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Wear debris in metal-on-metal bearings and modular junctions : What have we learned from the last decades? ORTHOPADIE (HEIDELBERG, GERMANY) 2023; 52:206-213. [PMID: 36820850 DOI: 10.1007/s00132-023-04346-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/12/2023] [Indexed: 02/24/2023]
Abstract
Metal-on-metal (MoM) bearing hip arthroplasty saw increasing utilization and peaked in the 1990s and early 2000s. Although the linear and volumetric wear rate for a MoM bearings was lower than its polyethylene counterpart, metal ion particles were found to be approximately 10 × smaller and 500 × higher in quantity compared to polyethylene wear debris. Research into these articulations have demonstrated their relationship to the formation of lymphocyte-mediated adverse local tissue reactions. The work-up for metal particle-associated conditions (metallosis) includes a thorough patient history and physical examination, blood laboratory studies for metal ion concentrations, and advanced imaging studies including magnetic resonance imaging (MRI). The treatment of metallosis and adverse local tissue reactions ranges from close serial observation to extensive debridement and full revision of arthroplasty components, when indicated.
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Bodiga VL, Vemuri PK, Kudle MR, Bodiga S. Ellagic Acid from Terminalia arjuna Fruits Protects Against Chromium and Cobalt Toxicity in Primary Human Lymphocytes. Biol Trace Elem Res 2022; 200:2698-2708. [PMID: 34432268 DOI: 10.1007/s12011-021-02900-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 08/21/2021] [Indexed: 12/28/2022]
Abstract
Increased accumulation of heavy metal ions such as Cr6+ and Co2+ due to release from prostheses and metallic implants has been reported. These metal ions have been shown to affect both resting and activated lymphocytes. Natural remedies towards mitigating the cytotoxic effects of metal ions are clearly warranted. Polyphenolic compounds which are part of hydrolysable tannins from natural plant sources are considered effective in cheating heavy metal ions in a biological system. We have isolated and characterized a polyphenolic compound (ellagic acid) from Terminalia arjuna fruits that has been tested for its ability to attenuate the metal ion toxicity in primary human lymphocytes in culture. Cr6+ and Co2+ (100 μM) decreased lymphocyte viability and proliferation and increased apoptosis of resting as well as CD3 and/or CD28-stimulated lymphocytes. Metal ions markedly diminished the cytokine (interleukin-2 and interferon-γ) secretion from activated lymphocytes. Pretreatment with ellagic acid at 25, 50, and 100 μM concentrations effectively improved viability and proliferative responses of both resting and activated lymphocytes, while attenuating the apoptotic index. Ellagic acid also tended to normalize the cytokine secretion from the activated lymphocytes even in the presence of metal ions, suggesting broad effects on the adaptive immune system.
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Affiliation(s)
- Vijaya Lakshmi Bodiga
- Department of Biochemistry and Molecular Biology, Institute of Genetics & Hospital for Genetic Diseases, Osmania University, Begumpet, Hyderabad, Telangana, India
| | - Praveen Kumar Vemuri
- Department of Biotechnology, Koneru Lakshmaiah University, Green Fields, Vaddeswaram, Guntur, Andhra Pradesh, India
| | - Madhukar Rao Kudle
- Department of Biochemistry, Kakatiya University, Warangal, Telangana, India
| | - Sreedhar Bodiga
- Laboratory of Biochemistry, Department of Basic Sciences, Forest College and Research Institute Hyderabad, Siddipet District Telangana, Mulugu, India.
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Pearce O, Matharu GS, Bolland BJ. Predictive Factors for Revision and Survivorship Analysis of a Prevalent 36-mm Metal-on-Metal Total Hip Replacement System: A Large Single-Center Retrospective Cohort Study. J Arthroplasty 2021; 36:1380-1387. [PMID: 33189496 DOI: 10.1016/j.arth.2020.10.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/11/2020] [Accepted: 10/15/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND To our knowledge, this is the largest single-center cohort of the 36-mm Corail-Pinnacle metal-on-metal total hip replacements system, aiming to determine 10-year survivorship and identify predictors of revision. We further assessed year of implantation given reports of manufacturing variations affecting shells made after 2006 predisposing these components to increasing wear. METHODS All Corail-Pinnacle 36-mm metal-on-metal hips implanted in a single center (2005-2012). The effect of patient and implant-related variables, and year of implantation on revision risk was assessed using Kaplan-Meier, Cox regression, and interrupted time series analysis. RESULTS In total, 1212 metal-on-metal total hip replacements were implanted with a 10-year survival rate of 83.4% (95% confidence interval [CI] = 81.3-85.5). Mean follow-up duration was 7.3 years with 61% of patients reaching a minimum of 7 years of follow-up. One hundred nineteen patients required revision surgery (9.8%). Univariate analysis identified female gender (hazard ratio [HR] = 1.608, CI = 1.093-2.364, P = .016), age at implantation (HR = 0.982, CI = 0.968-0.997, P = .019), smaller 50-mm to 54-mm cup diameter (HR = 1.527, CI = 1.026-2.274, P = .037), and high-offset stems (HR = 2.573, CI = 1.619-4.089, P < .001) as predictors of revision. Multivariate modeling confirmed female gender and high-offset stems as significant predictors of revision. For components implanted after 2007, the number of revisions showed no statistically significant step increase compared to pre-2007 implantation. CONCLUSION We observed a high 10-year failure rate (16.6%) with this implant, mostly due to adverse reaction to metal debris. Female gender and high femoral offset stems were significant predictors for all-cause revision. Year of implantation was not significantly associated with an increasing number of revisions from 2007 onwards, although further studies to validate the impact of manufacturing discrepancies are recommended.
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Affiliation(s)
- Oliver Pearce
- Department of Orthopaedic Surgery, Southmead Hospital, Bristol, United Kingdom
| | - Gulraj S Matharu
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Ben J Bolland
- Department of Orthopaedic Surgery, Musgrove Park Hospital, Taunton, United Kingdom
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Zhang T, Sze KY, Peng ZW, Cheung KMC, Lui YF, Wong YW, Kwan KYH, Cheung JPY. Systematic investigation of metallosis associated with magnetically controlled growing rod implantation for early-onset scoliosis. Bone Joint J 2020; 102-B:1375-1383. [PMID: 32993330 DOI: 10.1302/0301-620x.102b10.bjj-2020-0842.r1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS To investigate metallosis in patients with magnetically controlled growing rods (MCGRs) and characterize the metal particle profile of the tissues surrounding the rod. METHODS This was a prospective observational study of patients with early onset scoliosis (EOS) treated with MCGRs and undergoing rod exchange who were consecutively recruited between February 2019 and January 2020. Ten patients were recruited (mean age 12 years (SD 1.3); 2 M:8 F). The configurations of the MCGR were studied to reveal the distraction mechanisms, with crucial rod parts being the distractable piston rod and the magnetically driven rotor inside the barrel of the MCGR. Metal-on-metal contact in the form of ring-like wear marks on the piston was found on the distracted portion of the piston immediately outside the barrel opening (BO) through which the piston rod distracts. Biopsies of paraspinal muscles and control tissue samples were taken over and away from the wear marks, respectively. Spectral analyses of the rod alloy and biopsies were performed to reveal the metal constituents and concentrations. Histological analyses of the biopsies were performed with haematoxylin and eosin staining. RESULTS Titanium (Ti), vanadium (V), and neodymium (Nd) concentrations in the biopsies taken near the wear marks were found to be significantly higher than those in the control tissue samples. Significantly increased Nd concentrations were also found in the tissues near the barrel of the MCGR. Chronic inflammation was revealed by the histological studies with fibrosis and macrophage infiltration. Black particles were present within the macrophages in the fibrotic tissues. CONCLUSION Ti and V were generated mainly at the BO due to metal-on-metal contact, whereas the Nd from the rotor of the MCGR is likely released from the BO during distraction sessions. Phagocytotic immune cells with black particles inside raise concern regarding the long-term implications of metallosis. Cite this article: Bone Joint J 2020;102-B(10):1375-1383.
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Affiliation(s)
- Teng Zhang
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - K Y Sze
- Department of Mechanical Engineering, Faculty of Engineering, The University of Hong Kong, Hong Kong, China
| | - Z W Peng
- Department of Mechanical Engineering, Faculty of Engineering, The University of Hong Kong, Hong Kong, China
| | - Kenneth M C Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - Y F Lui
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - Y W Wong
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - Kenny Y H Kwan
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
| | - Jason P Y Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, China
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Reiner T, Haubenreisser H, Tripel E, Rosshirt N, Sorbi R, Nees TA, Gotterbarm T, Merle C, Moradi B, Hagmann S. Peripheral Blood Lymphocyte Subpopulations in Patients Following Small Diameter Metal-On-Metal Total Hip Replacement at Long-Term Follow-Up. J Clin Med 2020; 9:jcm9092877. [PMID: 32899901 PMCID: PMC7564376 DOI: 10.3390/jcm9092877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 09/03/2020] [Indexed: 11/22/2022] Open
Abstract
(1) Background: The objective of the present study was to investigate peripheral blood lymphocyte subpopulations in patients with small diameter metal-on-metal total hip arthroplasty (MoM THA) and elevated blood metal ion concentrations at long-term follow-up. The hypothesis was that increased blood metal ion levels or the presence of adverse local tissue reactions (ALTR) would be associated with changes in the peripheral expression of lymphocyte subpopulations, which could potentially serve as early diagnostic markers for metal wear related complications. (2) Methods: Peripheral blood samples were analyzed for leucocyte subgroups (CD3+, CD4+, CD8+, CD14+, CD16+/CD56+, CD25+/CD127−, CD19+, IFN-γ+, IL-4+ and IL-17A+ cells) in 34 patients with elevated blood metal ion levels (combined cobalt and chromium levels >2 µg/L) following small head MoM THA at a mean follow-up of 15.6 years. Fifteen patients with small head MoM THA and blood metal ion levels within the normal range and 15 patients with conventional ceramic-on-polyethylene THA served as control groups. In addition, blood metal ion levels and leucocyte subpopulations were compared between patients with and without adverse local tissue reactions (ALTR), which was investigated by MRI in 27 patients of the study cohort. (3) Results: There was a significant decrease in the levels of IFN-γ+ Type-1 T helper cells (Th1) in patients with MoM THA compared to the ceramic-on-polyethylene control group (p < 0.001). No statistically significant differences in the cell counts of other lymphocyte subpopulations were found between the three groups. Cobalt ion levels were significantly higher in patients with ALTR (p < 0.001) compared to the non-ALTR group, but no differences in the levels of lymphocyte subsets were found between the two groups. (4) Conclusions: No adverse systemic effects with respect to peripheral blood leucocyte subpopulations could be detected in the present study in patients following THA with a small diameter MoM articulation at long-term follow-up. We found a significant decrease of IFN-γ+ Th1 cells in patients with MoM THA compared to the control group, but no differences in the peripheral expression of leucocyte subpopulations were seen between patients with and without ALTR. Future studies with larger patient cohorts and additional histopathological investigations could help to better understand the role of Th1 cells and other cell lines of the adaptive immune system in the development of metal wear related complications after total joint replacement.
