RESUMEN
PURPOSE: This study aimed to evaluate the incidence of "implant" fractures after knee arthroplasty using clinical literature and worldwide arthroplasty registers. The hypothesis was that register datasets report higher rates of these rare complications than clinical studies. METHODS: Calculations were based on the pooled incidence of revision operations after fractures of knee arthroplasties, comparing clinical studies published in MEDLINE-listed journals and annual reports from worldwide arthroplasty registers in a structured literature analysis based on a standardized methodology. RESULTS: Twelve clinical studies and datasets from six worldwide registers were included. Rates of fractures of knee arthroplasties were reported from 0.2 to 2.5 % in clinical studies versus 0.02-0.17 % in worldwide arthroplasty registers. CONCLUSIONS: Fractures of knee arthroplasty systems are rare complications, with clinical studies showing higher incidence rates than worldwide arthroplasty registries. Unicompartmental knee arthroplasty (UKA) implanted before 2000, constrained primary or revision constrained total knee arthroplasties, and patellar replacements showed the highest incidence of implant fracture. The results of this analysis can help clinicians to counsel patients on potential complications following knee arthroplasty. LEVEL OF EVIDENCE: III.
Asunto(s)
Artroplastia de Reemplazo de Rodilla/efectos adversos , Fracturas Periprotésicas/epidemiología , Complicaciones Posoperatorias/epidemiología , Humanos , Incidencia , Prótesis de la Rodilla , Rótula/cirugía , Sistema de Registros , ReoperaciónRESUMEN
Since the α1-adrenergic antagonist prazosin (PRZ) was introduced into medicine as a treatment for hypertension and benign prostate hyperplasia, several studies have shown that PRZ induces apoptosis in various cell types and interferes with endocytotic trafficking. Because PRZ is also able to induce apoptosis in malignant cells, its cytotoxicity is a focus of interest in cancer research. Besides inducing apoptosis, PRZ was shown to serve as a substrate for an amine uptake mechanism originally discovered in neurones called transport-P. In line with our hypothesis that transport-P is an endocytotic mechanism also present in non-neuronal tissue and linked to the cytotoxicity of PRZ, we tested the uptake of QAPB, a fluorescent derivative of PRZ, in cancer cell lines in the presence of inhibitors of transport-P and endocytosis. Early endosomes and lysosomes were visualised by expression of RAB5-RFP and LAMP1-RFP, respectively; growth and viability of cells in the presence of PRZ and uptake inhibitors were also tested. Cancer cells showed co-localisation of QAPB with RAB5 and LAMP1 positive vesicles as well as tubulation of lysosomes. The uptake of QAPB was sensitive to transport-P inhibitors bafilomycin A1 (inhibits v-ATPase) and the antidepressant desipramine. Endocytosis inhibitors pitstop(®) 2 (general inhibitor of endocytosis), dynasore (dynamin inhibitor) and methyl-ß-cyclodextrin (cholesterol chelator) inhibited the uptake of QAPB. Bafilomycin A1 and methyl-ß-cyclodextrin but not desipramine were able to preserve growth and viability of cells in the presence of PRZ. In summary, we confirmed the hypothesis that the cellular uptake of QAPB/PRZ represents an endocytotic mechanism equivalent to transport-P. Endocytosis of QAPB/PRZ depends on a proton gradient, dynamin and cholesterol, and results in reorganisation of the LAMP1 positive endolysosomal system. Finally, the link seen between the cellular uptake of PRZ and cell death implies a still unknown pro-apoptotic membrane protein with affinity towards PRZ.
Asunto(s)
Antagonistas de Receptores Adrenérgicos alfa 1/farmacología , Antineoplásicos/farmacología , Apoptosis/efectos de los fármacos , Endocitosis/efectos de los fármacos , Neoplasias/tratamiento farmacológico , Prazosina/farmacología , Antagonistas de Receptores Adrenérgicos alfa 1/metabolismo , Antineoplásicos/metabolismo , Compuestos de Boro/metabolismo , Proliferación Celular/efectos de los fármacos , Supervivencia Celular/efectos de los fármacos , Colesterol/metabolismo , Dinaminas/metabolismo , Endosomas/efectos de los fármacos , Endosomas/metabolismo , Colorantes Fluorescentes/metabolismo , Humanos , Concentración de Iones de Hidrógeno , Células K562 , Proteínas de Membrana de los Lisosomas/metabolismo , Lisosomas/efectos de los fármacos , Lisosomas/metabolismo , Neoplasias/metabolismo , Neoplasias/patología , Prazosina/análogos & derivados , Prazosina/metabolismo , Proteínas de Unión al GTP rab5/metabolismoRESUMEN
Compressive residual stresses are commonly introduced into the near-surface regions of morse taper junctions of modular hip endoprostheses to prolong fatigue life. An increasing number of publications report that contamination of shot-peened surfaces can lead to enhanced corrosion and third body wear. This study evaluates deep rolling of titanium alloy rods as a possible alternative to shot peening. Ten rods of Ti6Al7Nb alloy with a diameter of 15 mm were deep rolled with various rolling parameters. The resulting surface topography and residual contamination was analyzed using a scanning electron microscope (SEM). The near-surface residual stress states after deep rolling were characterized by means of X-ray diffraction. The roughness of the surfaces before deep rolling was about R(z) = 14 microm, and after deep rolling surface roughness values of R(z) 0.4-7.5 microm were achieved. The results of the SEM and EDAX analyses of the sample surface showed no evidence of surface contamination by particles or abrasion products caused by any process. At a pressure of 300 bar, compressive stress reached the maximum of -1150 MPa at a depth of 0.1 mm. Deep rolling thus allows a smooth and particle-free surface to be obtained and therefore shows promise as a surface treatment for mating surfaces of morse tapers in modular hip endoprostheses.