Table Of ContentBiomarkers of Hip Implant Function
Biomarkers of Hip
Implant Function
Edited by
Ilona S´wia˛tkowska
InstituteofOrthopaedics and Musculoskeletal Science,
University College London,Stanmore,UnitedKingdom
List of contributors
ObakanyinJ.Akinfosile RegenerativeMedicineandDisabilityLaboratory,
Department of Biomedical Sciences, University of Illinois College of Medicine
Rockford,Rockford,IL,UnitedStates
RavindraV.Badhe RegenerativeMedicineandDisabilityLaboratory,Department
of Biomedical Sciences, University of Illinois College of Medicine Rockford,
Rockford,IL,UnitedStates
MarkBarba Orthoillinois,DepartmentofSurgery,Rockford,IL,UnitedStates
AndrewR.Beadling InstituteofFunctionalSurfaces(iFS),SchoolofMechanical
Engineering,UniversityofLeeds,Leeds,UnitedKingdom
ReshidBerber NottinghamUniversityHospitalNHSTrust,Nottingham,
UnitedKingdom
DivyaBijukumar BlazerNanomedicineLaboratory,DepartmentofBiomedical
Sciences,UniversityofIllinoisCollegeofMedicine,Rockford,IL,UnitedStates
BenjaminBloch NottinghamUniversityHospitals,NHSTrust,Nottingham,
UnitedKingdom
MichaelG.Bryant InstituteofFunctionalSurfaces(iFS),SchoolofMechanical
Engineering,UniversityofLeeds,Leeds,UnitedKingdom
AlisterJ.Hart RoyalNationalOrthopaedicHospital,Stanmore,UnitedKingdom
Laura-MariaHorga InstituteofOrthopaedicsandMusculoskeletalScience,
UniversityCollegeLondon,Stanmore,UnitedKingdom
HarryHothi RoyalNationalOrthopaedicHospital,Stanmore,UnitedKingdom
PeterJames NottinghamUniversityHospitals,NHSTrust,Nottingham,UnitedKingdom
Marc-OlivierKiss DepartmentofSurgery,HospitalMaisonneuve-Rosemont,
UniversityofMontreal,Montreal,QC,Canada
AndrewManktelow NottinghamUniversityHospitals,NHSTrust,Nottingham,
UnitedKingdom
VincentMasse´ DepartmentofSurgery,HospitalMaisonneuve-Rosemont,University
ofMontreal,Montreal,QC,Canada
MathewT.Mathew RegenerativeMedicineandDisabilityLaboratory,Department
of Biomedical Sciences, University of Illinois College of Medicine Rockford,
Rockford,IL,UnitedStates
AnneNeville InstituteofFunctionalSurfaces(iFS),SchoolofMechanical
Engineering,UniversityofLeeds,Leeds,UnitedKingdom
xi
xii Listofcontributors
ShirazA.Sabah NuffieldDepartmentofOrthopaedics,Rheumatology,and
MusculoskeletalSciences,UniversityofOxford,Oxford,UnitedKingdom
AngelaStyhler SurgeryDepartment,HoˆpitalMaisonneuve-Rosemont,Montreal
University,Montre´al,QC,Canada
Pascal-Andre´ Vendittoli SurgeryDepartment,HoˆpitalMaisonneuve-Rosemont,
MontrealUniversity,Montre´al,QC,Canada
IlonaS´wia˛tkowska InstituteofOrthopaedicsandMusculoskeletalScience,
UniversityCollegeLondon,Stanmore,UnitedKingdom
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Contents
Listofcontributors xi
Part I
Foundational information 1
1. Introduction to hip implants and biomarker testing 3
IlonaS´wia˛tkowska,ShirazA.Sabah,Laura-MariaHorgaand
AlisterJ.Hart
1.1 Overviewofthehipjoint 3
1.1.1 Anatomyofthehip 3
1.1.2 Hipjointpathologies 7
1.2 Overviewofhipimplants 10
1.2.1 Implantbiomaterials 10
1.2.2 Bonefixation 13
1.2.3 Implantclassification 13
1.2.4 Evolutionofatotalhipreplacement 15
1.2.5 Theriseandfallofhipresurfacing 17
1.2.6 Implantdegradation 18
1.2.7 Implantperformance 19
1.3 Introductiontobiomarkers 21
1.3.1 Biomarkerdiscovery 25
1.3.2 Assayvalidation 26
1.3.3 Evaluationofclinicalvalidity 26
1.3.4 Characteristicsofanidealbiomarker 34
1.3.5 Biomarkersofhipimplantfunctionandtoxicity 35
References 35
2. Degradation of metal hip implants 41
AndrewR.Beadling,AnneNevilleandMichaelG.Bryant
2.1 Introductiontometallicbiomaterials 41
2.1.1 Iron-basedalloys 41
2.1.2 Cobalt-basedalloys 42
2.1.3 Titanium-basedalloys 42
2.2 Introductiontotribology 42
2.2.1 Contactofsurfaces 43
v
vi Contents
2.2.2 Friction 44
2.2.3 Wearofmaterials 45
2.2.4 Lubrication 48
2.3 Introductiontocorrosion 50
2.3.1 Thermodynamicsandelectrochemistry 50
2.3.2 Passivityofmetallicmaterials 52
2.3.3 Typesofcorrosion 55
2.4 Tribocorrosion 57
