Opportunities and challenges of retrieval analysis

The role of standardized periprosthetic tissue and fluid analysis for assessing an aggravated host response

Yelizaveta Torosyan, John G. Bowsher, Steven M. Kurtz, William Mihalko, Danica Marinac-Dabic

Research output: Chapter in Book/Report/Conference proceedingConference contribution

1 Citation (Scopus)

Abstract

Despite the recent advances with implantable devices, implant longevity and functionality may be compromised by degradative processes such as wear and corrosion, and the implant performance may be further complicated by the resultant host responses. As a window into in vivo implant performance, retrieval analysis is paramount for providing an essential feedback for improving new biomaterial choices and device designs and for securing a decision-making accounting for interindividual variability of real-world performance. Acknowledging the need for leaving the device-tissue interface intact, the current retrieval recommendations (e.g., ASTM F561-13) refer to the importance of proper collecting and handling of the adjacent tissues and fluids so as not to interfere with device/tissue-related analyses or jeopardize patient safety. However, without further stipulation of the utmost importance of comprehensive histopathological assessment, the current retrieval practices remain mostly focused on the mechanical analyses of explanted devices, without sufficiently addressing the corresponding tissue/biofluid changes at microscopic and molecular levels. The recently accumulated evidence on biological responses that comprise implant reactivity provides an impetus for rethinking the retrieval-related potential to enhance our understanding of the implant-elicited host responses and thereby improve preclinical biocompatibility testing and enable more predictive evaluation of in vivo implant performance. The retrieval assessment may be improved by a more detailed characterization of the implant debris in terms of its cellular uptake (e.g., phagocytosability), immune and tissue-destructive responses (e.g., not limited to lymphocyte-mediated alterations), as well as other parameters the implant was exposed to that might affect implant longevity (e.g., mechanical alignment, cement technique, soft tissue support). The revised retrieval practices may help facilitate the Center for Devices and Radiological Health's mission and priorities for building the infrastructure and assessment tools for the National Evaluation System for Health Technology.

Original languageEnglish (US)
Title of host publicationBeyond the Implant
Subtitle of host publicationRetrieval Analysis Methods for Implant Surveillance
EditorsA. Seth Greenwald, William M. Mihalko, Steven M. Kurtz, Jack E. Lemons
PublisherASTM International
Pages215-228
Number of pages14
ISBN (Print)9780803176577
DOIs
StatePublished - Jan 1 2018
EventSymposium on Beyond the Implant: Retrieval Analysis Methods for Implant Surveillance - Toronto, Canada
Duration: May 9 2017 → …

Publication series

NameASTM Special Technical Publication
VolumeSTP 1606
ISSN (Print)0066-0558

Other

OtherSymposium on Beyond the Implant: Retrieval Analysis Methods for Implant Surveillance
CountryCanada
CityToronto
Period5/9/17 → …

Fingerprint

Tissue
Fluids
Health
Lymphocytes
Biocompatible Materials
Biocompatibility
Debris
Biomaterials
Cements
Decision making
Wear of materials
Corrosion
Feedback
Testing

All Science Journal Classification (ASJC) codes

  • Materials Science(all)

Cite this

Torosyan, Y., Bowsher, J. G., Kurtz, S. M., Mihalko, W., & Marinac-Dabic, D. (2018). Opportunities and challenges of retrieval analysis: The role of standardized periprosthetic tissue and fluid analysis for assessing an aggravated host response. In A. S. Greenwald, W. M. Mihalko, S. M. Kurtz, & J. E. Lemons (Eds.), Beyond the Implant: Retrieval Analysis Methods for Implant Surveillance (pp. 215-228). (ASTM Special Technical Publication; Vol. STP 1606). ASTM International. https://doi.org/10.1520/STP160620170040

Opportunities and challenges of retrieval analysis : The role of standardized periprosthetic tissue and fluid analysis for assessing an aggravated host response. / Torosyan, Yelizaveta; Bowsher, John G.; Kurtz, Steven M.; Mihalko, William; Marinac-Dabic, Danica.

