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Pechancová R, Gallo J, Baron D, Milde D, Antal P, Slobodová Z, Lemr K, Pluháček T. Detailed insight into chromium species released from failed CoCrMo implants: Ex vivo periprosthetic tissues study. J Biomed Mater Res B Appl Biomater 2023; 111:271-283. [PMID: 36507699 DOI: 10.1002/jbm.b.35149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 07/26/2022] [Accepted: 08/01/2022] [Indexed: 12/15/2022]
Abstract
This unique study provides information on Cr species and their distribution in periprosthetic tissues of patients with metal-on-polyethylene joint implants. Co-Cr-Mo alloy has been widely used in joint replacement and represents a source of metal derived species. In the case of chromium, previous studies on periprosthetic tissues revealed mainly Cr(III) distribution, whereas the potential release of carcinogenic Cr(VI) species has been still a subject of debate. Here, an analytical approach utilizing speciation and fractionation was developed to analyze periprosthetic tissue samples collected from wide range of patients with failed total hip or knee replacements. The results reveal that Cr(III) is mainly released in the form of insoluble CrPO4 and Cr2 O3 particles. The highest Cr contents were found in periprosthetic tissues of patients suffering from aseptic loosening and having more Cr-based implants in the body. Cr species penetrated tissue layers, but their levels decreased with the distance from an implant. The detailed speciation/fractionation study carried out using the set of consecutive periprosthetic tissues of a patient with extensive metallosis showed the presence of trace amounts of free Cr(III), nanoparticles, and metal-protein complexes, but the majority of Cr still occurred in CrPO4 form. Carcinogenic Cr(VI) species were not detected. Up to date, there is no published human tissue study focused on the detailed speciation of both soluble and insoluble Cr-based species in the context of failing total hip and knee replacements.
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Affiliation(s)
- Radka Pechancová
- Department of Analytical Chemistry, Faculty of Science, Palacký University Olomouc, Olomouc, Czech Republic
| | - Jiří Gallo
- Department of Orthopedics, Faculty of Medicine and Dentistry, Palacký University Olomouc, University Hospital Olomouc, Olomouc, Czech Republic
| | - Daniel Baron
- Department of Analytical Chemistry, Faculty of Science, Palacký University Olomouc, Olomouc, Czech Republic
| | - David Milde
- Department of Analytical Chemistry, Faculty of Science, Palacký University Olomouc, Olomouc, Czech Republic
| | - Peter Antal
- Department of Inorganic Chemistry, Faculty of Science, Palacký University Olomouc, Olomouc, Czech Republic
| | - Zuzana Slobodová
- Department of Clinical and Molecular Pathology, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Czech Republic
| | - Karel Lemr
- Department of Analytical Chemistry, Faculty of Science, Palacký University Olomouc, Olomouc, Czech Republic.,Institute of Microbiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Tomáš Pluháček
- Department of Analytical Chemistry, Faculty of Science, Palacký University Olomouc, Olomouc, Czech Republic
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2
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Bazin D, Foy E, Reguer S, Rouzière S, Fayard B, Colboc H, Haymann JP, Daudon M, Mocuta C. The crucial contribution of X-ray fluorescence spectroscopy in medicine. CR CHIM 2022. [DOI: 10.5802/crchim.103] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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3
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Chen J, Ding J, Wu Y, Zhang S, Zheng N, Yang J, Xu J. Chromium Oxide Nanoparticle Impaired Osteogenesis and Cellular Response to Mechanical Stimulus. Int J Nanomedicine 2021; 16:6157-6170. [PMID: 34511912 PMCID: PMC8423495 DOI: 10.2147/ijn.s317430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 08/11/2021] [Indexed: 12/28/2022] Open
Abstract
Background Release of metallic wear particles from hip replacement implants is closely associated with aseptic loosening that affects the functionality and survivorship of the prostheses. Chromium oxide nanoparticles (CrNPs) are the dominant form of the wear particles found in the periprosthetic tissues. Whether CrNPs play a role in the clinically observed particle-induced osteolysis, tissue inflammatory reactions and functional activities of human mesenchymal stem cells (MSCs) remain unknown. Methods A tibia-defect rat model, cytotoxicity assays and flow cytometry were applied to study the effect of CrNPs on MSCs survival and macrophage inflammatory response. Also, oscillatory fluid flow stimulation was used to analyse the osteogenic differentiation of MSCs while treated by CrNPs. In addition, the influence of CrNPs on MSC biomechanical properties was determined via atomic force microscope (AFM) and fluorescence microscopy. Results It was found that implantation of CrNPs significantly decreased bone formation in vivo. CrNPs had no obvious effects on inflammatory cytokines release of U937 macrophages. Additionally, CrNPs did not interfere with MSCs osteogenic differentiation under static culture. However, the upregulated osteogenic differentiation of MSCs due to fluid flow stimulation was reduced by CrNPs in a dose-dependent manner. Moreover, osteogenic gene expression of OPN, Cox2 and Rnux2 after mechanical stimulation was also decreased by CrNPs treatments. Furthermore, cell elasticity and adhesion force of MSCs were affected by CrNPs over 3 days of exposure. We further verified that these effects of CrNPs could be associated with its interruption on cell mechanical properties. Conclusion The results demonstrated that CrNPs impaired cellular response to mechanical stimulus and osteogenesis without noticeable effects on the survival of the human MSCs.
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Affiliation(s)
- Jian Chen
- Department of Paediatric Orthopaedics, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200092, People's Republic of China
| | - Jing Ding
- Department of Paediatric Orthopaedics, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200092, People's Republic of China
| | - Yuanhao Wu
- Biodiscovery Institute, School of Pharmacy, University of Nottingham, Nottingham, UK
| | - Shuqiong Zhang
- Department of Clinical Laboratory, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200092, People's Republic of China
| | - Naisheng Zheng
- Department of Clinical Laboratory, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200092, People's Republic of China
| | - Junyao Yang
- Department of Clinical Laboratory, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200092, People's Republic of China
| | - Jing Xu
- Department of Paediatric Orthopaedics, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200092, People's Republic of China
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Liu S, Hall DJ, Della Valle CJ, Walsh MJ, Jacobs JJ, Pourzal R. Simultaneous Characterization of Implant Wear and Tribocorrosion Debris within Its Corresponding Tissue Response Using Infrared Chemical Imaging. ACTA ACUST UNITED AC 2021; 26. [PMID: 33829077 DOI: 10.1016/j.biotri.2021.100163] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Biotribology is one of the key branches in the field of artificial joint development. Wear and corrosion are among fundamental processes which cause material loss in a joint biotribological system; the characteristics of wear and corrosion debris are central to determining the in vivo bioreactivity. Much effort has been made elucidating the debris-induced tissue responses. However, due to the complexity of the biological environment of the artificial joint, as well as a lack of effective imaging tools, there is still very little understanding of the size, composition, and concentration of the particles needed to trigger adverse local tissue reactions, including periprosthetic osteolysis. Fourier transform infrared spectroscopic imaging (FTIR-I) provides fast biochemical composition analysis in the direct context of underlying physiological conditions with micron-level spatial resolution, and minimal additional sample preparation in conjunction with the standard histopathological analysis workflow. In this study, we have demonstrated that FTIR-I can be utilized to accurately identify fine polyethylene debris accumulation in macrophages that is not achievable using conventional or polarized light microscope with histological staining. Further, a major tribocorrosion product, chromium phosphate, can be characterized within its histological milieu, while simultaneously identifying the involved immune cell such as macrophages and lymphocytes. In addition, we have shown the different spectral features of particle-laden macrophages through image clustering analysis. The presence of particle composition variance inside macrophages could shed light on debris evolution after detachment from the implant surface. The success of applying FTIR-I in the characterization of prosthetic debris within their biological context may very well open a new avenue of research in the orthopedics community.
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Affiliation(s)
- Songyun Liu
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, United States.,Richard and Loan Hill Department of Bioengineering, University of Illinois at Chicago, Chicago, IL, United States
| | - Deborah J Hall
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, United States
| | - Craig J Della Valle
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, United States
| | - Michael J Walsh
- Material Sciences and Biomedical Engineering Department, University of Wisconsin-Eau Claire, Eau Claire, WI, United States
| | - Joshua J Jacobs
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, United States
| | - Robin Pourzal
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, United States
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5
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Radice S, Westrick J, Ebinger K, Mathew MT, Wimmer MA. In-vitro studies on cells and tissues in tribocorrosion processes: A systematic scoping review. ACTA ACUST UNITED AC 2020; 24. [PMID: 33015276 DOI: 10.1016/j.biotri.2020.100145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Tribocorrosion of implants has been widely addressed in the orthopedic and dental research fields. This study is a systematic scoping review about research methods that combine tribocorrosion tests with cells/tissues cultures, aimed to identify related current problems and future challenges. We used 4 different databases to identify 1022 records responding to an articulated keywords search-strategy. After removing the duplicates and the articles that didn't meet the search-criteria, we assessed 20 full-text articles for eligibility. Of the 20 eligible articles, we charted 8 records on cell cultures combined with tribocorrosion tests on implant materials (titanium, CoCrMo, and/or stainless steel). The year of publication ranged from 1991 to 2019. The cell line used was mostly murine. Two records used fretting tests, while 6 used reciprocating sliding with pin-on-disc tribometers. An electrochemical three-electrode setup was used in 4 records. We identified overall two experimental approaches: cells cultured on the metal (5 records), and cells cultured near the metal (3 records). Research activities on tribocorrosion processes in the presence of cells have been undertaken worldwide by a few groups. After a limited initial interest on this topic in the 1990's, research activities have restarted in the last decade, renewing the topic with technologically more advanced setups and analytical tools. We identified the main problems to be the lack of test reproducibility and wear particle characterization. We believe that the main challenges lay in the interdisciplinary approach, the inter-laboratory validation of experiments, and the interpretation of results, particularly in relation to potential clinical significance.
