1
|
Richard OK, Liens A, Muirhead D, Weber K. Tissue response following implantation with the posterior dynamic distraction device (PDDD) in adolescent idiopathic scoliosis (AIS). Eur Spine J 2024:10.1007/s00586-024-08200-1. [PMID: 38584244 DOI: 10.1007/s00586-024-08200-1] [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] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 02/13/2024] [Accepted: 02/20/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE The PDDD is a ratchet-based, unidirectional expandable rod to treat adolescent idiopathic scoliosis (AIS), primarily by correcting scoliotic deformity without full spinal fusion. We hypothesized that the device will be fully tolerated by the host and, if aseptic screw loosening occurs, it will be unrelated to wear particle formation. METHODS This study comprised tissue samples from seven patients from a prospective study (NCT04296903) to assess the PDDD's safety and benefits, reoperated due to complications. Host response was assessed from histological slides (four levels/implant) in accordance with GLP and ISO10993-6:2016. The elementary chemical composition of wear particles present in tissue sections was quantified by energy dispersive X-ray spectroscopy (EDX). RESULTS Host reaction was minor, characterized by low levels of diverse inflammatory cells, mild fibrosis, occasional small necrotic foci, neovascularization, hemorrhage, and, rarely, small bone fragments. Twenty-four of 28 tissue sections displayed varying degrees of wear particles (black discoloration), and most sections (17) were scored as 1 (< 25% of the sample). The discoloration observed corresponded to black-appearing, fine granular pigment. EDX analysis confirmed particles were composed of titanium, aluminum, and vanadium. Twenty-six of 28 samples were scored zero for necrosis and 2/28 were scored 1. Eleven samples were scored zero for fibrosis, 12 as 1, and five as 2. No aseptic screw loosening occurred. CONCLUSION The PDDD induced minimal host reaction with little or no degeneration, inflammation or fibrosis. No changes present could be expected to promote device failure. The PDDD implant for treating AIS is well-tolerated and locally safe.
Collapse
Affiliation(s)
| | | | | | - Klaus Weber
- AnaPath Services GmbH, Liestal, Switzerland.
| |
Collapse
|
2
|
Hallab NJ, Hallab SR, Alexander A, Pourzal R. Characterization of residual debris on packaged hip arthroplasty stems demonstrates the dominance of less than 10 μm sized particulate: Updated USP788 guidelines for orthopedic implants. J Biomed Mater Res B Appl Biomater 2024; 112:e35387. [PMID: 38340016 DOI: 10.1002/jbm.b.35387] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 10/19/2023] [Accepted: 01/27/2024] [Indexed: 02/12/2024]
Abstract
Past evaluation of particle contamination on packaged implants has typically been conducted using US Pharmacopeia (USP) 788, a 1970s pharmaceutical guideline created to evaluate contaminant particles in injectable fluids and syringes. Our objective was to reestablish relevant acceptance criteria for residual orthopedic and other implant debris, including smaller particles (i.e., <10 μm in diameter). Packaged total hip arthroplasty (THA) titanium (Ti6Al4V)-alloy femoral stems were used (hydroxyapatite [HA]-coated and non-coated stems). Short-term ultrasonication and longer-term 24-hour soak/agitation methods were used to elute surface-bound contaminant particles, and released particles were analyzed via scanning electron microscopy, energy-dispersive x-ray analysis, image analysis, and particle characterization. For HA-coated THA-stems, >99% of eluted particles were calcium phosphate. For plain non-coated THA-stems, >99% of eluted particles were titanium-alloy-based. The number-based median size of particles in both groups was approximately 1.5 μm in diameter despite being composed of different materials. The total volume of particulate removed from HA-coated stems was 0.037 mm3 (671 × 103 particles total), which was approximately >50-fold more volume than that on plain non-coated stems at 0.0006 mm3 (89 × 103 particles total). Only non-coated THA stems passed reestablished USP788 acceptance criteria, compared by using equivalent total volumes of contaminant particulate within new and legacy guideline ranges of >10 and >25 μm ECD, that is, <1.0 × 107 particles for <1 μm diameter in size, <600,000 for <1-10 μm, <6000 for 10-25 μm and <600 for >25 μm. These results fill a knowledge gap on how much residual debris can be expected to exist on packaged implants and can be used as a basis for updating acceptance criteria (i.e., termed USP788-Implant [USP788-I]). Residual implant particulate assessment is critical given the increasing implant complexity and new manufacturing techniques (e.g., additive manufacturing).
Collapse
Affiliation(s)
- Nadim J Hallab
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
- Department of Biomedical Engineering, Bioengineering Solutions Inc, Chicago, Illinois, USA
| | - Salem R Hallab
- Department of Biomedical Engineering, Bioengineering Solutions Inc, Chicago, Illinois, USA
| | - Anastasia Alexander
- Department of Biomedical Engineering, Bioengineering Solutions Inc, Chicago, Illinois, USA
| | - Robin Pourzal
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| |
Collapse
|
3
|
Dong L, Shen Z, Zhang H, Zhang B, Zhou Y, Lv X, Hong X, Liu J, Yang W. Effect of unsoluble corrosion products of WE43 alloys in vitro on macrophages. J Biomed Mater Res A 2024; 112:6-19. [PMID: 37681297 DOI: 10.1002/jbm.a.37601] [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] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 08/06/2023] [Accepted: 08/16/2023] [Indexed: 09/09/2023]
Abstract
Magnesium alloys have been used to manufacture biodegradable implants, bone graft substitutes, and cardiovascular stents. WE43 was the most widely used magnesium alloy. The degradation process begins when the magnesium alloy stent is implanted in the body and comes into contact with body fluid. The degradation products include hydrogen, Mg2+ , local alkaline environment, and unsoluble products. A large number of studies focused on Mg2+ and pH in vitro, and in vivo of magnesium alloys, but few studies on unsoluble corrosion products (UCPs). In this study, UCPs of WE43 alloy were prepared by immersion in vitro, and their effects on macrophages were investigated. The results showed that the unsoluble corrosion products were Mg24Y5, Mg12YNd, and MgCO3 ·3H2 O, which were dose-dependent on the apoptosis and necrosis of macrophages. After phagocytosis of UCPs, macrophages mainly metabolize in lysosome, and autophagy also participates in the metabolism of UCPs. It also decreases mitochondrial membrane potential and increases lysosomes, endoplasmic reticulum stress, and P2X7 receptor activation. These will increase reactive oxygen species (ROS) in cells, activating NLRP3 inflammatory corpuscles, activating the downstream pro-IL18 and pro-IL1β, and converting it to IL-18, and IL-1β. However, its pro-inflammatory effect is far lower than that of the classical Lipopolysaccharide (LPS) pro-inflammatory pathway. This work has increased our understanding of magnesium alloy metabolism and provides new ideas for the clinical application of magnesium alloys.
Collapse
Affiliation(s)
- Li Dong
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhiyuan Shen
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Huidi Zhang
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Binmei Zhang
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yinze Zhou
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xin Lv
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xiaojian Hong
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jiaren Liu
- Department of Clinical Lab, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Wei Yang
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| |
Collapse
|
4
|
Hijazi KM, Dixon SJ, Armstrong JE, Rizkalla AS. Titanium Alloy Implants with Lattice Structures for Mandibular Reconstruction. Materials (Basel) 2023; 17:140. [PMID: 38203994 PMCID: PMC10779528 DOI: 10.3390/ma17010140] [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] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 11/30/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024]
Abstract
In recent years, the field of mandibular reconstruction has made great strides in terms of hardware innovations and their clinical applications. There has been considerable interest in using computer-aided design, finite element modelling, and additive manufacturing techniques to build patient-specific surgical implants. Moreover, lattice implants can mimic mandibular bone's mechanical and structural properties. This article reviews current approaches for mandibular reconstruction, their applications, and their drawbacks. Then, we discuss the potential of mandibular devices with lattice structures, their development and applications, and the challenges for their use in clinical settings.
