Nanomedicine: Nanotechnology, Biology and Medicine
Case StudyMulti-elemental nanoparticle exposure after tantalum component failure in hip arthroplasty: In-depth analysis of a single case
Graphical Abstract
Porous tantalum components are utilized in arthroplasty procedures of the hip joint. This study depicts a multiple metal exposure scenario originating from severe tantalum component failure. Metal level quantification and particle characterization in samples of local compartments reveal substantial in vivo exposure to tantalum, zirconium, titanium, aluminum, vanadium, chromium, cobalt and molybdenum in particulate and dissociated state. Besides micron-sized particles, nanoparticles of a broad size range and elemental composition are abundant in the periprosthetic region resulting in the occurrence of necrotic macrophages in periprosthetic soft tissue.
Section snippets
Clinical case
We report the case of a fifty-year-old female who experienced collapse of an elliptic Ta revision shell and a Ta acetabular wedge that became symptomatic about 62 months after implantation of those components.
The affected patient has complex orthopedic (Table 1) and medical histories (Supplementary Table 1) which caused her to retire at age 30 from a mainly sedentary office job. After a multitude of childhood and adulthood surgeries addressing bilateral congenital hip dislocation and its
Consent and sample harvesting
The study was approved by the local ethical committee (EA1/194/13) and written informed consent was obtained from the patient. Sample harvesting and patient data analyses were performed in accordance with our institutional guidelines.14 PT and synovial fluid (SF) were frozen at −80 °C prior to histopathological examination, metal level determination and particle characterization. MSCs were immediately isolated from the BM of the patient as described previously.15 The supernatant from the first
Metal exposure
Total Ta-levels demonstrate the massive exposure. Femoral and acetabular PTs consist of 4.8 wt% and 1.6 wt% Ta respectively. As expected, the levels of other attendant metals were lower when compared to total Ta-levels. However, the total levels of Zr, Ti, Al, V, Co and Cr were found unexpectedly high in the upper mg/kg range (Table 2).
The distinction of particulate and dissociated metal species provides information on the oxidative stability of the bulk materials and metallic particles in vivo
Discussion
The focus of this study was the exposure assessment of multiple particulate and dissociated metals in different periprosthetic compartments in a patient who experienced distinct acetabular Ta-component failure after repeat revision hip arthroplasty procedures. The causal chain of the components' failure is impossible to prove. However, we suspect a multifactorial origin of the massive metal particle release into the periprosthetic region, including deficient ingrowth, consecutive instability,
Acknowledgement
We are grateful to our patient for consenting to contributing to orthopedic research and to publication of this report. Further, the authors wish to thank Dr. med. U. Sentürk for stepping in as our intraoperative photographer. We gratefully acknowledge P. Reichardt for technical supervision during SP-ICP-MS analysis. We would like to thank P. Schrade of the multi-user facility ‘electron microscopy’, Charité-Universitätsmedizin Berlin, for her assistance on SEM imaging. We sincerely thank PD Dr.
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Financial support: This study was supported by the ‘Deutsche Arthrose-Hilfe e.V.’ (Project code: P327-A844-AE-EP1). This work was partially supported by grants from the German Federal Ministry of Education and Research (BMBF) and the German Research Foundation (DFG) to C.P., G.N.D, S.G. (Overload: 01EC1408A, DIMEOS: 01EC1402B, FOR2165: GE2512/2-1). ICP-MS analysis was supported by the Major Research Instrumentation Programme: INST336/58-1 to Professor H.-J. Holdt of the University of Potsdam, Institute of Chemistry, Inorganic Chemistry, University of Potsdam, 14476 Potsdam, Germany.
Conflict of interest disclosure: C.P. serves as consultant for Aesculap, CeramTec, Zimmer Biomet, DePuy Synthes, Smith & Nephew, receives royalties from Smith & Nephew, DePuy Synthes and receives institutional funding and research support from Aesculap. G.N.D serves as consultant for CeramTec, DePuy Synthes, ImplanTec and receives institutional funding and research support from Aesculap, CeramTec, DePuy Synthes, LINK, OHST, Peter Brehm, Smith & Nephew, Zimmer Biomet. These companies did not financially support this study, had no role in study design, sample collection, data collection and analysis, decision to publish, or preparation of the manuscript.
Prior presentations: Part of this work was presented at the 2017 Endoprothetikkongress, Berlin, Germany.