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

Abstract

Metal release in patients with joint replacements is associated with local tissue reactions, pain, and ultimately revision of implants. One of the causes of this metal loss is speculated to be due to a mechanism of inflammatory cell-induced corrosion (ICIC). In this knee retrieval study, we aimed to: (1) identify the extent and location of ICI corrosion patterns on our femoral and tibial components and (2) correlate our findings with implant and clinical information. We investigated 28 femoral and 9 tibial components made of polished CoCr for presence of ICIC, using macroscopic and microscopic screening and statistical analyses to identify any significant correlations between our results and clinical information. We found that 71% of femoral and 100% of tibial components showed evidence of ICIC and significantly more was present on non-contacting regions (p< 0.0001). We found a significant correlation between the presence of ICIC and instability (p = 0.0113) and a significant difference between poster stabilized and cruciate retaining designs in the amount of ICIC on internal edges (p = 0.0375). This corrosion pattern was prevalent in our series of knee retrievals and may help explain some of the mechanisms of material loss that may occur in vivo. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 460-467, 2018.

Enhanced corrosion resistance of zinc-containing nanowires-modified titanium surface under exposure to oxidizing microenvironment

“…Researchers hypothesized that different classes of cells from both the skeletal and immune systems (such as phagocytic cells, osteoclasts, macrophages and foreign giant cells) may directly attack surfaces of metal implants, creating corrosion-like pattern that is usually found on the non-contacting regions of retrieved components [17]. Some in vivo and in vitro studies also supported that monocytes can differentiate into osteoclasts and corrode metallic surfaces made of titanium and stainless steel [32]. Macrophages, as one of the inflammatory cells, has also been reported to significantly increase corrosion susceptibility of implants by secreting reactive oxygen species (ROS), specifically hydrogen peroxide (H 2 O 2 ).…”

The contribution of the histopathological examination to the diagnosis of adverse local tissue reactions in arthroplasty

“… 79 Although the degree of macrophage necrosis can vary depending on quantitative and qualitative aspects of the wear debris and host factors, its amount will increase during implantation time and remains a significant factor to be included in any study on the tribology of MoM and non-MoM hip arthroplasty. The presence of viable macrophages and multi-nucleated giant cells exfoliated into the synovial fluid provides support to the cellular mechanism of direct erosion of the metallic surface of the implant, 80 – 82 although some of the damage has been attributed to the use of electrocautery. 83 , 84 …”

Analysis of the Attune tibial tray backside

“…A published photogrammetric method 21,22 was used to grade the amount of cement attached to the tibial tray backside. High-resolution images of the tibial tray backside were captured using an EOS 5D Mark II camera (Canon Inc., Tokyo, Japan) (Fig.…”

“…Example of sample analyzed using the photogrammetric method. 20,21 a) Total tibial tray backside surface contours highlighted in red. b) Amount of surface covered by cement highlighted in red.…”