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Loosening
Kinds of Loosening Selected AbstractsEffect of Casting Procedures on Screw Loosening in UCLA-Type AbutmentsJOURNAL OF PROSTHODONTICS, Issue 2 2006Stefania C. Kano DDS Background: Screw loosening of implant restorations continues to be a complication in implant prosthodontics. Screw joints are subjected to a loss of initially applied torque because of friction and component misfit. It has been suggested that the loss of applied torque is less in machined metal abutments than in cast plastic abutments. Purpose: This study compared the loss of applied torque (detorque) values in machined titanium and in cast UCLA-type abutments for external hex abutment/implant interface. Materials and Methods: Four groups of 12 samples each were evaluated: (1) machined titanium abutments, (2) premachined palladium abutments cast with palladium, (3) plastic abutments cast with nickel-chromium, and (4) plastic abutments cast with cobalt-chromium. Each abutment was torqued to 30 Ncm according to the manufacturer's instructions and detorqued three times. The mean loss of applied torque (detorque) was recorded as a percentage of the torque applied. Group means were calculated and compared using ANOVA and Tukey's LSD test. Results: Mean detorque values were (1) 92.3 ± 2.9%, (2) 81.6 ± 5.0%, (3) 86.4 ± 4.6%, and (4) 84.0 ± 7.0%. Machined abutments demonstrated significantly greater detorque values compared with all cast groups (p < 0.05). No significant differences were found among cast groups. Conclusion: Machined abutments retained a significantly greater percentage of torque compared with cast abutments. Casting procedures decrease the percentage of applied torque, which may influence final screw joint stability. [source] Assessment of Five Interleukins in Human Synovial Fluid as Possible Markers for Aseptic Loosening of Hip ArthroplastyARTIFICIAL ORGANS, Issue 7 2009Alina Beraudi Abstract One of the most important factors that seems to be involved in total hip replacement is periprosthetic osteolysis. As it is well documented that several interleukins (ILs) are triggered in periprosthetic osteolysis, this article investigates the role of five ILs in primary and replacement total hip arthroplasty, understanding if one of them can also predict hip implant loosening, secondary surgery, and prosthesis breakage. The levels of IL-1,, 1,, 6, 8, and 10 in synovial fluid were examined, using a high sensitivity enzyme-linked immunosorbent assay (ELISA) test kit (Pierce Biotechnology, Inc., Rockford, IL, USA) to determine whether these cytokines could be used as markers of enhanced periprosthetic osteolysis, leading to aseptic loosening of total/partial hip arthroplasty or revision surgery. Synovial fluid was harvested from 23 patients undergoing primary total hip arthroplasty and 35 patients undergoing total/partial hip revision due to aseptic loosening. In the revision group, four cases had suffered a prosthesis fracture and five were second revisions. ILs 6 and 8 were significantly higher in the revisions (305 and 817 pg/mL) compared with the primary arthroplasties (151 and 151 pg/mL), including cases with prosthesis fracture and those requiring a second revision. IL-10 levels were lower (not significantly) in second revision samples compared with those of revision samples. IL-1, levels were significantly higher in prosthesis fracture samples compared with those of all the other revision samples. No statistically significant differences in IL levels were found between osteoarthritis samples and those of other diseases. These results are a step forward to elucidating the complex network of events that are involved in loosening of hip implants. [source] A Prospective Clinical Study on Titanium Implants in the Zygomatic Arch for Prosthetic Rehabilitation of the Atrophic Edentulous Maxilla with a Follow-Up of 6 Months to 5 YearsCLINICAL IMPLANT DENTISTRY AND RELATED RESEARCH, Issue 3 2006Carlos Aparicio DDS ABSTRACT Background, Prosthetic rehabilitation with implant-supported prostheses in the atrophic edentulous maxilla often requires a bone augmentation procedure to enable implant placement and integration. However, a rigid anchorage can also be achieved by using so-called zygomatic implants placed in the zygomatic arch in combination with regular implants placed in residual bone. Purpose, The aim of the present study was to report on the clinical outcome of using zygomatic and regular implants for prosthetic rehabilitation of the severely atrophic edentulous maxilla. Materials and Methods, Sixty-nine consecutive patients with severe maxillary atrophy were, during a 5-year period, treated with a total of 69 fixed full-arch prostheses anchored on 435 implants. Of these, 131 were zygomatic implants and 304 were regular implants. Fifty-seven bridges were screw-retained and 12 were cemented. The screw-retained bridges were removed at the examination appointments and each implant was tested for mobility. In addition, the zygomatic implants were subjected to Periotest® (Siemens AG, Bensheim, Germany) measurements. The patients had at the time of this report been followed for at least 6 months up to 5 years in loading. Results, Two regular implants failed during the study period giving a cumulative survival rate of 99.0%. None of the zygomatic implants was removed. All patients received and maintained a fixed full-arch bridge during the study. Periotest measurements of zygomatic implants showed a decreased Periotest values value with time, indictating an increased stability. Three patients presented with sinusitis 14,27 months postoperatively, which could be resolved with antibiotics. Loosening of the zygomatic implant gold screws was recorded in nine patients. Fracture of one gold screw as well as the prosthesis occurred twice in one patient. Fracture of anterior prosthetic teeth was experienced in four patients. Conclusions, The results from the present study show that the use of zygomatic and regular implants represents a predictable alternative to bone grafting in the rehabilitation of the atrophic edentulous maxilla. [source] An order-based algorithm for implementing multiparty synchronizationCONCURRENCY AND COMPUTATION: PRACTICE & EXPERIENCE, Issue 12 2004José A. Pérez Abstract Multiparty interactions are a powerful mechanism for coordinating several entities that need to cooperate in order to achieve a common goal. In this paper, we present an algorithm for implementing them that improves on