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Axenhus M, Bodén H, Kelly-Pettersson P, Sköldenberg O. Denosumab for treating periprosthetic osteolysis: a feasibility study. BMC Res Notes 2025; 18:151. [PMID: 40200363 PMCID: PMC11980280 DOI: 10.1186/s13104-025-07216-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2024] [Accepted: 03/31/2025] [Indexed: 04/10/2025] Open
Abstract
OBJECTIVE Wear-induced osteolysis is a leading cause of late failure in total hip arthroplasty (THA). Denosumab, a RANKL inhibitor, suppresses osteoclast activity and may slow osteolytic progression. This feasibility study aimed to assess the practicality of conducting a randomized, double-blind, placebo-controlled trial evaluating Denosumab's effect on periprosthetic osteolysis in asymptomatic THA patients. RESULTS Twelve patients were enrolled; ten completed follow-up. No significant difference in lesion volume change was observed between groups (Denosumab: +1.53 cm³; Placebo: +0.49 cm³). Secondary clinical outcomes also showed no notable differences. The trial protocol, recruitment, treatment, and follow-up were feasible, though slow enrollment limited statistical power. This study demonstrates the feasibility of a larger trial investigating Denosumab for osteolysis prevention. TRIAL REGISTRATION Clinicaltrails.gov, NCT02299817. Registered 20 November 2014. https://www. CLINICALTRIALS gov/study/NCT02299817?term=Denosumab%20for%20Treating%20Periprosthetic%20Osteolysis.%26;rank=1.
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Affiliation(s)
- Michael Axenhus
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
- Department of Orthopaedics, Danderyd University Hospital, Entrévägen 2 182 68, Danderyd, Stockholm, Sweden.
| | - Henrik Bodén
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
- Department of Orthopaedics, Danderyd University Hospital, Entrévägen 2 182 68, Danderyd, Stockholm, Sweden
| | - Paula Kelly-Pettersson
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
- Department of Orthopaedics, Danderyd University Hospital, Entrévägen 2 182 68, Danderyd, Stockholm, Sweden
| | - Olof Sköldenberg
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
- Department of Orthopaedics, Danderyd University Hospital, Entrévägen 2 182 68, Danderyd, Stockholm, Sweden
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Fracka AB, Allen MJ, Dejardin LM. Long-term clinical outcomes and retrieval analysis of a cementless total knee replacement in a dog. Vet Surg 2025; 54:621-631. [PMID: 39400340 PMCID: PMC11947295 DOI: 10.1111/vsu.14175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2024] [Revised: 09/17/2024] [Accepted: 09/27/2024] [Indexed: 10/15/2024]
Abstract
OBJECTIVE The aim of the study was to describe long-term outcomes and report post-retrieval implant analysis following cementless total knee replacement (TKR) in a dog. ANIMAL A seven-year-old, male neutered, Labrador retriever. METHODS The dog presented for evaluation of chronic left pelvic limb lameness. Orthopedic examination identified bilateral cranial drawer and medial buttress. Radiographs revealed severe bilateral osteoarthritis with moderate joint effusion/synovial hypertrophy. Given the end-stage osteoarthritis, TKR was considered more appropriate than tibial plateau leveling osteotomy (TPLO). The dog underwent a left cementless TKR. RESULTS Immediate postoperative radiographs showed appropriate implant positioning. Moderate left pelvic limb lameness with full, pain free and stable stifle range of motion (ROM) was documented at 2 weeks. Increased left hindlimb weight-bearing with a peak vertical force of 70% bodyweight (BW) versus 50% BW on the contralateral leg was reported at 6 weeks. Radiographs showed good implant osseointegration. Left stifle ROM was 50°/170°, a 30° increase compared to preoperative values. Additional rechecks at 14 and 30 weeks showed gradual improvement in stifle ROM and weight-bearing. The dog was euthanized 6 years after surgery for reasons unrelated to TKR. Radiographs demonstrated static implant position without signs of osteolysis and gross examination revealed mild polyethylene wear on the caudal aspects of the tibial insert. Histological evaluation of the implant-bone interface showed extensive and robust osseointegration. CONCLUSION This case demonstrates that cementless TKR can be associated with excellent clinical function over the course of at least 6 years and suggests that early surgical intervention could be considered.
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Affiliation(s)
- Agnieszka B. Fracka
- College of Veterinary MedicineMichigan State UniversityEast LansingMichiganUSA
| | - Matthew J. Allen
- Department of Veterinary MedicineUniversity of CambridgeCambridgeUK
| | - Loic M. Dejardin
- College of Veterinary MedicineMichigan State UniversityEast LansingMichiganUSA
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Yılmaz MK, Baochao J, Çakır N, Uzun A, Abbas AA, Culp B, Torga-Spak R, Azboy İ. Should Patient Activity Be Restricted After Total Hip, Total Knee, or Unicondylar Knee Arthroplasty? J Arthroplasty 2025; 40:S52-S54. [PMID: 39428011 DOI: 10.1016/j.arth.2024.10.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2024] [Revised: 10/08/2024] [Accepted: 10/08/2024] [Indexed: 10/22/2024] Open
Affiliation(s)
- Mehmet K Yılmaz
- Faculty of Medicine, Department of Orthopaedics and Traumatology, İstanbul Medipol University, İstanbul, Türkiye
| | - Ji Baochao
- Department of Orthopedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Niyazi Çakır
- Faculty of Medicine, Department of Orthopaedics and Traumatology, İstanbul Medipol University, İstanbul, Türkiye
| | - Alparslan Uzun
- Faculty of Medicine, Department of Orthopaedics and Traumatology, İstanbul Medipol University, İstanbul, Türkiye
| | - Azlina A Abbas
- National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur
| | - Brian Culp
- Penn Medicine, Princeton Health, Princeton Orthopaedic Associates, Princeton, New Jersey
| | | | - İbrahim Azboy
- Faculty of Medicine, Department of Orthopaedics and Traumatology, İstanbul Medipol University, İstanbul, Türkiye
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Liu F, Gao L, Wang D, Zhang Q. The addition of vitamin E could reduce femoral head penetration of the polyethylene liners. J Orthop Surg Res 2025; 20:72. [PMID: 39833940 PMCID: PMC11744862 DOI: 10.1186/s13018-024-05402-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2024] [Accepted: 12/21/2024] [Indexed: 01/22/2025] Open
Abstract
BACKGROUND Vitamin E-diffused highly cross-linked polyethylene (HXLPE/Vit E) is a relatively advanced material used in total hip arthroplasty (THA) but whether it shows superiority is unclear. OBJECTIVE This meta-analysis was performed to investigate the effect of HXLPE/Vit E liners in THA. METHODS Medline/PubMed, Embase and Cochrane Library databases were searched to retrieve studies assessing the efficacy of HXLPE/Vit E liners in THA with the design of a randomized, controlled trial. Meta-analyses were conducted to merge the outcome estimates of interest, such as the femoral head penetration (FHP), FHP rate, FHP in x- (medial/lateral), y- (vertical) and z- (anteroposterior) axes, cup inclination angle, Harris hip score (HHS), numeric rating scale (NRS) and complications. Then pooled outcomes at different time points during the follow-up period were calculated. RESULTS Follow an elaborate search of related databases, 23 studies involving a total of 54,920 participants were deemed eligible for this meta-analysis. The pooled results revealed significant decreased FHP at the last follow-up (pooled Mean Difference [MD] = -0.10, 95% confidence intervals [CIs]: -0.14 to -0.06). The subgroup analysis revealed a consistent trend at different time points during the follow-up. Significant decrease in the FHP rate were identified at the postoperative 1-2 years (pooled MD = -0.01, 95% CIs: -0.02 to -0.00) rather than at 2-5, 5-7, and 7-10 years. The combined results of clinical scores demonstrated no significant changes in the HHS, NRS, and EQ-5D variables. Additionally, no significant differences in the revision and cup inclination angle were identified during the follow-up period. CONCLUSIONS This study indicated that HXLPE/Vit E liner in total hip arthroplasty may decrease the femoral head penetration, mainly due to the decreased wear in proximal directions. However, no improvement on the clinical functions and complications were identified, and whether HXLPE/Vit E has the potential to prevent implant loosening or revision surgery could not be identified, which requires to be elaborated by high-quality randomized controlled trials.
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Affiliation(s)
- Fanxiao Liu
- Department of Orthopaedics, Liaocheng People's Hospital, Liaocheng, Shandong, P.R. China
- Department of Orthopaedics, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, P.R. China
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, P.R. China
| | - Ling Gao
- Scientific Center, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, 250021, China.
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.
| | - Dawei Wang
- Department of Orthopaedics, Liaocheng People's Hospital, Liaocheng, Shandong, P.R. China.
| | - Qingyu Zhang
- Department of Orthopaedics, Liaocheng People's Hospital, Liaocheng, Shandong, P.R. China.
- Department of Orthopaedics, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, P.R. China.
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, P.R. China.
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Johannessen HG, Hallan G, Kadar T, Fenstad AM, Lygre SHL, Haugan K, Høl PJ, Badawy M, Jonsson B, Indrekvam K, Aamodt A, Furnes O. Polyethylene wear and cup migration of cemented total hip arthroplasty with femoral heads made of oxidized zirconium, steel, or cobalt chromium: a 10-year secondary analysis from a randomized trial using radiostereometry. Acta Orthop 2024; 95:578-585. [PMID: 39347798 PMCID: PMC11441331 DOI: 10.2340/17453674.2024.41945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 08/26/2024] [Indexed: 10/01/2024] Open
Abstract
BACKGROUND AND PURPOSE We aimed to evaluate polyethylene (PE) wear, cup migration, and clinical outcome over 10 years in total hip arthroplasties (THA) using different articulations. METHODS This is a secondary analysis of 150 patients randomized into 5 groups, using different articulations: Charnley/Charnley Ogee for steel and conventional polyethylene (CPE), or Spectron EF/Reflection with either CPE or highly cross linked polyethylene (XLPE) cups, paired with heads made of either cobalt-chromium (CoCr) or oxidized zirconium (OxZr). All cups were cemented. Patients underwent repeated radiostereometric analysis (RSA) measurements for up to 10 years to assess wear and migration. Clinical outcome was assessed using Harris Hip Score (HHS). RESULTS After 10 years, the XLPE cups demonstrated low wear rates: 0.08 mm (95% confidence interval [CI] -0.11 to 0.26 mm) with CoCr heads and 0.06 mm (CI -0.14 to 0.26 mm) with OxZr heads, with a mean difference of 0.01 mm (CI -0.26 to 0.29 mm). In contrast, CPE cups exhibited significantly more wear: 1.35 mm (CI 1.16 to 1.55 mm) with CoCr heads and 1.68 mm (CI 1.44 to 1.92 mm) with OxZr heads, with a mean difference of 0.33 mm (CI 0.02 to 0.64 mm). The Charnley/Ogee group (CPE) showed PE wear of 0.34 mm (CI 0.12 to 0.56 mm). The CPE groups with OxZr and CoCr heads had 0.67 mm (CI 0.38 to 0.96 mm) and 0.35 mm (CI 0.09 to 0.61 mm) greater proximal migration respectively than the corresponding XLPE groups. HHS was similar across all groups. CONCLUSION We found no significant advantage of OxZr over CoCr heads in reducing wear or migration. XLPE demonstrated a major reduction in wear as well as a reduction in cup migration compared with CPE. Charnley performed better than the other CPE cups in terms of PE wear and cup migration. No differences in clinical outcome were found.
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Affiliation(s)
| | - Geir Hallan
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen; Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen; Coastal Hospital in Hagavik, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Thomas Kadar
- Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway
| | - Anne Marie Fenstad
- Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Stein Håkon Låstad Lygre
- Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen; Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
| | - Kristin Haugan
- Department of Orthopaedic Surgery, St. Olavs Hospital, Trondheim, Norway
| | - Paul Johan Høl
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen; Department of Orthopaedic Surgery, Biomatlab, Haukeland University Hospital, Bergen, Norway
| | - Mona Badawy
- Coastal Hospital in Hagavik, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | | | - Kari Indrekvam
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen; Coastal Hospital in Hagavik, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Arild Aamodt
- Department of Orthopaedic Surgery, Lovisenberg Diakonal Hospital, Oslo, Norway
| | - Ove Furnes
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen; Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
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Zhao C, Rong K, Liu P, Kong K, Li H, Zhang P, Chen X, Fu Q, Wang X. Preventing periprosthetic osteolysis in aging populations through lymphatic activation and stem cell-associated secretory phenotype inhibition. Commun Biol 2024; 7:962. [PMID: 39122919 PMCID: PMC11315686 DOI: 10.1038/s42003-024-06664-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 07/31/2024] [Indexed: 08/12/2024] Open
Abstract
With increases in life expectancy, the number of patients requiring joint replacement therapy and experiencing periprosthetic osteolysis, the most common complication leading to implant failure, is growing or underestimated. In this study, we found that osteolysis progression and osteoclast differentiation in the surface of the skull bone of adult mice were accompanied by significant expansion of lymphatic vessels within bones. Using recombinant VEGF-C protein to activate VEGFR3 and promote proliferation of lymphatic vessels in bone, we counteracted excessive differentiation of osteoclasts and osteolysis caused by titanium alloy particles or inflammatory cytokines LPS/TNF-α. However, this effect was not observed in aged mice because adipogenically differentiated mesenchymal stem cells (MSCs) inhibited the response of lymphatic endothelial cells to agonist proteins. The addition of the JAK inhibitor ruxolitinib restored the response of lymphatic vessels to external stimuli in aged mice to protect against osteolysis progression. These findings suggest that inhibiting SASP secretion by adipogenically differentiated MSCs while activating lymphatic vessels in bone offers a new method to prevent periprosthetic osteolysis during joint replacement follow-up.
