Interfacial shear strength of bioactive‐coated carbon fiber reinforced polyetheretherketone after in vivo implantation

Despite the excellent osseointegration of carbon‐fiber‐reinforced polyetheretherketone (CFR/PEEK) with a surface hydroxyapatite (HA) coating, the bone‐implant interfacial shear strength of HA‐coated CFR/PEEK after osseointegration is unclear. We examined the interfacial shear strength of HA‐coated CFR/PEEK implants after in vivo implantation in a rabbit femur‐implant pull‐out test model. HA coating was performed by a newly developed method. Uncoated CFR/PEEK, HA‐coated blasted titanium alloy, and uncoated blasted titanium alloy were used as control implants. The implants were inserted into drilled femoral cortex, and pull‐out tests were conducted after 6 and 12 weeks of implantation to determine maximum interfacial shear strength. The HA‐coated CFR/PEEK (15.7 ± 4.5 MPa) and HA‐coated titanium alloy (14.1 ± 6.0 MPa) exhibited significantly larger interfacial shear strengths than the uncoated CFR/PEEK (7.7 ± 1.8 MPa) and the uncoated titanium alloy (7.8 ± 2.1 MPa) at 6 weeks. At 12 weeks, only the uncoated CFR/PEEK (8.3 ± 3.0 MPa) exhibited a significantly smaller interfacial shear strength, as compared to the HA‐coated CFR/PEEK (17.4 ± 3.6 MPa), HA‐coated titanium alloy (14.2 ± 4.8 MPa), and uncoated titanium alloy (15.0 ± 2.6 MPa). Surface analysis of the removed implants revealed detachment of the HA layer in both the HA‐coated CFR/PEEK and titanium alloy implants. The proposed novel HA coating method of CFR/PEEK significantly increased interfacial shear strength between bone and CFR/PEEK. The achieved interfacial shear strength of the HA‐coated CFR/PEEK implant is of the same level as that of grit‐blasted titanium alloy with HA. © 2012 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 30:1618–1625, 2012     

Biological fixation of hydroxyapatite-coated versus grit-blasted titanium hip stems: a canine study

BACKGROUND: The purpose of the study was to evaluate the influence of a proximal hydroxyapatite (HA) coating in comparison with a grit-blasted titanium surface of an anatomic hip stem in an animal model over a maximum duration of 2 years. METHODS: Thirty adult dogs underwent implantation of either a proximally HA-coated or a grit-blasted anatomic titanium stem. The animals were clinically evaluated for their walking ability, and serial radiographs were taken. The femora were assessed histomorphologically at set time points from 6 weeks to 2 years postoperatively. Undecalcified thin section specimens through the proximal and distal portion of the coating or grit blasting were prepared. The percentage of implant surface with direct bone contact without connective tissue involvement was determined. RESULTS: Radiographically, animals with uncoated prostheses showed characteristic signs of loosening more frequently. Histomorphometrically, an average of 65% of the surface of HA-coated implants had bone contact, but only 14.7% of the surface of grit-blasted prostheses ( p=0.0001). There was no relationship between bone contact and the duration of implantation of the prosthesis, either for the coated or for the uncoated prostheses. HA coating enhances osseointegration of an anatomic hip stem. CONCLUSION: Anatomic stems with rounded design require a surface coating or surface structure, since the mere grit-blasting of the titanium surface does not ensure osseointegration in this animal model.     

Hydroxyapatite-coated titanium for orthopedic implant applications

The interface mechanical characteristics and histology of commercially pure (CP) titanium- and hydroxyapatite- (HA) coated Ti-6Al-4V alloy were investigated. Interface shear strength was determined using a transcortical push-out model in dogs after periods of three, five, six, ten, and 32 weeks. Undecalcified histologic techniques with implants in situ were used to interpret differences in mechanical response. The HA-coated titanium alloy implants developed five to seven times the mean interface strength of the uncoated, beadblasted CP titanium implants. The mean values for interface shear strength increased up to 7.27 megaPascals (MPa) for the HA-coated implants after ten weeks of implantation, and the maximum mean value of interface shear strength for the uncoated CP titanium implants was 1.54 MPa. For both implant types there was a slight decrease in mean shear strength from the maximum value to that obtained after the longest implantation period (32 weeks). Histologic evaluations in all cases revealed mineralization of interface bone directly onto the HA-coated implant surface, with no fibrous tissue layer interposed between the bone and HA visible at the light microscopic level. The uncoated titanium implants had projections of bone to the implant surface with apparent direct bone-implant apposition observed in some locations. Measurements of the HA coating material made from histologic sections showed no evidence of significant HA resorption in vivo after periods of up to 32 weeks.     

