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Archives of Orthopaedic and Trauma Surgery
Erschienen in: Archives of Orthopaedic and Trauma Surgery 5/2015

01.05.2015 | Knee Revision Surgery

Metal ions as inflammatory initiators of osteolysis

verfasst von: Kevin Magone, Daniel Luckenbill, Tarun Goswami

Erschienen in: Archives of Orthopaedic and Trauma Surgery | Ausgabe 5/2015

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Abstract

Osteolysis and aseptic loosening currently contribute 75 % of implant failures. Furthermore, with over four million joint replacements projected to be performed in the United States annually, osteolysis and aseptic loosening may continue to pose a significant morbidity. This paper reviews the osteolysis cascade leading to osteoclast activation and bone resorption at the biochemical level. Additionally, the metal ion release mechanism from metallic implants is elucidated. Even though metal ions are not the predominating initiator of osteolysis, they do increase the concentration of key inflammatory cytokines that stimulate osteoclasts and prove to be a contributor to osteolysis and aseptic loosening. Osteolysis is a competitive mechanism among a number of biological reactions, which includes debris release, macrophage and osteoclast activation, an inflammatory response as well as metal ion release. Pharmacological therapy for component loosening has also been reviewed. A non-surgical treatment of osteolysis has not been found in the literature and thus may become an area of future research. Even though this research is warranted, comprehensively understanding the immune response to orthopedic implants and their metallic ions, and thus, creating improved prostheses appears to be the most cost-effective approach to decrease the morbidity related to osteolysis and to design implants with greater longevity. The ionic forms, cytokines, toxicity, gene expression, biological effects, and hypersensitivity responses of metallic elements from metal implants are summarized as well.
Literatur
1.
Ollivere B, Wimhurst JA, Clark IM, Donell ST (2012) Current concepts in osteolysis. J Bone Jt Surg Br 94-B:10–15CrossRef
2.
Singh JA, Vessely MB, Harmsen WS, Schleck CD, Melton LJ, Kurland RL, Berry DJ (2010) A population-based study of trends in the use of total hip and total knee arthroplasty, 1969–2008. Mayo Clin Proc 85(10):898–904CrossRefPubMedCentralPubMed
3.
Espigares JLN, Torres EH (2008) Cost-outcome analysis of joint replacement: evidence from a Spanish Public Hospital. Gac Sanit 22(4):337–343CrossRef
4.
Talmo CT, Aghazadeh M, Bono JV (2012) Perioperative complications following total joint replacement. Clin Geriatr Med 28(3):471–487CrossRefPubMed
5.
Talmo CT, Robbins LE, Bono JV (2010) Total joint replacement in the elderly patient. Clin Geriatr Med 26(3):517–529CrossRefPubMed
6.
7.
Gallo J, Goodman SB, Lostak J, Janout M (2012) Advantages and disadvantages of ceramic on ceramic total hip arthroplasty: a review. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 156(3):204–212CrossRefPubMed
8.
9.
Sadoghi P, Schröder C, Fottner A, Steinbrück A, Betz O, Müller PE, Jansson V, Andreas Hölzer A (2012) Application and survival curve of total hip arthroplasties: a systematic comparative analysis using worldwide hip arthroplasty registers. Int Orthop 36:2197–2203CrossRefPubMedCentralPubMed
10.
Kurtz S, Ong K, Lau E, Mowat F, Halpern M (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Jt Surg Am 89(4):780–785CrossRef
11.
Schwab LP, Marlar J, Hasty KA, Smith RA (2011) Macrophage response to high number of titanium particles is cytotoxic and COX-2 mediated and it is not affected by the particle’s endotoxin content or the cleaning treatment. Wiley Online Library
12.
Ingham E, Fisher J, Stone MH (2003) Wear of historical polyethylenes in total hip prostheses. Biomechanical success and biological failure. Hip Int 13(1):17–27PubMed
13.
Beck RT, Illingworth KD, Saleh KJ (2011) Review of periprosthetic osteolysis in total joint arthroplasty: an emphasis on host factors and future directions. Wiley Online Library
14.
Sargeant A, Goswami T (2006) Pathophysiological aspects of hip implants. J Surg Orthop Adv 15(2):111–112PubMed
15.
Sargeant A, Goswami T (2007) Hip implants—paper VI—ion concentrations. Mater Des 28:155–171CrossRef
16.
