics and Trauma-Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Johannes Holinka
- Department of Orthopedics and Trauma-Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Reinhard Windhager
- Department of Orthopedics and Trauma-Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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Influence of Vanadium 4+ and 5+ Ions on the Differentiation and Activation of Human Osteoclasts. Int J Biomater 2017; 2017:9439036. [PMID: 28947903 PMCID: PMC5602644 DOI: 10.1155/2017/9439036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 05/09/2017] [Accepted: 06/19/2017] [Indexed: 12/04/2022] Open
Abstract
Background In the pathophysiology of implant failure, metal ions and inflammation-driven osteoclasts (OC) play a crucial role. The aim of this study was to investigate whether vanadium (V) ions induce differentiation of monocytic OC precursors into osteoresorptive multinucleated cells. In addition, the influence of V ions on the activation and function of in vitro generated OC was observed. Methods Human monocytes and osteoclasts were isolated from peripheral blood monocytic cells (PBMCs). Exposition with increasing concentrations (0–3 μM) of V4+/V5+ ions for 7 days followed. Assessment of OC differentiation, cell viability, and resorptional ability was performed by standard colorimetric cell viability assay 3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenil)-2H-tetrazolium (MTS), tartrate-resistant acid phosphatase (TRAP) expression, and functional resorption assays on bone slides during a period of 21 days. Results No significant differences were noted between V4+/V5+ ions (p > 0.05). MTS showed significant reduction in cellular viability by V concentrations above 3 μM (p < 0.05). V concentrations above 0.5 μM showed negative effects on OC activation/differentiation. Higher V concentrations showed negative effects on resorptive function (all p < 0.05) without affecting cell viability. V4+/V5+ concentrations below 3 μM have negative effects on OC differentiation/function without affecting cell survival. Conclusion Vanadium-containing implants may reduce implant failure rate by influencing osteoclast activity at the bone-implant interface. V-ligand complexes might offer new treatment options by accumulating in the bone.
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Querido W, Farina M, Anselme K. Strontium ranelate improves the interaction of osteoblastic cells with titanium substrates: Increase in cell proliferation, differentiation and matrix mineralization. BIOMATTER 2016; 5:e1027847. [PMID: 26176488 PMCID: PMC5044704 DOI: 10.1080/21592535.2015.1027847] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
We describe direct effects of strontium ranelate on the interaction of osteoblastic cells with different titanium substrates. Our goal was to better understand the potential of this drug for improving the efficacy of bone implants. Treatment was done with 0.12 and 0.5 mM Sr(2+) of strontium ranelate in cell culture. We analyzed cell response to the drug on titanium substrates with surface topographies obtained using acid etching, electro-erosion processing, sandblasting, and machine-tooling. Treatment preserved the initial cell adhesion to the substrates, cell shape parameters (area, aspect ratio, circularity, and solidity), and the orientation of cells on grooved surfaces. However, both concentrations of the drug increased cell proliferation in all substrates. Moreover, a dose-dependent increase in alkaline phosphatase activity and in the production of mineralized matrix with typical features of bone tissue was shown. The observed effects were similar in the different substrates. In conclusion, strontium ranelate improved the interaction of osteoblastic cells with titanium substrates, increasing cell proliferation and differentiation into mature osteoblasts and the production of bone-like mineralized matrix for all substrates. This study highlights a promising role of strontium ranelate on enhancing the clinical success of bone implants, particularly in patients with osteoporosis.
