Systemic Implications of Total Joint Replacement

全关节置换术的系统影响

• 批准号: 7924430
• 负责人: Joshua J Jacobs
• 金额: $ 11.99万
• 依托单位: RUSH UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-18 至 2011-09-17
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7924430
• 关键词: Address; Alloys; Aluminum; Area; Autopsy; Binding; Biological Availability; Body Burden; Cell Culture Techniques; Chromium; Clinical; Cobalt; Complex; Controlled Study; Corrosion; Devices; Elements; Equipment and supply inventories; Excretory function; Grant; Hip region structure; Human body; Hypersensitivity; Implant; In Vitro; Individual; Investigation; Liver; Longitudinal Studies; Mediating; Metals; Molecular Weight; Nature; Operative Surgical Procedures; Organ; Paraaortic; Particulate; Patients; Performance; Physiological; Polyethylenes; Polymethyl Methacrylate; Postoperative Period; Prevalence; Process; Prosthesis; Proteins; Replacement Arthroplasty; Reticuloendothelial System; Retrieval; Serum; Serum Proteins; Source; Spleen; Surface; Tissues; Titanium; Total Hip Replacement; Toxic effect; Urine; Vanadium; adduct; base; implantation; in vivo; interest; knee replacement arthroplasty; lymph nodes; migration; programs; prospective; protein complex; response; sample fixation; stem; urinary

DESCRIPTION (provided by applicant): There is an increasing recognition that, in the long-term, total joint replacement (TJR) may be associated with adverse local and remote tissue responses that are mediated by the degradation products of prosthetic materials. There has been particular interest in the metallic degradation products of TJR because of the known toxicities of the metallic elements that comprise implant alloys. In this long-term study, metal release, transport, storage and excretion in patients with TJRs habs been investigated. In the current grant period, it has been demonstrated that (1) elevations in serum Ti, Co and Cr can be detected in individuals with well functioning total hip and knee replacements up to 84 months postoperative; (2) the highest Cr and Co levels have been observed in patients with metal-on-metal bearings; (3) passive dissolution from extensively porous coated Co-base alloy femoral stems is not a dominant mode of metal release; rather, fretting corrosion of femoral components at modular junctions is more closely associated with elevations in serum Cr; (4) in patients with TJR and elevated serum metal concentrations, two molecular weight ranges were found to bind Cr (at approximately 70 kD and approximately 180 kD) whereas a single molecular weight range (at approximately 70 kD) was found to bind Ti; (5) following revision surgery for a failed total hip replacement, circulating metal levels diminish, but remain chronically elevated up to 60 months post-revision; (6) Co- and Ti-alloy particulate degradation products, usually from sources other than the bearing surface, commonly disseminate to paraaortic lymph nodes, liver and spleen, particularly in individuals who have had a failed TJR; and (7) the bioreactivity of metal degradation products is governed by its' physiochemical nature and protein adducts: a Cr-containing 180 kD metal-protein complex was the most stimulatory in these studies. This proposal expands on these findings by addressing the following Specific Aims: (1) to quantify metal release in the prospective primary THR study groups which will be 10 to 15 years postoperative, an interval in which complications related to the implant are more prevalent; (2) to prospectively follow patients with Co-alloy metal-on-metal hip replacements to determine the prevalence of metal hypersensitivity in correlation with the serum and urine metal content; (3) to expand the autopsy retrieval program to characterize not: only the systemic distribution of particulate wear debris but also the tissue metal levels and the cellular localization; and (4) to conduct bioavailability and bioreactivity studies of circulating metal-protein complexes which result from corrosion and wear of joint replacement components.