previous results in that it does not require the whole set of entities or interactions to be known at compile- or run-time, and it can deal with both terminating and non-terminating systems. We also present a comprehensive simulation analysis that shows how sensitive to changes our algorithm is, and compare the results with well-known proposals by other authors. This study proves that our algorithm still performs comparably to other proposals in which the set of entities and interactions is known beforehand, but outperforms them in some situations that are clearly identified. In addition, these results prove that our algorithm can be combined with a technique called synchrony loosening without having an effect on efficiency. Copyright © 2004 John Wiley & Sons, Ltd. [source] Proximal femoral resection for subluxation or dislocation of the hip in spastic quadriplegiaDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 7 2003Steve Ackerly MD Management of a painful or contracted hip dislocation in individuals with severe spastic quadriplegia is difficult. Clinical and radiographic results of 12 proximal femoral resection-interposition operations performed in seven non-ambulatory persons (five males, two females; mean age 14 years, 8 months; age range 6 years 11 months to 19 years 8 months) with severe spasticity were reviewed to determine if pain relief and restoration of motion were maintained. At a mean follow-up of 7 years 7 months (median 9 years 6 months) all participants maintained a good sitting position and a functional range of motion with improved hygiene. Hip pain was improved in all participants compared with their preoperative status. Proximal femur migration occurred causing slight pain in one person. Heterotopic ossification was observed but was not clinically significant. Complications included traction pin loosening and infection and a late supracondylar femur fracture 3 months after the operation. Proximal femoral resection effectively decreased pain and restored hip motion in those with severe spastic quadriplegia leading to improved sitting and perineal care. [source] Pharmacologic profile of zoledronic acid: A highly potent inhibitor of bone resorptionDRUG DEVELOPMENT RESEARCH, Issue 4 2002Jonathan R. Green Abstract Bisphosphonates are effective in treating benign and malignant skeletal diseases characterized by enhanced osteoclastic bone resorption (i.e., osteoporosis, Paget's disease, tumor-induced osteolysis). The nitrogen-containing bisphosphonate pamidronate is currently the standard treatment for hypercalcemia of malignancy (HCM) and skeletal complications of bone metastases. Zoledronic acid, a novel nitrogen-containing bisphosphonate with an imidazole substituent, has demonstrated more potent inhibition of osteoclast-mediated bone resorption than all other bisphosphonates, including pamidronate, in both in vitro and in vivo preclinical models. Zoledronic acid inhibited ovariectomy-induced bone loss in adult monkeys and rats, and long-term treatment prevented skeletal turnover and subsequent bone loss, reduced cortical porosity, and increased mechanical strength. Zoledronic acid also significantly inhibited bone loss associated with arthritis, bone metastases, and prosthesis loosening. The increased potency of zoledronic acid vs. pamidronate has been demonstrated clinically: zoledronic acid (4 or 8 mg iv) was superior to pamidronate (90 mg iv) in normalizing corrected serum calcium in patients with HCM. In patients with bone metastases, low doses of zoledronic acid (, 2 mg) suppressed bone resorption markers , 50% below baseline, whereas pamidronate 90 mg yielded only 20 to 30% suppression. Importantly, the increased potency of zoledronic acid is not associated with an increased incidence of local (bone) or systemic adverse events. Zoledronic acid does not impair bone mineralization and, compared with pamidronate, has a greater renal and intestinal tolerability therapeutic index. Thus, based on preclinical assays and clinical data, zoledronic acid is the most potent bisphosphonate tested to date. Given its potency and excellent safety profile, zoledronic acid is now poised to become the new standard of treatment for HCM and metastatic bone disease. Drug Dev. Res. 55:210,224, 2002. © 2002 Wiley-Liss, Inc. [source] The influence of strenuous exercise on collagen characteristics of articular cartilage in Thoroughbreds age 2 yearsEQUINE VETERINARY JOURNAL, Issue 6 2000P. A. J. BRAMA Summary In order to assess the influence of strenuous exercise on collagen characteristics of articularcartilage, the response of the collagen network was studied in seven 2-year-old Thoroughbreds subjected to strenuous exercise compared to 7 nontrained individuals. After 13 weeks, the animals were subjected to euthanasia, fetlock joints of the forelimbs were scored macroscopically after Indian Ink staining, and articular cartilage from different locations of the articular surface of the proximal first phalanx was sampled and analysed for water content, collagen content, hydroxylysine content and amount of hydroxylysylpyridinoline (HP) crosslinks. Gross lesions were significantly more severe in the exercised than in the nonexercised group. In the control animals, the characteristic site-specific differences in collagen parameters were found as described earlier, but in the strenuously exercised animals this physiological biochemical heterogeneity had disappeared. In the exercised animals, an increase in water content and a sharp decrease in HP crosslinking was found that was correlated with the presence of wear lines. It is concluded that the strenuous exercise provoked significant alterations in the characteristics of the collagen network of the articular cartilage of the fetlock joint which were suggestive of microdamage and loosening of the collagen network. The collagen component of cartilage, in contrast to the proteoglycan component, is known to have a very limited capacity for repairand remodelling due to an extremely low turnover rate. Therefore, alterations within the articular collagen network might be expected to play an important role in the pathophysiology of degenerative joint disorders. [source] Psychotherapy as a Rite of PassageFAMILY PROCESS, Issue 4 2007C. CHRISTIAN BEELS M.D. Some psychotherapies may work because they resemble rites of passage. To explore this idea, this article describes an "individual" case of depression in which drug, cognitive, and narrative approaches fell short of effectiveness, and