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Affiliation(s)
- William Querido
- a Institut de Sciences des Matériaux de Mulhouse; CNRS UMR7361; Université de Haute-Alsace ; Mulhouse , France.,b Instituto de Ciências Biomédicas; Universidade Federal do Rio de Janeiro ; Rio de Janeiro , Brazil.,c Instituto de Biofísica Carlos Chagas Filho; Universidade Federal do Rio de Janeiro ; Rio de Janeiro , Brazil
| | - Marcos Farina
- b Instituto de Ciências Biomédicas; Universidade Federal do Rio de Janeiro ; Rio de Janeiro , Brazil
| | - Karine Anselme
- a Institut de Sciences des Matériaux de Mulhouse; CNRS UMR7361; Université de Haute-Alsace ; Mulhouse , France
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Offermanns V, Andersen OZ, Riede G, Andersen IH, Almtoft KP, Sørensen S, Sillassen M, Jeppesen CS, Rasse M, Foss M, Kloss F. Bone regenerating effect of surface-functionalized titanium implants with sustained-release characteristics of strontium in ovariectomized rats. Int J Nanomedicine 2016; 11:2431-42. [PMID: 27313456 PMCID: PMC4892864 DOI: 10.2147/ijn.s101673] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Since strontium (Sr) is known for its anabolic and anticatabolic effect on bone, research has been focused on its potential impact on osseointegration. The objective of this study was to investigate the performance of nanotopographic implants with a Sr-functionalized titanium (Ti) coating (Ti–Sr–O) with respect to osseointegration in osteoporotic bone. The trial was designed to examine the effect of sustained-release characteristics of Sr in poor-quality bone. Three Ti–Sr–O groups, which differed from each other in coating thickness, Sr contents, and Sr release, were examined. These were prepared by a magnetron sputtering process and compared to uncoated grade 4 Ti. Composition, morphology, and mechanical stability of the coatings were analyzed, and Sr release data were gained from in vitro washout experiments. In vivo investigation was carried out in an osteoporotic rat model and analyzed histologically, 6 weeks and 12 weeks after implantation. Median values of bone-to-implant contact and new bone formation after 6 weeks were found to be 84.7% and 54.9% (best performing Sr group) as compared to 65.2% and 23.8% (grade 4 Ti reference), respectively. The 12-week observation period revealed 84.3% and 56.5% (best performing Sr group) and 81.3% and 39.4% (grade 4 Ti reference), respectively, for the same measurements. The increase in new bone formation was found to correlate with the amount of Sr released in vitro. The results indicate that sputtered nanostructured Ti–Sr–O coatings showed sustained release of Sr and accelerate osseointegration even in poor-quality bone, and thus, may have impact on practical applications for medical implants.
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Affiliation(s)
- Vincent Offermanns
- Department of Cranio-, Maxillofacial and Oral Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Ole Zoffmann Andersen
- Interdisciplinary Nanoscience Center (iNANO), Faculty of Science and Technology, Aarhus University, Aarhus, Denmark
| | - Gregor Riede
- Department of Cranio-, Maxillofacial and Oral Surgery, Medical University Innsbruck, Innsbruck, Austria
| | | | | | - Søren Sørensen
- Tribology Centre, Danish Technological Institute, Aarhus, Denmark
| | - Michael Sillassen
- Interdisciplinary Nanoscience Center (iNANO), Faculty of Science and Technology, Aarhus University, Aarhus, Denmark
| | | | - Michael Rasse
- Department of Cranio-, Maxillofacial and Oral Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - Morten Foss
- Interdisciplinary Nanoscience Center (iNANO), Faculty of Science and Technology, Aarhus University, Aarhus, Denmark
| | - Frank Kloss
- Department of Cranio-, Maxillofacial and Oral Surgery, Medical University Innsbruck, Innsbruck, Austria
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Densitometric evaluation of bone remodelling around Trabecular Metal Primary stem: a 24-month follow-up. Aging Clin Exp Res 2015; 27 Suppl 1:S69-75. [PMID: 26271819 DOI: 10.1007/s40520-015-0424-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 07/09/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Today, an increasing number of total hip arthroplasty (THA) procedures are being performed. Osseointegration is a physiological phenomenon that leads to the direct anchorage of an implant by the formation of bony tissue around the implant without the growth of fibrous tissue at the bone-implant interface. Several factors may affect this phenomenon: some of these depend on the patient and others may depend on implant design and materials. Variations in periprosthetic bone mineral density (BMD) can be studied through several scans by dual energy X-ray absorptiometry (DEXA) around the femoral stem. AIMS The purpose of this study is to investigate correlations between periprosthetic BMD and the factors affecting osseointegration. METHODS We retrospectively analysed patients who underwent primary THA. In all the patients, Trabecular Metal Primary (TMP), a standard uncemented tapered stem with a proximal porous tantalum coating, was implanted. Preoperatively, postoperatively, 3 and 6 months, 1 year and 2 years after implantation, DEXA scans were performed around the femoral stem. The patients were matched for diagnosis, sex, BMD of the lumbar spine and contralateral femur, Body Mass Index and age. RESULTS One hundred and eight patients (51 males and 57 females) with a mean age of 73 years were studied. Different BMD changing patterns were observed and a greater bone resorption was noted in all the conditions associated with poor bone quality. DISCUSSION The proximal coating of Trabecular Metal Primary (TMP) seemed to be effective in promoting new bone formation in the proximal femur also in the conditions associated with poor bone quality. CONCLUSIONS At the present time, DEXA is considered the most reliable tool for evaluating bone remodelling after THA.
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