Electrocautery-induced molten metal particle generation from total joint replacements: Morphology and chemistry.

Electrosurgical techniques are used during surgery to cauterize, and their damaging effects have primarily been documented in terms of tissue necrosis, charring, and localized heat accumulation. Metallic implants as well as the surgical blade can experience incidental electrosurgical current arcing that results in the generation and transfer of melted metallic particles. This work examines the composition, particle size distribution, and chemical state of the melted alloy surfaces and particles produced in vitro. Using scanning electron microscopy and energy dispersive spectroscopy, a flash-melting particle generation phenomenon between source 304 SSL blades and polished cobalt-chromium-molybdenum (CoCrMo) and titanium-6-aluminum-4-vandaium (Ti6Al4V) surfaces was documented where 304 SSL mixed heterogeneously with the CoCrMo and Ti6Al4V ejecting "splatter" particles from the cautery site. The spherical micron-sized particles were embedded with sub-micron-sized particles with 42% of the total sample population measuring between 0.25 and 0.35 µm in diameter. CoCrMo-304 SSL particles were principally made of high concentrations of iron, oxygen, and nickel with embedded sub-micron-sized particles containing oxygen, chromium, and cobalt with lower concentrations of iron and molybdenum. Ti6Al4V-304 SSL interactions resulted in similar micron-sized particles made up of high concentrations of iron, nickel, and chromium with embedded sub-micron-sized particles containing titanium, oxygen, and small amounts of aluminum. X-ray photoelectron spectroscopy of damaged CoCrMo surfaces confirmed the presence of chromium (VI) following dry electrocautery contact in coagulation mode. The structural effects of electrocautery-induced damage are becoming visible in retrieval analysis, but the long-term physiological implications during the lifetime of the implant from this damage mode have yet to be defined.

Synthetic periprosthetic synovial fluid development for in vitro cell-tribocorrosion testing using the Taguchi array approach.

Synovial fluid is dynamic in vivo with biological components changing in ratio and size depending on the health of the joint space, making it difficult to model in vitro. Previous efforts to develop synthetic synovial fluid have typically focused on single organic-tribological interactions with implant surfaces, thus ignoring interplay between multiple solution components. Using a Taguchi orthogonal array, we were able to isolate the individual effects of five independent synovial fluid composition variables: ratios of (1) hyaluronic acid to phospholipids (HA:PL) and (2) albumin to globulin (A:G), and concentrations of (3) hydrogen peroxide (H2 O2 ), (4) cobalt (Co2+ ) and (5) chromium (Cr3+ ) ions on macrophage viability and reduced glutathione production, local solution pH and the comprehensive CoCrMo alloy electrochemical response. While no single synovial fluid variable significantly affected the collective response, HA:PL ratio resulted in the largest impact factor (Δ) on 12 of the 13 measured responses with significant effects (p < .05) on the average macrophage survival rate and electrochemical capacitive state of the CoCrMo surface. Cluster analysis separated significant responses from all trials into three groups, corresponding to healthy, mild, or severely inflamed fluids, respectively; with the healthy synovial fluid composition having mid-range HA:PL ratios with no Co2+ ions, and the severely inflamed fluids consisting of low and high HA:PL ratios with H2 O2 and Co2+ ions. By utilizing the Taguchi approach in combination with cluster analysis, we were able to advance our knowledge of complex multivariate synthetic synovial fluids influence on macrophage and electrochemical behavior at the cell-solution-metal interface.

Sensing Localized Surface Corrosion Damage of CoCrMo Alloys and Modular Tapers of Total Hip Retrievals Using Nearfield Electrochemical Impedance Spectroscopy.

Wear and corrosion damage of biomedical alloys alters the structure and electrochemical properties of the surface heterogeneously. It was hypothesized that local regions on the same surface systematically differ from one another in terms of their impedance characteristics. To test this hypothesis, CoCrMo disks exposed to electrosurgical and inflammatory-species-driven damage were characterized using a localized impedance technique, nearfield electrochemical impedance spectroscopy (NEIS), to assess point-specific surface integrity in response to applied damage. It was found that electrosurgical damage, as may arise during primary arthroplasty and revision surgeries, and hydrogen peroxide concentrations of 5-10 mM significantly alter the corrosion susceptibility of the local surface compared to the as-polished CoCrMo surface. A CoCrMo retrieved neck taper (Goldberg score of 4) was scored in different local regions on the basis of visual appearance, and it was found that there is a direct relationship between increasing debris coverage and decreasing impedance, with the global surface impedance closest to the most severely scored local region. This noninvasive method, which uses a millielectrode configuration to test localized regions, can measure the heterogeneous electrochemical impedance of an implant surface and be tailored to assess specific damage and corrosion mechanisms revealed on retrieval surfaces.

