Does diametrical clearance influence the wear of Pinnacle hip implants?

Aims: The optimum clearance between the bearing surfaces of hip arthroplasties is unknown. Theoretically, to minimize wear, it is understood that clearances must be low enough to maintain optimal contact pressure and fluid film lubrication, while being large enough to allow lubricant recovery and reduce contact patch size. This study aimed to identify the relationship between diametrical clearance and volumetric wear, through the analysis of retrieved components. / Methods: A total of 81 metal-on-metal Pinnacle hips paired with 12/14 stems were included in this study. Geometrical analysis was performed on each component, using coordinate and roundness measuring machines. The relationship between their as-manufactured diametrical clearance and volumetric wear was investigated. The Mann-Whitney U test and unpaired t-test were used, in addition to calculating the non-parametric Spearman's correlation coefficient, to statistically evaluate the acquired data. / Results: The hips in this study were found to have had a median unworn diametrical clearance of 90.31 μm (interquartile range (IQR) 77.59 to 97.40); 32% (n = 26) were found to have been below the manufacturing tolerance. There was no correlation found between clearance and bearing (rs = -0.0004, p = 0.997) or taper (rs = 0.0048, p = 0.966) wear rates. The wear performance of hips manufactured within and below these specifications was not significantly different (bearing: p = 0.395; taper: p = 0.653). Pinnacles manufactured from 2007 onwards had a greater prevalence of bearing clearance below tolerance (p = 0.004). / Conclusion: The diametrical clearance of Pinnacle hips did not influence their wear performance, even when below the manufacturing tolerance. The optimum clearance for minimizing hip implant wear remains unclear

Variation in taper surface roughness for a single design effects the wear rate in total hip arthroplasty

Material loss from the head-stem taper junction of total hip arthroplasty (THA) is implicated in adverse reactions to metal debris (ARMD); the mechanisms for this are multi-factorial. We investigated the relationship between the roughness of the "as manufactured" taper surface and the wear rate from this junction. Fifty retrieved Pinnacle metal-on-metal (MOM) bearings paired with a Corail stem were included in the study. Multivariable statistical analysis was performed to determine the influence of taper roughness on material loss rate after controlling for other confounding surgical, implant, and patient factors. The surface roughness of the "as manufactured" head taper surface was associated with the rate of material loss from this surface. Four of eighteen roughness variables taken from ISO 4,287 and ISO 13,565-2 were significant: The Reduced Peak Height (Rpk, the protruding peaks above the core) (p = 0.004), Material Ratio 1 (Mr1, the ratio of the protruding peaks above the core) (p = 0.002), Area of the Peak Region (A1, the area of the Abbott-Curve that contains the peaks from the profile) (p = 0.003) and the Skewness (Rsk, the asymmetry of the height distribution corresponding to the height or depth of surface features) (p = 0.03). We found a large variability in the measured values with a median (range) of 0.50 (0.05-2.98), 11.98 (0.46-39.98), 30.89 (0.15-581.00), and 0.04 (-0.73-0.84), respectively. A 1-unit increase in Rpk was associated with a 73% increase in the taper wear rate. The variability of "as manufactured" surface roughness has a significant effect on taper material loss. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res

Perspectives for sustainable development of Nordic aquaculture:The Paban-Report

Aquaculture is one of the fastest growing productions and the value of aquaculture is now about to pass the value of capture fisheries. Among the Nordic countries, Norway in particular has been able to create a large aquaculture industry with high growth rates over a number of years. The other Nordic countries have only had limited growth, but have a high unutilised potential. There is a need to identify opportunities and limitations for increased growth with due care for sustainability and environment. This report identifies seven focus areas with special potential for creation of a sustainable, competitive Nordic aquaculture sector. These areas are new feeds, better use and reuse of nutrients (nitrogen, phosphorus and carbon), value adding of by-products, technological and regional development, domestication of new species and reduction of energy consumption. The aquaculture sector with its strengths and weaknesses is described for each of the Nordic countries.The report is compiled on basis of contributions from a Nordic group of experts. It was presented at a seminar on Green Growth at the annual meeting of the Nordic Ministers of Fisheries in Trondheim, July 2012

