羟基磷灰石涂层髋关节假体的研究与应用

背景：目前含有羟基磷灰石涂层的生物学髋关节假体已广泛应用于临床。 目的：复习相关文献,对羟基磷灰石涂层髋关节假体的生物学特性及临床应用效果进行综述。 方法：应用计算机检索1988/2011 PubMed数据库有关羟基磷灰石涂层髋关节假体生物学特性及临床应用效果的文章,检索词为“hydroxyapatite, hip arthroplasty,hip prosthesis”,排除发表时间早、重复及类似研究,纳入29篇文献进一步分析。 结果与结论：羟基磷灰石是一种具有良好生物相容性及生物活性的磷酸钙盐,通过处理,它可在金属表面形成薄层,这种处理方法可极大促进紧压配合假体的骨整合,能为假体提供骨性固定,直到骨长入到假体的多孔表面内。羟基磷灰石涂层的非骨水泥假体在置入早期即可促进骨长入,允许早期负重,具有良好的机械固定和长久的生物固定作用,且远期并发症如无菌性松动、假体周围骨溶解、假体下沉的发病率并不高于无羟基磷灰石涂层的髋关节假体。但目前在羟基磷灰石涂层的厚度、羟基磷灰石颗粒的大小、羟基磷灰石材料的结晶度等方面尚无统一意见,需要进一步的研究和探讨。     

Strontium in the bone-implant interface

Total hip replacement surgery is being performed on an increasingly large part of the population and at increasingly younger age. Because we live and stay physically active longer, and since hip replacement surgery has become quite successful, the treatment is being offered to progressively more patients. Unfortunately, about 17% of hip replacement surgeries currently involve revisions. Consequently, the longevity of both the primary and revision implant is an issue and warrants further investigation. Implants undergoing early instability or even subsidence correlate with an increased risk of aseptic loosening, subsequently requiring revision. Thus, the goal is early fixation by osseointegration of the implant. For revision implants, this is an even greater challenge since an allograft is often needed during surgery to obtain immediate stability of the implant. Bone grafts are rapidly resorbed. Thus, instability of the prosthesis may develop before new bone formation is well established and can mechanically secure the prosthesis. Strontium is a dual action drug; being both bone anabolic and anti-catabolic. In the form of strontiumranelate, it is used in the treatment of osteoporosis. Strontium may potentially improve the early osseointegration and fixation of implants. This dissertation consists of three studies investigating the effect of strontium at the bone-implant interface. The questions were firstly, what is the optimal delivery method for strontium to the interface, and secondly, can strontium exercise its dual action at the interface? The studies were performed in a cementless, experimental gap model in canine. The effects of strontium were evaluated by histomorphometrical analysis of the osseointegration and mechanical push-out test of implant fixation. Different stereological methods were used for the histomorphometrical analysis of each study. The methods used were reviewed critically and found valid. Study I compared a 5% strontium-substituted hydroxyapatite (HA) coating with an HA coating after 4 weeks and 12 weeks observation time. We examined whether fixation of the implant was improved by the strontium substitution. It was found that fixation of the implant was not improved by the strontium substituted HA coating at any of the two time points. Study II compared a 5% strontium-doped HA bone graft extender with an HA bone graft extender. The bone graft extender was mixed with allograft and impacted around a titanium implant. The objective of this study was to determine whether strontium doping of the bone graft extender could protect the allograft from fast resorption and increase gap healing, leading to the improved fixation of the implant. We found that the strontium doping increased gap healing and protected the allograft, however, results of the mechanical test were inconclusive. The reason might have been that the increased gap healing had not yet reached the implant during the 4 weeks observation time, so ongrowth onto the implant was not improved. Study III investigated the effects of bioactive glass coating with a 0%, 10% or 50% strontium-substitution versus HA coating of grit-blasted titanium alloy implants. The goal was to determine whether fixation of the implant would be improved by the bioactive glass coating, and then further improved by the strontium-substitution of the coating in a dose-dependent manner. Unfortunately, the bioactive glass coating failed, presumably due to aluminum contamination originating from the grit-blasting powder. The HA coated implants were superior in all parameters of osseointegration and the mechanical fixation of the implants. These studies show the importance of performing further experimental investigation. Even when investigating a known agent for use in a new application. Strontium delivered as doping of an HA bone graft extender showed potential as a dual acting agent in the interface. However, delivery methods of strontium to the bone-implant interface clearly need further investigation.     

