VASCULARITY STUDY ON PERIPROSTHETIC TISSUES AROUND ASEPTIC LOOSENING AFTER TOTAL HIP ARTHROPLASTY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WUWen , YANMengning , ZHUZhen'an ,  DAIKerong

Department of Orthopedics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, P. R. China;

Corresponding author：

DAIKerong, Email: krdai@163.com

Keywords：

Aseptic loosening; Total hip arthroplasty; Vascularity; Microvessel density

DOI：

10.7507/1002-1892.20160009

Video：

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Objective To observe the vascularity in periprosthetic tissues of aseptic loosening after total hip arthroplasty (THA) and to explore the relationship between expression of vascularity and osteolysis. Methods Between October 2009 and June 2012, interface tissues were obtained from 22 patients (22 hips) who underwent revision of THA because of prosthetic aseptic loosening, including 12 males and 10 females with the age range of 53-81 years and prosthesis survival range of 6-14 years. The interface tissues were divided into osteolysis group and non-osteolysis group based on preoperative X-ray findings and intraoperative observation. The synovial tissues were harvested from another 8 patients (3 males and 5 females, aged 58-72 years) with osteoarthritis undergoing THA as control group. HE stainging was used to observe the histological character, and low-wear or high-wear was identified according to metal or polyethylene particles amount in osteolysis group. The CD34 immunohistochemical staining was used to mark the blood vessels. Microvessel density and microvessel index were calculated with the use of image analysis software. Results Histological observation showed that wear particles and numerous macrophages/multinucleated giant cells accumulated in the membrane of osteolysis group, while many fibroblasts and synovial cells existed in non-osteolysis group. The microvessels density and microvessel index were significantly lower in non-osteolysis group than those in osteolysis group and control group (P＜0.05), and there was no significant difference in microvessel density and microvessel index between osteolysis group and control group (P>0.05). There were less microvessel density and microvessel index in heavy-loaded metal or polyethylene wear particles areas than those in low-loaded metal or polyethylene wear particles areas (P＜0.05), and there was no significant difference in microvessel index and microvessel index between low-wear group and high-wear group for either polyethylene or metal particles (P>0.05). Conclusion The phagocytosis of macrophage in periprosthetic tissues need vicinal microvessels formation and blood supply to some extent. Vascular injury and decreased blood supply at the implant-bone interface seem to be one of the reasons for insufficient implant osseointegration and aseptic loosening.

Citation： WUWen, YANMengning, ZHUZhen'an, DAIKerong. VASCULARITY STUDY ON PERIPROSTHETIC TISSUES AROUND ASEPTIC LOOSENING AFTER TOTAL HIP ARTHROPLASTY. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(1): 39-43. doi: 10.7507/1002-1892.20160009 Copy