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Affiliation(s)
- S Radice
- Rush University Medical Center, Department of Orthopedic Surgery, 1611 W. Harrison St., Chicago, IL 60612, USA
| | - J Westrick
- Library of Rush University Medical Center, 600 S. Paulina St., Chicago, IL 60612, USA
| | - K Ebinger
- Klinikum Garmisch-Partenkirche, Auenstraße 6, 82467 Garmisch-Partenkirchen, Germany
| | - M T Mathew
- College of Medicine at Rockford, University of Illinois, Department of Biomedical Sciences, 1601 Parkview Avenue, Rockford, IL 61107, USA
| | - M A Wimmer
- Rush University Medical Center, Department of Orthopedic Surgery, 1611 W. Harrison St., Chicago, IL 60612, USA
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6
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Eltit F, Wang Q, Wang R. Mechanisms of Adverse Local Tissue Reactions to Hip Implants. Front Bioeng Biotechnol 2019; 7:176. [PMID: 31417898 PMCID: PMC6683860 DOI: 10.3389/fbioe.2019.00176] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 07/08/2019] [Indexed: 12/11/2022] Open
Abstract
Adverse Local Tissue Reactions (ALTRs) are one of the main causes of hip implant failures. Although the metal release from the implants is considered as a main etiology, the mechanisms, and the roles of the released products are topics of ongoing research. The alloys used in the hip implants are considered biocompatible and show negligible corrosion in the body environment under static conditions. However, modularity and its associated mechanically assisted corrosion have been shown to release metal species into the body fluids. ALTRs associated with metal release have been observed in hip implants with metal-on-metal articulation initially, and later with metal-on-polyethylene articulation, the most commonly used design in current hip replacement. The etiological factors in ALTRs have been the topics of many studies. One commonly accepted theory is that the interactions between the metal species and body proteins and cells generate a delayed type IV hypersensitivity reaction leading to ALTRs. However, lymphocyte reactions are not always observed in ALTRS, and the molecular mechanisms have not been clearly demonstrated. A more accepted mechanism is that cell damage generated by metal ions may trigger the secretion of cytokines leading to the inflammatory reactions observed in ALTRs. In this inflammatory environment, some patients would develop hypersensitivity that is associated with poor outcomes. Concerns over ALTRS have brought significant impact to both the clinical selection and development of hip implants. This review is focused on the mechanisms of ALTRs, specifically, the metal release process and the roles of the metal species released in the etiology and pathogenesis of the disease. Hopefully, our presentation and discussion of this biological process from a material perspective could improve our current understanding on the ALTRs and provide useful guidance in developing preventive solutions.
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Affiliation(s)
- Felipe Eltit
- Department of Materials Engineering, University of British Columba, Vancouver, BC, Canada.,School of Biomedical Engineering, University of British Columba, Vancouver, BC, Canada.,Centre for Hip Health and Mobility, Vancouver, BC, Canada
| | - Qiong Wang
- Department of Materials Engineering, University of British Columba, Vancouver, BC, Canada.,School of Biomedical Engineering, University of British Columba, Vancouver, BC, Canada.,Centre for Hip Health and Mobility, Vancouver, BC, Canada
| | - Rizhi Wang
- Department of Materials Engineering, University of British Columba, Vancouver, BC, Canada.,School of Biomedical Engineering, University of British Columba, Vancouver, BC, Canada.,Centre for Hip Health and Mobility, Vancouver, BC, Canada
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7
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Radice S, Holcomb T, Pourzal R, Hallab NJ, Laurent MP, Wimmer MA. Investigation of CoCrMo material loss in a novel bio-tribometer designed to study direct cell reaction to wear and corrosion products. ACTA ACUST UNITED AC 2019; 18. [PMID: 30984811 DOI: 10.1016/j.biotri.2019.100090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Wear and corrosion in total hip replacement negatively impact implant service-life and patient well-being. The aim of this study was to generate a statistical response surface of material loss using an apparatus, capable of testing the effect of wear and corrosion products in situ on cells, such as macrophages. The test chamber of a ball-on-flat tribometer operating inside a CO2 incubator was integrated with an electrochemical setup and adapted for cell culture work. A 20-test series, following a 2-level 3-factor design of experiments, was performed with a ceramic head in reciprocating rotational motion against a CoCrMo-alloy disc, under constant load. The lubricant was cell culture medium (RPMI-1640+10vol% bovine serum). Response surfaces were generated, which statistically showed the influence of motion amplitude, load, and potential on the total mass loss and wear scar volume of the metallic discs. Potential had the highest impact on the total mass loss, while motion amplitude and load significantly influenced the wear scar volume. The concentrations of the alloy elements found in the lubricants reflected the bulk-alloy stoichiometry. The total concentration of Co released into the lubricant (2.3-63 ppm by total mass loss, 1.5 to 62 ppm by ICP-MS) corresponded well with the known range to trigger cell response. Tribocorrosion tests in the presence of cells and tissues, such as macrophages, lymphocytes and/or synovium, will be carried out in the future.
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Affiliation(s)
- S Radice
- Department of Orthopedic Surgery, Rush UniversityMedical Center, Chicago, IL, USA
| | - T Holcomb
- Department of Orthopedic Surgery, Rush UniversityMedical Center, Chicago, IL, USA
| | - R Pourzal
- Department of Orthopedic Surgery, Rush UniversityMedical Center, Chicago, IL, USA
| | - N J Hallab
- Department of Orthopedic Surgery, Rush UniversityMedical Center, Chicago, IL, USA
| | - M P Laurent
- Department of Orthopedic Surgery, Rush UniversityMedical Center, Chicago, IL, USA
| | - M A Wimmer
- Department of Orthopedic Surgery, Rush UniversityMedical Center, Chicago, IL, USA
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8
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Kovochich M, Finley BL, Novick R, Monnot AD, Donovan E, Unice KM, Fung ES, Fung D, Paustenbach DJ. Understanding outcomes and toxicological aspects of second generation metal-on-metal hip implants: a state-of-the-art review. Crit Rev Toxicol 2019; 48:853-901. [DOI: 10.1080/10408444.2018.1563048] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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9
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Lehtovirta L, Reito A, Parkkinen J, Peräniemi S, Vepsäläinen J, Eskelinen A. Association between periprosthetic tissue metal content, whole blood and synovial fluid metal ion levels and histopathological findings in patients with failed metal-on-metal hip replacement. PLoS One 2018; 13:e0197614. [PMID: 29768492 PMCID: PMC5955572 DOI: 10.1371/journal.pone.0197614] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 05/04/2018] [Indexed: 02/08/2023] Open
Abstract
Adverse Reaction to Metal Debris (ARMD) is a major cause of implant failure leading to revision surgery in patients with metal-on-metal (MoM) hip arthroplasties. However, the pathogenesis and its association to implant wear are poorly understood and previous studies have yielded discrepant results. We sought to investigate the associations between histological findings, whole blood and synovial fluid metal ion concentrations and periprosthetic tissue metal concentrations in patients with MoM total hip replacements and hip resurfacings revised for ARMD. 107 hips in total were included in our study. Of these, 87 were total hip replacements and 20 were hip resurfacings, respectively. We found that whole blood, synovial fluid and periprosthetic tissue metal concentrations correlated poorly with histological findings. We suggest that the lack of a clear association between histological findings and wear measures in the present study as well as in previous studies is mostly influenced by variability in patient susceptibility. However, patients presenting with perivascular lymphocytic infiltration had lower chromium concentration in their periprosthetic tissues than patients with no perivascular lymphocytic infiltration. This may reflect the role of metal hypersensitivity in implant failure in these patients. Patients with total hip replacements evinced more necrosis and lymphocytic infiltration in their tissues than patients with hip resurfacings. This suggests that trunnion wear debris is more cytotoxic and/or immunogenic than bearing wear debris leading to higher failure rates seen in patients with total hip replacements.
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Affiliation(s)
- Lari Lehtovirta
- University of Tampere, Tampere, Finland
- Coxa Hospital for Joint Replacement, Tampere, Finland
- * E-mail:
| | - Aleksi Reito
- Coxa Hospital for Joint Replacement, Tampere, Finland
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10
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Lanting BA, Teeter MG, Howard JL, MacDonald SJ, Van Citters DW. Metal-on-Metal Compared With Metal-on-Polyethylene: The Effect on Trunnion Corrosion in Total Hip Arthroplasty. J Arthroplasty 2017; 32:2574-2579. [PMID: 28483210 DOI: 10.1016/j.arth.2017.03.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 02/03/2017] [Accepted: 03/06/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Trunnion tribocorrosion in total hip arthroplasties is concerning, but retrieval studies often are subjective or lack comparison groups. Quantitative comparisons of clinically relevant implants are required. The purpose of this investigation was to evaluate material loss in metal-on-metal (MoM) and metal-on-polyethylene (MoP) total hip articulations while controlling for trunnion design and head size. METHODS The 166 retrieved femoral heads from 2 manufacturers were analyzed. Four cohorts based on head size, trunnion design, manufacturer, and articulation type (MoM vs MoP) were created. Corrosion was measured by a coordinate measurement machine, and material loss was assessed (MATLAB). RESULTS Retrieved femoral heads from MoP articulations had 5 times less trunnion material loss than MoM articulations, on average, for both manufacturers. There was no difference in material loss between large modular head (>40 mm) and 36-mm MoM hip trunnion. Implants with a material loss above the detectable limit demonstrated a correlation with time in vivo only in MoP articulations. CONCLUSION Retrieved femoral heads from MoP bearing couples had a lower magnitude of material loss than MoM couples, independent of head diameter. A time in vivo effect was only seen in MoP bearings.
