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Parilla FW, Youngman TR, Layon DR, Ince DC, Pashos GE, Maloney WJ, Clohisy JC. Excellent 20-Year Results of Total Hip Arthroplasty With Highly Cross-Linked Polyethylene on Cobalt-Chromium Femoral Heads in Patients ≤50 Years. J Arthroplasty 2024; 39:409-415. [PMID: 37572728 DOI: 10.1016/j.arth.2023.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 08/04/2023] [Accepted: 08/05/2023] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND Highly cross-linked polyethylene (HXLPE) acetabular bearing surfaces have appeared to offer excellent wear resistance, low incidence of wear-related osteolysis, and high implant survivorship at 10-year to 15-year follow-up. However, concerns over potential performance deterioration at longer-term follow-up remain - particularly in younger patients - and outcome data into the third decade have not been available. METHODS We retrospectively assessed 62 patients (68 hips) who underwent primary total hip arthroplasty (THA) at age ≤50 years with a single manufacturer's cementless components, remelted HXLPE liner, and small diameter (26 and 28 millimeter) cobalt-chromium (CoCr) femoral heads at minimum 18-year follow-up. We assessed clinical outcomes (modified Harris Hip score, University of California Los Angeles Activity Score, polyethylene wear rates, radiographic findings (osteolysis, component loosening), and implant survivorship. RESULTS At 20.6-year mean follow-up (range, 18 to 23 years) modified Harris Hip scores for surviving hips remained an average of 41 points above preoperative baseline (49 versus 90, P < .001) and UCLA scores 2.8 points above baseline (3.7 versus 6.4, P < .001). Wear analysis revealed a population linear wear rate of 0.0142 mm/y (standard deviation (SD), 0.0471) and volumetric wear rate of 10.14 mm3/y (SD, 23.41). Acetabular lysis was noted in 2 asymptomatic hips at 16.6 and 18.4 years. No components were radiographically loose. Survivorship free from wear-related revision was 100% at 20 years (97% free from any revision). CONCLUSION The HXLPE-CoCr bearing couple with small femoral heads continues to be extremely effective 20 years after primary THA in the younger patient population.
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Affiliation(s)
- Frank W Parilla
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Tyler R Youngman
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Daniel R Layon
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Deniz C Ince
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Gail E Pashos
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - William J Maloney
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California
| | - John C Clohisy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri
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Deans CF, Buckner BC, Garvin KL. Wear, Osteolysis, and Aseptic Loosening Following Total Hip Arthroplasty in Young Patients with Highly Cross-Linked Polyethylene: A Review of Studies with a Follow-Up of over 15 Years. J Clin Med 2023; 12:6615. [PMID: 37892754 PMCID: PMC10607435 DOI: 10.3390/jcm12206615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/26/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023] Open
Abstract
Total hip arthroplasty (THA) has in recent years trended toward a younger, more physically demanding patient population. Mid- to long-term studies of all ages of THA patients using highly cross-linked polyethylene (HXLPE) have been favorable, but concerns about its long-term failure and wear-related complications remain for young THA patients. In this narrative review, a search of the PubMed/MEDLINE and Cochrane databases was performed, and we identified six studies with a minimum 15-year follow-up of HXLPE with various femoral head materials. Wear-related revisions were exceedingly low for patients under the age of 55, with variable reports of non-clinically significant osteolysis. Higher activity levels, a larger femoral head size, and femoral head material were not associated with greater long-term wear rates. Young THA with metal or ceramic on HXLPE is exceedingly durable with favorable outcomes at follow-ups of over 15 years.
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Affiliation(s)
| | | | - Kevin L. Garvin
- Department of Orthopaedic Surgery & Rehabilitation, University of Nebraska Medical Center, 985640 Nebraska Medical Center, Omaha, NE 68198, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Sharma R, Yadav S, Yadav V, Akhtar J, Katari O, Kuche K, Jain S. Recent advances in lipid-based long-acting injectable depot formulations. Adv Drug Deliv Rev 2023; 199:114901. [PMID: 37257756 DOI: 10.1016/j.addr.2023.114901] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/28/2023] [Accepted: 05/23/2023] [Indexed: 06/02/2023]
Abstract
Long-acting injectable (LAIs) delivery systems sustain the drug therapeutic action in the body, resulting in reduced dosage regimen, toxicity, and improved patient compliance. Lipid-based depots are biocompatible, provide extended drug release, and improve drug stability, making them suitable for systemic and localized treatment of various chronic ailments, including psychosis, diabetes, hormonal disorders, arthritis, ocular diseases, and cancer. These depots include oil solutions, suspensions, oleogels, liquid crystalline systems, liposomes, solid lipid nanoparticles, nanostructured lipid carriers, phospholipid phase separation gel, vesicular phospholipid gel etc. This review summarizes recent advancements in lipid-based LAIs for delivering small and macromolecules, and their potential in managing chronic diseases. It also provides an overview of the lipid depots available in market or clinical phase, as well as patents for lipid-based LAIs. Furthermore, this review critically discusses the current scenario of using in vitro release methods to establish IVIVC and highlights the challenges involved in developing lipid-based LAIs.
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Affiliation(s)
- Reena Sharma
- Department of Pharmaceutics, Centre for Pharmaceutical Nanotechnology, National Institute of Pharmaceutical Education & Research (NIPER), Sector 67, S.A.S. Nagar (Mohali), Punjab 160062, India
| | - Sheetal Yadav
- Department of Pharmaceutics, Centre for Pharmaceutical Nanotechnology, National Institute of Pharmaceutical Education & Research (NIPER), Sector 67, S.A.S. Nagar (Mohali), Punjab 160062, India
| | - Vivek Yadav
- Department of Pharmaceutics, Centre for Pharmaceutical Nanotechnology, National Institute of Pharmaceutical Education & Research (NIPER), Sector 67, S.A.S. Nagar (Mohali), Punjab 160062, India
| | - Junia Akhtar
- Department of Pharmaceutics, Centre for Pharmaceutical Nanotechnology, National Institute of Pharmaceutical Education & Research (NIPER), Sector 67, S.A.S. Nagar (Mohali), Punjab 160062, India
| | - Oly Katari
- Department of Pharmaceutics, Centre for Pharmaceutical Nanotechnology, National Institute of Pharmaceutical Education & Research (NIPER), Sector 67, S.A.S. Nagar (Mohali), Punjab 160062, India
| | - Kaushik Kuche
- Department of Pharmaceutics, Centre for Pharmaceutical Nanotechnology, National Institute of Pharmaceutical Education & Research (NIPER), Sector 67, S.A.S. Nagar (Mohali), Punjab 160062, India
| | - Sanyog Jain
- Department of Pharmaceutics, Centre for Pharmaceutical Nanotechnology, National Institute of Pharmaceutical Education & Research (NIPER), Sector 67, S.A.S. Nagar (Mohali), Punjab 160062, India.
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Zheng C, Xu J, Wu L, Wu Y, Liu Y, Shen B. Comparisons of Different Bearing Surfaces in Cementless Total Hip Arthroplasty: A Systematic Review and Bayesian Network Analysis. J Arthroplasty 2023; 38:600-609. [PMID: 36265721 DOI: 10.1016/j.arth.2022.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/06/2022] [Accepted: 10/11/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND We aimed to make comparisons of different bearing surfaces in patients after cementless total hip arthroplasty. METHODS The network meta-analysis was guided by the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guideline. The primary outcomes were implant survival and Harris hip score (HHS). Secondary outcomes included linear wear rates and serum level of metal ions. Subgroup analyses were performed by: (1) classifying head sizes as small and large; (2) femoral heads as ceramic and metal; and (3) liners as metal, ceramic, polyethylene, highly cross-linked polyethylene (HXP), or vitamin E-infused highly cross-linked polyethylene (HXPE). A total of 64 eligible RCTs with different bearings were assessed. Overall inconsistency and heterogeneity were acceptable. RESULTS In the 10 years follow-up, metal-on-polythene and ceramic-on-polythene bearings with small heads showed higher risk for revisions compared with metal-on-HXP and ceramic-on-HXP bearings with small heads. Similarly, only metal or ceramic-on-polythene bearings with small heads showed inferiority in HHS compared with other bearings. Conventional polyethylene liners showed higher linear wear rates compared with HXP, HXPE, and ceramic liners at 5 and 10 years after surgery, while metal-on-metal and ceramic-on-metal bearings showed higher serum level of cobalt and chromium. CONCLUSION Bearings containing HXP, HXPE, and ceramic liners showed comparable survivorship and hip function at follow-up of 5 and 10 years. Hard-on-hard bearings containing metal had higher serum level of metal ions than others. Bearings containing conventional polyethylene had worse performance in terms of implant survival, hip function, and wear rates. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
- Che Zheng
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Jiawen Xu
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Liming Wu
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Yuangang Wu
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Yuan Liu
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Bin Shen
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
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Gautam R, Jo J, Acharya M, Maharjan A, Lee D, K C PB, Kim C, Kim K, Kim H, Heo Y. Evaluation of potential toxicity of polyethylene microplastics on human derived cell lines. Sci Total Environ 2022; 838:156089. [PMID: 35605862 DOI: 10.1016/j.scitotenv.2022.156089] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 05/14/2023]
Abstract
Microplastics bare of major concern for environmental conservation and animal welfare in recent years as its use has increased tremendously. Polyethylene microplastics (PE-MPs) are the most common microplastics and could get exposed to humans via different routes with oral>inhalation>dermal. Internalization of MPs through epithelial tissue could expose MPs to various cells such as dendritic cells, macrophages/monocytes, and/or T cells. In this study, we aimed at identifying the effects of two different sized (30.5 ± 10.5 and 6.2 ± 2.0 μm) PE-MPs on different human cell lines representing different tissues or cells that get exposed to MPs directly or indirectly. Six cell lines were cultured with different concentrations of PE-MPs and cell viability, intracellular reactive oxygen species (ROS), nitric oxide (NO), and cytokines were measured. PE-MPs did not substantially lower the cell viability of cells however highest concentration (1000 μg/mL) of both sized MPs slightly reduced cell viability in intestinal epithelial Caco-2 and lung epithelial A549 cells. Both sized PE-MPs induced higher NO in all the cell lines and upregulation of ROS generation was demonstrated at THP-1, Jurkat, and U937 immune cell lines. A pro-inflammatory cytokine response was seen in HaCaT keratinocyte cells when cultured with PE-MPs whereas the opposite effect was observed in THP-1 and U937 cells except with THP-1 cells cultured with larger-sized MPs. We found that the PE-MPs do not have the same effects on all kinds of cells and tissues exposed and the immune modulation is not necessarily inflammatory. Thus, this study gives insight into why more detailed studies focused on exposure routes and organ-specific effects of different MPs need to be carried out.
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Affiliation(s)
- Ravi Gautam
- Department of occupational health, College of Bio and Medical Sciences, Daegu Catholic University, Gyeongsan 38430, Republic of Korea.
| | - JiHun Jo
- Department of occupational health, College of Bio and Medical Sciences, Daegu Catholic University, Gyeongsan 38430, Republic of Korea
| | - Manju Acharya
- Department of occupational health, College of Bio and Medical Sciences, Daegu Catholic University, Gyeongsan 38430, Republic of Korea
| | - Anju Maharjan
- Department of occupational health, College of Bio and Medical Sciences, Daegu Catholic University, Gyeongsan 38430, Republic of Korea
| | - DaEun Lee
- Department of occupational health, College of Bio and Medical Sciences, Daegu Catholic University, Gyeongsan 38430, Republic of Korea
| | - Pramod Bahadur K C
- Graduate School Department of Toxicology, Daegu Catholic University, 38430 Gyeongsan, Republic of Korea
| | - ChangYul Kim
- Graduate School Department of Toxicology, Daegu Catholic University, 38430 Gyeongsan, Republic of Korea.
| | - KilSoo Kim
- Preclinical Research Center, Daegu-Gyeongbuk Medical Innovation Center, 41061 Daegu, Republic of Korea; College of Veterinary Medicine, Kyungpook National University, 41566 Daegu, Republic of Korea.
| | - HyoungAh Kim
- College of Medicine, Department of Preventive Medicine, The Catholic University of Korea, 06591 Seoul, Republic of Korea.
| | - Yong Heo
- Department of occupational health, College of Bio and Medical Sciences, Daegu Catholic University, Gyeongsan 38430, Republic of Korea; Graduate School Department of Toxicology, Daegu Catholic University, 38430 Gyeongsan, Republic of Korea.