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Affiliation(s)
- Chen Zhao
- Department of Orthopedics, Shanghai Key Laboratory of Orthopedics Implant, the Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kewei Rong
- Department of Orthopedics, Shanghai Key Laboratory of Orthopedics Implant, the Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Pengcheng Liu
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Keyu Kong
- Department of Orthopedics, Shanghai Key Laboratory of Orthopedics Implant, the Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haikuo Li
- Division of Biology & Biomedical Sciences, Washington University in St. Louis School of Medicine, St. Louis, USA
| | - Pu Zhang
- Department of Orthopedics, Shanghai Key Laboratory of Orthopedics Implant, the Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xuzhuo Chen
- Department of Oral Surgery, Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiang Fu
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Xiaoqing Wang
- Department of Orthopedics, Shanghai Key Laboratory of Orthopedics Implant, the Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Radtke L, Frandsen JJ, Lancaster AJ, Loughmiller S, Blackburn BE, Soltanolkotabi M, Anderson LA, Gililland JM. Early Radiographic and Clinical Outcomes of an Additive-Manufactured Acetabular Component. Arthroplast Today 2024; 27:101371. [PMID: 38585285 PMCID: PMC10995801 DOI: 10.1016/j.artd.2024.101371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 02/14/2024] [Accepted: 02/28/2024] [Indexed: 04/09/2024] Open
Abstract
Background Additive manufacturing has recently gained popularity and is widely adopted in the orthopaedic industry. However, there is a paucity of literature on the radiographic and clinical outcomes of these relatively novel components. The aim of this study was to assess the 2-year clinical and radiographic outcomes of a specific additive-manufactured acetabular component in primary total hip arthroplasty. Methods We performed a retrospective review of 60 patients who underwent primary total hip arthroplasty with the use of the Stryker's TRIDENT II acetabular component. Evaluation of radiographs was performed at 6 weeks, 1 year, and 2 years postoperatively. Radiographs were evaluated for radiolucencies in Charnley and DeLee zones, signs of biologic fixation, and acetabular inclination and anteversion measurements. Patient-reported outcomes and complications were also obtained. Results There were no cases of component loosening or changes in component position during follow-up, with an average follow-up time of 1.7 years. A radiolucent line was identified in one patient in zone 1 at 6 weeks; this was absent at 1 year. Radiographic signs of cup biologic fixation were present in 85% of cases by final follow-up. The average inclination was 45.1 (SD = 4.0), and the average anteversion was 26.9 (SD = 5.2). Patient-Reported Outcomes Measurement Information System scores significantly increased at the final follow-up, and there were no complications in this cohort. Conclusions This study demonstrated excellent radiographic and clinical outcomes with this novel additive-manufactured acetabular component at early follow-up. Although longer-term follow-up is warranted, this additively manufactured highly porous titanium acetabular component demonstrated excellent biologic fixation and reliable fixation at mid-term follow-up.
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Affiliation(s)
- Logan Radtke
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Jeffrey J. Frandsen
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Alex J. Lancaster
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Shanna Loughmiller
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Brenna E. Blackburn
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Maryam Soltanolkotabi
- Department of Radiology and Imaging Services, University of Utah, Salt Lake City, UT, USA
| | - Lucas A. Anderson
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
| | - Jeremy M. Gililland
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA
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Saviour CM, Gupta S. Towards an optimal design of a functionally graded porous uncemented acetabular component using genetic algorithm. Med Eng Phys 2024; 126:104159. [PMID: 38621833 DOI: 10.1016/j.medengphy.2024.104159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 02/23/2024] [Accepted: 03/22/2024] [Indexed: 04/17/2024]
Abstract
Generation of polyethylene wear debris and peri‑prosthetic bone resorption have been identified as potential causes of acetabular component loosening in Total Hip Arthroplasty. This study was aimed at optimization of a functionally graded porous acetabular component to minimize peri‑prosthetic bone resorption and polyethylene liner wear. Porosity levels (porosity values at acetabular rim, and dome) and functional gradation exponents (radial and polar) were considered as the design parameters. The relationship between porosity and elastic properties were obtained from numerical homogenization. The multi-objective optimization was carried out using a non-dominated sorting genetic algorithm integrated with finite element analysis of the hemipelvises subject to various loading conditions of common daily activities. The optimal functionally graded porous designs (OFGPs -1, -2, -3, -4, -5) exhibited less strain-shielding in cancellous bone compared to solid metal-backing. Maximum bone-implant interfacial micromotions (63-68 μm) for OFGPs were found to be close to that of solid metal-backing (66 μm), which might facilitate bone ingrowth. However, OFGPs exhibited an increase in volumetric wear (3-10 %) compared to solid metal-backing. The objective functions were found to be more sensitive to changes in polar gradation exponent than radial gradation exponent, based on the Sobol' method. Considering the common failure mechanisms, OFGP-1, having highly porous acetabular rim and less porous dome, appears to be a better alternative to the solid metal-backing.
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Affiliation(s)
- Ceby Mullakkara Saviour
- Department of Mechanical Engineering, Indian Institute of Technology Kharagpur, Kharagpur, 721 302, West Bengal, India
| | - Sanjay Gupta
- Department of Mechanical Engineering, Indian Institute of Technology Kharagpur, Kharagpur, 721 302, West Bengal, India.
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Sathishkumar S, Paulraj J, Chakraborti P, Muthuraj M. Comprehensive Review on Biomaterials and Their Inherent Behaviors for Hip Repair Applications. ACS APPLIED BIO MATERIALS 2023; 6:4439-4464. [PMID: 37871169 DOI: 10.1021/acsabm.3c00327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Developing biomaterials for hip prostheses is challenging and requires dedicated attention from researchers. Hip replacement is an inevitable and remarkable orthopedic therapy for enhancing the quality of patient life for those who have arthritis as well as trauma. Generally, five types of hip replacement procedures are successfully performed in the current medical market: total hip replacements, hip resurfacing, hemiarthroplasty, bipolar, and dual mobility systems. The average life span of artificial hip joints is about 15 years, and several studies have been conducted over the last 60 years to improve the performance and thereby increase the lifespan of artificial hip joints. Present-day prosthetic hip joints are linked to the wide availability of biomaterials. Metals, ceramics, and polymers are some of the most promising types of biomaterials; nevertheless, each biomaterial has advantages and disadvantages. Metals and ceramics fail in most applications owing to stress shielding and the emission of wear debris; ongoing research is being carried out to find a remedy to these unfavorable responses. Recent research found that polymers and composites based on polymers are significant alternative materials for artificial joints. With growing research and several biomaterials, recent reviews lag in effectively addressing hip implant materials' individual mechanical, tribological, and physiological behaviors. This Review comprehensively investigates the historical evolution of artificial hip replacement procedures and related biomaterials' mechanical, tribological, and biological characteristics. In addition, the most recent advances are also discussed to stimulate and guide future researchers as they seek more effective methods and synthesis of innovative biomaterials for hip arthroplasty application.
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10
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Boettcher JM, Sellenschloh K, Huber G, Ondruschka B, Morlock MM. The influence of hip revision stem spline design on the torsional stability in the presence of major proximal bone defects. PLoS One 2023; 18:e0291599. [PMID: 37708193 PMCID: PMC10501563 DOI: 10.1371/journal.pone.0291599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/04/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Despite the success of primary total hip arthroplasty, the number of revisions remains high. Infection, aseptic loosening, periprosthetic fractures and dislocations are the leading causes of hip revision. Current revision stem designs feature a tapered body with circumferential placed longitudinal thin metal splines that cut into the femoral cortex of the diaphysis to provide axial and rotational stability. Modifications to the spline design may help improve primary stability in various bone qualities. The purpose of this study was to evaluate whether the rotational stability of a revision hip stem can be improved by an additional set of less prominent, wider splines in addition to the existing set of splines. It is hypothesized that the additional splines will result in greater cortical contact, thereby improving torsional strength. METHODS AND FINDINGS The ultimate torsional strength of an established modular revision stem (Reclaim®, DePuy Synthes) was compared to a Prototype stem design with two sets of splines, differing in prominence by 0.25 mm. Five pairs of fresh-frozen human femurs (n = 10) were harvested and an extended trochanteric osteotomy was performed to obtain common bone defects in revision. Stems were implanted using successive droptower impacts to omit variability caused by mallet blows. The applied energy was increased from 2 J in 1 J increments until the planned implantation depth was reached or seating was less than 0.5 mm at 5 J impact. The ultimate torsional strength of the bone-to-implant interface was determined immediately after implantation. Image superposition was used to analyze and quantify the contact situation between bone and implant within the femoral canal. Cortical contact was larger for the Prototype design with the additional set of splines compared to the Reclaim stem (p = 0.046), associated with a higher torsional stability (35.2 ± 6.0 Nm vs. 28.2 ± 3.5 Nm, p = 0.039). CONCLUSIONS A second set of splines with reduced prominence could be shown to improve primary stability of a revision stem in the femoral diaphysis in the presence of significant proximal bone loss. The beneficial effect of varying spline size and number has the potential to further improve the longevity of revision hip stems.
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Affiliation(s)
- Julius M. Boettcher
- Institute of Biomechanics, Hamburg University of Technology, Hamburg, Germany
| | - Kay Sellenschloh
- Institute of Biomechanics, Hamburg University of Technology, Hamburg, Germany
| | - Gerd Huber
- Institute of Biomechanics, Hamburg University of Technology, Hamburg, Germany
| | - Benjamin Ondruschka
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael M. Morlock
- Institute of Biomechanics, Hamburg University of Technology, Hamburg, Germany
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11
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Bieganowski T, Singh V, Muthusamy N, Kugelman DN, Davidovitch RI, Schwarzkopf R. Short-term outcomes of thin highly cross-linked polyethylene liners in primary total hip arthroplasty. Hip Int 2023; 33:839-844. [PMID: 36124343 DOI: 10.1177/11207000221123905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The use of thin highly cross-linked polyethylene (HXLPE) liners in total hip arthroplasty (THA) allows utilisation of larger femoral heads. However, concern surrounding postoperative complications remains. This study aims to investigate rates of revision and re-admission associated with thin HXLPE liners at short-term follow-up. METHODS We retrospectively reviewed 3047 patients who underwent THA with a cementless modular acetabular implant with a 36-mm femoral head, and different thicknesses of HXPLE liners from 2011 to 2021. We identified 723 patients (23.7%) with a minimum 2-year follow-up and 206 patients (6.8%) with a minimum 5-year follow-up. Patients in the thin group (TG, n = 1020) received <5.1-mm liners with 52-mm size cups while patients in the non-thin group (NTG, n = 2027) received >5.1-mm liners with >52-mm size cups. Outcomes were compared using multi-variable logistic regressions while controlling for all significant demographic differences. RESULTS We found no significant differences in re-admission (3.9% vs. 4.3%, OR 0.97; 95% CI, 0.63-1.49; p = 0.874) and revision (2.5% vs. 3.2%, OR 0.72; 95% CI, 0.41-1.26; p = 0.246) rates between groups. The difference in fracture rate between groups was not significant, but the 1 recorded acetabular fracture (5%) occurred in the NTG. Although the rate of liner exchange was lower in the TG (1.1%) compared to the NTG (2.3%), the difference was not statistically significant (OR 0.51; 95% CI, 0.24-1.05; p = 0.068). Liners were exchanged for liner wear in 1 hip (1%), aseptic reasons in 38 hips (66%), and peri-prosthetic joint infection in 19 hips (33%). CONCLUSIONS Patients undergoing THA with a thin liner were not significantly predisposed to higher rates of revision surgery or poorer clinical outcomes at short-term follow-up when compared to those who received a thicker liner. Consequently, further long-term studies regarding the utility of thin HXLPE implants in reducing complications should be pursued.
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Affiliation(s)
- Thomas Bieganowski
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - Vivek Singh
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - Nishanth Muthusamy
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - David N Kugelman
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - Roy I Davidovitch
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
| | - Ran Schwarzkopf
- Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA
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12
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Saviour CM, Gupta S. Design of a functionally graded porous uncemented acetabular component: Influence of polar gradation. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2023:e3709. [PMID: 37089063 DOI: 10.1002/cnm.3709] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 02/14/2023] [Accepted: 04/05/2023] [Indexed: 05/03/2023]
Abstract
The functionally graded porous metal-backed (FGPMB) acetabular component has the potential to minimize strain-shielding induced bone resorption, caused by stiffness mismatch of implant and host bone. This study is aimed at a novel design of FGPMB acetabular component, which is based on numerical investigations of the mechanical behavior of acetabular components with regard to common failure scenarios, considering various daily activities and implant-bone interface conditions. Both radial and polar functional gradations were implemented, and the effects of the polar gradation exponent on the failure criteria were evaluated. The relationships between porosity and orthotropic mechanical properties of a tetrahedron-based unit cell were obtained using a numerical homogenization method. Strain-shielding in cancellous bone was relatively lesser for the FGPMB than solid metal-backing. Few nodes around the rim were susceptible to implant-bone interfacial debonding, irrespective of the polar gradation exponent. Although the most favorable bone remodeling predictions were obtained for a polar gradation exponent of 0.1, a sudden change in the porosity was observed near the rim of FGPMB. Bone remodeling patterns were similar for polar gradation exponent of 5.0 and solid metal-backing. Moreover, the volumetric wear was maximum and minimum for polar gradation exponents of 0.1 and 5, respectively. Furthermore, the micromotions of different polar gradation exponents were within a range (20-40 μm) that might facilitate bone ingrowth. Considering common failure mechanisms, the FGPMB having polar gradation exponents in the range of 0.1-0.5 appeared to be a viable alternative to the solid acetabular component, within which a gradation exponent of 0.25 seemed the most appropriate design parameter.
