Biotribological Layers in Metal-on-Metal Hip Replacement

金属对金属髋关节置换术中的生物摩擦层

• 批准号: 7855130
• 负责人: Joshua J Jacobs
• 金额: $ 70.68万
• 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: 2009-09-30 至 2011-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7855130
• 关键词: Address; Alloys; Area; Arthroplasty; Behavior; Cells; Chromium; Clinical; Cobalt; Complication; Corrosion; Corrosives; Couples; Delayed Hypersensitivity; Devices; Diaphyses; Engineering; Environment; Evolution; Failure; Film; Generations; Goals; Guidelines; Head; Hip region structure; Implant; In Vitro; Joint Dislocation; Joint repair; Joints; Laboratories; Lead; Marketing; Mechanics; Metallurgy; Metals; Metaphysis; Molecular Weight; Operative Surgical Procedures; Osteolysis; Particulate; Patients; Performance; Polyethylenes; Process; Property; Proteins; Reaction; Reporting; Resistance; Retrieval; Risk; Role; Running; Sampling; Surface; Surgeon; Testing; Tissues; base; bone; bone loss; design; improved; metal oxide; multidisciplinary; novel; particle; reconstruction; response; simulation; soft tissue; survivorship

DESCRIPTION (provided by applicant): Metal-on-metal (MoM) bearings for hip replacement have surged in popularity over the last several years due to lower volumetric wear (compared to conventional metal-on-ultrahigh molecular weight polyethylene) and the ability to use large femoral heads, reducing the risk of dislocation, a common complication of hip replacement necessitating revision surgery. Large femoral heads also provide the surgeon with the option of resurfacing the femoral head without breaching the femoral metaphysis or diaphysis (hip resurfacing arthroplasty) thereby preserving femoral bone stock. However, a cause for concern with MoM joint reconstruction, has recently emerged with increasing reports of early adverse local tissue responses compromising the functionality and survivorship of these reconstructions. These adverse responses, which include periprosthetic bone loss (osteolysis), delayed-type hypersensitivity and soft tissue masses (so-called pseudotumors) are governed by the local cellular reaction to particulate and ionic wear and corrosion debris. There is growing evidence that the local cell response is related to the amount of debris generated by these bearing couples. Thus, there is an urgent clinical need to delineate the mechanisms of debris generation in order to minimize these adverse local tissue responses. Unfortunately, the tribology of this bearing couple is little understood. Our laboratory has made the novel observation that metal-on-metal bearings undergo microstructural changes and tribochemical reactions with the joint environment during articulation. This behavior causes changes in the metallurgy of the upper surface and brings about the generation of a mechanically mixed zone of nanocrystalline metal (oxide) and organic constituents. Such a zone - also called tribomaterial - favorably influences the tribological properties as well as the tribocorrosive behavior, as has been shown for related boundary lubricated applications in mechanical and automotive engineering. In the present proposal, we will address the central hypothesis that the combination of metal particles and denatured proteins form a biotribological layer in metal on metal bearings that has synergistic effects in reducing wear and corrosion. We have assembled a multidisciplinary investigative team that will address the following specific aims that will likely have a significant impact of the performance of MoM bearings in hip replacement: 1) to determine the role of the biotribological layer constituents in the evolution of the near-surface region of the metal using wear simulations for accelerated testing and compare these to device retrievals obtained from patients undergoing MoM hip or surface replacement; 2) to determine the relevant properties of the mechanically mixed zone of retrievals and in-vitro samples and demonstrate the effect of embedded organic constituents; and 3) to demonstrate that the presence of a mechanically mixed zone will beneficially effect the (tribo-)corrosion behavior of the cobalt-chromium alloy

描述（由申请人提供）：在过去几年中，用于髋关节置换术的金属对金属（MoM）关节面因体积磨损较低（与传统金属对金属分子量聚乙烯相比）和能够使用大股骨头，降低了脱位风险（髋关节置换术的常见并发症，需要进行翻修手术）而受到广泛欢迎。大股骨头还为外科医生提供了在不破坏股骨干骺端或骨干的情况下对股骨头进行表面置换的选择（髋关节表面置换术），从而保留股骨骨量。然而，MoM关节重建的一个令人担忧的原因是，最近出现了越来越多的早期不良局部组织反应的报告，这些不良局部组织反应损害了这些重建的功能和存活率。这些不良反应，包括假体周围骨丢失（骨质溶解）、迟发型超敏反应和软组织肿块（所谓的假瘤），由对颗粒和离子磨损和腐蚀碎屑的局部细胞反应控制。越来越多的证据表明，局部细胞反应与这些轴承对产生的碎片量有关。因此，迫切的临床需要描述碎片产生的机制，以最大限度地减少这些不良的局部组织反应。不幸的是，这种轴承对的摩擦学很少被理解。我们的实验室进行了一项新的观察，即金属对金属关节面在关节连接过程中会发生微观结构变化和与关节环境的摩擦化学反应。这种行为导致上表面冶金学的变化，并产生纳米晶体金属（氧化物）和有机成分的机械混合区。这种区域（也称为摩擦材料）有利地影响摩擦学特性以及摩擦腐蚀行为，如已经在机械和汽车工程中的相关边界润滑应用中所示。在本提案中，我们将讨论中心假设，即金属颗粒和变性蛋白质的组合在金属对金属关节面中形成生物摩擦层，在减少磨损和腐蚀方面具有协同效应。我们组建了一个多学科研究团队，将解决以下可能对髋关节置换术中MoM关节面性能产生重大影响的具体目标：1）确定生物摩擦层成分在近-使用磨损模拟进行加速试验，并将其与接受MoM髋关节置换术的患者的器械回收进行比较，表面置换; 2）确定回收物和体外样本的机械混合区的相关特性，并证明嵌入的有机成分的影响;以及3）证明机械混合区的存在将有益于影响钴铬合金的（摩擦）腐蚀行为