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Affiliation(s)
- Brent A Lanting
- Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences Centre-University Campus, University of Western Ontario, London, Ontario, Canada
| | - Matthew G Teeter
- Department of Surgery, London Health Sciences Centre-University Campus, University of Western Ontario, London, Ontario, Canada
| | - James L Howard
- Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences Centre-University Campus, University of Western Ontario, London, Ontario, Canada
| | - Steven J MacDonald
- Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences Centre-University Campus, University of Western Ontario, London, Ontario, Canada
| | - Douglas W Van Citters
- Department of Surgery, Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
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11
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In-situ Generated Tribomaterial in Metal/Metal Contacts: current understanding and future implications for implants. ACTA ACUST UNITED AC 2017; 10:42-50. [PMID: 28808674 DOI: 10.1016/j.biotri.2017.03.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Artificial hip joints operate in aqueous biofluids that are highly reactive towards metallic surfaces. The reactivity at the metal interface is enhanced by mechanical interaction due to friction, which can change the near-surface structure of the metal and surface chemistry. There are now several reports in the literature about the in-situ generation of reaction films and tribo-metallurgical transformations on metal-on-metal hip joints. This paper summarizes current knowledge and provides a mechanistic interpretation of the surface chemical and metallurgical phenomena. Basic concepts of corrosion and wear are illustrated and used to interpret available literature on in-vitro and in-vivo studies of metal-on-metal hip joints. Based on this review, three forms of tribomaterial, characterized by different combinations of oxide films and organic layers, can be determined. It is shown that the generation of these tribofilms can be related to specific electrochemical and mechanical phenomena in the metal interface. It is suggested that the generation of this surface reaction layer constitutes a way to minimize (mechanical) wear of MoM hip implants.
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12
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Kovochich M, Fung ES, Donovan E, Unice KM, Paustenbach DJ, Finley BL. Characterization of wear debris from metal-on-metal hip implants during normal wear versus edge-loading conditions. J Biomed Mater Res B Appl Biomater 2017; 106:986-996. [PMID: 28480531 DOI: 10.1002/jbm.b.33902] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 03/14/2017] [Accepted: 04/03/2017] [Indexed: 12/12/2022]
Abstract
Advantages of second-generation metal-on-metal (MoM) hip implants include low volumetric wear rates and the release of nanosized wear particles that are chemically inert and readily cleared from local tissue. In some patients, edge loading conditions occur, which result in higher volumetric wear. The objective of this study was to characterize the size, morphology, and chemistry of wear particles released from MoM hip implants during normal (40° angle) and edge-loading (65° angle with microseparation) conditions. The mean primary particle size by volume under normal wear was 35 nm (range: 9-152 nm) compared with 95 nm (range: 6-573 nm) under edge-loading conditions. Hydrodynamic diameter analysis by volume showed that particles from normal wear were in the nano- (<100 nm) to submicron (<1000 nm) size range, whereas edge-loading conditions generated particles that ranged from <100 nm up to 3000-6000 nm in size. Particles isolated from normal wear were primarily chromium (98.5%) and round to oval in shape. Edge-loading conditions generated more elongated particles (4.5%) (aspect ratio ≥ 2.5) and more CoCr alloy particles (9.3%) compared with normal wear conditions (1.3% CoCr particles). By total mass, edge-loading particles contained approximately 640-fold more cobalt than normal wear particles. Our findings suggest that high wear conditions are a potential risk factor for adverse local tissue effects in MoM patients who experience edge loading. This study is the first to characterize both the physical and chemical characteristics of MoM wear particles collected under normal and edge-loading conditions. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 986-996, 2018.
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13
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A preliminary evaluation of immune stimulation following exposure to metal particles and ions using the mouse popliteal lymph node assay. Toxicol Appl Pharmacol 2016; 308:77-90. [DOI: 10.1016/j.taap.2016.07.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 06/17/2016] [Accepted: 07/26/2016] [Indexed: 01/22/2023]
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14
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Medley JB. Can physical joint simulators be used to anticipate clinical wear problems of new joint replacement implants prior to market release? Proc Inst Mech Eng H 2016; 230:347-58. [PMID: 27160555 DOI: 10.1177/0954411916643902] [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: 02/21/2016] [Accepted: 03/18/2016] [Indexed: 11/16/2022]
Abstract
One of the most important mandates of physical joint simulators is to provide test results that allow the implant manufacturer to anticipate and perhaps avoid clinical wear problems with their new products. This is best done before market release. This study gives four steps to follow in conducting such wear simulator testing. Two major examples involving hip wear simulators are discussed in which attempts had been made to predict clinical wear performance prior to market release. The second one, involving the DePuy ASR implant systems, is chosen for more extensive treatment by making it an illustrative example to explore whether wear simulator testing can anticipate clinical wear problems. It is concluded that hip wear simulator testing did provide data in the academic literature that indicated some risk of clinical wear problems prior to market release of the ASR implant systems. This supports the idea that physical joint simulators have an important role in the pre-market testing of new joint replacement implants.
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Affiliation(s)
- John B Medley
- Department of Mechanical and Mechatronics Engineering, University of Waterloo, Waterloo, ON, Canada
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15
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Pettersson M, Skjöldebrand C, Filho L, Engqvist H, Persson C. Morphology and Dissolution Rate of Wear Debris from Silicon Nitride Coatings. ACS Biomater Sci Eng 2016; 2:998-1004. [DOI: 10.1021/acsbiomaterials.6b00133] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Maria Pettersson
- Materials in Medicine Group,
Division of Applied Materials Science, Department of Engineering Sciences, Uppsala University, Lägerhyddsvägen 1, 752
37 Uppsala, Sweden
| | - Charlotte Skjöldebrand
- Materials in Medicine Group,
Division of Applied Materials Science, Department of Engineering Sciences, Uppsala University, Lägerhyddsvägen 1, 752
37 Uppsala, Sweden
| | - Luimar Filho
- Materials in Medicine Group,
Division of Applied Materials Science, Department of Engineering Sciences, Uppsala University, Lägerhyddsvägen 1, 752
37 Uppsala, Sweden
| | - Håkan Engqvist
- Materials in Medicine Group,
Division of Applied Materials Science, Department of Engineering Sciences, Uppsala University, Lägerhyddsvägen 1, 752
37 Uppsala, Sweden
| | - Cecilia Persson
- Materials in Medicine Group,
Division of Applied Materials Science, Department of Engineering Sciences, Uppsala University, Lägerhyddsvägen 1, 752
37 Uppsala, Sweden
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Kerwell S, Alfaro M, Pourzal R, Lundberg HJ, Liao Y, Sukotjo C, Mercuri LG, Mathew MT. Examination of failed retrieved temporomandibular joint (TMJ) implants. Acta Biomater 2016; 32:324-335. [PMID: 26768232 DOI: 10.1016/j.actbio.2016.01.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 12/09/2015] [Accepted: 01/03/2016] [Indexed: 12/27/2022]
Abstract
In the management of end-stage temporomandibular joint disorders (TMD), surgeons must often resort to alloplastic temporomandibular joint (TMJ) total joint replacement (TJR) to increase mandibular function and form, as well as reduce pain. Understanding wear and failure mechanisms of TMJ TJR implants is important to their in vivo longevity. However, compared to orthopedic TJR devices, functional wear of failed TMJ TJR implants has not been examined. Not only do wear and corrosion influence TJR implant in vivo longevity, but so does reactivity of peri-implant tissue to these two events. The aim of this study was to examine and report on the wear of retrieved, failed metal-on-metal (MoM), metal-on-polymer (MoP), and titanium-nitride coated (TiN Coated) TMJ TJR implant components. A total cohort of 31 TMJ TJR devices were studied of which 28 were failed, retrieved TMJ TJRs, 3 were never implanted devices that served as controls. The mean time from implantation to removal was 7.24 years (range 3-15), SD 3.01. Optical microscopy, White Light Interferometry (WLI), Scanning Electron Microscopy (SEM), and Raman spectroscopy were utilized to characterize the surfaces of the devices. Data was acquired and evaluated by analyzing alloy microstructure. Substantial surface damage was observed between the articulating areas of the condylar head and the glenoid fossa components. Damage included pitting corrosion, evidence of deposited corrosion products, specific wear patterns, hard phases, surface depressions, and bi-directional scratches. Electrochemical analysis was performed on the MoM Control, retrieved, failed MoM, and TiN Coated devices. Electrochemical tests consisted of open circuit potential (OCP) and electrochemical impedance spectroscopy (EIS) tests conducted using the condylar head of the retrieved failed devices. EIS confirmed material properties as well as corrosion kinetics in vivo help to mitigate corrosion as reflected by the Raman spectroscopy results. In summary, this study demonstrated the role of wear and corrosion interactions on the early failure of TMJ TJR devices. Since the materials employed in most orthopedic TJR devices are similar to those used in TMJ TJR implants, studies such as this can provide data that will improve future embodiment paradigms for both. Further studies will include in vitro investigation of corrosion kinetics and the underlying tribocorrosion mechanism of TMJ TJR devices. STATEMENT OF SIGNIFICANCE An attempt is made in this study, to examine the retrieved TMJ implants and conduct surface and electrochemical analysis; further a translation research approach is employed to compare the observations from the total hip replacement (THR) retrievals. A total cohort of 31 TMJ TJR devices were studied of which 28 were failed, retrieved TMJ TJRs, 3 were never implanted devices that served as controls. Data was acquired and evaluated by analyzing alloy microstructure. Substantial surface damage was observed between the articulating areas of the condylar head and the glenoid fossa components. Electrochemical analysis was performed on the MoM Control, retrieved, failed MoM, and TiN Coated devices. This study demonstrated the role of wear and corrosion interactions on the early failure of TMJ TJR devices. Since the materials employed in most orthopedic TJR devices are similar to those used in TMJ TJR implants, a comparison study was conducted.
