SYSTEMIC IMPLICATIONS OF TOTAL JOINT REPLACEMENT

全关节置换术的系统影响

• 批准号: 6341775
• 负责人: Joshua J Jacobs
• 金额: $ 28.19万
• 依托单位: RUSH UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 1989
• 资助国家: 美国
• 起止时间: 1989-05-01 至 2003-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6341775
• 关键词: X ray; aluminum oxide; atomic absorption spectrometry; biological transport; biomaterial compatibility; biomaterial evaluation; blood chemistry; chromium; cobalt; corrosions; hip prosthesis; human subject; joint prosthesis; knee; longitudinal human study; manganese; medical implant science; metal poisoning; nanotechnology; nickel; orthopedics; postoperative complications; scanning electron microscopy; titanium; urinalysis; vanadium

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 THR because of the known toxicities of the metallic elements that comprise the implant alloys. In this long term study, we have been investigating metal release, transport, storage and excretion in patients with total hip and knee replacements. In the current grant period, we have demonstrated that (1) elevations in serum titanium and chromium can be detected in individuals with well functioning total hip and knee replacements; (2) the highest chromium and cobalt levels have been observed in patients with metal-on-metal bearings; (3) passive dissolution from extensively porous coated cobalt- base alloy femoral stems is not a dominant model of metal release; rather, fretting corrosion of femoral components at modular junctions is more closely associated with elevations in serum chromium; (4) cobalt- and titanium-alloy particulate degradation products from TJR commonly disseminate to paraaortic lymph nodes, liver and spleen, particularly in individuals who have had a failed TJR; and (5) there are indications that individuals with elevated serum metal content may have associated liver cell injury. We propose to expand on these studies to (1) quantify metal release in the prospective study group which will be 7 to 12 years postoperative, an interval in which complications related to the implant are more prevalent; (2) prospectively follow patients up to 8 years after revision surgery who have demonstrated significant elevations in serum metal content to determine if serum metal transport diminishes with time; (3) expand our autopsy retrieval program to characterize not only tissue metal levels and systemic distribution of particulate wear debris but also the tissue and cellular localization of these degradation products; and (4) conduct bioavailability and bioreactivity studies of circulating metal-protein complexes which result from corrosion and wear of joint replacement components. This is one of four grants in an Orthopaedic Biomaterials Investigator- Initiated Interactive Research Project Grant entitled "Safety and Efficacy of Permanent Skeletal Replacement Implants". The studies proposed here address safety issues and are deemed critical in order to understand the prospective risks to patients undergoing total joint arthroplasty.

从长远来看，越来越多的认识 替换（TJR）可能与不利的局部和远程组织有关 假肢降解产物介导的响应 材料。金属特别感兴趣 由于已知的毒性，THR的降解产物的降解产物 构成植入合金的金属元素。在这个长期 研究，我们一直在调查金属释放，运输，存储和 总髋关节和膝盖置换患者的排泄。在 当前的赠款期，我们已经证明了（1）血清高程 可以在井中检测到钛和铬 总臀部和膝关节更换； （2）最高铬 在金属金属的患者中已经观察到钴水平 轴承； （3）从广泛的多孔涂层钴 - 被动溶解 底股骨茎不是金属释放的主要模型。 相反，在模块化连接处的股骨成分腐蚀为 与血清铬的升高更加紧密相关； （4）钴 - 通常来自TJR的钛合金颗粒物降解产物 传播到副淋巴结，肝脏和脾脏，特别是在 TJR失败的个人； （5）有指示 血清金属含量升高的个体可能有关联 肝细胞损伤。 我们建议将这些研究扩展到（1）量化金属释放 前瞻性研究小组将在术后7到12年， 与植入物相关的并发症的间隔更多 流行; （2）前瞻性跟踪患者长达8年 改良手术表现出血清的显着升高 金属含量以确定血清金属转运是否会减少 时间; （3）扩展我们的尸检检索程序，不仅表征 组织金属水平和颗粒磨损的全身分布 但是这些降解的组织和细胞定位 产品; （4）进行生物利用度和生物反应性研究 由腐蚀和磨损产生的循环金属蛋白质复合物 关节置换组件。 这是骨科生物材料研究者中的四项补助金之一 发起的互动研究项目赠款名为“安全和 永久骨骼置换植入物的功效”。 此处提议解决的安全问题，并认为至关重要 了解对持续关节的患者的预期风险 关节置换术。