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

为分析热颗粒化异体骨片的骨重建及假体周围骨与人工全髋关节假体之间的细胞宿主反应，对人工全髋关节假体植入物的病理、生物材料和临床资料进行分析：1.病理和材料特征分析观察松动种植体周围组织中MMP-1、MMP-2、MMP-3、MMP-9、MMP-13和MMP-14以及TIMP-1、TIMP-2和TIMP-3的表达。这种反应似乎与EMMPRIN、纤连蛋白、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原位增强MMP的产生。从松动的髋关节假体中回收的关节液中发现MMPs（MMP-1、MMP-2、MMP-3和MMP-9）和TIMPs（TIMP-1和TIMP-2）的水平升高，同时发现溶骨细胞因子、IL-1 β、IL-6和M-CSF的水平升高，这是由于局部宿主对植入物及其碎片的反应。通过将该液体加入小鼠骨髓细胞中，诱导成骨细胞增殖， ...更多信息 艾德能显著促进破骨细胞的形成，并能被骨保护素所抑制。假体周围骨分析显示高转换骨重建伴骨质脆弱。骨吸收过程依赖于破骨和非破骨机制。在非骨破坏机制中，酸性pH和巨噬细胞在此过程中起主要作用。该研究还表明，机械应力在假体周围骨重建中起着积极作用。微动结合炎症介质似乎促进骨重建过程。这种病理状态也被认为与通过撞击方法进行加热颗粒骨片移植后的假体周围骨重建有关。成骨细胞体外分析显示，机械牵张刺激后，考克斯-2、MMP-1和MMP-3的mRNA表达均为一过性。MMP-1及其激活剂MMP-3是成骨细胞在机械应力作用下骨重建因子的潜在候选者。骨重建的过程也受到材料性质的影响。不锈钢、钴铬合金和钛合金是股骨植入物的主要材料。超高密度聚乙烯、氧化铝/氧化锆陶瓷、不锈钢和钴铬合金已被用作滑动表面。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。为更好地了解颗粒状同种异体骨植入后假体周围骨改建的情况，建议今后对材料的性能及其在各个界面的行为进行分析。2.颗粒状同种异体骨碎片在植入后的转归临床分析。对假体周围骨重建和种植体存活进行临床评价。在撞击技术后，直径为2-3 mm的加热颗粒状同种异体骨碎片显示出良好的骨重建，翻修后的THA植入物功能良好。在髋臼区，Reinforcedevice、Kerboull和KT钢板系统有效地支撑了受影响的骨，并将机械应力适当地传递到骨，从而诱导了该区域良好的骨重建。在股骨侧重建中，牢固的打入和适当的股骨柄对线技术是获得更好组织再生的决定性因素。因此，加热颗粒化异体骨片在撞击技术后显示出良好的生物相容性，并有助于重建松动的全髋关节与大量的骨溶解，当在该过程中使用适当的支持系统。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