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

提案摘要和摘要 由于创伤受损，骨科器械通常被认为对糖尿病患者具有较高风险 可由减少的巨噬细胞、胶原酶和细胞增殖引起的愈合能力。仍不 很好地理解了哪些生物因素决定了周围骨愈合的有效性 糖尿病患者的骨科植入物。这可能会对成功和性能产生不利影响 由于植入物表面腐蚀、微动、脱位、感染或坏死， 周围组织，甚至是外科医生的错误。为了更好地确定未来的植入物如何成为 在糖尿病患者中更成功，我们想建立一个衰减量之间的相关性， 植入物表面和植入物所暴露的环境。本研究的总体目标是 了解从糖尿病患者体内取出的植入物的表面性质、形态特征和失效模式 患者 总之，将首先对收到用于分析的植入物进行光学显微镜检查，以识别 表面上存在的生物和金属产物的程度。这项技术还将使识别 具有有趣特征的区域进行进一步分析。然后植入物将根据视觉效果的程度进行排名， 生物和金属/磨损沉积。随后将对样本进行一系列清洁步骤 遵循我们小组开发的用于表面制备的先前方案。样本将再次成像 使用光学显微镜，将标记感兴趣的区域，并根据生物学和磨损程度进行分级 产品.然后用扫描电子显微镜对样本进行研究，然后用能量分析仪进行分析。 色散X射线光谱法和X射线光电子能谱法（XPS）用于化学分析 组成和氧化态的表面。在此之后，将对样本进行 电化学测试用于研究材料的腐蚀性能。免疫调节可能 是在受损的全身条件下改善骨愈合的重要机制。进一步 研究是必要的表面特性，可以调节炎症反应， 促进骨愈合。

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.