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Affiliation(s)
- Ceby Mullakkara Saviour
- Department of Mechanical Engineering, Indian Institute of Technology Kharagpur, Kharagpur, India
| | - Sanjay Gupta
- Department of Mechanical Engineering, Indian Institute of Technology Kharagpur, Kharagpur, India
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13
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Artero NA, Manchope MF, Carvalho TT, Saraiva-Santos T, Bertozzi MM, Carneiro JA, Franciosi A, Dionisio AM, Zaninelli TH, Fattori V, Ferraz CR, Piva M, Mizokami SS, Camilios-Neto D, Casagrande R, Verri WA. Hesperidin Methyl Chalcone Reduces the Arthritis Caused by TiO 2 in Mice: Targeting Inflammation, Oxidative Stress, Cytokine Production, and Nociceptor Sensory Neuron Activation. Molecules 2023; 28:molecules28020872. [PMID: 36677929 PMCID: PMC9864652 DOI: 10.3390/molecules28020872] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/27/2022] [Accepted: 01/11/2023] [Indexed: 01/18/2023] Open
Abstract
Arthroplasty is an orthopedic surgical procedure that replaces a dysfunctional joint by an orthopedic prosthesis, thereby restoring joint function. Upon the use of the joint prosthesis, a wearing process begins, which releases components such as titanium dioxide (TiO2) that trigger an immune response in the periprosthetic tissue, leading to arthritis, arthroplasty failure, and the need for revision. Flavonoids belong to a class of natural polyphenolic compounds that possess antioxidant and anti-inflammatory activities. Hesperidin methyl chalcone's (HMC) analgesic, anti-inflammatory, and antioxidant effects have been investigated in some models, but its activity against the arthritis caused by prosthesis-wearing molecules, such as TiO2, has not been investigated. Mice were treated with HMC (100 mg/kg, intraperitoneally (i.p.)) 24 h after intra-articular injection of 3 mg/joint of TiO2, which was used to induce chronic arthritis. HMC inhibited mechanical hyperalgesia, thermal hyperalgesia, joint edema, leukocyte recruitment, and oxidative stress in the knee joint (alterations in gp91phox, GSH, superoxide anion, and lipid peroxidation) and in recruited leukocytes (total reactive oxygen species and GSH); reduced patellar proteoglycan degradation; and decreased pro-inflammatory cytokine production. HMC also reduced the activation of nociceptor-sensory TRPV1+ and TRPA1+ neurons. These effects occurred without renal, hepatic, or gastric damage. Thus, HMC reduces arthritis triggered by TiO2, a component released upon wearing of prosthesis.
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Affiliation(s)
- Nayara A. Artero
- Laboratory of Pain, Inflammation, Neuropathy and Cancer, Department of Pathology, Centre of Biological Sciences, Londrina State University, Londrina 86057-970, PR, Brazil
| | - Marília F. Manchope
- Laboratory of Pain, Inflammation, Neuropathy and Cancer, Department of Pathology, Centre of Biological Sciences, Londrina State University, Londrina 86057-970, PR, Brazil
| | - Thacyana T. Carvalho
- Laboratory of Pain, Inflammation, Neuropathy and Cancer, Department of Pathology, Centre of Biological Sciences, Londrina State University, Londrina 86057-970, PR, Brazil
| | - Telma Saraiva-Santos
- Laboratory of Pain, Inflammation, Neuropathy and Cancer, Department of Pathology, Centre of Biological Sciences, Londrina State University, Londrina 86057-970, PR, Brazil
| | - Mariana M. Bertozzi
- Laboratory of Pain, Inflammation, Neuropathy and Cancer, Department of Pathology, Centre of Biological Sciences, Londrina State University, Londrina 86057-970, PR, Brazil
| | - Jessica A. Carneiro
- Laboratory of Pain, Inflammation, Neuropathy and Cancer, Department of Pathology, Centre of Biological Sciences, Londrina State University, Londrina 86057-970, PR, Brazil
| | - Anelise Franciosi
- Laboratory of Pain, Inflammation, Neuropathy and Cancer, Department of Pathology, Centre of Biological Sciences, Londrina State University, Londrina 86057-970, PR, Brazil
| | - Amanda M. Dionisio
- Laboratory of Pain, Inflammation, Neuropathy and Cancer, Department of Pathology, Centre of Biological Sciences, Londrina State University, Londrina 86057-970, PR, Brazil
| | - Tiago H. Zaninelli
- Laboratory of Pain, Inflammation, Neuropathy and Cancer, Department of Pathology, Centre of Biological Sciences, Londrina State University, Londrina 86057-970, PR, Brazil
| | - Victor Fattori
- Laboratory of Pain, Inflammation, Neuropathy and Cancer, Department of Pathology, Centre of Biological Sciences, Londrina State University, Londrina 86057-970, PR, Brazil
| | - Camila R. Ferraz
- Laboratory of Pain, Inflammation, Neuropathy and Cancer, Department of Pathology, Centre of Biological Sciences, Londrina State University, Londrina 86057-970, PR, Brazil
| | - Maiara Piva
- Laboratory of Pain, Inflammation, Neuropathy and Cancer, Department of Pathology, Centre of Biological Sciences, Londrina State University, Londrina 86057-970, PR, Brazil
| | - Sandra S. Mizokami
- Laboratory of Pain, Inflammation, Neuropathy and Cancer, Department of Pathology, Centre of Biological Sciences, Londrina State University, Londrina 86057-970, PR, Brazil
| | - Doumit Camilios-Neto
- Department of Biochemistry and Biotechnology, Centre of Exact Sciences, Londrina State University, Londrina 86057-970, PR, Brazil
| | - Rubia Casagrande
- Department of Pharmaceutical Sciences, Centre of Health Science, Londrina State University, Londrina 86039-440, PR, Brazil
| | - Waldiceu A. Verri
- Laboratory of Pain, Inflammation, Neuropathy and Cancer, Department of Pathology, Centre of Biological Sciences, Londrina State University, Londrina 86057-970, PR, Brazil
- Correspondence: ; Tel.: +55-43-3371-4979
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14
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Toemoe SET, Lu V, Singh PJ, Khanduja V. The Past, Present and Future of Hip Arthroplasty. HIP ARTHROPLASTY 2023:825-840. [DOI: 10.1007/978-981-99-5517-6_63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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15
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Kang HJ, Park SS, Tripathi G, Lee BT. Injectable demineralized bone matrix particles and their hydrogel bone grafts loaded with β-tricalcium phosphate powder and granules: A comparative study. Mater Today Bio 2022; 16:100422. [PMID: 36133794 PMCID: PMC9483747 DOI: 10.1016/j.mtbio.2022.100422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 11/26/2022] Open
Abstract
Demineralized bone matrix (DBM), has been used as a bone-graft material because of its osteoconductivity and osteoinductivity. However, the previous research report that supports the single use of DBM is limited by its rapid resorption caused by the lack of calcium and phosphate. β-Tricalcium phosphate (TCP) is an enriched calcium phosphate material suitable for bone healing with osteoconductive properties. In this study, we have developed injectable bone graft by the loading two kinds of TCP in DBM particles and thermo-sensitive DBM-derived hydrogel (hDBM). TCP powder (pTCP) and TCP granules (gTCP) were loaded into hDBM and DBM, respectively. The bone formation effect was investigated according to the morphological features of TCP. Residual growth factor concentrations were investigated; microstructure and morphology were characterized by SEM. In-vitro studies showed that hDBM/DBM/pTCP and hDBM/DBM/gTCP bone grafts were biocompatible and could promote osteogenesis by up-regulating the expression of Runx2 and OPN, bone-related genes. In-vivo studies using the rabbit-femur defect model revealed that the implanted hDBM/DBM/pTCP bone graft showed similar histology to that of fibrous dysplasia with the expression of CD68, whereas hDBM/DBM/gTCP showed good bone formation. Loading of gTCP in place of pTCP was noticed as an effective way to improve bone regeneration in an injectable hDBM/DBM hydrogel-based bone graft.
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Affiliation(s)
- Hoe-Jin Kang
- Institute of Tissue Regeneration, College of Medicine, Soonchunhyang University, Cheonan, South Korea
| | - Seong-Su Park
- Department of Regenerative Medicine, College of Medicine, Soonchunhyang University, Cheonan, South Korea
| | - Garima Tripathi
- Institute of Tissue Regeneration, College of Medicine, Soonchunhyang University, Cheonan, South Korea
| | - Byong-Taek Lee
- Institute of Tissue Regeneration, College of Medicine, Soonchunhyang University, Cheonan, South Korea.,Department of Regenerative Medicine, College of Medicine, Soonchunhyang University, Cheonan, South Korea
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16
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Konow T, Schlieker PJ, Lampe F, Ondruschka B, Morlock MM, Huber G. Influence of bone morphology and femur preparation method on the primary stability of hip revision stems. J Orthop Res 2022; 41:1283-1290. [PMID: 36370133 DOI: 10.1002/jor.25481] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/10/2022] [Accepted: 11/07/2022] [Indexed: 11/13/2022]
Abstract
Aseptic loosening is one of the major reasons for re-revisions of cementless revision stems. Insufficient primary stability is associated with bone characteristics and the surgical process. This study aimed to investigate how femur morphology and preparation methods influence the primary stability of revision stems. The Femur morphology was described by the upper femoral curvature (UFC) and an individualized Dorr type classification based on the ratio between the canal-to-calcar ratio (CCR*) and the cortical index (CI*) introduced as the cortical-canal shape (CCS). Manual and powered reaming in combination with helical and straight reamers were used to prepare the bone cavity of 10 cadaveric human femur pairs. Forces during stem impaction were recorded (Reclaim, Depuy Synthes). Micromotion at the bone-implant interface during cyclic axial loading and torsional load to failure was determined. The CCS and impaction forces (R2 = 0.817, p < 0.001) or torsional strength (R2 = 0.577, p < 0.001) are inversely related. CCS did not correlate with micromotion during axial loading (R2 = 0.001, p > 0.999), but proximal femoral curvature did (R2 = 0.462, p = 0.015). Powered reaming and straight reamers led to an improved torsional strength (both: p = 0.043). The Individualized Dorr classification CCS and UFC allows a good estimation of the primary stability of revision stems. For severely curved Dorr type-C femurs, an alternative anchorage method should be considered clinically.
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Affiliation(s)
- Tobias Konow
- Institute of Biomechanics, TUHH Hamburg University of Technology, Hamburg, Germany
| | - Peter J Schlieker
- Institute of Biomechanics, TUHH Hamburg University of Technology, Hamburg, Germany
| | - Frank Lampe
- Schön Klinik Hamburg Eilbek, Hamburg, Germany
| | - Benjamin Ondruschka
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael M Morlock
- Institute of Biomechanics, TUHH Hamburg University of Technology, Hamburg, Germany
| | - Gerd Huber
- Institute of Biomechanics, TUHH Hamburg University of Technology, Hamburg, Germany
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17
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Yoon BH, Park JW, Lee YK, Koo KH, Chang CB. Long-Term Wear-Related Complications of Cross-Linked Versus Conventional Polyethylene After Total Hip Arthroplasty: A Meta-Analysis. J Arthroplasty 2022; 37:2308-2315.e2. [PMID: 35568139 DOI: 10.1016/j.arth.2022.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/04/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Highly cross-linked polyethylene (HXLPE) liners have been developed to address the wear-related problems associated with conventional polyethylene (CPE) such as osteolysis or aseptic loosening in total hip arthroplasty (THA). In this systematic meta-analysis, we compared the long-term efficacy in preventing radiological osteolysis and revision surgery between HXLPE and CPE. METHODS We included 14 studies that compared HXLPE and CPE reporting the incidence of wear-related complications with a minimum follow-up of 10 years. We investigated 5 wear-related complications: osteolysis, excessive wear, linear wear rate, revision surgery due to wear, and progress of osteolysis/aseptic loosening. We conducted a pair-wise meta-analysis to estimate odds ratio (OR) and a proportional meta-analysis to estimate the incidence of each complication. RESULTS Among 1,175 THAs, 220 osteolysis and 78 wear-related revisions were detected. The use of HXLPE reduced the risk of overall osteolysis (OR 0.30; P = .001), excessive wear (OR 0.10; P < .001), linear wear rate (weighted mean difference 0.09; P < .001), the risk of overall wear-related revisions (OR 0.06; P < .001), and revisions due to aseptic loosening (OR 0.23; P = .015). As per the proportional meta-analysis, the pooled prevalence of osteolysis, excessive wear, and the overall wear-related revision rate were 14%, 8%, and 3% in HXLPE and 25%, 33%, and 20% in CPE, respectively. CONCLUSION The current evidence shows that HXLPE dramatically reduced the rate of osteolysis and wear-related revision surgery. However, as polyethylene wear and osteolysis still lead to revision surgery, ongoing clinical and retrieval studies are required to analyze long-term outcomes.
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Affiliation(s)
- Byung-Ho Yoon
- Department of Orthopedic Surgery, Ewha Womans University, College of Medicine, Mokdong Hospital, Seoul, South Korea
| | - Jung-Wee Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Chong Bum Chang
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
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18
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Otten V, Wästerlund D, Lindbjörn J, Mertens C, Mukka S, Crnalic S, Nilsson KG. Evaluation of a new cemented highly cross-linked all-polyethylene cup: a prospective and randomised study assessing wear and fixation characteristics using radiostereometric analysis. Hip Int 2022; 32:779-786. [PMID: 33566703 PMCID: PMC9726741 DOI: 10.1177/1120700021989991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND PURPOSE The aim of this prospective, randomised and controlled study was to evaluate the wear and fixation properties of a new cemented highly cross-linked all-polyethylene (HXLPE) cup in comparison with a conventional cemented ultra-high molecular weight polyethylene (ConvPE) cup using radiostereometric analysis (RSA). PATIENTS AND METHODS A total of 58 patients (58 hips) with primary osteoarthritis (OA) were enrolled in a randomised controlled trial to receive either a ConvPE cup (control) or HXLPE cup (intervention) with identical geometry. The subjects were randomised in a 1:1 ratio. The primary endpoint was proximal wear measured as femoral head penetration into the cup, secondary outcomes were 3D-wear and annual proximal wear from 1 to 5 years. Cup fixation was measured as movement of the cup in relation to the acetabular bone with proximal migration being the primary outcome measure, 3D-migration and change in inclination as secondary outcomes. The patients were followed for 5 years with RSA performed postoperatively, at 3, 12, 24, and 60 months. RESULTS The HXLPE displayed a lower median proximal femoral head penetration compared to ConvPE, with a median difference at 2 years of -0.07 mm (95% CI, -0.10 to -0.04 mm), and -0.19 mm (95% CI, -0.27 to -0.15 mm) at 5 years. Annual proximal wear between 1 and 5 years was 0.03 mm/year for HXLPE and 0.06 mm/year for ConvPE (mean difference 0.05 mm, [95% CI, 0.03-0.07 mm]). Proximal migration, 3D migration and change in inclination was numerically slightly higher for HXLPE, albeit not statistically significant. CONCLUSIONS Compared to ConvPE, the HXLPE cup displayed significantly lower polyethylene wear. Cup migration was not statistically significant different. CLINICALTRIALS.GOV IDENTIFIER NCT04322799.