钛合金表面新型生物玻璃/羟基磷灰石涂层的体内动物实验

目的为促进钛合金植入体与骨的结合,在其表面制备了生物玻璃/羟基磷灰石复合涂层,并植入兔子股骨内进行动物试验,采用等离子喷涂羟基磷灰石涂层和未涂层的Ti6Al4V合金作为对照。方法种植到期的植入体取出后进行组织学切片,采用品红-苦味酸染色后进行组织学观察,采用SEM高倍观察种植体与骨的结合界面,并对骨接触率和凹槽内骨长入量进行了统计分析和比较。结果三种植入体都具有良好的生物相容性。Ti6Al4V合金与骨之间是一种形态固定,而生物玻璃/羟基磷灰石涂层、等离子喷涂羟基磷灰石涂层可与骨形成骨键合。生物玻璃/羟基磷灰石涂层在植入期间与基体没有脱落,同时其与骨的接触率和凹槽内骨长入量要明显高于其余两个植入体,显示出促进骨生长的作用。结论由于具有良好的生物相容性和促进新骨生长的能力,生物玻璃/羟基磷灰石涂层可加快植入体与骨的愈合速度,在骨替代修复方面显示出优势和广阔的应用前景。     

Morphometric and mechanical evaluation of titanium implant integration: comparison of five surface structures

Achieving a stable bone-implant interface is an important factor in the long-term outcome of joint arthroplasty. In this study, we employed an ovine bicortical model to compare the bone-healing response to five different surfaces on titanium alloy implants: grit blasted (GB), grit blasted plus hydroxyapatite (50 microm thick) coating (GBHA), Porocoat(R) (PC), Porocoat(R) with HA (PCHA) and smooth (S). Push-out testing, histology, and backscatter scanning electron microscope (SEM) imaging were employed to assess the healing response at 4, 8, and 12 weeks. Push-out testing revealed PC and PCHA surfaces resulted in significantly greater mechanical fixation over all other implant types at all time points (p <.05). HA coating on the grit-blasted surface significantly improved fixation at 8 and 12 weeks (p <.05). The addition of HA onto the porous coating did not significantly improve fixation in this model. Quantification of ingrowth/ongrowth from SEM images revealed that HA coating of the grit-blasted surfaces resulted in significantly more ongrowth at 4 weeks (p <.05).     

In vivo comparison of the osseointegration of vacuum plasma sprayed titanium- and hydroxyapatite-coated implants

For the last 15 years, orthopedic implants have been coated with hydroxyapatite (HA) to improve implant fixation. The osteoconductive effect of HA coatings has been demonstrated in experimental and clinical studies. However, there are ongoing developments to improve the quality of HA coatings. The objective of this study was to investigate whether a rough and highly crystalline HA coating applied by vacuum plasma spraying (VPS) had a positive effect on the osseointegration of special, high-grade titanium (Ti) implants with the same surface roughness. Ti alloy implants were coated (VPS) with special, high-grade Ti or HA. The osseointegration of the implants was evaluated by either light microscopy or pullout tests after 1, 2, and 4 weeks of unloaded implantation in the cancellous bone of 18 sheep. The interface shear strength increased significantly over all time intervals. By 4 weeks, values had reached approximately 10N/mm(2). However, the difference between the coatings was not significant at any time interval. Direct bone-implant contact was significantly different between the coatings after 2 and 4 weeks, and reached 46% for Ti and 68% for HA implants by 4 weeks. This study indicates that the use of a rough and highly crystalline HA coating, applied by VPS, enhances early osseointegration. Accelerated establishment of secondary implant fixation decreases the risk of early loosening.     

Orthopaedic applications of hydroxyapatite.