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Affiliation(s)
- Tobias Reiner
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany; (H.H.); (E.T.); (N.R.); (R.S.); (T.A.N.); (C.M.); (B.M.)
- Correspondence: (T.R.); (S.H.); Tel.: +49-6221-5634803 (T.R.); +49-6221-5626289 (S.H.); Fax: +49-6221-5626179 (T.R.); +49-6221-5626348 (S.H.)
| | - Hester Haubenreisser
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany; (H.H.); (E.T.); (N.R.); (R.S.); (T.A.N.); (C.M.); (B.M.)
| | - Elena Tripel
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany; (H.H.); (E.T.); (N.R.); (R.S.); (T.A.N.); (C.M.); (B.M.)
| | - Nils Rosshirt
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany; (H.H.); (E.T.); (N.R.); (R.S.); (T.A.N.); (C.M.); (B.M.)
| | - Reza Sorbi
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany; (H.H.); (E.T.); (N.R.); (R.S.); (T.A.N.); (C.M.); (B.M.)
| | - Timo Albert Nees
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany; (H.H.); (E.T.); (N.R.); (R.S.); (T.A.N.); (C.M.); (B.M.)
| | - Tobias Gotterbarm
- Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, 4020 Linz, Austria;
| | - Christian Merle
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany; (H.H.); (E.T.); (N.R.); (R.S.); (T.A.N.); (C.M.); (B.M.)
| | - Babak Moradi
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany; (H.H.); (E.T.); (N.R.); (R.S.); (T.A.N.); (C.M.); (B.M.)
| | - Sébastien Hagmann
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany; (H.H.); (E.T.); (N.R.); (R.S.); (T.A.N.); (C.M.); (B.M.)
- Correspondence: (T.R.); (S.H.); Tel.: +49-6221-5634803 (T.R.); +49-6221-5626289 (S.H.); Fax: +49-6221-5626179 (T.R.); +49-6221-5626348 (S.H.)
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Brüggemann A, Mallmin H, Bengtsson M, Hailer NP. Safety of Use of Tantalum in Total Hip Arthroplasty. J Bone Joint Surg Am 2020; 102:368-374. [PMID: 31895169 DOI: 10.2106/jbjs.19.00366] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Tantalum implants have been used in >500,000 orthopaedic patients. Although the risks of metallosis and aseptic lymphocyte-dominated vasculitis-associated lesions (ALVAL) after total hip arthroplasty (THA) are being debated, we are not aware of any studies investigating the liberation of tantalum ions and their potential effects on the immune system. We evaluated whether tantalum concentrations are elevated after THA with acetabular tantalum implants and assessed potential alterations in T-cell subpopulations. METHODS After a mean follow-up of 4 years (range, 0.5 to 8.9 years) of 144 patients who had undergone THA, blood samples were analyzed regarding blood tantalum concentrations, total white blood-cell counts, and lymphocyte subsets in 3 groups of patients: those treated with non-tantalum primary THA ("primary non-tantalum," n = 30), those treated with primary THA with a tantalum cup ("primary tantalum," n = 30), and those who underwent revision surgery with a tantalum shell ("revision tantalum," n = 84). Blood donors served as controls for immunological parameters (n = 59). Correlations between tantalum concentrations and human leukocyte antigen (HLA)-DR T cells were calculated, radiographic signs of implant loosening were assessed, and the Harris hip score (HHS) was used to evaluate hip function. RESULTS The median tantalum concentration was similar to the detection limit both in the primary non-tantalum group (0.05 µg/L, 95% confidence interval [CI] = 0.05 to 0.05 µg/L) and in the primary tantalum group (0.051 µg/L, 95% CI = 0.050 to 0.055 µg/L), and it was 0.091 µg/L (95% CI = 0.083 to 0.112 µg/L) in the revision tantalum group (p < 0.0001 in the group-wise comparison with both primary non-tantalum and primary tantalum). We found a weak negative correlation of higher tantalum concentration with the concentration of HLA-DR/CD8 T cells (r = -0.22, 95% CI = -0.35 to -0.05, p = 0.01) but no correlation of tantalum concentration with the concentration of HLA-DR/CD4 T cells (r = -0.11, 95% CI = -0.27 to 0.06, p = 0.24). The values for all lymphocyte subgroups were within normal ranges. No implants were deemed loose. The median HHS was good to excellent. CONCLUSIONS Exposure to stable tantalum cups is associated with low blood concentrations of tantalum. Signs of T-cell activation typical of ALVAL seem to be lacking. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Anders Brüggemann
- Section of Orthopedics, Department of Surgical Sciences (A.B., H.M., and N.P.H.), and Department of Immunology, Pathology, and Genetics (M.B.), Uppsala University, Uppsala, Sweden
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Markel DC, Bou-Akl T, Rossi MD, Pizzimenti N, Wu B, Ren W. Blood metal levels, leucocyte profiles, and cytokine profiles in patients with a modular dual-mobility hip prosthesis: early results from a prospective cohort study. Bone Joint J 2019; 101-B:1035-1041. [PMID: 31474131 DOI: 10.1302/0301-620x.101b9.bjj-2019-0377.r2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
AIMS The aim of this study was to evaluate blood metal ion levels, leucocyte profiles, and serum cytokines in patients with a total hip arthroplasty (THA) involving modular dual-mobility components. PATIENTS AND METHODS A total of 39 patients were recruited, with clinical follow-up of up to two years. Outcome was assessed using the Harris Hip Score (HHS, the 12-Item Short-Form Health Survey (SF-12), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and a visual analogue scale (VAS) for pain. Blood concentrations of cobalt (Co), chromium (Cr), and serum cytokines were measured. Subpopulations of leucocytes were analyzed by flow cytometry. RESULTS The clinical performance was good. Blood Co levels (ref 1.0 µg/l) were mildly elevated in seven patients at three months, and two patients at two years' follow-up. The preoperative Cr levels were normal except for one patient with a detectable Cr (1.2 µg/l). Cr levels were detectable in three patients at three months, two patients at one year, and three patients at two years' follow-up. No patients had symptoms suggestive of failure. Although flow cytometry showed constant circulating leucocyte profiles, there was a significant reduction of serum interleukin (IL)-4, IL-5, and interferon gamma (IFNγ) postoperatively compared with the preoperative levels (p < 0.05). CONCLUSION These results suggest that THA using modular dual-mobility components is safe. This allows an opportunity to use a large femoral head and a thick polyethylene bearing surface, which is especially useful in revision procedures or high-risk situations when added stability is required. Cite this article: Bone Joint J 2019;101-B:1035-1041.
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Affiliation(s)
- David C Markel
- The CORE Institute, Novi, Michigan, USA.,Department of Biomedical Engineering, Wayne State University, Detroit, Michigan, USA.,Ascension Providence Hospital Orthopedic Research Laboratory, Southfield, Michigan, USA
| | - Therese Bou-Akl
- Providence Hospital Orthopedic Research Laboratory, Southfield, Michigan, USA
| | - Mario D Rossi
- Providence Hospital Orthopedic Research Laboratory, Southfield, Michigan, USA
| | | | - Bin Wu
- Providence Hospital Orthopedic Research Laboratory, Southfield, Michigan, USA
| | - Weiping Ren
- Department of Biomedical Engineering, Wayne State University, Detroit, Michigan, USA.,Providence Hospital Orthopedic Research Laboratory, Southfield, Michigan, USA.,John D. Dingle VA Medical Center, Detroit, Michigan, USA
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Markel D, Bou-Akl T, Rossi M, Pizzimenti NM, Wu B, Ren WP. Response profiles of circulating leukocytes and metal ions in patients with a modular dual-mobility hip implant. Hip Int 2019:1120700019865530. [PMID: 31328577 DOI: 10.1177/1120700019865530] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The purpose of this study was to retrospectively evaluate blood metal ion levels and leukocyte profiles in patients with modular dual-mobility hip implant (MDM) during a postoperative follow-up up to 2 years. METHODS We recruited 49 patients in a retrospective cohort study and had postoperative follow-up up to 2 years. Blood concentrations of chromium (Cr), cobalt (Co) and serum cytokines were measured. Flow cytometry was used to quantify the subpopulations of leukocytes, including CD14+ and CD16+ monocytes, CD3+ T lymphocytes, CD19+ B lymphocytes, CD4+ Helper T-cells and CD45+RA memory vs. naïve T-cells. RESULTS Clinical performances of implants were good during 2 years of follow-up. Cr levels were normal in all patients and only detectable in 1 patient (1.4µg/L, ref < 5.0µg/L). Co levels were mildly elevated in 4 patients at 1 year (mean 1.375µg/L, range 1.2-1.7µg/L, ref < 1.0µg/L) and in 2 patients at 2-year follow-up (both 1.2µg/L). Interestingly, Co level observed in 3 patients at 1 year converted to undetectable at their 2-year follow-up. Percentages of B cells, T cells and their subpopulations were within normal levels. There was no increase of CD16+ inflammatory monocytes. DISCUSSION With the recent introduction of MDM systems there is potential for metal ion release from the interface between the acetabular shell and CoCr liner. Clinical results have been good and metal levels undetectable or within acceptable ranges at 1-2 years. There was no evidence of activated immune response, as manifested by constant circulating leukocyte profiles and no increase of CD16+ inflammatory monocytes.