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Affiliation(s)
| | | | | | | | | | | | - Kjell G Nilsson
- Kjell G Nilsson, Orthopaedics, Department of Surgical and Perioperative Sciences, Umeå University, Umeå 90185, Sweden.
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19
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Sharma V, Gupta RK, Kailas SV, Basu B. Probing lubricated sliding wear properties of HDPE/UHMWPE hybrid bionanocomposite. J Biomater Appl 2022; 37:204-218. [PMID: 35502987 DOI: 10.1177/08853282221085633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Ultra-high molecular weight polyethylene (UHMWPE) and its derivatives have been clinically used as an acetabular liner material in total hip joint replacement (THR) over last six decades. Despite significant efforts, the longevity of UHMWPE implants is still impaired due to their compromised tribological performance, leading to osteolysis and aseptic loosening. The present study aims to critically evaluate and analyze the tribological performance, of the next generation acetabular liner material, that is, a chemically modified graphene oxide (GO) reinforced HDPE/UHMWPE (HU) bionanocomposite (HUmGO), against stainless steel (SS 316L) counterface in lubricated conditions. This work also provides a performance comparative assessment of HUmGO with respect to medical grades, UHMWPE (UC) and crosslinked UHMWPE (XL-UC). Significant attempts have been made to correlate the tribological properties (frictional behavior, wear rate, wear debris shape and size, wear mechanism) with the physicomechanical conditions (contact stresses) at sliding contact and the variation in molecular architecture of different UHMWPE materials. Additionally, an emphasis is put forward to critically anlyze the nature of lubrication regime based on the bearing characterstic parameters. HUmGO exhibited a lower COF (0.07) and specific wear rate (2.86 × 10-8 mm3/Nm) than UC and XL-UC under identical sliding conditions. The worn surfaces on HUmGO revealed the signatures of less abrasive wear and limited deformation. Based on the estimated lambda (λ) ratio and Sommerfield number, all the investigated sliding contacts exhibited boundary lubrication. Taken together, the modified GO reinforced HDPE/UHMWPE bionanocomposite can be considered as a new generation biomaterial for the fabrication of acetabular liner for hip-joint prosthesis.
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Affiliation(s)
- Vidushi Sharma
- Laboratory for Biomaterials, Materials Research Centre, 29120Indian Institute of Science, Bangalore, India.,Centre of Excellence for Dental and Orthopedic Applications, Material Research Centre, 29120Indian Institute of Science, Bangalore, India
| | - Rajeev K Gupta
- Surface Interaction and Manufacturing Laboratory, Department of Mechanical Engineering, 29120Indian Institute of Science, Bangalore, India
| | - Satish V Kailas
- Surface Interaction and Manufacturing Laboratory, Department of Mechanical Engineering, 29120Indian Institute of Science, Bangalore, India
| | - Bikramjit Basu
- Laboratory for Biomaterials, Materials Research Centre, 29120Indian Institute of Science, Bangalore, India.,Centre of Excellence for Dental and Orthopedic Applications, Material Research Centre, 29120Indian Institute of Science, Bangalore, India.,Centre for Biosystems Science and Engineering, 29120Indian Institute of Science, Bangalore, India
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20
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The lexicon for periprosthetic bone loss versus osteolysis after cervical disc arthroplasty: a systematic review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:830-842. [PMID: 34999945 DOI: 10.1007/s00586-021-07092-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 12/10/2021] [Accepted: 12/15/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Periprosthetic bone loss is a common observation following arthroplasty. Recognizing and understanding the nature of bone loss is vital as it determines the subsequent performance of the device and the overall outcome. Despite its significance, the term "bone loss" is often misused to describe inflammatory osteolysis, a complication with vastly different clinical outcomes and treatment plans. Therefore, the goal of this review was to report major findings related to vertebral radiographic bone changes around cervical disc replacements, mitigate discrepancies in clinical reports by introducing uniform terminology to the field, and establish a precedence that can be used to identify the important nuances between these distinct complications. METHODS A systematic review of the literature was conducted following PRISMA guidelines, using the keywords "cervical," "disc replacement," "osteolysis," "bone loss," "radiograph," and "complications." A total of 23 articles met the inclusion criteria with the majority being retrospective or case reports. RESULTS Fourteen studies reported periprosthetic osteolysis in a total of 46 patients with onset ranging from 15-96 months after the index procedure. Reported causes included: metal hypersensitivity, infection, mechanical failure, and wear debris. Osteolysis was generally progressive and led to reoperation. Nine articles reported non-inflammatory bone loss in 527 patients (52.5%), typically within 3-6 months following implantation. The reported causes included: micromotion, stress shielding, and interrupted blood supply. With one exception, bone loss was reported to be non-progressive and had no effect on clinical outcome measures. CONCLUSIONS Non-progressive, early onset bone loss is a common finding after CDA and typically does not affect the reported short-term pain scores or lead to early revision. By contrast, osteolysis was less common, presenting more than a year post-operative and often accompanied by additional complications, leading to revision surgery. A greater understanding of the clinical significance is limited by the lack of long-term studies, inconsistent terminology, and infrequent use of histology and explant analyses. Uniform reporting and adoption of consistent terminology can mitigate some of these limitations. Executing these actionable items is critical to assess device performance and the risk of revision. LEVEL OF EVIDENCE IV Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.
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21
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Kingsbury SR, Smith LK, Shuweihdi F, West R, Czoski Murray C, Conaghan PG, Stone MH. A comparative study of patients presenting for planned and unplanned revision hip or knee arthroplasty. Bone Joint J 2022; 104-B:59-67. [PMID: 34969282 PMCID: PMC8779949 DOI: 10.1302/0301-620x.104b1.bjj-2021-0032.r2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this study was to conduct a cross-sectional, observational cohort study of patients presenting for revision of a total hip, or total or unicompartmental knee arthroplasty, to understand current routes to revision surgery and explore differences in symptoms, healthcare use, reason for revision, and the revision surgery (surgical time, components, length of stay) between patients having regular follow-up and those without. METHODS Data were collected from participants and medical records for the 12 months prior to revision. Patients with previous revision, metal-on-metal articulations, or hip hemiarthroplasty were excluded. Participants were retrospectively classified as 'Planned' or 'Unplanned' revision. Multilevel regression and propensity score matching were used to compare the two groups. RESULTS Data were analyzed from 568 patients, recruited in 38 UK secondary care sites between October 2017 and October 2018 (43.5% male; mean (SD) age 71.86 years (9.93); 305 hips, 263 knees). No significant inclusion differences were identified between the two groups. For hip revision, time to revision > ten years (odds ratio (OR) 3.804, 95% confidence interval (CI) (1.353 to 10.694), p = 0.011), periprosthetic fracture (OR 20.309, 95% CI (4.574 to 90.179), p < 0.001), and dislocation (OR 12.953, 95% CI (4.014 to 41.794), p < 0.001), were associated with unplanned revision. For knee, there were no associations with route to revision. Revision after ten years was more likely for those who were younger at primary surgery, regardless of route to revision. No significant differences in cost outcomes, length of surgery time, and access to a health professional in the year prior to revision were found between the two groups. When periprosthetic fractures, dislocations, and infections were excluded, healthcare use was significantly higher in the unplanned revision group. CONCLUSION Differences between characteristics for patients presenting for planned and unplanned revision are minimal. Although there was greater healthcare use in those having unplanned revision, it appears unlikely that routine orthopaedic review would have detected many of these issues. It may be safe to disinvest in standard follow-up provided there is rapid access to orthopaedic review. Cite this article: Bone Joint J 2022;104-B(1):59-67.
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Affiliation(s)
- Sarah R Kingsbury
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - Lindsay K Smith
- Faculty of Health & Applied Sciences, University of the West of England, Bristol, UK
| | - Farag Shuweihdi
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Robert West
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - Martin H Stone
- NIHR Leeds Biomedical Research Centre, Leeds, UK.,Leeds Teaching Hospitals NHS Trust, Leeds, UK
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22
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da Silva Dias C, Rossi MC, Apolonio EVP, Dos Santos Rosa G, Pfeifer JPH, Hussni CA, Watanabe MJ, Alves ALG. Low Mg content on Ti-Nb-Sn alloy when in contact with eBMMSCs promotes improvement of its biological functions. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2021; 32:144. [PMID: 34862929 PMCID: PMC8643293 DOI: 10.1007/s10856-021-06620-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 11/07/2021] [Indexed: 06/13/2023]
Abstract
Magnesium is a metal used in the composition of titanium alloys and imparts porosity. Due to its osteoconductive, biocompatible and biodegradable characteristics, its application in the development of biomedical materials has become attractive. This study aimed to evaluate the influence of magnesium present in porous Ti-Nb-Sn alloys, which have a low elastic modulus in adhesive, osteogenic properties and the amount of reactive intracellular oxygen species released in mesenchymal stem cells derived from bone marrow equine bone (eBMMSCs). Mechanical properties of the alloy, such as hardness, compressive strength and elastic modulus, were analyzed, as well as surface morphological characteristics through scanning electron microscopy. The evaluation of magnesium ion release was performed by atomic force spectroscopy. The biological characteristics of the alloy, when in contact with the alloy surface and with the culture medium conditioned with the alloy, were studied by SEM and optical microscopy. Confirmation of osteogenic differentiation by alizarin red and detection of ROS using a Muse® Oxidative Stress Kit based on dihydroetide (DHE). The alloy showed an elastic modulus close to cortical bone values. The hardness was close to commercial Ti grade 2, and the compressive strength was greater than the value of cortical bone. The eBMMSCs adhered to the surface of the alloy during the experimental time. Osteogenic differentiation was observed with the treatment of eBMMMSCs with conditioned medium. The eBMMSCs treated with conditioned medium decreased ROS production, indicating a possible antioxidant defense potential of magnesium release.
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Affiliation(s)
- Carolina da Silva Dias
- Department of Veterinary Surgery and Anesthesiology, São Paulo State University - Júlio de Mesquita Filho Unesp Prof. Doutor Walter Mauricio Correa St., n/n, Botucatu, SP, ZIP- 18618-681, Brazil
| | - Mariana Correa Rossi
- Department of Veterinary Surgery and Anesthesiology, São Paulo State University - Júlio de Mesquita Filho Unesp Prof. Doutor Walter Mauricio Correa St., n/n, Botucatu, SP, ZIP- 18618-681, Brazil.
| | - Emanuel V P Apolonio
- Department of Veterinary Surgery and Anesthesiology, São Paulo State University - Júlio de Mesquita Filho Unesp Prof. Doutor Walter Mauricio Correa St., n/n, Botucatu, SP, ZIP- 18618-681, Brazil
| | - Gustavo Dos Santos Rosa
- Department of Veterinary Surgery and Anesthesiology, São Paulo State University - Júlio de Mesquita Filho Unesp Prof. Doutor Walter Mauricio Correa St., n/n, Botucatu, SP, ZIP- 18618-681, Brazil
| | - João Pedro Hübbe Pfeifer
- Department of Veterinary Surgery and Anesthesiology, São Paulo State University - Júlio de Mesquita Filho Unesp Prof. Doutor Walter Mauricio Correa St., n/n, Botucatu, SP, ZIP- 18618-681, Brazil
| | - Carlos Alberto Hussni
- Department of Veterinary Surgery and Anesthesiology, São Paulo State University - Júlio de Mesquita Filho Unesp Prof. Doutor Walter Mauricio Correa St., n/n, Botucatu, SP, ZIP- 18618-681, Brazil
| | - Marcos Jun Watanabe
- Department of Veterinary Surgery and Anesthesiology, São Paulo State University - Júlio de Mesquita Filho Unesp Prof. Doutor Walter Mauricio Correa St., n/n, Botucatu, SP, ZIP- 18618-681, Brazil
| | - Ana Liz Garcia Alves
- Department of Veterinary Surgery and Anesthesiology, São Paulo State University - Júlio de Mesquita Filho Unesp Prof. Doutor Walter Mauricio Correa St., n/n, Botucatu, SP, ZIP- 18618-681, Brazil
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23
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Li Y, Zhang L, Wang J, Zheng Y, Cui J, Yuan G. Tanshinone IIA attenuates polyethylene-induced osteolysis in a mouse model: The key role of miR-155-5p/FOXO3 axis. J Funct Foods 2021. [DOI: 10.1016/j.jff.2021.104784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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24
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Cooper AM, Connolly K, Penna S, Parvizi J. Evaluation and Management of a Painful Knee After Total Knee Arthroplasty. Orthopedics 2021; 44:341-352. [PMID: 34618636 DOI: 10.3928/01477447-20211001-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Pain after total knee arthroplasty (TKA) is not infrequent and may be indicative of a broad spectrum of prosthesis-related, intra-articular, or extra-articular pathologies. To diagnose and treat the underlying cause of a painful TKA, systematic evaluation of the patient is critical to ensure that they are managed appropriately and expeditiously. This evidence-based review presents current concepts regarding the pathophysiology, etiology, and diagnosis of painful TKA and our recommended approach for management. [Orthopedics. 2021;44(6):341-352.].
