title: The clinical, radiological, microbiological, and molecular profile of the skin-penetration site of transfemoral amputees treated with bone-anchored prostheses.
abstract: The breach of the skin barrier is a critical issue associated with the treatment of individuals with transfemoral amputation (TFA) using osseointegrated, percutaneous titanium implants. Thirty TFA patients scheduled for abutment exchange or removal were consecutively enrolled. The aims were to determine the macroscopic skin signs, the presence of bacteria and the gene expression in abutment-adherent cells and to conduct correlative and comparative analyses between the different parameters. Redness and a granulation ring were present in 47% of the patients. Bacteria were detected in 27/30 patients, commonly in the bone canal. Staphylococcus aureus, coagulase-negative staphylococci, streptococci, and Enterococcus faecalis were the most common. A positive correlation was found between TNF-α expression and the detection of S. aureus. Staphylococcus aureus together with other bacterial species revealed a positive relationship with MMP-8 expression. A negative correlation was demonstrated between the length of the residual femur bone and the detection of a granulation ring and E. faecalis. A positive correlation was revealed between fixture loosening and pain and the radiological detection of endosteal bone resorption. Fixture loosening was also correlated with the reduced expression of interleukin-10 and osteocalcin. It is concluded that several relationships exist between clinical, radiological, microbiological, and molecular assessments of the percutaneous area of TFAs. Further long term studies on larger patient cohorts are required to determine the precise cause-effect relationships and unravel the role of host-bacteria interactions in the skin, bone canal and on the abutment for the longevity of percutaneous implants as treatment of TFA. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 105A: 578-589, 2017.
authors.affiliation: Department of Biomaterials, Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg, Gothenburg, SE-405 30, Sweden Box 412.|BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Gothenburg, SE-405 30, Sweden Box 412.
authors.forename: Maria
authors.initials: M
authors.lastname: Lennerås
authors.affiliation: BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Gothenburg, SE-405 30, Sweden Box 412.|Department of Orthopaedics, Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg, Gothenburg, Sweden.
authors.forename: Georgios
authors.initials: G
authors.lastname: Tsikandylakis
authors.affiliation: Department of Biomaterials, Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg, Gothenburg, SE-405 30, Sweden Box 412.|BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Gothenburg, SE-405 30, Sweden Box 412.
authors.forename: Margarita
authors.initials: M
authors.lastname: Trobos
authors.affiliation: Department of Biomaterials, Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg, Gothenburg, SE-405 30, Sweden Box 412.|BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Gothenburg, SE-405 30, Sweden Box 412.
authors.forename: Omar
authors.initials: O
authors.lastname: Omar
authors.affiliation: Department of Biomaterials, Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg, Gothenburg, SE-405 30, Sweden Box 412.|BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Gothenburg, SE-405 30, Sweden Box 412.
authors.forename: Forugh
authors.initials: F
authors.lastname: Vazirisani
authors.affiliation: Department of Biomaterials, Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg, Gothenburg, SE-405 30, Sweden Box 412.|BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Gothenburg, SE-405 30, Sweden Box 412.
authors.forename: Anders
authors.initials: A
authors.lastname: Palmquist
authors.affiliation: BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Gothenburg, SE-405 30, Sweden Box 412.|Department of Orthopaedics, Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg, Gothenburg, Sweden.|Centre for Advanced Reconstruction of Extremities (CARE) Sahlgrenska University Hospital, Mölndal, SE-431 30, Sweden.
authors.forename: Örjan
authors.initials: Ö
authors.lastname: Berlin
authors.affiliation: BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Gothenburg, SE-405 30, Sweden Box 412.|Department of Orthopaedics, Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg, Gothenburg, Sweden.|Centre for Advanced Reconstruction of Extremities (CARE) Sahlgrenska University Hospital, Mölndal, SE-431 30, Sweden.|Department of Orthopaedics, International Center for Osseointegration Research, Education and Surgery (iCORES), University of California, San Francisco.
authors.forename: Rickard
authors.initials: R
authors.lastname: Brånemark
authors.affiliation: Department of Biomaterials, Institute of Clinical Sciences Sahlgrenska Academy University of Gothenburg, Gothenburg, SE-405 30, Sweden Box 412.|BIOMATCELL VINN Excellence Center of Biomaterials and Cell Therapy, Gothenburg, SE-405 30, Sweden Box 412.
authors.forename: Peter
authors.initials: P
authors.lastname: Thomsen
mesh_terms: D000328:Adult; D000368:Aged; D000674:Amputees; D000069343:Bone-Implant Interface; D003430:Cross-Sectional Studies; D013293:Enterococcus faecalis; D005260:Female; D005269:Femur / Q000378:metabolism / Q000382:microbiology / Q000601:surgery; D006801:Humans; D016753:Interleukin-10 / Q000096:biosynthesis*; D016209:Interleukin-8 / Q000096:biosynthesis*; D008297:Male; D008875:Middle Aged; D015675:Osteocalcin / Q000096:biosynthesis*; D013203:Staphylococcal Infections / Q000378:metabolism / Q000473:pathology; D013211:Staphylococcus aureus
chemical_list: C508606:CXCL8 protein, human; C508609:IL10 protein, human; D016209:Interleukin-8; D015675:Osteocalcin; D016753:Interleukin-10
keywords: gene expression; infection; osseointegration; percutaneous; transfemoral amputees