Histologic, Biochemical, and Ion Analysis of Tissue and Fluids Retrieved During Total Hip Arthroplasty

Dorr, Lawrence D.; Bloebaum, Roy D.; Emmanual, Janson; Meldrum, Russell D.

doi:10.1097/00003086-199012000-00010

Cited by 208 publications

(157 citation statements)

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“…21 It is well recognized that titanium degradation products including Ti(IV) ions are released by biocorrosion and accumulate in lymphoid tissues. 11,13,14,22,23 However, this is the first study using EFTEM analysis, which is recognized as the gold standard in identifying titanium availability in biological specimens, 24 to demonstrate the ability of human T-lymphocytes to take up Ti(IV). EFTEM results indicate a strong Ti(IV) affinity for phosphorus-containing molecules such as the euchromatin in the nucleus, ribosomes in the cytoplasm, and phospholipids in the cell membrane.…”

Section: Discussionmentioning

confidence: 99%

Titanium uptake, induction of RANK‐L expression, and enhanced proliferation of human T‐lymphocytes

Cadosch

Sutanto

Chan

et al. 2009

Journal Orthopaedic Research

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There is increasing evidence that titanium ions are released from orthopedic implants by biocorrosion. The aim of this study was to investigate titanium uptake by human T-lymphocytes and its effects on phenotype and proliferation. Freshly isolated human nonadherent peripheral blood mononuclear cells (NA-PBMC), were exposed to TiCl 4 [Ti(IV)]. Bioavailability and distribution of Ti(IV) in T-lymphocytes was determined by energy-filtered electron microscopy (EFTEM). The effects of Ti(IV) challenge on nonactivated and PHA-activated cells were assessed by flow cytometric analysis of surface markers, RANK-L production, and proliferation assays. EFTEM colocalized Ti(IV) with phosphorus in the nucleus, ribosomes, cytoplasmic membranes, and the surface membrane of T-lymphocytes. Ti(IV) increased significantly the expression of CD69, CCR4, and RANK-L in a concentration-dependent manner. Titanium enters T-lymphocytes through a currently unknown mechanism and binds to phosphorus-rich cell structures. Titanium influences phenotype and function of T-lymphocytes, resulting in activation of a CD69þ and CCR4þ T-lymphocyte population and secretion of RANK-L. These results strongly suggest the involvement of titanium ions challenged T-lymphocytes in the complex pathophysiological mechanisms of aseptic loosening of orthopedic implants. ß

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Section: Discussionmentioning

confidence: 99%

Titanium uptake, induction of RANK‐L expression, and enhanced proliferation of human T‐lymphocytes

Cadosch

Sutanto

Chan

et al. 2009

Journal Orthopaedic Research

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“…T 20,2013 a peak at 120 months. The titanium group experienced early elevations of serum chromium at twelve months (p < 0.03 in comparison with the control group), with a return to near baseline levels at 108 months.…”