Hydroxyapatite (HA) has been used for more than six years. More recently we have used HA composites in clinical orthopaedics for spacing or filling bone defects. In this application the advantages of HA include lack of immuno-reaction and absence of postoperative morphological change or volume decrease. HA implants fixed with cement avoid problems from high density polyethylene wear particles. Other applications of HA include femoral plugs in total hip replacement and HA coating on metal components for cementless fixation. For rapid and strong cementless fixation porous metal surfaces are used; HA coating of porous metal gives improved results. We have also developed a technique for bioactive interfacial bone cementation by interposing fine HA granules between the bone and PMMA cement.     

Percutaneous implants with porous titanium dermal barriers: an in vivo evaluation of infection risk

Osseointegrated percutaneous implants are a promising prosthetic alternative for a subset of amputees. However, as with all percutaneous implants, they have an increased risk of infection since they breach the skin barrier. Theoretically, host tissues could attach to the metal implant creating a barrier to infection. When compared with smooth surfaces, it is hypothesized that porous surfaces improve the attachment of the host tissues to the implant, and decrease the infection risk. In this study, four titanium implants, manufactured with a percutaneous post and a subcutaneous disk, were placed subcutaneously on the dorsum of eight New Zealand White rabbits. Beginning at four weeks post-op, the implants were inoculated weekly with 10(8) CFU Staphylococcus aureus until signs of clinical infection presented. While we were unable to detect a difference in the incidence of infection of the porous metal implants, smooth surface (no porous coating) percutaneous and subcutaneous components had a 7-fold increased risk of infection compared to the implants with a porous coating on one or both components. The porous coated implants displayed excellent tissue ingrowth into the porous structures; whereas, the smooth implants were surrounded with a thick, organized fibrotic capsule that was separated from the implant surface. This study suggests that porous coated metal percutaneous implants are at a significantly lower risk of infection when compared to smooth metal implants. The smooth surface percutaneous implants were inadequate in allowing a long-term seal to develop with the soft tissue, thus increasing vulnerability to the migration of infecting microorganisms.     

Stress distribution in porous surfaced medullary implants

Finite element stress analysis has been applied to examine the stress patterns in a prosthesis requiring fixation in the medullary shaft of a long bone. No specific prosthesis is considered but rather a generally applicable geometry has been chosen. This consists of a cylindrical section of cortical bone within which is implanted a prosthesis composed of a solid central rod surrounded by a porous coating. The finite element analysis utilized an axisymmetric model to determine the distribution of stresses throughout the system. The effect of changes in length of prosthesis, thickness of porous coating, depth and type of tissue ingrowth, and type of porous coating material were studied under conditions of axisymmetric loading. The results indicate that with complete bone ingrowth, the maximum shear stress and the distance necessary for load transfer are both independent of implant length. However, with incomplete ingrowth, increasing implant length reduces shear. Incomplete growth also produces lower shear stresses but higher shear strains in areas without ingrowth. In addition, a porous polyethylene coating gives a more even load transfer and lower shear than a porous coating of a high modulus material.     

Improved bone anchorage of hydroxypatite coated implants compared with tricalcium-phosphate coated implants in trabecular bone in dogs

Tricalcium phosphate (TCP) and hydroxyapatite (HA) ceramic coatings are bioactive coatings that have been shown to stimulate bone apposition onto ceramic-coated implants. TCP and HA ceramics have well-documented differences in physical properties, but both types of ceramics are used for stimulation of bone ongrowth to cementless endo-prosthetic components clinically. However, little is known about the difference in osteoconductive properties between these coatings when inserted into trabecular bone in a controlled experimental situation. Unloaded cylindrical gritblasted titanium (Ti-6A1-4V) implants (6 x 10 mm) coated with either hydroxyapatite (HA) or tricalcium phosphate (TCP) ceramic were inserted into the proximal humerus of 20 skeletally mature dogs. The implants were initially surrounded by a 2 mm gap. Each animal received one HA-coated implant and one TCP-coated implant. All dogs were sacrificed 6 weeks after surgery. Results were evaluated by histomorphometry and mechanical push-out test. Push-out tests demonstrated that HA-coated implants were 10-fold stronger fixated in comparison to TCP-coated implant. Bone ongrowth was significantly higher for HA-coated implants compared to TCP-coated implants. Bone volume in the gap showed a tendency to less bone volume around HA-coated implants compared to TCP-coated implants but this difference was insignificant. As expected almost all of the TCP coating were resorbed after 6 weeks and almost none of the HA coating. HA-coated implants with a grit-blasted surface provide a favorable early mechanical implant anchorage most likely due to superior ceramic stability compared to TCP-coated implants.     