change occurred in a series of experiences that resemble a rite of passage. This resemblance is illuminated by examining two apparently quite different healing processes,Alcoholics Anonymous and multifamily group therapy in schizophrenia,to explore the elements they have in common with the case described: the acceptance of what Victor Turner called a liminal experience, and the importance of witnesses to the ritual support for that acceptance. The discussion contributes to a loosening of the distinctions between the processes of individual, family, group, and other social therapies and leads to questions about the expert knowledge the therapist provides. [source] Physico-chemical properties of molten dimer ascorbate oxidaseFEBS JOURNAL, Issue 22 2006Eleonora Nicolai The possible presence of dimeric unfolding intermediates might offer a clue to understanding the relationship between tertiary and quaternary structure formation in dimers. Ascorbate oxidase is a large dimeric enzyme that displays such an intermediate along its unfolding pathway. In this study the combined effect of high pressure and denaturing agents gave new insight on this intermediate and on the mechanism of its formation. The transition from native dimer to the dimeric intermediate is characterized by the release of copper ions forming the tri-nuclear copper center located at the interface between domain 2 and 3 of each subunit. This transition, which is pH-dependent, is accompanied by a decrease in volume, probably associated to electrostriction due to the loosening of intra-subunit electrostatic interactions. The dimeric species is present even at 3 × 108 Pa, providing evidence that mechanically or chemically induced unfolding lead to a similar intermediate state. Instead, dissociation occurs with an extremely large and negative volume change (,V , ,200 mL·mol,1) by pressurization in the presence of moderate amounts of denaturant. This volume change can be ascribed to the elimination of voids at the subunit interface. Furthermore, the combination of guanidine and high pressure uncovers the presence of a marginally stable (,G , 2 kcal·mol,1) monomeric species (which was not observed in previous equilibrium unfolding measurements) that might be populated in the early folding steps of ascorbate oxidase. These findings provide new aspects of the protein folding pathway, further supporting the important role of quaternary interactions in the folding strategy of large dimeric enzymes. [source] The uses and abuses of time: globalization and time arbitrage in India's outsourcing industriesGLOBAL NETWORKS, Issue 1 2009SHEHZAD NADEEM Abstract Globalization has undoubtedly altered our conceptions and experience of time. It has sped up the pace of life and some scholars even suggest that a new temporal order is supplanting ,natural' and pre-existing cycles and rhythms. Yet time is not dissolved in the global circuits of capital. Rather, globalization has brought about a complex mixture of temporal orientations; the workplaces of ,new economy', for example, are traversed by novel and retrograde modes of work pace, rhythm and time-discipline. In this article, I explore the temporal implications of the outsourcing of information technology-based service work to India. Drawing on fieldwork and interviews with workers, managers and executives in the Indian IT and Business Processing Outsourcing industries, I address the following questions: (1) How are corporations using time arbitrage to reap the full benefits of a globally dispersed labour pool? (2) What impacts are these temporal changes having on the health and social lives of Indian workers? For corporations, time arbitrage means increased efficiency and cost-savings. But for workers, it results in long hours, an intense work pace, and temporal displacement. Night-shift employees, such as call centre workers, are particularly vulnerable to such displacement, as manifested in health and safety problems and social alienation. Globalization therefore does not entail the loosening of temporal chains, but their reconfiguration: a combination both rigid and flexible that binds even as it liberates. [source] Geographies of Housing Finance: The Mortgage Market in Milan, ItalyGROWTH AND CHANGE, Issue 2 2007MANUEL B. AALBERS ABSTRACT The geography of financial exclusion has mainly focused on exclusion from retail banking. Alternatively, and following the work of David Harvey, this paper presents a geography of access to and exclusion from home mortgage finance. The case of Milan shows that capital switching to the built environment is partly a sign of economic crisis and partly a sign of the intrinsic opportunities that the built environment provides. A major factor in both is the deregulation of the mortgage market that has enabled the loosening of historically stringent lending criteria, leading to a tremendous growth of the mortgage market, while leaving the co-evolution of family and home ownership intact. In addition, capital switches within sectors of the economy and between places. In Milan, once "unattractive" but currently gentrified nineteenth-century districts underwent cycles of devalorisation and revalorisation. Even though access to mortgages has increased throughout Milan, geographical disparities in mortgage lending persist: at present, yellowlining (differential access, based on less favourable terms) is common in parts of the Milanese periphery. The creation of boundaries makes the realisation of class-monopoly rent possible; while the subsequent redrawing of these boundaries creates new submarkets in which surplus value can be extracted. Based on the Milan case, one cannot explain the timing and geography of formation and reformation of submarkets in other cities, but it helps us to see how Harvey's abstract ideas of class-monopoly rent, submarket creation, and capital switching take place in the real world. [source] Modeling UHMWPE wear debris generationJOURNAL OF BIOMEDICAL MATERIALS RESEARCH, Issue 2 2007H. Baudriller Abstract It is widely recognized that polyethylene wear debris is one of the main causes of long-term prosthesis loosening. The noxious bioreactivity associated with this debris is determined by its size, shape, and quantity. The aim of this study was to develop a numerical tool that can be used to investigate the primary polyethylene wear mechanisms involved. This model illustrates the formation of varying flow of polyethylene debris with various shapes and sizes caused by elementary