Gap healing enhanced by hydroxyapatite coating in dogs.

During prosthetic implantation, gaps between the implant surface and the surrounding bone may occur resulting in reduced implant stability. In these instances bone-conductive materials might augment the formation of hosting bone into the pores of the implant and insure earlier implant stabilization and fixation by bony ingrowth. Titanium-alloy cylinders with a porous-titanium-alloy plasma spray coating were implanted into the medial femoral condyles in six mature dogs. In another group of six dogs, matched in age, weight, and gender, hydroxyapatite (HA) coated implants were used. All implants were surrounded by a 1-mm gap. Unilateral osteopenia of the knee, with a 20% reduction of bone density as judged by computed tomography scanning, was induced by 12 weekly intraarticular injections of carrageenin into the right knee before surgery. Four weeks after implantation, the HA-coated implants were compared to the parent porous-titanium implants by mechanical testing and histomorphometry. A marked positive influence of HA coating on bone mineralization and the strength of the interfacial bone between the bone and implant was found. The increment in interface shear strength and shear stiffness was three- to fivefold in osteopenic bone and two-fold in control bone. Coating of an unloaded porous-titanium-coated implant with HA accelerates the rate of bone ingrowth and thereby provides relatively high, early interfacial shear strengths in the presence of an initial gap between bone and implant even in the presence of osteopenic host bone.     

Porous-coated versus grit-blasted surface texture of hydroxyapatite-coated implants during controlled micromotion: Mechanical and histomorphometric results

Hydroxyapatite (HA)-coated implants with porous-coated and grit-blasted surface textures were inserted bilaterally in a paired design into the medial femoral condyles of eight dogs for 16 weeks. The implants were weight-loaded and initially subjected to controlled micromotion of 500 μm during each gait cycle. Histology revealed that five implants in each group had bony anchorage, and the remaining implants were surrounded by fibrous tissue. Push-out testing showed no difference in shear stiffness and strength, while energy absorption for porous-coated implants was increased significantly by threefold. The HA coating delaminated on grit-blasted implants during push-out testing, whereas porous-coated implants predominantly failed at the HA-tissue interface. Coverage, surface area, volume, and thickness of the HA coating were significantly reduced in vivo for porous-coated and grit-blasted implants. In conclusion, a plasma-sprayed porous-coated implant surface seems to give better fixation not only of the HA-coating to the implant surface but also of the implant to the surrounding tissues in comparison to a grit-blasted implant surface. The HA coating was reduced more on fibrous-anchored than on bony-anchored implants, suggesting that micromotion accelerates resorption of HA. Resorbed HA coating was replaced by more bone on porous-coated implants than on grit-blasted implants, which suggests that fixation of porous-coated implants will be durable.     

Osseointegration of polyethylene implants coated with titanium and biomimetically or electrochemically deposited hydroxyapatite in a rabbit model

Purpose

The aim of this study was to evaluate the osseointegration of a new coating directly deposited on PE at room temperature.

Methods

Thirty-six (36) male New Zealand rabbits were randomly assigned to receive one out of three types of implants: two tested implants, i.e. PE implant coated with TiPVD and biomimetic HA (biomimetic), PE implant coated with TiPVD and electrolytic HA (electrolytic), and positive control made of massive microrough titanium coated with plasma sprayed HA (TiHAPS). Osseointegration was evaluated by histomorphometry (bone tissue in contact [BIC]), mineralized bone area [MBA]) and mechanical testing (push-out test, interfacial shear strength [ISS]) at six and 12 weeks in the distal femurs.

Results

For BIC there were no differences between the groups at six (p = 0.98) and 12 weeks (p = 0.13). For MBA, no statistically significant difference was measured between groups at six (p = 0.52) and 12 weeks (p = 0.57). At six weeks, interfacial shear strength (ISS) was significantly higher (p = 0.01) for TiHAPs implants compared to biomimetic and electrolytic implants. This difference was not significant at 12 weeks (p = 0.92).