Denosumab prevents periprosthetic bone mineral density loss in the tibial metaphysis in total knee arthroplasty

BackgroundPeriprosthetic bone quality is one of the most important factors preventing early prosthesis migration and long-term failure. Although denosumab, which binds to the receptor activator of nuclear factor kappa-B ligand (RANKL), has been linked with periprosthetic bone mineral density (BMD), the effectiveness of denosumab against bone loss remains unclear. We hypothesized that denosumab treatment after total knee arthroplasty (TKA) could prevent periprosthetic bone resorption.MethodsIn this prospective cohort study, 28 patients with primary knee osteoarthritis were divided into two groups: denosumab (denosumab and vitamin D) and control (vitamin D only) groups. All patients underwent TKA with the same implant model and received medication after surgery. We used dual-energy X-ray absorptiometry to measure periprosthetic BMD after TKA.ResultsIn the control group, the BMD of the proximal medial tibia decreased drastically at 12 months after TKA (− 19.7%). Denosumab treatment significantly preserved this BMD loss (0.7%). The linear regression analysis revealed that denosumab intervention had the highest significantly positive relationship with BMD.ConclusionsOur results indicate that denosumab treatment significantly reduces periprosthetic BMD loss, even at the early stages after TKA. This therapeutic strategy may facilitate early stable fixation of the prosthesis which, in turn, may help to prevent early implant migration and reduce the need for revision surgery.     

Effect of zinc ions on improving implant fixation in osteoporotic bone

Abstract

The application of titanium (Ti) and its alloys in tooth restoration and joint replacement for aged patients with unfavorable conditions is gaining popularity. Therefore, strategies aiming at improving the fixation of Ti-based implants are worth investigating. This study was designed to observe whether modification of Ti implants by zinc (Zn) could enhance the fixation capability in osteoporotic bone. Two kinds of implants, hydroxyapatite (HA) coated Ti and Zn-incorporated HA (ZnHA) coated Ti, were inserted into the femoral metaphysis longitudinally in ovariectomized (OVX) rats. Specimens were harvested and subjected to double fluorescence labeling examination at week 6 after surgery. At week 12, samples were evaluated with histomorphometry, micro-CT (μCT) analysis and biomechanical test. Compared to the HA coated implants, ZnHA coating improved mineral apposition rate (MAR) of peri-implant bone, which was revealed by double fluorescence labeling; bone area ratio (BA) and bone-to-implant contact (BIC) were also higher for the latter group by histomorphometry. μCT images suggested that more bone mass was formed around the ZnHA coated implants as compared to the HA coated implants. Biomechanical push-out test showed that the ZnHA coated implants demonstrated higher strength of osseointegration than the HA group. The current study suggested that Zn ions could enhance bone formation and improve implant fixation in OVX rats.     

In vivo behaviour of hydroxyapatite coatings on titanium implants: a quantitative study in the rabbit