Collapse
Affiliation(s)
- Khaled M. Hijazi
- School of Biomedical Engineering, Faculty of Engineering, The University of Western Ontario, London, ON N6A 3K7, Canada
- Bone and Joint Institute, The University of Western Ontario, London, ON N6G 2V4, Canada
| | - S. Jeffrey Dixon
- Bone and Joint Institute, The University of Western Ontario, London, ON N6G 2V4, Canada
- Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON N6A 5C1, Canada
| | - Jerrold E. Armstrong
- Division of Oral and Maxillofacial Surgery, Department of Otolaryngology Head and Neck Surgery, Henry Ford Hospital, Detroit, MI 48202, USA
| | - Amin S. Rizkalla
- School of Biomedical Engineering, Faculty of Engineering, The University of Western Ontario, London, ON N6A 3K7, Canada
- Bone and Joint Institute, The University of Western Ontario, London, ON N6G 2V4, Canada
- Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON N6A 5C1, Canada
- Chemical and Biochemical Engineering, Faculty of Engineering, The University of Western Ontario, London, ON N6A 5B9, Canada
| |
Collapse
|
5
|
Ansaripour H, Haeussler KL, Ferguson SJ, Flohr M. Prioritizing biomaterials for spinal disc implants by a fuzzy AHP and TOPSIS decision making method. Sci Rep 2023; 13:21531. [PMID: 38057609 PMCID: PMC10700574 DOI: 10.1038/s41598-023-48735-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 11/29/2023] [Indexed: 12/08/2023] Open
Abstract
Considerable research has been focused on identifying the optimum biomaterial for spine implants. New technologies and materials have allowed surgeons to better grasp the biomechanical principles underpinning implant stability and function. An optimal biomaterial for total disc replacement (TDR) should include essential characteristics such as biocompatibility, long-term durability, the capacity to withstand mechanical stresses, and economic viability. Our research has focused on six biomaterials for TDR, including Ti-6Al-4V, CoCr alloy, stainless steel 316L, zirconia toughened alumina (ZTA), polyether ether ketone (PEEK) and ultra-high-molecular weight polyethylene (UHMWPE). Ten common properties, i.e., the Young's modulus, density, tensile strength, the expense of the manufacturing process, the cost of raw material, wear rate, corrosion resistance, thermal conductivity, fracture toughness and compressive strength were utilized to assess these six different materials. The purpose of this study was to evaluate and rank the six alternative biomaterials proposed for use in the endplates and articulating surface of a spinal TDR. To accomplish this, a multi-criteria decision-making approach, namely the fuzzy analytic hierarchy process (fuzzy AHP) and the Technique of Order Preference by Similarity to Ideal Solution (TOPSIS) was adopted to solve the model. For validation and robustness of the proposed method, sensitivity analysis was performed, and comparison was performed with fuzzy-VIKOR and fuzzy-MOORA methods. In light of the study's results, ZTA and Ti-6Al-4V were identified as the best suited materials for the articulating surface and endplates, respectively, in a spinal disc implant.
Collapse
Affiliation(s)
- Hossein Ansaripour
- CeramTec GmbH, CeramTec-Platz 1-9, 73207, Plochingen, Germany.
- Institute for Biomechanics, D-HEST, ETH Zurich, Gloriastrasse 37 / 39, 8092, Zurich, Switzerland.
| | | | - Stephen J Ferguson
- Institute for Biomechanics, D-HEST, ETH Zurich, Gloriastrasse 37 / 39, 8092, Zurich, Switzerland
| | - Markus Flohr
- CeramTec GmbH, CeramTec-Platz 1-9, 73207, Plochingen, Germany
| |
Collapse
|
6
|
Chamani S, Mobasheri L, Rostami Z, Zare I, Naghizadeh A, Mostafavi E. Heavy metals in contact dermatitis: A review. J Trace Elem Med Biol 2023; 79:127240. [PMID: 37331278 DOI: 10.1016/j.jtemb.2023.127240] [Citation(s) in RCA: 2] [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: 01/28/2023] [Revised: 06/01/2023] [Accepted: 06/06/2023] [Indexed: 06/20/2023]
Abstract
Contact dermatitis is an inflammatory skin reaction caused by direct contact with chemical substances in the environment and can either be irritant or allergic in nature. The clinical symptoms of contact dermatitis, include local skin rash, itching, redness, swelling, and lesions. Nowadays, 15-20% of people have some degree of contact dermatitis, which can be more or less severe. Immune responses in allergic contact dermatitis (ACD) are due to the effects of cytokines and allergen-specific CD4+ and CD8+ T cells on the skin. Acids and alkalis such as drain cleaners, plants such as poinsettias, hair colors, and nail polish remover, are all prominent causes of irritant contact dermatitis (ICDs). Heavy metals are metallic elements with a high atomic weight that are hazardous in low quantities and are known to cause dermatitis after systemic or local exposure. Nickel (Ni), chromium (Cr), lead (Pb), and copper (Cu) are among the most common heavy metals used in various industries. Metal allergies may cause ACD and also systemic contact dermatitis (SCD). Contact dermatitis is detected by laboratory tests such as patch testing, lymphocyte stimulation test (LST), and evaluation of cytokine production by primary cultures of peripheral blood mononuclear cells. This article presents an update on the epidemiological and clinical characteristics of ACD and SCD caused by three heavy metals (Cr, Cu, and Pb). Ni is not discussed due to recent coverage. Furthermore, the effects of contact sensitivity to some other heavy metals, such as gold (Au), cobalt (Co), palladium (Pd), and mercury (Hg) are discussed.
Collapse
Affiliation(s)
- Sajad Chamani
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran
| | - Leila Mobasheri
- Department of Pharmacology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zeinab Rostami
- Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
| | - Iman Zare
- Research and Development Department, Sina Medical Biochemistry Technologies Co. Ltd., Shiraz 7178795844, Iran
| | - Ali Naghizadeh
- Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran.
| | - Ebrahim Mostafavi
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA; Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA.
| |
Collapse
|
7
|
Echeverri E, Skjöldebrand C, O'Callaghan P, Palmquist A, Kreuger J, Hulsart-Billström G, Persson C. Fe and C additions decrease the dissolution rate of silicon nitride coatings and are compatible with microglial viability in 3D collagen hydrogels. Biomater Sci 2023; 11:3144-3158. [PMID: 36919682 DOI: 10.1039/d2bm02074b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
Silicon nitride (SiN) coatings may reduce unwanted release of metal ions from metallic implants. However, as SiN slowly dissolves in aqueous solutions, additives that reduce this dissolution rate would likely increase the lifetime and functionality of implants. Adding iron (Fe) and carbon (C) permits tuning of the SiN coatings' mechanical properties, but their effect on SiN dissolution rates, and their capacity to reduce metal ion release from metallic implant substrates, have yet to be investigated. Such coatings have recently been proposed for use in spinal implants; therefore, it is relevant to assess their impact on the viability of cells expected at the implant site, such as microglia, the resident macrophages of the central nervous system (CNS). To study the effects of Fe and C on the dissolution rate of SiN coatings, compositional gradients of Si, Fe and C in combination with N were generated by physical vapor deposition onto CoCrMo discs. Differences in composition did not affect the surface roughness or the release of Si, Fe or Co ions (the latter from the CoCrMo substrate). Adding Fe and C reduced ion release compared to a SiN reference coating, which was attributed to altered reactivity due to an increase in the fraction of stabilizing Si-C or Fe-C bonds. Extracts from the SiN coatings containing Fe and C were compatible with microglial viability in 2D cultures and 3D collagen hydrogels, to a similar degree as CoCrMo and SiN coated CoCrMo reference extracts. As Fe and C reduced the dissolution rate of SiN-coatings and did not compromise microglial viability, the capacity of these additives to extend the lifetime and functionality of SiN-coated metallic implants warrants further investigation.
Collapse
Affiliation(s)
- Estefanía Echeverri
- Division of Biomedical Engineering, Department of Materials Science and Engineering, Uppsala University, Sweden.
| | - Charlotte Skjöldebrand
- Division of Biomedical Engineering, Department of Materials Science and Engineering, Uppsala University, Sweden.
| | - Paul O'Callaghan
- Department of Medical Cell Biology, Science for Life Laboratory, Uppsala University, Sweden
| | | | - Johan Kreuger
- Department of Medical Cell Biology, Science for Life Laboratory, Uppsala University, Sweden
| | - Gry Hulsart-Billström
- Translational PET Imaging, Department of Medicinal Chemistry, Uppsala University, Sweden
| | - Cecilia Persson
- Division of Biomedical Engineering, Department of Materials Science and Engineering, Uppsala University, Sweden.