Conclusion

The osseointegration of biomimetic and electrolytic implants was equivalent to a positive control at 12 weeks.     

The effect of substrate roughness and hydroxyapatite coating thickness on implant shear strength

This study examined the role of substrate preparation and hydroxyapatite (HA) coating thickness on bone ongrowth and shear strength in a bilateral bicortical sheep model. Plasma-sprayed and grit-blasted titanium implants with different thickness HA coatings were examined at 4, 8, 12, and 26 weeks after implantation. Shear strength increased with time for all implants. Plasma-sprayed implants were superior to grit-blasted implants at all time points. The 100-microm-thick HA layer used in the present study provided greater fixation and ongrowth and less resorption compared with the 50-microm-thick layer. We did not observe any advantage in using a thicker HA coating for the titanium substrates examined.     

Effects of calcium ion implantation on osseointegration of surface-blasted titanium alloy femoral implants in a canine total hip arthroplasty model

Osteoconductivity of titanium-alloy implants may be improved when surface-modified by calcium ion (Ca2+) implantation. We studied the effects of Ca2+ implantation on osseointegration of a grit-blasted titanium-alloy stem using a canine total hip arthroplasty model. Fifteen dogs underwent bilateral hip arthroplasties and were sacrificed at 1, 6, and 12 months postoperatively. The hip components were evaluated by radiographic, qualitative, and quantitative histology methods. Radiographically and histologically, both Ca(2+)-implanted and non-Ca(2+)-implanted stems were well integrated. Ca(2+)-implanted stems had greater new bone apposition than non-Ca(2+)-implanted stems, although the difference was significant only at 1 month (15.8% +/- 3.5% of the implant perimeter for non-Ca(2+)-implanted, 25.4% +/- 4.7% for Ca(2+)-implanted, P< .05). This result could be related to chronological decrease of the dissolution rate of calcium ions from Ca(2+)-implanted surface. Although further improvement of the Ca2+ implantation technique for a sustained osteoconductive effect is necessary, Ca2+ implantation may be beneficial for early fixation of titanium-alloy implants.     

Shear and tensile strength of hydroxyapatite coating under loading conditions

The shear and tensile strength of a hydroxyapatite (HA) coating on a femoral component was studied after physiological loading conditions in 8 German Shepherds. A proximal macrostructure on the stem was used to protect this region from shear stresses. Another four implantations with uncoated components were used as controls. In vitro testing of the HA layer demonstrated excellent tensile strength and stability to surface deformation. The loaded implants were tested at 6, 12, and 24 weeks. At 6 weeks the HA-coated components could easily be removed by axial loading, whereas the HA layer remained undamaged on the metal. However, pull out tests of implants older than 12 weeks showed complete debonding of the HA layer from the non-macrostructured surface due to shear forces in all cases. Debonding of the HA layer was also observed with microradiography. The macrostructured surface prevented dislodging of the component from this area at pull out test by distributing shear forces. Unlike in uncoated implants, considerable amounts of bone remained attached onto the HA macrostructure when the surrounding femur was pulled out. Shear forces cause debonding of the HA layer, while tensile stress affects failure within the bone. Physiological loading partially produces gaps at the interface so direct transmission of tensile forces onto the bone is lost, and the coating-metal interface becomes the weak point in the system.     

Sealing effect of hydroxyapatite coating on peri-implant migration of particles. An experimental study in dogs

We have studied the beneficial effects of a hydroxyapatite (HA) coating on the prevention of the migration of wear debris along the implant-bone interface. We implanted a loaded HA-coated implant and a non-coated grit-blasted titanium alloy (Ti) implant in each distal femoral condyle of eight Labrador dogs. The test implant was surrounded by a gap communicating with the joint space and allowing access of joint fluid to the implant-bone interface. We injected polyethylene (PE) particles into the right knee three weeks after surgery and repeated this weekly for the following five weeks. The left knee received sham injections. The animals were killed eight weeks after surgery. Specimens from the implant-bone interface were examined under plain and polarised light. Only a few particles were found around HA-coated implants, but around Ti implants there was a large amount of particles. HA-coated implants had approximately 35% bone ingrowth, whereas Ti implants had virtually no bone ingrowth and were surrounded by a fibrous membrane. Our findings suggest that HA coating of implants is able to inhibit peri-implant migration of PE particles by creating a seal of tightly-bonded bone on the surface of the implant.     