The aim of this study was to evaluate quantitatively the behaviour of in vivo hydroxyapatite coated implants (HA) in the rabbit over time, and to compare the results with observations made on titanium plasma spray implants (TPS). Results were analysed according to the percentage of bone contact. Eighteen HA cylindrical implants (3.25 x 8 mm) and 6 TPS cylindrical implants from Steri-Oss were placed in the epiphysis of the femur in 24 white rabbits. Each rabbit received one implant. Three rabbits with one HA implant (n = 3) and 1 rabbit with one TPS implant (n = 1) were sacrificed after implantation periods of 2, 4, 6, 8, 10 and 12 months. Implants were cut along the long axis and prepared for histological and histomorphometrical evaluations. Measurements of coating thickness and percentage of bone contact were performed with scanning electron microscopy analysis on the sides of the implant, in 3 different types of bone, namely cortical, trabecular and marrow. In cortical bone, dense bone was apposed to the HA implants: from 92.3 +/- 5.5% at 2 months to 89.6 +/- 6.5% at 1 year, with no significant regression of HA thickness (P = 0.37). TPS coating showed less bone contact, but thickness was stable (P = 0.46). In trabecular zone, where bone contact was less pronounced, a significant regression of HA coatings thickness (P < 0.05) was observed. Nevertheless TPS coatings were stable (P = 0.81). Histomorphometrical results demonstrated that a highly significant regression (P < 0.0001) of HA thickness was observed in the marrow area, where the bone-to-implant contact never exceeded 7.6% from 2 to 12 months. TPS coating did not reveal any sign of resorption (P = 0.88), despite a rare bone contact. Histological analysis revealed inflammatory and giant cells, principally in the marrow area in contact with HA coating, but always in restrictive numbers. We conclude that bone contact protected the HA coating from resorption.     

Loading improves anchorage of hydroxyapatite implants more than titanium implants

Roentgen Stereophotogrammetric Analysis (RSA) studies have shown that the quality of the early fixation of implants has a dominant effect on their long-term function. To evaluate methods to improve their fixation, we examined the influence of mechanical loading and surface coating on the quality of the bone-implant interface. We compared the fixation of a cylindrical, stable 6.0 mm implant initially surrounded by a 0.75 mm concentric gap, after 4 weeks of loaded or unloaded conditions. Two types of surfaces were analyzed: plasma sprayed hydroxyapatite (HA) and plasma sprayed titanium (Ti). The histomorphometric evaluation showed that HA implants had greater bone coverage than Ti implants, and this coverage was further increased under loaded conditions only for HA. Furthermore, loading reduced the fibrous tissue coverage for the HA implants, while it increased fibrous tissue coverage for Ti implants. These findings were in agreement with pushout results showing that HA implants had greater shear strength, stiffness, and energy than Ti implants, and (except for energy) these parameters were further increased under loaded conditions only for HA. In addition, because the two implant surfaces exhibited a different relative response to load, it is important to evaluate new surfaces under the more clinically relevant loaded condition.     

Coralline hydroxyapatite granules inferior to morselized allograft around uncemented porous Ti implants: unchanged fixation by addition of concentrated autologous bone marrow aspirate

We compared early fixation of titanium implants grafted with impacted allograft bone or coralline hydroxyapatite (HA) granules (Pro Osteon 200) with and without the addition of concentrated bone marrow cells (BMC). Autologous bone marrow aspirate was centrifuged to increase the BMC concentration. Four nonloaded cylindrical, porous coated titanium implants with a circumferential gap of 2.3 mm were inserted in the proximal humeri of eight dogs. Coralline HA granules +/- BMC were impacted around the two implants on one side, and allograft +/- BMC was impacted around the contra lateral implants. Observation time was 4 weeks. The implants surrounded by allograft bone had a three-fold better fixation than the HA-grafted implants. The concentration of BMC after centrifugation was increased with a factor 2.1. The addition of BMC to either of the bone graft materials had no statistically significant effects on implant fixation. The allografted implants were well osseointegrated, whereas the HA-grafted implants were largely encapsulated in fibrous tissue. The addition of concentrated autologous BMCs to the graft material had no effect on implant fixation. The HA-grafted implants were poorly anchored compared with allografted implants, suggesting that coralline HA granules should be considered a bone graft extender rather than a bone graft substitute.     