描述（由申请人提供）：越来越多的人认识到，从长期来看，全关节置换术（TJR）可能与由假体材料降解产物介导的局部和远程组织不良反应有关。由于已知含有植入合金的金属元素的毒性，人们对TJR的金属降解产物特别感兴趣。在这项长期研究中，研究了金属在TJRs患者体内的释放、运输、储存和排泄。在目前的资助期内，已经证明(1)在全髋关节和膝关节置换术后84个月功能良好的个体中可以检测到血清Ti， Co和Cr的升高；(2)铬、钴含量在金属对金属轴承患者中最高；(3)广泛多孔涂层co基合金股骨干的被动溶解不是金属释放的主要方式；相反，模块连接处股骨部件的微动腐蚀与血清Cr升高密切相关；(4)在TJR和血清金属浓度升高的患者中，发现两个分子量范围的铬结合（约70 kD和约180 kD），而发现单分子量范围的钛结合（约70 kD）；(5)全髋关节置换术失败翻修手术后，循环金属水平降低，但在翻修后60个月仍长期升高；(6) Co-和ti -合金颗粒降解产物，通常来自轴承表面以外的来源，通常扩散到主动脉旁淋巴结、肝脏和脾脏，特别是在TJR失败的个体中；(7)金属降解产物的生物反应性受其物理化学性质和蛋白质加合物的支配：在这些研究中，含cr的180kd金属-蛋白质复合物是最具刺激性的。本研究通过解决以下具体目标来扩展这些研究结果：(1)量化术后10至15年THR原发性研究群体中的金属释放，这段时间内与植入物相关的并发症更为普遍；(2)对钴合金金属对金属髋关节置换术患者进行前瞻性随访，以确定金属过敏的患病率与血清和尿液金属含量的相关性；(3)扩大尸检检索程序，不仅表征颗粒磨损碎片的系统分布，而且表征组织金属水平和细胞定位；(4)对关节置换部件腐蚀磨损产生的循环金属-蛋白配合物进行生物利用度和生物反应性研究。

项目成果

Coventry Award paper. Backsurface wear and deformation in polyethylene tibial inserts retrieved postmortem.

考文垂奖论文。

• DOI: 10.1097/00003086-200211000-00004
• 发表时间: 2002
• 期刊: Clinical orthopaedics and related research
• 影响因子: 4.2
• 作者: Surace,MicheleF;Berzins,Aivars;Urban,RobertM;Jacobs,JoshuaJ;Berger,RichardA;Natarajan,RaghuN;Andriacchi,ThomasP;Galante,JorgeO
• 通讯作者: Galante,JorgeO

In vivo severe corrosion and hydrogen embrittlement of retrieved modular body titanium alloy hip-implants.

• DOI: 10.1002/jbm.b.31171
• 发表时间: 2009-01
• 期刊: JOURNAL OF BIOMEDICAL MATERIALS RESEARCH PART B-APPLIED BIOMATERIALS
• 影响因子: 3.4
• 作者: Rodrigues, Danieli C.;Urban, Robert M.;Jacobs, Joshua J.;Gilbert, Jeremy L.
• 通讯作者: Gilbert, Jeremy L.

Metal on Metal Bearings: A Practical Alternative to Metal on Polyethylene Total Joints?

金属对金属轴承：金属对聚乙烯全接头的实用替代方案？

• DOI: 10.1097/00003086-199608001-00021
• 发表时间: 1996
• 期刊: Clinical Orthopaedics and Related Research
• 影响因子: 4.2
• 作者: J. Black

Asymptomatic prospective and retrospective cohorts with metal-on-metal hip arthroplasty indicate acquired lymphocyte reactivity varies with metal ion levels on a group basis.

• DOI: 10.1002/jor.22214
• 发表时间: 2013-02
• 期刊: JOURNAL OF ORTHOPAEDIC RESEARCH
• 影响因子: 2.8
• 作者: Hallab, Nadim J.;Caicedo, Marco;McAllister, Kyron;Skipor, Anastasia;Amstutz, Harlan;Jacobs, Joshua J.
• 通讯作者: Jacobs, Joshua J.

Local and distant products from modularity.

来自模块化的本地和远程产品。

• 发表时间: 1995
• 期刊: Clinical orthopaedics and related research.
• 作者: Jacobs,JJ;Urban,RM;Gilbert,JL;Skipor,AK;Black,J;Jasty,M;Galante,JO
• 通讯作者: Galante,JO