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7
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Wu X, Cai C, Gil J, Jantz E, Al Sakka Y, Padial-Molina M, Suárez-López del Amo F. Characteristics of Particles and Debris Released after Implantoplasty: A Comparative Study. Materials (Basel) 2022; 15:ma15020602. [PMID: 35057319 PMCID: PMC8779414 DOI: 10.3390/ma15020602] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/05/2022] [Accepted: 01/11/2022] [Indexed: 02/08/2023]
Abstract
Titanium particles embedded on peri-implant tissues are associated with a variety of detrimental effects. Given that the characteristics of these detached fragments (size, concentration, etc.) dictate the potential cytotoxicity and biological repercussions exerted, it is of paramount importance to investigate the properties of these debris. This study compares the characteristics of particles released among different implant systems (Group A: Straumann, Group B: BioHorizons and Group C: Zimmer) during implantoplasty. A novel experimental system was utilized for measuring and collecting particles generated from implantoplasty. A scanning mobility particle sizer, aerodynamic particle sizer, nano micro-orifice uniform deposit impactor, and scanning electron microscope were used to collect and analyze the particles by size. The chemical composition of the particles was analyzed by highly sensitive microanalysis, microstructures by scanning electron microscope and the mechanical properties by nanoindentation equipment. Particles released by implantoplasty showed bimodal size distributions, with the majority of particles in the ultrafine size range (<100 nm) for all groups. Statistical analysis indicated a significant difference among all implant systems in terms of the particle number size distribution (p < 0.0001), with the highest concentration in Group B and lowest in Group C, in both fine and ultrafine modes. Significant differences among all groups (p < 0.0001) were also observed for the other two metrics, with the highest concentration of particle mass and surface area in Group B and lowest in Group C, in both fine and ultrafine modes. For coarse particles (>1 µm), no significant difference was detected among groups in terms of particle number or mass, but a significantly smaller surface area was found in Group A as compared to Group B (p = 0.02) and Group C (p = 0.005). The 1 first minute of procedures had a higher number concentration compared to the second and third minutes. SEM-EDS analysis showed different morphologies for various implant systems. These results can be explained by the differences in the chemical composition and microstructures of the different dental implants. Group B is softer than Groups A and C due to the laser treatment in the neck producing an increase of the grain size. The hardest implants were those of Group C due to the cold-strained titanium alloy, and consequently they displayed lower release than Groups A and B. Implantoplasty was associated with debris particle release, with the majority of particles at nanometric dimensions. BioHorizons implants released more particles compared to Straumann and Zimmer. Due to the widespread use of implantoplasty, it is of key importance to understand the characteristics of the generated debris. This is the first study to detect, quantify and analyze the debris/particles released from dental implants during implantoplasty including the full range of particle sizes, including both micro- and nano-scales.
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Affiliation(s)
- Xixi Wu
- Department of Periodontics, College of Dentistry, University of Oklahoma, Oklahoma City, OK 73117, USA; (X.W.); (E.J.)
| | - Changjie Cai
- Department of Occupational and Environmental Health, Hudson College of Public Health, University of Oklahoma, Oklahoma City, OK 73117, USA;
| | - Javier Gil
- Bioengineering Institute of Technology, Universitat Internacional de Catalunya, Josep Trueta s/n. Sant Cugat del Vallés, 08125 Barcelona, Spain
- Facultat de Odontologia, Universitat Internacional de Catalunya, Josep Trueta s/n. San Cugat del Vallés, 08125 Barcelona, Spain
- Correspondence: (J.G.); (F.S.-L.d.A.)
| | - Elizabeth Jantz
- Department of Periodontics, College of Dentistry, University of Oklahoma, Oklahoma City, OK 73117, USA; (X.W.); (E.J.)
| | | | - Miguel Padial-Molina
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, 18071 Granada, Spain;
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Ho MJ, Jeong MY, Jeong HT, Kim MS, Park HJ, Kim DY, Lee HC, Song WH, Kim CH, Lee CH, Choi YW, Choi YS, Han YT, Kang MJ. Effect of particle size on in vivo performances of long-acting injectable drug suspension. J Control Release 2021; 341:533-547. [PMID: 34902451 DOI: 10.1016/j.jconrel.2021.12.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 11/16/2021] [Accepted: 12/06/2021] [Indexed: 12/17/2022]
Abstract
Herein, entecavir-3-palmitate (EV-P), an ester prodrug of entecavir (EV), was employed as a model drug, and the effect of drug particle size on in vivo pharmacokinetic profiles and local inflammatory responses, and those associations were evaluated following intramuscular (IM) injection. EV-P crystals with different median diameters (0.8, 2.3, 6.3, 15.3 and 22.6 μm) were prepared using the anti-solvent crystallization method, with analogous surface charges (-10.7 ~ -4.7 mV), and crystallinity (melting point, 160-170 °C). EV-P particles showed size-dependent in vitro dissolution profiles under sink conditions, exhibiting a high correlation between the median diameter and Hixon-Crowell's release rate constant (r2 = 0.94). Following IM injection in rats (1.44 mg/kg as EV), the pharmacokinetic profile of EV exhibited marked size-dependency; 0.8 μm-sized EV-P particles about 1.6-, 3.6-, and 5.6-folds higher systemic exposure, compared to 6.3, 15.3, and 22.6 μm-sized particles, respectively. This pharmacokinetic pattern, depending on particle size, was also highly associated with histopathological responses in the injected tissue. The smaller EV-P particles (0.8 or 2.3 μm) imparted the larger inflammatory lesion after 3 days, lower infiltration of inflammatory cells, and thinner fibroblastic bands around depots after 4 weeks. Conversely, severe fibrous isolation with increasing particle size augmented the drug remaining at injection site over 4 weeks, impeding the dissolution and systemic exposure. These findings regarding the effects of formulation variable on the in vivo behaviors of long-acting injectable suspension, provide constructive knowledge toward the improved design in poorly water-soluble compounds.
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Affiliation(s)
- Myoung Jin Ho
- College of Pharmacy, Dankook University, 119 Dandae-ro, Dongnam-gu, Cheonan, Chungnam 330-714, Republic of Korea
| | - Min Young Jeong
- College of Pharmacy, Dankook University, 119 Dandae-ro, Dongnam-gu, Cheonan, Chungnam 330-714, Republic of Korea
| | - Hoe Taek Jeong
- College of Pharmacy, Dankook University, 119 Dandae-ro, Dongnam-gu, Cheonan, Chungnam 330-714, Republic of Korea
| | - Min Seob Kim
- College of Pharmacy, Dankook University, 119 Dandae-ro, Dongnam-gu, Cheonan, Chungnam 330-714, Republic of Korea
| | - Hyun Jin Park
- College of Pharmacy, Dankook University, 119 Dandae-ro, Dongnam-gu, Cheonan, Chungnam 330-714, Republic of Korea
| | - Dong Yoon Kim
- College of Pharmacy, Dankook University, 119 Dandae-ro, Dongnam-gu, Cheonan, Chungnam 330-714, Republic of Korea
| | - Hyo Chun Lee
- College of Pharmacy, Dankook University, 119 Dandae-ro, Dongnam-gu, Cheonan, Chungnam 330-714, Republic of Korea
| | - Woo Heon Song
- College of Pharmacy, Dankook University, 119 Dandae-ro, Dongnam-gu, Cheonan, Chungnam 330-714, Republic of Korea
| | - Chang Hyun Kim
- College of Pharmacy, Chung-Ang University, 221 Heuksuk-dong, Dongjak-gu, Seoul 156-756, Republic of Korea
| | - Choong Hyun Lee
- College of Pharmacy, Dankook University, 119 Dandae-ro, Dongnam-gu, Cheonan, Chungnam 330-714, Republic of Korea
| | - Young Wook Choi
- College of Pharmacy, Chung-Ang University, 221 Heuksuk-dong, Dongjak-gu, Seoul 156-756, Republic of Korea
| | - Yong Seok Choi
- College of Pharmacy, Dankook University, 119 Dandae-ro, Dongnam-gu, Cheonan, Chungnam 330-714, Republic of Korea
| | - Young Taek Han
- College of Pharmacy, Dankook University, 119 Dandae-ro, Dongnam-gu, Cheonan, Chungnam 330-714, Republic of Korea
| | - Myung Joo Kang
- College of Pharmacy, Dankook University, 119 Dandae-ro, Dongnam-gu, Cheonan, Chungnam 330-714, Republic of Korea.
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Vazquez DS, Schilbert HM, Dodero VI. Molecular and Structural Parallels between Gluten Pathogenic Peptides and Bacterial-Derived Proteins by Bioinformatics Analysis. Int J Mol Sci 2021; 22:9278. [PMID: 34502187 PMCID: PMC8430993 DOI: 10.3390/ijms22179278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 08/23/2021] [Accepted: 08/25/2021] [Indexed: 02/08/2023] Open
Abstract
Gluten-related disorders (GRDs) are a group of diseases that involve the activation of the immune system triggered by the ingestion of gluten, with a worldwide prevalence of 5%. Among them, Celiac disease (CeD) is a T-cell-mediated autoimmune disease causing a plethora of symptoms from diarrhea and malabsorption to lymphoma. Even though GRDs have been intensively studied, the environmental triggers promoting the diverse reactions to gluten proteins in susceptible individuals remain elusive. It has been proposed that pathogens could act as disease-causing environmental triggers of CeD by molecular mimicry mechanisms. Additionally, it could also be possible that unrecognized molecular, structural, and physical parallels between gluten and pathogens have a relevant role. Herein, we report sequence, structural and physical similarities of the two most relevant gluten peptides, the 33-mer and p31-43 gliadin peptides, with bacterial pathogens using bioinformatics going beyond the molecular mimicry hypothesis. First, a stringent BLASTp search using the two gliadin peptides identified high sequence similarity regions within pathogen-derived proteins, e.g., extracellular proteins from Streptococcus pneumoniae and Granulicatella sp. Second, molecular dynamics calculations of an updated α-2-gliadin model revealed close spatial localization and solvent-exposure of the 33-mer and p31-43 peptide, which was compared with the pathogen-related proteins by homology models and localization predictors. We found putative functions of the identified pathogen-derived sequence by identifying T-cell epitopes and SH3/WW-binding domains. Finally, shape and size parallels between the pathogens and the superstructures of gliadin peptides gave rise to novel hypotheses about activation of innate immunity and dysbiosis. Based on our structural findings and the similarities with the bacterial pathogens, evidence emerges that these pathologically relevant gluten-derived peptides could behave as non-replicating pathogens opening new research questions in the interface of innate immunity, microbiome, and food research.
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Affiliation(s)
- Diego S. Vazquez
- Grupo de Biología Estructural y Biotecnología (GBEyB-IMBICE), Departamento de Ciencia y Tecnología, Universidad Nacional de Quilmes, Roque Sáenz Peña 352, Bernal B1876BXD, Buenos Aires, Argentina;
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Av. Rivadavia 1917, Ciudad Autónoma C1033AAJ, Buenos Aires, Argentina
| | - Hanna M. Schilbert
- Department of Chemistry, Organic Chemistry OCIII, Universität Bielefeld, Universitätsstraße 25, 33615 Bielefeld, Germany;
| | - Veronica I. Dodero
- Department of Chemistry, Organic Chemistry OCIII, Universität Bielefeld, Universitätsstraße 25, 33615 Bielefeld, Germany;
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Moon NH, Shin WC, Do MU, Kang SW, Lee SM, Suh KT. Wear and osteolysis outcomes for highly cross-linked polyethylene in primary total hip arthroplasty compared with conventional polyethylene: a 15- to 18-year single-centre follow-up study. Hip Int 2021; 31:526-532. [PMID: 31912760 DOI: 10.1177/1120700019896970] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Although highly positive results for wear reduction of highly cross-linked polyethylene (HXLPE) have been reported around the 10-year follow-up, the long-term result related to reoperation and wear-related survival is still an issue. Therefore, this study aimed to compare the follow-up results of a single manufacture's polyethylene liner for >15 years in terms of survival and wear rate. METHODS This retrospective cohort study included 134 primary total hip arthroplasties (THAs) who were followed up for at least 15 years. The mean age at the time of surgery was 50.7 years (conventional polyethylene [CPE] group = 22; HXLPE group = 112). Linear and volumetric wear rates of polyethylene were measured, and the reoperation rate and radiographic osteolysis were evaluated and Kaplan-Meier survival analysis was performed in both groups. Implant-related complications were also examined. RESULTS HXLPE group showed a significantly lower wear rate in both linear and volumetric wear. None of the hip radiographs showed evidence of loosening or osteolysis in the HXLPE group. The survival rates at 15- to 18-year follow-up were 90.9% and 95.5% in the CPE and HXLPE groups when all-cause reoperation was the endpoint, and 90.9% and 100.0% when the wear-related reoperation was the endpoint, respectively. Implant-related complications were not different between the 2 groups. CONCLUSIONS Wear reduction and osteolysis showed a great advantage in HXLPE after a 15-year follow-up. Although the CPE and HXLPE showed excellent survival, wear and osteolysis were more frequent in the CPE; therefore, the high risk of reoperation in the future should be considered.