Mechanical and histological evaluation of hydroxyapatite-coated,titanium-coated and grit-blasted surfaces under weight-bearing conditions

Cylindric titanium rods with different surfaces were axially implanted into the femora of sheep. The three surfaces were grit-blasted titanium, plasma-sprayed titanium and plasma-sprayed hydroxyapatite (HA). After 2 months, a 2-cm segment of the femoral shaft was completely resected to load the implant, and the animals were allowed full weight-bearing for 9 months. Biomechanical and histological evaluation of the implants was undertaken 2 months after implantation and 9 months after the segmental resection. The mechanical testings of well-fixed implants were performed 9 months after segmental resection. Loosening of 45% of the titanium-coated implants was observed in the first 3 weeks, but thereafter, no further loosening occurred. The HA-coated implants remained entirely fixed for 3 weeks, but thereafter, a progressively increasing incidence of loosening up to 55% after 9 months of loading was detected as subsidence on X-radiographs. The maximum push-out strength of the titanium-coated implants was 4.9 MPa compared with 2.3 MPa for HA-coated ones. No significant mechanical interlock between the grit-blasted surface and bone was observed. The HA coating was found to be delaminated in all unstable implants, whereas the titanium coating remained completely intact. Morphometric analyses of well-fixed rods showed complete bony ingrowth onto the HA surface, whereas the contact area between the bone and the two titanium surfaces was less than 40%. Concerning clinical significance bony ingrowth with long-term mechanical interlock between the implant surface and the bone cannot be achieved by grit-blasting or HA-coating. The titanium plasma-coating, however, can induce a bone-implant interface which resists the mechanical stress resulting from continuous cyclic loading in vivo.Supported by Deutsche Forschungsgemeinschaft (Da-272/1-2)     

Improved bone-screw interface with hydroxyapatite coating: an in vivo study of loaded pedicle screws in sheep

STUDY DESIGN: An in vivo sheep model with loaded pedicle screws was used, wherein each animal served as its own control. OBJECTIVES: To examine the effects of hydroxyapatite (HA) coating on the bone-to-implant interface in loaded spinal instrumentations. SUMMARY OF BACKGROUND DATA: Spinal instrumentation improves the healing rate in spinal fusion, but screw loosening constitutes a problem. HA coating of other implants has resulted in favorable effects on the bone-to-implant interface. METHODS: Nine sheep were operated on with destabilizing laminectomies at two levels: L2-L3 and L4-L5. Each level was stabilized separately with a four-screw instrumentation. Uncoated screws (stainless steel) or the same type of screws coated with plasma-sprayed HA were used in either the upper or the lower instrumentation in a randomized fashion. The animals were killed at 6 or 12 weeks after surgery. The specimens were embedded in resin, ground to approximately 10 microm, and stained with toluidine blue. Histomorphometric evaluation was carried out in a Leitz Aristoplan (Wetzlar, Germany) light microscope equipped with a Leitz Microvid unit. RESULTS: The average percentage of bone-to-implant contact after 6 weeks was 69 +/- 10 for the HA-coated screws and 18 +/- 11 for the uncoated screws (P < 0.03), and after 12 weeks 64 +/- 31 (HA-coated) and 9 +/- 13 (uncoated, P < 0.02). The average bone volume in the area close to the screw was significantly higher for the HA-coated screws at both 6 and 12 weeks. CONCLUSIONS: HA coating improved the bone-to-implant interface significantly, indicating that HA coating can become useful for improving the purchase of pedicle screws.     