mechanical processes. Instead of using the classical continuum mechanics formulation for this purpose, we used a divided materials approach to simulate debris production and release. This approach involves complex nonlinear bulk behaviors, frictional adhesive contact, and characterizes material damage as a loss of adhesion. All the associated models were validated with various benchmark tests. The examples given show the ability of the numerical model to generate debris of various shapes and sizes such as those observed in implant retrieval studies. Most of wear mechanisms such as abrasion, adhesion, and the shearing off of micro-asperities can be described using this approach. Furthermore, it could be applied to study the effects of friction couples, macroscopic geometries, and material processing (e.g. irradiation) on wear. © 2006 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2007 [source] An experimental analogue to model the fibrous tissue layer in cemented hip replacementsJOURNAL OF BIOMEDICAL MATERIALS RESEARCH, Issue 2 2004Victor Waide Abstract Fibrous tissue at the bone,cement interface of cemented joint replacements has been reported frequently in cases of revisions made necessary by aseptic loosening. This work describes the development of in vitro specimens suitable for biomechanical modeling of cemented femoral hip replacements with a fibrous tissue layer at the bone,cement interface. In particular, a series of uniaxial compression tests were performed on silicone elastomer specimens to identify a suitable analogue with similar mechanical characteristics to those reported for the fibrous tissue layer. A method was developed to apply the silicone elastomer at the bone,cement interface. This was examined for two types of cemented hip replacements implanted in composite femurs. The selected thickness of the elastomer layers was in the range of those found in clinical cases of aseptic loosening. Specimens produced by these methods could be used in preclinical biomechanical tests (such as stability or stress shielding tests) to assess the effects of a soft-tissue layer, to model in vitro a long-term-implant scenario, and to provide validation for similar finite element studies. © 2004 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 69B: 232,240, 2004 [source] Analysis of a retrieved Isola spinal system fractured in serviceJOURNAL OF BIOMEDICAL MATERIALS RESEARCH, Issue 1 2003E. A. Magnissalis Abstract A 1/4-in.diameter two-column Isola spinal system implanted in a 13-year-old girl suffering from cerebral palsy and a severe neuromuscular scoliosis of 120°, was replaced 22 months after primary implantation. The system was removed due to fracture of the lower left (concave) bar, between its two cross connectors (i.e., the distal bypass connector and a transverse cross link), as a result of a postoperative infection and a subsequently developed pseudarthrosis. The retrieved implants were analyzed with the use of a multitechnique characterization procedure involving macroscopic and microscopic examination, micro-multiple internal reflectance FTIR spectroscopy, X-ray fluorescence (XRF) spectrometry, roughness measurement, and mechanical testing of the constituent material and components. Findings suggest that the spinal system failed due to in vivo loosening of a two-set screw tandem connector and subsequent overloading of the contralateral bar. © 2002 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 64B: 6,12, 2003 [source] Variation in the TNF Gene Promoter and Risk of Osteolysis After Total Hip ArthroplastyJOURNAL OF BONE AND MINERAL RESEARCH, Issue 11 2003FRCS, J Mark Wilkinson PhD Abstract Genetic factors may influence implant failure caused by osteolysis after THA. In an association study of 481 subjects after THA, we found that carriage of the TNF - 238A allele was associated with an increased incidence of osteolysis versus noncarriage (odds ratio, 1.7) and was independent of other risk factors. Genetic and environmental factors influence implant survival after THA. Introduction: Tumor necrosis factor (TNF) is thought to play a role in osteolysis, the major cause of implant failure after total hip arthroplasty (THA). Natural sequence variations at ,238 and ,308 in the TNF gene promoter are associated with differences in susceptibility to several TNF-mediated diseases. We tested whether these polymorphisms are associated with osteolysis after THA. Materials and Methods: A total of 481 whites (214 with failed versus 267 with intact implants) were recruited 11.7 ± 4 years after cemented THA. Genomic DNA was extracted from peripheral blood and genotyped for the ,238 and ,308 polymorphisms using the Taqman 5, nuclease method. Healthy controls (n = 500) from the background population were also genotyped to establish the local prevalence of these alleles. Results: The carriage of ,238A was 8.8% in the background population and 10.9% in the THA controls (p > 0.05). Carriage of ,238A in the osteolysis group was 17.3% (odds ratio, 1.7; 95% CI, 1.0,2.9). Carriage was highest (20.5%) in patients with more widespread osteolysis (OR, 2.1; 1.2,3.8). The association of ,238A with osteolysis was independent of other risk factors for osteolysis (logistic regression analysis: OR, 1.8; 1.0,3.2). Carriage of ,308A was not associated with osteolysis. Conclusion: Genetic, as well as environmental factors, influence implant failure after THA. Whether the TNF - 238 polymorphism causes a biological change that predisposes to loosening or is in linkage disequilibrium with such a locus is not yet known. [source] High-Turnover Periprosthetic Bone Remodeling and Immature Bone Formation Around Loose Cemented Total Hip JointsJOURNAL OF BONE AND MINERAL RESEARCH, Issue 1 2001Michiaki Takagi Abstract Aseptic loosening and periprosthetic osteolysis are the major problems awaiting solution in total hip surgery. The clinical investigation focused on the analysis of periprosthetic bone remodeling to clarify one important key event in the cascade of periprosthetic connective tissue weakening and osteolysis around loose artificial hip joints. Twelve acetabular bone samples adjacent to granulomatous synovial-like membrane of loose hip prosthesis were retrieved at revision surgery and processed for Villanueva bone staining for morphological observation and bone histomorphometric analysis. Eight well-fixed bony samples were used as control. Although osteoclastic surface and eroded surface by osteoclasts were evident in the periprosthetic bone