Beyond the Implant: Retrieval Analysis Methods for Implant Surveillance. ed. / A. Seth Greenwald; William M. Mihalko; Steven M. Kurtz; Jack E. Lemons. ASTM International, 2018. p. 215-228 (ASTM Special Technical Publication; Vol. STP 1606).

Research output: Chapter in Book/Report/Conference proceedingConference contribution

Torosyan, Y, Bowsher, JG, Kurtz, SM, Mihalko, W & Marinac-Dabic, D 2018, Opportunities and challenges of retrieval analysis: The role of standardized periprosthetic tissue and fluid analysis for assessing an aggravated host response. in AS Greenwald, WM Mihalko, SM Kurtz & JE Lemons (eds), Beyond the Implant: Retrieval Analysis Methods for Implant Surveillance. ASTM Special Technical Publication, vol. STP 1606, ASTM International, pp. 215-228, Symposium on Beyond the Implant: Retrieval Analysis Methods for Implant Surveillance, Toronto, Canada, 5/9/17. https://doi.org/10.1520/STP160620170040
Torosyan Y, Bowsher JG, Kurtz SM, Mihalko W, Marinac-Dabic D. Opportunities and challenges of retrieval analysis: The role of standardized periprosthetic tissue and fluid analysis for assessing an aggravated host response. In Greenwald AS, Mihalko WM, Kurtz SM, Lemons JE, editors, Beyond the Implant: Retrieval Analysis Methods for Implant Surveillance. ASTM International. 2018. p. 215-228. (ASTM Special Technical Publication). https://doi.org/10.1520/STP160620170040
Torosyan, Yelizaveta ; Bowsher, John G. ; Kurtz, Steven M. ; Mihalko, William ; Marinac-Dabic, Danica. / Opportunities and challenges of retrieval analysis : The role of standardized periprosthetic tissue and fluid analysis for assessing an aggravated host response. Beyond the Implant: Retrieval Analysis Methods for Implant Surveillance. editor / A. Seth Greenwald ; William M. Mihalko ; Steven M. Kurtz ; Jack E. Lemons. ASTM International, 2018. pp. 215-228 (ASTM Special Technical Publication).
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abstract = "Despite the recent advances with implantable devices, implant longevity and functionality may be compromised by degradative processes such as wear and corrosion, and the implant performance may be further complicated by the resultant host responses. As a window into in vivo implant performance, retrieval analysis is paramount for providing an essential feedback for improving new biomaterial choices and device designs and for securing a decision-making accounting for interindividual variability of real-world performance. Acknowledging the need for leaving the device-tissue interface intact, the current retrieval recommendations (e.g., ASTM F561-13) refer to the importance of proper collecting and handling of the adjacent tissues and fluids so as not to interfere with device/tissue-related analyses or jeopardize patient safety. However, without further stipulation of the utmost importance of comprehensive histopathological assessment, the current retrieval practices remain mostly focused on the mechanical analyses of explanted devices, without sufficiently addressing the corresponding tissue/biofluid changes at microscopic and molecular levels. The recently accumulated evidence on biological responses that comprise implant reactivity provides an impetus for rethinking the retrieval-related potential to enhance our understanding of the implant-elicited host responses and thereby improve preclinical biocompatibility testing and enable more predictive evaluation of in vivo implant performance. The retrieval assessment may be improved by a more detailed characterization of the implant debris in terms of its cellular uptake (e.g., phagocytosability), immune and tissue-destructive responses (e.g., not limited to lymphocyte-mediated alterations), as well as other parameters the implant was exposed to that might affect implant longevity (e.g., mechanical alignment, cement technique, soft tissue support). The revised retrieval practices may help facilitate the Center for Devices and Radiological Health's mission and priorities for building the infrastructure and assessment tools for the National Evaluation System for Health Technology.",
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