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In Vitro Evidence for Cell-Accelerated Corrosion Within Modular Junctions of Total Hip Replacements.

ABSTRACT: Corrosion at modular junctions of total hip replacement (THR) remains a major concern today. Multiple types of damage modes have been identified at modular junctions, correlated with different corrosion characteristics that may eventually lead to implant failure. Recently, within the head-taper region of the CoCrMo retrieval implants, cell-like features and trails of etching patterns were observed that could potentially be linked to the involvement of cells of the periprosthetic region. However, there is no experimental evidence to corroborate this phenomenon. Therefore, we aimed to study the potential role of periprosthetic cell types on corrosion of CoCrMo alloy under different culture conditions, including the presence of CoCrMo wear debris. Cells were incubated with and without CoCrMo wear debris (obtained from a hip simulator) with an average particle size of 119?±?138?nm. Electrochemical impedance spectroscopy (EIS) was used to evaluate the corrosion tendency, corrosion rate, and corrosion kinetics using the media after 24?h of cell culture as the electrolyte. Results of the study showed that there was lower corrosion resistance (p?corr ) (p?corr (p?2 O₂ solution. Overall, the study provides in vitro experimental evidence for the possible role of macrophages in altering the chemical environment within the crevice and thereby accelerating corrosion of CoCrMo alloy. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:393-404, 2020.

SUBMITTER: Bijukumar DR

PROVIDER: S-EPMC7370985 | biostudies-literature | 2020 Feb

REPOSITORIES: biostudies-literature

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In Vitro Evidence for Cell-Accelerated Corrosion Within Modular Junctions of Total Hip Replacements.

Bijukumar Divya Rani DR Salunkhe Shruti S Morris Dalton D Segu Abhijith A Hall Deborah J DJ Pourzal Robin R Mathew Mathew T MT

Journal of orthopaedic research : official publication of the Orthopaedic Research Society 20190901 2

Corrosion at modular junctions of total hip replacement (THR) remains a major concern today. Multiple types of damage modes have been identified at modular junctions, correlated with different corrosion characteristics that may eventually lead to implant failure. Recently, within the head-taper region of the CoCrMo retrieval implants, cell-like features and trails of etching patterns were observed that could potentially be linked to the involvement of cells of the periprosthetic region. However, ...[more]

PMID: 31436344

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Project description:Evidence that macrophages can play a role in accelerating corrosion in CoCrMo alloy in total hip replacement (THR) interfaces leads to questions regarding the underlying cellular mechanisms and immunological responses. Hence, we evaluated the role of macrophages in corrosion processes using the cell culture supernatant from different conditions and the effect of wear particles on macrophage dynamics. Monocytes were exposed to CoCrMo wear particles and their effect on macrophage differentiation was investigated by comparisons with M1 and M2 macrophage differentiation. Corrosion associated macrophages (MCA macrophages) exhibited upregulation of TNF-α, iNOS, STAT-6, and PPARG and down-regulation of CD86 and ARG, when compared to M1 and M2 macrophages. MCA cells also secreted higher levels of IL-8, IL-1β, IL-6, IL-10, TNF-α, and IL-12p70 than M1 macrophages and/or M2 macrophages. Our findings revealed variation in macrophage phenotype (MCA) induced by CoCrMo wear particles in generating a chemical environment that induces cell-accelerated corrosion of CoCrMo alloy at THR modular interfaces. STATEMENT OF SIGNIFICANCE: Fretting wear and corrosion within the implant's modular taper junction are prominent causes of implant failure, as they promote the release of corrosion products and subsequent development of adverse local tissue reactions. Being a multifactorial process, several in vitro models have been developed to recreate the in vivo corrosion process, often summarized as mechanically-assisted crevice corrosion. Considering the excellent corrosion properties of CoCrMo alloy, the severity of chemically-generated damage observed at the modular interface has been surprising and poorly understood. The aim of the current study is to provide a better understanding of macrophages and their plasticity at the THR taper interface when they encounter wear debris from CoCrMo alloy. This is a preliminary study along the path towards determining the mechanism(s) of CAC.

Project description:BackgroundDislocation following total hip replacement (THR) is associated with repeated hospitalisations and substantial costs to the health system. Factors influencing dislocation following primary THR are not well understood. We aimed to assess the associations of patient-, surgery-, implant- and hospital-related factors with dislocation risk following primary THR.MethodsWe did a systematic review and meta-analysis of all longitudinal studies reporting these associations. We searched MEDLINE, Embase, Web of Science, and Cochrane Library to March 8, 2019. Summary measures of association were calculated using relative risks (RRs) (with 95% confidence intervals, CIs). The review is registered on PROSPERO, number CRD42019121378.FindingsWe identified 149 articles based on 125 unique studies with data on 4 633 935 primary THRs and 35 264 dislocations. The incidence rates of dislocation ranged from 0·12% to 16·13%, with an overall pooled rate of 2·10% (1·83-2·38) over a weighted mean follow-up duration of 6 years. Using median year of data collection, there was a significant decline in dislocation rates from 1971 to 2015. Comparing males vs females, age ≥70 vs <70 years, and high vs low income, RRs (95% CIs) for dislocation were 0·97 (0·88-1·08), 1·27 (1·02-1·57), and 0·79 (0·74-0·85) respectively. White ethnicity, drug use disorder, and social deprivation were each associated with an increased dislocation risk. Comparing body mass index (BMI) ≥30 vs. <30 kg/m2, the RR (95% CI) for dislocation was 1·38 (1·03-1·85). Medical and surgical history-related factors associated with dislocation risk included neurological disorder, psychiatric disease, comorbidity indices, previous surgery including spinal fusion, and surgical indications including avascular necrosis, rheumatoid arthritis, inflammatory arthritis, and osteonecrosis. Surgical factors such as the anterolateral, direct anterior, or lateral approach and posterior with short external rotator and capsule repair were each associated with reduced dislocation risk. At the implant level, larger femoral head diameters, elevated acetabular liners, dual mobility cups, cemented fixations and standard femoral neck lengths reduced the risk of dislocation. Hospital-related factors such as experienced surgeons and high surgeon procedure volume each reduced the risk of dislocation.InterpretationDislocation following primary THR is on a temporal decline. Surgical approaches that reduce dislocation risk can be used by clinicians when performing primary THR. Alternative bearings such as dual mobility can be used in individuals at high risk of dislocation. Modifiable risk factors such as high BMI and comorbidities may be amenable to optimisation prior to surgery.FundingNational Institute for Health Research.

Dataset Information

In Vitro Evidence for Cell-Accelerated Corrosion Within Modular Junctions of Total Hip Replacements.

Publications

In Vitro Evidence for Cell-Accelerated Corrosion Within Modular Junctions of Total Hip Replacements.

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