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Objective To determine the prosthesis survival and limb function after revision of global modular replacement system (GMRS) tumor prosthesis. Methods We retrospectively analyzed the clinical data of 16 patients who developed aseptic loosening of lower extremity tumor prosthesis and subsequently received revision with GMRS from 2009 to 2012. Kaplan-Meier method was used to calculate the 5- and 8-year survival rates of the prosthesis. The MSTS function scale was used to evaluate the functional outcomes. Results The average follow-up time was 90 months (52-118 months). The 5- and 8-year survival rates of GMRS prosthesis were both 94%. After revision, two patients failed, including one case of infection and one case of repeated aseptic loosening. The average interval between the first joint replacement and revision surgery was 81 months (27-187 months). Until the last follow-up, 93.3%(14/15) of the patients did not develop repeated aseptic loosening, 85.7%(12/14) of the patients who underwent GMRS revision had a longer loosening-free survival than those with the primary joint replacement (90.6±19.3 vs. 43.4±29.7 months, P=0.001). The average MSTS functional score was 27.7(24-30). Conclusion The incidence of repeated aseptic loosening for GMRS prosthesis is low and the limb function is good. The reported technique is satisfactory in the middle and long term.
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Objective: To explore the feasibility of establishment of a artificial joint aseptic loosening mouse model by cobalt-chromium particles stimulation. Methods: Twenty-four 8-week-old male severe combined immunodeficient (SCID) mice were divided into experimental group ( n=12) and control group ( n=12). The titanium nail was inserted into the tibial medullary cavity of mouse in the two groups to simulate artificial joint prosthesis replacement. And the cobalt-chromium particles were injected into the tibial medullary cavity of mouse in experimental group. The survival of the mouse was observed after operation; the position of the titanium nail and the bone mineral density of proximal femur were observed by X-ray film, CT, and Micro-CT bone scanning; and the degree of dissolution of the bone tissue around the tibia was detected by biomechanical test and histological staining. Results: Two mice in experimental group died, and the rest of the mice survived until the experiment was completed. Postoperative imaging examination showed that there was no obvious displacement of titanium nails in control group, and there were new callus around the titanium nails. In experimental group, there was obvious osteolysis around the titanium nails. The bone mineral density of the proximal tibia was 91.25%±0.67%, and the maximum shear force at the tibial nail-bone interface was (5.93±0.85) N in experimental group, which were significantly lower than those in control group [102.07%±1.87% and (16.76±3.09) N] ( t=5.462, P=0.041; t=3.760, P=0.046). Histological observation showed that a large number of inflammatory cells could be seen around the titanium nails in experimental group, while there was no inflammatory cells, and obvious bone tissue formation was observed in control group. Conclusion: The artificial joint aseptic loosening mouse model can be successfully established by cobalt-chromium particles stimulation.
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BACKGROUND: Aseptic loosening of the femoral prosthesis is one of the important issues affecting the life of knee joint replacement. Particles from tibial polyethylene component wear and stress shielding are the main causes of this loosening, which are all related to the femoral prosthesis materials. OBJECTIVE: To study the effects of femoral prosthesis materials on the stress of the distal femur of the knee joint and the contact pressure on the polyethylene component by finite element method. METHODS: Knee arthroplasty models with four materials, titanium alloy, cobalt-chromium alloy, titanium-hydroxyapatite functional gradient biomaterial (FGBM I), titanium-bioactive glass functional gradient biomaterial (FGBM II), were established; the prosthesis was endowed with different material properties in the Abaqus finite element software. The stress distribution of the important vulnerable path in the femur and the changes of contact pressure on the polyethylene component under different materials were studied. RESULTS AND CONCLUSION: (1) Compared with the currently used titanium alloy and cobalt-chromium alloy, functional gradient biomaterials could significantly increase the stress at the femoral-prosthetic interface and the stress in the pathway of an important vulnerable region of the femur. In those materials, FGBM I increased most significantly. (2) Maximum stress of FGBM I and FGBM II prostheses on polyethylene insert was 20.41% and 19.98% lower than cobalt-chromium alloy, 20.07% and 19.63% lower than titanium alloy. (3) The results showed that functionally gradient biomaterials could produce higher stress at the distal end of the femur and lower contact pressure on the polyethylene insert, reducing the wear and stress shield on polyethylene insert, and FGBM I has significant effects.