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Affiliation(s)
- David Markel
- 1 The CORE Institute, Novi, MI
- 2 Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA
- 3 Ascension Providence Hospital Orthopedic Research Laboratory, Southfield, MI, USA
| | - Theresa Bou-Akl
- 3 Ascension Providence Hospital Orthopedic Research Laboratory, Southfield, MI, USA
| | - Maria Rossi
- 3 Ascension Providence Hospital Orthopedic Research Laboratory, Southfield, MI, USA
| | | | - Bin Wu
- 3 Ascension Providence Hospital Orthopedic Research Laboratory, Southfield, MI, USA
| | - Wei-Ping Ren
- 2 Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA
- 3 Ascension Providence Hospital Orthopedic Research Laboratory, Southfield, MI, USA
- 4 John D. Dingle VA Medical Center, Detroit, MI, USA
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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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10
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Markel DC, Bergum C, Flynn J, Jackson N, Bou-Akl T, Ren W. Relationship of Blood Metal Ion Levels and Leukocyte Profiles in Patients With Articular Surface Replacement Metal-on-Metal Hip Replacement. Orthopedics 2018; 41:e424-e431. [PMID: 29708567 DOI: 10.3928/01477447-20180409-02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 01/22/2018] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to compare blood leukocyte profiles and metal ion concentrations between hip resurfacing arthroplasty (articular surface replacement) patients with and without revision. A total of 25 articular surface replacement patients were recruited (10 with stable implants and 15 undergoing revision). Blood concentrations of chromium (Cr) and cobalt (Co) were measured. Flow cytometry was used to quantify the subpopulations of leukocytes, including CD14+ monocytes, CD16+ monocytes, CD3+ T-lymphocytes, CD19+ B-lymphocytes, CD4+ helper T-cells, and CD45+RA memory vs naïve T-cells. Patients undergoing revision had higher blood Co (mean, 10.85 µg/L) and Cr (mean, 3.19 µg/L) levels than patients with stable implants (mean Co, 3.06 µg/L; mean Cr, 1.07 µg/L) (P<.05). The number of CD4+ helper T-cells was higher in patients with stable implants (mean, 842±311 cells/µL) than in patients undergoing revision (mean, 591±208 cells/µL) (P<.05). There was a significant association between total metal ion levels (Co+Cr) and the number of CD14+ monocytes (P=.045) and inflammatory CD16+ monocytes (P=.046). The authors observed that the increase in blood metal ions was associated with an increase in CD16+ monocytes. They believe that continued analysis of blood leukocyte profiles may be helpful in defining differences among failed articular surface replacement, stable articular surface replacement, and failed metal-on-polyethylene implants. [Orthopedics. 2018; 41(3):e424-e431.].
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Fernandes CJC, Bezerra F, do Carmo MDD, Feltran GS, Rossi MC, da Silva RA, Padilha PDM, Zambuzzi WF. CoCr-enriched medium modulates integrin-based downstream signaling and requires a set of inflammatory genes reprograming in vitro. J Biomed Mater Res A 2017; 106:839-849. [PMID: 28941043 DOI: 10.1002/jbm.a.36244] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 07/31/2017] [Accepted: 09/19/2017] [Indexed: 12/22/2022]
Abstract
Significant health concerns have been raised by the high levels of Cr and Co ions into whole blood as resulted of corrosion process released from biomedical implants, but very little is known about their biological behavior in governing cell metabolism. Thus, we prompted to address this issue by exploring the effects of CoCr enriched medium on both fibroblast and preosteoblast (pre-Ob) cells. First, we showed there is a significant difference in Co and Cr releasing dependent on engineered surface, it being even more released in dual acid-etching treating surface (named w/DAE) than the machined surfaces (named wo/DAE). Thereafter, we showed CoCr affects pre-osteoblast and fibroblast metabolism by dynamically modulating integrin-based downstream signaling (FAK, Src, Rac1, and Cofilin). Specifically on this matter, we have shown there is dynamic β1-integrin gene activation up 24 h in both preosteoblast and fibroblast. Our analysis showed also that both pre-Ob and fibroblast are important resource of proinflammatory cytokines when responding to CoCr enriched medium. In addition, survival-related signaling pathway was also affected interfering on survival and proliferating signal, mainly affecting CDK2, mapk-Erk and mapk-p38 phosphorylations, while AKT/PKB-related gene remained active. In addition, during cell adhesion PP2A (an important Ser/Thr phosphatase) was inactive in both cell lineages and it seems be a CoCr's molecular fingerprint, regulating specific metabolic pathways involved with cytoskeleton rearrangement. Altogether, our results showed for the first time CoCr affects cellular performance in vitro by modulating integrin activation-based downstream signaling and requiring a reprograming of inflammatory genes activations in vitro. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 106A: 839-849, 2018.
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Affiliation(s)
- Célio J C Fernandes
- Department of Chemistry and Biochemistry, Bioscience Institute, State University of São Paulo, UNESP, Campus Botucatu, Botucatu, São Paulo, Brazil
| | - Fabio Bezerra
- Department of Chemistry and Biochemistry, Bioscience Institute, State University of São Paulo, UNESP, Campus Botucatu, Botucatu, São Paulo, Brazil
| | - Maiara das D do Carmo
- Department of Chemistry and Biochemistry, Bioscience Institute, State University of São Paulo, UNESP, Campus Botucatu, Botucatu, São Paulo, Brazil
| | - Georgia S Feltran
- Department of Chemistry and Biochemistry, Bioscience Institute, State University of São Paulo, UNESP, Campus Botucatu, Botucatu, São Paulo, Brazil
| | - Mariana C Rossi
- Department of Chemistry and Biochemistry, Bioscience Institute, State University of São Paulo, UNESP, Campus Botucatu, Botucatu, São Paulo, Brazil
| | - Rodrigo A da Silva
- Department of Chemistry and Biochemistry, Bioscience Institute, State University of São Paulo, UNESP, Campus Botucatu, Botucatu, São Paulo, Brazil
| | - Pedro de M Padilha
- Department of Chemistry and Biochemistry, Bioscience Institute, State University of São Paulo, UNESP, Campus Botucatu, Botucatu, São Paulo, Brazil
| | - Willian F Zambuzzi
- Department of Chemistry and Biochemistry, Bioscience Institute, State University of São Paulo, UNESP, Campus Botucatu, Botucatu, São Paulo, Brazil
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Acetabular Cups in 60 mm Metal-on-Metal Bearings Subjected to Dynamic Edge-Loading with 70° Peak-Inclination in 10-Million Cycle Simulator Study. LUBRICANTS 2017. [DOI: 10.3390/lubricants6010001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Drynda A, Ren Q, Buchhorn GH, Lohmann CH. The induction of CXCR4 expression in human osteoblast-like cells (MG63) by CoCr particles is regulated by the PLC-DAG-PKC pathway. J Biomed Mater Res B Appl Biomater 2016; 105:2326-2332. [PMID: 27504737 DOI: 10.1002/jbm.b.33770] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Revised: 06/13/2016] [Accepted: 07/26/2016] [Indexed: 01/13/2023]
Abstract
BACKGROUND Osteolysis which leads to aseptic loosening of implants is a fundamental problem in joint replacement surgery (arthroplasty) and the leading cause for implant failure and revision surgery. Metal (CoCr) particles separated from implants by wear cause osteolysis and the failure of orthopedic implants, but the molecular mechanism is not clear. The chemokine receptor CXCR4 has been shown to play a pivotal role in periprosthetic osteolysis. The aim of this study was to determine which signal transduction pathway (PLC-DAG-PKC or MAPK/ERK) induces CXCR4 expression in osteoblast-like cells (MG63) cells. METHODS MG63 and Jurkat cells were stimulated with different amounts of particles (107 , 106 , and 105 ) for different time periods (30 min to 24 h), in the presence and absence of specific inhibitors (chelerythrine for the PLC-DAG-PKC pathway and PD98059 for the MAPK/ERK pathway). The expression of CXCR4-specific mRNA was determined by real-time polymerase chain reaction (PCR), and the PKC activity was measured by Western Blot using an antibody specific for PKC-related phosphorylation. RESULTS Real-time PCR data showed that CXCR4 mRNA expression in MG63 cells induced by CoCr particles was significantly diminished by the PKC-specific inhibitor chelerythrine. This effect was not observed with the MAPK/ERK inhibitor PD98059. The involvement of PKC was also confirmed by an intensified phosphorylation pattern after stimulation with CoCr particles. In Jurkat cells, none of the inhibitors exhibited any effect. CONCLUSION The induction of CXCR4-specific mRNA expression in MG63 cells after stimulation with CoCr particles is regulated by the PLC-DAG-PKC pathway and not by the MAPK/ERK pathway. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 2326-2332, 2017.
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Affiliation(s)
- Andreas Drynda
- Department of Orthopaedic Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Qiang Ren
- Department of Orthopaedic Surgery, Otto-von-Guericke University, Magdeburg, Germany
| | | | - Christoph H Lohmann
- Department of Orthopaedic Surgery, Otto-von-Guericke University, Magdeburg, Germany
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Revell PA, Matharu GS, Mittal S, Pynsent PB, Buckley CD, Revell MP. Increased expression of inducible co-stimulator on CD4+ T-cells in the peripheral blood and synovial fluid of patients with failed hip arthroplasties. Bone Joint Res 2016; 5:52-60. [PMID: 26868893 PMCID: PMC4852791 DOI: 10.1302/2046-3758.52.2000574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 12/09/2015] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES T-cells are considered to play an important role in the inflammatory response causing arthroplasty failure. The study objectives were to investigate the composition and distribution of CD4+ T-cell phenotypes in the peripheral blood (PB) and synovial fluid (SF) of patients undergoing revision surgery for failed metal-on-metal (MoM) and metal-on-polyethylene (MoP) hip arthroplasties, and in patients awaiting total hip arthroplasty. METHODS In this prospective case-control study, PB and SF were obtained from 22 patients (23 hips) undergoing revision of MoM (n = 14) and MoP (n = 9) hip arthroplasties, with eight controls provided from primary hip osteoarthritis cases awaiting arthroplasty. Lymphocyte subtypes in samples were analysed using flow cytometry. RESULTS The percentages of CD4+ T-cell subtypes in PB were not different between groups. The CD4+ T-cells in the SF of MoM hips showed a completely different distribution of phenotypes compared with that found in the PB in the same patients, including significantly decreased CD4+ T-central memory cells (p < 0.05) and increased T-effector memory cells (p < 0.0001) in the SF. Inducible co-stimulator (ICOS) was the only co-stimulatory molecule with different expression on CD4+ CD28+ cells between groups. In PB, ICOS expression was increased in MoM (p < 0.001) and MoP (p < 0.05) cases compared with the controls. In SF, ICOS expression was increased in MoM hips compared with MoP hips (p < 0.05). CONCLUSIONS Increased expression of ICOS on CD4+ T-cells in PB and SF of patients with failed arthroplasties suggests that these cells are activated and involved in generating immune responses. Variations in ICOS expression between MoM and MoP hips may indicate different modes of arthroplasty failure.Cite this article: Professor P. A. Revell. Increased expression of inducible co-stimulator on CD4+ T-cells in the peripheral blood and synovial fluid of patients with failed hip arthroplasties. Bone Joint Res 2016;5:52-60. doi: 10.1302/2046-3758.52.2000574.
