Activation of Periprosthetic Connective Tissue in Aseptic Loosening of Total Hip Replacements

Santavirta,; Jw, Xu; Hietanen, Joel; eponis,; Sorsa, Timo; Kontio, Risto; Konttinen, Yrjö T.

doi:10.1097/00003086-199807000-00004

Cited by 32 publications

(42 citation statements)

References 25 publications

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“…The inability to process UHMWPE particles resulting from a lack of appropriate enzymes and resistance of the material to the acidic environment of the phagosome may lead to broad cellular activation in the macrophage population [16]. Phagocytic cells may acquire an activated macrophage phenotype, leading to a release of proinflammatory cytokines (notably interleukin-1b and tumor necrosis factor-a) and inflammatory mediators (prostaglandins and chemokines) that create an inflammatory tissue environment [24,62,78,83]. Necrotic cell death may follow macrophage frustration, heightening deleterious tissue effects and failing to alleviate the debris load.…”

Section: Discussionmentioning

confidence: 99%

“…Volume 472, Number 12, December 2014 Biological Reactions to Byproducts of Wear 3701 periprosthetic environment and their possible contribution to inflammatory osteolysis [12,47,53,62,76]. Other cells of potential interest in the pathology of debris-induced osteolysis include osteoclasts [28,58,60], osteoblasts [71], lymphocytes [7], and mesenchymal cells [62].…”

Section: Search Strategy and Criteriamentioning

confidence: 99%

“…Other cells of potential interest in the pathology of debris-induced osteolysis include osteoclasts [28,58,60], osteoblasts [71], lymphocytes [7], and mesenchymal cells [62].…”

Section: Search Strategy and Criteriamentioning

confidence: 99%

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How Has the Introduction of New Bearing Surfaces Altered the Biological Reactions to Byproducts of Wear and Modularity?

Wooley

2014

Clin Orthop Relat Res

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Background Biological responses to wear debris were largely elucidated in studies focused on conventional ultrahigh-molecular-weight polyethylene (UHMWPE) and some investigations of polymethymethacrylate cement and orthopaedic metals. However, newer bearing couples, in particular metal-on-metal but also ceramic-on-ceramic bearings, may induce different biological reactions. Questions/purposes Does wear debris from the newer bearing surfaces result in different biological responses compared with the known responses observed with conventional metal-on-UHMWPE bearings?Methods A Medline search of articles published after 1996 supplemented by a hand search of reference lists of included studies and relevant conference proceedings was conducted to identify the biological responses to orthopaedic wear debris with a focus on biological responses to wear generated from metal-on-highly crosslinked polyethylene, metal-on-metal, ceramic-on-ceramic, and ceramicon-polyethylene bearings. Articles were selected using criteria designed to identify reports of wear debris particles and biological responses contributing to prosthesis failure. Case reports and articles focused on either clinical outcomes or tribology were excluded. A total of 83 papers met the criteria and were reviewed in detail.

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Section: Discussionmentioning

confidence: 99%

Section: Search Strategy and Criteriamentioning

confidence: 99%

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How Has the Introduction of New Bearing Surfaces Altered the Biological Reactions to Byproducts of Wear and Modularity?

Wooley

2014

Clin Orthop Relat Res

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“…In the fixation of the prosthesis, the large elasticity difference between these two materials can cause stress shielding that leads to an increase in bone porosity and atrophy. In addition, there are some other clinical problems such as the activation of periprosthetic connective tissue, macrophage activation, and bone resorbtion, as well as wear and corrosion problems (Santavirta et al, 1998(Santavirta et al, , 1999. Release of nanosized particles of metal may also have undesired effects on the biology of tissues.…”

Section: Challenges Of Artificial Materials For Bone Reconstruction Omentioning

confidence: 99%

“…Therefore, new bone formation is limited only to the surface between the bone cement and the bone. If the fixation is only mechanical, the micromotion between the bone and the implant interface can lead to resorbtion of bone and then the failure and the final loosening of the prosthesis (Santavirta et al, 1998(Santavirta et al, , 1999. Therefore, some re-operations of total knee/hip replacement systems have been required even within four to eight years after the primary operation (Hooper et al, 2009), although all the prostheses should last for the rest of the patients' life.…”

Section: Challenges Of Artificial Materials For Bone Reconstruction Omentioning

confidence: 99%

Polymer Composites for Bone Reconstruction

Puska¹,

Aho²,

Vallittu³

2011

Advances in Composite Materials - Analysis of Natural and Man-Made Materials

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Development and characteristics of a synovial-like interface membrane around cemented tibial hemiarthroplasties in a novel rat model of aseptic prosthesis loosening

Pap

Machner

Rinnert

et al. 2001

Arthritis & Rheumatism

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Objective Aseptic prosthesis loosening (APL) is related to the formation and aggressive growth of a synovial‐like interface membrane (SLIM) between prosthesis and bone. However, investigation of the early phases of SLIM development in humans presents major difficulties. This study was undertaken to develop and characterize the usefulness of a novel animal model of APL that is based on an established model of defined exercise in a running wheel by Wistar rats that have been subjected to intracranial self‐stimulation (ICSS). Methods Cemented tibial hemiarthroplasties were implanted into the left knees of 7 male Wistar rats. After 2 weeks, exercise in a running wheel was started in all rats, with a running‐load of 2 hours/day for 5 days/week. Six months postoperatively, the knee joints were removed, decalcified, and embedded in paraffin. Histologic evaluation on hematoxylin and eosin–stained sections was performed to investigate the development of a SLIM and the presence of cement debris particles. To characterize the SLIM on a molecular level and investigate growth‐regulating factors, the expression of transforming growth factor β (TGFβ) and the antiapoptotic molecule Bcl‐2 was analyzed by immunohistochemistry. Results Although the prostheses appeared mechanically stable after 6 months, the development of SLIM with areas of bone resorption was seen in all samples. Resembling human SLIM, these membranes consisted of loose fibrous tissue, with cement debris particles located particularly at sites originally attached to the prostheses. Immunohistochemistry studies revealed the expression of TGFβ and Bcl‐2 in all specimens. Interestingly, staining for TGFβ and Bcl‐2 was restricted to areas where the SLIM were attached to bone. In contrast, there was only negligible expression of both proteins at sites adjacent to the prostheses. Conclusion Our findings demonstrate that the ICSS Wistar rat model constitutes a feasible tool for studying early stages of APL, and specifically the effect of defined running exercise on SLIM formation. The results further suggest that both cellular proliferation, as stimulated by TGFβ, and altered apoptosis contribute to early stages of SLIM formation. The expression patterns of TGFβ and Bcl‐2 indicate that the growth of the SLIM is initiated and promoted from the bone rather than from the prosthesis.

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Activation of Periprosthetic Connective Tissue in Aseptic Loosening of Total Hip Replacements

Cited by 32 publications

References 25 publications

How Has the Introduction of New Bearing Surfaces Altered the Biological Reactions to Byproducts of Wear and Modularity?

How Has the Introduction of New Bearing Surfaces Altered the Biological Reactions to Byproducts of Wear and Modularity?

Polymer Composites for Bone Reconstruction

Development and characteristics of a synovial-like interface membrane around cemented tibial hemiarthroplasties in a novel rat model of aseptic prosthesis loosening

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