| |
Collapse
|
8
|
Pagar RR, Musale SR, Pawar G, Kulkarni D, Giram PS. Comprehensive Review on the Degradation Chemistry and Toxicity Studies of Functional Materials. ACS Biomater Sci Eng 2022; 8:2161-2195. [PMID: 35522605 DOI: 10.1021/acsbiomaterials.1c01304] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In recent decades there has been growing interest of material chemists in the successful development of functional materials for drug delivery, tissue engineering, imaging, diagnosis, theranostic, and other biomedical applications with advanced nanotechnology tools. The efficacy and safety of functional materials are determined by their pharmacological, toxicological, and immunogenic effects. It is essential to consider all degradation pathways of functional materials and to assess plausible intermediates and final products for quality control. This review provides a brief insight into chemical degradation mechanisms of functional materials like oxidation, photodegradation, and physical and enzymatic degradation. The intermediates and products of degradation were confirmed with analytical methods such as proton nuclear magnetic resonance (1H NMR), gel permeation chromatography (GPC), UV-vis spectroscopy (UV-vis), infrared spectroscopy (IR), differential scanning calorimetry (DSC), mass spectroscopy, and other sophisticated analytical methods. These analytical methods are also used for regulatory, quality control, and stability purposes in industry. The assessment of degradation is important to predetermine the behavior of functional materials in specific storage conditions and can be relevant to their behavior during in vivo applications. Another important aspect is the evaluation of the toxicity of functional materials. Toxicity can be accessed with various methods using in vitro, in vivo, ex vivo, and in silico models. In vitro cell culture methods are used to determine mitochondrial damage, reactive oxygen species, stress responses, and cellular toxicity. In vitro cellular toxicity can be measured by MTT assay, LDH leakage assay, and hemolysis. In vivo studies are performed using various animal models involving zebrafish, rodents (mice and rats), and nonhuman primates. Ex vivo studies are also used for efficacy and toxicity determinations of functional materials like ex vivo potency assay and precision-cut liver slice (PCLS) models. The in silico tools with computational simulations like quantitative structure-activity relationships (QSAR), pharmacokinetics (PK) and pharmacodynamics (PD), dose and time response, and quantitative cationic-activity relationships ((Q)CARs) are used for prediction of the toxicity of functional materials. In this review, we studied the principle methods used for degradation studies, different degradation pathways, and mechanisms of functional material degradation with prototype examples. We discuss toxicity assessments with different toxicity approaches used for estimation of the safety and efficacy of functional materials.
Collapse
Affiliation(s)
- Roshani R Pagar
- Department of Pharmaceutics, Dr. D.Y. Patil Institute of Pharmaceutical Sciences and Research, Pimpri, Pune, Maharashtra 411018, India
| | - Shubham R Musale
- Department of Pharmaceutics, Dr. D.Y. Patil Institute of Pharmaceutical Sciences and Research, Pimpri, Pune, Maharashtra 411018, India
| | - Ganesh Pawar
- Department of Pharmacology, Dr. D.Y. Patil Institute of Pharmaceutical Sciences and Research, Pimpri, Pune, Maharashtra 411018, India
| | - Deepak Kulkarni
- Srinath College of Pharmacy, Bajajnagar, Aurangabad, Maharashtra 431136, India
| | - Prabhanjan S Giram
- Department of Pharmaceutics, Dr. D.Y. Patil Institute of Pharmaceutical Sciences and Research, Pimpri, Pune, Maharashtra 411018, India.,Department of Pharmaceutical Sciences, University at Buffalo, State University of New York, Buffalo, New York 14214, United States
| |
Collapse
|
9
|
Toth JM, Ankomah F, Kawakami N, Uno K. A comparison of the inflammatory host response to particulate debris adjacent to unlocked and locked screws of a growth guidance system for early onset scoliosis. Eur Spine J 2022. [PMID: 35695968 DOI: 10.1007/s00586-022-07271-2] [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: 12/17/2021] [Revised: 04/20/2022] [Accepted: 05/16/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The SHILLA™ Growth Guidance system is a stainless-steel rod and screw system used for Early Onset Scoliosis which incorporates a unique flanged set screw designed to capture the rod, while allowing it to slide as the patient grows. Concomitant with this design is the potential for generation of wear debris and for an inflammatory host response. We hypothesized that the magnitude of the host response adjacent to the unlocked screws and rods would be greater than the host response to the locked rod/screws. METHODS Seven tissue samples adjacent to locked (3) and unlocked screws (4) from three SHILLA patients (mean implantation time of 19 post-operative months) with infantile idiopathic scoliosis were obtained as part of an explant analysis protocol during a PMDA-approved clinical trial in Japan. Gross appearance, high-resolution radiographs, and histology were assessed. ISO Standard 10993 Part 6 was used to assess the host response. RESULTS All three locked screw had no metallosis. In contrast, metallosis for unlocked screw tissue samples were rated as "ubiquitous" (2/4), "focal" (1/4), or "absent" (1/4). Microscopic metallic debris was found intracellularly and within interstices of fibrous connective tissues more frequently adjacent to unlocked screws compared to locked screws. Cell type and population scoring consistently showed a modestly larger inflammatory response (macrophages) in the unlocked tissue samples. CONCLUSIONS The peri-prosthetic tissue response to the unlocked rods/screws had a higher reactivity grade (slight reaction, Δ = 4.0) per ISO 10993 Part 6 compared to the locked screws in three patients with the SHILLA™ Growth Guidance scoliosis system.
Collapse
|
10
|
Litak J, Szymoniuk M, Czyżewski W, Hoffman Z, Litak J, Sakwa L, Kamieniak P. Metallic Implants Used in Lumbar Interbody Fusion. Materials (Basel) 2022; 15:3650. [PMID: 35629676 DOI: 10.3390/ma15103650] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 02/07/2023]
Abstract
Over the last decade, pedicle fixation systems have evolved and modifications in spinal fusion techniques have been developed to increase fusion rates and improve clinical outcomes after lumbar interbody fusion (LIF). Regarding materials used for screw and rod manufacturing, metals, especially titanium alloys, are the most popular resources. In the case of pedicle screws, that biomaterial can be also doped with hydroxyapatite, CaP, ECM, or tantalum. Other materials used for rod fabrication include cobalt-chromium alloys and nitinol (nickel-titanium alloy). In terms of mechanical properties, the ideal implant used in LIF should have high tensile and fatigue strength, Young's modulus similar to that of the bone, and should be 100% resistant to corrosion to avoid mechanical failures. On the other hand, a comprehensive understanding of cellular and molecular pathways is essential to identify preferable characteristics of implanted biomaterial to obtain fusion and avoid implant loosening. Implanted material elicits a biological response driven by immune cells at the site of insertion. These reactions are subdivided into innate (primary cellular response with no previous exposure) and adaptive (a specific type of reaction induced after earlier exposure to the antigen) and are responsible for wound healing, fusion, and also adverse reactions, i.e., hypersensitivity. The main purposes of this literature review are to summarize the physical and mechanical properties of metal alloys used for spinal instrumentation in LIF which include fatigue strength, Young's modulus, and corrosion resistance. Moreover, we also focused on describing biological response after their implantation into the human body. Our review paper is mainly focused on titanium, cobalt-chromium, nickel-titanium (nitinol), and stainless steel alloys.
Collapse
|
11
|
Wan ZY, Shan H, Liu TF, Song F, Zhang J, Liu ZH, Ma KL, Wang HQ. Emerging Issues Questioning the Current Treatment Strategies for Lumbar Disc Herniation. Front Surg 2022; 9:814531. [PMID: 35419406 PMCID: PMC8999845 DOI: 10.3389/fsurg.2022.814531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 03/04/2022] [Indexed: 11/26/2022] Open
Abstract
Lumbar disc herniation is among the common phenotypes of degenerative lumbar spine diseases, significantly affecting patients' quality of life. The practice pattern is diverse. Choosing conservative measures or surgical treatments is still controversial in some areas. For those who have failed conservative treatment, surgery with or without instrumentation is recommended, causing significant expenditures and frustrating complications, that should not be ignored. In the article, we performed a literature review and summarized the evidence by subheadings to unravel the cons of surgical intervention for lumbar disc herniation. There are tetrad critical issues about surgical treatment of lumbar disc herniation, i.e., favorable natural history, insufficient evidence in a recommendation of fusion surgery for patients, metallosis, and implant removal. Firstly, accumulating evidence reveals immune privilege and auto-immunity hallmarks of human lumbar discs within the closed niche. Progenitor cells within human discs further expand the capacity with the endogenous repair. Clinical watchful follow-up studies with repeated diagnostic imaging reveal spontaneous resolution for lumbar disc herniation, even calcified tissues. Secondly, emerging evidence indicates long-term complications of lumbar fusion, such as adjacent segment disease, pseudarthrosis, implant failure, and sagittal spinal imbalance, which get increasing attention. Thirdly, systemic and local reactions (metallosis) for metal instrumentation have been noted with long-term health concerns and toxicity. Fourthly, the indications and timing for spinal implant removal have not reached a consensus. Other challenging issues include postoperative lumbar stiffness. The review provided evidence from a negative perspective for surgeons and patients who attempt to choose surgical treatment. Collectively, the emerging underlying evidence questions the benefits of traditional surgery for patients with lumbar disc herniation. Therefore, the long-term effects of surgery should be closely observed. Surgical decisions should be made prudently for each patient.