Cooper HJ, Ranawat AS, Potter HG, Foo LF, Koob TW, Ranawat CS (2010) Early reactive synovitis and osteolysis after total hip arthroplasty. Clin Orthop Relat Res 468:3278–3285CrossRefPubMedCentralPubMed
17.
Hallab NJ, Jacobs JJ (2009) Biologic effects of implant debris. Bull NYU Hosp Jt Dis 67(2):182–188PubMed
18.
Desai MA, Bancroft LW (2008) Periprosthetic osteolysis. Orthopedics 31(6):1–5CrossRef
19.
Fang Q, Wang H, Zhu S, Zhu Q (2011) N-acetyl-l-cysteine inhibits wear particle-induced prosthesis loosening. J Surg Res 168:163–172CrossRef
20.
Gallo J, Goodman SB, Konttinen YT, Raska M (2012) Particle disease: biological mechanisms of periprosthetic osteolysis in total hip arthroplasty. Innate Immun 1–12
21.
Gallo J, Slouf M, Goodman SB (2010) The relationship of polyethylene wear to particle size, distribution, and number: a possible factor explaining the risk of osteolysis after total hip arthroplasty. Wiley InterScience
22.
Callaghan JJ, Rosenberg AG, Rubash HE (2007) The adult hip 2(2):1505–1506
23.
Schwarz EM, Looney RJ, O’Keefe RJ (2000) Anti-TNF-A therapy as a clinical intervention for periprosthetic osteolysis. Arthritis Res 2:165–168CrossRefPubMedCentralPubMed
24.
Hjorth MH, Soballe K, Jakobsen SS, Lorenzen ND, Mechlenburg L, Stilling M (2014) No association between serum metal ions and implant fixation in large-head metal-on-metal total hip arthroplasty. Acta Orthop 85(4):355–362CrossRefPubMedCentralPubMed
25.
Hosman AH, Mei HC, Bulstra SK, Busscher HJ, Neut D (2010) Effects of metal-on-metal wear on the host immune system and infection in hip arthroplasty. Acta Orthopaedica 81(5):526–534CrossRefPubMedCentralPubMed
26.
Grosse S, Haugland HK, Lilleng P, Ellison P, Hallan G, Hol PJ (2014) Wear particles and ions from cemented and uncemented titanium-based hip prostheses—a histological and chemical analysis of retrieval material. J Biomed Mater Res B Appl Biomater
27.
Minoda Y, Kobayashi A, Iwaki H, Iwakiri K, Inori F, Sugama R, Ikebuchi M, Kadoya Y, Takaoka K (2009) In vivo analysis of polyethylene wear particles after total knee arthroplasty: the influence of improved materials and designs. J Bone Jt Surg Am 91(Suppl 6):67–73CrossRef
28.
Shon WY, Gupta S, Biswal S, Han SH, Hong SJ, Moon JG (2009) Pelvic osteolysis relationship to radiographs and polyethylene wear. J Arthroplast 24:743–750CrossRef
29.
Cadosch D, Chan E, Gautschi OP, Filgueira L (2009) Metal is not inert: role of metal ions released by biocorrosion in aseptic loosening-current concepts. Wiley InterScience
30.
Gallo J, Kamínek P, Tichá V, Řiháková P, Ditmar R (2002) Particle disease. A comprehensive theory of periprosthetic osteolysis: a review. Biomed Pap 146(2):21–28CrossRef
31.
32.
Yadav J, Samelko L, Gilvar P, McAllister K, Hallab NJ (2013) Osteoclasts lose innate inflammatory reactivity to metal and polymer implant debris compared to monocytes/macrophages. Orthop J 18(7):605–613
33.
Gustafson K, Jakobsen SS, Lorenzen ND, Thyssen JP, Johansen JD, Bonefeld CM, Stilling M, Baad-Hansen T, Søballe K (2014) Metal release and metal allergy after total hip replacement with resurfacing versus conventional hybrid prosthesis. Acta Orthop 85(4):348–354CrossRefPubMedCentralPubMed
34.
Gallo J, Raska M, Mrazek F, Petrek M (2008) Bone remodeling, particle disease and individual susceptibility to periprosthetic osteolysis. Physiol Res 57:339–349PubMed
35.
Emmanuel AR, Bergin KM, Kelly GE, McCoy GF, Wozniak AP, Quinlan JF (2014) The effect of acetabular inclination on metal ion levels following metal-on-metal hip arthroplasty. J Arthroplast 29(1):186–191CrossRef
36.
