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Kocjančič B, Avsec K, Šetina Batič B, Feizpour D, Godec M, Kralj-Iglič V, Podlipec R, Cör A, Debeljak M, Grant JT, Jenko M, Dolinar D. The Impact of Al 2O 3 Particles from Grit-Blasted Ti6Al7Nb (Alloy) Implant Surfaces on Biocompatibility, Aseptic Loosening, and Infection. MATERIALS (BASEL, SWITZERLAND) 2023; 16:6867. [PMID: 37959464 PMCID: PMC10648623 DOI: 10.3390/ma16216867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/17/2023] [Accepted: 10/21/2023] [Indexed: 11/15/2023]
Abstract
For the improvement of surface roughness, titanium joint arthroplasty (TJA) components are grit-blasted with Al2O3 (corundum) particles during manufacturing. There is an acute concern, particularly with uncemented implants, about polymeric, metallic, and corundum debris generation and accumulation in TJA, and its association with osteolysis and implant loosening. The surface morphology, chemistry, phase analysis, and surface chemistry of retrieved and new Al2O3 grit-blasted titanium alloy were determined with scanning electron microscopy (SEM), X-ray energy-dispersive spectroscopy (EDS), transmission electron microscopy (TEM), X-ray photoelectron spectroscopy (XPS) and confocal laser fluorescence microscopy, respectively. Peri-prosthetic soft tissue was studied with histopathology. Blasted retrieved and new stems were exposed to human mesenchymal stromal stem cells (BMSCs) for 7 days to test biocompatibility and cytotoxicity. We found metallic particles in the peri-prosthetic soft tissue. Ti6Al7Nb with the residual Al2O3 particles exhibited a low cytotoxic effect while polished titanium and ceramic disks exhibited no cytotoxic effect. None of the tested materials caused cell death or even a zone of inhibition. Our results indicate a possible biological effect of the blasting debris; however, we found no significant toxicity with these materials. Further studies on the optimal size and properties of the blasting particles are indicated for minimizing their adverse biological effects.
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Affiliation(s)
- Boštjan Kocjančič
- Department for Orthopaedic Surgery, UMC Ljubljana, Zaloška 9, 1000 Ljubljana, Slovenia; (B.K.); (K.A.); (D.D.)
- Chair of Orthopedics, Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Klemen Avsec
- Department for Orthopaedic Surgery, UMC Ljubljana, Zaloška 9, 1000 Ljubljana, Slovenia; (B.K.); (K.A.); (D.D.)
- Chair of Orthopedics, Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Barbara Šetina Batič
- Institute of Metals and Technology, Lepi pot 11, 1000 Ljubljana, Slovenia; (B.Š.B.); (D.F.); (M.G.)
| | - Darja Feizpour
- Institute of Metals and Technology, Lepi pot 11, 1000 Ljubljana, Slovenia; (B.Š.B.); (D.F.); (M.G.)
| | - Matjaž Godec
- Institute of Metals and Technology, Lepi pot 11, 1000 Ljubljana, Slovenia; (B.Š.B.); (D.F.); (M.G.)
| | - Veronika Kralj-Iglič
- University of Ljubljana, Faculty of Health Sciences, Laboratory of Clinical Biophysics, 1000 Ljubljana, Slovenia;
| | - Rok Podlipec
- Laboratory for Biophysics, Jozef Stefan Institute, Jamova 39, 1000 Ljubljana, Slovenia;
- Ion Beam Center, Helmholtz-Zentrum Dresden-Rossendorf e.V., 01328 Dresden, Germany
| | - Andrej Cör
- Orthopaedic Hospital Valdoltra, Jadranska cesta 31, 6280 Ankaran, Slovenia;
| | - Mojca Debeljak
- University Rehabilitation Institute Republic of Slovenia Soča, Linhartova 51, 1000 Ljubljana, Slovenia;
| | - John T. Grant
- Research Institute, University of Dayton, Dayton, OH 45469, USA;
| | - Monika Jenko
- Institute of Metals and Technology, Lepi pot 11, 1000 Ljubljana, Slovenia; (B.Š.B.); (D.F.); (M.G.)
- MD-RI Institute for Materials Research in Medicine, Bohoričeva 5a, 1000 Ljubljana, Slovenia
| | - Drago Dolinar
- Department for Orthopaedic Surgery, UMC Ljubljana, Zaloška 9, 1000 Ljubljana, Slovenia; (B.K.); (K.A.); (D.D.)
- Chair of Orthopedics, Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
- MD-RI Institute for Materials Research in Medicine, Bohoričeva 5a, 1000 Ljubljana, Slovenia
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Gibon E, Takakubo Y, Zwingenberger S, Gallo J, Takagi M, Goodman SB. Friend or foe? Inflammation and the foreign body response to orthopedic biomaterials. J Biomed Mater Res A 2023. [PMID: 37656958 DOI: 10.1002/jbm.a.37599] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 08/03/2023] [Accepted: 08/14/2023] [Indexed: 09/03/2023]
Abstract
The use of biomaterials and implants for joint replacement, fracture fixation, spinal stabilization and other orthopedic indications has revolutionized patient care by reliably decreasing pain and improving function. These surgical procedures always invoke an acute inflammatory reaction initially, that in most cases, readily subsides. Occasionally, chronic inflammation around the implant develops and persists; this results in unremitting pain and compromises function. The etiology of chronic inflammation may be specific, such as with infection, or be unknown. The histological hallmarks of chronic inflammation include activated macrophages, fibroblasts, T cell subsets, and other cells of the innate immune system. The presence of cells of the adaptive immune system usually indicates allergic reactions to metallic haptens. A foreign body reaction is composed of activated macrophages, giant cells, fibroblasts, and other cells often distributed in a characteristic histological arrangement; this reaction is usually due to particulate debris and other byproducts from the biomaterials used in the implant. Both chronic inflammation and the foreign body response have adverse biological effects on the integration of the implant with the surrounding tissues. Strategies to mitigate chronic inflammation and the foreign body response will enhance the initial incorporation and longevity of the implant, and thereby, improve long-term pain relief and overall function for the patient. The seminal research performed in the laboratory of Dr. James Anderson and co-workers has provided an inspirational and driving force for our laboratory's work on the interactions and crosstalk among cells of the mesenchymal, immune, and vascular lineages, and orthopedic biomaterials. Dr. Anderson's delineation of the fundamental biologic processes and mechanisms underlying acute and chronic inflammation, the foreign body response, resolution, and eventual functional integration of implants in different organ systems has provided researchers with a strategic approach to the use of biomaterials to improve health in numerous clinical scenarios.
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Affiliation(s)
- Emmanuel Gibon
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yuya Takakubo
- Department of Rehabilitation, Yamagata University, Faculty of Medicine, Yamagata, Japan
| | - Stefan Zwingenberger
- University Center for Orthopaedics, Traumatology, and Plastic Surgery, University Hospital Carl Gustav Carus at Technische Universität Dresden, Dresden, Germany
| | - Jiri Gallo
- Department of Orthopaedics, Faculty of Medicine and Dentistry, Palacky University Olomouc Teaching Hospital, Olomouc, Czech Republic
| | - Michiaki Takagi
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Stuart B Goodman
- Department of Orthopaedic Surgery and (by courtesy) Bioengineering, Stanford University Medical Center Outpatient Center, California, USA
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