A fluorescent approach for detecting and measuring reduction reaction byproducts near cathodically-biased metallic surfaces: Reactive oxygen species production and quantification.

During tribocorrosion of biomedical alloys, potentials may shift cathodically across the metal-oxide-electrolyte interface resulting in the increased reduction of local oxygen and water molecules. The products of reduction are thought to include reactive oxygen species (ROS) as well as hydroxide ions. Using fluorescent probes, developed for labeling intracellular ROS-based hydroxyl radicals (OH·) and hydrogen peroxide (H2O2), ROS generation due to reduction reactions at cathodically biased CoCrMo alloy surfaces was measured directly. Using terephthalic acid (TA) and pentafluorosulfonylbenzene-fluorescein (PFF) as fluorescent dosimeters, it was found that OH· and H2O2 concentrations increased up to 16 h and 2 h, respectively. Decreases in fluorescence past these time points were attributed to the continuous onset of reduction reactions consuming both the ROS and/or dosimeter. It was also found that voltages below and including -600 mV (vs. Ag/AgCl) produced measurable quantities of H2O2 after two hours of polarization, with concentrations increasing with decreasing potentials up to -1000 mV. The detection and quantification of ROS in a clinical setting could help us better understand the role of ROS in the inflammatory response as well as their impact on corrosion behavior of biomedical alloys.

Enhancing mechanical properties of an injectable two-solution acrylic bone cement using a difunctional crosslinker.

Two-solution bone cements modified with ethylene glycol-dimethacrylate (EG-DMA) as a crosslinker have been developed as an attempt to further improve the mechanical properties of acrylic bone cement. The result of this study shows that EG-DMA can increase the mechanical properties and fractional monomer conversion while preserving the thermal characteristics. The strength and bending modulus increase with EG-DMA concentrations at 5-10 vol % EG-DMA. Substituting the EG-DMA content past 10 vol % decreases the bending properties due to the effects of reduced monomer concentrations. Strengthened EG-DMA samples demonstrated an increase in ductility with noticeably different fracture surface morphologies than the control samples, indicated by microtroughs and ridge formation caused by excessive plastic strain. This work provides insight into the effect of substituting a crosslinker for MMA monomer in an injectable two-solution system and lays out the ideal concentrations of EG-DMA for superior mechanical or fractional monomer conversion properties. © 2018 Wiley Periodicals, Inc. J. Biomed. Mater. Res. Part B, 2018. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 783-790, 2019.

Electrochemical potential zone of viability on CoCrMo surfaces is affected by cell type: Macrophages under cathodic bias are more resistant to killing.

Electrochemical interactions at the cell-metal interface determine cell viability and influence behavior in response to different electrode potential conditions, specifically cathodic biases. Mechanically assisted crevice corrosion, for example, induces cathodic potentials and the associated electrochemical consequences of increased reduction reactions at the implant surface may affect cell viability in a manner that is different for various cell phenotypes. Monocyte macrophage-like U937 cells were cultured on cobalt-chromium-molybdenum (CoCrMo) metal surfaces in vitro for 24 h to assess cell behavior in response to sustained applied voltages. The electrochemical zone of viability for U937 cells polarized for 24 h in vitro was -1000 ≤ mV < +500, compared to -400 < mV < +500 for MC3T3-E1 preosteoblast-like cells cultured under the same conditions, likely as a result of intrinsic apoptosis. Voltages above +250 mV had a lethal effect on U937 cells that was similar to that seen previously for MC3T3-E1 cells on biased CoCrMo surfaces. It appears that cell phenotype directly influences behavior in response to cathodic electrochemical stimuli and that the monocyte macrophage-like cells are more resistant to cathodic potential stimuli than preosteoblasts. This may be due to a glutathione-based increased ability to quench reactive oxygen species and inflammatory-associated radicals hypothesized to be generated during reduction of oxygen. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 107A: 526-534, 2019.