Failure of total hip implants: metals and metal release in 52 cases

Jakobsen, Stig Storgaard; Lidén, Carola; Søballe, Kjeld; Johansen, Jeanne Duus; Menné, Torkil; Lundgren, L.; Bregnbak, David; Møller, Per; Jellesen, Morten Stendahl; Thyssen, Jacob P.

doi:10.1111/cod.12275

Cited by 29 publications

(12 citation statements)

References 27 publications

(33 reference statements)

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“…About 10% of these, however, will fail, due to infection, mechanical issues, and immune mediated responses to the implant [ 5 ]. All metal implants undergo corrosion in synovial fluid, and release metal ions that can act as haptens to activate the immune system [ 6 ]. As the number of arthroplasties increases worldwide, the incidence of implant failure caused by Ni 2+ hypersensitivity reactions will grow concomitantly.…”

Section: Introductionmentioning

confidence: 99%

The T Cell Repertoires from Nickel Sensitized Joint Implant Failure Patients

Chen

Zhang

Pacheco

et al. 2021

IJMS

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Nickel (Ni2+) is one of the most common allergens, affecting around 10–15% of the general population. As the demand for orthopedic implant surgery rises, the number of surgical revisions due to joint implant failure also increases. There is evidence that some patients develop joint failure due to an immune response to a component of the implant, and we have found that Ni2+ is an especially important cause. Hence, understanding the mechanisms by which Ni2+ allergy induces joint implant failure becomes a critical research question. The structural basis of Ni2+ activation of pathogenic T cells is still not clear. The purpose of this study was to characterize Ni2+-reactive T cell repertoires derived from the peripheral blood of joint failure patients due to Ni2+ sensitization using single-cell sequencing techniques. We stimulated the proliferation of Ni2+ -reactive T cells from two implant failure patients in vitro, and sorted them for single-cell VDJ sequencing (10× genomics). We identified 2650 productive V-J spanning pairs. Both TCR α chains and β chains were enriched. TRBV18 usage is the highest in the P7 CD4+ population (18.1%), and TRBV5-1 usage is the highest in the P7 CD8+ population (12.1%). TRBV19 and TRBV20-1 segments are present in a high percentage of both P7 and P9 sequenced T cells. Remarkably, the alpha and beta chain combination of TRAV41-TRBV18 accounts for 13.5% of the CD4+ population of P7 patient. Compared to current Ni specific T cell repertoire studies of contact dermatitis, the Vα and Vβ usages of these joint implant failure patients were different. This could be due to the different availability of self-peptides in these two different tissues. However, TRBV19 (Vβ17) was among frequently used TCR β chains, which are common in previous reports. This implies that some pathogenic T cells could be similar in Ni2+ hypersensitivities in skin and joints. The alignment of the TCR CDR3β sequences showed a conserved glutamic acid (Glu) that could potentially interact with Ni2+. The study of these Ni2+ specific TCRs may shed light on the molecular mechanism of T cell activation by low molecular weight chemical haptens.

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Section: Introductionmentioning

confidence: 99%

The T Cell Repertoires from Nickel Sensitized Joint Implant Failure Patients

Chen

Zhang

Pacheco

et al. 2021

IJMS

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“…Use of the DPC test for screening purposes resulted in the identification of chromium(VI) release from leather, screws, and earrings. In a former study, we screened 63 alloy parts from 52 failed hip implant patients, and found no positive test reactions with the DPC test . The high rate of positive findings when leather articles were screened was unexpected, but the DPC test appeared to reliably detect chromium(VI) release from leather.…”

Section: Discussionmentioning

confidence: 99%

Chromium(VI) release from leather and metals can be detected with a diphenylcarbazide spot test

et al. 2015

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“…Todas as propostas realizadas até o momento, em maior ou menor quantidade apresentaram falhas. Estudos relatam casos de falhas em implantes fabricados na liga Protasul liga (Co-Cr-Mo) (Martens et al, 1974;Pazzaglia et al, 1988); vitallium (liga Co-Cr-Mo) (Pizzoferrato et al, 1988); aço inoxidável 316L (Godec, 2011;Jakobsen et al, 2014;Kiani Khouzani et al, 2018;Maheshwari et al, 2012;Pazzaglia et al, 1988); aço inoxidável ASTM F-745 (Griza et al, 2008); aço inoxidável F-183 (Hernandez-Rodriguez et al, 2010); liga de titânio (Ceretti & Falez, 2016;Grupp et al, 2010;Jakobsen et al, 2014;Oshima & Fetto, 2015;Paydar et al, 2007;Pizzoferrato et al, 1988); liga Ti-6Al-4V (Chao & López, 2007;Cicero et al, 2007;Jakobsen et al, 2014;Moretti et al, 2012;Pimenta et al, 2021;Williams & Chawla, 2014); fibra de carbono (Adam et al, 2002).…”

Section: O Implanteunclassified

Falhas em implantes de quadril

Dias

Gonçalves

2021

RSD

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A fratura óssea, indubitavelmente, reside em um dos principais problemas associados ao aumento da expectativa de vida da população. Principalmente, as fraturas femorais, as quais demandam por tratamento cirúrgico para redução da fratura por osteossíntese. Nas fraturas femorais com comprometimento grave da estrutura anatômica na epífise proximal, recomenda-se a substituição da articulação por implante total do quadril (THR – Total Hip Replacement). A artroplastia de quadril trata-se de um procedimento largamente utilizado na medicina, contudo, diversas falhas de implantes são reportadas. O objetivo desse trabalho consistiu em apresentar, por meio de uma revisão de literatura, as principais causas que levam os implantes totais de quadril a falharem em uso e elucidar ações de medidas corretivas para evitar tais falhas. Foram identificadas as principais causas de falhas nos implantes: fadiga, afrouxamento, metalose, associados a outros insucessos relacionado ao perfil do paciente. Concluiu-se que os dispositivos de osteossíntese precisam ser elaborados de forma multidisciplinar com parâmetros exigentes, envolvendo ciência médica, projeto de engenharia e seleção de material, com propósito de minorar os riscos de falhas e prevenir acidentes, por conseguinte, evitar ressubmeter o indivíduo a novo procedimento cirúrgico de correção.

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Failure of total hip implants: metals and metal release in 52 cases

Abstract: We found that cobalt and nickel were released from some failed total hip arthroplasties, and corrosion was frequently observed. Metal ions and particles corroded from metal-on-polyethylene may play a role in the complex aetiopathology of implant failure.

Cited by 29 publications

References 27 publications

The T Cell Repertoires from Nickel Sensitized Joint Implant Failure Patients

The T Cell Repertoires from Nickel Sensitized Joint Implant Failure Patients

Chromium(VI) release from leather and metals can be detected with a diphenylcarbazide spot test

Falhas em implantes de quadril

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