Collapse
Affiliation(s)
- Zhong Y. Wan
- Department of Orthopedics, The Seventh Medical Center of General Hospital of People's Liberation Army (PLA), Beijing, China
| | - Hua Shan
- Institute of Integrative Medicine, Shaanxi University of Chinese Medicine, Xi'an, China
| | - Tang F. Liu
- Institute of Integrative Medicine, Shaanxi University of Chinese Medicine, Xi'an, China
| | - Fang Song
- Department of Stomatology, The Specialty Medical Center Rocket Force of People's Liberation Army (PLA), Beijing, China
| | - Jun Zhang
- Department of Orthopedics, Baoji Central Hospital, Baoji, China
| | - Zhi H. Liu
- Department of Cardiac Surgery, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Kun L. Ma
- Department of Orthopedics, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Hai Q. Wang
- Institute of Integrative Medicine, Shaanxi University of Chinese Medicine, Xi'an, China
- *Correspondence: Hai Q. Wang ;
| |
Collapse
|
12
|
Pana I, Braic V, Vladescu A, Ion R, Parau AC, Zoita NC, Dinu M, Kiss AE, Cimpean A, Braic M. SiC- and Ag-SiC-Doped Hydroxyapatite Coatings Grown Using Magnetron Sputtering on Ti Alloy for Biomedical Application. Coatings 2022; 12:195. [DOI: 10.3390/coatings12020195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
SiC- and Ag-SiC-doped hydroxyapatite (HA) coatings were deposited via magnetron sputtering aiming at increased corrosion protection of Ti-10Nb-10Zr-5Ta alloy in simulated body fluid environment and superior mechanical properties compared to plain hydroxyapatite. The coatings had a total thickness of about 350 nm. The X ray diffraction patterns indicate that HA coatings are polycrystalline with a hexagonal structure and the addition of SiC determined the coating amorphization. All coatings presented a lower roughness compared to the Ti alloy and were hydrophilic. Ag-SiC-HA coating presented the best corrosion resistance and tribological parameters. All coatings were biocompatible, as ascertained via indirect cytocompatibility studies conducted on Vero cells.
Collapse
|
13
|
Dordunoo D, Anaman-Torgbor J, Smith C, Shaik A, Hass M, Gordon C, An M, Aviles-G ML, Weinzierl M. Hypersensitivity in patients receiving metal implants: a scoping review protocol. JBI Evid Synth 2021; 19:1404-1411. [PMID: 33278266 DOI: 10.11124/jbies-20-00171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The objective of this scoping review is to gather the available evidence on metal hypersensitivity to determine the extent of the problem and identify gaps in the evidence about screening practices. INTRODUCTION Hypersensitivity to metal was first reported in 1966. Since this time, the use of metal in prosthetic devices has increased with an associated rise in reported hypersensitivity reaction to other metals. Symptoms of metal hypersensitivity can be subtle, and it is unclear whether clinicians are aware of or routinely ask patients about metal hypersensitivity when documenting allergies. This can lead to a delay in diagnosis, which puts patients at risk of poor outcomes. Hence, there is a need to map the available evidence on hypersensitivity reaction in people who receive metallic device implantation. INCLUSION CRITERIA The review will consider studies that include patients who undergo procedures involving metal implantation. The concept to be explored is hypersensitivity following a procedure that involves the implementation of a device with metal components. Implementation is defined as permanent integration of a foreign (non-biological) object into the human body to restore function. METHODS The proposed scoping review will be conducted in accordance with JBI methodology for scoping reviews. Searches will be generated in multiple databases and updated as needed. Gray literature and organizational websites will also be searched. Titles, abstracts, and full articles will be screened according to the inclusion criteria. Studies published in English from 1960 to the present will be included. Data will be extracted and findings will be presented in tabular form with a narrative summary.
Collapse
Affiliation(s)
- Dzifa Dordunoo
- School of Nursing/Human and Social Development, University of Victoria, Victoria, BC, Canada.,The University of Victoria (UVic) Centre for Evidence-Informed Nursing and Health (CEiNHC): A JBI Affiliated Group, Victoria, BC, Canada
| | - Judith Anaman-Torgbor
- School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Catherine Smith
- Faculty of Health Sciences, University of the Fraser Valley, Chilliwack, BC, Canada
| | - Ajijoon Shaik
- School of Nursing, Camosun College, Victoria, BC, Canada
| | | | - Carol Gordon
- School of Nursing/Human and Social Development, University of Victoria, Victoria, BC, Canada.,The University of Victoria (UVic) Centre for Evidence-Informed Nursing and Health (CEiNHC): A JBI Affiliated Group, Victoria, BC, Canada
| | - Minjeong An
- College of Nursing, Chonnam National University, Chonnam, South Korea
| | - Martha L Aviles-G
- School of Nursing/Human and Social Development, University of Victoria, Victoria, BC, Canada
| | - Miriam Weinzierl
- School of Nursing/Human and Social Development, University of Victoria, Victoria, BC, Canada
| |
Collapse
|
14
|
Komorowski P, Siatkowska M, Kamińska M, Jakubowski W, Walczyńska M, Walkowiak-Przybyło M, Szymański W, Piersa K, Wielowski P, Sokołowska P, Białkowska K, Makowski K, Elgalal M, Kierzkowska A, Ciupik L, Walkowiak B. Comprehensive Biological Evaluation of Biomaterials Used in Spinal and Orthopedic Surgery. Materials (Basel) 2020; 13:E4769. [PMID: 33114571 DOI: 10.3390/ma13214769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/16/2020] [Accepted: 10/20/2020] [Indexed: 12/03/2022]
Abstract
Biological acceptance is one of the most important aspects of a biomaterial and forms the basis for its clinical use. The aim of this study was a comprehensive biological evaluation (cytotoxicity test, bacterial colonization test, blood platelets adhesion test and transcriptome and proteome analysis of Saos-2 cells after contact with surface of the biomaterial) of biomaterials used in spinal and orthopedic surgery, namely, Ti6Al4V ELI (Extra Low Interstitials), its modified version obtained as a result of melting by electron beam technology (Ti6Al4V ELI-EBT), polyether ether ketone (PEEK) and polished medical steel American Iron and Steel Institute (AISI) 316L (the reference material). Biological tests were carried out using the osteoblasts-like cells (Saos-2, ATCC HTB-85) and bacteria Escherichia coli (DH5α). Results showed lack of cytotoxicity of all materials and the surfaces of both Ti6Al4V ELI and PEEK exhibit a significantly higher resistance to colonization with E. coli cells, while the more porous surface of the same titanium alloy produced by electron beam technology (EBT) is more susceptible to microbial colonization than the control surface of polished medical steel. None of the tested materials showed high toxicity in relation to E. coli cells. Susceptibility to platelet adhesion was very high for polished medical steel AISI 316L, whilst much lower for the other biomaterials and can be ranked from the lowest to the highest as follows: PEEK < Ti6Al4V ELI < Ti6Al4V ELI-EBT. The number of expressed genes in Saos-2 cells exposed to contact with the examined biomaterials reached 9463 genes in total (ranging from 8455 genes expressed in cells exposed to ELI to 9160 genes in cells exposed to PEEK). Whereas the number of differentially expressed proteins detected on two-dimensional electrophoresis gels in Saos-2 cells after contact with the examined biomaterials was 141 for PEEK, 223 for Ti6Al4V ELI and 133 for Ti6Al4V ELI-EBT. Finally, 14 proteins with altered expression were identified by mass spectrometry. In conclusion, none of the tested biomaterials showed unsatisfactory levels of cytotoxicity. The gene and protein expression analysis, that represents a completely new approach towards characterization of these biomaterials, showed that the polymer PEEK causes much more intense changes in gene and protein expression and thus influences cell metabolism.