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Affiliation(s)
- P A Revell
- The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Birmingham B31 2AP, UK
| | - G S Matharu
- The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Birmingham B31 2AP, UK
| | - S Mittal
- University of Birmingham, Edgbaston, Birmingham B15 2WD, UK
| | - P B Pynsent
- The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Birmingham B31 2AP, UK
| | - C D Buckley
- University of Birmingham, Edgbaston, Birmingham B15 2WD, UK
| | - M P Revell
- The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Birmingham B31 2AP, UK
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In Vitro Analyses of the Toxicity, Immunological, and Gene Expression Effects of Cobalt-Chromium Alloy Wear Debris and Co Ions Derived from Metal-on-Metal Hip Implants. LUBRICANTS 2015. [DOI: 10.3390/lubricants3030539] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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17
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Li DH, Yang Q, Zhou JS, Zhang ZW, Miao MY, Yang SS, Xu WD. Regulatory role of B-cell maturation antigen on the toxic effect of chromium ions on human SaOS-2 osteoblasts. Biotechnol Appl Biochem 2015; 64:638-646. [PMID: 26011700 DOI: 10.1002/bab.1401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Accepted: 05/21/2015] [Indexed: 01/07/2023]
Abstract
Metal prostheses of artificial joints undergo wear, producing numerous metal particles and ions, such as Cr3+ . Cr3+ is considered a key factor leading to aseptic loosening. Many studies focus on the effect of Cr3+ on osteoblasts; however, little is known about the effect of Cr3+ on the B-cell maturation antigen (BCMA) in the osteoblasts. In this study, we first demonstrated the BCMA expressed in human SaOS-2 osteoblasts through reverse transcriptase-PCR, Western blot, and immunocytochemical analyses. Cr3+ decreased alkaline phosphatase (ALP), osteocalcin (OC), cell mineralization, and collagen type I mRNA and protein expression. Moreover, Cr3+ has an inhibitive effect on the expression of the BCMA in human SaOS-2 osteoblasts. However, after we upregulated the expression of the BCMA, ALP, OC, cell mineralization, and collagen type I mRNA and protein expression were increased. Overall, this study demonstrates that the BCMA is involved in human SaOS-2 osteoblast osteogenetic metabolism and plays a regulatory role on the toxic effect of chromium ions on human SaOS-2 osteoblasts.
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Affiliation(s)
- D H Li
- Department of Orthopedics, Changhai Hospital Affiliated to the Second Military Medical University, Yangpu, Shanghai, People's Republic of China
| | - Q Yang
- Department of Orthopedics, Changhai Hospital Affiliated to the Second Military Medical University, Yangpu, Shanghai, People's Republic of China
| | - J S Zhou
- Department of Biochemistry and Molecular Biology, Second Military Medical University, Yangpu, Shanghai, People's Republic of China
| | - Z W Zhang
- Department of Biochemistry and Molecular Biology, Second Military Medical University, Yangpu, Shanghai, People's Republic of China
| | - M Y Miao
- Department of Biochemistry and Molecular Biology, Second Military Medical University, Yangpu, Shanghai, People's Republic of China
| | - S S Yang
- Department of Biochemistry and Molecular Biology, Second Military Medical University, Yangpu, Shanghai, People's Republic of China
| | - W D Xu
- Department of Orthopedics, Changhai Hospital Affiliated to the Second Military Medical University, Yangpu, Shanghai, People's Republic of China
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Kwon JY, Koedrith P, Seo YR. Current investigations into the genotoxicity of zinc oxide and silica nanoparticles in mammalian models in vitro and in vivo: carcinogenic/genotoxic potential, relevant mechanisms and biomarkers, artifacts, and limitations. Int J Nanomedicine 2014; 9 Suppl 2:271-86. [PMID: 25565845 PMCID: PMC4279763 DOI: 10.2147/ijn.s57918] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Engineered nanoparticles (NPs) are widely used in many sectors, such as food, medicine, military, and sport, but their unique characteristics may cause deleterious health effects. Close attention is being paid to metal NP genotoxicity; however, NP genotoxic/carcinogenic effects and the underlying mechanisms remain to be elucidated. In this review, we address some metal and metal oxide NPs of interest and current genotoxicity tests in vitro and in vivo. Metal NPs can cause DNA damage such as chromosomal aberrations, DNA strand breaks, oxidative DNA damage, and mutations. We also discuss several parameters that may affect genotoxic response, including physicochemical properties, widely used assays/end point tests, and experimental conditions. Although potential biomarkers of nanogenotoxicity or carcinogenicity are suggested, inconsistent findings in the literature render results inconclusive due to a variety of factors. Advantages and limitations related to different methods for investigating genotoxicity are described, and future directions and recommendations for better understanding genotoxic potential are addressed.
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Affiliation(s)
- Jee Young Kwon
- Department of Life Science, Institute of Environmental Medicine, Dongguk University, Seoul, Republic of Korea
| | - Preeyaporn Koedrith
- Faculty of Environment and Resource Studies, Mahidol University, Phuttamonthon District, NakhonPathom, Thailand
| | - Young Rok Seo
- Department of Life Science, Institute of Environmental Medicine, Dongguk University, Seoul, Republic of Korea
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Blood levels of cobalt and chromium are inversely correlated to head size after metal-on-metal resurfacing arthroplasty. Hip Int 2014; 23:529-34. [PMID: 23813179 DOI: 10.5301/hipint.5000057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/12/2013] [Indexed: 02/04/2023]
Abstract
Resurfacing arthroplasty has fallen out of favour in recent years due to unfavourable survivorship in joint registries and alarming reports of soft tissue reactions around metal on metal prostheses. Our aim was to assess the effect of head size, implant design and component positioning on metal production by resurfacing arthroplasties. We measured whole blood cobalt and chromium and component position in matched populations implanted with two designs of resurfacing arthroplasty over a two-year period. Both implants resulted in a significant increase in blood metal levels (p<0.001) though the ASR design generated significantly higher metal levels (p = 0.041). A significant inverse correlation was seen between component size and blood cobalt levels (p = 0.032) and blood chromium levels (p<0.001). No correlation was identified between component position and blood metal levels. Small diameter metal resurfacing components result in increased metal generation compared with larger components. As increased metal generation has been correlated to wear and therefore failure, caution must be used on implantation of smaller components and indeed, in those who require smaller components, alternative bearing materials should be considered. These results contrast with recent findings which have demonstrated early failure for larger diameter stemmed metal-on-metal prostheses.
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Serum metal ion concentrations in paediatric patients following total knee arthroplasty using megaprostheses. BIOMED RESEARCH INTERNATIONAL 2014; 2014:817257. [PMID: 25276819 PMCID: PMC4172978 DOI: 10.1155/2014/817257] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Revised: 07/17/2014] [Accepted: 08/11/2014] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to determine the concentrations of cobalt, chromium, and molybdenum in the serum of paediatric tumour patients after fixed hinge total knee arthroplasty. Further, these metal ion levels were compared with serum metal ion levels of patients with other orthopaedic devices such as hip and knee prostheses with metal-on-metal or metal-on-polyethylene articulation to find differences between anatomical locations, abrasion characteristics, and bearing surfaces. After an average follow-up of 108 months (range: 67 to 163) of 11 paediatric patients with fixed hinge total knee arthroplasty, the mean concentrations for Co and Cr were significantly increased while Mo was within the limits compared to the upper values from the reference laboratory. Furthermore, these serum concentrations were significantly higher compared to patients with a standard rotating hinge device (P = 0.002 and P < 0.001) and preoperative controls (P < 0.001). On the other hand, the serum levels of patients following MoM THA or rotating hinge arthroplasty using megaprostheses were higher. Therefore, periodic long-term follow-ups are recommended due to the rising concerns about systemic metal ion exposure in the literature. Upon the occurrence of adverse reactions to metal debris the revision of the fixed hinge implant should be considered.
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Matusiewicz H. Potential release of in vivo trace metals from metallic medical implants in the human body: from ions to nanoparticles--a systematic analytical review. Acta Biomater 2014; 10:2379-403. [PMID: 24565531 DOI: 10.1016/j.actbio.2014.02.027] [Citation(s) in RCA: 116] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 12/04/2013] [Accepted: 02/13/2014] [Indexed: 02/06/2023]
Abstract
Metal ion release from metallic materials, e.g. metallic alloys and pure metals, implanted into the human body in dental and orthopedic surgery is becoming a major cause for concern. This review briefly provides an overview of both metallic alloys and pure metals used in implant materials in dental and orthopedic surgery. Additionally, a short section is dedicated to important biomaterials and their corrosive behavior in both real solutions and various types of media that model human biological fluids and tissues. The present review gives an overview of analytical methods, techniques and different approaches applied to the measurement of in vivo trace metals released into body fluids and tissues from patients carrying metal-on-metal prostheses and metal dental implants. Reference levels of ion concentrations in body fluids and tissues that have been determined by a host of studies are compiled, reviewed and presented in this paper. Finally, a collection of published clinical data on in vivo released trace metals from metallic medical implants is included.
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On the inflammatory response in metal-on-metal implants. J Transl Med 2014; 12:74. [PMID: 24650243 PMCID: PMC3994416 DOI: 10.1186/1479-5876-12-74] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 03/10/2014] [Indexed: 12/04/2022] Open
Abstract
Background Metal-on-metal implants are a special form of hip endoprostheses that despite many advantages can entail serious complications due to release of wear particles from the implanted material. Metal wear particles presumably activate local host defence mechanisms, which causes a persistent inflammatory response with destruction of bone followed by a loosening of the implant. To better characterize this inflammatory response and to link inflammation to bone degradation, the local generation of proinflammatory and osteoclast-inducing cytokines was analysed, as was systemic T cell activation. Methods By quantitative RT-PCR, gene expression of cytokines and markers for T lymphocytes, monocytes/macrophages and osteoclasts, respectively, was analysed in tissue samples obtained intraoperatively during exchange surgery of the loosened implant. Peripheral T cells were characterized by cytofluorometry before surgery and 7 to 10 days thereafter. Results At sites of osteolysis, gene expression of cathepsin K, CD14 and CD3 was seen, indicating the generation of osteoclasts, and the presence of monocytes and of T cells, respectively. Also cytokines were highly expressed, including CXCL8, IL-1ß, CXCL2, MRP-14 and CXCL-10. The latter suggest T cell activation, a notion that could be confirmed by detecting a small, though conspicuous population of activated CD4+ cells in the peripheral blood T cells prior to surgery. Conclusion Our data support the concept that metallosis is the result of a local inflammatory response, which according to histomorphology and the composition of the cellular infiltrate classifies as an acute phase of a chronic inflammatory disease. The proinflammatory environment, particularly the generation of the osteoclast-inducing cytokines CXCL8 and IL1-ß, promotes bone resorption. Loss of bone results in implant loosening, which then causes the major symptoms of metallosis, pain and reduced range of motion.