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Affiliation(s)
- S Kerwell
- Department of Bioengineering, University of Illinois at Chicago, Chicago, USA; Department of Orthopedic Surgery, Rush University Medical Center, Chicago, USA; Institute of Biomaterials, Tribocorrosion and Nanomedicine (IBTN), Chicago, IL, USA
| | - M Alfaro
- Department of Restorative Dentistry, University of Illinois at Chicago, Chicago, USA; Institute of Biomaterials, Tribocorrosion and Nanomedicine (IBTN), Chicago, IL, USA
| | - R Pourzal
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, USA
| | - H J Lundberg
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, USA
| | - Y Liao
- Department of Material Science and Engineering, Northwestern University, Evanston, IL, USA
| | - C Sukotjo
- Department of Restorative Dentistry, University of Illinois at Chicago, Chicago, USA; Institute of Biomaterials, Tribocorrosion and Nanomedicine (IBTN), Chicago, IL, USA
| | - L G Mercuri
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, USA; Institute of Biomaterials, Tribocorrosion and Nanomedicine (IBTN), Chicago, IL, USA
| | - M T Mathew
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, USA; Department of Restorative Dentistry, University of Illinois at Chicago, Chicago, USA; Institute of Biomaterials, Tribocorrosion and Nanomedicine (IBTN), Chicago, IL, USA.
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17
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Toxicology of wear particles of cobalt-chromium alloy metal-on-metal hip implants Part I: Physicochemical properties in patient and simulator studies. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2015; 11:1201-15. [DOI: 10.1016/j.nano.2014.12.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 11/19/2014] [Accepted: 12/03/2014] [Indexed: 12/27/2022]
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Madl AK, Kovochich M, Liong M, Finley BL, Paustenbach DJ, Oberdörster G. Toxicology of wear particles of cobalt-chromium alloy metal-on-metal hip implants Part II: Importance of physicochemical properties and dose in animal and in vitro studies as a basis for risk assessment. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2015; 11:1285-98. [PMID: 25735266 DOI: 10.1016/j.nano.2015.02.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 12/03/2014] [Indexed: 12/28/2022]
Abstract
The objective of the Part II analysis was to evaluate animal and in vitro toxicology studies of CoCr particles with respect to their physicochemistry and dose relevance to metal-on-metal (MoM) implant patients as derived from Part I. In the various toxicology studies, physicochemical characteristics were infrequently considered and administered doses were orders of magnitude higher than what occurs in patients. Co was consistently shown to rapidly release from CoCr particles for distribution and elimination from the body. CoCr micron sized particles appear more biopersistent in vivo resulting in inflammatory responses that are not seen with similar mass concentrations of nanoparticles. We conclude, that in an attempt to obtain data for a complete risk assessment, future studies need to focus on physicochemical characteristics of nano and micron sized particles and on doses and dose metrics relevant to those generated in patients or in properly conducted hip simulator studies.
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Affiliation(s)
| | | | | | | | | | - Günter Oberdörster
- University of Rochester, Department of Environmental Medicine, Rochester, NY, USA
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19
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Prokopovich P. Interactions between mammalian cells and nano- or micro-sized wear particles: physico-chemical views against biological approaches. Adv Colloid Interface Sci 2014; 213:36-47. [PMID: 25307126 DOI: 10.1016/j.cis.2014.09.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Revised: 08/20/2014] [Accepted: 09/06/2014] [Indexed: 11/26/2022]
Abstract
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).
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20
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Affiliation(s)
- P Gopinathan
- Department of Orthopaedics, Gopinath Orthopaedic Centre, Calicut, Kerala 673305, India
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21
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Christian WV, Oliver LD, Paustenbach DJ, Kreider ML, Finley BL. Toxicology-based cancer causation analysis of CoCr-containing hip implants: a quantitative assessment of genotoxicity and tumorigenicity studies. J Appl Toxicol 2014; 34:939-67. [DOI: 10.1002/jat.3039] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 05/23/2014] [Accepted: 05/24/2014] [Indexed: 12/12/2022]
Affiliation(s)
| | - Lindsay D. Oliver
- Cardno ChemRisk; LLC, 4840 Pearl East Circle, Suite 300 West Boulder CO 80301 USA
| | | | - Marisa L. Kreider
- Cardno ChemRisk, LLC; 20 Stanwix St., Suite 505 Pittsburgh PA 15222 USA
| | - Brent L. Finley
- Cardno ChemRisk; LLC, 231 Front St., Suite 201 Brooklyn NY 11201 USA
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22
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Monnot AD, Christian WV, Paustenbach DJ, Finley BL. Correlation of blood Cr(III) and adverse health effects: Application of PBPK modeling to determine non-toxic blood concentrations. Crit Rev Toxicol 2014; 44:618-37. [DOI: 10.3109/10408444.2014.926472] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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23
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Okazaki Y. Effect of head size on wear properties of metal-on-metal bearings of hip prostheses, and comparison with wear properties of metal-on-polyethylene bearings using hip simulator. J Mech Behav Biomed Mater 2013; 31:152-63. [PMID: 24290355 DOI: 10.1016/j.jmbbm.2013.10.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Revised: 10/13/2013] [Accepted: 10/29/2013] [Indexed: 11/18/2022]
Abstract
The effects of articular head size on the wear losses of the metal insert and articular head for a metal-on-metal bearing were examined using a hip simulator manufactured to satisfy ISO 14242-1. The wear properties of metal-on-metal and metal-on-polyethylene bearings were also compared under the same conditions. The total wear losses of the metal insert and articular head decreased with increasing diameter of the metal insert in the range from 28 to 44mm. The total wear loss was greater for a diameter of 48mm than for a diameter of 44mm. When the articular metal insert diameter was smaller than 44mm, the wear loss was reduced because the contact surface pressure increased with increasing metal insert diameter. However, the increase in wear loss observed for the 48-mm-diameter insert might have been due to the considerable increase in the rotation moment with increasing insert diameter. The tendency of decreasing contact pressure calculated using the Hertzian contact stress equation nearly conformed to the change in wear loss. On the other hand, the wear loss of an artificial hip joint consisting of a cross-linked ultrahigh-molecular-weight polyethylene insert (UHMWPE) and a Co-Cr-Mo articular head was small.
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Affiliation(s)
- Yoshimitsu Okazaki
- National Institute of Advanced Industrial Science and Technology, 1-1 Higashi 1-chome, Tsukuba, Ibaraki 305-8566, Japan.
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24
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Caicedo MS, Samelko L, McAllister K, Jacobs JJ, Hallab NJ. Increasing both CoCrMo-alloy particle size and surface irregularity induces increased macrophage inflammasome activation in vitro potentially through lysosomal destabilization mechanisms. J Orthop Res 2013; 31:1633-42. [PMID: 23794526 PMCID: PMC4028039 DOI: 10.1002/jor.22411] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 05/28/2013] [Indexed: 02/04/2023]
Abstract
Recent investigations indicate that innate immune "danger-signaling" pathways mediate metal implant debris induced-inflammatory responses, for example, NALP3 inflammasome. How the physical characteristics of particles (size, shape, and chemical composition) affect this inflammatory reactivity remains controversial. We examined the role of Cobalt-Chromium-Molybdenum (CoCrMo) alloy particle shape and size on human macrophage phagocytosis, lysosomal destabilization, and inflammasome activation. Round/smooth versus irregularly shaped/rough CoCrMo-alloy particles of ∼1 and 6-7 µm diameter were investigated for differential lysosomal damage and inflammasome activation in human monocytes/macrophages. While spherical/smooth 1 µm CoCrMo-alloy particles did not measurably affect macrophage IL-1β production, irregular 1 µm CoCrMo-alloy particles induced significant IL-1β increases over controls. Both round/smooth particles and irregular CoCrMo-alloy particles that were 6-7 µm in size induced >10-fold increases in IL-1β production compared to similarly shaped smaller particles (p < 0.05). Larger irregular particles induced a greater degree of intracellular lysosomal damage and a >3-fold increase in IL-1β versus similarly sized round/smooth particles (at an equal dose, particles/cell). CoCrMo-alloy particle-size-induced IL-1β production was dependent on the lysosomal protease Cathepsin B, further supporting lysosomal destabilization as causative in inflammation. Phagocytosable larger/irregular shaped particles (6 µm) demonstrated the greatest lysosomal destabilization (observed immunofluorescently) and inflammatory reactivity when compared on an equal dose basis (particles/cell) to smaller/spherical 1 µm particles in vitro.
