Analysis of bone remodeling of impacted morselized chipped bone and its biological background for restoration of failed total hip arthroplasty with osteolysis.

目的：分析同种异体热碎化芯片的骨重塑及假体周围骨与全髋关节假体间的细胞宿主反应，并进行病理、生物材料和临床分析。病理及物质特征分析。在松动全髋关节中，观察到疏松假体周围组织中MMPs （MMP-1、MMP-2、MMP-3、MMP-9、MMP-13和MMP-14）和TIMPs （TIMP 1、TIMP-2和TIMP-3）的失衡。这种反应可能与EMMPRIN、纤维连接蛋白、层粘连蛋白和PGP 9.5的病理性表达增加有关，这些表达被认为可以促进原位MMP的产生。关节液中MMPs （MMP-1、MMP-2、MMP-3和MMP-9）和TIMPs （TIMP-1和TIMP-2）水平升高。此外，随着局部宿主对植入物及其碎片的反应，发现溶骨细胞因子、il - 1 β、IL-6和M-CSF增加。在小鼠骨髓细胞中加入该液，证实其具有溶骨潜能，可诱导明显的破骨细胞形成，并可被骨保护素抑制。假体周围骨分析显示高周转率骨重塑与脆弱的骨质量。骨吸收过程依赖于破骨和非破骨机制。在非破骨机制中，酸性pH和巨噬细胞在这一过程中起主要作用。该研究还显示机械应力积极参与假体周围骨重塑。微动联合炎症介质似乎可以促进骨重塑过程。这种病理状况也被认为与用内嵌法加热碎化骨片移植后假体周围骨重塑有关。成骨细胞体外分析发现，机械拉伸刺激后可瞬间产生COX-2、MMP-1和MMP-3 mRNA。MMP-1及其激活剂MMP-3是机械应力下成骨细胞骨重塑的有力候选因子。骨重建的过程也受材料性质的影响。不锈钢、钴铬合金和钛合金是股骨植入物的主要材料。滑面采用超高密度聚乙烯、氧化铝/氧化锆陶瓷、不锈钢、钴铬合金等。聚甲基丙烯酸甲酯和多孔涂层技术已用于骨和植入物之间。为了更好地理解同种异体骨嵌塞法移植后假体周围骨的重建，建议今后对材料的性质及其在各界面的行为进行分析。热碎化异体骨片嵌塞术后的临床分析。临床评估假体周围骨重塑和种植体存活。热碎化异体骨芯片，直径2-3毫米，嵌套技术后显示良好的骨重塑和改良的THA植入物功能良好。在髋臼区，rein - force装置、Kerboull和KT钢板系统非常有效，它们支持受影响的骨，并将机械应力适当地转移到骨上，从而诱导该区域良好的骨重塑。在股骨侧重建中，牢固的内嵌和适当的股骨柄对准技术是获得较好组织再生的决定性因素。因此，在采用合适的支持系统后，热的碎化异体骨芯片显示出良好的生物相容性，有助于重建大面积骨溶解的松动全髋关节。少

To analyze bone remodeling of heated morselized allobone chips and cellular host reaction between periprosthetic bone and total hip prosthesis implant) pathologic, biomaterial, and clinical analysis were analyzed.1.Analysis of pathologic and material features.In loose total hip joints, imbalance of MMPs (MMP-1, MMP-2, MMP-3, MMP-9, MMP-13, and MMP-14) and TIMPs (TIMP 1, TIMP-2, and TIMP-3) in the tissue around loose implants was abserved. This reaction seemed to be related to pathologic increased expression of EMMPRIN, fibronectin, laminin, and PGP 9.5, which are suggested to enhance MMP production in-situ. In joint fluid retrieved from loose hip prosthesis, increased level of MMPs (MMP-1, MMP-2, MMP-3, and MMP-9)) and TIMPs (TIMP-1 and TIMP-2) was found. As well, osteolytic cytokine, IL-I beta, IL-6, and M-CSF were found to be increase as local host response to implant and their debris. Osteolytic potential was confirmed by addition of the fluid to mouse bone marrow cells, which induc … More ed marked osteoclast formation and it was inhibited by addition of osteoprotegerin. Periprosthetic bone analysis revealed that high turnover bone remodeling with fragile bone quality. Process of bone resorption was dependent both on osteoclatic and non-osteoclastic mechanism. In non-osteoclastic mechanism, acidic pH and macrophage played major role in the process. The study also showed active involvement of mechanical stress in periprosthetic bone remodeling. Micromotion combined with inflammatory mediators seemed to enhance bone remodeling process. This pathologic condition was also considered to relate to periprothetic bone remodeling after heated morselized bone chip grafting by impaction methods. In-vitro analysis of osteoblast, mechanical stretch can produce mRNA of COX-2、MMP-1、and MMP-3, transiently, after stimuli. MMP-1 and its activator MMP-3 were potent candidate of bone remodeling factors of osteoblast in mechanical stress. The process of bone remodeling was also affected by the property of materials. Stainless steel, cobalt-chromium alloy, and titanium alloy were major materials for femoral implants. Ultra-high density polyethylene, almina/zirconia ceramics, stainless steel, and cobalt-chromium alloy have been used as gliding surface. Polymethylmethacrylate and porus coating techniques have been used between bone and implants. The properties of the materials and its behaviors in each interface were suggested to be analyzed in future in point of better understanding of periprosthetic bone remodeling after morselized allo-bone grafting by impaction methods.2.Clinical analysis of the fate of heated morselized allo-bone chips after impaction technique. Clinical evaluation of periprosthetic bone remodeling and implant survival was performed. Heated morselized allo-bone chips, 2-3 mm, in diameter, after impaction technique showed favorable bone remodeling and revised THA implants functioned well. In acetabular area, rein force devidce, Kerboull and KT plate systems were so effective that they support the impacted bones and transfer, mechanical stress properly to the bone, which induced good bone remodeling in the area. In femoral side reconstruction, firm impactions and appropriate alignment technique of the stem were the decisive factor to obtain better tissue regeneration. Thus, heated morselized allo-bone chips after impaction technique revealed good biocompatibility and contribute to reconstruction of loose total hip joint with massive osteolysis, when proper support system were used in the procedure. Less