In Vivo Analysis of Polyethylene Wear Particles After Total Knee Arthroplasty: The Influence of Improved Materials and Designs

Minoda, Yukihide; Kobayashi, Akio; Iwaki, Hiroaki; Iwakiri, Kentarou; Inori, Fumiaki; Sugama, Ryo; Ikebuchi, Mitsuhiko; Kadoya, Y.; Takaoka, Kunio

doi:10.2106/jbjs.i.00447

Cited by 45 publications

(35 citation statements)

References 29 publications

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“…In comparing our study findings with single-center studies [6,16], results were similar in not identifying major differences in CoCR-conventional polyethylene versus CoCr-HLXPE bearings. The results of our study also confirm earlier published findings from a large populationbased study with shorter followup [9].…”

Section: Discussionsupporting

confidence: 71%

“…One small (n = 100) retrospective case series reported no difference in HXLPE versus conventional polyethylene TKA revision rates at an average of 79 months followup [6]. An additional consecutive case series (n = 202) [16] also did not find differences in conventional polyethylene versus HXLPE TKAs in revision rates, osteolyisis, Knee Society scores, range of motion, or alignment at minimum 2 years followup. Although these studies suggest that HXLPE may be comparable to conventional polyethylene in TKA, the findings are limited as a result of small sample sizes, short-term followup, study attrition, and lack of generalizability as a result of singleinstitutional study designs.…”

Section: Introductionmentioning

confidence: 96%

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Is There a Difference in Total Knee Arthroplasty Risk of Revision in Highly Crosslinked versus Conventional Polyethylene?

Paxton

Inacio

Kurtz

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Highly crosslinked polyethylene (HXLPE) was introduced to reduce wear and associated osteolysis in total knee arthroplasty (TKA). However, there is limited clinical evidence that HXLPE is more effective than conventional polyethylene (CPE) in TKA. Questions/purposes (1) Do primary TKAs with HXLPE tibial inserts have a lower risk of revision (all-cause, aseptic, and septic) than TKAs with CPE tibial inserts? (2) In NexGen TKA (Zimmer Inc, Warsaw, IN, USA) bearings, do HXLPE tibial inserts have a lower risk of revision (all-cause, aseptic, and septic) than CPE tibial inserts? (3) In Press-Fit Condylar TKA (PFC or PFC Sigma; DePuy Inc, Warsaw, IN, USA), do HXLPE tibial inserts have a lower risk of revision (all-cause, aseptic, and septic) than procedures performed with CPE tibial inserts? Methods The Kaiser Permanente Total Joint Replacement Registry was used to identify primary TKAs (N = 77,084) performed during the study period (April 2001 to December 2011) with cobalt-chromium alloy on CPE (CoCr-CPE) and CoCr-HXLPE bearings. The registry has 95% voluntary participation and less than 9% were loss to followup during the 10-year study period. A total of 60,841 (79%) had CoCr-CPE bearings, 11,048 (14%) had CoCr-HXLPE bearings, and 5195 (7%) were unknown. Specific knee implant designs (NexGen, Zimmer and PFC-Sigma, DePuy Inc) were also evaluated. These implants represented 41% (31,793) and 49% (37,457), respectively, of the 77,084 TKAs of known implant types registered during that period; implant selection was at the discretion of the attending surgeon. Descriptive statistics and marginal Cox regression models with propensity score adjustments were applied to compare risk of revision for CoCr-CPE versus CoCr-HXLPE TKA bearings. Results At 5 years followup, cumulative incidence of revision for CoCr-CPE and CoCr-XLPE were 2.7% and 3.1%, respectively. Adjusted risks of all-cause (hazard ratio [HR], 1.05; 95% confidence interval [CI], 0.86-1.29; p = 0.620), aseptic (HR, 1.01; 95% CI, 0.77-1.32; p = 0.954), and septic revision (HR, 1.11; 95% CI, 0.81-1.51; p = 0.519) did not differ in patients with CoCr-XLPE bearings compared with CoCr-CPE. Within TKAs with NexGen components, the adjusted risks of all-cause (HR, 1.14; 95% CI, 0.86-1.51; p = 0.354), aseptic (HR, 1.14; 95% CI, 0.79-1.65; p = 0.493), and septic revision (HR, 1.14; 95% CI, 0.76-1.73; p = 518) were similar in patients with CoCr-XLPE compared with those with CoCr-CPE bearings. Finally, within the TKAs with PFC components, the adjusted risks of all-cause (HR, 0.80; 95% CI, 0.49-1.30; p = 0.369), aseptic (HR, 0.62; 95% CI, 0.62-1.14; p = 0.123), and septic revision (HR, 0.97; 95% CI, 0.51-1.85; p = 0.929) were also similar in patients with CoCr-XLPE compared with those with CoCr-CPE bearings. Conclusions In this large study, we did not find differences in risk of revision for CoCr-HXLPE compared with CoCr-CPE bearings at 5 years followup. In selecting HXLPE in TKA, clinicians should consider the increased cost and lack of available evidence of ...

