Orthopaedic metals and their potential toxicity in the arthroplasty patient

Keegan, Gemma; Learmonth, Ian D.; Case, C. P.

doi:10.1302/0301-620x.89b5.18903

Cited by 293 publications

(208 citation statements)

References 113 publications

Supporting

Mentioning

196

Contrasting

Unclassified

Order By: Relevance

“…In this process, the generation of wear debris, especially polyethylene, and their biological effects on periprosthetic tissues are an important factor determining implant removal [1][2][3]. Implantation of hip prostheses in younger, more active patients has led to a renewed interest and development of third-generation hard-on-hard bearings, including metal-on-metal (MOM) and ceramic-on-ceramic (COC).…”

Section: Introductionmentioning

confidence: 99%

Wear debris from hip prostheses characterized by electron imaging

Topolovec

Milošev²,

Cör³

et al. 2013

Open Medicine

View full text Add to dashboard Cite

AbstractThe characterization of wear particles is of great importance in understanding the mechanisms of osteolysis. In this unique study, thirty-one tissue samples were retrieved at revision surgeries of hip implants and divided into four groups according to the composition of metal prosthetic components. Tissue samples were first analyzed histologically and then by scanning electron microscopy (SEM) combined with back-scattered electron imaging and energy dispersive X-ray spectroscopy. Therefore, particles were studied directly in situ in tissue sections, without the requirement for particle isolation. The composition of metal wear particles detected in the tissue sections corresponded to the composition of the implant components. A considerable number of large metal particles were actually clusters of submicron particles. The clustering of submicron particles was observed primarily with CoCrMo (cobalt-chromiummolybdenum) and, to a lesser extent, for stainless steel particles. SEM secondary and back-scattered electron imaging was an appropriate and selective method for recognizing the composition of metal particles in the in situ tissue sections, without destroying their spatial relationship within the histology. This method can be used as a screening tool for composition of metal and ceramic particles in tissue sections, or as an additional method for particle identification.

show abstract

Section: Introductionmentioning

confidence: 99%

Wear debris from hip prostheses characterized by electron imaging

Topolovec

Milošev²,

Cör³

et al. 2013

Open Medicine

View full text Add to dashboard Cite

show abstract

“…For hand applications the irritation of overlying free gliding tendons in contact with the plate is also of concern (Nazzal et al, 2006). Furthermore, the negative influence of metal ions and salts on adjacent tissues and organs is well documented (Case et al, 1994: Kasai et al, 2003: Keegan et al, 2007Summer et al, 2007). Device extraction in children can further cloud the matter (Rosson and Shearer, 1991;Kahle, 1994;Alzahrani et al, 2003;Kim et al, 2005;Peterson, 2005;Busam et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

Surface polishing positively influences ease of plate and screw removal

Hayes

Seidenglanz²,

Pearce³

et al. 2010

eCM

View full text Add to dashboard Cite

Difficulties removing temporary fracture fixation devices due to excessive bony on-growth results in extended surgical time leading to excessive blood loss, debris contamination and potentially refracture. Commercially available locking plates and screws are manufactured for clinics with a micro-rough surface, which contributes to the excessive bony on-growth reported. We have applied polishing technology to commercially pure titanium locking compression plates (LCP) and titanium-6%aluminium-7%niobium (TAN) plates and screws to assess if it can alleviate problems with strong bony overgrowth. Samples were implanted for 6, 12 and 18 months in a bilateral sheep tibia non fracture model and assessed for screw removal torque, percentage of bone contact and tissue-material response. Both electropolishing (p=0.001) and paste polishing (p=0.010) of TAN screws significantly reduced the mean torque required for removal compared to their micro-rough counterparts. This was accompanied by a trend for a lower percentage of bone contact for polished screws. This difference in bone contact was significant for paste polished TAN screws (p<0.001) but not electropolished TAN screws (p=0.066). Ex vivo, soft tissue removal was much easier (~five minutes) for polished constructs, which was difficult and at least four times longer for standard micro-rough constructs. We suggest that polishing of locked plate/screw systems will improve ease of removal and reduce implant related removal complications encountered due to excessive strong bony on-growth while maintaining biocompatibility and implant stability. Future studies aim to assess the potential of this technology in the next level of complication, a fracture model.

show abstract

“…2,9,10 Adverse soft tissue reactions causing local tissue damage, 1 pain, 2,9,11-16 metallosis and metal ions potentially being carcinogenic were the main concerns (ARMD). [17][18][19][20][21][22][23][24] Implants such as the ASR system (DePuy Orthopaedics, Johnson & Johnson, Warsaw, IN, USA) experienced high failure rates and were recalled from the market. [25][26][27][28] The same concerns were extended to all metal on metal bearing hip replacements/resurfacings and in 2012 The Medicines and Healthcare Products Regulatory Agency (MHRA) (UK) issued guidelines to assess the performance and safety of these implants.…”

mentioning

confidence: 99%