Corrosion at the head-neck taper as a cause for aspetic loosening after total arthroplasty / 医学研究生学报

Metal wear debris,as the most common one,may cause aspetic loosening after total hip arthroplasty.It is gradual-ly recognized that wear of head-neck taper may produce metal wear debris after the decline of application of metal on metal prothesis. Wear of head neck taper is mainly relevant to material quality and taper connection at the head neck junction.So we wrote this review to analyze the mechanical and cellular mechanisms of wear of head -neck taper,and furthermore summarize the clinical diagnosis,pre-vention and treatment on adverse local tissue reactions based on large quantities of reference.

Recent researches and clinical progress of osteolysis after total Hip arthroplasty / 医学研究生学报

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.

Role of cannabinoid receptor 2 selective antagonist in titanium particles-induced inflammatory osteolysis / 中华创伤杂志

ObjectiveTo explore the therapeutic effect of selective antagonist-AM630 of cannabionid receptor 2 (CB2) in treatment of the titanium particles-induced inflammatory osteolysis.MethodsForty-five female BALB/c mice, 6-8 weeks old, were involved in the study, of which 15 mice were used as skull donors and the rest experimental animals were randomly divided into three groups, ie, black group, control group and treatment group, 10 mice per group.The mice model with air-pouch osteolysis induced by the titanium particles were established.The mice in the treatment group were injected with CB2 selective antagonist-AM630 (200 μg · kg-1 · d-1) intraperitoneally from two days before establishment of the air-pouch osteolysis model to two weeks after establishment of the model.Then, the mice were sacrificed and the pouch tissues were collected for molecular and histological analyses.The pouch membrane thickness and cell infiltration were tested by using computerized image analysis system and HE staining respectively.Osteoclast-like cells in the pouch membrane were determined by using tartrate-resistant acid phosphatase (TRAP) staining.Quantitative real-time polymerase chain reaction (RT-PCR) was employed to detect the mRNA levels of CB2, IL-1 β, TNF-α, receptor activator of NF-κB ligand (RANKL)and receptor activator of NF-κB (RANK).ResultsThere exhibited apparent erythematous and oedematous changes in the control group, which was mitigated around the bone implants with AM630 treatment.Quantitative image analysis of the histological sections revealed significant difference of the pouch membrane thickness among three groups, (192.2 ± 19.4)μm in control group, (88.5 ± 14.7) μm in blank group and (122.1 ± 15.2) μm in treatment group (F = 101.74, P ＜ 0.05).Intensive TRAP staining was identified much in the control group but markedly reduced after AM630 treatment in the pouch tissues.RT-PCR showed that titanium particle stimulation could enhance the expressions of CB2, IL-1 β, TNF-α, RANKL and RANK gene in the air pouch tissues.However, the mRNA levels of these genes were markedly reduced after AM630 treatment, with statistical difference compared with control group (P ＜ 0.05).ConclusionsCB2 selective antagonist AM630 can inhibit the process of titanium particlesstimulated inflammatory reaction and osteoclast activation.Therefore, CB2 represents a new suitable therapeutic candidate for the prevention and treatment of aseptic loosening of the artificial joint.

Expression of matrix metalloproteinase 2 and matrix metalloproteinase 9 induced by wear particles / 中国矫形外科杂志

[Objective] To compare the expression of matrix metalloproteinase 2(MMP-2)and matrix metalloproteinase 9(MMP-9)induced by alumina and ultra-high-molecular-weight polyethylene(UHMWPE)wear particles,and investigate the role of MMP-2 and MMP-9 in the mechanism of the periprosthetic osteolysis induced by wear debris during aseptic loosening.[Methods]Seventy-two Kunmin mice were divided into 3 groups(24 per group)in a murine air pouch model of inflammation.The air pouches were injected with 3ml of suspension containing 1?108 /ml alumina particles in group A,while UHMWPE particles in group B,and control pouches received 3ml of sterile PBS.All animals were sacrificed at 3、7、14 days after injection.Histological changes and cell counting were assessed by light microscope.RT-PCR and immunohistochemistry method were applied to detect the gene and protein expression of MMP-2 and MMP-9 in the pouches.[Results]Increased cell infiltration and MMP-2,MMP-9 mRNA and immunoreactivity expression were detected in group A and B,and compared to control group,cell number and gene and protein expression of MMP-2 and MMP-9 in group A and B was significantly higher(P

Experimerntal study of etanercept effects the wear debris-induced osteolysis / 中国矫形外科杂志

[Objective]To detect the effect of Etanercept on the Ti particles induced TNF-?IL-1 and IL-6 production by macrophage and to evaluate the validity of the etanercept on treatment of aseptic loosening of prosthesis.[Method]Separate and Cultivate mouse peritoneal macrophages were divide into 5 groups after 24 h.Group A was treated with M? alone,group B with M?+Ti particles,group C with M?+Ti particles + etanercept(10 ng/ml),group D with M? Ti particles + etanercept(100 ng/ml),group E with M? + Ti particles + etanercept(1000 ng/ml).After 18 h,the production of TNF-? IL-1 and IL-6 in culture supernatants was detected by ELISA.[Result]The levels of TNF-? IL-1 and IL-6 production were much higher in group B than those in group A,D,E(P0.05).[Conclusion]Is shows the Ti particles could stimulate M? to excrete profuse TNF-? IL-1 and IL-6 production,etanercept can significantly inhibited the production of TNF-? IL-1 and IL-6 secreted by Ti particles induced macrophages in a dose-dependent manner and hope to be a therapeutic candidate for the prevention of aseptic loosening.