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Affiliation(s)
- Marco S Caicedo
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612,Orthopedic Analysis, LLC, Chicago, IL 60612
| | - Lauryn Samelko
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612,Department of Immunology, Rush University Medical Center, Chicago, IL 60612
| | - Kyron McAllister
- Department of Immunology, Rush University Medical Center, Chicago, IL 60612
| | - Joshua J Jacobs
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612
| | - Nadim J Hallab
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612,Department of Immunology, Rush University Medical Center, Chicago, IL 60612,Orthopedic Analysis, LLC, Chicago, IL 60612
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25
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VanOs R, Lildhar LL, Lehoux EA, Beaulé PE, Catelas I. In vitro macrophage response to nanometer-size chromium oxide particles. J Biomed Mater Res B Appl Biomater 2013; 102:149-59. [PMID: 23997019 DOI: 10.1002/jbm.b.32991] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 04/05/2013] [Accepted: 05/28/2013] [Indexed: 12/13/2022]
Abstract
An increasing number of studies have reported adverse tissue reactions around metal-on-metal (MM) hip implants. However, the origin and mechanisms of these reactions remain unclear. Moreover, the biological effects of nanometer-size chromium oxide particles, the predominant type of wear particles produced by MM implants, remain mostly unknown. The purpose of this study was to analyze the cytotoxic effects of clinically relevant nanometer-size chromium oxide particles on macrophage response in vitro. J774.A1 macrophages were cultured with either 60 nm or 700 nm commercially available Cr2 O3 particles at different concentrations. Two different particle sizes were analyzed to evaluate potential volume effects. Cell mortality was analyzed by light microscopy, flow cytometry (annexin V-fluorescein isothiocyanate and propidium iodide assay), and using a cell death detection enzyme-linked immunosorbant assay (ELISA). Tumor necrosis factor alpha (TNF-α), monocyte chemotactic protein-1 (MCP-1), and macrophage inflammatory protein-1 alpha (MIP-1α) release was measured by ELISA, and gene expression was analyzed by quantitative real-time PCR. Results showed that, at high concentrations, Cr2 O3 particles of both sizes can be cytotoxic, inducing significant decreases in total cell numbers and increases in necrosis. Results also suggested that these effects were dependent on particle volume. However, TNF-α, MCP-1, and MIP-1α cytokine release and gene expression remained low. Overall, this study demonstrates that nanometer-size particles of Cr2 O3 , a stable form of chromium oxide ceramic, have rather low cytotoxic effects on macrophages. Therefore, these particles may not be the main culprit in the initiation of the inflammatory reaction in MM periprosthetic tissues. However, other parameters (e.g., potential intracellular damage) remain to be investigated.
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Affiliation(s)
- Robilyn VanOs
- Department of Mechanical Engineering, University of Ottawa, Ottawa, Ontario K1N 6N5, Canada
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26
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Abstract
AbstractThe characterization of wear particles is of great importance in understanding the mechanisms of osteolysis. In this unique study, thirty-one tissue samples were retrieved at revision surgeries of hip implants and divided into four groups according to the composition of metal prosthetic components. Tissue samples were first analyzed histologically and then by scanning electron microscopy (SEM) combined with back-scattered electron imaging and energy dispersive X-ray spectroscopy. Therefore, particles were studied directly in situ in tissue sections, without the requirement for particle isolation. The composition of metal wear particles detected in the tissue sections corresponded to the composition of the implant components. A considerable number of large metal particles were actually clusters of submicron particles. The clustering of submicron particles was observed primarily with CoCrMo (cobalt-chromiummolybdenum) and, to a lesser extent, for stainless steel particles. SEM secondary and back-scattered electron imaging was an appropriate and selective method for recognizing the composition of metal particles in the in situ tissue sections, without destroying their spatial relationship within the histology. This method can be used as a screening tool for composition of metal and ceramic particles in tissue sections, or as an additional method for particle identification.
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27
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Potnis PA, Dutta DK, Wood SC. Toll-like receptor 4 signaling pathway mediates proinflammatory immune response to cobalt-alloy particles. Cell Immunol 2013; 282:53-65. [PMID: 23680697 DOI: 10.1016/j.cellimm.2013.04.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 03/25/2013] [Accepted: 04/12/2013] [Indexed: 12/27/2022]
Abstract
Metal orthopedic implant debris-induced osteolysis of hip bone is a major problem in patients with prosthetic-hips. Although macrophages are the principal targets for implant-wear debris, the receptor(s) and mechanisms underlying these responses are not fully elucidated. We examined whether the TLR4 pathway mediates immune response to metal-on-metal (MoM) implant-generated wear particles. Human monocytes (THP-1) were exposed to Co-alloy particles at increasing particle:cell ratio for 24 h. Challenge with particles caused up-regulation of IL-1β, TNF-α and IL-8, and mediated degradation of cytosolic I-κB and nuclear translocation of NF-κB. Blocking antibodies against TLR4 or gene silencing of MyD88 and IRAK-1 prevented particle-induced I-κB/NF-κB activation response and markedly inhibited IL-8 release. Particle-mediated IL-8 response was not observed in TLR4-negative HEK293T cells; whereas transfection-based TLR4-overexpression in HEK293T enabled particle-sensitivity, as observed by I-κB degradation and IL-8 expression in response to particles. Results demonstrate that Co-alloy particles trigger immune response via the TLR4-MyD88-dependent signaling pathway.
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Affiliation(s)
- Pushya A Potnis
- Division of Biology, Office of Science and Engineering Laboratories (OSEL), Center for Devices and Radiological Health (CDRH), Food and Drug Administration (FDA), USA.
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28
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Al-Hajjar M, Fisher J, Williams S, Tipper JL, Jennings LM. Effect of femoral head size on the wear of metal on metal bearings in total hip replacements under adverse edge-loading conditions. J Biomed Mater Res B Appl Biomater 2013; 101:213-22. [PMID: 23281164 PMCID: PMC3746118 DOI: 10.1002/jbm.b.32824] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 06/24/2012] [Accepted: 08/05/2012] [Indexed: 12/12/2022]
Abstract
Metal-on-metal (MoM) bearings have shown low-wear rates under standard hip simulator conditions; however, retrieval studies have shown large variations in wear rates and mechanisms. High-wear in vivo has caused catastrophic complications and has been associated with steep cup-inclination angle (rotational malpositioning). However, increasing the cup-inclination angle in vitro has not replicated the increases in wear to the same extent as those observed in retrievals. Clinically relevant wear rates, patterns, and particles were observed in vitro for ceramic-on-ceramic bearings when microseparation (translational malpositioning) conditions were introduced into the gait cycle. In the present study, 28 and 36-mm MoM bearings were investigated under adverse conditions. Increasing the cup angle from 45° to 65° resulted in a significant increase in the wear rate of the 28 mm bearings. However, for the 36 mm bearings, head-rim contact did not occur under the steep cup-angle condition, and the wear rate did not increase. The introduction of microseparation to the gait cycle significantly increased the wear rate of the MoM bearings. Cup angle and head size did not influence the wear rate under microseparation conditions. This study indicated that high-in vivo wear rates were associated with edge loading due to rotational malpositioning such as high-cup-inclination angle and translational malpositioning that could occur due to several surgical factors. Translational malpositioning had a more dominant effect on the wear rate. Preclinical simulation testing should be undertaken with translational and rotational malpositioning conditions as well as standard walking cycle conditions defined by the ISO standard.
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Affiliation(s)
- Mazen Al-Hajjar
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, United Kingdom
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29
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Migaud H, Putman S, Combes A, Berton C, Bocquet D, Vasseur L, Girard J. Metal-on-Metal Bearing: Is This the End of the Line? We Do Not Think So. HSS J 2012; 8:262-9. [PMID: 24082870 PMCID: PMC3470659 DOI: 10.1007/s11420-012-9300-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2011] [Accepted: 07/05/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Recent studies have recommended the discontinuation of metal-on-metal (MoM) components in total hip arthroplasty (THA) because of adverse effects reported with large-diameter MoM THA. This is despite favorable long-term results observed with 28 and 32 mm MoM bearings. QUESTIONS/PURPOSES The aim of this study was to assess the value of calls for an end to MoM bearings as THA components. Specifically, we wish to address the risks associated with MoM bearings including adverse soft tissue reactions, metal ion release, and carcinogenic risk. METHODS The study evaluates the arguments in the literature reporting on MoM (adverse soft tissue reactions, metal ion release, and carcinogenic risk) and the experience of the current authors who re-introduced these bearings in 1995. They are balanced by a benefit-risk review of the literature and the authors' experience with MoM use. RESULTS Adverse reactions to metallic debris as well as metal ion release are predictable and can be prevented by adequate design (arc of coverage, clearance), metallurgy (forged instead of cast alloy, high-carbide content), and appropriate component orientation. There is no scientific evidence that carcinogenicity is increased in subjects with MoM hip prostheses. MoM articulations appear to be attractive allowing safe hip resurfacing, decreasing the risk of THA revision in active patients, and providing secure THA fixation with cement in cages in severely deformed hips. MoM bearings in women of child-bearing age are controversial, but long-term data on metallic devices in adolescents undergoing spinal surgery seem reassuring. DISCUSSION Adequate selection of MoM articulations ensures their safe use. These articulations are sensitive to orientation. Fifteen years of safe experience with 28- and 32-mm bearings of forged alloy and high-carbide content is the main reason for retaining them in primary and revision THA.