from loose hip joints (p = 0.003 and p = 0.027), increased osteoid/low-mineralized bone matrix (p < 0.001) and osteoid width (p < 0.001) also were significant findings in structural analysis. In addition, not only elevated mineral apposition rate (MAR; p = 0.044) but also increased mineralizing surface (p = 0.044) and bone formation rate (BFR; p = 0.002) in loose periprosthetic bones were shown in dynamic data analysis. These results were confirmed by precise morphological observation by confocal laser scanning microscopy. Active coupling of bone formation and resorption and increased osteocytes with abundant bone canalicular projections were found in combined with the presence of immature bone matrices (osteoid and low-mineralized bone areas) in periprosthetic bones from loose hip joints. These results indicated that active osteoclastic bone resorption and/or defective bone formation are coupled with monocyte/macrophage-mediated foreign body-type granuloma in the synovial-like interface membrane of loose hip joints. Thus, this unique high-turnover periprosthetic bone remodeling with bad bone quality probably is caused by the result of cellular host response combined with inappropriate cyclic mechanical loading. The fragile periprosthetic bone may contribute to hip prosthesis loosening. [source] Stimulation of macrophage TNF, production by orthopaedic wear particles requires activation of the ERK1/2/Egr-1 and NF-,B pathways but is independent of p38 and JNKJOURNAL OF CELLULAR PHYSIOLOGY, Issue 3 2008Michelle A. Beidelschies Bone loss that causes aseptic loosening of orthopedic implants is initiated by pro-inflammatory cytokines produced by macrophages in response to implant-derived wear particles. MAPK and NF-,B signaling pathways are activated by the particles; however, it is not clear which of the signaling pathways are important for the initial response to the wear particles and which are only involved at later steps in the process, such as osteoclast differentiation. Here, we show that the ERK1/2, p38, JNK, and NF-,B pathways are rapidly activated by the wear particles but that only the ERK1/2 and NF-,B pathways are required for the initial response to the wear particles, which include increases in TNF, promoter activity, TNF, mRNA expression, and secretion of TNF, protein. Moreover, ERK1/2 activation by wear particles is also required for increased expression of the transcription factor Egr-1 as well as Egr-1's ability to bind to and activate the TNF, promoter. These results, together with our previous studies of the PI3K/Akt pathway, demonstrate that wear particles coordinately activate multiple signaling pathways and multiple transcription factors to stimulate production of pro-inflammatory cytokines, such as TNF,. The current study also demonstrates that the signaling pathways are activated to a much greater extent by wear particles with adherent endotoxin than by "endotoxin-free" wear particles. These results, together with those demonstrating the requirement for ERK1/2/Egr-1 and NF-,B, show that activation of these signaling pathways is responsible for the ability of adherent endotoxin to potentiate cytokine production, osteoclast differentiation, and bone loss induced by wear particles. J. Cell. Physiol. 217: 652,666, 2008. © 2008 Wiley-Liss, Inc. [source] A biomechanical effect of wide implant placement and offset placement of three implants in the posterior partially edentulous regionJOURNAL OF ORAL REHABILITATION, Issue 1 2000Y. Sato To prevent loosening or fracture of screws retaining the prosthesis to the implants in the posterior partially edentulous region, the use of staggered buccal and lingual offset placement or wide implants is suggested. However, it is not known how this usage compensates for the torque produced by lateral occlusal forces. This study evaluated the effectiveness of offset placement of three implants and a wide implant placement at the most posterior site. Three-dimensional geometric analysis was used to calculate the tensile force applied to gold screws in clinical situations with buccal or lingual loading perpendicular to cuspal inclination (10 or 20°). Four variations of the placement of three implants (, 3·75 mm) are: (1) straight; (2) buccal offset of the second implant; (3) lingual offset of the second implant; (4) a wide implant (, 5 mm) placement at most posterior site. The offset placement did not always decrease tensile force at the gold screw, but wide implant placement and decrease in cuspal inclination did. [source] Hypoxia-like effect of Cobalt Chromium alloy micro particles on fibroblasts in vitroJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 10 2010Bernadette K. Madathil Abstract Periprosthetic osteolysis leading to asceptic loosening remains the primary cause of failure of joint replacement. Although many inflammatory cell types have been implicated, the exact pathomechanisms of asceptic loosening have not been delineated. In the present study we have adopted a proteomic approach to elucidate the initial signals that are expressed to particulate material, using an in vitro cell culture system. Human lung fibroblasts MRC-5 were cultured with Cobalt Chromium (CoCr ASTM F-75, 1,7,µm) particles. Cells were harvested after 72,h incubation and total cellular proteins extracted for downstream analysis via 2D Gel Electrophoresis and tandem mass spectrometry using MALDI-TOF-TOF-MS. Thirteen protein spots showed greater than twofold increase, following 72,h incubation of fibroblast with CoCr particles. Four of these proteins were identified by tandem mass spectrometry. These were Annexin II, Pyruvate kinase, Triose phosphate isomerase, and N-myc downstream regulated gene 1 protein. Cobalt is a hypoxia mimicking agent and N-myc downstream regulated gene 1 protein, Triose phosphate isomerase, Pyruvate kinase, and Annexin II are important hypoxia regulated gene products that are found to be over expressed in cellular oxidative stress response. Our data indicates that exposure of fibroblast to CoCr alloy induces the transition of these cells into a hypoxia like state and oxidative stress even in normoxic culture conditions. The study reflects the possibility of the presence of a hypoxic environment in the periprosthetic tissue surrounding metallic implants. Published by Wiley Periodicals, Inc. J Orthop Res 28:1360,1367, 2010 [source] Computational assessment of the effect of polyethylene wear rate, mantle thickness, and porosity on the mechanical failure of the acetabular