BACKGROUND: The objective of the study was to determine the association between periprosthetic concentrations of selected metals and changes induced in periprosthetic tissues (PT). METHODS: PT from 24 patients with metal-on-polyethylene or ceramic-on-polyethylene total joint replacements (TJRs) were examined. Samples underwent histological examination including quantification of cellular populations. Determination of metals was performed according to the published methodology. Results were processed using correlation analysis and Principal Component Analysis (PCA), respectively. RESULTS: Growing concentration of metals in the PT was found as a function of length of exposure (LoE). Differences in Ti, Co, Cr and V concentrations (per α = 0.05) depended on the type of alloy the implants were made from. On the contrary, the implant composition did not reflect in the different numbers of immune cells per 1 high power field, not even in distribution of the membrane type according to the Krenn classification. PCA revealed several clusters in dependence on the LoE, type of the membrane and presence of immune cells. High representation of lymphocytes in the PT was typical for clusters with the longest LoE while a higher representation of neutrophils was typical for a shorter time to reoperation. CONCLUSIONS: Correlation between the LoE and concentrations of metals in its surroundings was demonstrated. However, the tissue image analysis cannot differentiate finer, potentially metal-induced tissue changes. Importantly, the tissues become more similar with an increasing LoE. We draw a conclusion about predominantly non-specific stimulation of the PT jointly by metal and polyethylene particles in non-metal-on-metal TJRs.

• MeSH
• kovy MeSH
• kyčelní protézy * MeSH
• lidé MeSH
• lymfocyty MeSH
• náhrada kyčelního kloubu * MeSH
• polyethyleny MeSH
• protézy - design MeSH
• reoperace MeSH
• selhání protézy MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

V souvislosti s neúspěchem TEP kyčle typu kov-kov se oživil zájem o problematiku dlouhodobé akumulace kovů pocházejících z kloubní náhrady. Přitom je známo, že kovy se uvolňují také z ostatních typů kloubních náhrad, zejména mechanismem koroze. Kovy se dostávají do výpotku a do tkání, působí cytotoxicky, mohou indukovat změny DNA a stimulovat imunitní systém. Pravděpodobně nejdiskutovanějším tématem v souvislosti s kovy je alergická reakce a její podíl na předčasném selhání implantátu. Přes veškerý výzkum nepanuje v této otázce shoda. Některé vlivné odborné společnosti dokonce roli pozdní přecitlivělosti na kovy marginalizují a připouští pouze jako diagnózu per exclusionem. Obavy panují také z dlouhodobé akumulace kovů v těle, zejména u mladých pacientů. Nepodařilo se však prokázat ani genotoxický, ani kancerogenní efekt. Některé experimentální studie dokládají, že by se kovy uvolněné z povrchu kloubní náhrady mohly připojit k ostatním materiálům (polyetylen, kostní cement) při stimulaci nespecifické zánětlivé odpovědi, která se podílí na vzniku aseptického uvolnění a periprotetické osteolýzy. V článku jsou shrnuty současné pohledy na problematiku působení kovů na periprotetické tkáně i důsledky systémové zátěže.

In the context of metal-on-metal hip replacement failure, concerns regarding long-term accumulation of metals originating from joint replacement have been raised again. It is known at the same time that metals are released from other implant types as well, mainly by corrosion. Metals are released into surrounding tissues and joint fluid, produce cytotoxicity, stimulate immune reaction and can induce a DNA change. The most discussed topic regarding metals in joint arthroplasty probably is the allergic reaction and its contribution to premature implant failure. There still is no consensus on this topic despite all the research that has been made. Some clinical societies even marginalise the significance of late hypersensitivity and acknowledge the allergy only as a diagnosis of exclusion. So far, there is no definite evidence for a genotoxic or carcinogenic effect. Some experimental studies suggest that released metals in addition to other materials (polyethylene, bone cement) can take part in the innate immune response leading to periprosthetic osteolysis and aseptic loosening. This article summarises current views on the metal load effect on periprosthetic tissues and systemic metal burden effects.