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BACKGROUND: Obtaining synovial fluid for diagnostic test of periprosthetic joint infection is invasive and painful to patients. Platelet count is a regular blood test which has been used as a possible predictor of several infectious diseases. Presumably, it could be one of the indicators of periprosthetic joint infection. OBJECTIVE: To identify the accuracies of platelet combined with white blood cell, erythrocyte sedimentation rate or C-reactive protein in the diagnosis of periprosthetic joint infection. METHODS: Patients undergoing revision arthroplasty from March 2013 to December 2018 in the First Affiliated Hospital of Guangzhou University of Chinese Medicine were retrospectively enrolled. A diagnosis of periprosthetic joint infection was confirmed in 77 patients according to the criterions from the Musculoskeletal Infection Society; the remaining 137 patients were confirmed as aseptic cases. White blood cell, erythrocyte sedimentation rate, or C-reactive protein and platelet count were compared between the two groups. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated. RESULTS AND CONCLUSION: The platelet values were significantly increased in periprosthetic joint infection cases. Sensitivity and specificity of the platelet for periprosthetic joint infection were 64.94% and 86.13%, respectively. Platelet demonstrated a higher accuracy when compared to erythrocyte sedimentation rate and C-reactive protein. In such cases, the platelet shows a certain reference value in confirming the diagnosis of periprosthetic joint infection. Platelet was enough used as adjunct diagnostic tool in patients suspected with periprosthetic joint infection.
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BACKGROUND: Obtaining synovial fluid for diagnostic test of periprosthetic joint infection is invasive and painful to patients. Platelet count is a regular blood test which has been used as a possible predictor of several infectious diseases. Presumably, it could be one of the indicators of periprosthetic joint infection. OBJECTIVE: To identify the accuracies of platelet combined with white blood cell, erythrocyte sedimentation rate or C-reactive protein in the diagnosis of periprosthetic joint infection. METHODS: Patients undergoing revision arthroplasty from March 2013 to December 2018 in the First Affiliated Hospital of Guangzhou University of Chinese Medicine were retrospectively enrolled. A diagnosis of periprosthetic joint infection was confirmed in 77 patients according to the criterions from the Musculoskeletal Infection Society; the remaining 137 patients were confirmed as aseptic cases. White blood cell, erythrocyte sedimentation rate, or C-reactive protein and platelet count were compared between the two groups. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated. RESULTS AND CONCLUSION: The platelet values were significantly increased in periprosthetic joint infection cases. Sensitivity and specificity of the platelet for periprosthetic joint infection were 64.94％ and 86.13％, respectively. Platelet demonstrated a higher accuracy when compared to erythrocyte sedimentation rate and C-reactive protein. In such cases, the platelet shows a certain reference value in confirming the diagnosis of periprosthetic joint infection. Platelet was enough used as adjunct diagnostic tool in patients suspected with periprosthetic joint infection.
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PURPOSE: The purpose was to evaluate and compare the revision rate due to aseptic loosening between a high-flex prosthesis and a conventional prosthesis. MATERIALS AND METHODS: Two thousand seventy-eight knees (1,377 patients) with at least 2 years of follow-up after total knee arthroplasty were reviewed. Two types of implants were selected (LPS-Flex and LPS, Zimmer) to compare revision and survival rates and sites of loosened prosthesis component. RESULTS: The revision rate of the LPS-Flex (4.9%) was significantly higher than that of the conventional prosthesis (0.6%) (p<0.001). The 5-, 10-, and 15-year survival rates were 98.9%, 96.2% and 92.0%, respectively, for the LPS-Flex and 99.8%, 98.5% and 93.5%, respectively, for the LPS. The survival rate of the high-flex prosthesis was significantly lower than that of the conventional prosthesis, especially in the mid-term period (range, 5 to 10 years; p=0.002). The loosening rate of the femoral component was significantly higher in the LPS-Flex prosthesis (p=0.001). CONCLUSIONS: The LPS-Flex had a higher revision rate due to aseptic loosening than the LPS prosthesis in the large population series with a long follow-up. The LPS-Flex should be used carefully considering the risk of femoral component aseptic loosening in the mid-term (range, 5 to 10 years) follow-up period after initial operation.