cement mantleJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 5 2010Oliver J. Coultrup Abstract Clinical studies have revealed that aseptic loosening is the dominant cause of failure in total hip arthroplasty, particularly for the acetabular component. For a cemented polyethylene cup, failure is generally accompanied by the formation of fibrous tissue at the cement,bone interface. A variety of reasons for the formation of this tissue have been suggested, including osteolysis and mechanical overload at the cement,bone interface. In this study, a computational cement damage accumulation method was used to investigate the effect of polyethylene cup penetration, cement mantle thickness, and cement porosity on the number of cycles required to achieve mechanical fatigue failure of the cement mantle. Cup penetration was found to increase cement mantle stresses, resulting in a reduction in cement mantle fatigue life of 9% to 11% for a high cup penetration rate. The effect of using a thin (2 mm) over a thick (4 mm) cement mantle also reduced cement mantle fatigue life between 9% and 11%, and greatly raised cancellous bone stresses. Cement porosity was found to have very little effect on cement mantle fatigue life. Failure modes and cement stresses involved suggest that only extreme combinations of a thin cement mantle and high cup penetration may lead to mechanical failure of the cement mantle, thereby allowing wear debris access to the cement,bone interface. A thin cement mantle may also lead to the mechanical overload of the cement,bone interface. In this manner, the authors suggest that the mechanical factors may contribute to the failure mode of cemented polyethylene cups. © 2009 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 28:565,570, 2010 [source] FGF23 is a putative marker for bone healing and regenerationJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 9 2009Sascha Goebel Abstract Besides numerous other factors, fibroblast growth factor receptor (FGFR) signaling is involved in fracture healing and bone remodeling. FGF23 is a phosphatonin produced by osteoblastic cells, which signals via FGFR1, thereby exerting effects in bone and kidney. We analyzed if serum FGF23 levels might be an indicator to predict fracture healing and union. FGF23 (C-Term) was elevated on day 3 postoperatively in 55 patients sustaining an exchange of total hip implants due to aseptic loosening. A prospective study of 40 patients undergoing primary hip arthroplasty also showed elevated FGF23 (C-Term) but no change in FGF23 (intact) levels on days 1, 4, and 10 postoperatively. Serum phosphate and phosphate clearance stayed within normal ranges. FGF23 mRNA expression in ovine callus was compared between a standard and delayed course of osteotomy healing. In the standard model, a marked increase in FGF23 mRNA expression compared to the delayed healing situation was observed. Immunohistochemical analysis showed FGF23 production of osteoblasts and granulation tissue in the fracture callus during bone healing. In conclusion, FGF23 is involved in bone healing, can be measured by a sensitive assay in peripheral blood, and is a promising candidate as an indicator for healing processes prone to reunion versus nonunion. © 2009 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res [source] Fixation of hydroxyapatite-coated revision implants is improved by the surgical technique of cracking the sclerotic bone rimJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 8 2009Brian Elmengaard Abstract Revision joint replacement has poorer outcomes that have been associated with poorer mechanical fixation. We investigate a new bone-sparing surgical technique that locally cracks the sclerotic bone rim formed during aseptic loosening. We inserted 16 hydroxyapatite-coated implants bilaterally in the distal femur of eight dogs, using a controlled weight-bearing experimental model that replicates important features of a typical revision setting. At 8 weeks, a control revision procedure and a crack revision procedure were performed on contralateral implants. The crack procedure used a splined tool to perform a systematic local perforation of the sclerotic bone rim of the revision cavity. After 4 weeks, the hydroxyapatite-coated implants were evaluated for mechanical fixation by a push-out test and for tissue distribution by histomorphometry. The cracking revision procedure resulted in significantly improved mechanical fixation, significantly more bone ongrowth and bone volume in the gap, and reduced fibrous tissue compared to the control revision procedure. The study demonstrates that the sclerotic bone rim prevents bone ingrowth and promotes fixation by fibrous tissue. The effect of the cracking technique may be due to improved access to the vascular compartment of the bone. The cracking technique is a simple surgical method that potentially can improve the fixation of revision implants in sclerotic regions important for obtaining the fixation critical for overall implant stability. © 2009 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 27: 996,1001, 2009 [source] Soluble and particulate Co-Cr-Mo alloy implant metals activate the inflammasome danger signaling pathway in human macrophages: A novel mechanism for implant debris reactivityJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 7 2009Marco S. Caicedo Abstract Immune reactivity to soluble and particulate implant debris remains the primary cause of aseptic inflammation and implant loosening. However, the intracellular mechanisms that trigger immune cells to sense and respond to exogenous nonbiological agents such as metal particles or metal ions released from orthopedic implants remain unknown. Recent studies in immunology have outlined the importance of the intracellular inflammasome complex of proteins in sensing danger/stress signals triggered by nonbiological agents in the cytosol of macrophages. We hypothesized that metal implant debris can activate the inflammasome pathway in macrophages that causes caspase-1-induced cleavage of intracellular pro-IL-1, into its mature form, resulting in IL-1, secretion and induction of a broader proinflammatory response. We tested this hypothesis by examining whether soluble cobalt, chromium, molybdenum, and nickel ions and Co-Cr-Mo alloy particles induce inflammasome- mediated macrophage reactivity. Our results demonstrate that these agents stimulate IL-1, secretion in human macrophages that is inflammasome mediated (i.e., NADPH-, caspase-1-, Nalp3-, and