Aseptic loosening of a total knee prosthesis caused by delayed hypersensitivity to bone cement

Vega, Francisco; Bazire, Raphaëlle; Belver, María Teresa; Múgica, M. Álvarez; Urquía, Andrés; Blanco, Carlos

doi:10.1016/j.anai.2016.04.013

Cited by 8 publications

(5 citation statements)

References 9 publications

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“…Metallic debris is of special interest as it might induce late hypersensitivity [38]. Bone cement particles were also examined in relation to debris-induced inflammation [39] and hypersensitivity [40]. However, there is limited knowledge on the interrelations between prosthetic particle size, shape and surface charge and osteoclast differentiation-maturation-survival-functional capacity [20,41,42].…”

Section: Stimuli Of Periprosthetic Inflammationmentioning

confidence: 99%

Periprosthetic Osteolysis: Mechanisms, Prevention and Treatment

Goodman

Gallo

2019

JCM

174

163

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Clinical studies, as well as in vitro and in vivo experiments have demonstrated that byproducts from joint replacements induce an inflammatory reaction that can result in periprosthetic osteolysis (PPOL) and aseptic loosening (AL). Particle-stimulated macrophages and other cells release cytokines, chemokines, and other pro-inflammatory substances that perpetuate chronic inflammation, induce osteoclastic bone resorption and suppress bone formation. Differentiation, maturation, activation, and survival of osteoclasts at the bone–implant interface are under the control of the receptor activator of nuclear factor kappa-Β ligand (RANKL)-dependent pathways, and the transcription factors like nuclear factor κB (NF-κB) and activator protein-1 (AP-1). Mechanical factors such as prosthetic micromotion and oscillations in fluid pressures also contribute to PPOL. The treatment for progressive PPOL is only surgical. In order to mitigate ongoing loss of host bone, a number of non-operative approaches have been proposed. However, except for the use of bisphosphonates in selected cases, none are evidence based. To date, the most successful and effective approach to preventing PPOL is usage of wear-resistant bearing couples in combination with advanced implant designs, reducing the load of metallic and polymer particles. These innovations have significantly decreased the revision rate due to AL and PPOL in the last decade.

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Section: Stimuli Of Periprosthetic Inflammationmentioning

confidence: 99%

Periprosthetic Osteolysis: Mechanisms, Prevention and Treatment

Goodman

Gallo

2019

JCM

174

163

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“…Nonetheless, Bircher et al showed that removal of BC and change to uncemented endoprostheses resulted in considerable symptomatic improvements in 4 out of 5 BPO allergic patients with TJR [ 34 ]. Similarly, Vega et al [ 36 ] and Kenan et al [ 35 ] observed satisfactory long-term courses of uncemented revision arthroplasties in patients allergic to MMA, a BC component known to remain considerably longer at the site of implantation in cases of incomplete polymerization.…”

Section: Discussionmentioning

confidence: 93%

“…Interestingly, gentamicin sulfate triggered positive readouts in 25/250 patients (10%), with 17/25 reactions (68%) only appearing as late as day 6. However, the clinical relevance of positive patch tests to BC components has merely been suggested in a handful of case reports [ 33 – 36 ], with literature on revisions in the context of gentamicin allergy lacking completely. Thus, we followed up with our patients in an effort to investigate the rate and outcomes of re-operations in this cohort.…”

Section: Introductionmentioning

confidence: 99%

The role of antibiotic-loaded bone cement in complicated knee arthroplasty: relevance of gentamicin allergy and benefit from revision surgery — a case control follow-up study and algorithmic approach