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Arthroplasty , Arthroplasty, Replacement, Knee , Follow-Up Studies , Knee Prosthesis , Knee , Prostheses and Implants , Survival RateABSTRACT
Objective The dynamic detection of endotoxin is of great significance for the early diagnosis and treatment of prosthesis loosening after joint replacement. This study aimed to explore and analyze the clinical significance and efficacy of endotoxin detection in prosthetic joint loosening after joint replacement.Methods Fifty-eight patients who underwent arthroplasty in the department of orthopedics in Nanjing General Hospital from January 2015 to June 2016 were selected for prospective study. The patients were divided into the infection loosening group (patients with infectious loosening after arthroplasty, n=15), the aseptic loosening group (patients with aseptic loosening of after arthroplasty, n=23) and the control group (patients were normal after arthroplasty, n=20) according to the postoperative complications. Endotoxin was detected with MB-80 microbial dynamic rapid detection system. We compared the endotoxin level and the ROC curve was made to acquire the sensitivity and specificity under the different cut-off values. Eventually find the best diagnostic threshold.Results The levels of endotoxin in the infection loosening group and the aseptic loosening group \[(0.56±0.11, 0.49±0.08) ng/mL\] were significantly higher than that in the control group \[(0.24±0.06) ng/mL\]. The difference was statistically significant (P0.05). ROC curve analysis showed that when the serum endotoxin concentration was 0.36 ng/mL, the Youden index was the highest, which could be the best cut-off value for diagnosis. It had the best accuracy to judge the prosthesis loosening with a sensitivity of 66.7% and specificity of 88.2%.Conclusion The endotoxin can be a good indicator for early diagnosis of prosthesis looseness. It is helpful to the diagnosis of the prosthesis loosening after arthroplasty.
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Aseptic loosening is one of the most commonly seen longterm complications after joint arthroplasty. Previous stud-ies have shown that prosthetic wear is one of the major causes of chronic inflammation in tissues surrounding the prosthesis,and that macrophage is the key factor responsible for the interaction between prostheses-derived wear particles and the host. Wear particles acti-vate macrophages and secretion of inflammatory mediators stimulate osteoclastic bone resorption,resulting in reduction of bone mass a-round the prosthesis. However,the balance of bone turnover depends not only on osteoclast-mediated bone resorption but also on osteo-blast-mediated bone formation,both of which are in close cooperation. Osteoblasts are mainly derived from mesenchymal stem cells. A growing body of research shows that wear particles can significantly inhibit the differentiation of mesenchymal stem cell into osteoblasts and subsequent bone formation. However,some characteristics of mesenchymal stem cells enable them one of the main candidates for the treatment of aseptic loosening. We reviewed the current research advances on the aseptic loosening post arthroplasty using mesen-chymal stem cells as target.
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Objective At present, there is little report of clinical results of metal-on-metal HRA in China.This study was aimed at retrospectively analyzing the factors of survival rate of HRA in China. Methods A retrospective study was conducted in 113 patients who accepted HRA in our hospital from September 2005 to May 2010.All patients were followed up by telephone or outpatient visit,and the average follow-up time was 10.2 years.The clinical function was evaluated by Harris score,and the prosthesis was evalu-ated by pelvic film.Inductively coupled plasma mass spectrometry(ICP-MS)was used to detect the concentration of blood metal ions, ultrasound and MRI were used to screen and diagnose inflammatory pseudotumor.Cox proportional hazards models were used to analyze the factors affecting the survival rate of the prosthesis. Results A total of 91 patients(120 hips)were followed up while 22 patients (26 hips)were lost,the follow-up rate was 80.5%.17 patients underwent revision surgeries,including 8 cases of femoral neck fracture and 8 cases of aseptic loosening,the other one was infection.Revision in 13 cases was within 3 years, the proportion was as high as 76.5%.The 10-year survival rate of prosthesis was 87.1%,the abduction angle of acetabular prosthesis is the only risk factor affecting the survival. Conclusion Postoperative survival rate of HRA is relatively high, and the survival rate of prosthesis is relevant to socket position.We should notice that the risk increased when the acetabular abduction angle of the prosthesis was over 55 degree.O-verall,HRA is still a successful surgical method.
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Aseptic loosening is the most common chronic complication of total joint arthroplasty,which significantly shortens the life span of prosthesis and leads to mental stress and heavy economic burden of patients.Hence,how to overcome aseptic loosening is a focus in the research of joint arthroplasty.A series of mechanisms participates the pathogenesis of aseptic loosening,including oste-olysis induced by wear particles,micromotion,stress shielding,high fluid pressure,endotoxin and genetic factors.Osteolysis induced by wear particles is the most recognized mechanism.The latest study suggested that autophagy,epigenetic regulation and immunologic derangement all participate the development of osteolysis induced by wear particles.However,the prevention,treatment and even the concept of aseptic loosening is still controverial.We hope that the future study will provide a definite mechanism for aseptic loosening and provide new theoretic evidence for the prevention and treatment of aseptic loosening.
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Osteolysis is a primary reason causing aspetic loosening after total hip arthroplasty.But it still lacks of understand-ing of pathogenesis, special biomarkeres for diagnosis, drugs for prevention and clinical classification guiding treatment.This review aims to summarize the fundamental researches and the clinical diagnosis as well as the prevention and treatment of osteolysis based on our previous work and large quantities of references.
