Understanding The Impact of Diabetes on Implant Performance: A Retrieval Study

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Proposal Summary and Abstract Orthopedic devices have often been considered a higher risk to diabetic patients due to impaired wound healing abilities that can be caused by reduced macrophages, collagenase, and cell proliferation. It is still not well understood exactly which biological factors determine how effective bone healing is surrounding orthopedic implants within diabetic conditions. This can have adverse effects on the success and performance of the implant due to corrosion of the surface, micro motion, dislocation, infection or necrosis of the surrounding tissues, or even surgeon error. In order to better determine how future implants can become more successful in diabetic patients we would like to establish a correlation between the amount of decay of the implant surface and the environment that the implant was exposed to. The overall goal of this study is to understand surface properties, morphological features and failure modes of implants removed from diabetic patients. In summary, the implants received for analysis will be first subjected to optical microscopy to identify the degree of biological and metallic products present on the surface. This technique will also enable identification of areas with interesting features for further analysis. Then the implants will be ranked for the degree of visual biological and metallic/wear deposition. Specimens will be subsequently subjected to a series of cleaning steps following previous protocols developed in our group for surface preparation. Specimens will be again imaged with optical microscopy, areas of interest will be marked and ranked for degree of biological and wear products. Then specimens will be investigated with Scanning Electron Microscopy, followed by Energy Dispersive X-ray Spectroscopy and X-ray Photoelectron Spectroscopy (XPS) for analysis of the chemical composition and oxidation state, respectively, of surfaces. Following this, specimens will be subjected to electrochemical testing for investigation of the corrosion properties of the materials. Immunomodulation may be an important mechanism to improve osseous healing under compromised systemic conditions. Further investigation is warranted of the surface characteristics that can modulate the inflammatory response to promote osseous healing.