mentioning

confidence: 99%

Ten-Year Outcome of Serum Metal Ion Levels After Primary Total Hip Arthroplasty

Levine

Hsu

Skipor

et al. 2013

The Journal of Bone and Joint Surgery

101

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We previously reported on the metal ion concentrations of cobalt, chromium, and titanium that were found in the serum of patients three years after they had undergone primary total hip arthroplasty as compared with the concentrations found in the serum of control patients who did not have an implant. This study is a concise update on the serum metal levels found in a cohort of these patients ten years after the time of hip implantation. Of the original seventy-five subjects, metal ion levels were available for forty patients (53%). Ten patients (hybrid group) had received a hybrid total hip replacement that consisted of a modular cobalt-alloy femoral stem with a cobalt-alloy femoral head that had been inserted with cement and a titanium acetabular socket that had been inserted without cement. Nine patients (cobalt-chromium [CoCr] group) had received an implant with an extensively porous-coated modular cobalt-alloy femoral stem and femoral head along with a titanium acetabular socket; the femoral and acetabular components had each been inserted without cement. Eight patients (titanium group) had undergone insertion of a proximally porous-coated modular titanium-alloy femoral stem with a cobaltalloy femoral head and a titanium acetabular socket; the femoral and acetabular components had each been inserted without cement. Thirteen patients (control group) from the original control group of patients who had not received an implant served as control subjects. Serum metal levels were measured with use of high-resolution sector field inductively coupled plasma mass spectrometry. The hybrid total hip arthroplasty group had mean cobalt levels that were 3.2 times higher at 120 months than they were at baseline, and the cobalt levels in that group were significantly higher than those in the titanium total hip arthroplasty group at thirty-six, sixty, eighty-four, ninety-six, and 120 months (p < 0.01). The hybrid group had mean chromium levels that were 3.9 times higher at 120 months than they were at baseline, and the CoCr total hip arthroplasty group had chromium levels that were 3.6 times higher at 120 months than they were at baseline. The serum titanium levels were higher in the titanium group at all follow-up time intervals as compared with the levels in all other groups, and the level in the titanium group at 120 months was eighteen times higher than it was at baseline (p < 0.01). Patients with well-functioning primary metal-on-polyethylene total hip replacements had elevated serum metal levels for as many as ten years postoperatively. Furthermore, metal release at the modular femoral head-neck junctions, rather than passive dissolution from porous ingrowth surfaces, was likely the dominant source of serum cobalt and chromium.continued

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“…5 However, a relatively high modulus of elasticity, low shear strength and frictional characteristics, potential release of ions and wear debris particles, and absence of bioactive properties have encouraged researchers to improve the properties of titanium implants and to develop other implant materials. 6 Porous tantalum (Trabecular Metal TM , Ta) is an alternative to titanium and has been successfully used in numerous short-and long-term clinical implant studies for over a decade. [7][8][9][10] As an implant material, Ta possesses a variety of highly attractive physicochemical, mechanical, and biological properties, including a fully interconnecting porous structure, an apparent elastic modulus close to that of bone, high coefficient of friction against bone, resistance to corrosion, and compatibility with MRI and X-ray.…”

mentioning

confidence: 99%

Porous tantalum stimulates the proliferation and osteogenesis of osteoblasts from elderly female patients

Sagomonyants

Hakim-Zargar

Jhaveri

et al. 2010

Journal Orthopaedic Research

100

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Porous tantalum (Ta) implants have been successful in various orthopedic procedures for patients with compromised boneforming abilities. Previous studies demonstrated that human osteoblast (HOB) cultures from older female patients produced less bone on implant materials in vitro compared to HOBs from age-matched male and younger female patients. In this study, the responses of HOBs from younger (<45) and older (>60 years old) female patients were compared on Ta, titanium fiber mesh (TFM) and tissue culture plastic. Adhesion, proliferation, and mineralization were greater in cells from younger patients than from older patients. Cell adhesion was slightly higher on Ta than TFM or plastic. However, Ta highly stimulated cell proliferation with a 4-and 6-fold increase compared to TFM for cells from younger and older patients, respectively, and 12-and 16-fold increase in proliferation compared to cells on plastic ( p = 0.001). At 3 weeks, mineralization was significantly higher on Ta compared to TFM for HOBs from older patients ( p = 0.05). Expression levels of bone matrix markers demonstrated differences dependent on age and substrate. Scanning electron micrographs revealed HOBs covering the surfaces and entering the pores of both Ta and TFM. In conclusion, tantalum greatly stimulates cell proliferation, and improves the ability of HOBs from older patients to form bone. ß

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Histologic, Biochemical, and Ion Analysis of Tissue and Fluids Retrieved During Total Hip Arthroplasty

Cited by 208 publications

References 0 publications

Titanium uptake, induction of RANK‐L expression, and enhanced proliferation of human T‐lymphocytes

Titanium uptake, induction of RANK‐L expression, and enhanced proliferation of human T‐lymphocytes

Ten-Year Outcome of Serum Metal Ion Levels After Primary Total Hip Arthroplasty

Porous tantalum stimulates the proliferation and osteogenesis of osteoblasts from elderly female patients

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