Metal in Total Hip Arthroplasty: Wear Particles, Biology, and Diagnosis

Amanatullah, Derek F.; Sucher, Mark; Bonadurer, George F.; Pereira, Gavin; Taunton, Michael J.

doi:10.3928/01477447-20160719-06

Cited by 22 publications

(12 citation statements)

References 97 publications

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“…Resurfacing and total MoM hip arthroplasties produce abundant cobalt-chromium (Co-Cr)-containing metal wear debris in both particulate and soluble forms. In periprosthetic tissue, particulate Co-Cr wear debris is phagocytosed by macrophages and macrophage polykaryons (giant cells) as part of the innate immune response to foreign material [3, 5–8]. Co-Cr particles and Co and Cr ions are cytotoxic and can elicit an adaptive cell-mediated immune response; as a consequence, there is marked necrosis and inflammation in periprosthetic tissues and MoM arthroplasties have been associated with early implant failure and pseudotumour formation [5–10].…”

Section: Introductionmentioning

confidence: 99%

Solochrome cyanine: A histological stain for cobalt-chromium wear particles in metal-on-metal periprosthetic tissues

Papadimitriou-Olivgeri

Brown

Kilpatrick

et al. 2019

J Mater Sci: Mater Med

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Metal-on-metal (MoM) hip arthroplasties produce abundant implant-derived wear debris composed mainly of cobalt (Co) and chromium (Cr). Cobalt-chromium (Co-Cr) wear particles are difficult to identify histologically and need to be distinguished from other wear particle types and endogenous components (e.g., haemosiderin, fibrin) which may be present in MoM periprosthetic tissues. In this study we sought to determine whether histological stains that have an affinity for metals are useful in identifying Co-Cr wear debris in MoM periprosthetic tissues. Histological sections of periprosthetic tissue from 30 failed MoM hip arthroplasties were stained with haematoxylin-eosin (HE), Solochrome Cyanine (SC), Solochrome Azurine (SA) and Perls’ Prussian Blue (PB). Sections of periprosthetic tissue from 10 cases of non-MoM arthroplasties using other implant biomaterials, including titanium, ceramic, polymethylmethacrylate (PMMA) and ultra-high molecular weight polyethylene (UHMWP) were similarly analysed. Sections of 10 cases of haemosiderin-containing knee tenosynovial giant cell tumour (TSGCT) were also stained with HE, SC, SA and PB. In MoM periprosthetic tissues, SC stained metal debris in phagocytic macrophages and in the superficial necrotic zone which exhibited little or no trichrome staining for fibrin. In non-MoM periprosthetic tissues, UHMWP, PMMA, ceramic and titanium particles were not stained by SC. Prussian Blue, but not SC or SA, stained haemosiderin deposits in MoM periprosthetic tissues and TSGT. Our findings show that SC staining (most likely Cr-associated) is useful in distinguishing Co-Cr wear particles from other metal/non-metal wear particles types in histological preparations of periprosthetic tissue and that SC reliably distinguishes haemosiderin from Co-Cr wear debris.

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Section: Introductionmentioning

confidence: 99%

Solochrome cyanine: A histological stain for cobalt-chromium wear particles in metal-on-metal periprosthetic tissues

Papadimitriou-Olivgeri

Brown

Kilpatrick

et al. 2019

J Mater Sci: Mater Med

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“…From these results, it was suggested that repeat imaging should be performed at least annually, and the usefulness of results over a year old severely questioned. Furthermore, as cyst progression has not been observed earlier than 6 months postoperatively, annual followup has been recommended in other studies 43. In addition, although some work has begun to assess the time-course of growth of the pseudotumors, there is a large discrepancy between results.…”

Section: Introductionmentioning

confidence: 99%

Management Guidelines for Metal-on-metal Hip Resurfacing Arthroplasty: A Strategy on Followup

Nakano

Volpin

Bartlett

et al. 2017

IJOO

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Despite the initial promise of metal-on-metal (MoM) implants as the ideal bearing surface for hip replacements and resurfacings, high short term failure rates due to an adverse reaction to metal debris (ARMD) have led to a dramatic reduction in the number of MoM implants used in the modern era. With over one million patients worldwide having undergone hip operations utilizing a MoM bearing surface, the long term outcomes for such patients remains unknown, and there is much debate as to the most effective management of these patients. Although several regulatory bodies have released guidelines on the management of patients with MoM hips, these recommendations remain open to interpretation, and the most effective management for these patients remains unclear. The aim of this review is to compare the current guidelines for managing patients with MoM hips and also to discuss established ARMD risk factors, evidence regarding the optimum management for patients with MoM hips, and the indications for revision surgery. Furthermore, although specialized laboratory tests and imaging can be used to facilitate clinical decision making, over-reliance on any single tool should be avoided in the decision making process, and surgeons should carefully consider all findings when determining the most appropriate course of action.

