Acne Vulgaris ; complications ; Follow-Up Studies ; Humans ; Osteolysis ; etiology ; Time Factors ; Tooth Socket

BACKGROUND: Wear cannot be completely prevented after total hip arthroplasty. If severe polyethylene (PE) liner wear develops, the so-called catastrophic failure occurs and metallosis develops. We postulated that longevity of the new implant may be affected after revision surgery for metallosis following a catastrophic failure of a PE liner due to the substantial amount of PE wear particles and infiltration of the metal particles in this catastrophic condition. METHODS: Twenty-three hips of 23 patients were identified because they showed metallosis during revision total hip arthroplasties performed in Seoul National University Hospital between January 1996 and August 2004. They were followed for at least 6.5 years after the index revision total hip arthroplasty. The clinical and radiological results of revision total hip arthroplasties in these patients were evaluated. RESULTS: The median Harris hip score increased from 60 points before revision total hip arthroplasties to 90 points at the final follow-up. Osteolysis was detected at an average of 9.3 years after revision total hip arthroplasties in 13 hips and acetabular cup loosening at average 9.8 years after revision total hip arthroplasties in 9 hips. With radiographic evidence of osteolysis and loosening as the end points, the 15-year survival rates were 28.2% and 56.0%, respectively. CONCLUSIONS: The survival rate of revision total hip arthroplasty in patients with metallosis following a catastrophic failure of a PE liner was low.
Adolescent ; Adult ; *Arthroplasty, Replacement, Hip ; Biocompatible Materials ; Female ; Hip Joint/radiography/surgery ; Hip Prosthesis/*adverse effects ; Humans ; Joint Diseases/radiography/*surgery ; Male ; Metals/adverse effects ; Metals, Heavy/*poisoning ; Middle Aged ; Osteolysis/etiology/surgery ; Poisoning/etiology/*surgery ; Polyethylene/adverse effects ; Prosthesis Design ; *Prosthesis Failure/etiology ; Reoperation ; Young Adult

Aseptic looseningis is one of the most frequent long-term complications after joint replacement, which limits the service lire of prosthesis. A lot of studies have been focused on macrophage, osteoblast, osteoclast and fibroblast in interface membranes around prostheses recently. Aseptic loosening of orthopedic implants used in joint replacement results from bone loss that occurs through the resorptive activity of inflammatory cells activated by the presence of wear particles. Apoptosis has been observed in the periprosthetic site and it has been interpreted as a sign of resolution of inflammation suggesting that apoptosis-related events are indeed associated with periprosthetic osteolysis,targeting the Apoptosis pathway may lead to novel therapeutic approaches for the treatment of aseptic prosthesis loosening. In this thesis,the relationship between wear debris-induced apoptosis and aseptic loosening of prostheses are expounded in detail.
Apoptosis ; Humans ; Joint Prosthesis ; adverse effects ; Osteolysis ; Prosthesis Failure ; etiology

OBJECTIVETo explore effects of Yougui recipe (see text) and salmon calcitonin acetate in preventing osteolysis surrounding artificial prosthesis.

METHODSThirty-two SD male rats with weighted (250 +/- 20) g, aged 8 weeks, were randomly divided into four groups: blank group, model group, salmon calcitonin acetate group and Yougui recipe (see text) group, and 8 rats in each group. Blank group did not undergo any process, other 24 rats underwent anesthesia by chloral hydrate, their knee joints were exposed through medial patellar side,drilling from fermoral condyle nest to marrow cavity,high density of polythlene particles were injected into hole, titanium nail were put into, bone wax closed the window, then suturing step by step. After the molding, saline were used to gavaged in blank group and model group, Yougui recipe (see text) for Yougui recipe (see text) group, salmon calcitonin maximus injection for calcitonin group. After 10 weeks' mediation, rats were executed, and arterial blood and bilateral femoral organization were collected to biochemical, imaging morphology, tissue pathology and molecular biology detection.

RESULTSThe key gene expression of activiting osteoclast were inhibited in Yougui recipe (see text) group and calcitonin group. The level of OPG, Ca, ALP in Yougui recipe group were higher than calcitonin group (P<0.01); the content of RANKL were lower (P<0.01). There were no significance meaning in RANK, Trap5b, P between two groups.

CONCLUSIONBoth of Yougui recipe (see text) and calcitonin can slow and treat surrounding osteolysis of artificial joint prosthesis, and Yougui recipe (see text) has better effect in promoting bone formation. The effect of Yougui recipe (see text) in promoting bone formation, inhibiting osteoclasts to provide a new method to treating surrounding osteolysis of artificial joint prosthesis.