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Affiliation(s)
- Nam Hoon Moon
- Department of Orthopaedic Surgery, Pusan National University Hospital, Pusan, Republic of Korea
| | - Won Chul Shin
- Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Min Uk Do
- Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Suk-Woong Kang
- Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Sang-Min Lee
- Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Kuen Tak Suh
- Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
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11
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Ftaita S, Vanden Berghe A, Thienpont E. Vitamin E-enriched polyethylene bearings are not inferior to Arcom bearings in primary total knee arthroplasty at medium-term follow-up. Arch Orthop Trauma Surg 2021; 141:1027-33. [PMID: 33417026 DOI: 10.1007/s00402-020-03727-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 12/06/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The release of wear particles can be responsible for periprosthetic osteolysis, which can in turn, lead to aseptic loosening. Vitamin E-infused polyethylene (HXLPE Vit-E) has been shown, in vitro, to be more resistant to wear than conventional polyethylene (UHMWPE) by its crosslinking (HXLPE) and its higher resistance to oxidation. After reading a case report of a fracture of a vitamin E-enriched HXLPE bearing, the aim of this retrospective study was to evaluate fracture risk and clinical inferiority or not of vitamin-E HXLPE compared to conventional polyethylene in total knee arthroplasty (TKA). MATERIALS AND METHODS Three hundred and forty-nine patients (403 TKAs) were contacted, to find out whether they had undergone revision surgery for any reason after a mean (SD) of 7 (1.5) years. Follow-up control radiographs were analyzed for periprosthetic radiolucent lines (RLL) and loosening. Two different Patient Reported Outcome Measurements Scores (PROMS), KOOS and FJS-12, were utilized to assess the daily functionality and identify potential problems. RESULTS No statistically significant difference in revision rate, occurrence of aseptic loosening or RLL nor outcome as measured with PROMS was observed. CONCLUSIONS No bearing fractures or clinical inferiority was observed for vitamin E-enriched HXLPE at medium-term follow-up (7 years) compared to conventional Arcom polyethylene. LEVEL OF EVIDENCE Level III, therapeutic study.
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Prock-Gibbs H, Pumilia CA, Meckmongkol T, Lovejoy J, Mumith A, Coathup M. Incidence of Osteolysis and Aseptic Loosening Following Metal-on-Highly Cross-Linked Polyethylene Hip Arthroplasty: A Systematic Review of Studies with Up to 15-Year Follow-up. J Bone Joint Surg Am 2021; 103:728-740. [PMID: 33411465 DOI: 10.2106/jbjs.20.01086] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study compared the incidence of osteolysis, aseptic loosening, and revision following use of highly cross-linked polyethylene (HXLPE) or conventional polyethylene (CPE) at medium to long-term (>5 to 15 years) follow-up in primary total hip arthroplasty (THA). Incidences were quantified and compared with regard to age and method of implant fixation. METHODS Using the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines, 12 randomized controlled trials and 18 cohort studies were investigated for evidence-based outcomes following HXPLE and CPE use in 2,539 hips over a 5 to 15-year follow-up. RESULTS Lower rates of osteolysis, aseptic loosening, and implant revision were reported following use of HXLPE liners. Osteolysis was reduced from 25.4% with CPE to 4.05% with HXLPE in young patients, and from 29.7% to 6.6% in the older patient cohort. Similarities in osteolysis rates were observed when cemented (24.9% for CPE and 6.5% for HXLPE) and uncemented components (32.8% for CPE and 7.1% for HXLPE) were compared. No clear advantage in the type of HXLPE used was observed. CONCLUSIONS Over a follow-up period of up to 15 years, when compared with CPE, use of HXLPE liners reduced the incidence of osteolysis, aseptic loosening, and implant revision, regardless of the fixation method and including in younger and potentially more active patients. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
| | | | - Teerin Meckmongkol
- College of Medicine, University of Central Florida, Orlando, Florida.,Departments of General Surgery (T.M.) and Orthopaedics, Sports Medicine and Physical Medicine and Rehabilitation (J.L.), Nemours Children's Hospital, Orlando, Florida
| | - John Lovejoy
- College of Medicine, University of Central Florida, Orlando, Florida.,Departments of General Surgery (T.M.) and Orthopaedics, Sports Medicine and Physical Medicine and Rehabilitation (J.L.), Nemours Children's Hospital, Orlando, Florida
| | - Aadil Mumith
- College of Medicine, University of Central Florida, Orlando, Florida.,Department of Orthopaedics, Basingstoke and North Hampshire Hospital, Basingstoke, United Kingdom
| | - Melanie Coathup
- College of Medicine, University of Central Florida, Orlando, Florida
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13
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Yee MSL, Hii LW, Looi CK, Lim WM, Wong SF, Kok YY, Tan BK, Wong CY, Leong CO. Impact of Microplastics and Nanoplastics on Human Health. Nanomaterials (Basel) 2021; 11:496. [PMID: 33669327 PMCID: PMC7920297 DOI: 10.3390/nano11020496] [Citation(s) in RCA: 220] [Impact Index Per Article: 73.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 02/09/2021] [Accepted: 02/13/2021] [Indexed: 02/07/2023]
Abstract
Plastics have enormous impacts to every aspect of daily life including technology, medicine and treatments, and domestic appliances. Most of the used plastics are thrown away by consumers after a single use, which has become a huge environmental problem as they will end up in landfill, oceans and other waterways. These plastics are discarded in vast numbers each day, and the breaking down of the plastics from micro- to nano-sizes has led to worries about how toxic these plastics are to the environment and humans. While, there are several earlier studies reported the effects of micro- and nano-plastics have on the environment, there is scant research into their impact on the human body at subcellular or molecular levels. In particular, the potential of how nano-plastics move through the gut, lungs and skin epithelia in causing systemic exposure has not been examined thoroughly. This review explores thoroughly on how nanoplastics are created, how they behave/breakdown within the environment, levels of toxicity and pollution of these nanoplastics, and the possible health impacts on humans, as well as suggestions for additional research. This paper aims to inspire future studies into core elements of micro- and nano-plastics, the biological reactions caused by their specific and unusual qualities.
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Affiliation(s)
- Maxine Swee-Li Yee
- Centre of Nanotechnology and Advanced Materials, Faculty of Engineering, University of Nottingham Malaysia Campus, Jalan Broga, Semenyih 43500, Malaysia
| | - Ling-Wei Hii
- Center for Cancer and Stem Cell Research, Institute for Research, Development and Innovation (IRDI), International Medical University, Kuala Lumpur 57000, Malaysia; (L.-W.H.); (C.K.L.); (W.-M.L.)
- School of Postgraduate Studies, International Medical University, Kuala Lumpur 57000, Malaysia
- School of Pharmacy, International Medical University, Kuala Lumpur 57000, Malaysia
| | - Chin King Looi
- Center for Cancer and Stem Cell Research, Institute for Research, Development and Innovation (IRDI), International Medical University, Kuala Lumpur 57000, Malaysia; (L.-W.H.); (C.K.L.); (W.-M.L.)
- School of Postgraduate Studies, International Medical University, Kuala Lumpur 57000, Malaysia
| | - Wei-Meng Lim
- Center for Cancer and Stem Cell Research, Institute for Research, Development and Innovation (IRDI), International Medical University, Kuala Lumpur 57000, Malaysia; (L.-W.H.); (C.K.L.); (W.-M.L.)
- School of Pharmacy, International Medical University, Kuala Lumpur 57000, Malaysia
| | - Shew-Fung Wong
- Center for Environmental and Population Health, Institute for Research, Development and Innovation (IRDI), International Medical University, Kuala Lumpur 57000, Malaysia; (S.-F.W.); (Y.-Y.K.); (B.-K.T.); (C.-Y.W.)
- School of Medicine, International Medical University, Kuala Lumpur 57000, Malaysia
| | - Yih-Yih Kok
- Center for Environmental and Population Health, Institute for Research, Development and Innovation (IRDI), International Medical University, Kuala Lumpur 57000, Malaysia; (S.-F.W.); (Y.-Y.K.); (B.-K.T.); (C.-Y.W.)
- School of Health Sciences, International Medical University, 126, Jalan Jalil Perkasa 19, Bukit Jalil, Kuala Lumpur 57000, Malaysia
| | - Boon-Keat Tan
- Center for Environmental and Population Health, Institute for Research, Development and Innovation (IRDI), International Medical University, Kuala Lumpur 57000, Malaysia; (S.-F.W.); (Y.-Y.K.); (B.-K.T.); (C.-Y.W.)
- School of Medicine, International Medical University, Kuala Lumpur 57000, Malaysia
| | - Chiew-Yen Wong
- Center for Environmental and Population Health, Institute for Research, Development and Innovation (IRDI), International Medical University, Kuala Lumpur 57000, Malaysia; (S.-F.W.); (Y.-Y.K.); (B.-K.T.); (C.-Y.W.)
- School of Health Sciences, International Medical University, 126, Jalan Jalil Perkasa 19, Bukit Jalil, Kuala Lumpur 57000, Malaysia
| | - Chee-Onn Leong
- Center for Cancer and Stem Cell Research, Institute for Research, Development and Innovation (IRDI), International Medical University, Kuala Lumpur 57000, Malaysia; (L.-W.H.); (C.K.L.); (W.-M.L.)
- School of Pharmacy, International Medical University, Kuala Lumpur 57000, Malaysia
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14
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Rames RD, Hillen TJ, Pashos GE, Maloney WJ, Clohisy JC. Incidence and Characteristics of Osteolysis in HXLPE THA at 16-Year Follow up in Patients 50 Years and Less. J Arthroplasty 2021; 36:641-646. [PMID: 32948423 DOI: 10.1016/j.arth.2020.08.048] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/12/2020] [Accepted: 08/23/2020] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Young patients present a challenge for total hip arthroplasty (THA) survivorship. Highly cross-linked polyethylene (HXLPE) liners have decreased the prevalence of osteolysis; however, concerns exist regarding the biologic activity of wear particles. The purpose of this study was to determine the incidence and characteristics of osteolytic lesions in young HXLPE THA patients at an average 16-year follow up and determine the ability to detect osteolysis. METHODS We performed a retrospective study involving 22 patients (26 THA) under age 50 at primary THA receiving HXLPE liners coupled with cobalt-chrome (CoCr) femoral heads. Computed tomography (CT) scans were reviewed for osteolysis. Chi-squared analysis was used for categorical variables and unpaired Kruskal-Wallis rank-sum test for continuous variables. Logistic regression was used to compare wear rates between those patients with and without osteolysis. RESULTS The mean age at surgery was 38.5 years. The mean time from surgery to CT scan was sixteen years (range 14.25-19.5 years). Nine of the 26 THA showed osteolysis. The mean volume of the lesions was 2.8 cm3. Linear (mean 0.008 mm/y) and volumetric (mean 4.5 mm3/year) wear rates were negligible. One-third of osteolytic lesions were visible on radiographs. Logistic regression failed to demonstrate a correlation between wear rates or UCLA activity score and osteolysis. CONCLUSION We observed osteolysis in 35% of HXLPE THA in young patients at mean 16-year follow up despite zero revisions for wear-related problems and clinically insignificant wear rates. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Richard D Rames
- Department of Orthopaedic Surgery, Washington University School of Medicine, Campus Box 8233, St. Louis, MO
| | - Travis J Hillen
- Division of Musculoskeletal Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
| | - Gail E Pashos
- Department of Orthopaedic Surgery, Washington University School of Medicine, Campus Box 8233, St. Louis, MO
| | - William J Maloney
- Department of Orthopedic Surgery, Stanford Medicine Outpatient Center, Redwood City, CA
| | - John C Clohisy
- Department of Orthopaedic Surgery, Washington University School of Medicine, Campus Box 8233, St. Louis, MO
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15
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Clark I, Vissel B. Broader Insights into Understanding Tumor Necrosis Factor and Neurodegenerative Disease Pathogenesis Infer New Therapeutic Approaches. J Alzheimers Dis 2021; 79:931-948. [PMID: 33459706 PMCID: PMC7990436 DOI: 10.3233/jad-201186] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 12/12/2022]
Abstract
Proinflammatory cytokines such as tumor necrosis factor (TNF), with its now appreciated key roles in neurophysiology as well as neuropathophysiology, are sufficiently well-documented to be useful tools for enquiry into the natural history of neurodegenerative diseases. We review the broader literature on TNF to rationalize why abruptly-acquired neurodegenerative states do not exhibit the remorseless clinical progression seen in those states with gradual onsets. We propose that the three typically non-worsening neurodegenerative syndromes, post-stroke, post-traumatic brain injury (TBI), and post cardiac arrest, usually become and remain static because of excess cerebral TNF induced by the initial dramatic peak keeping microglia chronically activated through an autocrine loop of microglial activation through excess cerebral TNF. The existence of this autocrine loop rationalizes post-damage repair with perispinal etanercept and proposes a treatment for cerebral aspects of COVID-19 chronicity. Another insufficiently considered aspect of cerebral proinflammatory cytokines is the fitness of the endogenous cerebral anti-TNF system provided by norepinephrine (NE), generated and distributed throughout the brain from the locus coeruleus (LC). We propose that an intact LC, and therefore an intact NE-mediated endogenous anti-cerebral TNF system, plus the DAMP (damage or danger-associated molecular pattern) input having diminished, is what allows post-stroke, post-TBI, and post cardiac arrest patients a strong long-term survival advantage over Alzheimer's disease and Parkinson's disease sufferers. In contrast, Alzheimer's disease and Parkinson's disease patients remorselessly worsen, being handicapped by sustained, accumulating, DAMP and PAMP (pathogen-associated molecular patterns) input, as well as loss of the LC-origin, NE-mediated, endogenous anti-cerebral TNF system. Adrenergic receptor agonists may counter this.