ASC-dependent). Thus, metal ion- and particle-induced activation of the inflammasome in human macrophages provides evidence of a novel pathway of implant debris-induced inflammation, where contact with implant debris is sensed and transduced by macrophages into a proinflammatory response. © 2008 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 27: 847,854, 2009 [source] Gender-dependent association of the GNAS1 T393C polymorphism with early aseptic loosening after total hip arthroplastyJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 12 2008Hagen S. Bachmann Abstract The G-protein G,s is involved in the physiology and pathophysiology of bone. Especially, G,s is a key regulator of interleukin-6, which is a potent promoter of aseptic loosening. We hypothesized that the common single nucleotide polymorphism GNAS1 T393C could also affect time to aseptic loosening. Caucasian patients were genotyped for the GNAS1 T393C polymorphism. Time and median time to aseptic loosening were analyzed for dependency on GNAS1 genotypes. Time and median time were not significantly associated with genotypes. Additional analysis corrected for gender revealed, that the TT genotype was associated with significantly longer time (p,=,0.048) as well as median time (p,=,0.022) to aseptic loosening in female patients. In contrast to the findings in females, male TT genotype carriers had significantly shorter time (p,=,0.018) and median time (p,=,0.023) to aseptic loosening. Compared with TT genotype carriers heterozygous patients had a 6.25-fold lower risk with a hazard ratio of 0.160 (p,=,0.016) and male patients carrying the CC genotype had an 11-fold lower risk with a hazard ratio of 0.088 (p,=,0.006) in multivariate analysis. The present study suggests a significant gender-dependent role of the T393C polymorphism in aseptic loosening. The apparently contradictory results in women and men and the finding that the GNAS1 T393C genotype is an independent factor for time to aseptic loosening in male patients assigned this polymorphism as an interesting target for further investigations in bone diseases. © 2008 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res [source] Gene expression in endoprosthesis loosening: Chitinase activity for early diagnosis?,JOURNAL OF ORTHOPAEDIC RESEARCH, Issue 3 2008L. Morawietz Abstract The aim of the study was to identify markers for the early diagnosis of endoprosthesis loosening, for the differentiation between wear particle,induced and septic loosening and to gather new insights into the pathogenesis of endoprosthesis loosening. Gene expression profiles were generated from five periprosthetic membranes of wear particle,induced and five of infectious (septic) type using Affymetrix HG U133A oligonucleotide microarrays. The results of selected differentially expressed genes were validated by RT-PCR (n,=,30). The enzyme activity and the genotype of chitinase-1 were assessed in serum samples from 313 consecutive patients hospitalized for endoprosthesis loosening (n,=,54) or for other reasons, serving as control subjects (n,=,259). Eight hundred twenty-four genes were differentially expressed with a fold change greater than 2 (data sets on http://www.ncbi.nlm.nih.gov/geo/ GSE 7103). Among these were chitinase 1, CD52, calpain 3, apolipoprotein, CD18, lysyl oxidase, cathepsin D, E-cadherin, VE-cadherin, nidogen, angiopoietin 1, and thrombospondin 2. Their differential expression levels were validated by RT-PCR. The chitinase activity was significantly higher in the blood from patients with wear particle,induced prosthesis loosening (p,=,0.001). However, chitinase activity as a marker for early diagnosis has a specificity of 83% and a sensitivity of 52%, due to a high variability both in the disease and in the control group. © 2007 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 26:394,403, 2008 [source] Expression profiling reveals alternative macrophage activation and impaired osteogenesis in periprosthetic osteolysisJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 1 2008Panagiotis Koulouvaris Abstract Interactions between periprosthetic cells and prosthetic wear debris have been recognized as an important event in the development of osteolysis and aseptic loosening. Although the ability of wear debris to activate pro-inflammatory macrophage signaling has been documented, the full repertoire of macrophage responses to wear particles has not been established. Here, we examined the involvement of alternative macrophage activation and defective osteogenic signaling in osteolysis. Using real-time RT-PCR analysis of periprosthetic soft tissue from osteolysis patients, we detected elevated levels of expression of alternative macrophage activation markers (CHIT1, CCL18), chemokines (IL8, MIP1 ,) and markers of osteoclast precursor cell differentiation and multinucleation (Cathepsin K, TRAP, DC-STAMP) relative to osteoarthritis controls. The presence of cathepsin K positive multinuclear cells was confirmed by immunohistochemistry. Reduced expression levels of the osteogenic signaling components BMP4 and FGF18 were detected. Expression levels of TNF-,, IL-6, and RANKL were unchanged, while the anti-osteoclastogenic cytokine OPG was reduced in osteolysis patients, resulting in elevated RANKL:OPG ratios. In vitro studies confirmed the role of particulate debris in alternative macrophage activation and inhibition of osteogenic signaling. Taken together, these results suggest involvement in osteolysis of alternative macrophage activation, accompanied by elevated levels of various chemokines. Increased recruitment and maturation of osteoclast precursors is also observed, as is reduced osteogenesis. These findings provide new insights into the molecular pathogenesis of osteolysis, and identify new potential candidate markers for disease progression and therapeutic targeting. © 2007 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 26:106,116, 2008 [source] Knee biomechanics after UKA and its relation to the ACL,a robotic investigationJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 4 2006Jeremy F. Suggs Abstract Unicompartmental knee arthroplasty (UKA) has regained popularity in recent years. However, limited data exist on how UKA affects knee biomechanics. The role of the anterior cruciate ligament (ACL) after fixed bearing UKA remains controversial. In this study, a robotic testing system was used to apply a quadriceps/hamstrings load to cadaveric knee specimens in the intact state, after