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25
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Kelly GA, Hill JC, O'Brien S, McChesney J, Dennison J, Stevenson M, Beverland DE. Ten-year outcomes following a cohort of ASR XL total hip arthroplasties. Hip Int 2021; 31:759-765. [PMID: 32233664 DOI: 10.1177/1120700020913863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
AIMS To determine the outcome at 10 years of a cohort of ASR XL total hip arthroplasties (THAs) and reasons for revision. METHODS Between November 2005 and May 2007, 122 ASR XL THAs were implanted. All patients had a routine review at 6 weeks and 1 year, followed by a review in 2009 because of clinical concern and thereafter annual review up to 10 years with MRI. Review also included functional scores, radiographs, pain scores and blood metal ions. RESULTS 67 (54.9%) ASR XLs had been revised by 11.1 years. Reasons for revision included pain (89.6%), high levels of cobalt and chromium ions (50.7%) and radiographic or MRI changes (80.6%). All 3 factors were present in 23 (34.3%). Pain at 1 year did not predict revision, but pain at the 2009 review did. At 10 years the revised patients had an average Oxford Hip Score (OHS) of 25.38 (12-42) and the non-revised 23.61 (2-21), the difference was not significant (p = 0.48). 3 patients (4.5%) have had a further revision; 2 for a previously unrevised stem and the other for instability. CONCLUSIONS Our arthroplasty care practitioner service allowed us to identify increased pain and stop using the ASR XL over 3 years before the implant was recalled. The revised patients had similar functional outcome to those unrevised. Poorly performing implants need to be identified earlier.
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Affiliation(s)
| | - Janet C Hill
- Primary Joint Unit, Musgrave Park Hospital, Belfast, UK
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26
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Zhao F, Cang D, Zhang J, Zheng L. Chemerin/ChemR23 signaling mediates the effects of ultra-high molecular weight polyethylene wear particles on the balance between osteoblast and osteoclast differentiation. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1149. [PMID: 34430590 PMCID: PMC8350637 DOI: 10.21037/atm-21-2945] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/15/2021] [Indexed: 02/02/2023]
Abstract
Background Ultra-high molecular weight polyethylene (UHMWPE) is one of the favored materials for total joint replacement, but its wear particles cause osteolysis. This study aims to elucidate the signaling that mediates the effects of UHMWPE particles on bone cells. Methods RAW264.7 and MC3T3-E1 cells were treated with UHMWPE particles. Chemerin/ChemR23 signaling was manipulated by either overexpressing Rarres2 and Cmklr1 or silencing Cmklr1. The osteoblast and osteoclast differentiation was evaluated by Alizarin red and TRAP staining, respectively. The expression of osteogenic and osteoclastogenic markers was assessed with quantitative real time PCR and western blot. Results UHMWPE particles upregulated the expression of Rarres2 and Cmklr1 in both osteoblast and osteoclast precursor cells. UHMWPE particles induced osteoclast differentiation while inhibited osteoblast differentiation, and this effect was abrogated by silencing Cmklr1 but augmented by the overexpression of Rarres2 and Cmklr1. Similarly, the expression of osteogenic marker genes was inhibited while that of osteoclastogenic marker genes was activated by UHMWPE particles, and this effect was abolished by silencing Cmklr1 and enhanced by Rarres2 and Cmklr1 overexpression. Conclusions These results demonstrated that chemerin/ChemR23 signaling plays a central role in the effects of UHMWPE particles on the balance of osteogenic and osteoclastogenic differentiation, which changes the course of bone remodeling and eventually results in osteolysis.
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Affiliation(s)
- Fengchao Zhao
- Department of Orthopedic Surgery, the First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Dingwei Cang
- Department of Orthopedic Surgery, the First People's Hospital of Yancheng City, Yancheng, China
| | - Jianzhi Zhang
- Department of Central Laboratory, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Li Zheng
- Department of Orthopedic Surgery, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
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27
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Abstract
AbstractThe success of implant performance and arthroplasty is based on several factors, including oxidative stress-induced osteolysis. Oxidative stress is a key factor of the inflammatory response. Implant biomaterials can release wear particles which may elicit adverse reactions in patients, such as local inflammatory response leading to tissue damage, which eventually results in loosening of the implant. Wear debris undergo phagocytosis by macrophages, inducing a low-grade chronic inflammation and reactive oxygen species (ROS) production. In addition, ROS can also be directly produced by prosthetic biomaterial oxidation. Overall, ROS amplify the inflammatory response and stimulate both RANKL-induced osteoclastogenesis and osteoblast apoptosis, resulting in bone resorption, leading to periprosthetic osteolysis. Therefore, a growing understanding of the mechanism of oxidative stress-induced periprosthetic osteolysis and anti-oxidant strategies of implant design as well as the addition of anti-oxidant agents will help to improve implants’ performances and therapeutic approaches.
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28
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miR-9-5p promotes wear-particle-induced osteoclastogenesis through activation of the SIRT1/NF-κB pathway. 3 Biotech 2021; 11:258. [PMID: 33987074 DOI: 10.1007/s13205-021-02814-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/26/2021] [Indexed: 10/21/2022] Open
Abstract
To explore the potential function of miR-9-5p in wear-particle-induced osteoclastogenesis, we examined the expression of SIRT1 and miR-9-5p in particle-induced osteolysis (PIO) mice calvariae and polyethylene (PE)-induced RAW 264.7 cells and found that SIRT1 expression was downregulated while miR-9-5p expression was upregulated in both models. We then verified that miR-9-5p targets SIRT1. miR-9-5p was found to promote PE-induced osteoclast formation from RAW 264.7 cells by tartrate-resistant acid phosphatase staining and detection of osteoclast markers, and miR-9-5p activation of the SIRT1/NF-kB signaling pathway was found in cells by detecting the expression of SIRT1/NF-kB pathway-related proteins and rescue assays. In conclusion, we found that miR-9-5p activated the SIRT1/NF-κB pathway to promote wear-particle-induced osteoclastogenesis. miR-9-5p may be a useful therapeutic target for PIO remission and treatment.
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29
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Wang L, Wang Q, Wang W, Ge G, Xu N, Zheng D, Jiang S, Zhao G, Xu Y, Wang Y, Zhu R, Geng D. Harmine Alleviates Titanium Particle-Induced Inflammatory Bone Destruction by Immunomodulatory Effect on the Macrophage Polarization and Subsequent Osteogenic Differentiation. Front Immunol 2021; 12:657687. [PMID: 34079546 PMCID: PMC8165263 DOI: 10.3389/fimmu.2021.657687] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 04/26/2021] [Indexed: 01/16/2023] Open
Abstract
Peri-prosthetic osteolysis (PPO) and following aseptic loosening are regarded as the prime reasons for implant failure after joint replacement. Increasing evidence indicated that wear-debris-irritated inflammatory response and macrophage polarization state play essential roles in this osteolytic process. Harmine, a β-carboline alkaloid primitively extracted from the Peganum harmala seeds, has been reported to have various pharmacological effects on monoamine oxidase action, insulin intake, vasodilatation and central nervous systems. However, the impact of harmine on debris-induced osteolysis has not been demonstrated, and whether harmine participates in regulating macrophage polarization and subsequent osteogenic differentiation in particle-irritated osteolysis remains unknown. In the present study, we investigated the effect of harmine on titanium (Ti) particle-induced osteolysis in vivo and in vitro. The results suggested harmine notably alleviated Ti particle-induced bone resorption in a murine PPO model. Harmine was also found to suppress the particle-induced inflammatory response and shift the polarization of macrophages from M1 phenotypes to M2 phenotypes in vivo and in vitro, which improved anti-inflammatory and bone-related cytokines levels. In the conditioned medium from Ti particle-stimulated murine macrophage RAW264.7 cells treated with harmine, the osteoblast differentiation ability of mouse pre-osteoblastic MC3T3-E1 cells was greatly increased. And we also provided evidences that the immunomodulatory capacity of harmine might be attributed to the inhibition of the c-Jun N-terminal kinase (JNK) in wear particle-treated macrophages. All the results strongly show that harmine might be a promising therapeutic agent to treat PPO.
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Affiliation(s)
- Liangliang Wang
- Department of Orthopaedics, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Qing Wang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Wei Wang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Gaoran Ge
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Nanwei Xu
- Department of Orthopaedics, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Dong Zheng
- Department of Orthopaedics, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Shijie Jiang
- Department of Orthopaedics, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Gongyin Zhao
- Department of Orthopaedics, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Yaozeng Xu
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yuji Wang
- Department of Orthopaedics, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China.,Departments of Orthopedic Surgery and Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN, United States.,Department of Orthopedics, The Third Affiliated Hospital of Gansu University of Chinese Medicine, Baiyin, China
| | - Ruixia Zhu
- Department of Orthopaedics, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Dechun Geng
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China
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30
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Wang W, Han B, Chen J, Tian H, Sun M, Jiang Y, Xie W. Tolerogenic dendritic cells suppress titanium particle-induced inflammation. Exp Ther Med 2021; 22:712. [PMID: 34007321 PMCID: PMC8120651 DOI: 10.3892/etm.2021.10144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 03/10/2021] [Indexed: 02/05/2023] Open
Abstract
Aseptic loosening is a major complication of prosthetic joint surgery. The leading cause of arthroplasty failure is particulate wear debris such as titanium particles. Dendritic cells (DCs) are one type of immune cells that play an important role in the initiation and progression of inflammatory processes. DCs can develop into tolerogenic DCs (tolDCs), which present an alternative therapeutic strategy for inflammatory disorders. Previously, antigen-specific tolDCs were generated, which showed a promising effect in treating inflammatory arthritis and immune thrombocytopenia. The present study reports that tolDCs effectively inhibited titanium particle-induced inflammation in an air-pouch mouse model by decreasing pro-inflammatory cytokines. In addition, a mechanistic study demonstrated that tolDCs significantly protected against titanium particle-induced inflammatory processes in vitro by releasing anti-inflammatory cytokines, such as interleukin-10. Collectively, these findings not only demonstrate that tolDCs play an important role in inhibiting titanium particle-induced inflammation but also provide a potential alternative for the prevention or treatment of titanium particle-induced inflammation.
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Affiliation(s)
- Wenzhao Wang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China.,Department of Emergency Medicine, The Second Affiliated Hospital of Shandong First Medical University, Taian, Shandong 271000, P.R. China
| | - Bing Han
- Department of Orthopedic, Jinan Central Hospital Affiliated to Shandong First Medical University, Jinan Central Hospital Affiliated to Shandong University, Jinan, Shandong 250013, P.R. China.,Department of Orthopedics, Zoucheng People's Hospital, Zoucheng, Shandong 273500, P.R. China
| | - Jianan Chen
- Department of Orthopedic, Jinan Central Hospital Affiliated to Shandong First Medical University, Jinan Central Hospital Affiliated to Shandong University, Jinan, Shandong 250013, P.R. China
| | - Huichao Tian
- Department of Orthopedic, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Mingjie Sun
- Department of Orthopedic, Jinan Central Hospital Affiliated to Shandong First Medical University, Jinan Central Hospital Affiliated to Shandong University, Jinan, Shandong 250013, P.R. China
| | - Yunpeng Jiang
- Department of Orthopedic, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Wei Xie
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China.,Department of Emergency Medicine, The Second Affiliated Hospital of Shandong First Medical University, Taian, Shandong 271000, P.R. China
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31
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Allen Q, Raeymaekers B. Surface Texturing of Prosthetic Hip Implant Bearing Surfaces: A Review. JOURNAL OF TRIBOLOGY 2021; 143:040801. [PMID: 34168396 PMCID: PMC8208482 DOI: 10.1115/1.4048409] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/04/2020] [Accepted: 09/04/2020] [Indexed: 06/12/2023]
Abstract
More than 300,000 total hip replacement surgeries are performed in the United States each year to treat degenerative joint diseases that cause pain and disability. The statistical survivorship of these implants declines significantly after 15-25 years of use because wear debris causes inflammation, osteolysis, and mechanical instability of the implant. This limited longevity has unacceptable consequences, such as revision surgery to replace a worn implant, or surgery postponement, which leaves the patient in pain. Innovations such as highly cross-linked polyethylene and new materials and coatings for the femoral head have reduced wear significantly, but longevity remains an imminent problem. Another method to reduce wear is to add a patterned microtexture composed of micro-sized texture features to the smooth bearing surfaces. We critically review the literature on textured orthopedic biomaterial surfaces in the context of prosthetic hip implants. We discuss the different functions of texture features by highlighting experimental and simulated results documented by research groups active in this area. We also discuss and compare different manufacturing techniques to create texture features on orthopedic biomaterial surfaces and emphasize the key difficulties that must be overcome to produce textured prosthetic hip implants.