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Hailer NP, Bengtsson M, Lundberg C, Milbrink J. High metal ion levels after use of the ASR™ device correlate with development of pseudotumors and T cell activation. Clin Orthop Relat Res 2014; 472:953-61. [PMID: 24081666 PMCID: PMC3916604 DOI: 10.1007/s11999-013-3307-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 09/16/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Pseudotumors and immunologic alterations are reported in patients with elevated metal ion levels after resurfacing arthroplasty of the hip. A direct association of increased cobalt and chromium concentrations with the development of pseudotumors has not been established. QUESTIONS/PURPOSES We hypothesized that (1) patients with higher blood cobalt and chromium concentrations are more likely to have pseudotumors develop, (2) elevated cobalt and chromium concentrations correlate with increased activation of defined T cell populations, and (3) elevated metal ion levels, small implant size, cup inclination angle, and patient age are risk factors for the development of pseudotumors. METHODS A single-surgeon cohort of 78 patients with 84 Articular Surface Replacement(®) implants was retrospectively investigated. Between 2006 and 2010, we performed 84 THAs using the Articular Surface Replacement(®) implant; this represented 2% (84/4950) of all primary hip replacements performed during that period. Of the procedures performed using this implant, we screened 77 patients (99%) at a mean of 43 months after surgery (range, 24-60 months). Seventy-one patients were investigated using ultrasound scanning, and cobalt and chromium concentrations in whole blood were determined by high-resolution inductively coupled plasma mass spectrometry. Differential analysis of lymphocyte subsets was performed by flow cytometry in 53 patients. Results of immunologic analyses were investigated separately for patients with and without pseudotumors. Pseudotumors were found in 25 hips (35%) and were more common in women than in men (p = 0.02). Multivariable regression analysis was performed to identify risk factors for the development of pseudotumors. RESULTS Cobalt and chromium concentrations were greater in patients with pseudotumors than in those without (cobalt, median 8.3 versus median 1.0 μg/L, p < 0.001; chromium, median 5.9 versus median 1.3 μg/L, p < 0.001). The percentage of HLA-DR(+)CD4(+) T cells was greater in patients with pseudotumors than in those without (p = 0.03), and the proportion of this lymphocyte subtype was positively correlated with cobalt concentrations (r = 0.3, p = 0.02). Multivariable regression analysis indicated that increasing cobalt levels were associated with the development of pseudotumors (p < 0.001), and that patients with larger implants were less likely to have them develop (p = 0.04); age and cup inclination were not risk factors. CONCLUSIONS We found a distinct association of elevated metal ion concentrations with the presence of pseudotumors and a correlation of increased cobalt concentrations with the proportion of activated T helper/regulator cells. Thus, the development of soft tissue masses after metal-on-metal arthroplasty could be accompanied by activation of T cells, indicating that this complication may be partly immunologically mediated. Further investigations of immunologic parameters in larger cohorts of patients with metal-on-metal arthroplasties are warranted. LEVEL OF EVIDENCE Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Nils P. Hailer
- Department of Orthopaedics, Institute of Surgical Sciences, Uppsala University Hospital, Uppsala, Uppland 75591 Sweden
| | - Mats Bengtsson
- Department of Immunology, Genetics and Pathology, Uppsala University Hospital, Uppsala, Sweden
| | - Christina Lundberg
- Department of Radiology, Institute of Radiology, Oncology and Radiation Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Jan Milbrink
- Department of Orthopaedics, Institute of Surgical Sciences, Uppsala University Hospital, Uppsala, Uppland 75591 Sweden
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Clarke IC, Lazennec JY, Brusson A, Savisaar C, Bowsher JG, Burgett M, Donaldson TK. Risk of impingement and third-body abrasion with 28-mm metal-on-metal bearings. Clin Orthop Relat Res 2014; 472:497-508. [PMID: 24297107 PMCID: PMC3890183 DOI: 10.1007/s11999-013-3399-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Concerns have been raised about the sequelae of metal-on-metal (MoM) bearings in total hip arthroplasty (THA). However, retrieval studies, which offer the best insight into the clinically relevant mechanisms of MoM wear, have followed predictable trends to date such as indicting cobalt-chromium (CoCr) metallurgy, cup design, high conformity between the head and cup, "steep cups," "microseparation," and "edge wear." QUESTIONS/PURPOSES We wished to evaluate a set of retrieved 28-mm MoM THA for signs of (1) cup-to-stem impingement; (2) normal wear pattern and concomitant stripe damage on femoral heads that would signify adverse wear mechanics; and (3) well-defined evidence of third-body scratches on bearings that would indicate large abrasive particles had circulated the joint space. METHODS Ten 28-mm MOM retrievals were selected on the basis that femoral stems were included. Revision surgeries at 3 to 8 years were for pain, osteolysis, and cup loosening. CoCr stems and the MoM bearings were produced by one vendor and Ti6Al4V stems by a second vendor. All but two cases had been fixed with bone cement. We looked for patterns of normal wear and impingement signs on femoral necks and cup rims. We looked for adverse wear defined as stripe damage that was visually apparent on each bearing. Wear patterns were examined microscopically to determine the nature of abrasions and signs of metal transfer. Graphical models recreated femoral neck and cup designs to precisely correlate impingement sites on femoral necks to cup positions and head stripe patterns. RESULTS The evidence revealed that all CoCr cup liners had impinged on either anterior or posterior facets of femoral necks. Liner impingement at the most proximal neck notch occurred with the head well located and impingement at the distal notch occurred with the head rotated 5 mm out of the cup. The hip gained 20° motion by such a subluxation maneuver with this THA design. All heads had stripe wear, the basal and polar stripes coinciding with cup impingement sites. Analysis of stripe damage revealed 40 to 100-μm wide scratches created by large particles ploughing across bearing surfaces. The association of stripe wear with evidence of neck notching implicated impingement as the root cause, the outcome being the aggressive third-body wear. CONCLUSIONS We found consistent evidence of impingement, abnormal stripe damage, and evidence of third-body abrasive wear in a small sample of one type of 28-mm MoM design. Impingement models demonstrated that 28-mm heads could lever 20° out of the liners. Although other studies continue to show good success with 28-mm MoM bearings, their use has been discontinued at La Pitie Hospital.
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Affiliation(s)
- Ian C. Clarke
- Department of Orthopaedics, Loma Linda University, Loma Linda, CA USA ,DARF Center, 900E Washington Street #200, Colton, CA 92324 USA
| | - Jean-Yves Lazennec
- Department of Orthopaedics, La Pitie Hospital, UPMC University, Paris, France
| | - Adrien Brusson
- Department of Orthopaedics, La Pitie Hospital, UPMC University, Paris, France
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Myant C, Cann P. On the matter of synovial fluid lubrication: implications for Metal-on-Metal hip tribology. J Mech Behav Biomed Mater 2014; 34:338-48. [PMID: 24462265 DOI: 10.1016/j.jmbbm.2013.12.016] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 12/11/2013] [Accepted: 12/14/2013] [Indexed: 11/26/2022]
Abstract
Artificial articular joints present an interesting, and difficult, tribological problem. These bearing contacts undergo complex transient loading and multi axes kinematic cycles, over extremely long periods of time (>10 years). Despite extensive research, wear of the bearing surfaces, particularly metal-metal hips, remains a major problem. Comparatively little is known about the prevailing lubrication mechanism in artificial joints which is a serious gap in our knowledge as this determines film formation and hence wear. In this paper we review the accepted lubrication models for artificial hips and present a new concept to explain film formation with synovial fluid. This model, recently proposed by the authors, suggests that interfacial film formation is determined by rheological changes local to the contact and is driven by aggregation of synovial fluid proteins. The implications of this new mechanism for the tribological performance of new implant designs and the effect of patient synovial fluid properties are discussed.
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Paustenbach DJ, Galbraith DA, Finley BL. Interpreting cobalt blood concentrations in hip implant patients. Clin Toxicol (Phila) 2013; 52:98-112. [DOI: 10.3109/15563650.2013.857024] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Jantzen C, Jørgensen HL, Duus BR, Sporring SL, Lauritzen JB. Chromium and cobalt ion concentrations in blood and serum following various types of metal-on-metal hip arthroplasties: a literature overview. Acta Orthop 2013; 84:229-36. [PMID: 23594249 PMCID: PMC3715816 DOI: 10.3109/17453674.2013.792034] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [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 Widely different metal ion concentrations in blood and serum have been reported with metal-on-metal (MoM) implants. We reviewed the literature on blood and serum ion concentrations of chromium (Cr) and cobalt (Co) following various MoM hip arthroplasties. METHODS Studies were searched for in the Medline database, Embase, and the Cochrane Database of Systematic Reviews. Highest mean or median ion concentrations of Cr and Co after a minimum of 1 year of follow-up were extracted and grouped according to sample- and articulation type, and average values were calculated. RESULTS 43 studies were included and 16 different MoM implants were identified. For the different types of bearings, average ion concentrations and range were calculated from the mean or median ion concentration. The average Cr concentration ranged between 0.5 and 2.5 μg/L in blood and between 0.8 and 5.1 μg/L in serum. For Co, the range was 0.7-3.4 μg/L in blood and 0.3-7.5 μg/L in serum. INTERPRETATION When the average blood ion concentrations calculated for the different implants, together with the concentrations measured in the individual studies, were compared with the upper acceptable limit for Cr and Co in blood, no clear pattern was recognized. Furthermore, we were unable to detect any clear difference in ion concentrations between different types of implants (THA and resurfacing).
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Affiliation(s)
| | - Henrik L Jørgensen
- Clinical Biochemistry, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
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The effect of femoral head size on functional outcome in primary total hip arthroplasty: a single-blinded randomised controlled trial. Hip Int 2013; 22:592-7. [PMID: 23250715 DOI: 10.5301/hip.2012.10360] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2012] [Indexed: 02/04/2023]
Abstract
We conducted a prospective single-blinded randomised controlled trial to compare the functional and quality of life outcomes in two groups of patients between 60 and 80 years of age undergoing THR; the first receiving a small head (28-32 mm) metal on polyethylene (MoP) articulation, and the second receiving a large head (44-54 mm) metal on metal (MoM) articulation. We recruited 49 patients and randomised them into one of the two groups (22 MoP and 27 MoM). The results demonstrated no statistical difference in any of the assessed functional outcomes at any follow-up point (p>0.05). There were no dislocations or revisions in either group. Although it has been suggested that large head MoM articulations in THA offer superior stability and function, our results suggest that small head MoP articulations can achieve comparable ROM, function and quality of life at short-term follow-up.
