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Treatment of Ankle Osteoarthritis with Total Ankle Replacement Through a Lateral Transfibular Approach
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Autoinflammation Around AES Total Ankle Replacement Implants.

Helka Koivu1, Yuya Takakubo2, Zygmunt Mackiewicz3

  • 1Hospital Terveystalo Pulssi, and University of Turku, Turku, Finland helka.koivu@gmail.com.

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|July 30, 2015
PubMed
Summary
This summary is machine-generated.

Failure in total ankle replacement (TAR) involves osteolysis, potentially driven by autoinflammatory responses. This study found increased danger signals and receptors in failed implants, suggesting a role in implant failure.

Keywords:
HIF-1αHMGB1RAGETLRankle replacement implantscaspase-3osteolysis

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Area of Science:

  • Orthopedic Surgery
  • Immunology
  • Biomaterials Science

Background:

  • Total ankle replacement (TAR) failure can manifest as early peri-implant osteolysis, even with minimal wear particles.
  • The study investigates the role of autoinflammatory responses, mediated by damage-associated molecular patterns (DAMPs) and pattern-recognizing receptors (PRRs), in this failure mechanism.

Purpose of the Study:

  • To determine if autoinflammatory responses contribute to osteolysis in failed total ankle replacements.
  • To evaluate the expression of specific DAMPs and PRRs in peri-implant tissues of failed TAR implants.

Main Methods:

  • Immunohistochemical staining of peri-implant tissues from 10 patients with failed AES implants.
  • Analysis of hypoxia-inducible factor-1α (HIF-1α), activated caspase-3, high-mobility group box 1 (HMGB1), receptor for advanced glycation end product (RAGE), and toll-like receptors (TLR2, TLR4).
  • Semi-quantitative scoring of protein expression on a 0-4 scale.

Main Results:

  • Increased expression of high-mobility group box 1 (HMGB1), a DAMP, with translocation from the nucleus to the cytoplasm.
  • Elevated levels of activated caspase-3 positive cells.
  • Upregulation of all assessed pattern-recognizing receptors (PRRs) in revision samples compared to controls.

Conclusions:

  • Increased expression of HMGB1 and other danger signals, along with heightened PRR responsiveness, may drive autoinflammatory peri-implantitis.
  • These inflammatory processes could contribute to multilocular cyst formation and osteolysis observed in failed total ankle replacements.
  • The findings suggest a potential mechanism linking wear particles to bone loss through innate immune system activation.