nitinol and Osteoarthritis

Tibiotalocalcaneal (TTC) arthrodesis using an intramedullary hindfoot nail is a common procedure for deformity correction and the treatment of combined tibiotalar and subtalar end-stage arthritis. Nonunion at one or both fusion sites is a difficult complication that can result in reoperation, significant morbidity, and below-knee amputation. There is currently a need for sustained compression across fusion sites using a TTC hindfoot nail with good mechanical stability. The DynaNail TTC Fusion System (MedShape, Inc, Atlanta, GA) uses an internal nitinol compression element to apply sustained compression across the tibiotalar and subtalar joints after surgery. In preliminary clinical cases, we have found that the nail is safe, reliable, and has promising clinical and radiographic results in settings of hindfoot arthritis, complex deformity, Charcot arthropathy, and talar avascular necrosis.. Expert opinion, Level V.

Topics: Adult; Alloys; Ankle Injuries; Arthrodesis; Arthropathy, Neurogenic; Bone Nails; Equipment Design; Female; Fluoroscopy; Follow-Up Studies; Humans; Osteoarthritis; Postoperative Complications; Risk Assessment; Subtalar Joint; Treatment Outcome

PURPOSE OF THE STUDY Nitinol (NiTi) is a biomaterial widely used in medicine based on super-elastic and shape memory properties. miR-124 has a key role in inflammatory process, osteoblasts differentiation, and mineralization. The aim of study was evaluating the differences in gene expression of miR-124 of human physiological osteoblasts (HOB) and human osteoarthritic osteoblasts (OSBA) as a response to NiTi alloy in different heat treatments. MATERIAL AND METHODS The cells were cultivated with NiTi discs with/without addition of bacterial lipopolysaccharide (LPS) for 72 hours. MicroRNAs were isolated, underwent reverse transcription and were analyzed by RT-PCR. RESULTS As a response to LPS, HOB overexpressed miR-124, while in OSBA expression change did not occur. Overexpression was also observed in both cell lines as a response to hydrogen and helium treated NiTi discs. HOB expressed significantly higher amount of miR-124 than OSBA as a response to hydrogen treatment of NiTi discs. In addition, hydrogen treatment caused significantly higher expression in HOB than LPS. The combination of NiTi disc and LPS treatment in HOB didn't cause any expression changes. Comparing to LPS-only treatment, the expression in HOB with combination of LPS and alloy was significantly lower. In OSBA, the expression was increased by the combination of LPS and hydrogen disc, in case of helium disc, the expression was decreased. CONCLUSIONS In conclusion, human physiological and osteoarthritic osteoblasts respond to NiTi alloy with both surface (hydrogen and helium atmosphere) treatment by overexpression of miR-124. The effect of LPS as inflammatory modulator suggests the presence of an "anti-inflammatory preconditioning" in osteoarthritic osteoblasts, as physiological osteoblasts overexpression was significantly higher. Key words: nitinol, osteoblast, miR-124, lipopolysaccharide.

Topics: Alloys; Helium; Humans; Hydrogen; Lipopolysaccharides; MicroRNAs; Osteoarthritis; Osteoblasts; Titanium

This study aims to evaluate the nitinol (X-Fuse®) implant in arthrodesis of the distal interphalangeal and the thumb joints with respect to bone fusion and clinical efficiency.. This prospective study included 24 consecutive patients (7 males, 17 females; mean age 56.8 years; range 27 to 79 years) with nitinol (X-Fuse®) implants in their 41 joints. All patients were followed-up clinically and radiographically with respect to fusion, complications and outcome at a minimum of 14 months postoperatively (mean 28±6 months). X-rays, Disabilities of the Arm, Shoulder and Hand, and visual analog scale scores were recorded preoperatively and at postoperative fifth week, third month, first year, and subsequent visits.. The Disabilities of the Arm, Shoulder and Hand score improved significantly from preoperative 37.7 points to postoperative 14.5 points at first year. The visual analog scale score improved significantly from preoperative 5.5 to postoperative 0.85 points at first year. Failure to fuse only occurred in two joints (5%), resulting in fusion after reoperation. No other severe complications such as deep infection, intraoperative fracture, wound healing problems or regional dystrophy were observed.. The X-Fuse® implant may be a reliable alternative method for finger joint arthrodesis.

Topics: Adult; Aged; Alloys; Arthrodesis; Female; Finger Joint; Humans; Male; Middle Aged; Osteoarthritis; Outcome and Process Assessment, Health Care; Postoperative Complications; Prospective Studies; Prostheses and Implants; Radiography; Reoperation; Treatment Outcome

Prospective study evaluating the adjacent segment degeneration after lumbar dynamic stabilization using pedicle screws and a Nitinol spring rod system.. To assess the changes of the adjacent and implantation segments after lumbar dynamic stabilization surgery using magnetic resonance imaging (MRI).. Lumbar fusion operations can accelerate the degeneration of adjacent levels. Recently, motion preservation surgery has been attempted for the treatment of lumbar degenerative diseases to prevent degeneration of adjacent levels. However, there is a controversy over whether lumbar dynamic stabilization accelerates degeneration of adjacent levels.. We performed the dynamic stabilization procedure in patients with grade 1 degenerative lumbar spondylolisthesis, lumbar spondylotic stenosis with segmental instability, or a herniated lumbar disc with segmental instability. Postoperative MRI scans were taken for >2 years in all enrolled 25 patients. We compared the findings regarding disc degeneration in the cranial, implantation, and caudal segments between the preoperative period and 2-year-plus postoperative period using T2-weighted sagittal MR images. In addition, we investigated the progression of the central and foraminal stenosis of the adjacent cranial and caudal levels.. Three of the 25 cranial adjacent discs (12.0%) and 4 of the 25 (16%) caudal adjacent discs demonstrated progression of degeneration after dynamic stabilization. One of the 13 discs in the implantation segment demonstrated progression of degeneration, and 2 of the 13 discs in the implantation segment showed improvement of their disc degeneration (disc rehydration). A total of 5 (10.0%) of the 50 segments (3 cranial and 2 caudal adjacent) showed increased spinal stenosis postoperatively. Among the 5 cases, 3 patients had symptomatic adjacent stenosis.. According to our results, lumbar dynamic stabilization using pedicle screws and a Nitinol spring rod system may not prevent adjacent level degeneration completely.

Topics: Aged; Alloys; Bone Screws; Decompression, Surgical; Disease Progression; Diskectomy; Female; Follow-Up Studies; Foraminotomy; Humans; Internal Fixators; Intervertebral Disc Degeneration; Intervertebral Disc Displacement; Joint Instability; Laminectomy; Lumbar Vertebrae; Magnetic Resonance Imaging; Male; Middle Aged; Osteoarthritis; Postoperative Period; Prospective Studies; Spinal Fusion; Spinal Stenosis; Spondylolisthesis; Spondylosis