• Klíčová slova
• pseudotumor,
• MeSH
• alergie diagnóza   etiologie   terapie   MeSH
• artroplastiky kloubů škodlivé účinky   MeSH
• biokompatibilní materiály škodlivé účinky   MeSH
• biologické jevy MeSH
• cysty chemicky indukované   diagnóza   MeSH
• karcinogeneze MeSH
• koroze MeSH
• kovy * klasifikace   krev   škodlivé účinky   MeSH
• lidé MeSH
• osteolýza chemicky indukované   MeSH
• protézy kloubů * škodlivé účinky   MeSH
• slitiny klasifikace   škodlivé účinky   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH
• přehledy MeSH

Poruchy metabolismu chrupavky a zánětlivé změny kloubní výstelky hrají zásadní roli ve vývoji degenerativních a dalších kloubních onemocnění. Na tyto procesy cílí substance podávané perorálně k léčbě kloubní symptomatologie při chondropatiích a osteoartróze. Některé z nich stimulují obnovu mezibuněčné hmoty chrupavky, podílí se na regulaci jejího metabolismu a do určité míry tlumí zánětlivé procesy. Mají pomalý nástup účinku, působí symptomaticky a někdy je u nich uváděn i efekt zpomalující průběh onemocnění. Nejrozšířenější a také nejvíce prostudované jsou chondroitinsulfát a glukosaminsulfát, mnohem méně informací máme o klinickém efektu diacereinu, piascledinu či metylsulfonylmetanu. Shoda ohledně jejich klinické užitečnosti se stále hledá. Většina odborných společností zabývajících se terapií osteoartrózy podávání těchto látek doporučuje. Jednotlivá doporučení se však liší ve stupni ocenění intervence. Obecně platí, že s narůstající závažností klesá efekt podávání nutraceutik.

Metabolic disorders and inflammatory processes in cartilage tissue have a pivotal role in the course of degenerative and other joint diseases. These processes are aimed at by orally administered medication for treatment of osteoarthritis and joint symptoms. Some of these substances stimulate recovery of the extracellular matrix in the cartilage, take part in its metabolic regulation and supress inflammatory changes to a certain extent. These drugs have a slow onset of effect, alleviate symptoms and are thought to have a disease-modifying effect. Chondroitin sulfate and glucosamine sulfate are most commonly used and best studied; less information is available for diacerein, piascledine and methylsulfonylmethane. An agreement on their clinical usefulness is yet to be found. Most of the clinical societies involved in osteoarthritis treatment recommend administering these substances. However, significance of this intervention can differ in various guidelines.

• Klíčová slova
• diacerein, piascledine, metylsulfonylmetan,
• MeSH
• aplikace orální MeSH
• chondroitinsulfáty aplikace a dávkování   farmakologie   MeSH
• chrupavka patofyziologie   MeSH
• glukosamin aplikace a dávkování   farmakologie   klasifikace   MeSH
• lidé MeSH
• nemoci kloubů * diagnostické zobrazování   farmakoterapie   patofyziologie   prevence a kontrola   terapie   MeSH
• osteoartróza diagnostické zobrazování   farmakoterapie   patofyziologie   prevence a kontrola   terapie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH