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Affiliation(s)
- I.A. Clark
- Research School of Biology, Australian National University, Canberra, Australia
| | - B. Vissel
- Centre for Neuroscience and Regenerative Medicine, Faculty of Science, University of Technology, Sydney, Australia
- St. Vincent’s Centre for Applied Medical Research, Sydney, Australia
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16
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van Loon J, Hoornenborg D, Sierevelt I, Opdam KTM, Kerkhoffs GMMJ, Haverkamp D. Highly cross-linked versus conventional polyethylene inserts in total hip arthroplasty, a five-year Roentgen stereophotogrammetric analysis randomised controlled trial. World J Orthop 2020; 11:442-452. [PMID: 33134107 PMCID: PMC7582113 DOI: 10.5312/wjo.v11.i10.442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/03/2020] [Accepted: 08/26/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Polyethylene (PE) particles produced by wear of the acetabular insert are thought to cause osteolysis and thereby aseptic loosening of the implant in total hip arthroplasty (THA). As highly cross-linked polyethylene (HXLPE) is presumed to give lower wear rates, in vivo studies are needed to confirm this.
AIM To compare the wear of REXPOL, a HXPLE, with conventional PE within the first five years after implantation using Roentgen stereophotogrammetric analysis (RSA).
METHODS Patients were randomised to receive either a HXLPE (REXPOL) or a conventional PE insert during primary THA. RSA images were obtained directly postoperative and after 6 wk, 12 wk, 6 mo, 12 mo, 24 mo and five years. Functional outcomes were assessed using the Hip Injury and Osteoarthritis Outcome Score and Harris Hip Score at baseline and five years after surgery.
RESULTS The HXLPE (REXPOL) showed less wear in the latero-medial direction. Significant wear rates of conventional PE were seen in the latero-medial and center-proximal direction and in volume and corrected volume, whereas the REXPOL did not show these outcomes over time. Improvement from baseline in functional outcome did not significantly differ.
CONCLUSION Total 3D wear is less in THAs inserted with a REXPOL inlay than a conventional PE inlay after five years. This study confirms, for the first, that the REXPOL HXLPE inlay is preferred to standard PE.
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Affiliation(s)
- Justin van Loon
- Department of Orthopaedic Surgery, Xpert Orthopedie Amsterdam/Specialized Center of Orthopedic Research and Education, Amsterdam 1101EA, Netherlands
- Department of Orthopaedic Surgery, Amsterdam University Medical Centres, Location Academic Medical Center, Amsterdam 1105AZ, Netherlands
| | - Daniël Hoornenborg
- Department of Orthopaedic Surgery, Xpert Orthopedie Amsterdam/Specialized Center of Orthopedic Research and Education, Amsterdam 1101EA, Netherlands
| | - Inger Sierevelt
- Department of Orthopaedic Surgery, Xpert Orthopedie Amsterdam/Specialized Center of Orthopedic Research and Education, Amsterdam 1101EA, Netherlands
| | - Kim TM Opdam
- Department of Orthopaedic Surgery, Amsterdam University Medical Centres, Location Academic Medical Center, Amsterdam 1105AZ, Netherlands
| | - Gino MMJ Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam University Medical Centres, Location Academic Medical Center, Amsterdam 1105AZ, Netherlands
| | - Daniël Haverkamp
- Department of Orthopaedic Surgery, Xpert Orthopedie Amsterdam/Specialized Center of Orthopedic Research and Education, Amsterdam 1101EA, Netherlands
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Fukui K, Kaneuji A, Wang X, Ichiseki T, Matsumoto T, Kawahara N. Computed Tomographic Osteolytic Analysis of a First-Generation Remelted Highly Cross-Linked Polyethylene in Total Hip Arthroplasty-At a Minimum of 15-Year Follow-Up. J Arthroplasty 2020; 35:1417-23. [PMID: 31948813 DOI: 10.1016/j.arth.2019.12.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 11/25/2019] [Accepted: 12/09/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Low polyethylene wear rate and low incidence of osteolysis have been reported after total hip arthroplasty (THA) using first-generation remelted highly cross-linked polyethylene (HXLPE). However, osteolysis has not been evaluated in long-term studies of these patients (15 years or more). The present study assessed computed tomography (CT) images to determine the incidence of osteolysis associated with HXLPE in THA during at least 15 years of follow-up. METHODS We evaluated 105 primary THAs in 84 patients (77 women and 7 men). Mean follow-up was 15.9 years (range, 15-18 years). All THAs used a Longevity HXLPE liner and a 26-mm zirconia femoral head. Areas of osteolysis were identified from CT images using 3D and multiplanar reconstruction views. RESULTS CT 3D multiplanar reconstruction images at 15-year follow-up showed no obvious osteolysis in the acetabulum or femur of any patient. No patients developed cup loosening or liner breakage. CONCLUSION Our study indicates that first-generation remelted HXLPE liners do not increase the risk of osteolysis during 15-year follow-up and suggests that the wear particles from first-generation remelted HXLPE are less biologically active than those generated by conventional polyethylene devices.
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Braun S, Jaeger S, Sonntag R, Schroeder S, Kretzer JP. Quantitative Measurements of Backside Wear in Acetabular Hip Joint Replacement: Conventional Polyethylene Versus Cross-Linked Polyethylene. Materials (Basel) 2020; 13:E1854. [PMID: 32326506 DOI: 10.3390/ma13081854] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/26/2020] [Accepted: 04/07/2020] [Indexed: 11/16/2022]
Abstract
As shown in previous studies, the modification of conventional polyethylene (CPE) to cross-linked polyethylene (XLPE) and the contribution of antioxidants result in a reduction in total wear. The aim of this study was to evaluate XLPE inserts with vitamin E and CPE regarding their resistance to the backside wear mechanism. A cementless hip cup system (Plasmafit® Plus 7, Aesculap) was dynamically loaded using CPE and XLPE inserts. The backside wear was isolated, generated and collected using the two-chamber principle. The chambers were filled with ultrapure water. After 2 × 106 cycles, the fluids were examined for wear particles according to a particle analysis. Using XLPE inserts, the backside wear was significantly reduced by 35%. While XLPE backside wear particles are significantly larger than CPE particles, they do not differ in their morphology. This study confirms the greater resistance to backside wear of XLPE compared to CPE. It can be assumed that the improved fatigue resistance of the vitamin E-stabilized XLPE inserts demonstrates XLPE’s effectiveness against micro-motion and the resulting changing tensions in interface areas like surface breakdown, pitting and the release of very small particles.
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Shi J, Zhu W, Liang S, Li H, Li S. Cross-Linked Versus Conventional Polyethylene for Long-Term Clinical Outcomes After Total Hip Arthroplasty: A Systematic Review and Meta-Analysis. J INVEST SURG 2019; 34:307-317. [PMID: 31266381 DOI: 10.1080/08941939.2019.1606370] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background: Cross-linked polyethylene (HXLPE) liners have been used for total hip arthroplasty (THA) to address the problem of osteolysis and revision surgery associated with conventional polyethylene (CPE) liners. This systematic review and meta-analysis investigated the long-term efficacy of HXLPE in preventing revision surgery and radiological osteolysis in comparison to CPE. Materials and Methods: A comprehensive search of PubMed, Embase, and the Cochrane Library from their respective inception to September 2018 was conducted to identify potential candidate articles. Data were pooled using Stata software 14.0. The quality of randomized controlled trials (RCTs) and observational studies was assessed by two different authors using the Cochrane risk-of-bias tool and the Newcastle-Ottawa scale (NOS), respectively. Results: Eight RCTs and six observational studies were included in this review. The pooled results significantly favored HXLPE over CPE in terms of total number of revisions and radiological osteolysis, with a risk reduction of 78% (95% confidence interval [CI] 0.13-0.36; p < 0.001) and 80% (95% CI 0.13-0.29; p < 0.001), respectively. Additionally, subgroup analyses of pooled data from RCTs and observational studies both showed the efficacy of HXLPE in the prevention of revision and osteolysis. Polyethylene wear in the HXLPE group was significantly less than that in the CPE group in terms of linear wear rates and head penetration rates (both p < 0.001). No significant differences were observed with regard to functional outcomes. Conclusions: The current evidence shows that HXLPE significantly improved the clinical and radiographic outcomes, but not the functional outcomes, in comparison to CPE in long-term follow-up.
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Affiliation(s)
- Jiangyuan Shi
- Department of Orthopedics, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Weicong Zhu
- Guangzhou Institute of Traumatic Surgery, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Shaohua Liang
- Department of Orthopedics, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Hongling Li
- Department of Orthopedics, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Siming Li
- Department of Orthopedics, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
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20
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Rames RD, Stambough JB, Pashos GE, Maloney WJ, Martell JM, Clohisy JC. Fifteen-Year Results of Total Hip Arthroplasty With Cobalt-Chromium Femoral Heads on Highly Cross-Linked Polyethylene in Patients 50 Years and Less. J Arthroplasty 2019; 34:1143-1149. [PMID: 30808529 DOI: 10.1016/j.arth.2019.01.071] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/25/2019] [Accepted: 01/28/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Highly cross-linked polyethylene (HXLPE) is the most commonly used bearing surface in total hip arthroplasty (THA) because of its superior wear properties, but long-term results in young patients are limited. Mid-term survivorship has been promising; however, polyethylene wear rates and need for revision surgeries remain a concern in this population. The purpose of our study is to investigate polyethylene wear rates, implant survivorship, wear-related revisions, and patient-reported outcomes in a young patient cohort at 15-year follow-up. METHODS We performed a retrospective study of a prospective longitudinal cohort of 82 consecutive patients (89 hips) who underwent primary THA with an HXLPE acetabular liner and a cobalt-chromium femoral head. The mean age at the time of surgery for the cohort was 38.8 years (range 12-50). All patients received HXLPE liners with a cementless acetabular component coupled with a cobalt-chrome femoral head through a posterior approach with a cementless femoral component. All components were from a single manufacturer. We recorded University of California, Los Angeles Activity, and modified Harris Hip Scores. Wear calculations were made using the Martell Hip Analysis Suite (Version 8.0.4.3). RESULTS At average 15 years (range 13.1-18.5), there was a revision-free survivorship of 97.8% in our HXLPE group with no wear-related revisions. We observed a linear wear rate of 0.0185 mm/y (standard deviation 0.05) after accounting for a 1-year bedding-in period. The volumetric wear rate was found to be 12.80 mm3/y (standard deviation 22.69). These numbers are registered as clinically undetectable and are comparable to steady state wear rates in the same cohort of patients at earlier time points. We found no radiographic changes concerning osteolysis. We observed excellent patient-reported outcomes at this time point with improvements in modified Harris Hip Scores (35.3 [22.5], P < .0001) and University of California, Los Angeles Activity Scores (median 6.0, P < .0001). CONCLUSION At 15-year follow-up, we demonstrated that HXLPE bearings in this young cohort had excellent wear properties, maintained superior clinical improvements, and underwent no wear-related revision operations. The HXLPE and cobalt-chrome bearing couple continues to be extremely effective 15 years after primary THA in patients less than 50 years. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Richard D Rames
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Jeffrey B Stambough
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Gail E Pashos
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO
| | - William J Maloney
- Department of Orthopedic Surgery, Stanford Medicine Outpatient Center, Redwood City, CA
| | - John M Martell
- Department of Orthopaedic Surgery and Rehabilitation Medicine, Orthopaedic Biomedical Institute, University of Chicago Medicine & Biological Sciences, Chicago, IL
| | - John C Clohisy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO
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Li J, Li Z, Tu J, Jin G, Li L, Wang K, Wang H. In vitro and in vivo investigations of a-C/a-C:Ti nanomultilayer coated Ti6Al4V alloy as artificial femoral head. Mater Sci Eng C Mater Biol Appl 2019; 99:816-826. [PMID: 30889756 DOI: 10.1016/j.msec.2019.02.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 01/15/2019] [Accepted: 02/06/2019] [Indexed: 12/13/2022]
Abstract
Hydrogen-free a-C/a-C:Ti nanomultilayer (a-C NM) films were deposited on medical Ti6Al4V by the magnetron sputtering technique under bias-graded voltage. Cell tests and implantations were performed for the a-C NM films coated Ti6Al4V with the uncoated Ti6Al4V as the control. The canine total hip arthroplasty (THA) surgeries were conducted for 12 dogs using the coated femoral heads, with the CoCr heads as the control. Results of cell tests showed that the coated Ti6Al4V had no cytotoxicity, and there was no statistical difference of the cell attachment rates between the coated and uncoated sample (P = 0.091). No significant difference of the tissue response around the coated and uncoated implants were observed after the intramuscular (P = 0.679) and intraosseous implantations (P = 0.122). After two years of successful canine THA, the polyethylene wear particles isolated from periprosthetic soft tissue showed similar sizes, shapes and counts in the two groups (all of the P values >0.05). The retrieved femoral heads showed slightly change of the surface roughness, but no statistical differences between groups (P = 0.696). However, the systemic metal ion analysis indicated that the content of Co and Cr ions released in the coated group (Co: 0.71 ± 0.06 μg/L, Cr: 0.52 ± 0.05 μg/L) were significant lower than that in the control (Co: 1.98 ± 0.16 μg/L, Cr: 1.17 ± 0.19 μg/L) (both P < 0.005). Histological analysis of the periprosthetic tissue in CoCr group showed a severer histiocyte response than that in the coated group (P = 0.029). The head-taper interfaces showed galvanic corrosion attack in the CoCr group, but not in the coated Ti6Al4V group. Therefore, the a-C NM films coated Ti6Al4V exhibited good biocompatibility as an implant material. Compared with the CoCr, the coated Ti6Al4V femoral head could provide comparable in vivo wear properties, release less harmful metal ions and reduce the inflammatory response in periprosthetic tissue, which may help to prolong the longevity of prostheses.