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Affiliation(s)
- Quentin Allen
- Department of Mechanical Engineering, University of Utah, 1495 E. 100 S. (1550 MEK), Salt Lake City, UT 84112
| | - Bart Raeymaekers
- Department of Mechanical Engineering, University of Utah, 1495 E. 100 S. (1550 MEK), Salt Lake City, UT 84112
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32
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Causey GC, Picha GJ, Price J, Pelletier MH, Wang T, Walsh WR. In-Vivo response to a novel pillared surface morphology for osseointegration in an ovine model. J Mech Behav Biomed Mater 2021; 119:104462. [PMID: 33839536 DOI: 10.1016/j.jmbbm.2021.104462] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 11/16/2022]
Abstract
Primary stability and secondary fixation of orthopedic implants to bony tissues are important for healing and long-term functionality. Load sharing and stress transfer are key requirements of an effective implant/tissue interface. This paper presents a novel, macro-scale osseointegration surface morphology which addresses the implant/tissue interface from both the biologic as well as biomechanical perspective. The surface morphology is a controlled, engineered, open topography manifested as discrete pillars projecting from the implant enabling continuous bone ingrowth. The pillared surface is distinct from other porous surfaces and can be differentiated by the localization of the implant material into discrete pillars enabling a continuous mass of bone to freely and easily interdigitate into the pillared structure. Traditional porous structures distribute the implant material throughout the surface forcing the bone to grow in a discontinuous manner. Creating an open and continuous space or "open porosity" in and around the pillar structure allows the bone to easily interdigitate with the implant surface without encumberment from a continuous porous structure. An in-vivo study, using an established ovine model, was undertaken examining the effects of pillar morphology on bone ingrowth and mechanical performance. Cortical and cancellous sites were evaluated utilizing histology, histomophometry, and mechanical pushout, at 4 and 12 weeks. Robust bone ingrowth occurred for all morphologies as was noted in review of the study results. An increase in volume and maturity of bone was noted between the intermediated and final time points. Histomophometry demonstrated over 40% and 80% new bone occupied the available "ingrowth" area at 12 weeks for cancellous and cortical sites (respectively). Histologic review showed little fibrous tissue ingrowth at the interface with no adverse cellular reactions. Testing of cortical samples demonstrated a significant increase in pushout load between the 4 and 12 week timepoints and a 4-8 fold increase in pushout load as compared to the grit blast control. These results demonstrated the effectiveness of the novel interface for orthopedic applications in an in-vivo ovine model.
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Affiliation(s)
| | | | - Jamey Price
- Applied Medical Technology, Brecksville, OH, USA
| | | | - Tian Wang
- The University of New South Wales, Australia
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33
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Huang H, Jiang W, Hong K, Cai J, He Y, Ma X, Wu P, Lang J, Ma Y, Huang C, Yuan J. Protocatechualdehyde inhibits receptor activator of nuclear factor kappa-B ligand-induced osteoclastogenesis and attenuates lipopolysaccharide-induced inflammatory osteolysis. Phytother Res 2021; 35:3821-3835. [PMID: 33778997 DOI: 10.1002/ptr.7088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 02/22/2021] [Accepted: 02/22/2021] [Indexed: 12/31/2022]
Abstract
Inflammatory osteolysis as a consequence of chronic bacterial infection underlies several lytic bone conditions, such as otitis media, osteomyelitis, septic arthritis, periodontitis, periprosthetic infection, and aseptic loosening of orthopedic implants. In consideration of the lack of effective preventive or treatments options against infectious osteolysis, the exploitation of novel pharmacological compounds/agents is critically required. The present study assessed the effect of protocatechualdehyde (PCA), a natural occurring polyphenolic compound with diverse biological activities including but not limited to antibacterial and antiinflammatory properties, on nuclear factor-κB ligand (RANKL)-induced osteoclastogenesis in vitro and lipopolysaccharide (LPS)-induced bone loss in vivo. In the present study, it was found that PCA potently inhibited RANKL-induced osteoclast formation, fusion, and activation toward bone resorption in a dose-dependent manner via the suppression of the ERK/c-Fos/nuclear factor of activated T-cells, cytoplasmic 1 signaling axis. It was further demonstrated that the in vivo administration of PCA could effectively protect mice against the deleterious effects of LPS-induced calvarial bone destruction by attenuating osteoclast formation and activity in a dose-dependent manner. Collectively, these findings provided evidence for the potential therapeutic application of PCA in the prevention and treatment of infectious osteolytic conditions, and potentially other osteoclast-mediated bone diseases.
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Affiliation(s)
- Hao Huang
- Department of Orthopedics, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, China
| | - Wenli Jiang
- Department of Biochemistry and Molecular Biology, College of Basic Medical, Navy Medical University, Shanghai, China
| | - Kehua Hong
- Department of Orthopedics, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jie Cai
- Department of Orthopedics, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yongchao He
- Department of Orthopedics, The Affiliated Cangnan Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xuming Ma
- Department of Orthopedics, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Peng Wu
- Department of Orthopedics, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Junzhe Lang
- Department of Orthopedics, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yuegang Ma
- Department of Orthopedics, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing, China
| | - Caiguo Huang
- Department of Biochemistry and Molecular Biology, College of Basic Medical, Navy Medical University, Shanghai, China
| | - Jiandong Yuan
- Department of Orthopedics, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Fortier LM, Rockov ZA, Chen AF, Rajaee SS. Activity Recommendations After Total Hip and Total Knee Arthroplasty. J Bone Joint Surg Am 2021; 103:446-455. [PMID: 33337819 DOI: 10.2106/jbjs.20.00983] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
» A formal unsupervised activity program should be recommended to all patients recovering from total knee arthroplasty (TKA) and total hip arthroplasty (THA). » In a subset of all patients undergoing TKA or THA, studies have found that an unsupervised activity program may be as efficacious as supervised physical therapy (PT) after surgery. Certain patients with inadequate independent function may continue to benefit from supervised PT. » For TKA, supervised telerehabilitation has also been proven to be an effective modality, with studies suggesting equivalent efficacy compared with supervised in-person PT. » Following TKA, there is no benefit to the use of continuous passive motion or cryotherapy devices, but there are promising benefits from the use of pedaling exercises, weight training, and balance and/or sensorimotor training as adjuncts to a multidisciplinary program after TKA. » No standardized postoperative limitations exist following TKA, and the return to preoperative activities should be dictated by an individual's competency and should consist of methods to minimize high impact stress on the joint. » Despite traditional postoperative protocols recommending range-of-motion restrictions after THA, it is reasonable to recommend that hip precautions may not be needed routinely following elective primary THA.
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Affiliation(s)
- Luc M Fortier
- Georgetown University School of Medicine, Washington, DC
| | - Zachary A Rockov
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Antonia F Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sean S Rajaee
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, California
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Abstract
BACKGROUND This study aimed to examine the major reasons for total hip arthroplasty (THA) failure and temporal patterns in THA revisions. METHODS A retrospective chart review was conducted on 535 revisions performed on 444 THAs from January 2010 to May 2019 at our institution. RESULTS The average time to revision THA was 8.51 ± 8.38 years, with 136 cases (30.9%) occurring within 2 years after primary THA. The major mechanisms of failure that resulted in revision surgery were mechanical failure (162, 36.5%), metallosis (95, 21.4%), dislocation or instability (65, 14.6%), periprosthetic fracture (46, 10.4%), infection (44, 9.9%), hematoma or poor wound healing (15, 3.4%), and pain or other (17, 3.8%). CONCLUSION Based on our institutional experience over the past decade, mechanical failure without dislocation, metallosis, dislocation, periprosthetic fracture, and infection are typical reasons patients present for primary THA revision. Revisions within 2 years after primary THA are more likely to be the result of infection and periprosthetic fracture. Mechanical failure is the most common reason for revision THA overall, and mechanical failure and metallosis are more likely to be the reason revision is necessary 2 or more years after primary THA.
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36
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Wang L, Gao Z, Zhang J, Huo Y, Xu Q, Qiu Y. Netrin-1 regulates ERK1/2 signaling pathway and autophagy activation in wear particle-induced osteoclastogenesis. Cell Biol Int 2021; 45:612-622. [PMID: 33386763 PMCID: PMC8048890 DOI: 10.1002/cbin.11544] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 11/08/2020] [Accepted: 11/11/2020] [Indexed: 12/11/2022]
Abstract
Background Artificial joint replacement surgery is often accompanied by osteolysis induced aseptic loosening around the prosthesis. Wear particles from joint replacement are thought to be one of the main factors leading to local inflammation and osteolysis at the prosthesis site. The aim of this study was to investigate the molecular mechanism of osteoclast formation and dissolution induced by wear particles and the potential roles of Netrin‐1, the ERK1/2 pathway and autophagy activation in this process. Methods The messenger RNA levels in cells and tissues were detected with real‐time quantitative PCR. The western blotting was used to detect the expression of proteins. A CCK‐8 kit was used to detect the viability of RAW 264.7 cells. Moreover, an air pouch model of bone resorption was established. Immunohistochemistry was used to detect the expression of TRAP and Netrin‐1 in rat bone tissue. Cell culture supernatants were collected in the rat air pouch model of bone resorption, and the levels of RANKL and OPG were detected with enzyme‐linked immunosorbent assay. The protein levels of TRAP and Netrin‐1 in bone tissue were examined by immunohistochemistry. Results Titanium wear particles induced osteoclast formation and autophagy activation. Moreover, blocking autophagy suppressed the osteoclastogenesis after exposure to wear particles in vitro. The activation of the ERK1/2 pathway and the overexpression of Netrin‐1 were both found to play important roles in osteoclastogenesis mediated by autophagy. Moreover, 3‐MA effectively decreased the secretion of proinflammatory cytokines mediated by wear particles. Conclusion Blockade of autophagy inhibits the osteoclastogenesis and inflammation induced by wear particles, thus potentially providing novel treatment strategies for abnormal osteoclastogenesis and aseptic prosthesis loosening induced by wear particles.
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Affiliation(s)
- Lei Wang
- Department of Orthopedics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Department of Orthopedics, Affiliated Hospital of Yan'an University, Yan'an, Shaanxi, China
| | - Zhibiao Gao
- Department of Orthopedics, Affiliated Hospital of Yan'an University, Yan'an, Shaanxi, China
| | - Jie Zhang
- Department of Orthopedics, Affiliated Hospital of Yan'an University, Yan'an, Shaanxi, China
| | - Yulong Huo
- Department of Orthopedics, Affiliated Hospital of Yan'an University, Yan'an, Shaanxi, China
| | - Qiang Xu
- Department of Orthopedics, Affiliated Hospital of Yan'an University, Yan'an, Shaanxi, China
| | - Yusheng Qiu
- Department of Orthopedics, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
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Massier JRA, Van Erp JHJ, Snijders TE, Gast ADE. A vitamin E blended highly cross-linked polyethylene acetabular cup results in less wear: 6-year results of a randomized controlled trial in 199 patients. Acta Orthop 2020; 91:705-710. [PMID: 32835560 PMCID: PMC8023918 DOI: 10.1080/17453674.2020.1807220] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Survivorship of total hip arthroplasty (THA) with the ultra-high molecular weight polyethylene (UHMWPE) monoblock cup has been limited due to periprosthetic osteolysis and aseptic loosening, secondary to wear of the UHMWPE. In response, a vitamin E blended highly cross-linked polyethylene (HXLPE) cup was developed. This study set out to compare the wear and clinical 6-year outcomes of vitamin E blended HXLPE with UHMWPE in an isoelastic monoblock cup in patients with hip osteoarthritis who underwent uncemented THA. The 2-year results have been reported previously. Patients and methods - For this randomized controlled trial 199 patients were included. 102 patients received the vitamin E blended HXLPE uncemented acetabular cup and 97 patients the uncemented UHMWPE monoblock cup. Clinical and radiographic parameters were obtained preoperatively, directly postoperatively, and at 3, 12, 24, and 72 months. Wear rates were compared using the femoral head penetration (FHP) rate. Results - 173 patients (87%) completed the 6-year follow-up. The mean NRS scores for rest pain, load pain, and patient satisfaction were 0.3 (SD 1), 0.6 (SD 1), and 8.6 (SD 1) respectively. The mean Harris Hip Score was 93 (SD 12). The FHP rate was lower in the vitamin E blended HXLPE cup (0.028 mm/year) compared with the UHMWPE cup (0.035 mm/year) (p = 0.002). No adverse reactions associated with the clinical application of vitamin E blended HXLPE were observed. 15 complications occurred, equally distributed between the two cups. The 6-year survival to revision rate was 98% for both cups. There was no aseptic loosening. Interpretation - This study shows the superior performance of the HXLPE blended with vitamin E acetabular cup with clinical and radiographic results similar to the UHMWPE acetabular cup.
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Affiliation(s)
- Julie R A Massier
- Clinical Orthopedic Research Center – mN, Zeist,Department of Orthopedic Surgery, Diakonessenhuis, Utrecht, the Netherlands
| | - Joost H J Van Erp
- Clinical Orthopedic Research Center – mN, Zeist,Department of Orthopedic Surgery, Diakonessenhuis, Utrecht, the Netherlands,Correspondence:
| | | | - Arthur DE Gast
- Clinical Orthopedic Research Center – mN, Zeist,Department of Orthopedic Surgery, Diakonessenhuis, Utrecht, the Netherlands
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Chen Y, Lu J, Li S, Zhang C, Yang Q, Hu B, Zhou C, Hong J, Jiang G, Yan S. Carnosol attenuates RANKL-induced osteoclastogenesis in vitro and LPS-induced bone loss. Int Immunopharmacol 2020; 89:106978. [PMID: 33039968 DOI: 10.1016/j.intimp.2020.106978] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 09/01/2020] [Accepted: 09/03/2020] [Indexed: 02/02/2023]
Abstract
Osteolysis is characterized by the imbalance of bone remodeling triggered by excessive activation of osteoclasts, which ultimately leads to pathological bone destruction. Diseases caused by overactive osteoclasts, such as osteolysis around the prosthesis, periodontitis and osteoporosis, are clinically common but lack effective treatment. Therefore, exploring regimens that could specifically impair the formation and function of osteoclasts has become a breakthrough in the treatment of these diseases. Carnosol is a natural phenolic diterpene with anti-inflammatory, antibacterial, anti-tumor and antioxidant properties. In this study, we found that carnosol can impede RANKL-induced osteoclastogenesis via modulating the activation of NF-κb and JNK signaling pathways in vitro. Additionally, we confirmed that carnosol could alleviate bone loss in amurine model of LPS-induced inflammatory bone erosion in vivo. Thence, these findings demonstrate that carnosol may be a potentially effective regent for the treatment of osteoclast-related disorders.