PURPOSE OF THE STUDY By 7th December 2016, 4,755 Bicon-Plus cups in total were implanted in the Czech Republic. Some of them have been continuously re-operated, while the most frequent reason of failure is polyethylene wear and aseptic loosening. The present study is focused on surface analysis of retrieved polyethylene Bicon-Plus cups and the determination of the roughness of their bearing surfaces. MATERIAL AND METHODS In this study, we had 13 high molecular weight polyethylene cups with the average time in situ of 8.11 years (3.6-13.7, SD 3.2) before the retrieval. The study population was composed of 3 men, 10 women, with the mean age of 53.31 years. An optical scanning method, based on the principle of active triangulation, was used to determine wear rate. The rate of wear was identified by means of an obtained scan subsequently processed with the use of the GOM Inspect software. The roughness of surfaces was analysed with the application of Contour GT-X8 profiler using the principle of phase shifting interferometry. Measurements of surface topography of the retrieved cups were performed on the entire bearing surfaces. For the individual surface changes, a typical range of surface roughness, describing the particular wear character, was determined. By means of morphology analysis of the tested implants, three areas were identified: unworn area; area representing the worn part of the cup; and the area roughened by parallel grooving. The total surface roughness was evaluated as an arithmetic mean of the measured values. Subsequently, the values were sorted based on frequency and were classified into categories defining the particular wear mechanisms. RESULTS Wear rate of the retrieved acetabular cups was evaluated based on the wear direction vector and the size of linear wear. The average linear wear was equal to 0.13 mm/year (ranging from 0.26 to 2.29 mm/year), and the mean value of total volumetric material loss was 44.37 mm3/year (the range being from 51.80 to 1,119.7 mm3/year). Using the optical profilometer, a map of roughness distribution of the individual cups was obtained. For each implant, 76 values of roughness were evaluated. With the respect to average roughness, the samples were sorted to various categories describing: surface polishing; abrasiveadhesive wear; surfaces with preserved grooving; substantial plastic deformation. DISCUSSION The results clearly showed an increase of wear depending on implant survival; however, the tendency is not linear. This fact can be attributed to a larger amount of abrasive particles, causing an increase of wear or occurrence of surface wear in terms of micro cracks and oxidation degradation of polyethylene. This study indicates that geometry, positioning, and cup alignment during the implantation have a fundamental impact on the cup durability. Further correlation, which was observed in the case of the cup with prevailing roughness in the range from 0.1 to 0.3 μm, is a relatively wide wear vector angle determined with the use of the optical method. Considering the implants with the longest survival time with no loosening of the acetabular cup, the mean angle of direction vector was 56.8° (SD 2.1°). CONCLUSIONS The present study provides the results of morphology analysis of the retrieved Bicon-Plus cups. In general, relatively high wear rate, mainly of abrasive-adhesive character was identified. The dependence between wear and implant in situ longevity was not clearly linear, which suggests the influence of other parameters on the polyethylene wear rate. An important role of implant positioning on survival was also revealed. Moreover, it seems that it can be a more important parameter than the characteristics of the patient. Key words: total hip arthroplasty, Bicon-Plus cup, retrieval analysis, surface analysis, wear measurement, roughness, deformation, survivorship.

• MeSH
• analýza selhání vybavení MeSH
• kyčelní protézy * MeSH
• lidé středního věku MeSH
• lidé MeSH
• náhrada kyčelního kloubu přístrojové vybavení   MeSH
• polyethylen MeSH
• povrchové vlastnosti MeSH
• protézy - design MeSH
• selhání protézy * MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

• MeSH
• antirevmatika farmakologie   terapeutické užití   MeSH
• bisfosfonáty farmakologie   terapeutické užití   MeSH
• diklofenak farmakologie   terapeutické užití   MeSH
• hormony kůry nadledvin farmakologie   terapeutické užití   MeSH
• ibuprofen farmakologie   terapeutické užití   MeSH
• inhibitory cyklooxygenasy farmakologie   terapeutické užití   MeSH
• kmenové buňky MeSH
• kyselina hyaluronová farmakologie   terapeutické užití   MeSH
• lidé MeSH
• management bolesti metody   MeSH
• management nemoci MeSH
• opioidní analgetika farmakologie   terapeutické užití   MeSH
• osteoartróza * farmakoterapie   terapie   MeSH
• plazma bohatá na destičky MeSH
• směrnice pro lékařskou praxi jako téma MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

Prosthetic joint infection (PJI) is a feared complication of total joint arthroplasty associated with increased morbidity and mortality. There is a growing body of evidence that bacterial colonization and biofilm formation are critical pathogenic events in PJI. Thus, the choice of biomaterials for implanted prostheses and their surface modifications may significantly influence the development of PJI. Currently, silver nanoparticle (AgNP) technology is receiving much interest in the field of orthopaedics for its antimicrobial properties and a strong anti-biofilm potential. The great advantage of AgNP surface modification is a minimal release of active substances into the surrounding tissue and a long period of effectiveness. As a result, a controlled release of AgNPs could ensure antibacterial protection throughout the life of the implant. Moreover, the antibacterial effect of AgNPs may be strengthened in combination with conventional antibiotics and other antimicrobial agents. Here, our main attention is devoted to general guidelines for the design of antibacterial biomaterials protected by AgNPs, its benefits, side effects and future perspectives in PJI prevention.

• MeSH
• antibakteriální látky terapeutické užití   MeSH
• biofilmy MeSH
• biokompatibilní materiály škodlivé účinky   MeSH
• infekce spojené s protézou * prevence a kontrola   MeSH
• lidé MeSH
• nanočástice terapeutické užití   MeSH
• protézy kloubů škodlivé účinky   MeSH
• sloučeniny stříbra * terapeutické užití   MeSH
• techniky in vitro metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH