Corrosion Induced Hip Implant Failure: Synergistic Interactions of Patient, Mater

腐蚀引起的髋关节植入物失败：患者、母亲的协同相互作用

• 批准号: 9763319
• 负责人: Hannah Jean Lundberg
• 金额: $ 38.57万
• 依托单位: RUSH UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-19 至 2021-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9763319
• 关键词: 3-Dimensional; Address; Adverse effects; Affect; Alloys; Area; Autopsy; Behavior; Biological; Ceramics; Chemicals; Clinical; Complement; Complex; Corrosion; Data; Environment; Face; Failure; Finite Element Analysis; Gait; Goals; Grain; Head; Health Care Costs; Hip Pain; Hip region structure; Human; Implant; Incidence; Infection; Intervention; Ions; Joints; Knowledge; Lead; Length; Life; Longevity; Lymphocyte; Medical Care Costs; Metallurgy; Metals; Methods; Mission; Motion; National Institute of Arthritis and Musculoskeletal and Skin Diseases; Necrosis; Operative Surgical Procedures; Patients; Periodicity; Personal Satisfaction; Phase; Preclinical Testing; Procedures; Public Health; Quality Control; Quality of life; Reaction; Replacement Arthroplasty; Research; Retrieval; Role; Sampling; Source; Standardization; Structure; Surface; Surgeon; Testing; Time; Tissue Sample; Tissues; Total Hip Replacement; Tweens; United States National Institutes of Health; Work; computerized tools; disability; experimental study; high risk; hip replacement arthroplasty; implant design; implant material; implantation; improved; innovation; interdisciplinary approach; macrophage; mechanical behavior; mechanical properties; novel; pain relief; stem; synergism

Adverse local tissue reactions (ALTRs) in patients with total hip replacements (THRs) are on the rise and are on par with periprosthetic infection as a major reason for THR failure. Corrosion products generated within modular junctions of the implants lead to ALTRs; thus, modular junction corrosion is one of the most urgent topics in joint arthroplasty. The long term goal of this work is to reduce corrosion damage and increase longevity of THRs by optimizing material quality and surface finish. It is the objective of this application to identify modes of corrosion that lead to ALTRs and how they depend on material, implant design, surgical implantation and patient factors. The central hypothesis is that specific corrosion modes can be inhibited by a homogeneous implant alloy with moderate grain size and optimal synergism between global and local implant design factors. The rationale underlying the proposed research is that, determining the material microstructure and surface topography that minimizes corrosion and micromotion will improve modular junctions and reduce implant failure. We have three specific aims: 1) Identify the material, implant design, surgical implantation and patient factors that most significantly reduce corrosion damage in modular junctions using a) retrieval analysis and b) multiscale finite element analysis (FEA); 2) Determine how alloy microstructure affects specific corrosion modes under a) cyclic load, and b) additional micromotion (fretting), and experimentally and computationally simulate the effect of ceramic head intervention on the corrosion and mechanical behavior of these alloys; and 3) Determine how specific modes of corrosion and subsequent corrosion products influence the occurrence, extent and type of ALTRs (macrophage or lymphocyte dominated). Under aim 1, we will quantify the extent of corrosion damage on retrieved THRs, and use previously developed multiscale FEA to determine the material, implant design and surgical implantation factors that minimize corrosion damage, given differences in the patient. Under aim 2, material samples prepared from the retrieved implants will be used in crevice- and fretting-corrosion tests to determine the effect of material microstructure on metal ion release. Experimental tests and FEA will be used to investigate the consequences of surgical intervention with ceramic femoral heads on damaged stem tapers. Under aim 3, tissue samples and implant surfaces from patients with macrophage and lymphocyte dominated ALTRs will be analyzed and compared to well-functioning (postmortem) controls. The experimental approach is innovative because it uses actual implant material samples, applies more relevant loads and motions which can only be derived by multiscale FEA, and analyzes the biological impact of corrosion modes using tissue samples from the same retrieved implants. The proposed research is significant because it will collectively fill a knowledge gap on how corrosion in modular junctions leads to ALTRs. Ultimately this knowledge has the potential to drive new manufacturing, quality control and preclinical testing methods for THRs, increasing implant life time and improving the well-being of THR patients.

总髋关节置换（THR）患者的不良局部组织反应（ALTR）正在上升，并且是 与周围感染作为THR失败的主要原因相当。内部生成的腐蚀产品 植入物的模块化连接会导致Altrs；因此，模块化连接腐蚀是最紧急的腐蚀之一 关节置换术中的主题。这项工作的长期目标是减少腐蚀损害并增加 通过优化材料质量和表面饰面，THR的寿命。这是该应用程序的目的 识别导致Altr的腐蚀模式以及它们如何依赖材料，植入物设计，外科手术 植入和患者因素。中心假设是特定的腐蚀模式可以被A抑制 均匀的植入物合金，具有中等晶粒尺寸和最佳协同作用在全球和局部植入物之间 设计因素。拟议研究的基本原理是，确定材料微观结构 最小化腐蚀和微功能的表面形态将改善模块化连接并减少 植入物故障。我们有三个具体的目的：1）确定材料，植入物设计，外科植入和 使用a）检索分析的患者因素最大程度地减少模块化连接中的腐蚀损伤 b）多尺度有限元分析（FEA）； 2）确定合金微观结构如何影响特定 a）循环负载下的腐蚀模式，b）额外的微功能（fretting），并通过实验和 计算模拟陶瓷头干预对腐蚀和机械行为的影响 这些合金； 3）确定腐蚀和随后的腐蚀产物的特定模式如何影响 ALTR的发生，程度和类型（巨噬细胞或淋巴细胞主导）。在AIM 1下，我们将 量化检索到的THR的腐蚀损害程度，并使用先前开发的多尺度FEA 确定材料，植入物设计和手术植入因子，以最大程度地减少腐蚀损伤 患者的差异。在AIM 2下，从检索到的植入物中制备的材料样品将用于 缝隙和烦恼测试，以确定材料微结构对金属离子释放的影响。 实验测试和FEA将用于研究陶瓷手术干预的后果 股骨头上受损的茎锥子。在AIM 3下，来自患者患者的组织样品和植入表面 将分析巨噬细胞和淋巴细胞主导的奥特尔斯，并与功能良好 （验尸）控件。实验方法具有创新性，因为它使用了实际的植入物材料 样本，应用更多相关的负载和动作，只能通过多尺度FEA得出，并分析 腐蚀模式使用来自同一植入物的组织样品的生物学影响。提议 研究之所以重要，是因为它将集体填补有关模块化连接中如何腐蚀的知识差距 导致Altrs。最终，这种知识有可能推动新的制造，质量控制和 THR的临床前测试方法，增加植入物寿命并改善THR患者的福祉。