The role of bacterial corrosion on recolonization of titanium implant surfaces: An in vitro study.

BACKGROUND: Inflammation triggered by bacterial biofilms in the surrounding tissue is a major etiological factor for peri-implantitis and subsequent implant failure. However, little is known about the direct effects of bacterial corrosion and recolonization on implant failure PURPOSE: To investigate the influence of oral commensals on bacterial corrosion and recolonization of titanium surfaces. MATERIALS AND METHODS: Streptococcus sanguinis (S. sanguinis) and Porphyromonas gingivalis (P. gingivalis), which are key bacteria in oral biofilm formation, were cultured on commercially pure titanium and titanium-aluminum-vanadium (Ti6Al4V) plates in artificial saliva/brain heart infusion medium under aerobic or anaerobic conditions. Biofilm formation was examined after 7 and 21 days by crystal violet and live/dead staining. Titanium ions released into culture supernatants were analyzed over a period of 21 days by atomic absorption spectrometry. Visual changes in surface morphology were investigated using scanning electron microscopy. Biofilm formation on sterilized, biocorroded, and recolonized implant surfaces was determined by crystal violet staining. RESULTS: S. sanguinis and P. gingivalis formed stable biofilms on the titanium samples. Bacterial corrosion led to a significant increase in titanium ion release from these titanium plates (p < 0.01), which was significantly higher under aerobic conditions on pure titanium (p ≤ 0.001). No obvious morphological surface changes, such as pitting and discoloration, were detected in the titanium samples. During early biofilm formation, the addition of titanium ions significantly decreased the number of live cells. In contrast, a significant effect on biofilm mass was only detected with P. gingivalis. Bacterial corrosion had no influence on bacterial recolonization following sterilization of titanium and Ti6Al4V surfaces. CONCLUSION: Bacterial corrosion differs between oral commensal bacteria and leads to increased titanium ion release from titanium plates. The titanium ion release did not influence biofilm formation or bacterial recolonization under in vitro conditions.

Influence of Metallic Deposition on Ceramic Femoral Heads on the Wear Behavior of Artificial Hip Joints: A Simulator Study.

Several retrieval studies have reported on metallic depositions on ceramic femoral heads, but the effect on the wear behavior of artificial hip joints has not been investigated in wear simulator studies. In the present study, retrieved ceramic heads with metallic depositions as third particles were tested against cross-linked ultra-high-molecular-weight polyethylene (UHMWPE) liners in a hip wear simulator. The amount of liner wear and expansion of metallic depositions on the heads were determined before and after wear testing with digital microscopy. The surface roughness of the heads was investigated in areas with and without metallic depositions by laser scanning microscopy. After five million load cycles, a non-significant reduction in the metallic formation on the retrieved heads was found. The metallic areas showed a higher surface roughness compared to unconcerned areas. The liners showed a higher wear rate of 1.57 ± 1.36 mg/million cycles for 28 mm heads and 2.42 ± 0.82 mg/million cycles for 36 mm heads with metallic depositions, in comparison with new ceramic heads with a 28 mm size ((-0.06 ± 0.89) mg/million cycles) and 36 mm size ((2.04 ± 0.46) mg/million cycles). Metallic transfer on ceramic heads can lead to an increased surface roughness and higher wear rates at the UHMWPE liners. Therefore, metallic contact of the ceramic femoral head should be avoided.

Influence of Different Damage Patterns of the Stem Taper on Fixation and Fracture Strength of Ceramic Ball Heads for Total Hip Replacement.

