Ion release in ceramic bearings for total hip replacement: Results from an in vitro and an in vivo study

Kretzer, Jan Philippe; Mueller, Ulrike; Streit, Marcus R.; Kiefer, H.; Sonntag, Robert; Streicher, Robert; Reinders, Joern

doi:10.1007/s00264-017-3568-1

Cited by 7 publications

(5 citation statements)

References 29 publications

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“…The causes of osteolysis following TAR are multiple, ranging from an inflammatory cytokine-cascade response to wear debris, 16,20 mechanical factors such as high joint fluid pressure, implant micro-motion and stress shielding, 1,8,9 and material properties of the implants themselves. 1,22,27 Malpositioning of implants in TAR surgery leads to higher contact pressures and greater shear stress, and can lead to higher rates of osteolysis. 3,10,21,26,30 A full discussion on this subject is beyond the scope of this article but we would like to reinforce the argument that the existence of preoperative cysts is an important variable that needs to be considered in the analysis of postoperative cysts.…”

Section: Discussionmentioning

confidence: 99%

Bone Cysts and Osteolysis in Ankle Replacement

2020

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Background: Total ankle replacements (TARs) have higher rates of osteolysis than hip or knee replacements. It is unclear whether this is a pathologic immunologic process in response to wear debris, or expansion of pre-existing osteoarthritic bone cysts. We aimed to determine the incidence of bone cysts in patients with end-stage ankle arthritis prior to surgery and review the literature on bone cysts and osteolysis in relation to TAR. Methods: This is a descriptive/prevalence study in which all patients with end-stage ankle arthritis underwent plain radiographic imaging and computed tomographic (CT) scans prior to TAR surgery. Their imaging was assessed for the presence of cysts, measured on sagittal, axial, and coronal slices of the CT scan at the widest diameter. All cysts that would be removed as a result of the bone resection for the implant were excluded using digital analysis software. We assessed 120 consecutive patients with mean age of 63.4 years. Results: Seventeen patients (14%) did not have any bone cysts based on CT images. Ten patients (8%) had cysts that would have been completely removed by surgery, leaving 93 patients for analysis (78%). In 60% of these cases, the cysts were not seen on the plain radiographs. In 39 patients (33%), the cysts were greater than 5 mm in size. The medial (36%) and lateral malleoli (33%) were the most common location for the cysts (mean diameter 4.6±2.0 and 4.2±2.3 mm, respectively). Conclusion: Bone cysts outside of the resection margins for a TAR were present in 78% of patients with ankle arthritis prior to undergoing surgery. In 30% of cases, cysts were greater than 5 mm in size. In 60% of cases, the cysts were not seen on plain radiographs. Preoperative 3-dimensional imaging can provide a foundation to observe and quantify cyst presence, expansion, and time of onset in the postoperative setting. Level of Evidence: Level IIc, diagnostic/prevalence study.

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Section: Discussionmentioning

confidence: 99%

Bone Cysts and Osteolysis in Ankle Replacement

2020

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“…As reported in recent studies, metal ions and wear particles have the potential to leach from metallic implants, eliciting adverse immunologic reactions [ 192 , 193 , 194 ]. In in vitro studies conducted by Moeed Akbar et al, Cr (6+) and Co (2+) ions affected primary human lymphocytes by inducing apoptosis, inhibiting T lymphocytes and impeding the release of IL-2 through yet unknown mechanisms [ 195 ].…”

Section: Biological Response To Metal Implants Used In Lifmentioning

confidence: 99%

Metallic Implants Used in Lumbar Interbody Fusion

et al. 2022

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Over the last decade, pedicle fixation systems have evolved and modifications in spinal fusion techniques have been developed to increase fusion rates and improve clinical outcomes after lumbar interbody fusion (LIF). Regarding materials used for screw and rod manufacturing, metals, especially titanium alloys, are the most popular resources. In the case of pedicle screws, that biomaterial can be also doped with hydroxyapatite, CaP, ECM, or tantalum. Other materials used for rod fabrication include cobalt–chromium alloys and nitinol (nickel–titanium alloy). In terms of mechanical properties, the ideal implant used in LIF should have high tensile and fatigue strength, Young’s modulus similar to that of the bone, and should be 100% resistant to corrosion to avoid mechanical failures. On the other hand, a comprehensive understanding of cellular and molecular pathways is essential to identify preferable characteristics of implanted biomaterial to obtain fusion and avoid implant loosening. Implanted material elicits a biological response driven by immune cells at the site of insertion. These reactions are subdivided into innate (primary cellular response with no previous exposure) and adaptive (a specific type of reaction induced after earlier exposure to the antigen) and are responsible for wound healing, fusion, and also adverse reactions, i.e., hypersensitivity. The main purposes of this literature review are to summarize the physical and mechanical properties of metal alloys used for spinal instrumentation in LIF which include fatigue strength, Young’s modulus, and corrosion resistance. Moreover, we also focused on describing biological response after their implantation into the human body. Our review paper is mainly focused on titanium, cobalt–chromium, nickel–titanium (nitinol), and stainless steel alloys.

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“…The biological safety of alumina and zirconia and of alumina-zirconia composites has been established for a long time and was recently confirmed [15][16][17][18]. Tests on alumina, zirconia, and alumina-zirconia composites were performed using materials in the form of powders or dense ceramics, particularly addressing physicochemical features such as surface reactivity, chemical composition, impurity content, and type of stabilizer.…”

Section: Biocompatibility Of Alumina and Zirconia Compositesmentioning

confidence: 99%

Oxide Bioceramic Composites in Orthopedics and Dentistry

Piconi

Sprio

2021

J. Compos. Sci.

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Ceramic composites based on alumina and zirconia have found a wide field of application in the present century in orthopedic joint replacements, and their use in dentistry is spreading. The development of this class of bioceramic composites was started in the 1980s, but the first clinical applications of the total hip replacement joint were introduced in the market only in the early 2000s. Since then, several composite systems were introduced in joint replacements. These materials are classified as Zirconia-Toughened Alumina if alumina is the main component or as Alumina-Toughened Zirconia when zirconia is the main component. In addition, some of them may contain a third phase based on strontium exa-aluminate. The flexibility in device design due to the excellent mechanical behavior of this class of bioceramics results in a number of innovative devices for joint replacements in the hip, the knee, and the shoulder, as well in dental implants. This paper gives an overview of the different materials available and on orthopedic and dental devices made out of oxide bioceramic composites today on the market or under development.

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Ion release in ceramic bearings for total hip replacement: Results from an in vitro and an in vivo study

Abstract: This study supports that ZPTA ceramic articulation components are safe in terms of ion release, and may be an excellent alternative to bearings based on Co-28Cr-6Mo alloys.

Cited by 7 publications

References 29 publications

Bone Cysts and Osteolysis in Ankle Replacement

Bone Cysts and Osteolysis in Ankle Replacement

Metallic Implants Used in Lumbar Interbody Fusion

Oxide Bioceramic Composites in Orthopedics and Dentistry

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