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Affiliation(s)
- Yazhou Chen
- Department of Orthopedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, No. 88, Jiefang Road, Hangzhou 310009, China; Orthopedics Research Institute of Zhejiang University, No. 88, Jiefang Road, Hangzhou 310009, China
| | - Jinwei Lu
- Department of Orthopedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, No. 88, Jiefang Road, Hangzhou 310009, China; Orthopedics Research Institute of Zhejiang University, No. 88, Jiefang Road, Hangzhou 310009, China
| | - Sihao Li
- Department of Orthopedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, No. 88, Jiefang Road, Hangzhou 310009, China; Orthopedics Research Institute of Zhejiang University, No. 88, Jiefang Road, Hangzhou 310009, China
| | - Caihua Zhang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, No. 88, Jiefang Road, Hangzhou 310009, China; Orthopedics Research Institute of Zhejiang University, No. 88, Jiefang Road, Hangzhou 310009, China
| | - Quanming Yang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, No. 88, Jiefang Road, Hangzhou 310009, China; Orthopedics Research Institute of Zhejiang University, No. 88, Jiefang Road, Hangzhou 310009, China
| | - Bin Hu
- Department of Orthopedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, No. 88, Jiefang Road, Hangzhou 310009, China; Orthopedics Research Institute of Zhejiang University, No. 88, Jiefang Road, Hangzhou 310009, China
| | - Chenhe Zhou
- Department of Orthopedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, No. 88, Jiefang Road, Hangzhou 310009, China; Orthopedics Research Institute of Zhejiang University, No. 88, Jiefang Road, Hangzhou 310009, China
| | - Jianqiao Hong
- Department of Orthopedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, No. 88, Jiefang Road, Hangzhou 310009, China; Orthopedics Research Institute of Zhejiang University, No. 88, Jiefang Road, Hangzhou 310009, China
| | - Guangyao Jiang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, No. 88, Jiefang Road, Hangzhou 310009, China; Orthopedics Research Institute of Zhejiang University, No. 88, Jiefang Road, Hangzhou 310009, China
| | - Shigui Yan
- Department of Orthopedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, No. 88, Jiefang Road, Hangzhou 310009, China; Orthopedics Research Institute of Zhejiang University, No. 88, Jiefang Road, Hangzhou 310009, China.
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Wyatt MC, Roberton A, Foxall-Smi M, Beswick AD, Kunutsor SK, Whitehouse MR. Does vitamin E highly-crosslinked polyethylene convey an advantage in primary total hip replacement? A systematic review and meta-analysis. Hip Int 2020; 30:598-608. [PMID: 31213083 DOI: 10.1177/1120700019858335] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Vitamin E highly cross-linked polyethylene (HXLPE) was developed to reduce wear in total hip replacement (THR). This formal systematic review and meta-analysis aimed to provide independent synthesis of wear characteristics of Vitamin E treated HXLPE compared to HXPLE/UHMWPE. Secondary outcome measures were differences in revision rates and functional scores. METHODS We performed a formal systematic review as per PRISMA guidelines; literature searches were conducted on 14 November 2017 (MEDLINE, Embase on Ovid, and the Cochrane Library). We included randomised controlled trials, analyses of joint registries, and case-controlled studies of primary THR comparing cups with a vitamin E HXLPE bearing with bearing surfaces made from other types of polyethylene. Initial screening was performed by 2 independent assessors; disagreement resolved in discussion with a third reviewer. Studies were evaluated using the Cochrane risk of bias tool. Data extraction permitted meta-analysis. RESULTS 372 studies were identified on initial screening, 5 studies met the eligibility criteria. There was no significant heterogeneity between studies. There was variable risk of bias. At a mean of 35 (range 20-60) months, Vitamin E HXLPE had significant advantages over highly cross-linked polyethylene with regards total femoral head penetration (p = 0.004). Given the RSA measurement errors this may not be clinically significant.There were neither significant differences in revision rates nor Harris Hip Scores (p = 0.06). CONCLUSION At a minimum of 3 years follow-up there was reduced total femoral head penetration for vitamin E HXLPE over HXLPE. This bearing surface does not, as yet, have clinically significant advantages in terms of revision rates or patient function over HXLPE.
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Affiliation(s)
- Michael C Wyatt
- Musculoskeletal Research Unit, Southmead Hospital, Bristol, UK.,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol
| | - Andrew Roberton
- Musculoskeletal Research Unit, Southmead Hospital, Bristol, UK.,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol
| | - Michael Foxall-Smi
- Musculoskeletal Research Unit, Southmead Hospital, Bristol, UK.,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol
| | - Andrew D Beswick
- Musculoskeletal Research Unit, Southmead Hospital, Bristol, UK.,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol
| | - Setor K Kunutsor
- Musculoskeletal Research Unit, Southmead Hospital, Bristol, UK.,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol
| | - Michael R Whitehouse
- Musculoskeletal Research Unit, Southmead Hospital, Bristol, UK.,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol
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40
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Wu TK, Liu H, Wang BY, He JB, Ding C, Rong X, Yang Y, Huang KK, Hong Y. Incidence of bone loss after Prestige-LP cervical disc arthroplasty: a single-center retrospective study of 396 cases. Spine J 2020; 20:1219-1228. [PMID: 32445801 DOI: 10.1016/j.spinee.2020.05.102] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 05/08/2020] [Accepted: 05/08/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND CONTEXT The development of bone loss (BL) at the operated level after cervical disc arthroplasty (CDA) has not been well recognized. The incidence of BL may be correlated with the prosthesis type. Currently, no study has reported the incidence of BL after CDA with the Prestige-LP disc, and this remains an active area of research. PURPOSE To determine the incidence of BL after Prestige-LP CDA and evaluate the impact of BL on clinical and radiological outcomes. STUDY DESIGN This is an observational study. PATIENT SAMPLE A total of 396 patients were reviewed. OUTCOME MEASURES The Japanese Orthopedics Association (JOA), Visual Analogue Scale (VAS), and Neck Disability Index (NDI) scores were evaluated. Cervical lordosis, disc angle, global and segmental range of motion (ROM), heterotopic ossification (HO), and BL were measured. METHODS We retrospectively reviewed patients who underwent Prestige-LP disc from January 2008 to October 2018 at our institution. Clinical outcomes were evaluated using JOA, VAS, and NDI scores. Radiological variables, including cervical lordosis, disc angle, global and segmental ROM, HO, and BL, were retrieved. RESULTS A total of 396 patients and 483 CDAs were evaluated. BL occurred in 56.6% of patients and 52.8% of CDA segments. Mild BL occurred in 30.2%, moderate BL in 37.3%, and severe BL in 32.5% of CDA segments. Notably, 88.2% of CDA segments developed BL within the first 3 months, and 19.1% of them progressed at 6 months. However, no progressive BL after 12 months was seen. About 50.2% of CDAs showed superior and inferior endplates involvement. The incidence of BL was associated with age, surgery type, level distribution, and incidence and grade of HO. Patients with BL had a better segmental ROM, but no relationships between patients with or without BL were found in clinical outcomes. CONCLUSIONS BL was a common but self-limited phenomenon after CDA at the early postoperative stage. It occurred more often in relatively young age patients, two-level CDA, and C5/6 segment. However, patients suffering from BL showed no deterioration of the clinical outcomes, more exceptional motion preservation at the arthroplasty level, and lower incidence with a lower grade of HO.
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Affiliation(s)
- Ting-Kui Wu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu 610041, China.
| | - Hao Liu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu 610041, China.
| | - Bei-Yu Wang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu 610041, China.
| | - Jun-Bo He
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu 610041, China.
| | - Chen Ding
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu 610041, China.
| | - Xin Rong
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu 610041, China.
| | - Yi Yang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu 610041, China.
| | - Kang-Kang Huang
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu 610041, China.
| | - Ying Hong
- Department of Operating Room, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu 610041, China.
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Viitala R, Saikko V. Effect of random variation of input and various daily activities on wear in a hip joint simulator. J Biomech 2020; 106:109831. [PMID: 32517982 DOI: 10.1016/j.jbiomech.2020.109831] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/21/2020] [Accepted: 05/05/2020] [Indexed: 11/24/2022]
Abstract
The ISO 14242-1 standard specifies fixed, simplified, sinusoidal motion and double-peak load cycles for wear testing of total hip prostheses. In order to make the wear simulation more realistic, random variation was added for the first time to the motion and load control signals of a hip joint simulator. For this purpose and for the simulation of various daily activities, computer-controlled, servo-electric drives were mounted on a biaxial hip simulator frame and successfully introduced. Random variation did not result in a statistically significant difference in the wear factor of large diameter VEXLPE liners compared with fixed sinusoidal waveforms. However, level walking according to biomechanical literature surprisingly resulted in a 134 per cent higher, and jogging in a 57 per cent lower wear factor compared with the fixed sinusoidal waveforms. These wear phenomena were likely to be caused by a variation in the lubrication conditions and frictional heating. Simplified motion waveforms may result in an underestimation of wear in walking.
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Affiliation(s)
| | - Vesa Saikko
- Aalto University School of Engineering, Finland.
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42
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van Erp JHJ, Massier JRA, Halma JJ, Snijders TE, de Gast A. 2-year results of an RCT of 2 uncemented isoelastic monoblock acetabular components: lower wear rate with vitamin E blended highly cross-linked polyethylene compared to ultra-high molecular weight polyethylene. Acta Orthop 2020; 91:254-259. [PMID: 32098534 PMCID: PMC8023900 DOI: 10.1080/17453674.2020.1730073] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - The long-term survival of arthroplasty components may be limited by polyethylene wear-related problems such as periprosthetic osteolysis and aseptic loosening. Highly cross-linked polyethylene (HXLPE) blended with vitamin E was introduced to improve oxidative stability and to avoid long-term embrittlement. This study clinically compares the tribological behavior and clinical outcome of vitamin E blended HXLPE with ultra-high molecular weight polyethylene (UHMWPE) in an isoelastic monoblock cup for uncemented total hip arthroplasty.Patients and methods - In this randomized controlled trial (RCT), 199 patients were included: 102 patients received the vitamin E blended HXLPE cup, 97 patients the UHMWPE cup. Clinical and radiographic parameters were obtained preoperatively, directly postoperative and at 3, 12, and 24 months. Wear rates were compared using the mean linear femoral head penetration (FHP) rate.Results - 188 patients (94%) completed the 2-year follow-up. Mean patient satisfaction was higher in the vitamin E blended HXLPE group (8.9 [1]) than in in the control group (8.5 [2], p = 0.03). The Harris Hip Score (HHS) was higher in the vitamin E blended HXLPE group (95 [8]) than in the control group (92 [11], p = 0.3). The FHP rate was lower in the vitamin E blended HXLPE group: 0.046 mm/year compared with 0.056 mm/year in the control group (p = 0.05). No adverse reactions associated with the clinical application of vitamin E blended HXLPE were observed during follow-up, with an excellent 2-year survival to revision rate of 98% for both cups.Interpretation - This study shows the superior performance of the HXLPE blended with vitamin E acetabular cup with lower linear femoral head penetration rates and better clinical results compared with the UHMWPE acetabular cup after 2 years.
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Affiliation(s)
- Joost H J van Erp
- Clinical Orthopedic Research Center—mN, Zeist, the Netherlands; ,Department of Orthopedic Surgery, Diakonessenhuis, Utrecht, the Netherlands,Correspondence::
| | - Julie R A Massier
- Clinical Orthopedic Research Center—mN, Zeist, the Netherlands; ,Department of Orthopedic Surgery, Diakonessenhuis, Utrecht, the Netherlands
| | - Jelle J Halma
- Clinical Orthopedic Research Center—mN, Zeist, the Netherlands;
| | - Thom E Snijders
- Clinical Orthopedic Research Center—mN, Zeist, the Netherlands;
| | - Arthur de Gast
- Clinical Orthopedic Research Center—mN, Zeist, the Netherlands; ,Department of Orthopedic Surgery, Diakonessenhuis, Utrecht, the Netherlands
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Wei X, Fan B, Chen X, Cheng Y, Zhang A, Yu S, Zhang S, Zhao H. DAPT inhibits titanium particle-induced osteolysis by suppressing the RANKL/Notch2 signaling pathway. J Biomed Mater Res A 2020; 108:2150-2161. [PMID: 32323420 DOI: 10.1002/jbm.a.36972] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 03/24/2020] [Accepted: 03/28/2020] [Indexed: 01/03/2023]
Abstract
Artificial prosthesis is wildly used in clinical medicine for degenerative disease such as osteoclast-related diseases. However, the material wear particles released from the surface of prostheses cause prosthetic loosening as a result of aseptic osteolysis in long-term use. Therefore, it is important to find an agent that inhibits the formation and function of osteoclast for therapeutic use. Notch signaling pathway plays a lot of roles in cell proliferation, differentiation, and apoptosis. However, the role of Notch signaling pathway in osteoclastogenesis remains unclear. The aim of this study is to assess the effects of γ-secretase inhibitor DAPT on osteoclastogenesis via Notch signaling pathway in vitro and titanium particle-induced osteolysis in vivo. In animal experiments, the inhibitory effect of DAPT on titanium particle-induced osteolysis in a mouse calvaria model was demonstrated. Interestingly, few resorption pits were observed following administration of DAPT and almost no osteoclasts formed at high concentration of DAPT. in vitro experiments revealed the mechanism of the effects of DAPT on osteoclastogenesis. DAPT inhibited the formation and function of osteoclast by blocking RANKL-induced Notch2-NF-κB complex signaling pathway. In conclusion, these results indicated that DAPT could prevent and cure titanium particle-induced prosthetic loosening and other osteoclast-related diseases.