Animals ; Biomarkers ; metabolism ; Drugs, Chinese Herbal ; pharmacology ; Gene Expression Regulation ; drug effects ; Interleukin-1 ; genetics ; Interleukin-6 ; genetics ; Male ; Osteolysis ; etiology ; metabolism ; pathology ; prevention & control ; Prostheses and Implants ; adverse effects ; Rats ; Rats, Sprague-Dawley ; Tomography, X-Ray Computed ; Vacuolar Proton-Translocating ATPases ; genetics

OBJECTIVETo observe the effect of a slow-release recombinant human bone morphogenetic protein-2 (rhBMP-2) formulation on the expressions of receptor activator of nuclear factor-κB ligand (RANKL) and osteoprotegerin (OPG) in a murine air pouch model of bone implantation.

METHODSA cranial bone allograft was implanted in the air pouch induced on the back of the recipients. The rat models were then randomized into 5 groups, including a blank control group, chromium particle group, and 3 rhBMP-2 groups receiving 50, 100 or 200 µg/L slow-release rhBMP-2 in addition to chromium particles. Three weeks later, the expressions of RANKL and OPG in the air pouch was detected using Western blotting and RT-PCR, and the positively stained area for osteoclasts in the bone graft was determined with TRAP staining for drug effect assessment.

RESULTSRANKL and OPG expressions were found in the air pouches in all the 5 groups. RANKL and OPG protein and mRNA expressions, RANKL/OPG ratio and osteoclast staining area in the bone graft were the highest in chromium particle group (P<0.05), but were significantly decreased by treatment with the slow-release rhBMP-2 formulation (P<0.05); the measurements showed no significant differences between the blank control group and 200 µg/L rhBMP-2 group (P>0.05).

CONCLUSIONChromium particles can cause osteolysis by increasing the RANKL/OPG ratio in rats, and intervention with slow-release rhBMP-2 can significantly promote bone formation and suppress bone resorption by decreasing RANKL/OPG ratio.

Animals ; Arthroplasty, Replacement ; adverse effects ; Bone Morphogenetic Protein 2 ; pharmacology ; Bone Resorption ; prevention & control ; Bone Transplantation ; Chromium ; adverse effects ; chemistry ; Delayed-Action Preparations ; Disease Models, Animal ; Female ; Male ; Osteolysis ; etiology ; prevention & control ; Particle Size ; Rats ; Rats, Sprague-Dawley ; Recombinant Proteins ; pharmacology ; Skull ; Transforming Growth Factor beta ; pharmacology

OBJECTIVETo study the clinical and radiographic results of tatal hip arthroplasty (THA) with an uncemented femoral component after 6 to 10 years follow-up, and to investigate factors effecting their efficacy.

METHODSFrom January 2000 to December 2003, 58 patients were treated with primary total hip arthroplasty. Among the patients, 27 patients were male and 31 patients were female, ranging in age from 25 to 73 years, with an average of 56 years. The 58 patients were clinically and radiographically followed up including before operation, postoperative 1.5, 3, 6 and 12 months, and then once a year. Therapeutic evaluation was measured by using Harris scoring system. The incidence of osteolysis around the components in different Gruen zones was radiologically determined. The data were analyzed by SPSS 16.0 software.

RESULTSAll the patients were followed up, and the duration ranged from 6 to 10 years, with a mean of 8.2 years. The Harris hip score of the patients improved from preoperative mean of (54.0 +/- 7.8) to (88.3 +/- 6.1) at the latest follow-up. There were 32 patients with an excellent result, 22 good, 3 fair and 1 poor. Radiological analysis showed that 48 patients had stable bone in growth, 10 patients got stable fibrous in growth and nobody showed unstable fixation with aseptic loosening. Subsidence (1 to 3 mm) was observed in 4 patients. Osteolysis of the femoral cortex was seen in 4 patients without progressive development, and the latest follow-up radiographs showed a significantly greater incidence of osteolysis in Gruen zone I, VI, VII compared with others (P = 0.031). All the patients with low Harris score had received prostheses which were undersized in the intramedullary canal, and these differences were statistically significant.

CONCLUSIONThe uncemented femoral component has good medium-term clinical follow-up results because of high stability and no aseptic loosening.

Adult ; Aged ; Arthroplasty, Replacement, Hip ; adverse effects ; methods ; Female ; Femur ; diagnostic imaging ; pathology ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Osteolysis ; etiology ; Postoperative Complications ; etiology ; Radiography ; Retrospective Studies