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Section: Discussionsupporting

confidence: 71%

Section: Introductionmentioning

confidence: 96%

Is There a Difference in Total Knee Arthroplasty Risk of Revision in Highly Crosslinked versus Conventional Polyethylene?

Paxton

Inacio

Kurtz

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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show abstract

“…Ceramics have been shown to demonstrate excellent wear resistance with either soft or hard bearings, as well as tribology characteristics [13][14][15]. Therefore, based on previous in vitro data, ceramics have been identified as an interesting material for application in TKA [9,14,15].…”

Section: Discussionmentioning

confidence: 99%

“…The first experimental and clinical studies to investigate retrieved polyethylene inserts demonstrated that ceramic-on-polyethylene bearings used for TKA resulted in up to four to five times less wear compared to metal-on-polyethylene bearings [13,14]. The use of ceramics in TKA should not be expected to increase the functional outcome.…”

Section: Introductionmentioning

confidence: 99%

Prospective comparative clinical study of ceramic and metallic femoral components for total knee arthroplasty over a five-year follow-up period

Bergschmidt

Ellenrieder²,

Bader³

et al. 2016

The Knee

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“…A recent approach has focused on understanding and manipulating wear debris-induced inflammatory osteolysis at the molecular level by pharmacological intervention (Purdue et al, 2007). Previous studies found that phagocytic macrophages in the tissue surrounding the prosthetic site engulf small wear particles, resulting in high levels of cytokine secretion, osteoclastogenesis, activation, and subsequent bone resorption (Purdue et al, 2007;Minoda et al, 2009). Moreover, small wear particles stimulate fibroblasts, macrophages, and foreign body giant cells in the interfacial membranes, resulting in the secretion of high levels of proinflammatory cytokines and other factors, such as interleukin (IL)-1, IL-6, tumor necrosis factor (TNF)-α, metalloproteinases (MMPs), and prostaglandin (PG)E 2 .…”

Section: Introductionmentioning

confidence: 99%

Protective effect of p38 MAPK inhibitor on wear debris-induced inflammatory osteolysis through downregulating RANK/RANKL in a mouse model

Chen

Guo

et al. 2015

Genet. Mol. Res.

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ABSTRACT. Aseptic loosening associated with wear particle-induced inflammation is a major cause of joint implant failure. Recent studies have demonstrated the therapeutic effects of p38 mitogen-activated protein kinase (MAPK)-based therapies on chronic inflammatory diseases. The purpose of this study was to investigate whether SB203580, a p38 MAPK inhibitor, inhibits wear debris-induced inflammatory osteolysis in mice through downregulation of receptor activator of nuclear factor kβ (RANK)/RANK ligand (RANKL). We used a murine osteolysis model to study the effect of SB203580 on RANKL/RANK signaling and titanium particle-induced osteolysis in vivo. Pouch membranes p38 inhibitor on wear debris-induced inflammatory osteolysis with intact bone implants were analyzed using histological analysis and transmission electron microscopy, and the levels of RANK and RANKL protein and mRNA were evaluated by immunohistological staining and real-time reverse transcriptase-polymerase chain reaction. SB203580 had less of an effect on RANK and RANKL expression under wear debris-induced conditions. The number of TRAP-positive cells was remarkably reduced in Ti-particle-induced pouch tissues. These effects were confirmed through the transmission electron microscopy results. These results suggest that p38 MAPK-based therapies are beneficial in preventing aseptic loosening associated with total joint replacement by modulating RANK-RANKL signaling.

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In Vivo Analysis of Polyethylene Wear Particles After Total Knee Arthroplasty: The Influence of Improved Materials and Designs

Cited by 45 publications

References 29 publications

Is There a Difference in Total Knee Arthroplasty Risk of Revision in Highly Crosslinked versus Conventional Polyethylene?

Is There a Difference in Total Knee Arthroplasty Risk of Revision in Highly Crosslinked versus Conventional Polyethylene?

Prospective comparative clinical study of ceramic and metallic femoral components for total knee arthroplasty over a five-year follow-up period

Protective effect of p38 MAPK inhibitor on wear debris-induced inflammatory osteolysis through downregulating RANK/RANKL in a mouse model

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