Salmon Calcitonin Affect The Service Life Of The Prosthesis After Artificial Hip Replacement

With aging population growing, more and more elderly patients suffering from femoral head necrosis or accidental femoral neck fracture choose the treatment of artificial hip prosthesis replacement. The total hip replacement has been the common treatment for joint function reconstruction since the first clinical application by Charnley in the 30s of the 21st century. However complications have occurred increasingly with rising of operation cases and widening of application scopes. The most common complication that both doctors and patients have to face with is aseptic loosening of prosthesis after replacement which causes the repair of prosthesis within the service life and even leads to failure of the operation. According to relative literature statistics, up to 10% cases have to be repaired because of the prosthesis loosening within 10 years after the operation. Therefore it is very urgent to solve the technical problem of prosthesis loosening by studying deeply on causes and mechanisms of aseptic loosening, exploring feasible protection and lengthening the service life of the prosthesis.In recent years many researchers prove that a lot of factors cause the aseptic loosening of the artificial joint prosthesis, including the wear debris particles, jiggle, stress shielding and high liquid pressure. Also many studies show that macrophages, fibroblasts, foreign body giant cells and osteoblasts, stimulated by wear debris particles, can trigger such bone resorbing factors claimed by osteoclasts as Tumor necrosis factor-α, Interleukins-1 and Interleukins-6.Those factors can improve the bone absorption ability of osteoclasts; can cause dissolution and absorption of the bones around the artificial joint prosthesis and also cause the jiggle between the bone and the prosthesis. In conclusion, growing and dysfunction of osteoclasts can directly influence stability between bones and prosthesis, lead to the bone dissolution and absorption around the prosthesis and result in failure of the artificial joint replacement operation.Based on the above analysis, the question arises whether it is possible to lengthen the service life of the prosthesis after replacement by inhibiting activity of osteoclasts, and reducing the number of osteoclasts to prevent the bone dissolution and absorption ambient the prosthesis. Osteoclasts are targeted cells of salmon calcitonin, which is proved to completely inhibit the bone absorption of osteoclasts and obviously reduce the number of osteoclasts through studies in vivo with pharmacological dosage. The goal of the topic is to do the following researches by studying calcitonin and its receptor specificity to provide experimental basis for improving the service life of the prosthesis of artificial joint replacement in clinic.The topic consists of 3 sections:Section 1:The analysis of effects of application of salmon calcitonin on the prosthesis renovation in the total hip replacement of the patients with osteoporosisSection 2:The study of animal experiments on prosthesis loosening caused by wear debris particlesSection 3:The experimental study on effects of salmon calcitonin on aseptic loosening of artificial jointsSection 1:The analysis of effects of application of salmon calcitonin on the prosthesis renovation in the total hip replacement of the patients with osteoporosisObjective:To retrospectively analyze effects of salmon calcitonin on the second renovation of the prosthesis for the patients with osteoporosis after receiving the first total hip replacement in 5 years.Methods:500 cases of artificial hip replacement in the Central Hospital of Jingzhou from 2010 to 2015 had been selected randomly. Among those there were 126 cases with osteoporosis. The cases with double hip replacement had been excluded from the total in the process of retrieval.43 cases with the second renovation because of various causes had been retrieved on the condition of the second renovation on the aimed samples. Among them 17 cases using salmon calcitonin after the first replacement had been included in the treatment group A. From the rest cases 17 cases without salmon calcitonin had been selected randomly as the control group B.2 group had been contrasted clinically by referring to prosthesis type, age, gender, period between the first replacement and renovation. The data had been analyzed by SPSS 17.0. T-test of the independent sample had been made for normal distribution and rank test had been made for nonnormal distribution. The renovation rate had been compared between the group A and B. There had been statistical differences(P< 0.05).Results:The group A ranged in age from 72 to 84, average age 76.8, with 6 male cases and 11 female cases. The group B ranged from 56 to 82, average age 68.6, with 8 female cases and 9 male. There was no statistical significance(P>0.05).The average duration from the first replacement to renovation was 35.7 months, with the shortest 26 months and the longest 49, in the group A, respectively 23.5,14 and 33.Conclusion:Salmon calcitonin is the most effective medicine for osteoporosis and can inhibit formation of osteoclasts during treatment. It also can reduce bone dissolution ambient the prosthesis, prevent slight movement and sinking between the prosthesis and the bones and then lengthen the service life of the prosthesis.Section 3:The experimental study on effects of salmon calcitonin on aseptic loosening of artificial jointsSection 1:The analysis of effects of application of salmon calcitonin