Local Cellular Responses to Titanium Dioxide from Orthopedic Implants

^[dagger]

These authors contributed equally.

^[Dagger]

Current address: Department of Biological Sciences, Hampton University, Hampton, Virginia.

*, Address correspondence to: David G. Lewallen, MD, Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, E-mail: [email protected], or, Andre J. van Wijnen, PhD, Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, E-mail: [email protected]

© Jie J. Yao et al. 2017; Published by Mary Ann Liebert, Inc. This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Introduction

Total joint arthroplasty (TJA) is the definitive treatment for severely damaged synovial joints (e.g., symptomatic osteoarthritis^1,2 ). As the number of TJA patients in the United States rises from an estimated 7 million,^3,4 demands for revision TJA will concurrently increase. Indications for revision TJA include septic and aseptic etiologies (e.g., dislocations, polyethylene wear, wear-induced osteolysis, implant loosening, and adverse local tissue reactions^5,6 ), whereas the causes of such complications often go undetected (e.g., latent periprosthetic joint infections), and mechanisms remain unidentified.⁷ Poor surgical technique and implant design cause implant failure, yet 10-15% of patients experience aseptic implant failure despite well-designed implants and meticulous surgical technique.^8-10 We propose that the release of titanium nanoparticles may contribute to aseptic implant loosening by negatively influencing periprosthetic skeletal repair cells.

Implant materials can corrode, degrade, and...