The bones are the most common sites of breast cancer metastasis. Upon arrival within the bone microenvironment, breast cancer cells coordinate the activities of stromal cells, resulting in an increase in osteoclast activity and bone matrix degradation. In late stages of bone metastasis, breast cancer cells induce apoptosis in osteoblasts, which further exacerbates bone loss. However, in early stages, breast cancer cells induce osteoblasts to secrete inflammatory cytokines purported to drive tumor progression. To more thoroughly evaluate the role of osteoblasts in early stages of breast cancer metastasis to the bones, we used green fluorescent protein-labeled human breast cancer cell lines MDA-MB-231 and MDA-MB-435, which both induce osteolysis after intra-femoral injection in athymic mice, and the murine pre-osteoblastic cell line MC3T3-E1 to modulate osteoblast populations at the sites of breast cancer metastasis. Breast cancer cells were injected directly into the femur with or without equal numbers of MC3T3-E1 cells. Tumors grew significantly larger when co-injected with breast cancer cells and MC3T3-E1 cells than injected with breast cancer cells alone. Osteolysis was induced in both groups, indicating that MC3T3-E1 cells did not block the ability of breast cancer cells to cause bone destruction. MC3T3-E1 cells promoted tumor growth out of the bone into the extraosseous stroma. These data suggest that breast cancer cells and osteoblasts communicate during early stages of bone metastasis and promote tumor growth.
Animals ; Bone Neoplasms ; secondary ; Breast Neoplasms ; pathology ; Cell Line ; Cell Line, Tumor ; Disease Models, Animal ; Female ; Femur ; pathology ; Humans ; Mice ; Mice, Nude ; Neoplasm Transplantation ; Osteoblasts ; cytology ; physiology ; Osteolysis ; etiology ; Tumor Burden

PURPOSE: This study analyzed the long-term results of cementless total hip arthroplasty using an extensively porous coated stem in patients younger than 45 years old. MATERIALS AND METHODS: The clinical and radiographic results of 45 hips from 38 patients who underwent cementless total hip replacement arthroplasty with an AML prosthesis were reviewed retrospectively. The average follow-up was 12 years (range, 10-15 years). RESULTS: The average Harris hip score at the time of final follow-up was 87.3 (range 77-94) points. Forty two hips (93.3%) showed excellent and good clinical results. Osteolysis occurred around the stem in 20 hips (44.4%) and around the cup in 26 hips (57.8%). Stress-mediated femoral resorption was observed in 33 hips (73.3%) at 10 years. There was no incidence of resorption progressing after 5 years postoperatively. There was no stem loosening. Five hips were revised for osteolysis, cup loosening and polyethylene wear. CONCLUSION: The long term results of total hip arthroplasty using an extensively porous coated stem were acceptable, and there was no case involving the progression of proximal bone resorption.
Adult ; Arthroplasty, Replacement, Hip/*adverse effects ; Female ; Hip Prosthesis/*adverse effects ; Humans ; Male ; Osteolysis/etiology ; Retrospective Studies ; Treatment Outcome

Polyfibromatosis syndrome is a rare disease entity that is characterized by various clinical features such as palmar, plantar, and penile fibromatoses, keloid formations of the skin, and erosive arthropathy. Its precise pathophysiology or etiology remains unclear. In addition to distinctive diverse skin manifestations, patients with polyfibromatosis have been previously reported to show erosive arthropathy with significant limitation of movement at affected joints. However, the presence of erosive polyarthropathy in polyfibromatosis has not emphasized in previous cases. Here, we report a case of polyfibromatosis syndrome combined with painless massive structural destruction of hand and foot joints, and review the characteristics of erosive arthropathy in previous cases.
Adult ; Arthrography ; Diagnosis, Differential ; Fibroma/*diagnosis/pathology/radiography ; Foot Joints/pathology/radiography ; Hand Joints/pathology/*radiography ; Humans ; Magnetic Resonance Imaging ; Male ; Metacarpophalangeal Joint/pathology/radiography ; Osteolysis/*diagnosis/etiology

OBJECTIVESTo measure the linear polyethylene wear with use of a computer-assisted two-dimensional method, and to evaluate the relationship between wear and long-term clinic-radiological findings.

METHODSBetween December 1991 and December 1995, the senior author performed 40 primary total hip arthroplasties with use of H/G porous-coated acetabular component. Radiographs of 40 H/G cementless total hip arthroplasties were examined for osteolysis, radiolucent line, cup migration and so on. To measure the linear polyethylene wear, migration in the femoral head center relative to the cup shell center was calculated on digitized consecutive radiographs with special computer software program.

RESULTSThe minimum follow-up was 10 years. Total linear wear was 2-8 mm, the mean rate of linear polyethylene wear was (0.32+/-0.31) mm/year. Twelve acetabular components (30%) were revised at an average follow-up point of 12 years. Three types of polyethylene liner failure were identified: wear-through of the polyethylene liner with resultant metallosis (5 hips), excessive wear necessitating revision (5 hips), and polyethylene liner dissociation without gross evidence of wear (2 hips).

CONCLUSIONSHigh wear rates and femoral and acetabular osteolysis have been and still are the main problems in uncemented total hip replacement. There is clear relationship between wear and acetabular osteolysis or loosening of the prostheses. The poor long-term results with these uncemented total hip arthroplasties illustrate the necessity of regular radiographic evaluation in order to detect osteolysis and liner failure, which are both generally asymptomatic until catastrophic failure appears.

Adult ; Aged ; Arthroplasty, Replacement, Hip ; methods ; Follow-Up Studies ; Hip Prosthesis ; Humans ; Middle Aged ; Osteolysis ; etiology ; Polyethylene ; Postoperative Complications ; Prosthesis Failure ; Retrospective Studies