Clinical relevance of corrosion patterns attributed to inflammatory cell‐induced corrosion: A retrieval study

Abstract

In vitro studies have shown that human osteoclasts can corrode stainless steel and titanium leading to the production of metal ions responsible for inflammatory reactions. Moreover, traces of cellular activities on metal orthopaedic explants have recently been reported as inflammatory cell-induced (ICI) corrosion being the result of the cells sealing on the metal surfaces and releasing reactive oxygen species (ROS) through Fenton-like reactions. The extent and clinical relevance of this phenomenon has yet to be understood. We analysed a cohort of 100 CoCr alloy hips collected at our retrieval centre; we performed macroscopic and microscopic screening and used statistical analysis to correlate our findings with implant and clinical variables. We found that 59% of our implants had evidence of surface damage consistent with what has previously been described as cell-induced corrosion. There was a significant association between the patterns and aseptic loosening for the ASR modular (r = -0.488, p = 0.016) and the Durom modular (r = 0.454, p = 0.026). This is the largest implant retrieval study to examine the phenomena of so-called ICI corrosion and is the first to investigate its clinical relevance. We recommend further work to determine the role of cells in the damage patterns observed. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 155-164, 2017.

Inflammatory cell‐induced corrosion in total knee arthroplasty: A retrieval study

“…In this study we focused our analysis on the polished CoCr components, using similar methods to those described by Gilbert and Di Laura . We analyzed 28 femoral components and 9 polished tibial plates.…”

“…All implants were decontaminated using 10% formaldehyde solution followed by soaking in 10% solution of Decon 90 in an ultrasonic cleaning bath for 30 min, and subsequent rinsing in distilled water and left to air dry …”

“…Metals are widely used in orthopedic implants due to their favorable mechanical properties and biocompatibility . Numerous studies have reported evidence of metal release in patients with joint replacements leading to local tissue reactions, pain, and ultimately revision of the implant . The mechanisms of metal loss are multifactorial and can include mechanically assisted crevice corrosion (MACC), wear at the bearing surfaces and the recently described phenomenon of inflammatory cell‐induced corrosion (ICIC) .…”

Electrochemical potential zone of viability on CoCrMo surfaces is affected by cell type: Macrophages under cathodic bias are more resistant to killing

“…29 Retrieved CoCrMo alloy hip implant surfaces with damage that is hypothesized to be the result of cell-induced corrosion (ICI) has been recently reported. [30][31][32] Evidence of cellular remnants and biological material on the surfaces of CoCrMo alloy 30 was characterized as osteoclast resorption and the oxidizing effect of molecules (i.e., cytokines, hydrogen peroxide) released from vesicles during necrosis. 30 While some of these observations were later found to be the result of electrocautery effects, 33 there were other examples where ICI appeared to play a role.…”

The effect of simulated inflammatory conditions and Fenton chemistry on the electrochemistry of CoCrMo alloy

“…They reported evidence of apparent cell‐based patterns of corrosion damage in retrieved implant surfaces with or without MAC. This raises significant new questions about the mechanism of in vivo corrosion of CoCrMo alloy and the clinical consequences of such corrosion interactions . Iron ions are known be present in vivo in ferritins (proteins that sequester iron) and may further aggravate inflammation in the presence of ROS and Fenton reactions.…”