Collapse
|
15
|
Curley KL, Krishna C, Maiti TK, Mcclendon J, Bendok BR. Metal Hypersensitivity After Spinal Instrumentation: When to Suspect and How to Treat. World Neurosurg 2020; 139:471-7. [DOI: 10.1016/j.wneu.2020.04.093] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 04/10/2020] [Accepted: 04/11/2020] [Indexed: 11/18/2022]
|
16
|
Fernández Bances I, Paz Aparicio J, Alvarez Vega MA. Evaluation of Titanium Serum Levels in Patients After Spine Instrumentation: Comparison Between Posterolateral and 360º Spinal Fusion Surgery. Cureus 2019; 11:e5451. [PMID: 31511816 PMCID: PMC6716769 DOI: 10.7759/cureus.5451] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction The use of orthopedic implants is a cause for concern for the release of its integrating metals and the systemic complications that may occur. Instrumented spine arthrodesis is the recommended treatment for many spine diseases. Different segmental fixation devices, commonly made of titanium and its alloys, are used in these surgeries. The use of this metal for spinal fusion has introduced the possibility of generating microscopic metal particles that are present in the tissues of the surrounding implants (peri-implant environment). In fact, metal debris has been found in the paraspinal soft tissues of patients with posterior lumbar instrumentation and showed to be particularly high in patients undergoing revision procedures of pseudoarthrosis. In addition, part of the metals might also dissolve (either from the released particles or directly from the implant surface) and circulate in the body fluids, accumulating (eventually) in remote organs. Material and methods A prospective study was designed with patients who were to be operated by the pathology of the lumbar spine to perform a vertebral arthrodesis composed of a titanium alloy (n=32). Two subgroups were differentiated according to the type of surgery performed: a) Posterolateral arthrodesis (N=5); b) Circumferential arthrodesis intervertebral implant of polyester-ether ketone (PEEK) (N=8) or titanium (N=19). The blood sample was taken before surgery and one year later. The samples were analyzed by mass spectrophotometry with a double focus inductive coupling plasma source (DF-ICP-MS). Results Blood titanium levels prior to surgery were similar to those in other publications (0.7449 micrograms per liter-1 (µgL-1), Standard Deviation (SD)=0.562). The average titanium concentration levels found after surgery was 2.5406 µgL-1 (SD=3,69), near 3.5-fold increase. After surgery, there was a significant mean increase in serum titanium levels of 1.7957 µgL-1 (SD=3.5765, Range=-0.57 µgL-1; 14.60 µgL-1). There is a statistically significant increment (p=0.00049) of the titanium concentration in the serum of the patients after surgery. If we analyze the patients in three groups according to the type of implants used (posterolateral, circumferential with PEEK, and circumferential with titanium), there are no differences between those who did not have an intersomatic device implanted and those in which PEEK implants were implanted, but with those in which it was titanium it was p=0.006 and p=0.018, respectively. Conclusions Patients undergoing vertebral instrumentation experience a significant increase in serum titanium levels compared to before surgery levels. The use of an intersomatic device did not show differences in titanium release with not using it when it was PEEK. There are significant differences between patients without intersomatic implants or those who had a PEEK implant with those in whom it was titanium, with a significant increase in blood titanium levels.
Collapse
Affiliation(s)
| | - José Paz Aparicio
- Spine Unit, Orthopedic Surgery and Traumatology Department, University Central Hospital of Asturias, Oviedo, ESP
| | | |
Collapse
|
17
|
Zhang S, Ren Q, Qi H, Liu S, Liu Y. Adverse Effects of Fine-Particle Exposure on Joints and Their Surrounding Cells and Microenvironment. ACS Nano 2019; 13:2729-2748. [PMID: 30773006 DOI: 10.1021/acsnano.8b08517] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Current understanding of the health risks and adverse effects upon exposure to fine particles is premised on the direct association of particles with target organs, particularly the lung; however, fine-particle exposure has also been found to have detrimental effects on sealed cavities distant to the portal-of-entry, such as joints. Moreover, the fundamental toxicological issues have been ascribed to the direct toxic mechanisms, in particular, oxidative stress and proinflammatory responses, without exploring the indirect mechanisms, such as compensated, adaptive, and secondary effects. In this Review, we recapitulate the current findings regarding the detrimental effects of fine-particle exposure on joints, the surrounding cells, and microenvironment, as well as their deteriorating impact on the progression of arthritis. We also elaborate the likely molecular mechanisms underlying the particle-induced detrimental influence on joints, not limited to direct toxicity, but also considering the other indirect mechanisms. Because of the similarities between fine air particles and engineered nanomaterials, we compare the toxicities of engineered nanomaterials to those of fine air particles. Arthritis and joint injuries are prevalent, particularly in the elderly population. Considering the severity of global exposure to fine particles and limited studies assessing the detrimental effects of fine-particle exposure on joints and arthritis, this Review aims to appeal to a broad interest and to promote more research efforts in this field.
Collapse
Affiliation(s)
- Shuping Zhang
- Institute for Medical Engineering and Science , Massachusetts Institute of Technology , Cambridge , Massachusetts 02139 , United States
| | - Quanzhong Ren
- State Key Laboratory of Environmental Chemistry and Ecotoxicology , Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences , Beijing 100085 , P. R. China
| | - Hui Qi
- Beijing Jishuitan Hospital , Peking University Health Science Center , Beijing 100035 , P. R. China
- Beijing Research Institute of Traumatology and Orthopaedics , Beijing 100035 , P. R. China
| | - Sijin Liu
- State Key Laboratory of Environmental Chemistry and Ecotoxicology , Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences , Beijing 100085 , P. R. China
| | - Yajun Liu
- Beijing Jishuitan Hospital , Peking University Health Science Center , Beijing 100035 , P. R. China
| |
Collapse
|
18
|
Arnin U, El-Hawary R, Betz RR, Lonner BS, Floman Y. Preclinical Bench Testing on a Novel Posterior Dynamic Deformity Correction Device for Scoliosis. Spine Deform 2019; 7:203-212. [PMID: 30660213 DOI: 10.1016/j.jspd.2018.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 02/22/2018] [Revised: 08/07/2018] [Accepted: 08/19/2018] [Indexed: 10/27/2022]
Abstract
STUDY DESIGN Biomechanical test. OBJECTIVE To summarize the preclinical tests performed to assess the durability of a novel fusionless dynamic device for the treatment of adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA The minimal invasive deformity correction (MID-C) system is a distractible posterior dynamic deformity correction device designed to reduce scoliosis for AIS patients, to maintain curve correction, and to preserve spinal motion. To overcome the challenges of wear and fatigue of this procedure, the system has two unique features: polyaxial joints at the rod-screw interface and a ceramic coating of the moving parts. METHODS Five biomechanical tests were performed: Static compression to failure, fatigue loading per ASTM F 1717 with 5.5-mm screws for 10 million cycles (MC) at 5 Hz, wear assessment, wear test of the polyaxial joint under 100 N load for 10 MC, and wear particle implantation in rabbits. RESULTS The system failed through buckling of the rod with loads over 3000 N (400% of human body weight). Dynamically, the system maintained 700 N for 10 MC with 5.5 mm screws. The maximum total steady-state wear rate was 0.074 mg/MC (0.03 per polyaxial joint and 0.014 mg/MC for the ratchet mechanism). Histologic evaluation of the particle injection sites indicated no difference in the local tissue response between the control and test articles. At 3 and 6 months postinjection, there were neither adverse local effects nor systemic effects observed. CONCLUSIONS The unique design features of the MID-C system, based on polyaxial joints and ceramic coating, resulted in favorable static, fatigue, and wear resistance properties. Wear properties were superior to those published for artificial spinal discs. Long-term outcomes from clinical use will be required to correlate these bench tests to the in vivo reality of clinical use. LEVEL OF EVIDENCE Level V.
Collapse
Affiliation(s)
- U Arnin
- Israel Spine Center, Assuta Hospital, Tel Aviv, Israel
| | | | - R R Betz
- Institute for Spine and Scoliosis Lawrenceville, USA
| | | | - Y Floman
- Israel Spine Center, Assuta Hospital, Tel Aviv, Israel
| |
Collapse
|
19
|
Rani Bijukumar D, Segu A, Mou Y, Ghodsi R, Shokufhar T, Barba M, Li XJ, Thoppil Mathew M. Differential toxicity of processed and non-processed states of CoCrMo degradation products generated from a hip simulator on neural cells. Nanotoxicology 2018; 12:941-56. [PMID: 30251573 DOI: 10.1080/17435390.2018.1498929] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Physico-chemical characteristics of the CoCrMo degradation products have played an important role in cytotoxicity and clinical complications on the orthopedic patients who have metal implants. Previous studies have limited reflection on the physicochemical characteristics of the degradation products generated in vivo, which are very different from individual metal particles and/or ions obtained from different commercial sources. In this study, we aimed to understand the differences in toxicity induced by the degradation products in as-synthesized form as well as those obtained after post-processing. The degradation products were generated using a hip-simulator by maintaining physiological conditions closer to in vivo and separated into two batches, one with processing by washing and drying called processed degradation products (PDP) and another batch as 'as-synthesized' degradation product (DP). We studied the dose-dependent toxicity response by neural cells derived from induced pluripotent stem cells. The results of the study show that as-synthesized DPs are more toxic to neural cells even at lower concentrations studied with evident low TC50 (1-5 μg/ml) concentrations compared to PDP (25 μg/ml). Flow cytometric analysis showed a significant (p<.01) increase in uptake of the particles after 24 h and corresponding ROS production in DP-treated cells. RT-PCR analysis of oxidative specific gene expression showed, elevated mRNA levels of NADPH oxidase-1, nuclear transcription factor, superoxide dismutase-2 and glutaredoxin-2 in DP-treated cells after 6 h. The results of the study provided a clear evidence of the differential response of neural cells on the degradation products as a function of concentrations and their chemical nature.
