Characteristics of synovial fluid required for optimization of lubrication fluid for biotribological experiments

Abstract

Wear testing of total joint replacement (TJR) is mandatory in preclinical testing before implantation of TJR into the human body. Testing is governed by current international standards that recommend bovine serum (BS) as a lubricating fluid to replace synovial fluid (SF). Recently, the use of BS has been criticized because of differences in content, fluid characteristics, and nonhuman origin. As a result, a more realistic lubricant mimicking SF is needed. To define SF composition, we analyzed SF obtained during revisions of total hip and knee arthroplasties and compared it with SF obtained during primary arthroplasties and from patients without TJR. Samples were acquired from 152 patients. We found that the median total protein concentration for all SF was 36.8 mg/mL, which is significantly higher than concentrations currently recommended by the ISO standards. The γ-globulin concentration was significantly higher and the phospholipid concentration significantly lower in patients with revision of TJR compared with patients without TJR. No significant difference was found in hyaluronic acid concentration and viscosity among the groups. Our results support the need to improve the definition of a more clinically relevant wear testing lubricant in the ISO standards. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 1422-1431, 2017.

A systematic review on correlation between biochemical and mechanical processes of lubricant film formation in joint replacement of the last 10 years

“…The levels of different components within SF may differ with the person and age, and they also depend on the presence of disease. The total volume of SF, protein concentration, pH value, viscosity, and other properties are known to vary between healthy persons and patients with OA at different stages . The concentration of proteins and other components differs for diseased and periprosthetic SF, and the condition includes decreased effective viscosity, increased protein content, and increased pH …”

“…From the experiment of Galandáková et al, four types of sample were collected as below: Patient with aseptic loosening of total joint replacement Patient with total joint replacement but without any sign of aseptic loosening Patient without total joint replacement and the end stage of OA Healthy SF …”

“…The average concentrations of the constituents of the joint fluid from the different stages of osteoarthritis. Average total concentration of protein found 40.3–35.5 mg/mL, average concentration of albumin 29.1–26.7 mg/mL, average concentration of globulin 11.5–8.7 mg/mL, and HA 0.8–2.0 mg/mL for different groups of patients as described above [Colour figure can be viewed at wileyonlinelibrary.com]…”

“…Galandáková et al concluded that lubricant film is predominantly formed because of bovine serum proteins. Duong et al stated that the concentration of BSA and γ‐globulin regulates the frictional behaviour of the CoCr femoral head.…”

The development of a small-scale wear test for CoCrMo specimens with human synovial fluid

“…The most abundant components of SF reported in the literature [22][23][24][25][26]28] are summarised in Table 1. The primary proteins are identified as albumin and γ-globulin and their relative and total concentration can vary widely depending on the fluid pathology [23,24,26].…”