SGER: Separation of Polyethylene Wear Debris Found in Synovial Fluid Generated from Total Joint Prostheses Using Bio-Ferrography

[00:92944]在发生导致翻修手术的并发症之前，了解全髋关节和膝关节置换术患者的滑液中所含各种成分的比例，将使骨科界受益。对有适应症的患者进行关节抽吸是在翻修手术前特别推荐的。这些患者的吸出液将被用作拟议的实验集的基础。成分之间的比率可以被医生用作决定是否进行翻修手术的几种工具之一。也可能在某些情况下，部分基于颗粒物比例不推荐手术，在这种情况下，对患者和经济都有好处。临床意义在于，外科医生在手术前可以对假体进行准内部检查，从而提供假体哪些区域可能需要修复的一些信息。这不是在x光或其他视觉手段中可以轻易看到的信息。SGER奖支持研究使用一种称为生物铁谱的技术来分离全髋关节和膝关节置换术中形成的各种磨损颗粒的可行性。PI有一个独特的收集超过一百份记录良好的滑液抽吸样本，这些样本是在翻修手术前从全髋关节和膝关节置换术中获得的。主要的磨损颗粒是来自髋臼杯的超高分子量聚乙烯（UHMWPE），来自股骨头的金属颗粒，如不锈钢或钴铬钼，用于在骨/种植体界面固定假体的骨水泥颗粒，以及骨颗粒本身。这些粒子将被磁性标记分子所标记，这使得在生物铁谱中通过磁场对它们进行分类成为可能。确定合适的标记分子，根据材料和大小对颗粒进行分类，并将磨损颗粒的性质和数量与手术期间和术后对磨损关节的观察相关联，将是该研究的主要组成部分

0092944MeyerThe orthopedic community would benefit from knowing the ratio of the various constituents contained in the synovial fluid of patients with total hip and knee replacements before the onset of complications leading to revision surgery. Aspirating the joints of patients with indications is recommended most specifically prior to revision surgery. It is the aspirate from these patients that will be used as the basis for the proposed set of experiments. The ratios of the constituents to each other may be used by physicians as one of several tools in the decision whether to perform revision surgery. There may also be instances in which surgery will not be recommended based in part on the particulate ratios, in which case benefits to both the patient and the economy may be realized. The clinical relevance would be that the surgeon now has a quasi-inside look at the prosthesis before surgery, offering some information about what area(s) of the implant may require revision. This is not information that can be readily seen in x-rays or by other visual means. An SGER award supports research to examine the feasibility of using a technique called Bio-Ferrography to separate the various types of wear particles which form in total hip and knee replacements as they wear. The PI has access to a unique collection of over one hundred well-documented samples of synovial fluid aspirate which has been obtained from total hip and knee replacements prior to revision surgery. The primary wear particles are ultra high molecular weight polyethylene (UHMWPE) from the acetabular cup, metal particles such as stainless steel or cobalt-cromium-molybdenum from the femoral head, particles of bone cement used for fixation of the prostheses at the bone/implant interface, and bone particulate itself. The particles will be tagged with magnetic tagging molecules which make it possible to sort them by the magnetic field in the bio-ferrograph. Identification of suitable tagging molecules, sorting of the particles by material and size, and relating the nature and amount of wear particles to observations made of the worn joint during and after surgery will be the main components of the study.***