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Penny JØ, Varmarken J, Ovesen O, Nielsen C, Overgaard S. Metal ion levels and lymphocyte counts: ASR hip resurfacing prosthesis vs. standard THA: 2-year results from a randomized study. Acta Orthop 2013; 84:130-7. [PMID: 23597114 PMCID: PMC3639332 DOI: 10.3109/17453674.2013.784657] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [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 Wear particles from metal-on-metal arthroplasties are under suspicion for adverse effects both locally and systemically, and the DePuy ASR Hip Resurfacing System (RHA) has above-average failure rates. We compared lymphocyte counts in RHA and total hip arthroplasty (THA) and investigated whether cobalt and chromium ions affected the lymphocyte counts. METHOD In a randomized controlled trial, we followed 19 RHA patients and 19 THA patients. Lymphocyte subsets and chromium and cobalt ion concentrations were measured at baseline, at 8 weeks, at 6 months, and at 1 and 2 years. RESULTS The T-lymphocyte counts for both implant types declined over the 2-year period. This decline was statistically significant for CD3(+)CD8(+) in the THA group, with a regression coefficient of -0.04 × 10(9)cells/year (95% CI: -0.08 to -0.01). Regression analysis indicated a depressive effect of cobalt ions in particular on T-cells with 2-year whole-blood cobalt regression coefficients for CD3+ of -0.10 (95% CI: -0.16 to -0.04) × 10(9) cells/parts per billion (ppb), for CD3+CD4+ of -0.06 (-0.09 to -0.03) × 10(9) cells/ppb, and for CD3(+)CD8(+) of -0.02 (-0.03 to -0.00) × 10(9) cells/ppb. INTERPRETATION Circulating T-lymphocyte levels may decline after surgery, regardless of implant type. Metal ions-particularly cobalt-may have a general depressive effect on T- and B-lymphocyte levels. Registered with ClinicalTrials.gov under # NCT01113762.
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Affiliation(s)
- Jeannette Ø Penny
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense,Department of Orthopaedics, Hospital South – Naestved, Region Zealand
| | | | - Ole Ovesen
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense
| | - Christian Nielsen
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark.
| | - Søren Overgaard
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense
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Kayani B, Rahman J, Hanna SA, Cannon SR, Aston WJ, Miles J. Delayed sciatic nerve palsy following resurfacing hip arthroplasty caused by metal debris. BMJ Case Rep 2012; 2012:bcr-2012-006856. [PMID: 23152177 DOI: 10.1136/bcr-2012-006856] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The rapid rise in the incidence of failed metal-on-metal hip articulations in recent years has led to many patients requiring complex revision surgery. These failed metal prostheses may produce local metallic debris, which promotes both local and systemic adverse effects. We report an unusual case of failed metal-on-metal resurfacing hip arthroplasty presenting with ipsilateral buttock pain and foot drop 6 months after surgery. After thorough investigations, the metal-on-metal bearing was revised to a metal-on-polyethylene total hip replacement. This resulted in marked improvement in the systemic symptoms, inflammatory marke and metal ion levels postoperatively. However, neither clinical nor neurophysiological sciatic nerve recovery followed. The patient eventually required tendon transfer surgery for her persistent foot drop.
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Affiliation(s)
- Babar Kayani
- Joint Reconstruction Unit, Royal National Orthopaedic Hospital, Stanmore, UK.
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Malviya A, Stafford GH, Villar RJF, Villar RN. Have the media influenced the use of hip resurfacing arthroplasty? A review of UK print media. Ann R Coll Surg Engl 2012; 94:432-7. [PMID: 22943335 PMCID: PMC3954326 DOI: 10.1308/003588412x13171221592014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION The aim of this study was to look at the different claims made about hip resurfacing arthroplasty in the popular UK print media and how this relates to findings in the scientific literature. METHODS A review of UK popular print media from January 1992 to June 2011 was performed using the Lexis(®) Library online news database. Only articles discussing the clinical results of hip resurfacing arthroplasty were included. After excluding duplicates, 49 newspaper articles were found suitable for this study. The main outcome measure was the claims made in popular UK print media about hip resurfacing. These were compared with the scientific publication. We reviewed the trend of use of hip resurfacing prostheses during the same period as reported in the National Joint Registry. RESULTS A disparity was found between the claims in the newspapers and published scientific literature. The initial newspaper articles highlighted only the positive aspects of hip resurfacing arthroplasty, without definitive contemporary evidence backing the claims. Most of these claims were refuted by future scientific publications. The initial positive media reports coincided with an increase in the use of hip resurfacing but the decline coincided with negative reports in the scientific literature. CONCLUSIONS The trend of the newspaper articles and that of the number of hip resurfacing prostheses implanted suggests that the media may have been partly responsible for the increased use of this prosthesis. The subsequent decrease was initiated by the scientific literature.
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Affiliation(s)
- A Malviya
- Spire Cambridge Lea Hospital, 81 Daylesford Drive, Newcastle upon Tyne NE3 1TW, UK.
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32
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Metal-on-metal bearings, inflammatory pseudotumours and their neurological manifestations. Hip Int 2012; 22:129-36. [PMID: 22476931 DOI: 10.5301/hip.2012.9185] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/17/2012] [Indexed: 02/04/2023]
Abstract
Metal-on-metal bearings have become more popular for hip arthroplasty in younger patients in the last 15 years. We present a review of the neurological consequences relating to such bearing surfaces illustrated by an appropriate case report. The mechanisms of increased metal ion production and pseudotumour formation are discussed. If unexplained neurology, hip/groin pain or a localised mass around the hip are present with a metal bearing hip then urgent referral to a specialist orthopaedic surgeon is warranted for consideration of exchange arthroplasty.
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Bernstein M, Desy NM, Petit A, Zukor DJ, Huk OL, Antoniou J. Long-term follow-up and metal ion trend of patients with metal-on-metal total hip arthroplasty. INTERNATIONAL ORTHOPAEDICS 2012; 36:1807-12. [PMID: 22678122 DOI: 10.1007/s00264-012-1570-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2012] [Accepted: 04/28/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Long-term studies are required to support the use of metal-on-metal (MoM) bearings in total hip arthroplasty (THA) given the concern about systemic metal ion release and reports of adverse local soft tissue reactions. The purpose of this study was to report the seven to 13-year clinical, radiographic, and metal ion results in patients following MoM THA. METHODS We studied 163 prostheses after second-generation MoM THA between July 1997 and November 2003. Cobalt and chromium metal ions were collected using whole and analysed by inductively-coupled plasma-mass spectrometry. RESULTS The mean follow-up was 8.87 years (range, 7-13 years). Four hips (2.5 %) were revised. The Kaplan-Meier survivorship was 91.3 % for revision for all causes, and 97.5 % when excluding the hips revised for a manufacturer's defect. Median whole blood cobalt levels peaked at a value of 2.87 μg/L at four years (p < 0.0001 vs. pre-operative) and subsequently decreased to 2.0 μg/L after nine years (p = 0.002 vs. four years). Median chromium levels maximally increased up to 0.75 μg/L after five years (p < 0.0001 vs. pre-operative) and tended to decrease thereafter to values of 0.56 μg/L after seven years. CONCLUSIONS This seven to 13-year follow-up study indicates that the clinical and radiological results following MoM THA are satisfactory with low revision rates. Cobalt and chromium ion levels peaked at four and five years, respectively, and gradually decreased thereafter.
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Affiliation(s)
- Mitchell Bernstein
- Division of Orthopaedic Surgery, McGill University Health Centre, 1650 Cedar Avenue, Room B5.159.6, Montreal, Quebec, Canada H3G 1A4
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Maurer-Ertl W, Friesenbichler J, Sadoghi P, Pechmann M, Trennheuser M, Leithner A. Metal ion levels in large-diameter total hip and resurfacing hip arthroplasty--preliminary results of a prospective five year study after two years of follow-up. BMC Musculoskelet Disord 2012; 13:56. [PMID: 22494794 PMCID: PMC3490776 DOI: 10.1186/1471-2474-13-56] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 03/27/2012] [Indexed: 01/15/2023] Open
Abstract
Background Metal-on-metal hip resurfacing is an alternative to metal-on-metal total hip arthroplasty, especially for young and physically active patients. However, wear which might be detected by increased serum ion levels is a matter of concern. Methods The aims of this preliminary study were to determine the raise of metal ion levels at 2-years follow-up in a prospective setting and to evaluate differences between patients with either resurfacing or total hip arthroplasty. Furthermore we investigated if the inclination of the acetabular component and the arc of cover would influence these findings. Therefore, 36 patients were followed prospectively. Results The results showed increments for Co and Cr in both implant groups. Patients treated with large-diameter total hip arthroplasty showed fourfold and threefold, respectively, higher levels for Co and Cr compared to the resurfacing group (Co: p < 0,001 and Cr: p = 0,005). Nevertheless, we observed no significant correlation between serum ion levels, inclination and arc of cover. Discussion In order to clarify the biologic effects of ion dissemination and to identify risks concerning long-term toxicity of metals, the exposure should be monitored carefully. Therefore, long-term studies have to be done to determine adverse effects of Co and Cr following metal-on-metal hip replacement.
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Affiliation(s)
- W Maurer-Ertl
- Department of Orthopaedic Surgery, Medical University of Graz, Graz, Austria
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35
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Jiang H, Liu F, Yang H, Li Y. Effects of cobalt nanoparticles on human T cells in vitro. Biol Trace Elem Res 2012; 146:23-9. [PMID: 21968949 DOI: 10.1007/s12011-011-9221-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Accepted: 09/22/2011] [Indexed: 11/27/2022]
Abstract
Limited information is available on the potential risk of degradation products of metal-on-metal bearings in joint arthroplasty. The aim of this study was to investigate the cytotoxicity and genotoxicity of orthopedic-related cobalt nanoparticles on human T cells in vitro. T cells were collected using magnetic CD3 microbeads and exposed to different concentrations of cobalt nanoparticles and cobalt chloride. Cytotoxicity was evaluated by methyl thiazolyl tetrazolium and lactate dehydrogenase release assay. Cobalt nanoparticles dissolution in culture medium was determined by inductively coupled plasma-mass spectrometry. To study the probable mechanism of cobalt nanoparticles effects on T cells, superoxide dismutase, catalase, and glutathione peroxidase level was measured. Cobalt nanoparticles and cobalt ions could inhibit cell viability and enhance lactate dehydrogenase release in a concentration- and time-dependent manner (P < 0.05). The levels of cobalt ion released from cobalt nanoparticles in the culture medium were less than 40% and increased with cobalt nanoparticles concentration. Cobalt nanoparticles could induce primary DNA damage in a concentration-dependent manner, and the DNA damage caused by cobalt nanoparticles was heavier than that caused by cobalt ions. Cobalt nanoparticles exposure could significantly decrease superoxide dismutase, catalase, and glutathione peroxidase activities at subtoxic concentrations (6 μM, <CC(50)). These findings suggested that cobalt nanoparticles could generate potential risks to the T cells of patients suffer from metal-on-metal total hip arthroplasty, and the inhibition of antioxidant capacity may play important role in cobalt nanoparticles effects on T cells.