Collapse
|
20
|
Bijukumar DR, Segu A, Souza JCM, Li X, Barba M, Mercuri LG, J Jacobs J, Mathew MT. Systemic and local toxicity of metal debris released from hip prostheses: A review of experimental approaches. Nanomedicine 2018; 14:951-963. [PMID: 29339190 PMCID: PMC6017990 DOI: 10.1016/j.nano.2018.01.001] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 12/22/2017] [Accepted: 01/02/2018] [Indexed: 12/12/2022]
Abstract
Despite the technological improvements in orthopedic joint replacement implants, wear and corrosion products associated with the metal components of these implants may result in adverse local tissue and perhaps systemic reactions and toxicities. The current review encompasses a literature review of the local and systemic toxicity studies concerning the effect of CoCrMo wear debris released from wear and corrosion of orthopedic implants and prostheses. Release of metallic debris is mainly in the form of micro- and nano-particles, ions of different valences, and oxides composed of Co and Cr. Though these substances alter human biology, their direct effects of these substances on specific tissue types remain poorly understood. This may partially be the consequence of the multivariate research methodologies employed, leading to inconsistent reports. This review proposes the importance of developing new and more appropriate in-vitro methodologies to study the cellular responses and toxicity mediated by joint replacement wear debris in-vivo.
Collapse
Affiliation(s)
- Divya Rani Bijukumar
- Regenerative Medicine and Disability Research Lab, Department of Biomedical Sciences, University of Illinois College of Medicine at Rockford, IL, USA
| | - Abhijith Segu
- Regenerative Medicine and Disability Research Lab, Department of Biomedical Sciences, University of Illinois College of Medicine at Rockford, IL, USA
| | - Júlio C M Souza
- Center for MicroElectromechanical Systems (CMEMS-UMINHO), University of Minho, Guimaraes, Portugal
| | - XueJun Li
- Regenerative Medicine and Disability Research Lab, Department of Biomedical Sciences, University of Illinois College of Medicine at Rockford, IL, USA
| | - Mark Barba
- Regenerative Medicine and Disability Research Lab, Department of Biomedical Sciences, University of Illinois College of Medicine at Rockford, IL, USA; OrthoIllinois, Rockford, IL, USA
| | - Louis G Mercuri
- Department of Orthopedics, Rush University Medical Center, Chicago, IL, USA
| | - Joshua J Jacobs
- Department of Orthopedics, Rush University Medical Center, Chicago, IL, USA
| | - Mathew Thoppil Mathew
- Regenerative Medicine and Disability Research Lab, Department of Biomedical Sciences, University of Illinois College of Medicine at Rockford, IL, USA; Department of Orthopedics, Rush University Medical Center, Chicago, IL, USA; Department of Bioengineering, University of Illinois at Chicago, IL, USA.
| |
Collapse
|
21
|
Abstract
BACKGROUND Replacement of a diseased lumbar intervertebral disc with an artificial device, a procedure known as lumbar total disc replacement (LTDR), has been practiced since the 1980s. METHODS Comprehensive review of published literature germane to LTDR, but comment is restricted to high-quality evidence reporting implantation of lumbar artificial discs that have been commercially available for at least 15 years at the time of writing and which continue to be commercially available. RESULTS LTDR is shown to be a noninferior (and sometimes superior) alternative to lumbar fusion in patients with discogenic low back pain and/or radicular pain attributable to lumbar disc degenerative disease (LDDD). Further, LTDR is a motion-preserving procedure, and evidence is emerging that it may also result in risk reduction for subsequent development and/or progression of adjacent segment disease. CONCLUSIONS In spite of the substantial logistical challenges to the safe introduction of LTDR to a health care facility, the procedure continues to gain acceptance, albeit slowly. CLINICAL RELEVANCE Patients with LDDD who are considering an offer of spinal surgery can only provide valid and informed consent if they have been made aware of all reasonable surgical and nonsurgical options that may benefit them. Accordingly, and in those cases in which LTDR may have a role to play, patients under consideration for other forms of spinal surgery should be informed that this valid procedure exists.
Collapse
Affiliation(s)
- Stephen Beatty
- Institute of Health Sciences, Waterford Institute of Technology, Waterford, Republic of Ireland
| |
Collapse
|
22
|
Wright TM. CORR Insights ®: Periprosthetic UHMWPE Wear Debris Induces Inflammation, Vascularization, and Innervation After Total Disc Replacement in the Lumbar Spine. Clin Orthop Relat Res 2017; 475:1382-1385. [PMID: 27535283 PMCID: PMC5384907 DOI: 10.1007/s11999-016-5026-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 08/05/2016] [Indexed: 01/31/2023]
Affiliation(s)
- Timothy M Wright
- Department of Biomechanics, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021-4892, USA.
| |
Collapse
|
23
|
Villanueva J, Trino L, Thomas J, Bijukumar D, Royhman D, Stack MM, Mathew MT. Corrosion, Tribology, and Tribocorrosion Research in Biomedical Implants: Progressive Trend in the Published Literature. ACTA ACUST UNITED AC 2017; 3. [DOI: 10.1007/s40735-016-0060-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
24
|
Zhao M, Li H, Liu X, Wei J, Ji J, Yang S, Hu Z, Wei S. Response of Human Osteoblast to n-HA/PEEK--Quantitative Proteomic Study of Bio-effects of Nano-Hydroxyapatite Composite. Sci Rep 2016; 6:22832. [PMID: 26956660 PMCID: PMC4783780 DOI: 10.1038/srep22832] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 02/22/2016] [Indexed: 01/27/2023] Open
Abstract
Nano-sized hydroxyapatite (n-HA) is considered as a bio-active material, which is often mixed into bone implant material, polyetheretherketone (PEEK). To reveal the global protein expression modulations of osteoblast in response to direct contact with the PEEK composite containing high level (40%) nano-sized hydroxyapatite (n-HA/PEEK) and explain its comprehensive bio-effects, quantitative proteomic analysis was conducted on human osteoblast-like cells MG-63 cultured on n-HA/PEEK in comparison with pure PEEK. Results from quantitative proteomic analysis showed that the most enriched categories in the up-regulated proteins were related to calcium ion processes and associated functions while the most enriched categories in the down-regulated proteins were related to RNA process. This enhanced our understanding to the molecular mechanism of the promotion of the cell adhesion and differentiation with the inhibition of the cell proliferation on n-HA/PEEK composite. It also exhibited that although the calcium ion level of incubate environment hadn't increased, merely the calcium fixed on the surface of material had influence to intracellular calcium related processes, which was also reflect by the higher intracellular Ca(2+) concentration of n-HA/PEEK. This study could lead to more comprehensive cognition to the versatile biocompatibility of composite materials. It further proves that proteomics is useful in new bio-effect discovery.