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Affiliation(s)
- Henri Migaud
- Department of Orthopedic Surgery, Roger Salengro Hospital, University of Lille, 2 Av Oscar Lambret, 59037 Lille Cedex, France ,Orthopaedics Department, University of Lille, 2 avenue Oscar Lambret, 59037 Lille Cedex, France
| | - Sophie Putman
- Department of Orthopedic Surgery, Roger Salengro Hospital, University of Lille, 2 Av Oscar Lambret, 59037 Lille Cedex, France ,Orthopaedic Department, Lille University Hospital, 2 avenue Oscar Lambret, 59037 Lille Cedex, France
| | - Antoine Combes
- Department of Orthopedic Surgery, Roger Salengro Hospital, University of Lille, 2 Av Oscar Lambret, 59037 Lille Cedex, France ,Orthopaedics Department, University of Lille, 2 avenue Oscar Lambret, 59037 Lille Cedex, France
| | - Charles Berton
- Department of Orthopedic Surgery, Roger Salengro Hospital, University of Lille, 2 Av Oscar Lambret, 59037 Lille Cedex, France ,Orthopaedics Department, University of Lille, 2 avenue Oscar Lambret, 59037 Lille Cedex, France
| | - Donatien Bocquet
- Department of Orthopedic Surgery, Roger Salengro Hospital, University of Lille, 2 Av Oscar Lambret, 59037 Lille Cedex, France ,Orthopaedics Department, University of Lille, 2 avenue Oscar Lambret, 59037 Lille Cedex, France
| | - Laurent Vasseur
- Department of Orthopedic Surgery, Roger Salengro Hospital, University of Lille, 2 Av Oscar Lambret, 59037 Lille Cedex, France ,Orthopaedics Department, University of Lille, 2 avenue Oscar Lambret, 59037 Lille Cedex, France
| | - Julien Girard
- Department of Orthopedic Surgery, Roger Salengro Hospital, University of Lille, 2 Av Oscar Lambret, 59037 Lille Cedex, France ,Department of Sport and Medicine, University of Lille 2, Lille, France ,Orthopaedics Department, University of Lille, 2 avenue Oscar Lambret, 59037 Lille Cedex, France
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30
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Hart AJ, Quinn PD, Lali F, Sampson B, Skinner JA, Powell JJ, Nolan J, Tucker K, Donell S, Flanagan A, Mosselmans JFW. Cobalt from metal-on-metal hip replacements may be the clinically relevant active agent responsible for periprosthetic tissue reactions. Acta Biomater 2012; 8:3865-73. [PMID: 22688088 DOI: 10.1016/j.actbio.2012.05.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Revised: 04/30/2012] [Accepted: 05/04/2012] [Indexed: 11/29/2022]
Abstract
Some types of metal-on-metal (MOM) hip replacements have unacceptably high rates of failure, such as the Ultima TPS MOM hip, with 13.8% failure at 5 years. This has been attributed to an inflammatory reaction following the release of cobalt (Co) and chromium (Cr) from the bearing surfaces and modular junctions. There is in vitro evidence that Co is more important than Cr in the inflammatory process, but there are no reported human tissue studies of the analysis of implant-derived metals.
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Affiliation(s)
- Alister J Hart
- Department of Orthopaedic Surgery, Imperial College and Imperial College Healthcare NHS Trust, Charing Cross Hospital Campus, London, UK.
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31
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Golish SR, Anderson PA. Bearing surfaces for total disc arthroplasty: metal-on-metal versus metal-on-polyethylene and other biomaterials. Spine J 2012; 12:693-701. [PMID: 21700505 DOI: 10.1016/j.spinee.2011.05.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Revised: 04/10/2011] [Accepted: 05/16/2011] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Concerns about the effect of metallic wear debris from metal-on-metal bearing surfaces in total hip arthroplasty have increased. Some spinal arthroplasty devices include metal-on-metal bearing surfaces. PURPOSE To review the literature for clinical reports of complications because of wear debris from metal-on-metal spinal arthroplasty devices. To review the biology of wear debris from metal-on-metal bearing surfaces drawn from the hip arthroplasty literature and place it in the context of global regulatory actions and clinical and laboratory studies. STUDY DESIGN Literature review. METHODS To identify clinical reports, the PubMed database from the United States National Library of Medicine was queried using Medical Subject Headings terms and additional keyword terms. In addition, experts from academia and regulatory agencies were questioned regarding their knowledge of reports, including experts who attended the US Food and Drug Administration roundtable in September 2010. RESULTS Three case reports and one case series including seven total cases were identified in which abnormal inflammatory reactions and soft-tissue masses after metal-on-metal disc replacements were consistent with pseudotumor and metal hypersensitivity. Spinal cases are present as pain and neurologic symptoms. On plain radiography, there is no clear periprosthetic osteolysis or loosening. On magnetic resonance imaging, there is increased magnetic susceptibility artifact because of metallic debris that renders images inadequate. Computed tomography myelography demonstrates a soft-tissue mass, which exhibits epidural extension surgically. Histologically, large areas of necrotic debris and exudates are interspersed with chronic inflammatory cells. Lymphocyte or macrophage predominance is determined by the rate of wear and the presence of gross, microscopic, or submicron metallic wear debris. The metallurgy of the involved devices is cobalt-chromium-molybdenum (CoCrMo) alloy, and the bearing surface is CoCrMo-on-CoCrMo. CONCLUSIONS Metal-on-metal spinal arthroplasty devices are subject to postoperative complications because of metallic wear debris with similar clinical, radiographic, histologic, gross anatomic, and device-related features to those found in metal-on-metal bearing surfaces in total hip arthroplasty.
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Affiliation(s)
- S Raymond Golish
- Department of Orthopedic Surgery, PeaceHealth Corp., 1615 Delaware St., Longview, WA 98632-2367, USA.
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Dalal A, Pawar V, McAllister K, Weaver C, Hallab NJ. Orthopedic implant cobalt-alloy particles produce greater toxicity and inflammatory cytokines than titanium alloy and zirconium alloy-based particles in vitro, in human osteoblasts, fibroblasts, and macrophages. J Biomed Mater Res A 2012; 100:2147-58. [DOI: 10.1002/jbm.a.34122] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 02/22/2012] [Indexed: 12/13/2022]
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Finley BL, Monnot AD, Gaffney SH, Paustenbach DJ. Dose-response relationships for blood cobalt concentrations and health effects: a review of the literature and application of a biokinetic model. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART B, CRITICAL REVIEWS 2012; 15:493-523. [PMID: 23199219 DOI: 10.1080/10937404.2012.744287] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Cobalt (Co) is an essential component of vitamin B(12). As with all metals, at sufficiently high doses, Co may exert detrimental effects on different organ systems, and adverse responses have been observed in animals, patients undergoing Co therapy, and workers exposed to respirable Co particulates. Although blood Co concentrations are postulated to be the most accurate indicator of ongoing Co exposure, little is known regarding the dose-response relationships between blood Co concentrations and adverse health effects in various organ systems. In this analysis, the animal toxicology and epidemiology literature were evaluated to identify blood Co concentrations at which effects have, and have not, been reported. Where necessary, a biokinetic model was used to convert oral doses to blood Co concentrations. Our results indicated that blood Co concentrations of 300 μg/L and less have not been associated with adverse responses of any type in humans. Concentrations of 300 μg/L and higher were associated with certain hematological and reversible endocrine responses, including polycythemia and reduced iodide uptake. Blood Co concentrations of 700-800 μg Co/L and higher may pose a risk of more serious neurological, reproductive, or cardiac effects. These blood concentrations should be useful to clinicians and toxicologists who are attempting to interpret blood Co concentrations in exposed individuals.
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Characterization of metal-wear nanoparticles in pseudotumor following metal-on-metal hip resurfacing. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2011; 7:674-81. [PMID: 21856277 DOI: 10.1016/j.nano.2011.08.002] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Revised: 08/03/2011] [Accepted: 08/05/2011] [Indexed: 12/18/2022]
Abstract
UNLABELLED Biopsies from a typical case of pseudotumor following metal-on-metal hip resurfacing (MoMHR) were analyzed using light and transmission electron microscopy, backscatter scanning electron microscopy and energy dispersive x-ray spectrometry (EDS). Heavy macrophage infiltration was observed in all black pigmented specimens. Metal nanoparticles (NPs) were observed exclusively within phagosomes of living macrophages and fragments of dead macrophages. Although dead fibroblasts were found to be juxtaposed with dead and disintegrated macrophages, the NPs were not seen within either live or dead fibroblasts. Chromium (Cr) but not cobalt (Co) was the predominant component of the remaining wear NPs in tissue. The current study finding suggests that corrosion of Co in phagosomes of macrophages and resultant Co ion release lead to tissue necrosis and adverse soft tissue reactions (pseudotumors). Further studies are required to elucidate the precise mechanism of intracellular corrosion of metal NPs and the long-term toxicity of the Cr remaining in the peri-prosthetic tissues. FROM THE CLINICAL EDITOR In this study of metal-on-metal hip resurfacing-related tissue necrosis and pseudotumor formation, corrosion and decomposition of metallic cobalt in phagosomes of macrophages and resultant cobalt ion release were demonstrated to be the key elements of pathogenesis.