Hallab NJ, Caicedo M, McAllister K, Skipor A, Amstutz H, Jacobs JJ (2013) Asymptomatic prospective and retrospective cohorts with metal-on-metal hip arthroplasty indicate acquired lymphocyte reactivity varies with metal ion levels on a group basis. J Orthop Res 31(2):173–182CrossRefPubMedCentralPubMed
37.
Ingham E, Fisher J (2005) The role of macrophages in osteolysis of total joint replacement. Biomaterials 26:1271–1286CrossRefPubMed
38.
Tomazic-Jezic VJ, Merritt K, Umbreit TH (2001) Significance of the type and the size of biomaterial particles on phagocytosis and tissue distribution. J Biomed Mater Res 55:523–529CrossRefPubMed
39.
Chan E, Cadosch D, Gautschi OP, Sprengel K, Filgueira L (2011) Influence of metal ions on human lymphocytes and the generation of titanium specific T lymphocytes. J Appl Biomater Biomech 9:137–143PubMed
40.
Cadosch D, Sutanto M, Chan E, Mhawi A, Gautschi OP, Katterfeld B, Simmen HP, Filgueira L (2009) Titanium uptake, induction of RANK-L expression, and enhanced proliferation of human T-Lymphocytes. Wiley InterScience
41.
Caicedo MS, Desai R, McAllister K, Reddy A, Jacobs JJ, Hallab NJ (2008) Soluble and particulate Co-Cr-Mo alloy implant metals activate the inflammasome danger signaling pathway in human macrophages: a novel mechanism for implant debris reactivity. Wiley InterScience
42.
43.
Niki Y, Matsumoto H, Suda Y, Otani T, Fujikawa K, Toyama Y, Hisamori N, Nozue A (2003) Metal ions induce bone-resorbing cytokine production through the redox pathway in synoviocytes and bone marrow macrophages. Biomaterials 24:1447–1457CrossRefPubMed
44.
Ritchlin CT, Schwarz EM, O’Keefe RJ, Looney RJ (2004) RANK, RANKL and OPG in inflammatory arthritis and periprosthetic osteolysis. J Musculoskel Neuron Interact 4(3):276–284
45.
Merkel KD, Erdmann JM, McHugh KP, Abu-Amer Y, Ross FP, Teitelbaum SL (1999) Tumor necrosis factor-a mediates orthopedic implant osteolysis. Am J Pathol 154:203–210CrossRefPubMedCentralPubMed
46.
Wang JY, Wicklund BH, Gustilo RB, Tsukayama DT (1996) Titanium, chromium and cobalt ions modulate the release of bone-associated cytokines by human monocytes/macrophages in vitro. Biomaterials 17(23):2233–2240CrossRefPubMed
47.
Hanawa T (2004) Metal ion release from metal implants. Mater Sci Eng 24:745–752CrossRef
48.
Hallab NJ, Skipor A, Jacobs JJ (2003) Interfacial kinetics of titanium- and cobalt-based implant alloys in human serum: metal release and biofilm formation. Wiley Periodicals
49.
Cadosch D, Chan E, Gautschi O, Meagher J, Zellweger R, Filgueira L (2008) Titanium IV ions induced human osteoclast differentiation and enhanced bone resorption in vitro. Wiley InterScience
50.
Chan EP, Mhawi A, Clode P, Saunders M, Filgueira L (2009) Effects of titanium(IV) ions on human monocyte-derived dendritic cells. Metallomics 1:166–174CrossRefPubMed
51.
Mishra PK, Wu W, Rozo C, Hallab NJ, Benevenia J, Gause WC (2011) Micrometer-sized titanium particles can induce potent Th2-type responses through TLR4-independent pathways. Immunology 187:6491–6498CrossRef
52.
Haleem-Smith H, Argintar E, Bush C, Hampton D, Postma WF, Chen FH, Rimington T, Lamb J, Tuan RS (2012) Biological responses of human mesenchymal stem cells to titanium wear debris particles. J Orthop Res 30(6):853–863CrossRefPubMedCentralPubMed
53.
Lohmann CH, Dean DD, Oster GK, Casasola D, Buchhorn GH, Fink U, Schwartz Z, Boyan BD (2002) Ceramic and PMMA particles differentially affect osteoblast phenotype. Biomaterials 23:1855–1863CrossRefPubMed
54.
Carr AM, Desteiger R (2008) Osteolysis in patients with a metal-on-metal hip arthroplasty. Anz J Surg 78:144–147CrossRefPubMed
55.