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Affiliation(s)
- Xiang Wei
- Shandong Province Key Laboratory of Oral Tissue Regeneration, School of Stomatology, Shandong University, Jinan, China.,Department of Oral and Maxillofacial Surgery, School of Stomatology, Shandong University, Jinan, China
| | - Baoting Fan
- Department of Oral and Maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xuzhuo Chen
- Department of Oral and Maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yutian Cheng
- Department of Stomatology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, China
| | - Aobo Zhang
- Shandong Province Key Laboratory of Oral Tissue Regeneration, School of Stomatology, Shandong University, Jinan, China.,Department of Oral and Maxillofacial Surgery, School of Stomatology, Shandong University, Jinan, China
| | - Shiqi Yu
- Shanghai Ninth People's Hospital, School of Biomedical Engineering, Shanghai Jiaotong University, Shanghai, China
| | - Shanyong Zhang
- Department of Oral and Maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Huaqiang Zhao
- Shandong Province Key Laboratory of Oral Tissue Regeneration, School of Stomatology, Shandong University, Jinan, China.,Department of Oral and Maxillofacial Surgery, School of Stomatology, Shandong University, Jinan, China
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44
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Zhang L, Yang Y, Liao Z, Liu Q, Lei X, Li M, Saijilafu, Zhang Z, Hong D, Zhu M, Li B, Yang H, Chen J. Genetic and pharmacological activation of Hedgehog signaling inhibits osteoclastogenesis and attenuates titanium particle-induced osteolysis partly through suppressing the JNK/c-Fos-NFATc1 cascade. Theranostics 2020; 10:6638-6660. [PMID: 32550895 PMCID: PMC7295048 DOI: 10.7150/thno.44793] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 05/07/2020] [Indexed: 12/19/2022] Open
Abstract
Rationale: Wear particle-induced periprosthetic osteolysis (PPO) is a common long-term complication of total joint arthroplasty, and represents the major cause of aseptic loosening and subsequent implant failure. Previous studies have identified the central role of osteoclast-mediated bone resorption in the pathogenesis of PPO. Thus, therapeutic approaches of inhibiting osteoclast formation and activity are considered to be of great potential to prevent and treat this osteolytic disease. Hedgehog (Hh) signaling has been shown to play an important role in promoting osteoblast differentiation and bone formation. While Hh signaling is also implicated in regulating osteoclastogenesis, whether it can directly inhibit osteoclast differentiation and bone resorption remains controversial. Moreover, its potential therapeutic effects on PPO have never been assessed. In this study, we explored the cell-autonomous role of Hh signaling in regulating osteoclastogenesis and its therapeutic potential in preventing wear particle-induced osteolysis. Methods: Hh signaling was activated in macrophages by genetically ablating Sufu in these cells using LysM-Cre or by treating them with purmorphamine (PM), a pharmacological activator of Smoothened (Smo). In vitro cell-autonomous effects of Hh pathway activation on RANKL-induced osteoclast differentiation and activity were evaluated by TRAP staining, phalloidin staining, qPCR analyses, and bone resorption assays. In vivo evaluation of its therapeutic efficacy against PPO was performed in a murine calvarial model of titanium particle-induced osteolysis by μCT and histological analyses. Mechanistic details were explored in RANKL-treated macrophages through Western blot analyses. Results: We found that Sufu deletion or PM treatment potently activated Hh signaling in macrophages, and strongly inhibited RANKL-induced TRAP+ osteoclast production, F-actin ring formation, osteoclast-specific gene expression, and osteoclast activity in vitro. Furthermore, we found that Sufu deletion or PM administration significantly attenuated titanium particle-induced osteoclast formation and bone loss in vivo. Our mechanistic study revealed that activation of Hh signaling suppressed RANKL-induced activation of JNK pathway and downregulated protein levels of two key osteoclastic transcriptional factors, c-Fos and its downstream target NFATc1. Conclusions: Both genetic and pharmacological activation of Hh signaling can cell-autonomously inhibit RANKL-induced osteoclast differentiation and activity in vitro and protect against titanium particle-induced osteolysis in vivo. Mechanistically, Hh signaling hinders osteoclastogenesis partly through suppressing the JNK/c-Fos-NFATc1 cascade. Thus, Hh signaling may serve as a promising therapeutic target for the prevention and treatment of PPO and other osteolytic diseases.
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Affiliation(s)
- Liwei Zhang
- Department of Orthopaedics, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China
- Orthopedic Institute, Medical College, Soochow University, Suzhou, Jiangsu 215007, China
| | - Yanjun Yang
- Department of Orthopaedics, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China
- Orthopedic Institute, Medical College, Soochow University, Suzhou, Jiangsu 215007, China
| | - Zirui Liao
- Orthopedic Institute, Medical College, Soochow University, Suzhou, Jiangsu 215007, China
| | - Qingbai Liu
- Department of Orthopaedics, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China
| | - Xinhuan Lei
- Orthopedic Department, Taizhou Hospital Affiliated to Wenzhou Medical University, Linhai, Zhejiang 317000, China
| | - Meng Li
- Department of Orthopaedics, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China
- Orthopedic Institute, Medical College, Soochow University, Suzhou, Jiangsu 215007, China
| | - Saijilafu
- Department of Orthopaedics, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China
- Orthopedic Institute, Medical College, Soochow University, Suzhou, Jiangsu 215007, China
| | - Zunyi Zhang
- Institute of Life Sciences, College of Life and Environmental Science, Key Laboratory of Mammalian Organogenesis and Regeneration, Hangzhou Normal University, Hangzhou, Zhejiang 310036, China
| | - Dun Hong
- Orthopedic Department, Taizhou Hospital Affiliated to Wenzhou Medical University, Linhai, Zhejiang 317000, China
| | - Min Zhu
- Orthopedic Department, Taizhou Hospital Affiliated to Wenzhou Medical University, Linhai, Zhejiang 317000, China
| | - Bin Li
- Department of Orthopaedics, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China
- Orthopedic Institute, Medical College, Soochow University, Suzhou, Jiangsu 215007, China
| | - Huilin Yang
- Department of Orthopaedics, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China
- Orthopedic Institute, Medical College, Soochow University, Suzhou, Jiangsu 215007, China
| | - Jianquan Chen
- Department of Orthopaedics, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China
- Orthopedic Institute, Medical College, Soochow University, Suzhou, Jiangsu 215007, China
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Davis ET, Pagkalos J, Kopjar B. Effect of Bearing Surface on Survival of Cementless and Hybrid Total Hip Arthroplasty: Study of Data in the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man. JB JS Open Access 2020; 5:e0075. [PMID: 33123668 PMCID: PMC7418917 DOI: 10.2106/jbjs.oa.19.00075] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Modern bearing surface options have increased implant survivorship after total hip arthroplasty (THA). We utilized data from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (NJR) to analyze implant survivorship after THAs with uncemented acetabular components with different bearing combinations. Methods Polyethylene (PE) manufacturing properties supplied by the manufacturers were used to subdivide the NJR data set into cross-linked PE (XLPE) and conventional PE groups. Overall and cause-specific revisions for various bearing combinations were analyzed using Kaplan-Meier and multivariate Cox proportional hazard regression survival analyses. Results Of 420,339 primary THAs, 8,025 were revised during an average follow-up period of 4.4 years (maximum, 13.3 years). In the Cox regression model with metal on conventional PE as the reference, the lowest risk of revision for any reason was for ceramicized metal on XLPE (hazard ratio [HR] = 0.58, 95% confidence interval [CI] = 0.48, 0.71), followed by ceramic on XLPE (HR = 0.66, 95% CI = 0.60, 0.72), ceramic on PE (HR = 0.74, 95% CI = 0.66, 0.82), ceramic on ceramic (HR = 0.77, 95% CI = 0.72, 0.82), and metal on XLPE (HR = 0.81, 95% CI = 0.76, 0.87). A similar pattern was observed when patients under the age of 55 years were analyzed independently. Younger age, male sex, and cementless stem fixation were associated with a higher risk of revision. Conclusions In a fully adjusted model, ceramicized metal on XLPE and ceramic on XLPE were associated with the lowest risk of revision for any reason. This finding was sustained when patients under the age of 55 years were analyzed independently. On the basis of the NJR data set, use of XLPE markedly reduces the risk of revision. Level of Evidence Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Edward T Davis
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom.,Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Joseph Pagkalos
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom
| | - Branko Kopjar
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom.,School of Public Health, University of Washington, Seattle, Washington
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Computed Tomographic Osteolytic Analysis of a First-Generation Remelted Highly Cross-Linked Polyethylene in Total Hip Arthroplasty-At a Minimum of 15-Year Follow-Up. J Arthroplasty 2020; 35:1417-1423. [PMID: 31948813 DOI: 10.1016/j.arth.2019.12.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 11/25/2019] [Accepted: 12/09/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Low polyethylene wear rate and low incidence of osteolysis have been reported after total hip arthroplasty (THA) using first-generation remelted highly cross-linked polyethylene (HXLPE). However, osteolysis has not been evaluated in long-term studies of these patients (15 years or more). The present study assessed computed tomography (CT) images to determine the incidence of osteolysis associated with HXLPE in THA during at least 15 years of follow-up. METHODS We evaluated 105 primary THAs in 84 patients (77 women and 7 men). Mean follow-up was 15.9 years (range, 15-18 years). All THAs used a Longevity HXLPE liner and a 26-mm zirconia femoral head. Areas of osteolysis were identified from CT images using 3D and multiplanar reconstruction views. RESULTS CT 3D multiplanar reconstruction images at 15-year follow-up showed no obvious osteolysis in the acetabulum or femur of any patient. No patients developed cup loosening or liner breakage. CONCLUSION Our study indicates that first-generation remelted HXLPE liners do not increase the risk of osteolysis during 15-year follow-up and suggests that the wear particles from first-generation remelted HXLPE are less biologically active than those generated by conventional polyethylene devices.
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Jaeger S, Uhler M, Schroeder S, Beckmann NA, Braun S. Comparison of Different Locking Mechanisms in Total Hip Arthroplasty: Relative Motion between Cup and Inlay. MATERIALS 2020; 13:ma13061392. [PMID: 32204382 PMCID: PMC7142960 DOI: 10.3390/ma13061392] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 03/11/2020] [Accepted: 03/16/2020] [Indexed: 01/03/2023]
Abstract
The resulting inflammatory reaction to polyethylene (PE) wear debris, which may result in osteolysis, is still considered to be a main reason for aseptic loosening. In addition to the primary wear in hip joint replacements caused by head-insert articulation, relative motions between the PE liner and the metal cup may cause additional wear. In order to limit this motion, various locking mechanisms were used. We investigated three different locking mechanisms (Aesculap, DePuy, and Zimmer Biomet) to address the resulting relative motion between the acetabular cup and PE liner and the maximum disassembly force. A standardized setting with increasing load levels was used in combination with optically based three-dimensional measurements. In addition the maximum disassembly forces were evaluated according to the ASTM F1820-13 standard. Our data showed significant differences between the groups, with a maximum relative motion at the maximum load level (3.5 kN) of 86.5 ± 32.7 µm. The maximum axial disassembly force was 473.8 ± 94.6 N. The in vitro study showed that various locking mechanisms may influence cup-inlay stability.
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Affiliation(s)
- Sebastian Jaeger
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg University, 69118 Heidelberg, Germany; (S.S.); (S.B.)
- Correspondence: (S.J.); (M.U.)
| | - Maximilian Uhler
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg University, 69118 Heidelberg, Germany; (S.S.); (S.B.)
- Correspondence: (S.J.); (M.U.)
| | - Stefan Schroeder
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg University, 69118 Heidelberg, Germany; (S.S.); (S.B.)
| | - Nicholas A. Beckmann
- Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg University, 69118 Heidelberg, Germany;
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, 3010 Bern, Switzerland
| | - Steffen Braun
- Laboratory of Biomechanics and Implant Research, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg University, 69118 Heidelberg, Germany; (S.S.); (S.B.)
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Hallstrom BR, Hughes RE. Controversies in Hip Arthroplasty: Using Registries to Answer Difficult Questions. JAMA 2020; 323:1046-1048. [PMID: 32181833 DOI: 10.1001/jama.2020.2274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Brian R Hallstrom
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor
| | - Richard E Hughes
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor
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Saikko V. Effect of inward-outward rotation on hip wear simulation. J Biomech 2020; 101:109638. [DOI: 10.1016/j.jbiomech.2020.109638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 11/27/2019] [Accepted: 01/12/2020] [Indexed: 10/25/2022]
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50
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Wang X, Yamauchi K, Mitsunaga T. A review on osteoclast diseases and osteoclastogenesis inhibitors recently developed from natural resources. Fitoterapia 2020; 142:104482. [PMID: 31954740 DOI: 10.1016/j.fitote.2020.104482] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/09/2020] [Accepted: 01/14/2020] [Indexed: 12/14/2022]
Abstract
Natural products have been investigated as potential candidates of novel therapeutics and play a crucial role in advanced medicinal drugs. Natural resources, including local medicinal plants (especially folk medicinal plants), animals, bacteria, and fungi have been used for more than a century, and are precious gifts from nature, providing potential medicines with high safety. Osteoclast-related diseases, such as osteoporosis, rheumatoid arthritis, Paget's disease, osteoclastoma, and periprosthetic osteolysis, are currently the most common reasons for bone inflammation, pain and fractures, resulting in low quality of life. However, the curative effects of current therapeutic drugs for these osteoclast-related diseases are limited, and long-term treatment is needed. Further, in severe cases, surgical treatments are necessary, which may cause unaffordable expenses and subsequent influences such as neuralgia, mental stress, and even development of cancer. Thus, safer inhibitors and potential drugs with enhanced curative effects and quick relief are needed to treat patients with osteoclast diseases. This review aims to introduce the main osteoclast-related diseases and some of the recently developed naturally sourced inhibitors against osteoclastogenesis, also it is desired to attract people's attention on using widely available natural resources for the evolution of new types of osteoclast inhibitors with minimal or no side-effects upon long-term treatments.
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Affiliation(s)
- Xiaoyu Wang
- The United Graduate School of Agricultural Science, Gifu University, Gifu, Japan
| | - Kosei Yamauchi
- The United Graduate School of Agricultural Science, Gifu University, Gifu, Japan
| | - Tohru Mitsunaga
- The United Graduate School of Agricultural Science, Gifu University, Gifu, Japan.
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