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Affiliation(s)
- Haitao Jiang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Shizi Street, Suzhou, 215006, Jiangsu Province, People's Republic of China
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Kwon YM, Mellon SJ, Monk P, Murray DW, Gill HS. In vivo evaluation of edge-loading in metal-on-metal hip resurfacing patients with pseudotumours. Bone Joint Res 2012; 1:42-9. [PMID: 23610670 PMCID: PMC3626206 DOI: 10.1302/2046-3758.14.2000019] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Accepted: 03/20/2012] [Indexed: 12/12/2022] Open
Abstract
Objectives Pseudotumours (abnormal peri-prosthetic soft-tissue reactions)
following metal-on-metal hip resurfacing arthroplasty (MoMHRA) have
been associated with elevated metal ion levels, suggesting that
excessive wear may occur due to edge-loading of these MoM implants.
This study aimed to quantify in vivo edge-loading
in MoMHRA patients with and without pseudotumours during functional
activities. Methods The duration and magnitude of edge-loading in vivo was
quantified during functional activities by combining the dynamic
hip joint segment contact force calculated from the three-dimensional
(3D) motion analysis system with the 3D reconstruction of orientation
of the acetabular component and each patient’s specific hip joint
centre, based on CT scans. Results Edge-loading in the hips with pseudotumours occurred with a four-fold
increase in duration and magnitude of force compared with the hips
without pseudotumours (p = 0.02). Conclusions The study provides the first in vivo evidence to support that
edge-loading is an important mechanism that leads to localised excessive
wear (edge-wear), with subsequent elevation of metal ion levels
in MoMHRA patients with pseudotumours.
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Affiliation(s)
- Y-M Kwon
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Suite 3B, Boston, Massachusetts 02114, USA
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Afolaranmi GA, Akbar M, Brewer J, Grant MH. Distribution of metal released from cobalt-chromium alloy orthopaedic wear particles implanted into air pouches in mice. J Biomed Mater Res A 2012; 100:1529-38. [DOI: 10.1002/jbm.a.34091] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Revised: 12/10/2011] [Accepted: 01/10/2012] [Indexed: 11/11/2022]
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Sampson B, Hart A. Clinical usefulness of blood metal measurements to assess the failure of metal-on-metal hip implants. Ann Clin Biochem 2012; 49:118-31. [PMID: 22155921 PMCID: PMC4527411 DOI: 10.1258/acb.2011.011141] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2011] [Indexed: 02/06/2023]
Abstract
In April 2010, a Medicines and Healthcare Products Regulatory Agency safety alert concerning all metal-on-metal (MOM) hip replacements recommended measuring chromium and cobalt concentrations when managing patients with painful prostheses. The need for this review is illustrated by the recent surge in requests for these blood tests from orthopaedic surgeons following this alert. The aim is to provide guidance to laboratories in assessing these requests and advising clinicians on interpretation. First, we summarize the basic terminology regarding the types of hip replacements, with emphasis on the MOM type. Second, we describe the clinical concerns over implant-derived wear debris in the local tissues and distant sites. Analytical aspects of the measurement of the relevant metal ions and what factors affect the levels measured are discussed. The application of inductively coupled plasma mass spectrometry techniques to the measurement of these metals is considered in detail. The biological effects of metal wear products are summarized with local toxicity and systemic biological effects considered, including carcinogenicity, genotoxicity and systemic toxicity. Clinical cases are used to illustrate pertinent points.
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Affiliation(s)
- Barry Sampson
- Department of Clinical Biochemistry, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Road, London, UK.
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Abstract
We compared 47 patients with groin pain following hip resurfacing to a matched control group. Functional scores and plain radiographs were assessed along with measurement of whole blood cobalt and chromium by inductively coupled mass spectrometry. Symptomatic patients underwent ultrasound scan of the affected hip. Mean functional outcomes were poor in those with pain and good in the control group. Groin pain was associated with valgus stem positioning and lower neck:head ratio (relatively narrow neck) (p=0.03, p=0.04 respectively). We classified patients with groin pain into two groups: biological and mechanical. The biological group had soft tissue abnormalities on USS and higher levels of cobalt and chromium (p=0.04, p=0.05 respectively). The mechanical group had normal USS, lower metal ion levels and more retroverted femoral components (p=0.01).
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40
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Polyzois I, Nikolopoulos D, Michos I, Patsouris E, Theocharis S. Local and systemic toxicity of nanoscale debris particles in total hip arthroplasty. J Appl Toxicol 2012; 32:255-69. [PMID: 22328167 DOI: 10.1002/jat.2729] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Revised: 12/29/2011] [Accepted: 12/29/2011] [Indexed: 11/06/2022]
Abstract
Over the past 30 years joint replacement prostheses have been developed and refined to enhance durability and reproducibility. Total hip joint arthroplasty is being performed in an increasing number of younger patients; therefore orthopaedic surgeons seek implants with a longer life span. With regards to the progress of mechanical behaviour of the biomaterials used in an arthroplasty, little is known about the long-term biological effects of wear debris. Owing to the composition of the prostheses currently in use, systemic exposure to chromium (Cr), cobalt (Co), nickel (Ni) and aluminium (Al) alloys occurs as a result of the formation of metal wear nano-particles that are released both from metal-on-metal and polyethylene-on-metal bearings, resulting in a postoperative increase in metal ion levels at different organ sites. These particles circulate both locally and systemically, penetrate cell plasma membranes, bind to cellular proteins and enzymes and modulate cytokine expression. Their physiologic effects are poorly understood and their potential toxicity, hypersensitivity and carcinogenicity remain a cause for concern. In this article we will address the issue of whether these nanoscale degradation products are associated with adverse, clinically significant local or systemic toxicologic sequelae.
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Affiliation(s)
- Ioannis Polyzois
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens, and 4th Orthopaedic Department, Ascleipion Voulas General Hospital, Athens, Greece
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Gontarewicz A, Niggemeyer O, Tharun L, Grancicova L, Rüther W, Zustin J. Morphological study of synovial changes in two-stage reconstructions of the infected hip and knee arthroplasties. BMJ Open 2012; 2:bmjopen-2012-001467. [PMID: 22893669 PMCID: PMC3425892 DOI: 10.1136/bmjopen-2012-001467] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To study the morphological changes of the regenerating synovium in two-stage revision arthroplasty, which is the gold standard for treatment of periprosthetic joint infection. DESIGN The authors analysed a series of synovial biopsies to examine morphological changes in healing periprosthetic tissues damaged by previous surgery and infection. METHODS Synovial tissues from 19 patients (10 knees and 9 hips) who underwent a two-stage exchange surgery for periprosthetic infection were reviewed and correlated with clinical and laboratory findings. SETTING Retrospective morphological study. PARTICIPANTS Archival tissues from 19 two-stage revision arthroplasties in adult patients. RESULTS Healing synovial tissue obtained at the reimplantation surgery showed characteristic layering: superficial fibrin exudate, immature richly vascularised granulation tissue and deeper maturing granulation tissue and fibrosis. Although increased neutrophil counts were found in the majority of cases, 2 of 19 cases showed dense infiltrates indicative of persistent infection, which correlated with positive microbiology in one case. One of the cases failed due to acetabular loosening and two cases failed due to late superinfection. One case showed a dense infiltration of eosinophils suggestive of a hypersensitivity reaction, which was subsequently proven by cutaneous tests. Foci of extramedullary haematopoiesis were detected in two cases. CONCLUSIONS We observed characteristic morphological changes in the healing synovial tissue during reimplantation surgery for periprosthetic infection in serologically and microbiologically sterile tissues. Substantial increased counts of synovial neutrophils (>200 cells/10 high-power fields) seem to be indicative of persistent infection of the joint; therefore, prolonged antibiotic therapy should be considered in positive cases.
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Affiliation(s)
- Arthur Gontarewicz
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Oliver Niggemeyer
- Department of Orthopedics, Clinic Bad Bramstedt, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- AG and ON contributed equally
| | - Lars Tharun
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Livia Grancicova
- Institute of Infection Medicine and Microbiology, University Medical Center Schleswig-Holstein, Campus Kiel, Germany
| | - Wolfgang Rüther
- Department of Orthopedics, Clinic Bad Bramstedt, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jozef Zustin
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Afolaranmi GA, Grant MH. Effect of ascorbic acid on the distribution of Cr(VI) and Co(II) in the blood and organs of rats. Toxicology 2011. [DOI: 10.1016/j.tox.2011.09.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fan J, Myant CW, Underwood R, Cann PM, Hart A. Inlet protein aggregation: a new mechanism for lubricating film formation with model synovial fluids. Proc Inst Mech Eng H 2011; 225:696-709. [PMID: 21870377 PMCID: PMC4107775 DOI: 10.1177/0954411911401306] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This paper reports a fundamental study of lubricant film formation with model synovial fluid components (proteins) and bovine serum (BS). The objective was to investigate the role of proteins in the lubrication process. Film thickness was measured by optical interferometry in a ball-on-disc device (mean speed range of 2-60 mm/s). A commercial cobalt-chromium (CoCrMo) metal femoral head was used as the stationary component. The results for BS showed complex time-dependent behaviour, which was not representative of a simple fluid. After a few minutes sliding BS formed a thin adherent film of 10-20 nm, which was attributed to protein absorbance at the surface. This layer was augmented by a hydrodynamic film, which often increased at slow speeds. At the end of the test deposited surface layers of 20-50 nm were measured. Imaging of the contact showed that at slow speeds an apparent 'phase boundary' formed in the inlet just in front of the Hertzian zone. This was associated with the formation of a reservoir of high-viscosity material that periodically moved through the contact forming a much thicker film. The study shows that proteins play an important role in the film-forming process and current lubrication models do not capture these mechanisms.