Hallab NJ, Caicedo M, Epstein R, McAllister K, Jacobs JJ (2009) In vitro reactivity to implant metals demonstrates a person-dependent association with both T-cell and B-cell activation. Wiley InterScience
56.
Hallab NJ, Caicedo M, Finnegan A, Jacobs JJ (2008) Th1 type lymphocyte reactivity to metals in patients with total hip arthroplasty. J Orthop Surg Res 3:6CrossRefPubMedCentralPubMed
57.
Griem P, Gleichmann E (1995) Metal ion induced autoimmunity. Immunology 7:831–838
58.
Caicedo MS, Pennekamp PH, McAllister K, Jacobs JJ, Hallab NJ (2009) Soluble ions more than particulate cobalt-alloy implant debris induce monocyte costimulatory molecule expression and release of proinflammatory cytokines critical to metal-induced lymphocyte reactivity. Wiley InterScience
59.
Catelas I, Petit A, Zukor DJ, Antoniou J, Huk OL (2003) TNF-α secretion and macrophage mortality induced by cobalt and chromium ions in vitro-qualitative analysis of apoptosis. Biomaterials 24:383–391CrossRefPubMed
60.
Patton MS, Lyon TDB, Ashcroft GP (2008) Levels of systemic metal ions in patients with intramedullary nails. Acta Orthop 79(6):820–825CrossRefPubMed
61.
Savarino L, Maci GS, Greco M, Baldini N,Giunti A (2007) Metal ion release from fracture fixation devices: a potential marker of implant failure. Wiley InterScience
62.
Sidaginamale RP, Joyce TJ, Lord JK, Jefferson R, Blaine PG, Nargol AVF, Langton DJ (2013) Blood metal ion testing is an effective screening tool to identify poorly performing metal-on-metal bearing surfaces. Bone Jt Res 2(5):84–95CrossRef
63.
Delaunay C, Petit I, Learmonth ID, Oger P, Vendittoli PA (2010) Metal-on-metal bearings total hip arthroplasty: the cobalt and chromium ions release concern. Orthop Traumatol Surg Res 96:894–904CrossRefPubMed
64.
Lin HY, Bumgardner JD (2004) In vitro biocorrosion of Co-Cr-Mo implant alloy by macrophage cells. J Orthop Res 22:1231–1236CrossRefPubMed
65.
Shrivastava R, Upreti RK, Seth PK, Chaturvedi UC (2002) Effects of chromium on the immune system. FEMS Immunol Med Microbiol 34:1–7CrossRefPubMed
66.
Hallab NJ, Vermes C, Messina C, Roebuck KA, Glant TT, Jacobs JJ (2002) Concentration and composition dependent effects of metal ions on human MG63 osteoblasts. J Biomed Mater Res 60(3):420–433CrossRefPubMed
67.
Vermes C, Glant TT, Hallab NJ, Fritz EA, Roebuck KA, Jacobs JJ (2001) The potential role of the osteoblast in the development of periprosthetic osteolysis: review of in vitro osteoblast responses to wear debris, corrosion products, and cytokines and growth factors. J Arthroplast 16:95–100CrossRef
68.
Wang JY, Wicklund BH, Gustilo RB, Tsukayama DT (1997) Prosthetic metals interfere with the functions of human osteoblast cells in vitro. Clin Orthop Relat Res 339:216–226CrossRefPubMed
69.
Nichols KG, Puleo DA (1997) Effect of metal ions on the formation and function of osteoclastic cells in vitro. J Biomed Mater Res 35:265–271CrossRefPubMed
70.
Burton L, Paget D, Binder NB, Bohnert K, Nestor BJ, Sculco TP, Santambrogio L, Ross FP, Goldring SR, Purdue PE (2012) Orthopedic wear debris mediated inflammatory osteolysis is mediated in part by NALP3 inflammasome activation. Wiley Online Library
71.
Lewis JB, Wataha JC, Randol TM, McCloud VV, Lockwood PE (2003) Metal ions alter lipopolysaccharide-induced NFkb binding in monocytes. Wiley Periodicals, Inc.
72.
Wei S, Siegal GP (2008) Mechanisms modulating inflammatory osteolysis: a review with insights into therapeutic targets. Pathol Res Pract 204:695–706CrossRefPubMedCentralPubMed
73.