1.	魏均强,蔡谞,王岩,等.人工关节无菌性松动的发生和防治.中国修复重建外科杂志, 2010, 24(3):296-300.
2.	Gallo J, Vaculova J, Goodman SB, et al. Contributions of human tissue analysis to understanding the mechanisms of loosening and osteolysis in total hip replacement. Acta Biomater, 2014, 10(6):2354-2366.
3.	Takagi M, Konttinen YT, Santavirta S, et al. Extracellular matrix metalloproteinases around loose total hip prostheses. Acta Orthop Scand, 1994, 65(3):281-286.
4.	Hirose S, Otsuka H, Morishima T, et al. Outcomes of Charnley total hip arthroplasty using improved cementing with so-called second-and third-generation techniques. J Orthop Sci, 2012, 17(2):118-123.
5.	Aghayev E, Teuscher R, Neukamp M, et al. The course of radiographic loosening, pain and functional outcome around the first revision of a total hip arthroplasty. BMC Musculoskelet Disord, 2013, 14:167.
6.	孙燕萍,杜湘珂,陈雷.人工髋关节置换术后常见并发症的X线表现.中华放射学杂志, 2003, 37(4):352-355.
7.	Gruen TA, McNiece GM, Amstutz HC. "Modes of failure" of cemented stem-type femoral components:a radiographic analysis of loosening. Clin Orthop Relat Res, 1979, (141):17-27.
8.	DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res, 1976, (121):20-32.
9.	Doorn PF, Mirra JM, Campbell PA, et al. Tissue reaction to metal on metal total hip prostheses. Clin Orthop Relat Res, 1996, (329 Suppl):S187-205.
10.	Weidner N. Current pathologic methods for measuring intratumoral microvessel density within breast carcinoma and other solid tumors. Breast Cancer Res Treat, 1995, 36(2):169-180.
11.	Ingham E, Fisher J. The role of macrophages in osteolysis of total joint replacement. Biomaterials, 2005, 26(11):1271-1286.
12.	Saran U, Gemini Piperni S, Chatterjee S. Role of angiogenesis in bone repair. Arch Biochem Biophys, 2014, 561:109-117.
13.	Jiranek WA, Machado M, Jasty M, et al. Production of cytokines around loosened cemented acetabular components. Analysis with immunohistochemical techniques and in situ hybridization. J Bone Joint Surg (Am), 1993, 75(6):863-879.
14.	Holt G, Murnaghan C, Reilly J, et al. The biology of aseptic osteolysis. Clin Orthop Relat Res, 2007, 460(7):240-252.
15.	Spanogle JP, Miyanishi K, Ma T, et al. Comparison of VEGF-producing cells in periprosthetic osteolysis. Biomaterials, 2006, 27(21):3882-3887.
16.	Santavirta S, Ceponis A, Solovieva SA, et al. Periprosthetic microvasculature in loosening of total hip replacement. Arch Orthop Trauma Surg, 1996, 115(5):286-289.
17.	漆启华,戴闽,董谢平.细胞外基质金属蛋白酶诱导因子及基质金属蛋白酶9在镁硅玉人工关节假体无菌性松动中的作用.中国修复重建外科杂志, 2013, 27(10):1175-1180.
18.	Jell GM, Al-Saffar N. Does a pro-angiogenic state exist in the bone-implant interface of aseptically loosened joint prosthesis. J Mater Sci Mater Med, 2001, 12(10-12):1069-1073.
19.	Waris V, Sillat T, Waris E, et al. Role and regulation of VEGF and its receptors 1 and 2 in the aseptic loosening of total hip implants. J Orthop Res, 2012, 30(11):1830-1836.
20.	Taylor PC, Sivakumar B. Hypoxia and angiogenesis in rheumatoid arthritis. Curr Opin Rheumatol, 2005, 17(3):293-298.
21.	Wagner M, Hermanns I, Bittinger F, et al. Induction of stress proteins in human endothelial cells by heavy metal ions and heat shock. Am J Physiol, 1999, 277(5 Pt 1):L1026-1033.
22.	Nich C, Goodman SB. Role of macrophages in the biological reaction to wear debris from joint replacements. J Long Term Eff Med Implants, 2014, 24(4):259-265.
23.	Syggelos SA, Aletras AJ, Smirlaki I, et al. Extracellular matrix degradation and tissue remodeling in periprosthetic loosening and osteolysis:focus on matrix metalloproteinases, their endogenous tissue inhibitors, and the proteasome. Biomed Res Int, 2013, (2013):230805.
24.	戴闽,钟艳春,宗凌,等. VEGF抗体抑制磨损颗粒诱导骨溶解的实验研究.中国修复重建外科杂志, 2012, 26(6):647-651.