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Affiliation(s)
- Ji Li
- Department of Orthopedics, General Hospital of PLA, No. 28 Fuxing Road, Haidian District, Beijing 100853, China
| | - Zhongli Li
- Department of Orthopedics, General Hospital of PLA, No. 28 Fuxing Road, Haidian District, Beijing 100853, China.
| | - Jiangping Tu
- State Key Laboratory of Materials and Department of Materials Science and Engineering, Zhejiang University, Hangzhou 310027, China
| | - Gong Jin
- ZhongAoHuiCheng Technology Co., No. 20 Kechuang Road, Economic and Technological Development Zone, Beijing 100176, China
| | - Lingling Li
- State Key Laboratory of Materials and Department of Materials Science and Engineering, Zhejiang University, Hangzhou 310027, China
| | - Ketao Wang
- Department of Orthopedics, General Hospital of PLA, No. 28 Fuxing Road, Haidian District, Beijing 100853, China
| | - Haoran Wang
- Department of Orthopedics, General Hospital of PLA, No. 28 Fuxing Road, Haidian District, Beijing 100853, China
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Motojima N, Nakashima Y, Fujiwara Y, Komohara Y, Takeya M, Miura H, Hino K, Higaki H, Hata H, Nakanishi Y. Relationship between wear behaviour of ultra‐high‐molecular‐weight polyethylene and surface profile of Co–Cr–Mo alloy in artificial joint. Biosurface and Biotribology 2019. [DOI: 10.1049/bsbt.2018.0029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Nana Motojima
- Graduate School of Science and TechnologyKumamoto University2‐39‐1 Kurokami Cyuo‐kuKumamoto860‐8555Japan
| | - Yuta Nakashima
- Faculty of Advanced Science and TechnologyKumamoto UniversityKumamotoJapan
| | - Yukio Fujiwara
- Faculty of Life Science and TechnologyKumamoto UniversityKumamotoJapan
| | | | - Motohiro Takeya
- Faculty of Life Science and TechnologyKumamoto UniversityKumamotoJapan
| | | | - Kazunori Hino
- Graduate School of MedicineEhime UniversityEhimeJapan
| | | | - Hidehiro Hata
- Faculty of Advanced Science and TechnologyKumamoto UniversityKumamotoJapan
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23
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Gao Y, Jin Z. Biomechanics and Biotribology of UHMWPE Artificial Hip Joints. Springer Series in Biomaterials Science and Engineering 2019. [DOI: 10.1007/978-981-13-6924-7_8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Shen W, Tomita N, Niikura M, Sugino T. Amount of TNF‐α released from macrophages reacting with polyethylene particles showed dose‐dependent relationship to the total surface area of added particles. Biosurface and Biotribology 2018. [DOI: 10.1049/bsbt.2018.0026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Weiqi Shen
- Department of Mechanical Engineering and ScienceKyoto UniversityKyotoJapan
| | - Naohide Tomita
- Department of Mechanical Engineering and ScienceKyoto UniversityKyotoJapan
| | - Miho Niikura
- Department of Mechanical Engineering and ScienceKyoto UniversityKyotoJapan
| | - Takuma Sugino
- Department of Mechanical Engineering and ScienceKyoto UniversityKyotoJapan
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Theodorides AA, Stewart TD, Venkatesh R. Can the radiopaque marker in surgical swabs scratch orthopaedic implant surfaces? Eur J Orthop Surg Traumatol 2019; 29:383-8. [PMID: 30269182 DOI: 10.1007/s00590-018-2309-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 09/12/2018] [Indexed: 10/28/2022]
Abstract
AIMS To determine whether the radiopaque marker strip, which is woven in surgical swabs, causes measureable wear on metal implants at pressures typically used to wipe off fluid from their surface. MATERIALS AND METHODS Finger pressure used to wipe a surface was measured and used as a reference pressure for further testing. A tribological wear rig was then used to analyse the wear caused on polished titanium plates by a cobalt chromium pin (the control test), the pin covered by a surgical swab and the pin covered by a radiopaque marker strip. RESULTS It was found that the cotton part or the radiopaque marker of surgical swabs on polished medical grade titanium plates caused no significant wear. In contrast severe scratching was observed from the cobalt chromium pin on its own. CONCLUSION To our knowledge, this is the first study in the literature analysing the wear caused by the surgical swabs and radiopaque strip on metal implants. The results suggest that surgical swabs are safe to use on metallic implants at pressures typical of a wiping motion.
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Peng KT, Tsai MH, Lee CW, Chiang YC, Chen PC, Chen CC, Chang CH, Shih HN, Chang PJ. Dysregulated expression of antioxidant enzymes in polyethylene particle-induced periprosthetic inflammation and osteolysis. PLoS One 2018; 13:e0202501. [PMID: 30125327 PMCID: PMC6101395 DOI: 10.1371/journal.pone.0202501] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 08/03/2018] [Indexed: 01/01/2023] Open
Abstract
Small wear particles (0.1–10 μm) in total joint replacement are generally considered as the major causative agent leading to periprosthetic inflammation and osteolysis. However, little is known about the roles of larger wear particles (10–100 μm) in periprosthetic inflammation and osteolysis. Additionally, although ample studies demonstrated that increased oxidative stress is critically involved in particle-induced inflammation and osteolysis, detailed changes in antioxidant enzymes expression in the disease development remain largely unclear. Herein, we used a rat knee prosthesis model to assess effects of polyethylene (PE) particles (20–60 μm) on the levels of oxidative stress markers such as malondialdehyde (MDA) and total antioxidant capacity (TAC) in blood plasma, and on the expression profiles of antioxidant enzymes in knee joint tissues. In combination with a forced-exercise intervention for all surgical rats, we found that the rat groups treated with both artificial joint and PE particles exhibited higher MDA levels and lower TAC levels, together with lower levels of physical activity and higher levels of inflammatory markers, than the sham group and the groups receiving artificial joint or PE particles alone at weeks 20–24 post-operatively. Dose-response relationships between the exposure to PE particles and the induction of oxidative stress and inflammation were also observed in the artificial joint/PE groups. Under such conditions, we unexpectedly found that most of antioxidant enzymes displayed pronounced up-regulation, with concomitant induction of inflammatory and osteoclast-inducing factors (including IL-1β, NF-κB and RANKL), in the artificial joint/PE groups as compared to the sham, artificial joint only, or PE only group. Only a few antioxidant enzymes including SOD2 and GPx2 showed down-regulation. Collectively, our findings demonstrate that implantation of artificial joint along with large PE particles synergistically trigger the induction of oxidative stress; however, down-regulation of many antioxidant enzymes may not necessarily occur during the disease development.
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Affiliation(s)
- Kuo-Ti Peng
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
- College of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - Meng-Hsueh Tsai
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chiang-Wen Lee
- Division of Basic Medical Sciences, Department of Nursing, and Chronic Diseases and Health Promotion Research Center, Chang Gung Institute of Technology, Chiayi, Taiwan
| | - Yao-Chang Chiang
- Center for Drug Abuse and Addiction, China Medical University Hospital, Taichung, Taiwan
| | - Pei-Chun Chen
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chun-Chieh Chen
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chih-Hsiang Chang
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Hsin-Nung Shih
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
- * E-mail: (PJC); (HNS)
| | - Pey-Jium Chang
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang-Gung University, Taoyuan, Taiwan
- Department of Nephrology, Chang-Gung Memorial Hospital, Chiayi, Taiwan
- * E-mail: (PJC); (HNS)
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Esvaran M, Conway PL. Lactobacilli can attenuate inflammation in mouse macrophages exposed to polyethylene particles in vitro. BMC Res Notes 2018; 11:567. [PMID: 30089517 DOI: 10.1186/s13104-018-3676-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 08/03/2018] [Indexed: 11/10/2022] Open
Abstract
Objective It is well established that polyethylene (PE) wear particles induce macrophage production of cytokines and mediators associated with the pathogenesis of inflammatory osteolysis. The objective of this study was to examine the potential of three Lactobacillus strains to attenuate the TNF-α cytokine response of macrophages exposed to Ceridust 3615 PE particles. An in vitro experimental model using the RAW 246.7 macrophage cell line and PE particles was utilized. Results Lactobacillus strains were found to modulate the cytokines in a strain and dose specific manner. Only the Lactobacillus acidophilus strain that was tested was able to attenuate PE particle-induced TNF-α production by RAW 246.7 macrophages. This effect was independent of IL-10 cytokine levels since all three strains of lactobacilli yielded comparable levels of IL-10. It was concluded that some, but not all, Lactobacillus strains may be useful in reducing the risk of inflammatory osteolysis and that further studies in appropriate in vivo models are warranted. Furthermore, this in vitro model can be used to evaluate the inflammatory potential of new materials being tested for use as joint implants.
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Lasurt-bachs S, Torner P, Maculé F, Prats E, Menéndez-garcía F, Ríos-guillermo J, Torrents A. Cross-linked polyethylene does not reduce wear in total knee arthroplasty. Rev Esp Cir Ortop Traumatol (Engl Ed) 2018; 62:197-203. [DOI: 10.1016/j.recote.2018.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Lasurt-Bachs S, Torner P, Maculé F, Prats E, Menéndez-García F, Ríos-Guillermo J, Torrents A. Cross-linked polyethylene does not reduce wear in total knee arthroplasty. Rev Esp Cir Ortop Traumatol (Engl Ed) 2018; 62:197-203. [PMID: 29454601 DOI: 10.1016/j.recot.2017.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 11/22/2017] [Accepted: 11/29/2017] [Indexed: 10/18/2022] Open
Abstract
AIM To compare two different types of inserts: Ultra-high molecular weight polyethylene (UHMWPE) and cross-linked polyethylene with a quantitative and qualitative study of polyethylene wear particles in synovial fluid 3 years after total knee arthroplasty. MATERIAL AND METHODS A prospective, randomized, controlled cohort study with blinded evaluation was carried out on 25 patients undergoing staged bilateral total knee replacement, 6 months apart. Knee arthrocentesis was performed on 12 patients 3 years after surgery, and the polyethylene particles were analyzed. RESULTS No significant differences were found in the number of particles generated by the two different types of inserts at 3 years from total knee arthroplasty (3,000×: x¯ cross-linked=849.7; x¯ UHMWPE=796.9; P=.63; 20,000×: x¯ cross-linked=66.3; x¯ UHMWPE=73.1; P=.76). Likewise, no differences in the probability of finding elongated (χ2=0.19; P=.66) or rounded (χ2=1.44; P=.23) particles in both types of inserts were observed. However, the probability of finding fibrillar particles is 3.08 times greater in UHMWPE. CONCLUSIONS Cross-linked polyethylene does not significantly reduce the generation of polyethylene particles in patients with total knee arthroplasty, 3 years after the surgical procedure.
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Affiliation(s)
- S Lasurt-Bachs
- Unitat de Genoll, Servei de Cirurgia Ortopèdica i Traumatologia, Consorci Sanitari Integral Baix Llobregat, Universitat de Barcelona, Barcelona, España.
| | - P Torner
- Servei de Cirurgia Ortopèdica i Traumatologia, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Sabadell, Barcelona, España; Universitat Autònoma de Barcelona (UAB), Barcelona, España
| | - F Maculé
- Unidad de Rodilla, Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | - E Prats
- Departamento de Microscopía Electrónica, Centres Científics i Tecnològics de la UB (CCiTUB), Barcelona, España
| | - F Menéndez-García
- Unidad de Análisis Elemental, Centres Científics i Tecnològics de la Universitat de Barcelona (CCiTUB), Barcelona, España
| | - J Ríos-Guillermo
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Departamento de Estadística, Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | - A Torrents
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Departamento de Estadística, Hospital Clínic, Universitat de Barcelona, Barcelona, España
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Li J, Wang K, Li Z, Tu JP, Jin G, Su J, Zhai B. Mechanical tests, wear simulation and wear particle analysis of carbon-based nanomultilayer coatings on Ti6Al4V alloys as hip prostheses. RSC Adv 2018; 8:6849-6857. [PMID: 35540330 PMCID: PMC9078386 DOI: 10.1039/c7ra12080j] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 02/06/2018] [Indexed: 11/21/2022] Open
Abstract
Carbon-based nanomultilayer coatings were deposited on medical-grade Ti6Al4V alloy using a magnetron sputtering technique under a graded bias voltage.