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“…Several studies involving different types of implant-derived wear products (ions/particles) and their biological effects on living cells have been conducted recently (Alves et al, 2013(Alves et al, , 2015Amanatullah et al, 2016;Bitar and Parvizi, 2015;Cvijović-Alagić et al, 2016;Konttinen and Pajarinen, 2013;Ribeiro et al, 2016;Sukur et al, 2016;Vasconcelos et al, 2016). Previously, Hallab et al (2001) already studied the metal concentrations in blood serum and implant-surrounding tissues after revision surgeries in human patients with orthopedic devices based on Ti-6Al-4V alloy (and others).…”

Section: Discussionmentioning

confidence: 99%

“…As previously mentioned, wear particles also may trigger increased production of proinflammatory cytokines by different cells in vivo, activating osteoclasts, increasing bone resorption by osteolysis, leading to different adverse tissue reactions, such as metallosis, particle disease and, ultimately, the implant loosening (Amanatullah et al, 2016;Bitar and Parvizi, 2015;Hallab and Jacobs, 2017;Landgraeber et al, 2014;Sukur et al, 2016;Veronesi et al, 2017). Important aspects addressed in these studies are the physicochemical characteristics of the wear particles used, such as, size, morphology, and chemical composition, which will strongly influence their biological fate inside a living organism (Madejczyk et al, 2015;Ribeiro et al, 2016;Sansone et al, 2013;Vasconcelos et al, 2016;Zhang et al, 2017).…”

Section: Discussionmentioning

confidence: 99%

“…Consequently, metallic ions and/or particles https://doi.org/10.1016/j.jmbbm.2019.04.003 Received 27 February 2019; Received in revised form 4 April 2019; Accepted 5 April 2019 T may be released from the implant surface and affect the surrounding living cells and tissues. However, the associated short and long-term biological effects are still unclear (Alves et al, 2013(Alves et al, , 2015Amanatullah et al, 2016;Cvijović-Alagić et al, 2016;Ribeiro et al, 2016;Vasconcelos et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

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Exposure effects of endotoxin-free titanium-based wear particles to human osteoblasts

Costa

Alves

Toptan

et al. 2019

Journal of the Mechanical Behavior of Biomedical Materials

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Titanium-based materials are widely employed by the biomedical industry in orthopedic and dental implants. However, when placed into the human body, these materials are highly susceptible to degradation processes, such as corrosion, wear, and tribocorrosion. As a consequence, metallic ions or particles (debris) may be released, and although several studies have been conducted in recent years to better understand the effects of their exposure to living cells, a consensual opinion has not yet been obtained. In this work, we produced metallicbased wear particles by tribological tests carried out on Ti-6Al-4V and Ti-15Zr-15Mo alloys. They were posteriorly physicochemically characterized according to their crystal structure, size, morphology, and chemical composition and compared to Ti-6Al-4V commercially available particles. Finally, adsorbed endotoxins were removed (by applying a specific thermal treatment) and endotoxin-free particles were used in cell experiments to evaluate effects of their exposure to human osteoblasts (MG-63 and HOb), namely cell viability/metabolism, proinflammatory cytokine production (IL-6 and PGE2), and susceptibility to internalization processes. Our results indicate that tribologically-obtained wear particles exhibit fundamental differences in terms of size (smaller) and morphology (irregular shapes and rough surfaces) when compared to the commercial ones. Consequently, both Ti-6Al-4V and Ti-15Zr-15Mo particles were able to induce more pronounced effects on cell viability (decrease) and cytokine production (increase) than did Ti-6Al-4V commercial particles. Furthermore, both types of wear particles penetrated osteoblast membranes and were internalized by the cells. Influences on cytokine production by endotoxins were also demonstrated.

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Metal in Total Hip Arthroplasty: Wear Particles, Biology, and Diagnosis

Cited by 22 publications

References 97 publications

Solochrome cyanine: A histological stain for cobalt-chromium wear particles in metal-on-metal periprosthetic tissues

Solochrome cyanine: A histological stain for cobalt-chromium wear particles in metal-on-metal periprosthetic tissues

Management Guidelines for Metal-on-metal Hip Resurfacing Arthroplasty: A Strategy on Followup

Exposure effects of endotoxin-free titanium-based wear particles to human osteoblasts

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