羟基磷灰石梯度涂层的生物学研究

目的：本实验研究HA梯度涂层材料在体内负重条件下的生物学表现,方法：将经梯度涂层羟基磷灰石的钛合金栓与非涂层钛合金栓分别植入狗下肢的负重区,观察植入体与骨结合界面的生物学特性,结果：组织学研究显示类骨样基质直接沉积在HA涂层表面,涂层与宿主骨紧密结合。而非涂层组新生骨形成的数量和速度远低于HA涂层组,生物力学测试显示HA组与宿主骨结合界面的抗剪强度均远大于非涂层组（P＜0．01）,结论：结果表明HA梯度涂层法作为新颖的层方法有其实际临床应用价值。     

Effects of hydroxyapatite tricalcium phosphate coating and intracancellous placement on bone ingrowth in titanium fibermetal implants

The purpose of this study was to compare the host—bone response to hydroxyapatite/tricalcium phosphate (HA/TCP)-coated and noncoated titanium fibermetal implants placed in a load-sharing cancellous bone environment of the distal femurs of rabbits. The influence of implantation site was also investigated by comparing these intracancellous implants with intramedullary implants evaluated in a previous study. Three parameters were measured: percentage implant perimeter surface length in contact with new bone, percentage internal fibermetal surface length in contact with ingrown bone, and percentage of available pore space filled with bone. The HA/TCP coating significantly accelerated and increased bone ongrowth, new bone formation on the perimeter and internal surface of the implants. This effect was evident as early as 2 weeks after implantation. In contrast, there was no difference between HA/TCP-coated and noncoated implants in the bone ingrowth parameter, percentage of available pore space filled with bone, or pull-out strength. Scanning electron microscopy in the backscatter mode demonstrated that new bone formed directly onto the HA/TCP-coated fibers and did not usually form directly on noncoated fibers. Analysis of fluorochrome labeling revealed that bone formation in weeks 1 through 4 was primarily woven and there-after lamellar. Compared with intramedullary placement, intracancellous placement significantly accelerated the apposition of bone to the perimeter and internal surface of HA/TCP-coated implants and both accelerated and increased bone ingrowth as a percentage of available pore volume. These data show that the host response to titanium fibermetal implants is influenced both by HA/TCP coating and by the implantation site.     

Effect of local TGF-��1 and IGF-1 release on implant fixation: comparison with hydroxyapatite coating: A paired study in dogs

Background and purpose Hydroxyapatite (HA) coating stimulates the osseointegration of cementless orthopedic implants. Recently, locally released osteogenic growth factors have also been shown experimentally to stimulate osseointegration so that bone fills gaps around orthopedic implants. Here, we have compared the effect of local release of TGF-β 1 and IGF-1 with that of hydroxyapatite coating on implant fixation.Method Weight-bearing implants with a 0.75-mm surrounding gap were inserted bilaterally in the knees of 10 dogs. Growth factors were incorporated in a biodegradable poly(D,L-lactide) coating on porous coated titanium implants. Plasma-sprayed HA implants served as controls. The dogs were killed at 4 weeks and the implants were evaluated by mechanical push-out test and by histomorphometry.Results There was no difference in any of the mechanical parameters. Bone ongrowth was 3-fold higher for HA-coated implants (p < 0.001). For growth factor-coated implants, bone volume was 26% higher in the inner half of the gap and 28% higher in the outer half compared to HA (p < 0.03).Interpretation- The mechanical fixation of porous-coated titanium implants with local growth factor release is comparable to that of HA coating. While HA mainly stimulated bone ongrowth, local release of TGFβ 1 and IGF-1 stimulated gap healing.     

Calcium phosphate coatings for fixation of bone implants: Evaluated mechanically and histologically by stereological methods