BACKGROUND: Modularity finds frequent application in total hip replacement, allowing a preferable individual configuration and a simplified revision by retaining the femoral stem and replacing the prosthetic head. However, micromotions within the interface between the head and the stem taper can arise, resulting in the release of wear debris and corrosion products. The aim of our experimental study was to evaluate the influence of different taper damages on the fixation and fracture stability of ceramic femoral heads, after static and dynamic implant loading. METHODS: Ceramic ball heads (36 mm diameter) and 12/14 stem tapers made of titanium with various mild damage patterns (intact, scratched, and truncated) were tested. The heads were assembled on the taper with a quasistatic load of 2 kN and separated into a static and a dynamic group afterwards. The dynamic group (n = 18) was loaded over 1.5 million gait cycles in a hip wear simulator (ISO 14242-1). In contrast, the static group (n = 18) was not mechanically loaded after assembly. To determine the taper stability, all heads of the dynamic and static groups were either pulled off (ASTM 2009) or turned off (ISO 7206-16). A head fracture test (ISO 7206-10) was also performed. Subsequent to the fixation stability tests, the taper surface was visually evaluated in terms of any signs of wear or corrosion after the dynamic loading. RESULTS: In 10 of the 18 cases, discoloration of the taper was determined after the dynamic loading and subsequent cleaning, indicating the first signs of corrosion. Pull-off forces as well as turn-off moments were increased between 23% and 54% after the dynamic loading compared to the unloaded tapers. No significant influence of taper damage was determined in terms of taper fixation strength. However, the taper damage led to a decrease in fracture strength by approximately 20% (scratched) and 40% (truncated), respectively. CONCLUSION: The results suggest that careful handling and accurate manufacturing of the stem taper are crucial for the ceramic head fracture strength, even though a mild damage showed no significant influence on taper stability. Moreover, our data indicate that a further seating of the prosthetic head may occur during daily activities, when the resulting hip force increases the assembly load.

Neuromuscular function of the quadriceps muscle during isometric maximal, submaximal and submaximal fatiguing voluntary contractions in knee osteoarthrosis patients.

INTRODUCTION: Knee osteoarthrosis (KOA) is commonly associated with a dysfunction of the quadriceps muscle which contributes to alterations in motor performance. The underlying neuromuscular mechanisms of muscle dysfunction are not fully understood. The main objective of this study was to analyze how KOA affects neuromuscular function of the quadriceps muscle during different contraction intensities. MATERIALS AND METHODS: The following parameters were assessed in 20 patients and 20 healthy controls: (i) joint position sense, i.e. position control (mean absolute error, MAE) at 30° and 50° of knee flexion, (ii) simple reaction time task performance, (iii) isometric maximal voluntary torque (IMVT) and root mean square of the EMG signal (RMS-EMG), (iv) torque control, i.e. accuracy (MAE), absolute fluctuation (standard deviation, SD), relative fluctuation (coefficient of variation, CV) and periodicity (mean frequency, MNF) of the torque signal at 20%, 40% and 60% IMVT, (v) EMG-torque relationship at 20%, 40% and 60% IMVT and (vi) performance fatigability, i.e. time to task failure (TTF) at 40% IMVT. RESULTS: Compared to the control group, the KOA group displayed: (i) significantly higher MAE of the angle signal at 30° (99.3%; P = 0.027) and 50° (147.9%; P < 0.001), (ii) no significant differences in reaction time, (iii) significantly lower IMVT (-41.6%; P = 0.001) and tendentially lower RMS-EMG of the rectus femoris (-33.7%; P = 0.054), (iv) tendentially higher MAE of the torque signal at 20% IMVT (65.9%; P = 0.068), significantly lower SD of the torque signal at all three torque levels and greater MNF at 60% IMVT (44.8%; P = 0.018), (v) significantly increased RMS-EMG of the vastus lateralis at 20% (70.8%; P = 0.003) and 40% IMVT (33.3%; P = 0.034), significantly lower RMS-EMG of the biceps femoris at 20% (-63.6%; P = 0.044) and 40% IMVT (-41.3%; P = 0.028) and tendentially lower at 60% IMVT (-24.3%; P = 0.075) and (vi) significantly shorter TTF (-51.1%; P = 0.049). CONCLUSION: KOA is not only associated with a deterioration of IMVT and neuromuscular activation, but also with an impaired position and torque control at submaximal torque levels, an altered EMG-torque relationship and a higher performance fatigability of the quadriceps muscle. It is recommended that the rehabilitation includes strengthening and fatiguing exercises at maximal and submaximal force levels.