et al. 2020

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Background Antibiotic-loaded (particularly gentamicin) bone cement (BC) is widely used in total joint arthroplasty (TJA) to prevent periprosthetic infections (PPIs), but may itself cause implant failure. In light of a complete lack in literature, the objective was to assess the clinical relevance of gentamicin allergy for failure of cemented total knee arthroplasties in 25 out of 250 patients with positive patch test reactions to gentamicin and otherwise unexplained symptoms by evaluating benefits from revision with change to gentamicin-free cement. Methods Fifteen of these 25 patients and their treating orthopaedic surgeons agreed to a re-assessment. They were surveyed regarding interim course of therapy and symptoms, including re-assessment of the Knee Injury and Osteoarthritis Outcome Score (KOOS), and underwent follow-up clinical and radiographic investigations. The initial use of gentamicin-loaded BC was reaffirmed by review of the primary implantation operative reports and respective implant passports. Primary and follow-up KOOS scores were analyzed regarding benefits from revision surgery by comparing nine patients with revision to six without revision. Results Mean follow-up time was 38 months. The entirety of patients experienced an improvement of self-reported symptoms, with revision surgery (i.e., switching to gentamicin-free BC or uncemented total knee arthroplasty) yielding significantly greater improvement ( p = 0.031): the nine revised patients reported a significant symptom relief ( p = 0.028), contrary to the six unrevised patients ( p = 0.14). Interestingly, the decision to proceed with revision surgery was significantly correlated with higher symptom severity ( p = 0.05). Conclusion In symptomatic total knee arthroplasty with gentamicin allergy, uncemented revision arthroplasty or change to gentamicin-free BC provides significant symptom relief.

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“…Based on the biotribological experiments, materials which are hard similar to ceramics that create nanosized wear particles can cause inflammation [46]. Bone cement debris and metallic debris were also noted to have relation to hypersensitivity and inflammation [47][48][49]. Nevertheless, there is limited evidence on the influence of the prosthetic particle dimension, surface charge, shape, and osteoclast capacity.…”

Section: E Biological Mechanisms Of Osteolysismentioning

confidence: 99%

Osteolysis: A Literature Review of Basic Science and Potential Computer‐Based Image Processing Detection Methods

Saadi

Ranjbarzadeh

kazemi³

et al. 2021

Computational Intelligence and Neuroscience

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Osteolysis is one of the most prominent reasons of revision surgeries in total joint arthroplasty. This biological phenomenon is induced by wear particles and corrosion products that stimulate inflammatory biological response of surrounding tissues. The eventual responses of osteolysis are the activation of macrophages leading to bone resorption and prosthesis failure. Various factors are involved in the initiation of osteolysis from biological issues, design, material specifications, and model of the prosthesis to the health condition of the patient. Nevertheless, the factors leading to osteolysis are sometimes preventable. Changes in implant design and polyethylene manufacturing are striving to improve overall wear. Osteolysis is clinically asymptomatic and can be diagnosed and analyzed during follow-up sessions through various imaging modalities and methods, such as serial radiographic, CT scan, MRI, and image processing-based methods, especially with the use of artificial neural network algorithms. Deep learning algorithms with a variety of neural network structures such as CNN, U-Net, and Seg-UNet have proved to be efficient algorithms for medical image processing specifically in the field of orthopedics for the detection and segmentation of tumors. These deep learning algorithms can effectively detect and analyze osteolytic lesions well in advance during follow-up sessions in order to administer proper treatments before reaching a critical point. Osteolysis can be treated surgically or nonsurgically with medications. However, revision surgeries are the only solution for the progressive osteolysis. In this literature review, the underlying causes, mechanisms, and treatments of osteolysis are discussed with the main focus on the possible computer-based methods and algorithms that can be effectively employed for the detection of osteolysis.

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Aseptic loosening of a total knee prosthesis caused by delayed hypersensitivity to bone cement

Cited by 8 publications

References 9 publications

Periprosthetic Osteolysis: Mechanisms, Prevention and Treatment

Periprosthetic Osteolysis: Mechanisms, Prevention and Treatment

The role of antibiotic-loaded bone cement in complicated knee arthroplasty: relevance of gentamicin allergy and benefit from revision surgery — a case control follow-up study and algorithmic approach

Osteolysis: A Literature Review of Basic Science and Potential Computer‐Based Image Processing Detection Methods

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