The osteoconductive properties of HA coatings are well-documented. HA coating is able to enhance bone ingrowth and to reduce early migration of both hip and knee prostheses. Despite the clinical use of HA-coated prostheses several aspects relevant to HA coatings have not been elucidated. The optimum coating quality and surface texture is still a matter of debate. Moreover, the significance of coating resorption is controversial. It has been suggested that resorption disintegrates the coating and reduces the bonding strength between implant and bone and the strength of the coating-implant interface, which might lead to implant loosening, coating delamination and acceleration of third body wear processes. This thesis aimed to investigate the effects of Ca-P coating type, quality and surface texture on mechanical fixation, bone ingrowth and loss of coating in experimental models in dogs and man. Furthermore, the significance of systematic sampling in bone histomorphometry using the unbiased stereological vertical section method was analyzed. Results . The first group of studies showed that HA-coated implants with porous-coated surface demonstrated increased energy absorption compared with grit-blasted implants during both non weight-bearing and weight-bearing conditions with controlled micromotion of 500 &#119 m. In addition, the HA coating delaminated on gritblasted implants during mechanical testing in contrast to porous-coated implants. Histomorphometry showed increased bone ingrowth to grit-blasted implants demonstrating that surface topology influenced surface activity. The next series of studies focused on the effects of Ca-P coating type, HA versus FA, during stable weight-bearing and non weight-bearing conditions. In dogs, no difference in mechanical fixation and bone ingrowth was demonstrated. However, in humans, HA-coated implants had significantly greater bone ongrowth than FA-coated implants after one year. The third group of studies evaluated the effects of HA coating crystallinity during controlled micromotion of 250 &#119 m. After 16 weeks, low crystalline (50%) HA coating accelerated mechanical fixation and bone ingrowth compared with high crystalline HA (75%). High crystalline HA achieved significantly better anchorage from 16 to 32 weeks whereas mechanical fixation of low crystalline HA was unchanged. In all studies, loss of Ca-P coating was evaluated. It was demonstrated that the coatings were resorbed, partially, in vivo irrespective type and quality of the coating. HA coverage on porouscoated implants was significantly more reduced than on grit-blasted implants in dogs. No difference in overall resorption between HA and FA coatings was demonstrated. However, in humans, significantly less HA and FA coating was resorbed when bone was present on the coating surface compared with bone marrow or fibrous tissue. In addition, resorption of HA was greater than FA in the presence of bone marrow indicating that FA was more stable than HA. Low (50%) crystalline HA coating was significantly more reduced compared with high (75%) crystalline HA at both 16 and 32 weeks. However, no further coating loss was observed from 16 to 32 weeks suggesting two phases of coating resorption: Phase I (0-16 weeks) with rapid coating loss, and phase II (16-32 weeks) with slow loss. Another important finding was that continuous loading and micromovements of 150 &#119 m accelerated resorption in contrast to immobilization of the implant. In addition, unstable fibrous anchored implants had significantly more loss of HA coating as compared with bony anchored implants. In all studies, resorbed coating was partly replaced by bone in direct contact with the implant surface suggesting durable implant fixation. Sampling efficiency in the unbiased stereological vertical section method was analyzed in order to find an optimal sampling design for histomorphometric analyzes at different sampling levels (humans, sections, fields of view and number of counting items) with different sampling intensities. The analysis showed that only minor changes in variances were observed when the initial scheme of 14 sections from each implant was reduced to include only one of the two possible implant sides, every third field of view and half the probe density, reducing the total workload at the microscope to less than 10% on all sections. In addition, the number of sections for analysis could be reduced to every fourth section per implant (3-4 sections for evaluation) without significantly increase in variance. The study demon strated that biological variation contributed to the majority of the total observed variance. Conclusion . The present series of investigations demonstrated that Ca-P coating type and quality and the underlying surface texture had significant influence on either mechanical fixation, bone in/ongrowth and loss of coating in dogs and man. In addition, the sampling design for histomorphometry could be optimized without reducing the quality of the data.     

Relative contributions of chemistry and topography to the osseointegration of hydroxyapatite coatings

The purpose of the current study was to ascertain the relative contributions of surface chemistry and topography to the osseointegration of hydroxyapatite-coated implants. A canine femoral intramedullary implant model was used to compare the osseous response to commercially pure titanium implants that were either polished, grit-blasted, plasma-sprayed with hydroxyapatite, or plasma-sprayed with hydroxyapatite and masked with a very thin layer of titanium using physical vapor deposition (titanium mask). The titanium mask isolated the chemistry of the underlying hydroxyapatite layer without functionally changing its surface topography and morphologic features. At 12 weeks, the bone-implant specimens were prepared for undecalcified thin section histologic evaluation and serial transverse sections were quantified with backscattered scanning electron microscopy for the percentage of bone apposition to the implant surface. Bone apposition averaged 3% for the polished implants and 23% for the grit-blasted implants. Bone apposition to the hydroxyapatite-coated implants averaged 74% whereas bone apposition to the titanium mask implants averaged 59%. Although there was significantly greater osseointegration with the hydroxyapatite-coated implants, 80% of the maximum bone forming response to the implant surfaces developed with the titanium mask implants. This simple, controlled experiment revealed that topography is the dominant factor governing bone apposition to hydroxyapatite-coated implants.     