Local biologic reactions induced by wear debris / 医学研究生学报

Aseptic loosening is the most common cause of implant failure after total hip replacement. Studies have shown that the aseptic loosening is related to the cellular mechanisms involved in the interactions between particulate wear debris from materials used in the prothesis and the surrounding macrophages. A fundamental understanding of how particulate debris incites the release of biologic mediators, such as the proinflammatory/proresorptive cytokines or cellular recruitment, will provide important information regarding the development of interventional therapies to prolong the life of a total hip replacement.

Intrapelvic Pseudo-tumor Caused by Polyethylene wear Debris in Total Hip Arthroplasty: A Case Report / 대한정형외과학회잡지

After total hip arthroplasty, long-term complications such as loosening, wear, osteolytic lesion and granulomatous reaction by foreign bodies can occur. Granulomatous reaction is a chronic inflammatory reaction caused by polyethylene debris, which is rarely present as a mass. The case of a pseudotumor, which required surgical intervention because of pain and its large size with compression symptoms, has not been reported yet. This 70 year old male patient was admitted complaining of RLQ pain, a palpable mass and compressed adjacent organs, 2 years after a revision total hip arthroplasty performed in September 1999. During the operation, a well-encapsulated large mass was noted, which was near the lateral side of the iliopsoas muscle and compressed the femoral nerve from the posterolateral side. Here, we report a case of pseudotumor caused by polyethylene wear debris.

Metalosis por titanio. diagnostico diferencial de masa de compartimiento iliopssoas: caso clínico / Titanium metalosis. differential diagnosis of iliopssoas compartment mass: clinical case

An 52 year-old female patient with right hip joint Tuberculosis, received a Titanium total joint arthroplasty in 1991. Eleven years later, she presented low extremity swelling and inguinal mass, which was studied with ultrasound and computed tomography. The main differential diagnosis was an iliopsoas sarcoma, so an ultrasound-guided biopsy was performed. The result was Titanium particle debris. The lesion was removed, but it recurred, so that joint replacement was required. Joint Titanium particle wear debris a condition due to particle releaseis as an arthroplasty complication. When its clinical manifestation is a pelvic mass, the main differential diagnoses include tumors and granulomatous disease. Both clinical manifestations and the radiology are variable. This pathology in patient with hip joint Titanium arthroplasty must be consided.

Se presenta el caso clínico de una paciente de 52 años con diagnóstico de tuberculosis de cadera derecha a quien en 1991 se le instala prótesis de Titanio. Once años después presenta aumento de volumen de la extremidad inferior y masa palpable en zona inguinal. Fue estudiada con ultrasonografía y tomografía computada cuyos hallazgos se describen. Se planteó como diagnóstico diferencial principal un sarcoma en compartimiento iliopsoas por lo cual se realiza biopsia bajo ultrasonografía que demostró metalosis por Titanio diagnóstico que debe ser considerado en pacientes con masa inguinal y prótesis de cadera. Se reseca la lesión, la cual recidiva, requiriendo recambio articular.

Effect Of the Polyethylene Wear On Osteolysis in Cementless Primary Total Hip Arthroplasty: Minimum 5 Years' Follow - Up Study / 대한정형외과학회잡지

We measured poiyethylene wear radiographically in 85 cementless primary total hip arthroplasties by the modified technique of Livermore et al. All the patients were followed up for at least five years (mean, 6.31 years; range, 5 years-8 years 2 months). The mean extent of linear wear was 0.88mm (range, 0.0083-3.2839mm), and the mean rate of linear wear was 0.14mm/year(range, 0.00-0.47mm /year). The mean volumetric wear was 539.42mm (range, 5.11 2022.09mm), and the mean rate of volumetric wear was 87.69mm/year(range, 0.65-290.12mm/year). The polyethylene wear was correlated inversely with the patients age only, but was not influenced by weight or gender of the patients, Harris hip score, thickness of the polyethylene, the abduction angle of acetahular cup, or the duration of in situ implantation. Osteolysis developed in the femur of 34 hips(40%) and in the acetabulum of 11 hips(12.9%). Radiographic loosening was found in one case in the femur and none in the acetabul pm. The extent of polyethylene wear was significantly correlated with frequencies and sizes of the osteolytic lesion and was not directly associated with radiographic loosening of the prostheses. Calcar resorption was observed in 39 hips(45.9%) and was not associated with polyethylene wear. These results indicated that polyethylene wear of primary total hip arthroplasty should be considered one of major causes of osteolysis and has no direct relationship with prosthesis loosening. To reduce the extent of polyethylene wear, the material characteristics of polyethylene should be improved or new, durable, articulating materials should be researched.