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Brian Webb, MD

Diabetes as a Risk Factor for Orthopedic Implant Surface Performance: A Retrieval and <em>In Vitro</em> Study

Mon, 06/21/2021 - 05:00

J Bio Tribocorros. 2021 Jun;7(2):51. doi: 10.1007/s40735-021-00486-8. Epub 2021 Feb 22.

ABSTRACT

Orthopedic devices are often associated with increased risk for diabetic patients due to impaired wound healing capabilities. Adverse biological responses for immunocompromised patients at the implant-tissue interface can lead to significant bone resorption that may increase failure rates. The goal of this study was to characterize the surface of implants removed from diabetic patients to determine underlying mechanisms of diabetes-induced impaired osseointegration. Thirty-nine retrieved titanium and stainless-steel orthopedic devices were obtained from diabetic and non-diabetic patients, and compared to non-implanted controls. Optical Microscopy, Scanning Electron Microscopy, Energy Dispersive X-ray Spectroscopy, and X-ray Photoelectron Spectroscopy revealed changes in morphology, chemical composition, oxidation state, and oxide thickness of the retrieval specimens, respectively. Additionally, titanium disks were immersed for 28 days in simulated in vitro diabetic conditions followed by Inductively Coupled Plasma-Optical Emission Spectroscopy to quantify metal dissolution. Electrochemical testing was performed on specimens from retrievals and in vitro study. Aside from biological deposits, retrievals demonstrated surface discoloration, pit-like formations and oxide thinning when compared to non-implanted controls, suggesting exposure to unfavorable acidic conditions. Cyclic load bearing areas on fracture-fixation screws and plates depicted cracking and delamination. The corrosion behavior was not significantly different between diabetic and non-diabetic conditions of immersed disks or implant type. However, simulated diabetic conditions elevated aluminum release. This elucidates orthopedic implant failures that potentially arise from diabetic environments at the implant-tissue interface. Design of new implant surfaces should consider specific strategies to induce constructive healing responses in immunocompromised patients while also mitigating corrosion in acidic diabetic environments.

PMID:34150468 | PMC:PMC8211117 | DOI:10.1007/s40735-021-00486-8

Asymptomatic Migration of a Kirschner Wire from the Proximal Aspect of the Humerus to the Thoracic Cavity: A Case Report.

Wed, 01/30/2019 - 08:14
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Asymptomatic Migration of a Kirschner Wire from the Proximal Aspect of the Humerus to the Thoracic Cavity: A Case Report.

JBJS Case Connect. 2016 Jul-Sep;6(3):e77

Authors: Pientka WF, Bates CM, Webb BG

Abstract
CASE: A 78-year-old man presented with an open fracture of the proximal aspect of the humerus and an axillary artery laceration; the fracture was treated provisionally with Kirschner wires (K-wires). Forty-five days postoperatively, he presented with pin prominence at the lateral aspect of the arm, and was incidentally noted to have migration of a separate K-wire to the left lung. He underwent successful thoracotomy and lung wedge resection for wire removal.
CONCLUSION: K-wires used in the fixation of fractures of the proximal aspect of the humerus may migrate into the thoracic cavity. No modification of this technique, including the use of threaded, terminally bent, or external pins that are visibly secured, eliminates the potential for devastating complications.

PMID: 29252654 [PubMed - indexed for MEDLINE]

Risk factors in total joint arthroplasty: comparison of infection rates in patients with different socioeconomic backgrounds.

Wed, 01/30/2019 - 08:14
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Risk factors in total joint arthroplasty: comparison of infection rates in patients with different socioeconomic backgrounds.

Orthopedics. 2008 May;31(5):445

Authors: Webb BG, Lichtman DM, Wagner RA

Abstract
Infection after total joint arthroplasty is a serious complication. Several risk factors have been shown to increase the risk of total joint infections. The purpose of this study was to evaluate whether socioeconomic background was a risk factor for infection in primary total joint arthroplasty. A retrospective chart review was conducted over a 4-year period on a single surgeon's split practice between private patients with mostly private insurance and Medicare and county based patients with predominately indigent county health coverage and Medicaid. An infection rate was calculated for each population in both primary total knee and hip arthroplasty. The two populations were statistically analyzed for differences in age, preoperative diagnoses, and socioeconomic background. To our knowledge, this is the first study showing an increased risk of infection in total joint arthroplasty based on socioeconomic background.

PMID: 19292321 [PubMed - indexed for MEDLINE]