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Objective To investigate the effect of amentoflavone(AMF)on inhibiting wear debris-in-duced osteolysis in vivo and RANKL-induced osteoclastogenesis in vitro. Methods Twenty-four male C57BL/J6 mice were randomly divided into four groups:the control group,titanium group,the low and high concentration group.Micro-CT and histological analysis were performed.CCK-8 assay was used to determin the effect of AMF on the proliferation of BMMs.TRAP staining and bone resorption assays were used to investigate the effect of AMF on osteoclastogenesis and function. The effect of AMF on prevention MAPK signaling was detected by Western blot assay. Results AMF could prevent osteolysis in vivo and suppress osteoclastogenesis,bone resorption without cytotoxicity in vitro.AMF suppressed MAPK signaling pathways.Conclusion AMF could inhibit osteoclastogenesis and titanium debris-induced osteolysis through suppressing MAPK signaling.
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The imbalance between bone formation and osteolysis plays a key role in the pathogenesis of aseptic loosening. Strontium ranelate (SR) can promote bone formation and inhibit osteolysis. The aim of this study was to explore the role and mechanism of SR in aseptic loosening induced by wear particles. Twenty wild-type (WT) female C57BL/6j mice and 20 sclerostin-/- female C57BL/6j mice were used in this study. Mice were randomly divided into four groups: WT control group, WT SR group, knockout (KO) control group, and KO SR group. We found that SR enhanced the secretion of osteocalcin (0.72±0.007 in WT control group, 0.98±0.010 in WT SR group, P=0.000), Runx2 (0.34±0.005 in WT control group, 0.47±0.010 in WT SR group, P=0.000), β-catenin (1.04±0.05 in WT control group, 1.22±0.02 in WT SR group, P=0.000), and osteoprotegerin (OPG) (0.59±0.03 in WT control group, 0.90±0.02 in WT SR group, P=0.000). SR significantly decreased the level of receptor activator for nuclear factor-κB ligand (RANKL) (1.78±0.08 in WT control group, 1.37±0.06 in WT SR group, P=0.000) and improved the protein ratio of OPG/RANKL, but these effects were not observed in sclerostin-/- mice. Our findings demonstrated that SR enhanced bone formation and inhibited bone resorption in a wear particle-mediated osteolysis model in wild-type mice, and this effect relied mainly on the down-regulation of sclerostin levels to ameliorate the inhibition of the canonical Wnt pathway.
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Animals , Female , Rabbits , Osteolysis/drug therapy , Artificial Limbs , Thiophenes/pharmacology , Bone Resorption/drug therapy , Prosthesis Implantation , Lower Extremity/surgery , Biomechanical Phenomena , Enzyme-Linked Immunosorbent Assay , Blotting, Western , Mice, Inbred C57BLABSTRACT
Objective To explore the correlation between HIF-1α expression and RANKL/OPG pathway activation of fibroblast-like synoviocytes(FLSs)induced by Ti particles in aseptic loosening interfacial membrane. Method FLSs were extracted from the synovial tissue collected in surgeries and then co-cultured with Ti particles. QRT-PCR and Western blotting were conducted to measure the mRNA and protein expression of RANKL ,OPG and HIF-1αin FLSs at different concentration and time. Results Genes and protein expression levels of RANKL/OPG and HIF-1α were up-regulated with the increase of concentration of Ti particles. Expression of HIF-1α gene and protein increased time-dependently;the mRNA and protein expression of RANKL/OPG increased firstly and then declined alongside the increase of HIF-1αexpression. Conclusions Ti particles induce the up-regulation of HIF-1α expression and activate RANKL/OPG pathway. Up-regulation of HIF-1α may suppress the activation of RANKL/OPG pathway in FLSs of the interfacial membrane induced by Ti particles.