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Affiliation(s)
- J Fan
- Tribology Group, Department of Mechanical Engineering, Imperial College London, London, UK
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44
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Pazzaglia UE, Apostoli P, Congiu T, Catalani S, Marchese M, Zarattini G. Cobalt, chromium and molybdenum ions kinetics in the human body: data gained from a total hip replacement with massive third body wear of the head and neuropathy by cobalt intoxication. Arch Orthop Trauma Surg 2011; 131:1299-308. [PMID: 21298277 DOI: 10.1007/s00402-011-1268-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2010] [Indexed: 11/29/2022]
Abstract
INTRODUCTION A patient with a total hip replacement developed optic, acoustic and peripheral neuropathy from metal ions intoxication, due to the wear products released from the prosthesis. Subsequently the kinetics of the metal ions was studied. MATERIALS AND METHODS Massive wear and acute intoxication allowed a study of the metal ions kinetics and of EDTA treatment. RESULTS Plasma and other organic fluids were saturated by each of the metal ions released from the exposed surface according to the solubility of each ion; a larger fraction of Co ions was bound within red cells, while the plasmatic fraction appeared more movable. In a patient with a prosthesis subjected to wear, the ions released are from the prosthetic and from the debris surface (spread in the body). The latter is a function of the number and size of particles. DISCUSSION Revision of the prosthesis from the point of view of the metal ions kinetics corresponded to a reduction of the releasing surface because of debris washed out by irrigation and tissue excision; however, the metal particles spread by lymphatic circulation continued to release ions even though the source of wear had been removed. Early diagnosis of high metal wear can be ascertained with mass spectrometry and after revision high levels of metal ions can only be reduced with repeated chelating treatment. It is preferable not to revise fractured ceramic components with a polyethylene-metal articulation.
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45
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Serum metal ion levels after rotating-hinge knee arthroplasty: comparison between a standard device and a megaprosthesis. INTERNATIONAL ORTHOPAEDICS 2011; 36:539-44. [PMID: 21755331 DOI: 10.1007/s00264-011-1317-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Accepted: 06/24/2011] [Indexed: 01/08/2023]
Abstract
PURPOSE The effects of systemic metal ion exposure in patients with implants made of common prosthetic alloys continue to be a matter of concern. The aim of the study was to determine the measurement values of cobalt (Co), chromium (Cr) and molybdenum (Mo) in serum following rotating-hinge knee arthroplasty. METHODS Blood was taken from 25 patients [mean follow-up 35 (range nine to 67) months] treated with megaprostheses (n=17) or standard rotating-hinge devices (n=8) and analysed using electrothermal graphite furnace atomic absorption spectrometry (ET-ASS). RESULTS Determining the concentrations of metal ions following rotating-hinge knee arthroplasty revealed increments for Co and Cr but not Mo. Metal ion release was significantly higher in patients with megaprostheses compared to a standard rotating-hinge knee device (Co p=0,024; Cr p=0.025). CONCLUSION The authors believe there might be an additional metal ion release from the surface of the prosthesis and not only from the articulating surfaces because, in cases of rotating-hinge knee prosthesis, there is a metal-on-polyethylene articulation and not a direct metal-on-metal junction. Nevertheless, long-term studies are required to determine adverse effects of Co, Cr and Mo following total hip replacement and total knee arthroplasty.
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46
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Haddad FS, Thakrar RR, Hart AJ, Skinner JA, Nargol AVF, Nolan JF, Gill HS, Murray DW, Blom AW, Case CP. Metal-on-metal bearings: the evidence so far. ACTA ACUST UNITED AC 2011; 93:572-9. [PMID: 21511920 DOI: 10.1302/0301-620x.93b4.26429] [Citation(s) in RCA: 214] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Lately, concerns have arisen following the use of large metal-on-metal bearings in hip replacements owing to reports of catastrophic soft-tissue reactions resulting in implant failure and associated complications. This review examines the literature and contemporary presentations on current clinical dilemmas in metal-on-metal hip replacement.
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Affiliation(s)
- F S Haddad
- Department of Orthopaedics, University College Hospital, 235 Euston Road, London NW1 2BU, UK.
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47
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Mao X, Wong AA, Crawford RW. Cobalt toxicity — an emerging clinical problem in patients with metal‐on‐metal hip prostheses? Med J Aust 2011; 194:649-51. [DOI: 10.5694/j.1326-5377.2011.tb03151.x] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2011] [Accepted: 05/19/2011] [Indexed: 11/17/2022]
Affiliation(s)
- Xinzhan Mao
- Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | | | - Ross W Crawford
- Prince Charles Hospital, Brisbane, QLD
- School of Engineering Systems and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD
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Bernstein M, Walsh A, Petit A, Zukor DJ, Antoniou J, Antoniou J. Femoral head size does not affect ion values in metal-on-metal total hips. Clin Orthop Relat Res 2011; 469:1642-50. [PMID: 20963530 PMCID: PMC3094634 DOI: 10.1007/s11999-010-1630-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Metal-on-metal articulations can release substantial amounts of particles containing cobalt and chromium into the surrounding milieu, causing concern for cellular toxicity and adverse local soft tissue reactions. The diameter of the femoral head has been one of the variables that inversely affects wear of metal-on-metal total hip arthroplasty (THA). The oxidative stress of increased metal ions can be measured with serum markers. It is still controversial if larger femoral head diameters decrease wear rates in patients with metal-on-metal THA and if the increased metal ions alter the body's antioxidant status. QUESTIONS/PURPOSES We therefore (1) determined whole blood metal ions in patients with small (28 mm and 36 mm) and large (40 mm and 44 mm) diameter femoral heads; (2) measured oxidative stress markers (total antioxidants, nitrotyrosine, and peroxides); and (3) determined whether acetabular version or inclination influenced ion levels. METHODS One hundred four patients were retrospectively studied. We recorded Harris hip scores and UCLA activity scores. All patients were followed at 1 year. RESULTS The activity scores were similar in the two groups. There was no difference in metal ion levels or oxidative stress markers between patients with small- or large-diameter femoral heads. Acetabular inclination and anteversion had no effect on the metal ion levels. CONCLUSIONS The data suggest there is no difference in ion values in patients with large or small metal-on-metal THA and the increased metal ions do not alter the oxidant status of the patient.
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Affiliation(s)
- Mitchell Bernstein
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Alan Walsh
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, QC, Canada ,Lady Davis Institute for Medical Research, SMBD-Jewish General Hospital, Montreal, QC, Canada
| | - Alain Petit
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, QC, Canada ,Lady Davis Institute for Medical Research, SMBD-Jewish General Hospital, Montreal, QC, Canada
| | - David J. Zukor
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, QC, Canada ,Lady Davis Institute for Medical Research, SMBD-Jewish General Hospital, Montreal, QC, Canada
| | - John Antoniou
- Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, QC, Canada ,Lady Davis Institute for Medical Research, SMBD-Jewish General Hospital, Montreal, QC, Canada ,Department of Orthopaedics, Chemin de la Côte Ste-Catherine, Room E-003, SMBD-Jewish General Hospital, 3755, Montreal, QC H3T 1E2 Canada
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Desy NM, Bergeron SG, Petit A, Huk OL, Antoniou J. Surgical variables influence metal ion levels after hip resurfacing. Clin Orthop Relat Res 2011; 469:1635-41. [PMID: 20972653 PMCID: PMC3094610 DOI: 10.1007/s11999-010-1636-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Metal-on-metal bearings in surface arthroplasty are associated with prolonged periods of elevated ion circulation. However, there exists some controversy regarding the effect of different surgical variables on the concentration of metal ions in whole blood of patients after hip resurfacing. QUESTIONS/PURPOSES We sought to confirm which clinical and radiographic parameters are associated with elevated levels of cobalt, chromium, and molybdenum after unilateral metal-on-metal surface arthroplasty. METHODS We retrospectively reviewed 91 patients with a minimum followup of 24 months (mean, 37 months; range, 24-55 months). The clinical variables consisted of age, gender, preoperative severity of osteoarthritis, component size, and functional outcome measures using the Harris hip score and UCLA activity score. The radiographic parameters included acetabular inclination and version as well as femoral component alignment from both the anteroposterior and lateral radiographs. RESULTS A smaller femoral head diameter was associated with larger levels of cobalt and chromium. We observed a negative correlation between ion levels and the Harris hip score or UCLA score. A larger acetabular inclination showed a direct relationship with the concentration of metal ions. Severity of preoperative osteoarthritis, acetabular version, femoral stem-shaft and valgus angle, and anterior orientation of the femoral component had no effect on the circulating metal ion levels. CONCLUSIONS The data suggest a smaller implant diameter, larger cup inclination, and lower postoperative functional scores are associated with increased cobalt and chromium levels after metal-on-metal hip resurfacing.
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Affiliation(s)
- Nicholas M. Desy
- Division of Orthopaedic Surgery, Montreal General Hospital, McGill University Health Centre, Montreal, QC Canada
| | - Stephane G. Bergeron
- Division of Orthopaedic Surgery, Montreal General Hospital, McGill University Health Centre, Montreal, QC Canada
| | - Alain Petit
- Division of Orthopaedic Surgery, McGill University and Lady Davis Institute for Medical Research, SMBD-Jewish General Hospital, 3755 Chemin de la Côte Ste-Catherine, Room E-003, Montreal, QC H3T 1E2 Canada
| | - Olga L. Huk
- Division of Orthopaedic Surgery, McGill University and Lady Davis Institute for Medical Research, SMBD-Jewish General Hospital, 3755 Chemin de la Côte Ste-Catherine, Room E-003, Montreal, QC H3T 1E2 Canada
| | - John Antoniou
- Division of Orthopaedic Surgery, McGill University and Lady Davis Institute for Medical Research, SMBD-Jewish General Hospital, 3755 Chemin de la Côte Ste-Catherine, Room E-003, Montreal, QC H3T 1E2 Canada
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Langton DJ, Joyce TJ, Mangat N, Lord J, Van Orsouw M, De Smet K, Nargol AVF. Reducing metal ion release following hip resurfacing arthroplasty. Orthop Clin North Am 2011; 42:169-80, viii. [PMID: 21435493 DOI: 10.1016/j.ocl.2011.01.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Recent guidelines have suggested that routine postoperative care of patients with metal-on-metal hip prostheses should involve metal ion analysis. This study sought to investigate the relationship between bearing surface wear rates of metal components and serum metal ion analysis and also to quantify the incidence of excessive increases in serum metal ion concentrations post-hip resurfacing arthroplasty.
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Affiliation(s)
- David J Langton
- Joint Replacement Unit, University Hospital of North Tees, Hardwick, Stockton-on-Tees, UK.
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