Collapse
Affiliation(s)
- Minzhi Zhao
- CAS Key Laboratory for Biomedical Effects of Nanomaterials & Nanosafety, National Center for Nanoscience and Technology, Chinese Academy of Sciences, Beijing 100190, China
| | - Haiyun Li
- CAS Key Laboratory for Biomedical Effects of Nanomaterials & Nanosafety, National Center for Nanoscience and Technology, Chinese Academy of Sciences, Beijing 100190, China
| | - Xiaochen Liu
- Center for Biomedical Materials and Tissue Engineering, Academy for Advanced Interdisciplinary Studies, Peking University, 100871, Beijing, China
| | - Jie Wei
- Key Laboratory for Ultrafine Materials of Ministry of Education, East China University of Science and Technology, Shanghai 200237, China
| | - Jianguo Ji
- State Key Laboratory of Protein and Plant Gene Research, College of Life Sciences, Peking University, Beijing 100871, China
| | - Shu Yang
- CAS Key Laboratory for Biomedical Effects of Nanomaterials & Nanosafety, National Center for Nanoscience and Technology, Chinese Academy of Sciences, Beijing 100190, China
| | - Zhiyuan Hu
- CAS Key Laboratory for Biomedical Effects of Nanomaterials & Nanosafety, National Center for Nanoscience and Technology, Chinese Academy of Sciences, Beijing 100190, China
| | - Shicheng Wei
- Center for Craniofacial Stem Cell Research and Regeneration, Department of Orthodontics, Laboratory of Interdisciplinary Studies, Peking University School and Hospital of Stomatology, Beijing 100081, China
- Center for Biomedical Materials and Tissue Engineering, Academy for Advanced Interdisciplinary Studies, Peking University, 100871, Beijing, China
| |
Collapse
|
25
|
Kienle A, Graf N, Wilke HJ. Does impaction of titanium-coated interbody fusion cages into the disc space cause wear debris or delamination? Spine J 2016; 16:235-42. [PMID: 26409208 DOI: 10.1016/j.spinee.2015.09.038] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [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: 06/11/2015] [Accepted: 09/15/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT A large number of interbody fusion cages are made of polyetheretherketone (PEEK). To improve bone on-growth, some are coated with a thin layer of titanium. This coating may fail when subjected to shear loading. PURPOSE The purpose of this testing was to investigate whether impaction of titanium-coated PEEK cages into the disc space can result in wear or delamination of the coating, and whether titanium cages with subtractive surface etching (no coating) are less susceptible to such failure. STUDY DESIGN/SETTING A biomechanical study was carried out to simulate the impaction process in clinical practice and to evaluate if wear or delamination may result from impaction. MATERIALS AND METHODS Two groups of posterior lumbar interbody fusion cages with a similar geometry were tested: n=6 titanium-coated PEEK and n=6 surface-etched titanium cages. The cages were impacted into the space in between two vertebral body substitutes (polyurethane foam blocks). The two vertebral body substitutes were fixed in a device, through which a standardized axial preload of 390 N was applied. The anterior tip of the cage was positioned at the posterior border of the space between the two vertebral body substitutes. The cages were then inserted using a drop weight with a mass representative of a surgical hammer. The drop weight impacted the insertion instrument at a maximum speed of about 2.6 m/s, which is in the range of the impaction speed in vivo. This was repeated until the cages were fully inserted. The wear particles were captured and analyzed according to the pertinent standards. RESULTS The surface-etched titanium cages did not show any signs of wear debris or surface damage. In contrast, the titanium-coated PEEK cages resulted in detached wear particles of different sizes (1-191 µm). Over 50% of these particles had a size <10 µm. In median, on 26% of the implants' teeth, the coating was abraded. Full delamination was not observed. CONCLUSIONS In contrast to the surface-etched implants, the titanium-coated PEEK implants lost some coating material. This was visible to the naked eye. More than half of all particles were of a size range that allows phagocytosis. This study shows that titanium-coated implants are susceptible to impaction-related wear debris.
Collapse
Affiliation(s)
- Annette Kienle
- SpineServ GmbH & Co. KG, Soeflinger Strasse 100, Ulm D-89077, Germany.
| | - Nicolas Graf
- SpineServ GmbH & Co. KG, Soeflinger Strasse 100, Ulm D-89077, Germany
| | - Hans-Joachim Wilke
- Institute for Orthopedic Research and Biomechanics, Helmholtzstr. 14, Ulm D-89081, Germany
| |
Collapse
|
26
|
|
27
|
Soto-Alvaredo J, Blanco E, Bettmer J, Hevia D, Sainz RM, López Cháves C, Sánchez C, Llopis J, Sanz-Medel A, Montes-Bayón M. Evaluation of the biological effect of Ti generated debris from metal implants: ions and nanoparticles. Metallomics 2014; 6:1702-8. [DOI: 10.1039/c4mt00133h] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Metallic implants placed in humans exhibit wear and corrosion that result in the liberation of metal-containing by-products.
Collapse
Affiliation(s)
- J. Soto-Alvaredo
- Department of Physical and Analytical Chemistry
- Faculty of Chemistry
- University of Oviedo
- 33006 Oviedo, Spain
| | - E. Blanco
- Department of Physical and Analytical Chemistry
- Faculty of Chemistry
- University of Oviedo
- 33006 Oviedo, Spain
| | - J. Bettmer
- Department of Physical and Analytical Chemistry
- Faculty of Chemistry
- University of Oviedo
- 33006 Oviedo, Spain
| | - D. Hevia
- Department of Morphology and Cell Biology
- Faculty of Medicine
- Cancer Research Institute of Principado de Asturias (IUOPA)
- University of Oviedo
- 33006 Oviedo, Spain
| | - R. M. Sainz
- Department of Morphology and Cell Biology
- Faculty of Medicine
- Cancer Research Institute of Principado de Asturias (IUOPA)
- University of Oviedo
- 33006 Oviedo, Spain
| | - C. López Cháves
- Department of Physiology
- Faculty of Pharmacy
- University of Granada
- Campus de Cartuja
- 18071 Granada, Spain
| | - C. Sánchez
- Department of Physiology
- Faculty of Pharmacy
- University of Granada
- Campus de Cartuja
- 18071 Granada, Spain
| | - J. Llopis
- Department of Physiology
- Faculty of Pharmacy
- University of Granada
- Campus de Cartuja
- 18071 Granada, Spain
| | - A. Sanz-Medel
- Department of Physical and Analytical Chemistry
- Faculty of Chemistry
- University of Oviedo
- 33006 Oviedo, Spain
| | - M. Montes-Bayón
- Department of Physical and Analytical Chemistry
- Faculty of Chemistry
- University of Oviedo
- 33006 Oviedo, Spain
| |
Collapse
|
28
|
Ristic L, Vucevic D, Radovic L, Djordjevic S, Nikacevic M, Colic M. Corrosive and cytotoxic properties of compact specimens and microparticles of Ni-Cr dental alloy. J Prosthodont 2013; 23:221-6. [PMID: 24118161 DOI: 10.1111/jopr.12100] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2013] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Nickel-chromium (Ni-Cr) dental alloys have been widely used in prosthodontic practice, but there is a permanent concern about their biocompatibility due to the release of metal ions. This is especially important when Ni-Cr metal microparticles are incorporated into gingival tissue during prosthodontic procedures. Therefore, the aim of this study was to examine and compare the corrosion and cytotoxic properties of compact specimens and microparticles of Ni-Cr dental alloy. MATERIALS AND METHODS Ni-Cr alloy, Remanium CSe bars (4 mm diameter), were made by the standard casting method and then cut into 0.5-mm-thick disks. Metal particles were obtained by scraping the bars using a diamond instrument for crown preparation. The microstructure was observed by an optical microscope. Quantitative determination and morphological and dimensional characterization of metal particles were carried out by a scanning electron microscope and Leica Application Suite software for image analysis. Corrosion was studied by conditioning the alloy specimens in the RPMI 1640 medium, containing 10% fetal calf serum in an incubator with 5% CO2 for 72 hours at 37°C. Inductively coupled plasma-optical emission spectrometry was used to assess metal ion release. The cytotoxity of conditioning medium (CM) was investigated on L929 cells using an MTT test. One-way ANOVA was used for statistical analysis. RESULTS After casting, the microstructure of the Remanium CSe compact specimen composed of Ni, Cr, Mo, Si, Fe, Al, and Co had a typical dendritic structure. Alloy microparticles had an irregular shape with a wide size range: from less than 1 μm to more than 100 μm. The release of metal ions, especially Ni and Mo from microparticles, was significantly higher, compared to the compact alloy specimen. The CM prepared from compact alloy was not cytotoxic at any tested dilutions, whereas CM from alloy microparticles showed dose-dependent cytotoxicity (90% CM and 45% CM versus control; p < 0.005). CONCLUSION Ni-Cr microparticles showed less corrosion resistance and lower biocompatibility than compact alloy. This could affect health on long-term exposure, especially in sensitized individuals.
