Spatial variation of wear on Charité lumbar discs

Cobalt and titanium nanoparticles influence on mesenchymal stem cell elasticity and turgidity

Bone cells are damaged by wear particles originating from total joint replacement implants. We investigated Mesenchymal stem cells (MSCs) nanomechanical properties when exposed to cobalt and titanium nanoparticles (resembling wear debris) of different sizes for up to 3days using AFM nanoindentation; along with flow-cytometry and MTT assay. The results demonstrated that cells exposed to increasing concentrations of nanoparticles had a lower value of elasticity and spring constant without significant effect on cell metabolic activity and viability but some morphological alteration (bleeping). Cobalt induced greater effects than titanium and this is consistent with the general knowledge of cyto-compatibility of the later. This work demonstrates for the first time that metal nanoparticles do not only influence MSCs enzymes activity but also cell structure; however, they do not result in full membrane damage. Furthermore, the mechanical changes are concentration and particles composition dependent but little influenced by the particle size.

Wear of the Charité® lumbar intervertebral disc replacement investigated using an electro-mechanical spine simulator

The Charité^® lumbar intervertebral disc replacement was subjected to wear testing in an electro-mechanical spine simulator. Sinusoidally varying compression (0.6–2 kN, frequency 2 Hz), rotation (±2°, frequency 1 Hz), flexion–extension (6° to −3°, frequency 1 Hz) and lateral bending (±2°, frequency 1 Hz) were applied out of phase to specimens immersed in diluted calf serum at 37 °C. The mass of the ultra-high-molecular weight polyethylene component of the device was measured at intervals of 0.5, 1, 2, 3, 4 and 5 million cycles; its volume was also measured by micro-computed tomography. Total mass and volume losses were 60.3 ± 4.6 mg (mean ± standard deviation) and 64.6 ± 6.0 mm³. Corresponding wear rates were 12.0 ± 1.4 mg per million cycles and 12.8 ± 1.2 mm³ per million cycles; the rate of loss of volume corresponds to a mass loss of 11.9 ± 1.1 mg per million cycles, that is, the two sets of measurements of wear agree closely. Wear rates also agree closely with measurements made in another laboratory using the same protocol but using a conventional mechanical spine simulator.

Cobalt, titanium and PMMA bone cement debris influence on mouse osteoblast cell elasticity, spring constant and calcium production activity

Periprosthetic osteolysis and implant loosening are the outcomes of wear debris generation in total joint replacements. Wear debris formed from the implanted materials consisting of metals, polymers, ceramic and bone cement initiate the immune system response. Often osteoblasts, the principal cell type in bone tissue adjacent to the prostheses, are directly impacted. In this study, the influence of cobalt, titanium and PMMA bone cement particles of different sizes, charges and compositions on mouse osteoblast adhesion, nanomechanics (elasticity and spring constant) and metabolic activity were investigated. These studies were accompanied by osteoblast mineralisation experiments and cell uptake after exposure to particles at defined time points. Our results demonstrate that alteration of the nanomechanical properties are mainly dependent on the metal type rather than nanoparticles size and concentration. Moreover, despite uptake increasing over exposure time, the cell characteristics exhibit changes predominately after the first 24 hours, highlighting that the cell responses to nanoparticle exposure are not cumulative. Understanding these processes is critical to expanding our knowledge of implant loosening and elucidating the nature of prosthetic joint failure.

Fluoroscopic assessment of lumbar total disc replacement kinematics during walking

STUDY DESIGN

Descriptive.

OBJECTIVE

The purpose of this study was to determine the in vivo kinematics of functional spinal units, during gait, in individuals with a single-level lumbar total disc replacement (TDR).

SUMMARY OF BACKGROUND DATA

TDR is a motion preservation technology that offers an alternative to spinal fusion for treatment of degenerative disc disease. The aim of TDRs is to replicate motion of the functional spinal units, which may protect adjacent intervertebral discs against accelerated degeneration. At present, there is limited understanding of the in vivo motion of TDRs, particularly during dynamic activities such as gait. Such information is important for understanding the wear characteristics of TDRs and furthering design rationale of future implants.

METHODS

TDR motions were obtained from 24 participants who underwent implantation with single-level L4-L5 or L5-S1 CHARITÉ or In Motion TDRs. Video fluoroscopy was used to obtain measurements in the frontal and sagittal planes during fixed speed treadmill walking.

RESULTS

The mean range of motion between the upper and lower lumbar TDR endplates during walking was 1.6° and 2.4° in the frontal and sagittal planes, respectively. These values were significantly different from zero and corresponded to 19% of the maximum static range of motion in each plane.

CONCLUSION

Lumbar TDRs provide a degree of motion preservation at the operative level during moderate speed walking. The distribution of lumbar TDR motions during walking presented here will inform relevant standards for conducting standardized tests of lumbar TDRs, particularly wear assessments, and, hence, enable more realistic mechanical and computer-based wear simulations to be performed.

LEVEL OF EVIDENCE

N/A.

