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

在导致翻修手术的并发症发生之前，了解全髋关节和膝关节置换术患者的滑液中包含的各种成分的比率将使骨科团体受益。对于有适应症的患者，建议在翻修手术前抽吸关节。这些患者的吸出物将被用作拟议的一系列实验的基础。这些成分的比例可以被医生用作决定是否进行翻修手术的几个工具之一。也可能会有部分基于颗粒物比率而不建议手术的情况，在这种情况下，可能会实现对患者和经济的好处。临床上的意义是，外科医生现在可以在手术前对假体进行准内部观察，提供一些关于植入物的哪个区域(S)可能需要修改的信息。这不是很容易在X射线或其他视觉手段中看到的信息。SGER奖支持研究使用一种名为生物铁谱的技术来分离在全髋关节和膝关节置换中形成的各种磨损颗粒的可行性。PI可以获得一个独特的超过100个记录良好的关节液抽吸物样本，这些样本是从翻修手术前的全髋关节和膝关节置换手术中获得的。主要的磨损颗粒是来自髋臼杯的超高相对分子质量聚乙烯(UHMWPE)，来自股骨头的不锈钢或钴-铬-钼等金属颗粒，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。这些颗粒将被贴上磁性标记分子的标签，这使得有可能根据生物铁谱中的磁场对它们进行分类。识别合适的标记分子，按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中和手术后对磨损关节的观察联系起来，将是这项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.***