Rao AJ, Gibon E, Ma T, Yao Z, Smith RL, Goodman SB (2012) Revision joint replacement, wear particles and macrophage polarization. Acta Biomaterialia 8:2815–2823CrossRefPubMedCentralPubMed
74.
Catelas I, Jacobs JJ (2010) Biologic activity of wear particles. Instr Course Lect 59:3–16PubMed
75.
Ingham E, Fisher J (2000) Biological reactions to wear debris in total joint replacement. Proc Inst Mech Eng H 214(1):21–37CrossRefPubMed
76.
Meneghini RM, Hallab NJ, Jacobs JJ (2005) The biology of alternative bearing surfaces in total joint arthroplasty. Instr Course Lect 54:481–493PubMed
77.
Nikolaou VS, Edwards MR, Bogoch E, Schemitsch EH, Waddell JP (2012) A prospective randomized controlled trial comparing three alternative bearing surfaces in primary total hip replacement. J Bone Jt Surg Br 94(4):459–465CrossRef
78.
Sato T, Nakashima Y, Akiyama M, Yamamoto T, Mawatari T, Itokawa T, Ohishi M, Motomura G, Hirata M, Iwamoto Y (2012) Wear resistant performance of highly cross-linked and annealed ultra-high molecular weight polyethylene against ceramic heads in total hip arthroplasty. J Orthop Res 30(12):2031–2037CrossRefPubMed
79.
Clarke IC (1992) Role of ceramic implants. design and clinical success with total hip prosthetic ceramic-to-ceramic bearings. Clin Orthop Relat Res 282:19–30PubMed
80.
Dumbleton JH, Manley MT, Edidin AA (2002) A literature review of the association between wear rate and osteolysis in total hip arthroplasty. J Arthroplast 17(5):649–661CrossRef
81.
Nho Jh, Park JS, Song US, Kim WJ, Suh YS (2013) Ceramic head fracture in ceramic-on-polyethylene total joint arthroplasty. Yonsei Med J 54(6):1550–1553CrossRefPubMedCentralPubMed
82.
Bouras T, Repantis T, Fennema P, Kororessis P (2013) Low aseptic loosening and revision rate in Zweymuller-Plus total hip arthroplasty with ceramic-on-ceramic bearings. Eur J Orthop Surg Traumatol
83.
Nehme A, Maalouf G, Tricoire JL, Giordano G, Chiron P, Puget J (2003) Effect of alendronate on periprosthetic bone loss after cemented primary total hip arthroplasty: a prospective randomized study. Rev Chir Orthop Reparatrice Appar Mot 89(7):593–598PubMed
84.
Arabmotlagh M, Pilz M, Warzecha J, Rauschmann M (2009) Changes of femoral periprosthetic bone mineral density 6 years after treatment with alendronate following total hip arthroplasty. J Orthop Res 27(2):183–188CrossRefPubMed
85.
Tapaninen TS, Venesmaa PK, Jurvelin JS, Miettinen HJA, Kröger HPJ (2010) Alendronate reduces periprosthetic bone loss after uncemented primary total hip arthroplasty—a 5-year follow-up of 16 patients. Scand J Surg 99:32–37PubMed
86.
Khurjekar KS, Vidyadhara S, Dheenadhayalan J, Rajasekaran S (2006) Spontaneous rapid osteolysis in paget’s disease after internal fixation of subtrochanteric femoral fracture. Singap Med J 47(10):897–900
87.
Kinov P, Tivchev P, Doukova P, Leithner A (2006) Effect of risedronate on bone metabolism after total hip arthroplasty: a prospective randomised study. Acta Orthop Belg 72(1):44–50PubMed
88.
Vasudevan A, DiCarlo EF, Wright T, Chen D, Figgie MP, Goldring SR, Mandl LA (2012) Cellular response to prosthetic wear debris differs in patients with and without rheumatoid arthritis. Arthritis Rheum 64(4):1005–1014CrossRefPubMedCentralPubMed
89.
Hagman S, Kirsch J, Kretzer J, Moradi B (2013) In vitro analysis of impact of metal ions on human lymphocyte cultures. Orthopade 42(8):643–650CrossRef
Metadaten
Titel
Metal ions as inflammatory initiators of osteolysis
verfasst von
Kevin Magone
Daniel Luckenbill
Tarun Goswami
Publikationsdatum
01.05.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
Archives of Orthopaedic and Trauma Surgery / Ausgabe 5/2015
Print ISSN: 0936-8051
Elektronische ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-015-2196-8

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