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Pourzal R, Catelas I, Theissmann R, Kaddick C, Fischer A. Characterization of Wear Particles Generated from CoCrMo Alloy under Sliding Wear Conditions. WEAR : AN INTERNATIONAL JOURNAL ON THE SCIENCE AND TECHNOLOGY OF FRICTION LUBRICATION AND WEAR 2011; 271:1658-1666. [PMID: 21804652 PMCID: PMC3144580 DOI: 10.1016/j.wear.2010.12.045] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Biological effects of wear products (particles and metal ions) generated by metal-on-metal (MoM) hip replacements made of CoCrMo alloy remain a major cause of concern. Periprosthetic osteolysis, potential hypersensitivity response and pseudotumour formation are possible reactions that can lead to early revisions. To accurately analyse the biological response to wear particles from MoM implants, the exact nature of these particles needs to be characterized. Most previous studies used energy-dispersive X-ray spectroscopy (EDS) analysis for characterization. The present study used energy filtered transmission electron microscopy (TEM) and electron diffraction pattern analysis to allow for a more precise determination of the chemical composition and to gain knowledge of the crystalline structure of the wear particles.Particles were retrieved from two different test rigs: a reciprocating sliding wear tribometer (CoCrMo cylinder vs. bar) and a hip simulator according to ISO 14242-1 (CoCrMo head vs. CoCrMo cup). All tests were conducted in bovine serum. Particles were retrieved from the test medium using a previously published enzymatic digestion protocol.Particles isolated from tribometer samples had a size of 100 - 500 nm. Diffraction pattern analysis clearly revealed the lattice structure of strain induced hcp ε-martensite. Hip simulator samples revealed numerous particles of 15 - 30 nm and 30 - 80 nm size. Most of the larger particles appeared to be only partially oxidized and exhibited cobalt locally. The smallest particles were Cr(2)O(3) with no trace of cobalt. It optically appeared that these Cr(2)O(3) particles were flaking off the surface of larger particles that depicted a very high intensity of oxygen, as well as chromium, and only background noise of cobalt. The particle size difference between the two test rigs is likely related to the conditions of the two tribosystems, in particular the difference in the sample geometry and in the type of sliding (reciprocating vs. multidirectional).Results suggest that there may be a critical particle size at which chromium oxidation and cobalt ionization is accelerated. Since earlier studies have shown that wear particles are covered by organic residue which may act as a passive layer inhibiting further oxidation, it would suggest that this organic layer may be removed during the particle isolation process, resulting in a change of the particle chemical composition due to their pyrophoric properties. However, prior to being isolated from the serum lubricant, particles remain within the contact area of head and cup as a third-body. It is therefore possible that during that time, particles may undergo significant transformation and changes in chemical composition in the contact area of the head and cup within the tribological interface due to mechanical interaction with surface asperities.
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Affiliation(s)
- R. Pourzal
- University Duisburg-Essen, Materials Science and Engineering, Lotharstr. 1, 47057 Duisburg, Germany
| | - I. Catelas
- University of Ottawa, Mechanical Engineering, 161 Louis Pasteur, Ottawa, ON, K1N 6N5, Canada
| | - R. Theissmann
- University Duisburg-Essen, Faculty of Engineering and CeNIDE, Lotharstr. 1, 47057 Duisburg, Germany
| | - C. Kaddick
- ENDOLAB GmbH, Seb.-Tiefenthaler Str. 13, 83101 Thansau/Rosenheim, Germany
| | - A. Fischer
- University Duisburg-Essen, Materials Science and Engineering, Lotharstr. 1, 47057 Duisburg, Germany
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Catelas I, Wimmer MA. New insights into wear and biological effects of metal-on-metal bearings. J Bone Joint Surg Am 2011; 93 Suppl 2:76-83. [PMID: 21543694 PMCID: PMC3086265 DOI: 10.2106/jbjs.j.01877] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Despite the renewed interest in metal-on-metal implants in the past two decades, the underlying wear mechanisms and biological effects are still not fully understood. METHODS This paper first reviews the tribology of metal-on-metal bearings, bringing new insights into the interaction of wear and corrosion, and putting the characteristics and the potential origin of wear particles in perspective with the proposed wear mechanisms. It then summarizes the current knowledge on the biological effects of particles and metal ions in relation to these wear mechanisms. RESULTS Tribochemical reactions play an important role in the wear of metal-on-metal joints. The generated tribomaterial, which progressively forms by mechanical mixing of the uppermost nanocrystalline zone of the metal surface with proteins from the synovial fluid, governs the wear rate and influences the corrosive behavior of the bearing. Nanometer-sized wear particles may initially originate from the passivation layer covering the implant surface and then detach from this tribolayer. The inflammatory response observed surrounding metal-on-metal implants appears to be lower than that around metal-on-polyethylene implants. However, metallic byproducts, which can complex with proteins, may lead to a T lymphocyte-mediated hypersensitivity response. CONCLUSIONS The tribolayer appears to have beneficial effects on the wear rate. Much information has been gained on wear particle characteristics, but the exact mechanisms of particle detachment remain to be further elucidated. Excessive wear along with a hypersensitivity response may be at the origin of the early adverse tissue reactions that have been recently reported in some patients with metal-on-metal implants.
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Affiliation(s)
- Isabelle Catelas
- Department of Mechanical Engineering, University of Ottawa, 161 Louis Pasteur, Ottawa, ON K1N 6N5, Canada. E-mail address:
| | - Markus A. Wimmer
- Department of Orthopaedic Surgery, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL, 60612. E-mail address:
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Polyethylene and metal wear particles: characteristics and biological effects. Semin Immunopathol 2011; 33:257-71. [PMID: 21267569 DOI: 10.1007/s00281-011-0242-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Accepted: 01/01/2011] [Indexed: 12/12/2022]
Abstract
This paper first presents a brief overview about the mechanism of wear particle formation as well as wear particle characteristics in metal-on-polyethylene and metal-on-metal artificial hip joints. The biological effects of such particles are then described, focusing on the inflammatory response induced by each type of particles as well as on how metal wear products may be the source of a T lymphocyte-mediated specific immune response, early adverse tissue responses, and genotoxicity. Finally, some of the current in vivo models used for the analysis of tissue response to various wear particles are presented.
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Abstract
In this article, a concise review of the current literature on metal-on-metal hip resurfacing (MoMHR) is given. In contrast to conventional total hip arthroplasty, older age, female sex and small femoral head sizes predispose to failure. Neck fracture and metal wear-related complications account for the most frequent reasons for re-operations. Although the long-term consequences of metal ion release remain unknown, the increasing prevalence of soft tissue related problems with potentially devastating functional consequences in this younger patient group are of concern. Outcome after revision for metal wear related failure of MoMHR is poor. In our opinion, patients with this device should be managed in dedicated centers with facilities for data collection and monitoring. The majority of proposed advantages of MoMHR cannot be supported by the published evidence.
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Affiliation(s)
- Gavin J Macpherson
- Department of Orthopaedic Surgery, The Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, UK
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Visuri T, Borg H, Pulkkinen P, Paavolainen P, Pukkala E. A retrospective comparative study of mortality and causes of death among patients with metal-on-metal and metal-on-polyethylene total hip prostheses in primary osteoarthritis after a long-term follow-up. BMC Musculoskelet Disord 2010; 11:78. [PMID: 20416065 PMCID: PMC2874765 DOI: 10.1186/1471-2474-11-78] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2009] [Accepted: 04/23/2010] [Indexed: 11/13/2022] Open
Abstract
Background All patients with total hip arthroplasty (THA), especially those with metal-on-metal (MM) THA, are exposed to metallic particles and ions, which may cause total or site-specific mortality. We analyzed the causes of total and site-specific mortality among a cohort of patients with MM and with metal-on-polyethylene (MP) THA after a long follow-up time. Methods Standardized mortality ratios (SMR) of total and site-specific causes of death were calculated for 579 patients with MM (McKee-Farrar) and 1585 patients with MP (Brunswik, Lubinus) THA for primary osteoarthritis. Results Mean follow-up time was 17.9 years for patients with MM and 16.7 years for patients with MP. Overall SMR was 0.95 for the MM cohort and 0.90 for the MP cohort, as compared to the normal population. Both cohorts showed significantly decreased mortality for the first decade postoperatively, equal mortality over the next 10 years, and significantly increased mortality after 20 years. Patients with MM THA had higher cancer mortality (SMR 1.01) than those with MP THA (SMR 0.66) during the first 20 years postoperatively, but not thereafter. Conclusion Both MM and MP prostheses are safe based on total and site-specific mortality of recipients during the first 20 postoperative years in comparison with the general population.
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Affiliation(s)
- Tuomo Visuri
- Research Institute of Military Medicine, Helsinki, Finland.