Morphology of Phagophore Precursors by Correlative Light-Electron Microscopy

Autophagosome biogenesis occurs in the transient subdomains of the endoplasmic reticulum that are called omegasomes, which, in fluorescence microscopy, appear as small puncta, which then grow in diameter and finally shrink and disappear once the autophagosome is complete. Autophagosomes are formed by phagophores, which are membrane cisterns that elongate and close to form the double membrane that limits autophagosomes. Earlier electron-microscopy studies showed that, during elongation, phagophores are lined by the endoplasmic reticulum on both sides. However, the morphology of the very early phagophore precursors has not been studied at the electron-microscopy level. We used live-cell imaging of cells expressing markers of phagophore biogenesis combined with correlative light-electron microscopy, as well as electron tomography of ATG2A/B-double-deficient cells, to reveal the high-resolution morphology of phagophore precursors in three dimensions. We showed that phagophores are closed or nearly closed into autophagosomes already at the stage when the omegasome diameter is still large. We further observed that phagophore precursors emerge next to the endoplasmic reticulum as bud-like highly curved membrane cisterns with a small opening to the cytosol. The phagophore precursors then open to form more flat cisterns that elongate and curve to form the classically described crescent-shaped phagophores

Virus-Encapsulated DNA Origami Nanostructures for Cellular Delivery

Peer reviewe

Lack of evidence-the anti-stepwise introduction of metal-on-metal hip replacements: A systematic review and a comparative assessment of the literature and registry data

Background and purpose - Orthopedics and especially joint replacement surgery have had more than their fair share of unsuccessful innovations that have violated widely endorsed principles for the introduction of new surgical innovations. We aimed to investigate (1) the trends in the use of the Birmingham Hip Resurfacing (BHR), the ASR hip resurfacing (ASR HRA) and the ASR XL total hip replacement (ASR XL THR) system with very different market approval processes and (2) whether their use was corroborated by clinical trials published in the peer-reviewed literature.Methods - The literature was searched for any clinical studies that reported outcomes of the BHR, ASR HRA and ASR XL THRs. Data from 7 national hip arthroplasty registers were collected and the number of annually implanted devices was matched to those reported in the literature.Results - The cumulative number of implanted and published BHRs grew proportionally with a small lag. The growth of implanted BHRs started to decline at the same time as the ASR HR was introduced. With regard to ASR HRAs, the cumulative proportion of implanted hips and those included in the published studies grew disproportionately after the introduction of the ASR in 2003. For ASR XL THRs, the disproportionality is even higher.Interpretation - The adoption of ASR hip replacements did not follow the proposed stepwise introduction of orthopedic implants. The adoption and use of any new implant should follow a strict guideline and algorithm even if the theoretical basis or the results of preclinical studies are excellent

Revision surgery of metal-on-metal hip arthroplasties for adverse reactions to metal debris

Background and purpose The initial outcomes following metal-on-metal hip arthroplasty (MoMHA) revision surgery performed for adverse reactions to metal debris (ARMD) were poor. Furthermore, robust thresholds for performing ARMD revision are lacking. This article is the second of 2. The first article considered the various investigative modalities used during MoMHA patient surveillance (Matharu et al. 2018aMatharu G S, Judge A, Eskelinen A, Murray D W, Pandit H G. What is appropriate surveillance for metal-on-metal hip arthroplasty patients? A clinical update. Acta Orthop 2018a; 89 (1): 29–39.[Taylor & Francis Online], [Web of Science ®], [Google Scholar]). The present article aims to provide a clinical update regarding ARMD revision surgery in MoMHA patients (hip resurfacing and large-diameter MoM total hip arthroplasty), with specific focus on the threshold for performing ARMD revision, the surgical strategy, and the outcomes following revision. Results and interpretation The outcomes following ARMD revision surgery appear to have improved with time for several reasons, among them the introduction of regular patient surveillance and lowering of the threshold for performing revision. Furthermore, registry data suggest that outcomes following ARMD revision are influenced by modifiable factors (type of revision procedure and bearing surface implanted), meaning surgeons could potentially reduce failure rates. However, additional large multi-center studies are needed to develop robust thresholds for performing ARMD revision surgery, which will guide surgeons’ treatment of MoMHA patients. The long-term systemic effects of metal ion exposure in patients with these implants must also be investigated, which will help establish whether there are any systemic reasons to recommend revision of MoMHA