In vivo effects of coating loaded and unloaded Ti implants with collagen, chondroitin sulfate, and hydroxyapatite in the sheep tibia.

The in vivo effects of coating titanium implants with organic extracellular matrix molecules were examined in the sheep tibia. Titanium screws (5.0 mm) were coated with type I collagen (Ti/Coll) or type I collagen and chondroitin sulfate (Ti/Coll/CS) by biomimetic fibrillogenesis. Uncoated screws (Ti) and screws coated with hydroxyapatite (Ti/HA) served as control. Six adult female sheep received one screw of each type to stabilize a midshaft tibial fracture with external fixation. Four cylindrical implants of 4-mm outer diameter and 3.3-mm inner diameter with the same coatings were inserted into the tibial head. No pin track infections were seen at the time of implant retrieval 6 weeks after implantation. Extraction torque was greater for Ti/HA (1181 Nmm) and Ti/Coll/CS (1088 Nmm) compared to Ti/Coll (900 Nmm) and Ti (904 Nmm) [N.S.]. Newly formed bone was noted around all coated screws within the medullary cavity. Macrophage and osteoclast activity was significantly reduced around Ti/Coll/CS in both types of implants compared to uncoated controls (p < 0.05). Osteoblast activity was significantly increased around loaded Ti/Coll and Ti/Coll/CS screws compared to uncoated Ti screws (p < 0.05). Microtomographic evaluation (SRmicroCT) revealed no significant differences in new bone formation around the unloaded tibial head implants.Coating of external fixation devices with of type I collagen and chondroitin sulfate appears to have similar effects with respect to stability and bone healing as HA but with less osteoclast activity. These findings were more pronounced under loaded than unloaded conditions in the sheeptibia.     

Clinical total hip replacement with hydroxyapatite from 1984 to 1991

Hydroxyapatite (HA) has been used for revision and primary total hip replacement surgery. HA has been used on both textured and porous coated implants for both primary and revision surgery. The results with textured implants have been compared with those of textured press-fit implants; with both revision and primary surgery the HA-coated prostheses were superior both clinically and roentgenographically. The results with porous coated implants have shown better bone remodeling and less radiolucent lines around the implants. The author's conclusions are that HA is effective in providing earlier stability of the implant and demonstrates better remodeling of the bone around the implant than do implants without HA. The author recommends the use of HA on porous coated implants so that if resorption of the HA occurs, the fixation of the porous coating will be present to provide durability.     

Bone ingrowth into polymer coated porous synthetic coralline hydroxyapatite

Porous hydroxyapatite, converted hydrothermally from the calcium carbon exoskeleton of the coral genus Goniopora (CHAG), has been shown to be effective as a scaffold for bone ingrowth (2,3,5-7,9). However, the large pores in the material resulted in low compressive strengths. In a previous study, we found that microcoating the internal surfaces of CHAG with dilactic-polyactic acid (DL-PLA) improved significantly its compressive properties. The objective of this study was to determine the effect of PLA microcoating on bone ingrowth into CHAG plugs. Plugs of thick- (3:1 chloroform to DL-PLA by weight), medium- (10:1), and thin- (30:1) coated as well as uncoated CHAG were implanted transcortically in the proximal third of the diaphysis of the rabbit tibia. Specimens were harvested at 3, 12, and 24 weeks for mechanical testing and contralaterally for histological and histomorphometric assessment. At 12 weeks, uncoated CHAG plugs developed an average ultimate interface shear stress of 26.7 MPa, compared with 17 MPa for 30:1 and 8 MPa for 10:1 and 3:1 coated specimens. At 24 weeks, there were no significant differences in shear stress among any of the specimens. Histomorphometric assessments showed that the ratio of area fractions of new bone to area fractions of new bone and void space increased from 68-70% for 3:1 and 10:1 coated specimens at 3 weeks, and to 85.5-89.5% at 24 weeks. In comparison, uncoated and 30:1 specimens had area fraction ratios of about 82% at 3 weeks and 93% at 24 weeks. Histologic sections demonstrated direct apposition of new bone to both the coating and the hydroxyapatite as well as degradation of the coating.