Department of Orthopaedic Surgery, Otto-von-Guericke University, Magdeburg, Germany.
Mathys AG Bettlach, Bettlach, Switzerland.
Bone Joint J. 2018 Jul;100-B(7):882-890. doi: 10.1302/0301-620X.100B7.BJJ-2017-1590.R2.
Early evidence has emerged suggesting that ceramic-on-ceramic articulations induce a different tissue reaction to ceramic-on-polyethylene and metal-on-metal bearings. Therefore, the aim of this study was to investigate the tissue reaction and cellular response to ceramic total hip arthroplasty (THA) materials in vitro, as well as the tissue reaction in capsular tissue after revision surgery of ceramic-on-ceramic THAs.
We investigated tissue collected at revision surgery from nine ceramic-on-ceramic articulations. we compared our findings with tissue obtained from five metal-on-metal THA revisions, four ceramic-on-polyethylene THAs, and four primary osteoarthritis synovial membranes. The latter were analyzed to assess the amount of tissue fibrosis that might have been present at the time of implantation to enable evaluation, in relation to implantation time, of any subsequent response in the tissues.
There was a significant increase in tissue fibrosis with implantation time for all implant types tested. Interestingly, the tissue fibrosis in ceramic-on-ceramic THAs was significantly increased compared with metal-on-metal and ceramic-on-polyethylene. Additionally, we found ceramic wear particles in the periprosthetic tissue of ceramic implants. Fibroblasts responded with expression of cytokines when cultured on alumina-toughened zirconia (ATZ) and zirconia-toughened alumina (ZTA) ceramic surfaces. This response was more pronounced on ATZ ceramics compared with ZTA ceramics. The same inflammatory response was observed with peripheral blood mononuclear cells (PBMCs) cultured on ZTA and ATZ.
Our findings therefore, corroborate the previous findings that ceramic-on-ceramic periprosthetic revision tissue is fibrous and offer an explanation for this observation. We detected a long-term inflammatory response of PBMCs and an inflammatory response of fibroblasts to ATZ and ZTA ceramic. These findings partially explain the fibrotic tissue change in periprosthetic tissue of ceramic-on-ceramic bearings. Cite this article: Bone Joint J 2018;100-B:882-90.
早期证据表明，陶瓷-陶瓷关节与陶瓷-聚乙烯和金属-金属关节相比，会引起不同的组织反应。因此，本研究旨在体外研究陶瓷全髋关节置换术（THA）材料的组织反应和细胞反应，以及陶瓷-陶瓷 THA 翻修手术后囊组织的组织反应。
我们研究了 9 例陶瓷-陶瓷关节翻修手术中采集的组织。我们将研究结果与 5 例金属-金属 THA 翻修、4 例陶瓷-聚乙烯 THA 和 4 例原发性骨关节炎滑膜的组织进行了比较。后者的分析旨在评估植入时可能存在的组织纤维化量，以便根据植入时间评估组织的任何后续反应。
所有测试植入物类型的组织纤维化均随植入时间的增加而显著增加。有趣的是，陶瓷-陶瓷 THA 的组织纤维化明显高于金属-金属和陶瓷-聚乙烯。此外，我们在陶瓷植入物的假体周围组织中发现了陶瓷磨损颗粒。成纤维细胞在氧化铝增韧氧化锆（ATZ）和氧化锆增韧氧化铝（ZTA）陶瓷表面培养时，通过表达细胞因子来响应。与 ZTA 陶瓷相比，ATZ 陶瓷的反应更为明显。在 ZTA 和 ATZ 陶瓷上培养的外周血单核细胞（PBMC）也观察到相同的炎症反应。
因此，我们的研究结果证实了之前的研究结果，即陶瓷-陶瓷假体周围组织是纤维状的，并为这一观察结果提供了解释。我们检测到 PBMC 的长期炎症反应和成纤维细胞对 ATZ 和 ZTA 陶瓷的炎症反应。这些发现部分解释了陶瓷-陶瓷关节假体周围组织的纤维组织变化。
Bone Joint J 2018;100-B:882-90.