on the prosthesis renovation in the total hip replacement of the patients with osteoporosisObjective:To retrospectively analyze effects of salmon calcitonin on the second renovation of the prosthesis for the patients with osteoporosis after receiving the first total hip replacement in 5 years.Methods:500 cases of artificial hip replacement in the Central Hospital of Jingzhou from 2010 to 2015 had been selected randomly. Among those there were 126 cases with osteoporosis. The cases with double hip replacement had been excluded from the total in the process of retrieval.43 cases with the second renovation because of various causes had been retrieved on the condition of the second renovation on the aimed samples. Among them 17 cases using salmon calcitonin after the first replacement had been included in the treatment group A. From the rest cases 17 cases without salmon calcitonin had been selected randomly as the control group B.2 group had been contrasted clinically by referring to prosthesis type, age, gender, period between the first replacement and renovation. The data had been analyzed by SPSS 17.0. T-test of the independent sample had been made for normal distribution and rank test had been made for nonnormal distribution. The renovation rate had been compared between the group A and B. There had been statistical differences(P< 0.05).Results:The group A ranged in age from 72 to 84, average age 76.8, with 6 male cases and 11 female cases. The group B ranged from 56 to 82, average age 68.6, with 8 female cases and 9 male. There was no statistical significance(P>0.05).The average duration from the first replacement to renovation was 35.7 months, with the shortest 26 months and the longest 49, in the group A, respectively 23.5,14 and 33.Conclusion:Salmon calcitonin is the most effective medicine for osteoporosis and can inhibit formation of osteoclasts during treatment. It also can reduce bone dissolution ambient the prosthesis, prevent slight movement and sinking between the prosthesis and the bones and then lengthen the service life of the prosthesis.Section 2:The study of animal experiments on prosthesis loosening caused by wear debris particlesObjectives:To explore effects of wear debris particles on changes of bone mass between the prosthesis and the bones, changes of osteoclasts and morphology.Methods:12 New Zealand healthy adult white rabbits raised in aseptic ambient had been divided randomly into 2 groups, respectively the experimental group and the control group (provided and fed by experimental animal center in the college of traditional Chinese medicine of Jingzhou city, hubei province).Any of weight 2.3+/-0.4 Kg. Both of group animals have selected the left hip for experimental area.4 weeks later titanium metal particles as wear debris particles had been aseptically injected to articular cavity every 2 weeks after the hip replacement in the experimental group, with saline injected in the control group.14 weeks later changes of bone mass had been observed by bone mineral density detection, and 16 weeks later pathological sections of the bones around the prosthesis had been made to observe condition of periosteum tissue and had been analyzed statistically. The determination of TNF-α, IL-6 levels will been tested by radiation immunity analysis method.Results:DEXA bone scan showed the BMD have obviously decreased in the experimental group around the prosthesis RO1, between the two groups have significant differences increased(P<0.05), and the comparison between the experimental way visible comparing preoperative BMD have significant statistical difference with the passage of time until 16 weeks later(P<0.01). The same way showed that it had no statistical significance in the control group(P>0.05). The formation of periosteum tissue and the bone dissolution around the prosthesis were observed with no formation of new bones in the experimental group. No periosteum but new bones were observed in the control group. Osteonecrosis, bone collapses, dim bone texture, unclear edge and ambient fiber tissue hyperplasia were observed through microscope. Both of two groups have germicultured were negative results.The experimental group radiation immunity analysis method test of TNF-a is significantly higher than the control group with statistical difference (P<0.05). The experimental group radiation immunity analysis method test of IL-6 is also significantly higher than the control group with statistical difference (P<0.05).Conclusion:There are similarities in aseptic replacement of artificial joints between the animal model research and in clinic. It is concluded that wear debris particles can cause loss of the bone mass around the prosthesis and increase the number of osteoclasts and finally trigger bone dissolution and absorption, which leads to prosthesis loosening and shortening of the service life of the prosthesis. traditional Chinese medicine of Jingzhou city, hubei province).Any of weight 2.3+/-0.4 Kg. Both of group animals have selected the left hip for experimental area.4 weeks later titanium metal particles as wear debris particles had been aseptically injected to articular cavity every 2 weeks after the hip replacement in the experimental group, with saline injected in the control group.14 weeks later changes of bone mass had been observed by bone mineral density detection, and 16 weeks later pathological sections of the bones around the prosthesis had been made to observe condition of periosteum tissue and had been analyzed statistically. The determination of TNF-α, IL-6 levels will been tested by