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Affiliation(s)
- Ji Li
- Department of Orthopedics
- General Hospital of PLA
- Beijing 100853
- China
| | - Ketao Wang
- Department of Orthopedics
- General Hospital of PLA
- Beijing 100853
- China
| | - Zhongli Li
- Department of Orthopedics
- General Hospital of PLA
- Beijing 100853
- China
| | - J. P. Tu
- State Key Laboratory of Materials and Department of Materials Science and Engineering
- Zhejiang University
- Hangzhou 310027
- China
| | - Gong Jin
- ZhongAoHuiCheng Technology Co
- Economic and Technological Development Zone
- Beijing 100176
- China
| | - Jian Su
- Beijing Institute of Medical Instruments
- Beijing 101111
- China
| | - Bao Zhai
- Beijing Institute of Medical Instruments
- Beijing 101111
- China
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Liu Y, Shi F, Bo L, Zhi W, Weng J, Qu S. A novel alginate-encapsulated system to study biological response to critical-sized wear particles of UHMWPE loaded with alendronate sodium. Materials Science and Engineering: C 2017. [DOI: 10.1016/j.msec.2017.05.119] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Broomfield JAJ, Malak TT, Thomas GER, Palmer AJR, Taylor A, Glyn-Jones S. The Relationship Between Polyethylene Wear and Periprosthetic Osteolysis in Total Hip Arthroplasty at 12 Years in a Randomized Controlled Trial Cohort. J Arthroplasty 2017; 32:1186-1191. [PMID: 27998657 DOI: 10.1016/j.arth.2016.10.037] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 10/24/2016] [Accepted: 10/28/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Polyethylene acetabular components are common in hip arthroplasty. Highly cross-linked polyethylene (HXLPE) has lower wear than ultra-high molecular weight polyethylene (UHMWPE). Evidence suggests that wear particles induce inflammation causing periprosthetic osteolysis contributing to implant loosening with wear rates of 0.05 mm/y were considered safe. We aimed to compare incidence and volume of periacetabular osteolysis between HXLPE and UHMWPE using computed tomography. METHODS Initially, 54 hips in 53 patients were randomized to HXLPE or UHMWPE acetabular liner. At 10 years, 39 hips in 38 patients remained for the radiostereometric analysis' demonstrating significantly lower wear in the HXLPE group. At 12 years, 14 hips in 13 patients were lost to follow-up leaving 25 hips for computed tomography assessment. Images were reconstructed to detect osteolysis and where identified, areas were segmented and volumized. RESULTS Osteolysis was observed in 8 patients, 7 from the UHMWPE group and only 1 from the HXLPE group (Fisher exact, P = .042). There was no correlation between the amount of polyethylene wear and osteolysis volume; however, the radiostereometric analysis-measured wear rate in patients with osteolysis from both groups was significantly higher than overall average wear rate. CONCLUSION This data demonstrates lower incidence of periacetabular osteolysis in the HXLPE group of a small cohort. Although numbers are too low to estimate causation, in the context of lower wear in the HXLPE group, this finding supports the hypothesis that HXLPE may not elevate osteolysis risk, and hence does not suggest that HXLPE wear particles are more biologically active than those generated by earlier generations of polyethylene.
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Affiliation(s)
- John A J Broomfield
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford, United Kingdom
| | - Tamer T Malak
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford, United Kingdom
| | - Geraint E R Thomas
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford, United Kingdom
| | - Antony J R Palmer
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford, United Kingdom
| | - Adrian Taylor
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford, United Kingdom
| | - Sion Glyn-Jones
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Oxford, United Kingdom
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Krenn S, Thomsen M, Usbeck S, Scheuber LF, Boettner F, Krukemeyer MG, Huber M, Kretzer JP, Gehrke T, Krenn V. Supramacroparticulate PE in 6 different joint endoprostheses localisations: An indicator for PE damage? Pathol Res Pract 2017; 213:987-996. [PMID: 28602486 DOI: 10.1016/j.prp.2017.03.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 03/27/2017] [Accepted: 03/29/2017] [Indexed: 10/19/2022]
Abstract
In the histopathological particle algorithm polyethylene (PE) particles with maximum lengths of more than 100μm - called PE supramacroparticles - are identified exclusively for knee joint and hip prostheses. However, a definitive characterisation, detection in all joint localisations and a causal clarification of the pathogenesis are lacking. In this study a total of 175 SLIM (synovial-like interface membrane) cases with PE supramacroparticles of knee joint prostheses (n=89), hip joint prostheses (n=44), ankle joint prostheses (n=36) and prostheses in three localisations of the upper extremities (n=6) were systematically investigated. The arithmetic mean of the particle length varied greatly within the prosthesis types. This had a significant positive correlation with the prosthesis lifetime and negative correlation with the date of implantation. It can be concluded that both the lifetime and the time of implantation have an influence on the particle length. The prostheses with supramacroparticulate damage moreover showed a clearly reduced survival rate compared with other data published on the prosthesis lifetime. The material wear therefore could not be attributed solely to the usual fatigue factors. Since loosening of the prostheses, decentring of the PE components or damage to the PE inlay existed in all cases, mechanical dysloading seems to be the most probable cause of PE supramacroparticle genesis. Due to the striking length and for demarcation from PE macroparticles, the term supramacroparticulate PE is proposed for a length of more than 100μm. In the extended histopathological particle algorithm supramacroparticulate PE has been included in the macroparticles category and should be taken into account and interpreted causally in histopathological diagnostics of joint prosthesis failure.
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Affiliation(s)
- Simon Krenn
- MVZ-Zentrum für Histologie, Zytologie und Molekulare Diagnostik, Trier, Germany; Danube Private University, Krems-Stein, Austria.
| | | | | | | | | | | | - Monika Huber
- Pathologisch-bakteriologisches Institut, Otto Wagner Spital, Wien, Austria
| | - Jan Philippe Kretzer
- Labor für Biomechanik und Implantat-Forschung, Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Heidelberg, Germany
| | | | - Veit Krenn
- MVZ-Zentrum für Histologie, Zytologie und Molekulare Diagnostik, Trier, Germany
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Zaveri TD, Dolgova NV, Lewis JS, Hamaker K, Clare-Salzler MJ, Keselowsky BG. Macrophage integrins modulate response to ultra-high molecular weight polyethylene particles and direct particle-induced osteolysis. Biomaterials 2017; 115:128-140. [PMID: 27889664 PMCID: PMC5431751 DOI: 10.1016/j.biomaterials.2016.10.038] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 10/26/2016] [Accepted: 10/26/2016] [Indexed: 12/25/2022]
Abstract
Aseptic loosening due to peri-prosthetic osteolysis is one of the primary causes for failure of artificial joint replacements. Implant-derived wear particles, often ultra-high molecular weight polyethylene (UHMWPE) microparticles, initiate an inflammatory cascade upon phagocytosis by macrophages, which leads to osteoclast recruitment and activation, ultimately resulting in osteolysis. Investigation into integrin receptors, involved in cellular interactions with biomaterial-adsorbed adhesive proteins, is of interest to understand and modulate inflammatory processes. In this work, we investigate the role of macrophage integrins Mac-1 and RGD-binding integrins in response to UHMWPE wear particles. Using integrin knockout mice as well as integrin blocking techniques, reduction in macrophage phagocytosis and inflammatory cytokine secretion is demonstrated when these receptors are either absent or blocked. Along this line, various opsonizing proteins are shown to differentially modulate microparticle uptake and macrophage secretion of inflammatory cytokines. Furthermore, using a calvarial osteolysis model it is demonstrated that both Mac-1 integrin and RGD-binding integrins modulate the particle induced osteolysis response to UHMWPE microparticles, with a 40% decrease in the area of osteolysis by the absence or blocking of these integrins, in vivo. Altogether, these findings indicate Mac-1 and RGD-binding integrins are involved in macrophage-directed inflammatory responses to UHMWPE and may serve as therapeutic targets to mitigate wear particle induced peri-prosthetic osteolysis for improved performance of implanted joints.
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Affiliation(s)
- Toral D Zaveri
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL 32611, USA; Department of Food Science, The Pennsylvania State University, University Park, PA 16802, USA
| | - Natalia V Dolgova
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL 32611, USA
| | - Jamal S Lewis
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL 32611, USA; Department of Biomedical Engineering, University of California, Davis, Davis, CA 95618, USA
| | - Kiri Hamaker
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL 32611, USA
| | - Michael J Clare-Salzler
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL 32611, USA
| | - Benjamin G Keselowsky
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL 32611, USA.
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Sartori M, Vincenzi F, Ravani A, Cepollaro S, Martini L, Varani K, Fini M, Tschon M. RAW 264.7 co-cultured with ultra-high molecular weight polyethylene particles spontaneously differentiate into osteoclasts: an in vitro model of periprosthetic osteolysis. J Biomed Mater Res A 2016; 105:510-520. [PMID: 27667508 DOI: 10.1002/jbm.a.35912] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 09/07/2016] [Accepted: 09/20/2016] [Indexed: 12/19/2022]
Abstract
Wear-particle osteolysis affects prosthesis survival leading to implant loosening up to 70% of revisions. Therapeutic strategies are increasing, however alternative testing methods to experimentally evaluate such treatments are lacking. The aim of this study was to reproduce an in vitro osteolysis model recapitulating the events that, starting from the exposure of macrophages to polyethylene, lead to the establishment of osteoclastogenesis and inflammation. Responses to polyethylene, at 3 and 7 days, in a macrophage cell line, RAW 264.7, were determined by DNA quantification, immunofluorescence, pit assay, gene expression, cytokine production and NF-kB activation. Results showed that 3 days exposure to particles could induce a significant production of Tumor Necrosis Factor alpha (p < 0.0005) and Prostaglandin E2 (p < 0.005) compared to controls. Particles also induced macrophages to spontaneously differentiate into mature and active osteoclasts, in terms of identification of multinucleated cells by Phalloidin staining and by the analysis of osteoclast-specific gene markers. In particular, at 3 days polyethylene induced a significant up-regulation of Nuclear Factor of Activated T-cells, cytoplasmic 1, Receptor Activator of Nuclear factor Kappa-B and Receptor Activator of Nuclear Factor Kappa-B Ligand genes (p < 0.0005) compared to controls. At protein level, the particles induced a significant increase of Receptor Activator of Nuclear Factor Kappa-B Ligand at day 7 over controls (p < 0.0005). Osteoclasts were capable to resorb bone even in absence of differentiating factors. The possible mechanism, beside spontaneous osteoclastogenesis mediated by wear debris, was identified in an autocrine up-regulation of Receptor activator of nuclear factor kappa-B ligand gene expression and protein synthesis. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 105A: 510-520, 2017.
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Affiliation(s)
- M Sartori
- Laboratory of Biocompatibility, Technological Innovations and Advanced Therapies, BITTA, Rizzoli Orthopaedic Institute- Research, Innovation and Technology Department (RIT), via di Barbiano 1/10, 40136, Bologna, Italy
| | - F Vincenzi
- Laboratory of Cellular and Molecular Pharmacology Department of Medical Sciences, University of Ferrara, via Fossato di Mortara 17-19, Ferrara, 44121, Italy
| | - A Ravani
- Laboratory of Cellular and Molecular Pharmacology Department of Medical Sciences, University of Ferrara, via Fossato di Mortara 17-19, Ferrara, 44121, Italy
| | - S Cepollaro
- Laboratory of Preclinical and Surgical Studies, Rizzoli Orthopaedic Institute, via di Barbiano 1/10, Bologna, 40136, Italy
| | - L Martini
- Laboratory of Preclinical and Surgical Studies, Rizzoli Orthopaedic Institute, via di Barbiano 1/10, Bologna, 40136, Italy
| | - K Varani
- Laboratory of Cellular and Molecular Pharmacology Department of Medical Sciences, University of Ferrara, via Fossato di Mortara 17-19, Ferrara, 44121, Italy
| | - M Fini
- Laboratory of Preclinical and Surgical Studies, Rizzoli Orthopaedic Institute, via di Barbiano 1/10, Bologna, 40136, Italy
| | - M Tschon
- Laboratory of Preclinical and Surgical Studies, Rizzoli Orthopaedic Institute, via di Barbiano 1/10, Bologna, 40136, Italy
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Yoshioka R, Nakashima Y, Fujiwara Y, Komohara Y, Takeya M, Nakanishi Y. The biological response of macrophages to PMMA particles with different morphology and size. Biosurface and Biotribology 2016. [DOI: 10.1016/j.bsbt.2016.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Sukur E, Akman YE, Ozturkmen Y, Kucukdurmaz F. Particle Disease: A Current Review of the Biological Mechanisms in Periprosthetic Osteolysis After Hip Arthroplasty. Open Orthop J 2016; 10:241-51. [PMID: 27499822 PMCID: PMC4951796 DOI: 10.2174/1874325001610010241] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 05/16/2016] [Accepted: 05/31/2016] [Indexed: 02/08/2023] Open
Abstract
Background: Inflammatory responses to wear debris cause osteolysis that leads to aseptic prosthesis loosening and hip arthroplasty failure. Although osteolysis is usually associated with aseptic loosening, it is rarely seen around stable implants. Aseptic implant loosening is a simple radiologic phenomenon, but a complex immunological process. Particulate debris produced by implants most commonly causes osteolysis, and this is called particle-associated periprosthetic osteolysis (PPO). Objective: The objective of this review is to outline the features of particle-associated periprosthetic osteolysis to allow the physician to recognise this condition and commence early treatment, thereby optimizing patient outcome. Methods: A thorough literature search was performed using available databases, including Pubmed, to cover important research published covering particle-associated PPO. Results: Although osteolysis causes bone resorption, clinical, animal, and in vitro studies of particle bioreactivity suggest that particle-associated PPO represents the culmination of several biological reactions of many cell types, rather than being caused solely by the osteoclasts. The biological activity is highly dependent on the characteristics and quantity of the wear particles. Conclusion: Despite advances in total hip arthroplasty (THA), particle-associated PPO and aseptic loosening continue to be major factors that affect prosthetic joint longevity. Biomarkers could be exploited as easy and objective diagnostic and prognostic targets that would enable testing for osteolysis after THA. Further research is needed to identify new biomarkers in PPO. A comprehensive understanding of the underlying biological mechanisms is crucial for developing new therapeutic interventions to reverse or suppress biological responses to wear particles.
