Cellular immune responses to orthopaedic implant materials following cemented total joint replacement
Cellular immune responses to orthopaedic implant materials following cemented total joint replacement
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DOI：
10.1002/jor.1100150613
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发表时间：
1997-11-01
影响因子：
2.8
通讯作者：
Nasser, S
中科院分区：
文献类型：
--
作者：
Wooley, PH;Petersen, S;Nasser, S
在185名患者中，术前测量了对颗粒形式的金属和聚合物植入材料的体外细胞免疫应答。患者为初次全关节置换术（n = 65）或翻修关节置换术（n = 120）的候选者。骨关节炎患者在因无菌性松动进行翻修手术时对聚甲基丙烯酸甲酯颗粒的反应显著高于骨关节炎患者在初次手术或因假体机械失效或败血症进行手术翻修时的反应。翻修手术时对钴铬合金颗粒的反应也高于初次手术时的反应。在手术后至少10个月后，对32例患者的反应进行了重新评估，以将生物学反应的个体变化与临床进展相关联。对接受初次手术的患者进行早期随访时的重新评估显示，与术前反应相比，聚甲基丙烯酸甲酯和钴铬合金颗粒的增殖反应和体外细胞因子产生显著升高。相比之下，接受翻修手术的患者在随访时对聚甲基丙烯酸甲酯的反应显著降低，并且这种降低与翻修手术后疼痛、关节活动和功能的显著改善相对应。这些数据表明，对聚甲基丙烯酸甲酯或钴铬合金颗粒或两者的特定细胞反应可能与假体松动或疼痛有关。
In vitro cellular immune responses to metallic and polymeric implant materials in particulate form were measured preoperatively in 185 patients. The patients were candidates for either primary total joint replacement (n = 65) or revision arthroplasty (n = 120). Proliferative cellular responses to polymethylmethacrylate particles in patients with osteoarthritis at revision surgery for aseptic loosening were significantly higher than the responses of patients with osteoarthritis at either primary surgery or surgical revision for mechanical failure of the prosthesis or sepsis. The responses to particles of cobalt-chromium alloy at revision surgery were also higher than the responses at primary surgery. The responses were reevaluated in 32 patients after a minimum of 10 months following surgery to correlate individual changes in the biological responses with clinical progress. Reevaluation at early follow-up of patients who had undergone primary surgery revealed significantly elevated proliferative responses and in vitro cytokine production in response to polymethylmethacrylate and cobalt-chromium alloy particles compared with their preoperative responses. In contrast, the response at follow-up to polymethylmethacrylate was significantly reduced in patients who had undergone revision surgery, and this reduction corresponded with a marked improvement in pain, joint motion, and function following revision surgery. These data suggest that specific cellular responses to polymethylmethacrylate or cobalt-chromium alloy particles, or both, may be associated with loose or painful prostheses.