medial UKA, and after transection of the ACL in UKA. The load was applied to the knee from full extension to 120° of flexion in 30° increments. UKA generally did not affect anterior,posterior (AP) femoral position, but did cause external tibial rotation and variations in varus,valgus rotation compared to the intact knee. ACL transection after UKA shifted the femur posteriorly compared to the intact and UKA knees and increased internal tibial rotation compared to the UKA knee at low flexion. The AP motion of the articular contact position in the implant was increased after ACL transection. These data might help explain the mechanism of tibial component loosening and provide insight into further investigations of polyethylene wear in UKA. Based on the kinematic data, the ACL should be functional to provide patients the greatest opportunity for long-term success after medial UKA. © 2006 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res [source] Arthroplasty membrane-derived fibroblasts directly induce osteoclast formation and osteolysis in aseptic looseningJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 3 2005A. Sabokbar Abstract Purpose: Both macrophages and fibroblasts are the main cell types found in periprosthetic tissues surrounding failed joint arthroplasties. These fibroblasts are known to express RANKL and to produce TNF,, factors which promote osteoclast formation and bone resorption. In this study we have analysed the role that arthroplasty membrane-derived fibroblasts (AFb) play in inducing the generation of bone resorbing osteoclasts. Methods: Fibroblasts were isolated from periprosthetic tissues and co-cultured with human monocytes in an osteoclast differentiation assay in the presence or absence of M-CSF and inhibitors of RANKL (OPG) and/or TNF,. RANKL expression by AFbs was determined by RT-PCR and the extent of osteoclast differentiation by the expression of TRAP, VNR and evidence of lacunar resorption. Results: In the presence of M-CSF, large numbers of TRAP+ and VNR+ multinucleated cells capable of lacunar resorption, were noted in co-cultures of monocytes and RANKL-expressing AFbs. Cell-cell contact was required for osteoclast formation. The addition of OPG and anti-TNF, alone significantly reduced but did not abolish the extent of osteoclast formation, whereas the addition of both together abolished osteoclast formation and lacunar resorption. Conclusion: Our results indicate that fibroblasts in periprosthetic tissues are capable of inducing the differentiation of normal human peripheral blood mononuclear cells to mature osteoclasts by a mechanism that involves both RANKL and TNF,. Suppression of both RANKL and inflammatory cytokines is likely to be required to control periprosthetic osteolysis. © 2004 Orthopaedic Research Society. Published by Elsevier Ltd. All rights reserved. [source] Accuracy and precision of radiostereometric analysis in the measurement of three-dimensional micromotion in a fracture model of the distal radiusJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 2 2005Rami Madanat Abstract The purpose of the current study was to verify the feasibility of radiostereometric analysis (RSA) in monitoring three-dimensional fracture micromotion in fractures of the distal radius. The experimental set-up consisted of a simulated model of an extra-articular Colles' fracture, including metallic beads inserted into the bone on either side of the fracture site. The model was rigidly fixed to high precision micrometer stages allowing controlled translation in three axes and rotation about the longitudinal and transverse axes. The whole construct was placed inside a RSA calibration cage with two perpendicular radiographic film cassettes. Accuracy was calculated as the 95% prediction intervals from the regression analyses between the micromotion measured by RSA and actual displacements measured by micrometers. Precision was determined as the standard deviation of five repeated measurements of a 200 ,m displacement or a 0.5° rotation along a specific axis. Translations from 25 ,m to 5 mm were measured with an accuracy of ±6,m and translations of 200,m were measured with a precision of 2,6 ,m. Rotations ranging from 1/6° to 2° were measured with an accuracy of ±0.073° and rotations of 1/2° were measured with a precision of 0.025°,0.096°. The number of markers and their configuration had greater impact on the accuracy and precision of rotation than on those of translation. Aside from the unknown rate of clinical marker loosening, the current results favor the use of at least four markers in each bone fragment in distal radius fractures. These results suggest a strong rationale for the use of RSA as an objective tool for comparing different treatment modalities and novel bone graft substitutes aimed at stabilization of fractures of the distal radius. © 2004 Orthopaedic Research Society. Published by Elsevier Ltd. All rights reserved. [source] Creep dominates tensile fatigue damage of the cement,bone interfaceJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 3 2004Do-Gyoon Kim Abstract Fatigue damage from activities of daily living has been considered to be a major cause of aseptic loosening in cemented total hip arthroplasty. The cement,bone interface is one region where loosening could occur, but to date the fatigue response of the interface has not been examined. Cement,bone specimens were prepared from fresh frozen human cadaver tissue using simulated in vivo conditions. Tensile fatigue tests to failure were performed in an environmental chamber. Loss of specimen stiffness (stiffness damage) and permanent displacement after unloading (creep damage) were found in all specimens. At failure, creep damage accounted for the majority (79.9 ± 10.6%) of the total strain damage accumulation at failure (apparent strain, , = 0.0114 ± 0.00488). A power law relationship between strain-damage rate and time-to-failure showed that the strain-damage rate was an excellent predictor of the fatigue life of the cement,bone interface. The S,N response of the interface was obtained as a function of the applied stress ratio and the initial apparent strain. The total motion between cement and bone (72.2 ± 29.8 ,m) prior to incipient failure due to both stiffness and creep fatigue damage may be sufficient to result in fibrous tissue formation and contribute to eventual clinical loosening. © 2004 Orthopaedic Research Society. Published by Elsevier Ltd. All rights reserved. [source] | |||||||||||||||||||||||||