1. 魏均强,蔡谞,王岩,等.人工关节无菌性松动的发生和防治.中国修复重建外科杂志, 2010, 24(3):296-300.
2. Gallo J, Vaculova J, Goodman SB, et al. Contributions of human tissue analysis to understanding the mechanisms of loosening and osteolysis in total hip replacement. Acta Biomater, 2014, 10(6):2354-2366.
3. Takagi M, Konttinen YT, Santavirta S, et al. Extracellular matrix metalloproteinases around loose total hip prostheses. Acta Orthop Scand, 1994, 65(3):281-286.
4. Hirose S, Otsuka H, Morishima T, et al. Outcomes of Charnley total hip arthroplasty using improved cementing with so-called second-and third-generation techniques. J Orthop Sci, 2012, 17(2):118-123.
5. Aghayev E, Teuscher R, Neukamp M, et al. The course of radiographic loosening, pain and functional outcome around the first revision of a total hip arthroplasty. BMC Musculoskelet Disord, 2013, 14:167.
6. 孙燕萍,杜湘珂,陈雷.人工髋关节置换术后常见并发症的X线表现.中华放射学杂志, 2003, 37(4):352-355.
7. Gruen TA, McNiece GM, Amstutz HC. "Modes of failure" of cemented stem-type femoral components:a radiographic analysis of loosening. Clin Orthop Relat Res, 1979, (141):17-27.
8. DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res, 1976, (121):20-32.
9. Doorn PF, Mirra JM, Campbell PA, et al. Tissue reaction to metal on metal total hip prostheses. Clin Orthop Relat Res, 1996, (329 Suppl):S187-205.
10. Weidner N. Current pathologic methods for measuring intratumoral microvessel density within breast carcinoma and other solid tumors. Breast Cancer Res Treat, 1995, 36(2):169-180.
11. Ingham E, Fisher J. The role of macrophages in osteolysis of total joint replacement. Biomaterials, 2005, 26(11):1271-1286.
12. Saran U, Gemini Piperni S, Chatterjee S. Role of angiogenesis in bone repair. Arch Biochem Biophys, 2014, 561:109-117.
13. Jiranek WA, Machado M, Jasty M, et al. Production of cytokines around loosened cemented acetabular components. Analysis with immunohistochemical techniques and in situ hybridization. J Bone Joint Surg (Am), 1993, 75(6):863-879.
14. Holt G, Murnaghan C, Reilly J, et al. The biology of aseptic osteolysis. Clin Orthop Relat Res, 2007, 460(7):240-252.
15. Spanogle JP, Miyanishi K, Ma T, et al. Comparison of VEGF-producing cells in periprosthetic osteolysis. Biomaterials, 2006, 27(21):3882-3887.
16. Santavirta S, Ceponis A, Solovieva SA, et al. Periprosthetic microvasculature in loosening of total hip replacement. Arch Orthop Trauma Surg, 1996, 115(5):286-289.
17. 漆启华,戴闽,董谢平.细胞外基质金属蛋白酶诱导因子及基质金属蛋白酶9在镁硅玉人工关节假体无菌性松动中的作用.中国修复重建外科杂志, 2013, 27(10):1175-1180.
18. Jell GM, Al-Saffar N. Does a pro-angiogenic state exist in the bone-implant interface of aseptically loosened joint prosthesis. J Mater Sci Mater Med, 2001, 12(10-12):1069-1073.
19. Waris V, Sillat T, Waris E, et al. Role and regulation of VEGF and its receptors 1 and 2 in the aseptic loosening of total hip implants. J Orthop Res, 2012, 30(11):1830-1836.
20. Taylor PC, Sivakumar B. Hypoxia and angiogenesis in rheumatoid arthritis. Curr Opin Rheumatol, 2005, 17(3):293-298.
21. Wagner M, Hermanns I, Bittinger F, et al. Induction of stress proteins in human endothelial cells by heavy metal ions and heat shock. Am J Physiol, 1999, 277(5 Pt 1):L1026-1033.
22. Nich C, Goodman SB. Role of macrophages in the biological reaction to wear debris from joint replacements. J Long Term Eff Med Implants, 2014, 24(4):259-265.
23. Syggelos SA, Aletras AJ, Smirlaki I, et al. Extracellular matrix degradation and tissue remodeling in periprosthetic loosening and osteolysis:focus on matrix metalloproteinases, their endogenous tissue inhibitors, and the proteasome. Biomed Res Int, 2013, (2013):230805.
24. 戴闽,钟艳春,宗凌,等. VEGF抗体抑制磨损颗粒诱导骨溶解的实验研究.中国修复重建外科杂志, 2012, 26(6):647-651.

Chinese Journal of Reparative and Reconstructive Surgery

VASCULARITY STUDY ON PERIPROSTHETIC TISSUES AROUND ASEPTIC LOOSENING AFTER TOTAL HIP ARTHROPLASTY

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