2.5 Modernhipreplacements 59
2.5.1 Sourcesofdegradation 60
2.5.2 Adversereactiontometaldebris 64
2.5.3 Assessingmateriallossfrommetalhipimplants 64
2.5.4 Studyingmetaldepositsintissue 66
2.6 Summaryandfuturedirections 70
References 70
3. Implant metals and their potential toxicity 75
IlonaS´wia˛tkowska
3.1 Hipimplantmetalsandthehumanhealth 75
3.1.1 Cobalt 76
3.1.2 Chromium 80
3.1.3 Molybdenum 84
3.1.4 Nickel 85
3.1.5 Titanium 86
3.1.6 Vanadium 88
3.1.7 Aluminium 90
3.1.8 Reproductivetoxicity 91
3.1.9 Genotoxicityandcarcinogenicity 92
3.2 Metalhypersensitivity 93
3.3 Localeffectsofmetaldebris 94
References 96
Part II
Assessing hip implant function and risk of
local and systemic adverse reactions 105
4. Markers of hip implant degradation: analytical
considerations and clinical interpretation 107
Pascal-Andre´ Vendittoli,AngelaStyhlerandIlonaS´wia˛tkowska
4.1 Introduction 107
4.2 Mechanismsofimplantdegradation 108
4.2.1 Passivecorrosion 108
4.2.2 Galvaniccorrosion 109
Contents vii
4.2.3 Mechanicallyassistedcorrosion 110
4.2.4 Bearingwear 111
4.2.5 Abnormalcomponentcontact 112
4.3 Measuringsystemiclevelsofcobalt,chromium,and
titanium 113
4.3.1 Choiceofsampletype 114
4.3.2 Specimencollectionandstorage 116
4.3.3 Quantificationofmetallevels 117
4.4 Usingsystemicmetallevelstoassessimplant
degradationandriskoflocaladversereactions 121
4.4.1 Cobaltandchromium 123
4.4.2 Titanium 125
4.5 Summaryandfuturedirections 127
References 129
5. Biomarkers of compromised implant fixation 137
ReshidBerber,BenjaminBloch,PeterJamesand
AndrewManktelow
5.1 Introduction 137
5.2 Osseointegrationofhipimplants 138
5.2.1 Implantdesign 140
5.2.2 Patient-relatedfactors 143
5.2.3 Surgeon-relatedfactors 144
5.3 Periprostheticosteolysisandasepticloosening 145
5.4 Postoperativemeasurestostimulateosseointegrationand
inhibitosteolysis 146
5.4.1 Rehabilitationandpostoperativedrugs 146
5.4.2 Pharmacologicalinhibitionofperiprostheticosteolysis 147
5.4.3 Biophysicalstimulation 148
5.5 Monitoringpatientsforsignsofperiprosthetic
osteolysisandasepticloosening 149
5.6 Molecularbiomarkersofperiprostheticosteolysisand
asepticloosening 152
5.6.1 Inflammatorymarkers 152
5.6.2 Markersofboneturnover 153
5.6.3 Markersofoxidativestress 155
5.6.4 Single-nucleotidepolymorphisms 157
5.7 Summaryandfuturedirections 159
References 160
6. Biomarkers of periprosthetic joint infection 167
Marc-OlivierKissandVincentMasse´
6.1 Introduction 167
6.2 Periprostheticjointinfection 168
6.2.1 Pathogenesisandbacterialaetiology 168
viii Contents
6.2.2 Clinicalpresentation 169
6.2.3 Treatment 169
6.3 Clinicaldefinitionofperiprostheticjointinfection 170
6.4 Diagnosticcategories 172
6.4.1 Clinicalsymptoms 172
6.4.2 Imagingstudies 172
6.4.3 Bloodbiomarkers 179
6.4.4 Synovialbiomarkers 184
6.4.5 Microbiology 189
6.4.6 Histology 191
6.4.7 Moleculartechniques 192
6.5 Confoundingfactors 193
6.5.1 Adversereactiontometaldebris 193
6.5.2 Inflammatoryarthritis 194
6.5.3 Crystal-inducedarthritis 194
6.6 Summaryandfuturedirections 195
References 196
7. Hip implants and systemic cobalt toxicity: a
comprehensive review with case studies 205
IlonaS´wia˛tkowska,ObakanyinJ.Akinfosile,RavindraV.Badhe,
MarkBarba,MathewT.MathewandDivyaBijukumar
7.1 Introduction 205
7.2 Arthroprostheticcobaltism 207
7.2.1 Casestudies 216
7.2.2 Mechanismsofcobalttoxicity 226
7.2.3 Differentialdiagnosis 229
7.2.4 Treatment 233
7.2.5 Individualsusceptibilitytosystemiccobalttoxicity 236
7.2.6 Systemictoxicityandfreecobaltionlevels 238
7.3 Summaryandfuturedirections 239
References 240
Part III
Translational effect of biomarker research on
clinical practice 249
8. Clinical guidelines on the use of biomarkers for
surveillance of hip replacements 251
HarryHothi,ReshidBerber,ShirazA.SabahandAlisterJ.Hart
8.1 Introduction 251
8.2 Evaluatingimplantwearandriskoflocaladversereactions
tometaldebrisinpatientswithmetal-on-metalhips 252