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OBJECTIVE:To study the effect of tanshinone on inflammatory response in air-pouch model mice with artificial joint aseptic loosening. METHODS:Mice were randomly divided into blank control group(normal saline),titanium particle group (normal saline),tanshinone low-dose,medium-dose,high-dose groups(50,100,200 mg/kg),10 in each group. Air-pouch mod-els were induced. Except that mice were injected 0.5 mL normal saline into air-pouch in blank control group,other groups were in-jected 0.5 mL Titanium particle suspension(10 mg/mL)into air-pouch,continuously administrated medicines by 0.1 mL/10 g after 24 h,ig,for 14 d. After 24 h of last administration,the air-pouch was collected,air-pouch inflammation was observed by eyes and by microscopy after hematoxylin-eosin staining,and inflammatory cell density was calculated. Real-time quantitative poly-merase chain reaction method was conducted to detect the tumor necrosis factor α(TNF-α),interleukin 1β(IL-1β)mRNA expres-sion;enzyme-linked immunosorbent method was used to detect the TNF-α,IL-1β protein expression. RESULTS:Compared with blank control group,air-pouch swelling was obvious in titanium particle group,much exudation and neovascular were observed,in-flammatory response was severe,inflammatory cell density was increased significantly(P<0.05);TNF-α,IL-1β mRNA and pro-tein expression were obviously enhanced(P<0.05). Compared with titanium particle group,air-pouch swelling was relieved in tan-shinone doses groups,exudation and neovascular were decreased,inflammatory response was relieved,inflammatory cell density was decreased significantly(P<0.05);TNF-α,IL-1β mRNA and protein expression were obviously decreased(P<0.05),with a dose-dependent manner. CONCLUSIONS:Tanshinone can effectively inhibit the aseptic inflammatory response in air-pouch model mice with artificial joint aseptic loosening.
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Aseptic loosening, ascribes to particle induced osteolysis, is the most common reason for total joint arthroplasty failure. Wear particles, liberated from the surface of prostheses, mediate the expression of inflammatory cytokines in macrophages and increase the osteoclastogenesis. However, it remains unclear how macrophages can recognize wear particles and be induced by wear particles. Recently, a number of studies have demonstrated that Toll like receptors and inflammasome may play a critical role in osteolysis. However, the mechanism of activation of Toll like receptors and the relationship between TLR pathway and downstream signaling pathways still remain unclear. It will be beneficial to understand the pathogenesis of aseptic loosening by exploring these mechanisms. This article highlights the role of Toll like receptors and inflammasome in aseptic loosening, which is helpful to the development of therapies that prevent wear particle induced aseptic loosening.
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Objective To investigate effect of alendronate on prevention of aseptic loosening prothesis.Method Twelve beagles which had been implanted a titanium plug in femur were divided into two groups randomly,one received alendronate,and the other placebo as control.After 12 weeks,all beagles were sacrificed.specimens of femur were studied by biomechanical test.Independent sample t test was used for statistical analyses.Results The pull-out strength of the experimental group was higher than that of the control (P ＜ 0.05),and the torsion strength was also higher in the experimental group(P ＜ 0.05).Conclusion The therapy of alendronate can change the bone strength,inhibit aseptic loosening of prosthesis in beagle and could be a good drug for the prevention and treatment of aseptic loosening prothesis.
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10.3969/j.issn.2095-4344.2013.26.005
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Objective To propose some detailed methods for diagnosis of aseptic loosening failure in clinic by studying the mechanical mechanism and the specific causes of aseptic loosening failure after the total hip arthroplasty (THA). Methods The causes of aseptic loosening were investigated from the view of biomechanics, such as strength of the bone cement layer, interface fretting, stress shielding, wear and osteolysis; the relationships between aseptic loosening failure and products, clinical and patient factors were analyzed; the method to detect loosening before the revision surgery was also studied. Results The reasoning route for aseptic loosening failure analysis after THA was proposed, and detection of aseptic loosening with fluoroscopic analysis (FSA) technique before the revision surgery was conducted successfully. Conclusions The reasoning route for aseptic loosening failure analysis can help to discover reasons of failure occurrence. Loosening can be detected and confirmed in vivo by FSA method, which can also assist the clinician for diagnosis and treatment of aseptic loosening after the THA.
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Objective: To analyze the cause of prosthesis loosening by observing the interface membranes harvested during the hip restoration operation. Methods: A total of 28 specimens of interface membrane around the loose prosthesis were harvested from 28 patients undergoing the restoration of total hip replacement. All the specimens underwent the observation of appearance, light microscopy and scanning electronic microscopy(SEM). Results: All the gaps around the loose prosthesis were filled with interface membrane of different thickness. The color of the most interface membrane was madder red, and the other one third of membrane was black. The comparatively thicker membrane was similar to scar connective tissue while the thinner was similar to fiber membrane. A large number of wear debris, macrophages and foreign-body giant cells were found under light microscope. With SEM observation a large number of different diameter collagen fibra structures that looked like scar tissues were arranged disorderly in a great mass, foreign particles and bone debris of different size were distributed unevenly, and the fibroblast was distributed in the collagen fiber. Conclusion: Wear debris is related to inflammatory cell response around the interface membrane of the loose prosthesis. The wear debris engulfed by macrophage stimulates the interface membrane to release bone resorption factors (such as TNF) which lead to osteolysis, and this is one of the most important causes of the prosthesis loosening.