In Total Knee Arthroplasty (TKA) a proper choice of the implant size is mandatory in order to guarantee the success of the prosthesis, although the tribological behavior TKA is strongly influenced by the implant design. Retrieval analysis of failed total knee prosthesis is essential to investigate the wear mechanism leading to osteolysis and loosening of the implant. Assessments from retrieval studies constitute crucial information in the effort to improve prosthesis functionality and reduce the risk of revision. The aim of the present study was to investigate the correlation among different implant sizes of retrieved TKA and patients' variables such as Body Mass Index (BMI) in terms of surface modifications and morphology change, in order to examine prosthesis properties and performances. In particular, this study can improve the understanding of the tribological behavior of total knee prosthesis and it can help the surgeon to select the best implant size of TKA considering patient's variables. Twelve retrieved total knee prostheses of the same design but with different sizes were investigated. These prostheses were all cemented, fixed and posterior stabilized. These prostheses were explanted from 12 patients after a mean of 3.2 years (from 1.1 to 7.4 years). These patients had undergone a primary TKA at our hospital between 2005 and 2010; there were 10 women and 2 men with a mean age of 68 years (ranging from 48 to 77 years) at implantation. A qualitative assessment of wear patterns and surface damages was performed on femoral components and polyethylene inserts. Roughness analyses were obtained on femoral components to assess surface modifications. Surface roughness of the metallic femoral components was performed with a contact rugosimeter. Following an internal protocol, thirty measurements were acquired from each condyle. Two roughness parameters were take into account: Ra (the Mean Roughness, i.e. the arithmetical mean value of the deviations of the roughness profile about the centre line) and Rsk. (i.e. the skewness, indicates the prevalence of peaks or valleys and quantifies the asymmetry of the profile variation from the mean line). Prostheses time in-vivo and patient details were known.Introduction
Methods
The development of multidisciplinary therapy for Ewing’s sarcoma (ES) has increased current long-term survival rates to greater than 50%, but only 20% for patients with clinically detectable metastases at diagnosis, or not responding to therapy or with disease relapse. Anti-bone resorption bisphosphonates (BP) may represent promising adjuvant molecules to limit the osteolytic component of bone tumor. The combination of zoledronic acid (ZOL) and ifosfamide (IFOS) or mafosfamide (MAFOS) was studied in ES models and in 8 human cell lines all expressing the EWS-FLI1 fusion gene. Cell proliferation, viability, apoptosis and cell cycle distribution were analysed. The ES models were developed in immuno-deficient mice by inoculating the human tumor cells either intra-muscular (soft tissue tumor development) or intra-osseous (bone tumor development). Mice were then treated with ZOL (100 μg/kg twice or 4 times/week) and/or ifosfamide (IFOS 30 mg/kg, one to 3 sequences of 3 injections). All the cell lines studied were more or less sensitive to ZOL and MAFOS in terms of cell proliferation. Both drugs induced cell cycle arrest respectively in S and G2M phase and final apoptosis associated to caspase 3 activation. In vivo, ZOL had no effect on soft tumor progression although it dramatically inhibits ES development in bone site. When combined with IFOS, ZOL exerts synergistic effects in the soft tissue model leading to a similar quantitative inhibitory effect when associated with 1 sequence IFOS as compared to 3 sequences of IFOS alone. In the bone model, ZOL prevents tumor recurrence observed with a lonely sequence of IFOS. Combination of ZOL with conventional chemotherapy showed promising results in both ES models and could allow the clinicians to diminish the doses of chemotherapy. Moreover, as ZOL and MAFOS induce cell death by different pathways, respective resistance may be circumvented.