Collapse
Affiliation(s)
- Ljubisa Ristic
- Dental Clinic, Military Medical Academy, Belgrade, Serbia
| | | | | | | | | | | |
Collapse
|
29
|
Hallab NJ, Bao QB, Brown T. Assessment of epidural versus intradiscal biocompatibility of PEEK implant debris: an in vivo rabbit model. Eur Spine J 2013; 22:2740-51. [PMID: 23996005 DOI: 10.1007/s00586-013-2904-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 06/25/2013] [Accepted: 07/08/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To understand the relative histopathological effects of PEEK particulate debris when applied within the epidural versus the intervertebral disc space. We hypothesized that due to the avascular nature of the intervertebral disc acting as a barrier to immune cells, the intradiscal response would be less than the epidural response. METHODS The inflammatory effects of clinically relevant doses (3 mg/5-kg rabbit) and sizes (1.15 µm diameter) of PEEK implant debris were assed when placed dry on epidural and intradiscal tissues in an in vivo rabbit model. The size of the particulate was based on wear particulate analysis of wear debris generated from simulator wear testing of PEEK spinal disc arthroplasty devices. Local and systemic gross histology was evaluated at the 3- and 6-month time points. Quantitative immunohistochemistry of local tissues was used to quantify the common inflammatory mediators TNF-α, IL-1β, and IL-6. RESULTS Both treatments did not alter the normal appearance of the dura mater and vascular structures; however, limited epidural fibrosis was observed. Epidural challenge of PEEK particles resulted in a significant (30 %) increase (p < 0.007) in TNF-α and IL-1β at both 3 and 6 months compared to that of controls, and IL-6 at 6 months (p < 0.0001). Intradiscal challenge of PEEK particles resulted in a significant increase in IL-1β, IL-6 and TNF-α at 6-months post-challenge (p ≤ 0.03). However, overall there were only moderate increases in the relative amount of these cytokines when compared with surgical controls (10-20 %). In contrast, epidural challenge resulted in a 50-100 % increase. CONCLUSIONS The results of this study are similar to past investigations of PEEK, whose results have not been shown to elicit an aggressive immune response. The degree to which these results will translate to the clinical environment remains to be established, but the pattern of subtle elevations in inflammatory cytokines indicated both a mild persistence of responses to PEEK debris, and that intradiscal implant debris will likely result in less inflammation than epidural implant debris.
Collapse
|
30
|
Behl B, Papageorgiou I, Brown C, Hall R, Tipper JL, Fisher J, Ingham E. Biological effects of cobalt-chromium nanoparticles and ions on dural fibroblasts and dural epithelial cells. Biomaterials 2013; 34:3547-58. [DOI: 10.1016/j.biomaterials.2013.01.023] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 01/04/2013] [Indexed: 12/26/2022]
|
31
|
Hallab NJ, Caicedo M, McAllister K, Skipor A, Amstutz H, Jacobs JJ. Asymptomatic prospective and retrospective cohorts with metal-on-metal hip arthroplasty indicate acquired lymphocyte reactivity varies with metal ion levels on a group basis. J Orthop Res 2013; 31:173-82. [PMID: 22941579 PMCID: PMC3534831 DOI: 10.1002/jor.22214] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [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] [Received: 03/26/2012] [Accepted: 07/26/2012] [Indexed: 02/04/2023]
Abstract
Some tissues from metal-on-metal (MoM) hip arthroplasty revisions have shown evidence of adaptive-immune reactivity (i.e., excessive peri-implant lymphocyte infiltration/activation). We hypothesized that, prior to symptoms, some people with MoM hip arthroplasty will develop quantifiable metal-induced lymphocyte reactivity responses related to peripheral metal ion levels. We tested three cohorts (Group 1: n = 21 prospective longitudinal MoM hip arthroplasty; Group 2: n = 17 retrospective MoM hip arthroplasty; and Group 3: n = 20 controls without implants). We compared implant position, metal-ion release, and immuno-reactivity. MoM cohorts had elevated (p < 0.01) amounts of serum Co and Cr compared to controls as early as 3 months post-op (Group 1:1.2 ppb Co, 1.5 ppb Cr; Group 2: 3.4 ppb Co, 5.4 ppb Cr; Group 3: 0.01 ppb Co, 0.1 ppb Cr). However, only after 1-4 years post-op did 56% of Group 1 develop metal-reactivity (vs. 5% pre-op, metal-LTT, SI > 2), compared with 76% of Group 2, and 15% of Group 3 controls (patch testing was a poor diagnostic indicator with only 1/21 Group 1 positive). Higher cup-abduction angles (50° vs. 40°) in Group 1 were associated with higher serum Cr (p < 0.07). However, sub-optimal cup-anteversion angles (9° vs. 20°) had higher serum Co (p < 0.08). Serum Cr and Co were significantly elevated in reactive versus non-reactive Group-1 participants (p < 0.04). CD4+CD69+ T-helper lymphocytes (but not CD8+) and IL-1β, IL-12, and IL-6 cytokines were all significantly elevated in metal-reactive versus non-reactive Group 1 participants. Our results showed that lymphocyte reactivity to metals can develop within the first 1-4 years after MoM arthroplasty in asymptomatic patients and lags increases in metal ion levels. This increased metal reactivity was more prevalent in those individuals with extreme cup angles and higher amounts of circulating metal.
Collapse
Affiliation(s)
- NJ Hallab
- Dept of Ortho Surg, Rush University Medical Center, Chicago, IL 60612
| | - M Caicedo
- Dept of Ortho Surg, Rush University Medical Center, Chicago, IL 60612
| | - K McAllister
- Dept of Ortho Surg, Rush University Medical Center, Chicago, IL 60612
| | - A Skipor
- Dept of Ortho Surg, Rush University Medical Center, Chicago, IL 60612
| | - H Amstutz
- Dept Ortho Surg, Los Angeles Orthopaedic Hospital, Los Angeles, CA
| | - JJ Jacobs
- Dept of Ortho Surg, Rush University Medical Center, Chicago, IL 60612
| |
Collapse
|
32
|
Hallab NJ, Jacobs JJ. Orthopedic Applications. Biomater Sci 2013. [DOI: 10.1016/b978-0-08-087780-8.00073-5] [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: 10/27/2022]
|
33
|
Zhao M, An M, Wang Q, Liu X, Lai W, Zhao X, Wei S, Ji J. Quantitative proteomic analysis of human osteoblast-like MG-63 cells in response to bioinert implant material titanium and polyetheretherketone. J Proteomics 2012; 75:3560-73. [DOI: 10.1016/j.jprot.2012.03.033] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2011] [Revised: 02/27/2012] [Accepted: 03/19/2012] [Indexed: 02/02/2023]
|
34
|
Hallab NJ, Chan FW, Harper ML. Quantifying subtle but persistent peri-spine inflammation in vivo to submicron cobalt-chromium alloy particles. Eur Spine J 2012; 21:2649-58. [PMID: 22407269 DOI: 10.1007/s00586-012-2251-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Revised: 12/14/2011] [Accepted: 02/26/2012] [Indexed: 01/28/2023]
Abstract
PURPOSE We evaluated the consequences of cobalt-chromium alloy (CoCr) wear debris challenge in the peri-spine region to determine the inflammation and toxicity associated with submicron particulates of CoCr-alloy and nickel on the peri-spine. METHODS The lumbar epidural spaces of (n = 50) New Zealand white rabbits were challenged with: 2.5 mg CoCr, 5.0 mg CoCr, 10.0 mg CoCr, a positive control (20.0 mg of nickel) and a negative control (ISOVUE-M-300). The CoCr-alloy and Ni particles had a mean diameter of 0.2 and 0.6 μm, respectively. Five rabbits per dose group were studied at 12 and 24 weeks. Local and distant tissues were analyzed histologically and quantitatively analyzed immunohistochemically (TNF-α and IL-6). RESULTS Histologically, wear particles were observed in all animals. There was no evidence of toxicity or local irritation noted during macroscopic observations in any CoCr-dosed animals. However, Ni-treated control animals experienced bilateral hind leg paralysis and were euthanized at Day 2. Histopathology of the Ni particle-treated group revealed severe neuropathy. Quantitative immunohistochemistry demonstrated a CoCr-alloy dose-dependent increase in cytokines (IL-6, TNF-α, p < 0.05) at 12 and 24 weeks. CONCLUSIONS Subtle peri-spine inflammation associated with CoCr-alloy implant particles was dose dependent and persistent. Neuropathy can be induced by highly reactive Ni particles. This suggests peri-spine challenge with CoCr-alloy implant debris (e.g., TDA) is consistent with past reports using titanium alloy particles, i.e., mild persistent inflammation.
Collapse
Affiliation(s)
- Nadim James Hallab
- Department of Orthopaedic Surgery, Rush University Medical Center, 1735 West Harrison, Chicago, IL 60612, USA.
| | | | | |
Collapse
|
35
|
Hallab NJ, McAllister K, Brady M, Jarman-Smith M. Macrophage reactivity to different polymers demonstrates particle size- and material-specific reactivity: PEEK-OPTIMA® particles versus UHMWPE particles in the submicron, micron, and 10 micron size ranges. J Biomed Mater Res B Appl Biomater 2011; 100:480-92. [DOI: 10.1002/jbm.b.31974] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 06/08/2011] [Accepted: 07/12/2011] [Indexed: 12/24/2022]
|