Role of hydroxyapatite coating in resisting wear particle migration and osteolysis around acetabular components

The main problem facing the longevity of total joint replacements is wear particle-induced osteolysis, particularly around the acetabular component. Ovine Total Hip Replacement surgery was performed with roughened femoral heads in order to enhance wear debris generation in vivo. The resistance to aseptic loosening of acetabular components with different surface coatings was investigated. Implants remained in vivo for 1 year. Sheep were randomly assigned to one of six experimental groups where the acetabular cup was fixed utilising an: (a) cemented polyethylene acetabular cup, (b) metal backed grit blasted surface, (c) metal backed plasma sprayed titanium porous coating, (d) metal backed sintered beaded coating, (e) Hydroxyapatite (HA)-coated grit blasted surface (f) and HA-coated porous components. Ground Reaction Force (GRF) was used to asses the functional performance of the implants and data was collected pre-operatively and at 12, 24, 36 and 52 weeks post op. Wear debris generated was analysed and radiographs taken prior to preparation of thin sections. Fibrous tissue (FT) thickness and bone contact at 1 mm intervals along the acetabular bone-implant interface was calculated. GRF data demonstrated significant differences between experimental groups. In all groups there was an increase in the function of the hip after surgery and up to 24 weeks but thereafter the function of the group with the grit blasted surface reduced whereas the function of the other groups did not significantly change. Average wear particles generated were <1 microm in size. The cemented group demonstrated a significantly thicker average FT layer (2.69 mm) when compared with all other groups (p<0.05 in all cases) except the grit blasted group (1.56 mm). HA porous coated cups demonstrated significantly least fibrous tissue adjacent to its interface when compared with all other groups (cemented p<0.05, grit blasted p=0.029, porous p<0.05, sintered beads p<0.05 and HA grit blasted p<0.05). Significantly increased bone contact to HA-coated porous cups (73.33%) when compared with all groups was identified except HA-coated grit blasted cups where no significant difference was demonstrated. Radiographic signs of loosening were visible in all groups except the HA-coated porous group. Results demonstrated that HA porous coated acetabular components significantly enhanced bone ingrowth in the presence of wear particles, preventing their migration and reducing osteolysis. Non-HA-coated porous and sintered beaded components provided a more effective seal against the ingress of wear debris when compared with cemented cups.     

Comparison of plasma-sprayed hydroxyapatite coatings and zirconia-reinforced hydroxyapatite composite coatings: in vivo study

The clinical use of plasma-sprayed hydroxyapatite (HA) coatings on metal implants has been widely adopted because the HA coating can achieve the firmly and directly biological fixation with the surrounding bone tissue. However, the long-term mechanical properties of HA coatings has been concern for the long-term clinical application. Previous research showed that the concept of adding ZrO2 as second phase to HA significantly increased the bonding strength of plasma-sprayed composite material. The present work aimed to explore the biological properties, including the histological responses and shear strength, between the plasma-sprayed HA and HA/ZrO2 coating, using the transcortical implant model in the femora of canines. After 6 and 12 weeks of implantation, the HA coating revealed the direct bone-to-coating contact by the backscattered electron images (BEIs) of scanning electron microscope (SEM), but the osseointegration was not observed at the surface of HA/ZrO2 coating. For new bone healing index (NBHI) and apposition index (AI), the values for HA implants were significantly higher than that for HA/ZrO2 coatings throughout all implant periods. After push-out test, the shear strength of HA-coated implants were statistically higher than HA/ZrO2 coated implants at 6- and 12-week implantation, and the failure mode of HA/ZrO2 coating was observed at the coating-bone interface by SEM. The results indicate that the firm fixation between bone and HA/ZrO2 has not been achieved even after 12-week implantation. Consequently, the addition of ZrO2 could improve the mechanical properties of coatings, while the biocompatibility was influenced by the different material characteristics of HA/ZrO2 coating compared to HA coatings.     

Bone ingrowth and total knee replacement

Biological fixation by bone ingrowth into prosthetic components in total knee arthroplasty is a complex process involving the integration of numerous biological and mechanical factors. These factors include the presentation of an appropriate porous-coated surface of such pore size and pore geometry as to allow bone ingrowth. Additionally, there must be intimate contact and minimal interface motion between the prosthesis and the bone for ingrowth to occur. Numerous factors have been shown to influence bone ingrowth including various types of bone graft material, electrical stimulation, drugs and ionizing radiation. The application of ingrowth biology to total knee arthroplasty technology has unique implications for the patellar, femoral and tibial prosthetic components. While the early clinical and retrival results of total knee arthroplasty using bio-ingrowth technology were somewhat controversial, more recent reports have been more favourable. As more clinical, basic science and retrieval studies become available in the 1990s the role of bio-ingrowth technology in the clinician's armamentarium will be further elucidated.     