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Wimmer MA, Fischer A, Büscher R, Pourzal R, Sprecher C, Hauert R, Jacobs JJ. Wear mechanisms in metal-on-metal bearings: the importance of tribochemical reaction layers. J Orthop Res 2010; 28:436-43. [PMID: 19877285 DOI: 10.1002/jor.21020] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Metal-on-metal (MoM) bearings are at the forefront in hip resurfacing arthroplasty. Because of their good wear characteristics and design flexibility, MoM bearings are gaining wider acceptance with market share reaching nearly 10% worldwide. However, concerns remain regarding potential detrimental effects of metal particulates and ion release. Growing evidence is emerging that the local cell response is related to the amount of debris generated by these bearing couples. Thus, an urgent clinical need exists to delineate the mechanisms of debris generation to further reduce wear and its adverse effects. In this study, we investigated the microstructural and chemical composition of the tribochemical reaction layers forming at the contacting surfaces of metallic bearings during sliding motion. Using X-ray photoelectron spectroscopy and transmission electron microscopy with coupled energy dispersive X-ray and electron energy loss spectroscopy, we found that the tribolayers are nanocrystalline in structure, and that they incorporate organic material stemming from the synovial fluid. This process, which has been termed "mechanical mixing," changes the bearing surface of the uppermost 50 to 200 nm from pure metallic to an organic composite material. It hinders direct metal contact (thus preventing adhesion) and limits wear. This novel finding of a mechanically mixed zone of nanocrystalline metal and organic constituents provides the basis for understanding particle release and may help in identifying new strategies to reduce MoM wear.
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Affiliation(s)
- Markus A Wimmer
- Department of Orthopedic Surgery, Rush University Medical Center, 1653 West Congress Parkway, Chicago, Illinois 60612, USA.
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Damm P, Graichen F, Rohlmann A, Bender A, Bergmann G. Total hip joint prosthesis for in vivo measurement of forces and moments. Med Eng Phys 2010; 32:95-100. [DOI: 10.1016/j.medengphy.2009.10.003] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2009] [Revised: 09/25/2009] [Accepted: 10/03/2009] [Indexed: 11/16/2022]
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Kaddick C, Catelas I, Pennekamp PH, Wimmer MA. [Implant wear and aseptic loosening. An overview]. DER ORTHOPADE 2009; 38:690-7. [PMID: 19657620 DOI: 10.1007/s00132-009-1431-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Wear of total joint implants is multifactorial in nature. Even for identical materials and geometries, the interaction of those parameters can generate different numbers of particles as well as different particle sizes and shapes. These different wear-particle characteristics will directly influence the biological response to an implant and thereby its clinical success. The long-term success of a total joint replacement requires an optimized compromise among implant material, design, surgical procedure, and biological performance.
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Affiliation(s)
- C Kaddick
- EndoLab GmbH, Seb.-Tiefenthaler Strasse 13, 83101 Thansau/Rosenheim, Deutschland.
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Leslie IJ, Williams S, Isaac G, Ingham E, Fisher J. High cup angle and microseparation increase the wear of hip surface replacements. Clin Orthop Relat Res 2009; 467:2259-65. [PMID: 19363640 PMCID: PMC2866926 DOI: 10.1007/s11999-009-0830-x] [Citation(s) in RCA: 136] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2008] [Accepted: 03/24/2009] [Indexed: 01/31/2023]
Abstract
High wear rates and high patient ion levels have been associated with high (> 55 degrees) cup inclination angles for metal-on-metal surface replacements. Wear rates and patterns have been simulated for ceramic-on-ceramic bearings by applying microseparation to replicate head offset deficiency. We tested 39-mm metal-on-metal surface replacements (n = 5) in a hip simulator with (A) an increased cup inclination angle of 60 degrees and (B) an increased cup inclination angle and microseparation over 2 million cycles. (A) resulted in a ninefold increase in wear rate and (B) resulted in a 17-fold increase in wear rate compared to a standard gait condition study. Wear particles produced under microseparation conditions were larger than those produced under standard conditions but of similar shape (round to oval). The data suggest both head and cup position influence the wear of surface replacements; we believe it likely bearings with high wear either have a high cup inclination angle, an offset deficient head, or a combination of both.
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Affiliation(s)
- Ian J. Leslie
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, West Yorkshire LS2 9JT UK
| | - Sophie Williams
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, West Yorkshire LS2 9JT UK
| | - Graham Isaac
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, West Yorkshire LS2 9JT UK ,DePuy International, Leeds, UK
| | - Eileen Ingham
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, West Yorkshire LS2 9JT UK
| | - John Fisher
- Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, West Yorkshire LS2 9JT UK
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Lazennec JY, Boyer P, Poupon J, Rousseau MA, Roy C, Ravaud P, Catonné Y. Outcome and serum ion determination up to 11 years after implantation of a cemented metal-on-metal hip prosthesis. Acta Orthop 2009; 80:168-73. [PMID: 19404797 PMCID: PMC2823177 DOI: 10.3109/17453670902947408] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Little is known about the long-term outcome of cemented metal-on-metal hip arthroplasties. We evaluated a consecutive series of metal-on-metal polyethylene-backed cemented hip arthroplasties implanted in patients under 60 years of age. METHODS 109 patients (134 joint replacements) were followed prospectively for mean 9 (7-11) years. The evaluation included clinical score, radiographic assessment, and blood sampling for ion level determination. RESULTS At the final review, 12 hips had been revised, mainly because of aseptic loosening of the socket. Using revision for aseptic loosening as the endpoint, the survival rate at 9 years was 91% for the cup and 99% for the stem. In addition, 35 hips showed radiolucent lines at the bone-cement interface of the acetabulum and some were associated with osteolysis. The median serum cobalt and chromium levels were relatively constant over time, and were much higher than the detection level throughout the study period. The cobalt level was 1.5 microg/L 1 year after implantation, and 1.44 microg/L 9 years after implantation. INTERPRETATION Revisions for aseptic loosening and radiographic findings in the sockets led us to halt metal-on-metal-backed polyethylene cemented hip arthroplasty procedures. If the rigidity of the cemented socket is a reason for loosening, excessive release of metal ions and particles may be involved. Further investigations are required to confirm this hypothesis and to determine whether subluxation, microseparation, and hypersensitivity also play a role.
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Affiliation(s)
- Jean-Yves Lazennec
- Department of Orthopaedic Surgery, Pitié-Salpétrière HospitalParisFrance
| | - Patrick Boyer
- Department of Orthopaedic Surgery, Bichat HospitalParisFrance
| | - Joel Poupon
- Laboratory of Toxicology, Lariboisière HospitalParisFrance
| | | | - Carine Roy
- Department of Statistics, Bichat Hospital, Université Paris Diderot, Asistance Publique-Hopitaux de ParisParisFrance
| | - Philippe Ravaud
- Department of Statistics, Bichat Hospital, Université Paris Diderot, Asistance Publique-Hopitaux de ParisParisFrance
| | - Yves Catonné
- Department of Orthopaedic Surgery, Pitié-Salpétrière HospitalParisFrance
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Milošev I, Remškar M. In vivoproduction of nanosized metal wear debris formed by tribochemical reaction as confirmed by high-resolution TEM and XPS analyses. J Biomed Mater Res A 2008; 91:1100-10. [DOI: 10.1002/jbm.a.32301] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Leslie I, Williams S, Brown C, Isaac G, Jin Z, Ingham E, Fisher J. Effect of bearing size on the long-term wear, wear debris, and ion levels of large diameter metal-on-metal hip replacements-An in vitro study. J Biomed Mater Res B Appl Biomater 2008; 87:163-72. [PMID: 18386846 DOI: 10.1002/jbm.b.31087] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Hip resurfacing arthroplasty has become a popular alternative to conventional hip surgery. Surface replacements with bearing sizes of 55 mm (n = 5) and 39 mm (n = 5) were tested in a hip simulator for 15 million cycles (Mc). Wear debris was isolated from the serum lubricant and characterized by field emmitting gun scanning electorn microscopy, and ion levels were measured via inductively coupled plasma mass spectroscopy at intervals throughout the test. The 39 mm bearings showed significantly greater bedding in volumetric wear (2.58 mm(3)) compared with the 55 mm bearings (1.15 mm(3)). There was no significant difference between the steady state wear rates (1-15 Mc) between the two sizes (0.10 and 0.09 mm(3)/Mc, respectively); however, this parity only became clear after 7 Mc. The wear debris isolated was oval in morphology with a mean particle size of 28 nm and a range of 9-108 nm. The Co levels measured at 0.13 Mc were significantly greater than at 3.6 Mc for both bearing sizes (10926 ppb and 176 ppb, respectively). After 0.5 Mc, the Co levels from the 39 mm bearings were significantly higher than the 55 mm (11,007 vs. 1475 ppb). The wear results support previous findings showing that increasing the femoral head size decreased volumetric bedding in wear. The ion levels measured suggest both bearing sizes have similar initial wear rates; however, the 55 mm bearings reach steady state wear more rapidly.
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Affiliation(s)
- Ian Leslie
- Institute of Medical & Biological Engineering, University of Leeds, Leeds, United Kingdom
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Abstract
This paper considers the increased risk of the development of lymphoma in patients with chronic inflammatory disease who undergo metal-on-metal arthroplasty.
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Affiliation(s)
- L. Lidgren
- Department of Orthopaedics and Clinical Sciences, Lund University Hospital, SE-221 85 Lund, Sweden
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