Interactions between mammalian cells and nano- or micro-sized wear particles: physico-chemical views against biological approaches

Total joint arthroplasty (TJA) is a more and more frequent approach for the treatment of end-stage osteoarthritis in young and active adults; it successfully relieves joint pain and improves function significantly enhancing the health-related quality of life. Aseptic loosening and other wear-related complications are some of the most recurrent reasons for revision of TJA. This review focuses on current understanding of the biological reactions to prosthetic wear debris comparing in vivo and in vitro results. Mechanisms of interactions of various types of cells with metal, polymeric and ceramic wear particles are summarised. Alternative views based on multidisciplinary approaches are proposed to consider physico-chemical, surface parameters of wear particles (such as: particle size, geometry and charge) and material (particle chemical composition and its nature) with biological effects (cellular responses).

Adhesive forces and surface properties of cold gas plasma treated UHMWPE

Cold atmospheric plasma (CAP) treatment was used on ultra-high molecular weight polyethylene (UHMWPE), a common articulating counter material employed in hip and knee replacements. UHMWPE is a biocompatible polymer with low friction coefficient, yet does not have robust wear characteristics. CAP effectively cross-links the polymer chains of the UHMWPE improving wear performance (Perni et al., Acta Biomater. 8(3) (2012) 1357). In this work, interactions between CAP treated UHMWPE and spherical borosilicate sphere (representing model material for bone) were considered employing AFM technique. Adhesive forces increased, in the presence of PBS, after treatment with helium and helium/oxygen cold gas plasmas. Furthermore, a more hydrophilic surface of UHMWPE was observed after both treatments, determined through a reduction of up to a third in the contact angles of water. On the other hand, the asperity density also decreased by half, yet the asperity height had a three-fold decrease. This work shows that CAP treatment can be a very effective technique at enhancing the adhesion between bone and UHMWPE implant material as aided by the increased adhesion forces. Moreover, the hydrophilicity of the CAP treated UHMWPE can lead to proteins and cells adhesion to the surface of the implant stimulating osseointegration process.

Potent antimicrobial activity of bone cement encapsulating silver nanoparticles capped with oleic acid

Bone cement is widely used in surgical treatments for the fixation for orthopaedic devices. Subsequently, 2–3% of patients undergoing these procedures develop infections that are both a major health risk for patients and a cost for the health service providers; this is also aggravated by the fact that antibiotics are losing efficacy because of the rising resistance of microorganisms to these substances. In this study, oleic acid capped silver nanoparticles (NP) were encapsulated into Poly(methyl methacrylate) (PMMA)-based bone cement samples at various ratios. Antimicrobial activity against Methicillin Resistant Staphylococcus aureus, S. aureus, Staphylococcus epidermidis, Acinetobacter baumannii was exhibited at NP concentrations as low as 0.05% (w/w). Furthermore, the mechanical properties and cytotoxicity of the bone cement containing these NP were assessed to guarantee that such material is safe to be used in orthopaedic surgical practice. © 2014 The Authors. Journal of Biomedical Materials Research Part B: Applied Biomaterials Published by Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 103B: 273–281, 2015.

Effect of lubricants on friction in laboratory tests of a total disc replacement device

Some designs of total disc replacement devices have articulating bearing surfaces, and these devices are tested in vitro with a lubricant of diluted calf serum. It is believed that the lubricant found in total disc replacement devices in vivo is interstitial fluid that may have properties between that in Ringer's solution and diluted calf serum. To investigate the effect of lubricants, a set of friction tests were performed on a generic model of a metal against metal ball-and-socket total disc replacement device. Two devices were tested: one with a ball radius of 10 mm and other with a ball radius of 16 mm; each device had a radial clearance of 0.015 mm. A spine simulator was used to measure frictional torque for each device in axial rotation, flexion-extension and lateral bending at frequencies of 0.25-2 Hz, under 1200 N axial load. Each device was tested with two different lubricants: a solution of new born calf serum diluted with deionised water and Ringer's solution. The results showed that the frictional torque generated between the bearing surfaces was significantly higher in Ringer's solution than in diluted calf serum. The use of Ringer's solution as a lubricant provides a stringent test condition to detect possible problems. Diluted calf serum is more likely to provide an environment closer to that in vivo. However, the precise properties of the fluid lubricating a total disc replacement device are not known; hence, tests using diluted calf serum may not necessarily give the same results as those obtained in vivo.

Cold atmospheric pressure gas plasma enhances the wear performance of ultra-high molecular weight polyethylene

Ultra-high molecular weight polyethylene (UHMWPE) is frequently employed in joint replacements because of its high biocompatibility; however, this material does not exhibit particularly strong wear performance, thus potentially reducing the longevity of such devices. Numerous techniques have been investigated to increase the resistance to wear of UHMWPE, but they are all based on expensive machinery and require a high level of safety precautions. Cold atmospheric pressure gas plasma treatment is an inexpensive process that has been used as a surface modification method and as a sterilization technique. We demonstrate for the first time that a helium/oxygen cold atmospheric pressure gas plasma can be used to enhance the wear performance of UHMWPE without affecting the cytocompatibility of the material. The exposure to a cold atmospheric pressure gas plasma results in a greater level of crosslinking of the polyethylene chains. As a consequence of the higher crosslinking, the material stiffness of the treated surface is increased.