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Affiliation(s)
- Erhan Sukur
- Sakarya Education and Research Hospital, 54100, Sakarya, Turkey
| | - Yunus Emre Akman
- Metin Sabancı Baltalimanı Bone Diseases Training and Research Hospital, 34470, Istanbul, Turkey
| | - Yusuf Ozturkmen
- Istanbul Education and Research Hospital, 34100, Istanbul, Turkey
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Brulefert K, Córdova LA, Brulin B, Faucon A, Hulin P, Nedellec S, Gouin F, Passuti N, Ishow E, Heymann D. Pro-osteoclastic in vitro effect of Polyethylene-like nanoparticles: Involvement in the pathogenesis of implant aseptic loosening. J Biomed Mater Res A 2016; 104:2649-57. [PMID: 27254768 DOI: 10.1002/jbm.a.35803] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 03/07/2016] [Accepted: 03/16/2016] [Indexed: 12/21/2022]
Abstract
Polyethylene micro-sized wear particles released from orthopedic implants promote inflammation and osteolysis; however, less is known about the bioactivity of polyethylene nanosized wear particles released from the last generation of polymer-bearing surfaces. We aim to assess the internalization of fluorescent polyethylene-like nanoparticles by both human macrophages and osteoclasts and also, to determine their effects in osteoclastogenesis in vitro. Human macrophages and osteoclasts were incubated with several ratios of fluorescent polyethylene-like nanoparticles between 1 and 72 h, and 4 h, 2, 4, 6, and 9 days, respectively. The internalization of nanoparticles was quantified by flow cytometry and followed by both confocal and video time-lapse microscopy. Osteoclast differentiation and activity was semiquantified by tartrate-resistant acid phosphatase (TRAP) staining, TRAP mRNA relative expression, and pit resorption assay, respectively. Macrophages, osteoclast precursors and mature osteoclasts internalized nanoparticles in a dose- and time-dependent manner and maintained their resorptive activity. In addition, nanoparticles significantly increased the osteoclastogenesis as shown by upregulation of the TRAP expressing cell number. We conclude that polyethylene-like nanosized wear particles promote osteoclast differentiation without alteration of bone resorptive activity of mature osteoclasts and they could be considered as important actors in periprosthetic osteolysis of the last new generation of polymer-bearing surfaces. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 104A: 2649-2657, 2016.
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Affiliation(s)
- Kevin Brulefert
- Laboratory of Pathophysiology of Bone Resorption and Therapy of Primary Bone Tumours, INSERM, UMR 957, Nantes, 44035, France.,University of Nantes, Nantes Atlantique Universities, Nantes, France.,Nantes University Hospital, Nantes, France
| | - Luis A Córdova
- Laboratory of Pathophysiology of Bone Resorption and Therapy of Primary Bone Tumours, INSERM, UMR 957, Nantes, 44035, France. .,University of Nantes, Nantes Atlantique Universities, Nantes, France. .,Department of Oral and Maxillofacial Surgery-Faculty of Dentistry, University of Chile-Conicyt, Santiago, Chile.
| | - Bénédicte Brulin
- Laboratory of Pathophysiology of Bone Resorption and Therapy of Primary Bone Tumours, INSERM, UMR 957, Nantes, 44035, France.,University of Nantes, Nantes Atlantique Universities, Nantes, France
| | - Adrien Faucon
- CEISAM-UMR CNRS 6230, University of Nantes, Nantes, France
| | - Philipe Hulin
- Nantes University Hospital, Nantes, France.,MicroPICell Platform, SFR Santé François Bonamy, INSERM, UMS 016-UMS CNRS 3556, Nantes, France
| | - Steven Nedellec
- Nantes University Hospital, Nantes, France.,MicroPICell Platform, SFR Santé François Bonamy, INSERM, UMS 016-UMS CNRS 3556, Nantes, France
| | - François Gouin
- Laboratory of Pathophysiology of Bone Resorption and Therapy of Primary Bone Tumours, INSERM, UMR 957, Nantes, 44035, France.,University of Nantes, Nantes Atlantique Universities, Nantes, France.,Nantes University Hospital, Nantes, France
| | - Norbert Passuti
- Laboratory of Pathophysiology of Bone Resorption and Therapy of Primary Bone Tumours, INSERM, UMR 957, Nantes, 44035, France.,University of Nantes, Nantes Atlantique Universities, Nantes, France.,Nantes University Hospital, Nantes, France
| | - Eléna Ishow
- CEISAM-UMR CNRS 6230, University of Nantes, Nantes, France
| | - Dominique Heymann
- Laboratory of Pathophysiology of Bone Resorption and Therapy of Primary Bone Tumours, INSERM, UMR 957, Nantes, 44035, France.,University of Nantes, Nantes Atlantique Universities, Nantes, France.,Nantes University Hospital, Nantes, France.,Department of Oncology and Metabolism, University of Sheffield, The Medical School, Sheffield, England, United Kingdom
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Hanna SA, Somerville L, McCalden RW, Naudie DD, MacDonald SJ. Highly cross-linked polyethylene decreases the rate of revision of total hip arthroplasty compared with conventional polyethylene at 13 years' follow-up. Bone Joint J 2016; 98-B:28-32. [PMID: 26733512 DOI: 10.1302/0301-620x.98b1.36527] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
AIMS The purpose of this study was to compare the long-term results of primary total hip arthroplasty (THA) in young patients using either a conventional (CPE) or a highly cross-linked (HXLPE) polyethylene liner in terms of functional outcome, incidence of osteolysis, radiological wear and rate of revision. METHODS We included all patients between the ages of 45 and 65 years who, between January 2000 and December 2001, had undergone a primary THA for osteoarthritis at our hospital using a CPE or HXLPE acetabular liner and a 28 mm cobalt-chrome femoral head. From a total of 160 patients, 158 (177 hips) were available for review (CPE 89; XLPE 88). The mean age, body mass index (BMI) and follow-up in each group were: CPE: 56.8 years (46 to 65); 30.7 kg/m(2) (19 to 58); 13.2 years (2.1 to 14.7) and HXLPE: 55.6 years (45 to 65); BMI: 30 kg/m(2) (18 to 51); 13.1 years (5.7 to 14.4). RESULTS The mean Harris hip score (HHS) at final follow-up was 89.3 for the CPE group and 90.9 for the HXLPE group (p = 0.078). Osteolysis was present around 15 acetabular (17%) and 16 femoral (18%) components in the CPE hips compared with none (0%) in the HXLPE hips. The mean radiological linear wear of the CPE liners was 0.11 mm/year compared with 0.035 mm/year for the HXLPE liners (p = 0.006). The cumulative implant survival, with revision for polyethylene wear as the endpoint, was 86% (95% confidence interval 78 to 94) in the CPE group and 100% in the HXLPE group at 13 years (numbers at risk at 13 years - CPE: 65, XLPE: 61). DISCUSSION This study shows that HXLPE liners are associated with significantly less osteolysis and a lower rate of revision THA than CPE liners at long-term follow-up. TAKE HOME MESSAGE The findings of this study highlight the clinical benefits of using HXLPE liners in THA and support the routine use of the material in order to improve implant longevity and to decrease the number of patients needing revision for aseptic osteolysis.
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Affiliation(s)
- S A Hanna
- University of Western Ontario, London, Ontario, N6G 2V4, Canada
| | - L Somerville
- University of Western Ontario, London, Ontario, N6G 2V4, Canada
| | - R W McCalden
- University of Western Ontario, London, Ontario, N6G 2V4, Canada
| | - D D Naudie
- University of Western Ontario, London, Ontario, N6G 2V4, Canada
| | - S J MacDonald
- University of Western Ontario, London, Ontario, N6G 2V4, Canada
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40
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Chikaura H, Nakashima Y, Fujiwara Y, Komohara Y, Takeya M, Nakanishi Y. Effect of particle size on biological response by human monocyte-derived macrophages. Biosurface and Biotribology 2016; 2:18-25. [DOI: 10.1016/j.bsbt.2016.02.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Krenn V, Hopf F, Thomas P, Thomsen M, Usbeck S, Boettner F, Müller S, Saberi D, Hügle T, Huber M, Scheuber L, Hopf J, Kretzer J. Supramakropartikuläres Polyethylen bei Entzündungen periprothetischer Membranen: Charakterisierung und Nomenklaturvorschlag. Orthopäde 2016; 45:256-65. [DOI: 10.1007/s00132-015-3194-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Stambough JB, Pashos G, Bohnenkamp FC, Maloney WJ, Martell JM, Clohisy JC. Long-Term Results of Total Hip Arthroplasty with 28-Millimeter Cobalt-Chromium Femoral Heads on Highly Cross-Linked Polyethylene in Patients 50 Years and Less. J Arthroplasty 2016; 31:162-7. [PMID: 26260785 DOI: 10.1016/j.arth.2015.07.025] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 07/07/2015] [Accepted: 07/13/2015] [Indexed: 02/01/2023] Open
Abstract
Highly cross-linked polyethylene (HXLPE) is the most commonly used bearing surface in total hip arthroplasty (THA) because of its superior wear properties, but long-term results in young patients are limited. We report on the clinical outcome, radiographic wear patterns and survivorship of 72 patients ≤50 years old who had a 28-millimeter cobalt-chromium femoral head on HXLPE acetabular liner. Mean and median true linear wear rates at average ten-year follow-up were 0.0104 and 0.01 mm per year ± 0.07 mm. Mean and median two-dimensional volumetric wear rates were 12.79 mm(3) and 5.834 mm(3) per year ± 26.1mm(3) as determined by Martell analysis. As a result of the minimal wear profile, there was no evidence of radiographic osteolysis and no wear-related revisions.
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Li P, Hashimoto Y, Honda Y, Arima Y, Matsumoto N. The Effect of Interferon-γ and Zoledronate Treatment on Alpha-Tricalcium Phosphate/Collagen Sponge-Mediated Bone-Tissue Engineering. Int J Mol Sci 2015; 16:25678-90. [PMID: 26516841 DOI: 10.3390/ijms161025678] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 10/15/2015] [Accepted: 10/15/2015] [Indexed: 11/23/2022] Open
Abstract
Inflammatory responses are frequently associated with the expression of inflammatory cytokines and severe osteoclastogenesis, which significantly affect the efficacy of biomaterials. Recent findings have suggested that interferon (IFN)-γ and zoledronate (Zol) are effective inhibitors of osteoclastogenesis. However, little is known regarding the utility of IFN-γ and Zol in bone tissue engineering. In this study, we generated rat models by generating critically sized defects in calvarias implanted with an alpha-tricalcium phosphate/collagen sponge (α-TCP/CS). At four weeks post-implantation, the rats were divided into IFN-γ, Zol, and control (no treatment) groups. Compared with the control group, the IFN-γ and Zol groups showed remarkable attenuation of severe osteoclastogenesis, leading to a significant enhancement in bone mass. Histomorphometric data and mRNA expression patterns in IFN-γ and Zol-injected rats reflected high bone-turnover with increased bone formation, a reduction in osteoclast numbers, and tumor necrosis factor-α expression. Our results demonstrated that the administration of IFN-γ and Zol enhanced bone regeneration of α-TCP/CS implants by enhancing bone formation, while hampering excess bone resorption.
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Ong SM, Biswas SK, Wong SC. MicroRNA-mediated immune modulation as a therapeutic strategy in host-implant integration. Adv Drug Deliv Rev 2015; 88:92-107. [PMID: 26024977 DOI: 10.1016/j.addr.2015.05.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 05/05/2015] [Accepted: 05/21/2015] [Indexed: 12/29/2022]
Abstract
The concept of implanting an artificial device into the human body was once the preserve of science fiction, yet this approach is now often used to replace lost or damaged biological structures in human patients. However, assimilation of medical devices into host tissues is a complex process, and successful implant integration into patients is far from certain. The body's immediate response to a foreign object is immune-mediated reaction, hence there has been extensive research into biomaterials that can reduce or even ablate anti-implant immune responses. There have also been attempts to embed or coat anti-inflammatory drugs and pro-regulatory molecules onto medical devices with the aim of preventing implant rejection by the host. In this review, we summarize the key immune mediators of medical implant reaction, and we evaluate the potential of microRNAs to regulate these processes to promote wound healing, and prolong host-implant integration.
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Affiliation(s)
- Siew-Min Ong
- Singapore Immunology Network (SIgN), Agency for Science, Technology and Research (A*STAR), 8A Biomedical Grove, Immunos Building, Level 4, Biopolis, Singapore 138648, Singapore
| | - Subhra K Biswas
- Singapore Immunology Network (SIgN), Agency for Science, Technology and Research (A*STAR), 8A Biomedical Grove, Immunos Building, Level 4, Biopolis, Singapore 138648, Singapore
| | - Siew-Cheng Wong
- Singapore Immunology Network (SIgN), Agency for Science, Technology and Research (A*STAR), 8A Biomedical Grove, Immunos Building, Level 4, Biopolis, Singapore 138648, Singapore.