radiation immunity analysis method.Results:DEXA bone scan showed the BMD have obviously decreased in the experimental group around the prosthesis RO1, between the two groups have significant differences increased(P<0.05), and the comparison between the experimental way visible comparing preoperative BMD have significant statistical difference with the passage of time until 16 weeks later(P<0.01). The same way showed that it had no statistical significance in the control group(P>0.05). The formation of periosteum tissue and the bone dissolution around the prosthesis were observed with no formation of new bones in the experimental group. No periosteum but new bones were observed in the control group. Osteonecrosis, bone collapses, dim bone texture, unclear edge and ambient fiber tissue hyperplasia were observed through microscope. Both of two groups have germicultured were negative results.The experimental group radiation immunity analysis method test of TNF-a is significantly higher than the control group with statistical difference (P<0.05). The experimental group radiation immunity analysis method test of IL-6 is also significantly higher than the control group with statistical difference (P<0.05).Conclusion:There are similarities in aseptic replacement of artificial joints between the animal model research and in clinic. It is concluded that wear debris particles can cause loss of the bone mass around the prosthesis and increase the number of osteoclasts and finally trigger bone dissolution and absorption, which leads to prosthesis loosening and shortening of the service life of the prosthesis.Section 3:The experimental study on effects of salmon calcitonin on aseptic loosening of artificial jointsObjective:To experimentally research the prevention function of salmon calcitionin used for treating osteoporosis in prosthesis loosening after the total hip replacement and explore the possibility of application in clinic.Methods:18 New Zealand healthy adult white rabbits raised in aseptic ambient had been divided randomly into 3 groups, respectively the medicine group、the dynamic model control group and normal saline control group. (provided and fed by experimental animal center in the college of traditional Chinese medicine of Jingzhou city, hubei province).Any of weight 2.4+/-0.3 Kg. All of group animals have selected the left hip for experimental area.4,6,8,10,12 and 14 weeks later the hybrid suspension of titanium alloy wear debris particles had been injected into right hip joint cavities of white rabbits every 2 weeks in the three groups from the 4th week after the former treatment until the 14th week.1 ml salmon calcitonin had been injected into the joint cavity of the rabbits every 3 days in the medicine group from the 2th week after the former treatment until the 16th week, and meanwhile the rabbits in the other groups had been injected with 1 ml saline.All of groups white rabbits have been daily feed contains Caltrate in the test weeks, and 16 weeks later pathological sections of the bones around the prosthesis had been made to observe condition of periosteum tissue and had been analyzed statistically. The determination of TNF-a, IL-6 levels will been tested by radiation immunity analysis method.Results:The trabecular bone of medicine group around the artificial prosthesis is relatively complete then the saline control group, and animal model control group have wrapped with a layer of fiber sample groups around the artificial prosthesis.All of groups bacterial culture showed the negative results. The formation of periosteum tissue and the bone dissolution around the prosthesis were observed with no formation of new bones in the animal model control group. Osteonecrosis, bone collapses, dim bone texture, unclear edge and ambient fiber tissue hyperplasia were observed through microscope. No periosteum but new bones were observed in the durg control group, and traumatic inflammatory change due to the destruction of the surrounding tissue in the process of operation inthe saline control group.The implant bone mass loss in the drug treatment group was significantly decreased then the pure animal model group after intervention salmon calcitonin treatment, between the two groups have significantly statistical differences (P<0.05). Compared the two control groups,the implant bone mass loss in the wear debris animal control group was significantly higher then the pure saline model group,and exists statistically difference (P< 0.01).The bone mass loss have no difference in the short term (within 8 weeks) between the drug therapy group and the normal saline control group (P> 0.05).However, the salmon calcitonin treatment group bone mass loss more relatived by saline control group, and exists statistically difference (P<0.05). TNF-α and IL-6 of drug treatment group organization are significantly lower than the animal model control group by the statistics result, and exists statistically difference (P< 0.05). TNF-α and IL-6 of animal models group organization are significantly higher than saline control group, and exists statistically difference (P<0.05).,while TNF-α and IL-6 have no difference between the drug therapy group and normal saline control group, don’t have statistically significant.Conclusion:Salmon calcitonin can be used to treat osteoporosis. At the same time it can be used to inhibit activity of osteoclasts, reduce the number of osteoclasts to slow down the bone dissolution stimulated by wear debris particles and indirectly improve the service life of the prosthesis in the artificial joint replacement.