Ballooning osteolysis in 71 failed total ankle arthroplasties

Singh, Gurpal; Reichard, Theresa; Hameister, Rita; Awiszus, Friedemann; Schenk, Katja; Feuerstein, Bernd; Roessner, Albert; Lohmann, Christoph H.

doi:10.1080/17453674.2016.1188346

Cited by 31 publications

(35 citation statements)

References 27 publications

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“…All lower-limb arthroplasties [28] generate wear particles during each step during the time of service. Ample evidence is available for the pathological role of polyethylene particles in the mechanisms leading to PPOL and AL [11,[29][30][31][32].…”

Section: Stimuli Of Periprosthetic Inflammationmentioning

confidence: 99%

Periprosthetic Osteolysis: Mechanisms, Prevention and Treatment

Goodman

Gallo

2019

JCM

177

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

177

163

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“…An important development in this regard was plasma-sprayed hydroxyapatite coatings which produce improved bone bonding of implants to bone and increased longevity of some joint replacements [ 19 , 20 ]. However, the risks associated with these relatively thick coatings is delamination and there is continued concern about the resorption of HA by interfacial remodelling in some applications [ 21 – 23 ]. The phosphorylcholine side chain of the PC-polymer contains the phosphate moiety present in phosphatidylcholine and phosphatidylserine, the latter being membrane lipid component that is able to bind calcium and is implicated in biomineralization [ 24 – 26 ].…”

Section: Introductionmentioning

confidence: 99%

The effect of cationically-modified phosphorylcholine polymers on human osteoblasts in vitro and their effect on bone formation in vivo

Lawton

Habib

et al. 2017

J Mater Sci: Mater Med

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The effect of introducing cationic charge into phosphorylcholine (PC)-based polymers has been investigated in this study with a view to using these materials as coatings to improve bone formation and osseointegration at the bone-implant interface. PC-based polymers, which have been used in a variety of medical devices to improve biocompatibility, are associated with low protein adsorption resulting in reduced complement activation, inflammatory response and cell adhesion. However, in some applications, such as orthopaedics, good integration between the implant and bone is needed to allow the distribution of loading stresses and a bioactive response is required. It has previously been shown that the incorporation of cationic charge into PC-based polymers may increase protein adsorption that stimulates subsequent cell adhesion. In this paper, the effect of cationic charge in PC-based polymers on human osteoblasts (HObs) in vitro and the effect of these polymers on bone formation in the rat tibia was assessed. Increasing PC positive surface charge increased HOb cell adhesion and stimulated increased cell differentiation and the production of calcium phosphate deposits. However, when implanted in bone these materials were at best biotolerant, stimulating the production of fibrous tissue and areas of loosely associated matrix (LAM) around the implant. Their development, as formulated in this study, as bone interfacing implant coatings is therefore not warranted.Graphical abstract

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“…It has been shown to be stable with eversion and inversion. The prosthesis involves minimal bone resection with stable fixation, which does not require cementing or intramedullary fixation, thus making the surgery technically easier (1,9,12,17,(33)(34)(35)(36) .…”

Section: Discussionmentioning

confidence: 99%

“…According to this theory, cytokines are released by activated macrophages (histiocytes) after phagocytosing PE particles. The cytokines activate osteoclasts and inhibit osteoblast activity, leading to periprosthetic bone lysis (3,21,25,(35)(36) . The biological response by the host depends on particle size and concentration (3,21) .…”

Section: Discussionmentioning

confidence: 99%

Medium-term results of the HINTEGRA total ankle arthroplasty

2020

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Objective: The aim of this study was to determine patient satisfaction, survivorship, and revision rate of the HINTEGRA total ankle arthroplasty (TAA). Our secondary objective was to assess hindfoot function. Methods: All patients who underwent a HINTEGRA TAA between 2007 and 2014 were evaluated. We included a total of 69 patients (69 ankles), who were subjected to clinical and radiological examination and completed a visual analogue scale (VAS) for pain, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle score, and the self-reported foot and ankle score (SEFAS). Hindfoot function was assessed using the AOFAS hindfoot score. Mean follow-up was 62 (57–101) months. Results: The mean VAS score was 2 (0–3) and the SEFAS was 37 (26–48) at the most recent follow-up, while the AOFAS ankle score improved from 57 (52–62) to 87 (82–93). The AOFAS hindfoot score improved from 82 to 92 postoperatively. Eight patients had periprosthetic osteolysis and 5 underwent bone grafting of cysts. We detected polyethylene and hydroxyapatite particles in specimens obtained from the cysts. Eight patients had their procedures converted to an ankle arthrodesis. Conclusion: In select patients, TAA improved quality of life. Our medium-term follow-up of the HINTEGRA TAA observed a survivorship of 89% at 5 years with an improvement in the AOFAS score and a mean SEFAS score of 37. We recommend that large periprosthetic cysts, which may be caused by the hydroxyapatite coating and polyethylene particles, be bone grafted prophylactically. We found hindfoot function to be preserved. Level of Evidence IV; Therapeutic Studies; Case Series.

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Ballooning osteolysis in 71 failed total ankle arthroplasties

Cited by 31 publications

References 27 publications

Periprosthetic Osteolysis: Mechanisms, Prevention and Treatment

Periprosthetic Osteolysis: Mechanisms, Prevention and Treatment

The effect of cationically-modified phosphorylcholine polymers on human osteoblasts in vitro and their effect on bone formation in vivo

Medium-term results of the HINTEGRA total ankle arthroplasty

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