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Cang D, Guo K, Zhao F. Dendritic cells enhance UHMWPE wear particle-induced osteoclast differentiation of macrophages. J Biomed Mater Res A 2015; 103:3349-54. [PMID: 25808788 DOI: 10.1002/jbm.a.35459] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 03/03/2015] [Accepted: 03/13/2015] [Indexed: 12/22/2022]
Affiliation(s)
- Dingwei Cang
- Xuzhou Medical College; Xuzhou Jiangsu 221004 People's Republic of China
| | - Kaijin Guo
- The Affiliate Hospital of Xuzhou Medical College; Xuzhou Jiangsu 221004 China
| | - Fengchao Zhao
- The Affiliate Hospital of Xuzhou Medical College; Xuzhou Jiangsu 221004 China
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Ayers DC, Greene M, Snyder B, Aubin M, Drew J, Bragdon C. Radiostereometric analysis study of tantalum compared with titanium acetabular cups and highly cross-linked compared with conventional liners in young patients undergoing total hip replacement. J Bone Joint Surg Am 2015; 97:627-34. [PMID: 25878306 PMCID: PMC4391964 DOI: 10.2106/jbjs.n.00605] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Radiostereometric analysis provides highly precise measurements of component micromotion relative to the bone that is otherwise undetectable by routine radiographs. This study compared, at a minimum of five years following surgery, the micromotion of tantalum and titanium acetabular cups and femoral head penetration in highly cross-linked polyethylene liners and conventional (ultra-high molecular weight polyethylene) liners in active patients who had undergone total hip replacement. METHODS This institutional review board-approved prospective, randomized, blinded study involved forty-six patients. Patients were randomized into one of four cohorts according to both acetabular cup and polyethylene liner. Patients received either a cementless cup with a titanium mesh surface or a tantalum trabecular surface and either a highly cross-linked polyethylene liner or an ultra-high molecular weight polyethylene liner. Radiostereometric analysis examinations and Short Form-36 Physical Component Summary, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), University of California Los Angeles (UCLA) activity, and Harris hip scores were obtained preoperatively, postoperatively, at six months, and annually thereafter. RESULTS All patients had significant improvement (p < 0.05) in Short Form-36 Physical Component Summary, WOMAC, UCLA activity, and Harris hip scores postoperatively. On radiostereometric analysis examination, highly cross-linked polyethylene liners showed significantly less median femoral head penetration at five years (p < 0.05). Steady-state wear rates from one year to five years were 0.04 mm per year for ultra-high molecular weight polyethylene liners and 0.004 mm per year for highly cross-linked polyethylene liners. At the five-year follow-up, the median migration (and standard error) was 0.05 ± 0.20 mm proximally for titanium cups and 0.21 ± 0.05 mm for tantalum cups. CONCLUSIONS In this young population who had undergone total hip replacement, radiostereometric analysis showed significantly less femoral head penetration in the highly cross-linked polyethylene liners compared with that in the conventional ultra-high molecular weight polyethylene liners. Penetration rates were one order of magnitude less in highly cross-linked polyethylene liners compared with ultra-high molecular weight polyethylene liners. There was no significant difference in proximal migration between the tantalum and titanium acetabular cups through the five-year follow-up (p > 0.19).
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Affiliation(s)
- David C. Ayers
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medical School, UMass Memorial Health Care, 55 Lake Avenue North, Worcester, MA 01655. E-mail address for D. Ayers:
| | - Meridith Greene
- The Harris Orthopaedic Laboratory, Massachusetts General Hospital, 55 Fruit Street, GRJ 1126, Boston, MA 02114
| | - Benjamin Snyder
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medical School, UMass Memorial Health Care, 55 Lake Avenue North, Worcester, MA 01655. E-mail address for D. Ayers:
| | - Michelle Aubin
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medical School, UMass Memorial Health Care, 55 Lake Avenue North, Worcester, MA 01655. E-mail address for D. Ayers:
| | - Jacob Drew
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medical School, UMass Memorial Health Care, 55 Lake Avenue North, Worcester, MA 01655. E-mail address for D. Ayers:
| | - Charles Bragdon
- The Harris Orthopaedic Laboratory, Massachusetts General Hospital, 55 Fruit Street, GRJ 1126, Boston, MA 02114
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Abstract
BACKGROUND Biological responses to wear debris were largely elucidated in studies focused on conventional ultrahigh-molecular-weight polyethylene (UHMWPE) and some investigations of polymethymethacrylate cement and orthopaedic metals. However, newer bearing couples, in particular metal-on-metal but also ceramic-on-ceramic bearings, may induce different biological reactions. QUESTIONS/PURPOSES Does wear debris from the newer bearing surfaces result in different biological responses compared with the known responses observed with conventional metal-on-UHMWPE bearings? METHODS A Medline search of articles published after 1996 supplemented by a hand search of reference lists of included studies and relevant conference proceedings was conducted to identify the biological responses to orthopaedic wear debris with a focus on biological responses to wear generated from metal-on-highly crosslinked polyethylene, metal-on-metal, ceramic-on-ceramic, and ceramic-on-polyethylene bearings. Articles were selected using criteria designed to identify reports of wear debris particles and biological responses contributing to prosthesis failure. Case reports and articles focused on either clinical outcomes or tribology were excluded. A total of 83 papers met the criteria and were reviewed in detail. RESULTS Biological response to conventional UHMWPE is regulated by the innate immune response. It is clear that the physical properties of debris (size, shape, surface topography) influence biological responses in addition to the chemical composition of the biomaterials. Highly crosslinked UHMWPE particles have the potential to alter, rather than eliminate, the biological response to conventional UHMWPE. Metal wear debris can generate elevated plasma levels of cobalt and chromium ions. These entities can provoke responses that extend to the elicitation of an acquired immune response. Wear generated from ceramic devices is significantly reduced in volume and may provide the impression of an "inert" response, but clinically relevant biological reactions do occur, including granulomatous responses in periprosthetic tissues. CONCLUSIONS The material composition of the device, the physical form of the debris, and disease pathophysiology contribute to complex interactions that determine the outcome to all wear debris. Metal debris does appear to increase the complexity of the biological response with the addition of immunological responses (and possibly direct cellular cytotoxicity) to the inflammatory reaction provoked by wear debris in some patients. However, the introduction of highly crosslinked polyethylene and ceramic bearing surfaces shows promising signs of reducing key biological mechanisms in osteolysis.
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Shen C, Tang ZH, Hu JZ, Zou GY, Xiao RC, Yan DX. Does cross-linked polyethylene decrease the revision rate of total hip arthroplasty compared with conventional polyethylene? A meta-analysis. Orthop Traumatol Surg Res 2014; 100:745-50. [PMID: 25281549 DOI: 10.1016/j.otsr.2014.07.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 05/30/2014] [Accepted: 07/10/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Although cross-linked polyethylene is resistant to wear in comparison to conventional polyethylene, it remains unknown whether it can decrease the wear-related revision rate of total hip arthroplasty. OBJECTIVES To determine whether cross-linked polyethylene decreases the wear-related revision rate of total hip arthroplasty compared with conventional polyethylene. DATA SOURCES Electronic databases, including PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials, were queried from inception to July 6, 2013. STUDY SELECTION Randomized controlled trials (RCTs) comparing cross-linked polyethylene with conventional polyethylene were included. In addition, the standard 28-mm femoral head was used, and follow-up was performed for a minimum of 5 years. The primary outcome assessed was wear-related revision. The secondary outcome measures evaluated were the incidence of osteolysis, the linear wear rate, and the linear head penetration. DATA SYNTHESIS The Cochrane Collaboration's tool for assessing the risk of bias was used for quality assessment. Data from eligible studies were pooled using a random effects model. RESULTS Eight studies involving 735 patients were included in this study. Meta-analysis showed there was no significant difference between cross-linked and conventional polyethylene group in terms of osteolysis or wear-related revision. The pooled mean differences were significantly less for the linear wear rate and linear head penetration for cross-linked polyethylene than for conventional polyethylene. LIMITATIONS The studies differed with respect to the cross-linked liner brands, manufacturing processes, and radiological evaluation methods. Moreover, the follow-up periods of the RCTs were not long enough. CONCLUSIONS The current limited evidence suggests that cross-linked polyethylene significantly reduced the radiological wear compared with conventional polyethylene at midterm follow-up periods. However, there is no evidence that cross-linked polyethylene had an advantage over conventional polyethylene in terms of reducing osteolysis or wear-related revision. Nevertheless, future long-term RCTs on this topic are needed. KEY FINDINGS Cross-linked polyethylene significantly reduced radiological wear but not osteolysis or wear-related revision in comparison to conventional polyethylene at midterm follow-up periods. LEVEL OF EVIDENCE Level I, systematic review of level I studies.
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Affiliation(s)
- C Shen
- Department of Orthopedics, Affiliated Hospital of Guilin Medical College, 541001 Guilin, Guangxi, China.
| | - Z-H Tang
- Department of Orthopedics, Affiliated Hospital of Guilin Medical College, 541001 Guilin, Guangxi, China
| | - J-Z Hu
- Department of Orthopedics, Affiliated Hospital of Guilin Medical College, 541001 Guilin, Guangxi, China
| | - G-Y Zou
- Department of Orthopedics, Affiliated Hospital of Guilin Medical College, 541001 Guilin, Guangxi, China
| | - R-C Xiao
- Department of Orthopedics, Affiliated Hospital of Guilin Medical College, 541001 Guilin, Guangxi, China
| | - D-X Yan
- Department of Orthopedics, Affiliated Hospital of Guilin Medical College, 541001 Guilin, Guangxi, China
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Cordova L, Stresing V, Gobin B, Rosset P, Passuti N, Gouin F, Trichet V, Layrolle P, Heymann D. Orthopaedic implant failure: aseptic implant loosening–the contribution and future challenges of mouse models in translational research. Clin Sci (Lond) 2014; 127:277-93. [DOI: 10.1042/cs20130338] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Aseptic loosening as a result of wear debris is considered to be the main cause of long-term implant failure in orthopaedic surgery and improved biomaterials for bearing surfaces decreases significantly the release of micrometric wear particles. Increasingly, in-depth knowledge of osteoimmunology highlights the role of nanoparticles and ions released from some of these new bearing couples, opening up a new era in the comprehension of aseptic loosening. Mouse models have been essential in the progress made in the early comprehension of pathophysiology and in testing new therapeutic agents for particle-induced osteolysis. However, despite this encouraging progress, there is still no valid clinical alternative to revision surgery. The present review provides an update of the most commonly used bearing couples, the current concepts regarding particle–cell interactions and the approaches used to study the biology of periprosthetic osteolysis. It also discusses the contribution and future challenges of mouse models for successful translation of the preclinical progress into clinical applications.
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50
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Zaveri TD, Lewis JS, Dolgova NV, Clare-Salzler MJ, Keselowsky BG. Integrin-directed modulation of macrophage responses to biomaterials. Biomaterials 2014; 35:3504-15. [PMID: 24462356 PMCID: PMC3970928 DOI: 10.1016/j.biomaterials.2014.01.007] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 01/07/2014] [Indexed: 01/08/2023]
Abstract
Macrophages are the primary mediator of chronic inflammatory responses to implanted biomaterials, in cases when the material is either in particulate or bulk form. Chronic inflammation limits the performance and functional life of numerous implanted medical devices, and modulating macrophage interactions with biomaterials to mitigate this response would be beneficial. The integrin family of cell surface receptors mediates cell adhesion through binding to adhesive proteins nonspecifically adsorbed onto biomaterial surfaces. In this work, the roles of integrin Mac-1 (αMβ2) and RGD-binding integrins were investigated using model systems for both particulate and bulk biomaterials. Specifically, the macrophage functions of phagocytosis and inflammatory cytokine secretion in response to a model particulate material, polystyrene microparticles were investigated. Opsonizing proteins modulated microparticle uptake, and integrin Mac-1 and RGD-binding integrins were found to control microparticle uptake in an opsonin-dependent manner. The presence of adsorbed endotoxin did not affect microparticle uptake levels, but was required for the production of inflammatory cytokines in response to microparticles. Furthermore, it was demonstrated that integrin Mac-1 and RGD-binding integrins influence the in vivo foreign body response to a bulk biomaterial, subcutaneously implanted polyethylene terephthalate. A thinner foreign body capsule was formed when integrin Mac-1 was absent (~30% thinner) or when RGD-binding integrins were blocked by controlled release of a blocking peptide (~45% thinner). These findings indicate integrin Mac-1 and RGD-binding integrins are involved and may serve as therapeutic targets to mitigate macrophage inflammatory responses to both particulate and bulk biomaterials.
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Affiliation(s)
- Toral D Zaveri
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL 32611, USA
| | - Jamal S Lewis
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL 32611, USA
| | - Natalia V Dolgova
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL 32611, USA
| | - Michael J Clare-Salzler
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL 32611, USA
| | - Benjamin G Keselowsky
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL 32611, USA.
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