Replacement of the anterior cruciate ligament with a coated carbon fibre prosthesis: a biomechanical study in goats

Anterior cruciate ligament replacement was performed in goats to evaluate a coated carbon fibre prosthesis. Anatomical placement of the implant was performed using either the prosthesis alone or the prosthesis augmented with soft tissue. Animals were assessed 13 and 52 weeks after surgery. Mechanical testing of the bone-ligament-bone complex was used to determine the failure load and the mode of failure. Both types of implant failed by prosthesis slippage at the femoral fixation site. Failure loads were significantly higher for augmented repairs than for plain carbon repairs at both 13 and 52 weeks. Augmentation of the prosthesis with patellar tendon and fascia lata enhanced the fixation strength of the implant.     

Dissolution control and cellular responses of calcium phosphate coatings on zirconia porous scaffold

Different types of calcium phosphates [hydroxyapatite (HA), fluorapatite (FA), tricalcium phosphate (TCP), and their composites (HA + FA, HA + TCP)] were coated on a zirconia (ZrO(2)) porous scaffold using a powder slurry method. The ZrO(2) porous scaffold was intended for a load-bearing implant, and the apatite layers were coated to improve osteoconductivity. The insertion of an FA intermediate layer between the coating layer and ZrO(2) scaffold effectively suppressed the reaction between the calcium phosphate and ZrO(2) and maintained the coating layer at the initial powder composition. The obtained coating layer, of a thickness of approximately 30 microm, was relatively microporous and firmly adherent to the ZrO(2) scaffold. Dissolution tests in physiological solution showed typical differences depending on the coating layers, with the dissolution rate increasing in the order TCP > HA + TCP > HA > HA + FA > FA. This result suggests the functional coating of the calcium phosphates in view of tailoring the solubility. Osteoblast-like cells, MG63 and HOS, responded similarly in terms of cell growth, morphology, and proliferation rate regardless of the coating types, indicating favorable and comparable cell viability. However, the alkaline phosphatase (ALP) activity of the cells on the pure HA and HA composite coatings (HA + FA and HA + TCP) expressed at higher levels compared to those on pure FA and pure TCP coatings for both MG63 and HOS cells, suggesting a selective cell activity depending on the coating types. All the calcium phosphate-coated-ZrO(2) scaffolds showed higher ALP levels compared to pure ZrO(2) scaffold.     

Hydroxyapatite-coated polyurethane for auricular cartilage replacement: an in vitro study

Auricular reconstruction remains a major challenge facing reconstructive surgeons owing to the complexity of autogenous transplants. In this study, the development of a three-dimensional custom-made polyurethane (PU) auricular implant with hydroxyapatite (HA) coating is described. The PU implant was produced by computerized tomography (CT) scanning and indirect rapid prototyping. To improve the physiological response of the implant, the PU prototype was coated with a microrough, homogenous layer of HA by a novel solvent-compression coating method. Bioactivity of the HA coated PU substrates was confirmed by apatite formation on the HA coating after 9 days in revised simulated body fluid (pH 7.4). Adhesion strength of the HA coating to the PU surface using the tensile pull-off test revealed partial failure of the coating with an average tensile strength of 1.6 MPa. As an initial stage indication of cytocompatibility for a soft tissue application, in vitro cell culturing on the HA-coated PU substrates using Graham 293 fibroblast cells was performed. After 24 and 72 h, the HA coated surfaces displayed significantly higher cell numbers and metabolically active cells compared with the virgin uncoated PU surfaces. This indicates that HA coated PU surfaces are cytocompatible towards fibroblasts and could potentially be applied to auricular cartilage tissue replacement.