The effect of hydroxyapatite coating on bone growth into porous titanium alloy implants

In rabbits and goats, test implants with a porous surface of two layers of Tl-6A;-4V beads were examined at intervals for bond strength with bone. Half of the implants were coated with hydroxyapatite by plasma spray. The bonding strength with bone in the coated specimens was about four times greater than that of the uncoated specimens at two weeks, and twice as strong at six weeks. Twelve weeks after implantation, the strengths were similar. The hydroxyapatite coating of the beads provided earlier and stronger fixation.     

Bioactive glass enhances bone ingrowth into the porous titanium coating on orthopaedic implants

Purpose

The aim of the study was to verify the ability of nanoparticulate bioactive glass (BAG) to infiltrate into the porous titanium (Ti) layer on Ti-based implants to promote osseointegration.

Methods

The porous titanium layer on Ti-based implants was impregnated with nanoparticulate BAG. The implants without or with BAG were implanted bilaterally in tibial holes of ten New Zealand white rabbits. The rabbits were sacrificed after ten weeks for examinations. Beside histological examination, EDXS analysis of polished cross-sections of explanted implants was also performed with the aim to quantitatively evaluate the bone-to-pore contact and bone-in-pore ratio.

Results

After ten weeks, EDXS analyses of cross-sections of the explanted implants confirmed that bioactive glass was fully resorbed and that the pores throughout the thickness of the porous titanium layer were to a large extent filled with a new bone. In the absence of bioactive glass, only the outer part of the porous layer was filled with bone. The implants without BAG in the porous Ti-layer exhibited similar bone-to-pore contact, while significant improvement of bone ingrowth into the pores was observed for the implants with BAG (38%), as opposed to those without it (22%).

Conclusion

This study confirmed that the nanoparticulate bioactive glass within the porous titanium surface layer on implants promotes osseointegration and stimulates the formation of bone within the pores.     

Effects of fibrin sealant on the fixation of porous titanium and pyrolytic carbon implants

The authors investigated the potential role the fibrin sealant system may portray in the fixation of osseous implants. The application of a layer of fibrin did not interfere with the fixation of osseous implants of either pyrolytic carbon or Biolite-coated porous titanium. A greater percentage of tissue ingrowth was observed in the porous titanium implants in the presence of the fibrin sealant system; however, no significant difference in the ultimate interfacial shear stress was observed.     

Zoledronic acid causes enhancement of bone growth into porous implants

The effect of zoledronic acid on bone ingrowth was examined in an animal model in which porous tantalum implants were placed bilaterally within the ulnae of seven dogs. Zoledronic acid in saline was administered via a single post-operative intravenous injection at a dose of 0.1 mg/kg. The ulnae were harvested six weeks after surgery. Undecalcified transverse histological sections of the implant-bone interfaces were imaged with backscattered scanning electron microscopy and the percentage of available pore space that was filled with new bone was calculated. The mean extent of bone ingrowth was 6.6% for the control implants and 12.2% for the zoledronic acid-treated implants, an absolute difference of 5.6% (95% confidence interval, 1.2 to 10.1) and a relative difference of 85% which was statistically significant. Individual islands of new bone formation within the implant pores were similar in number in both groups but were 69% larger in the zoledronic acid-treated group. The bisphosphonate zoledronic acid should be further investigated for use in accelerating or enhancing the biological fixation of implants to bone.     

Interface mechanics and bone growth into porous Co-Cr-Mo alloy implants

The interface mechanics and bone growth into porous Co-Cr-Mo alloy implants were evaluated. Three mean pore sizes (155, 235, and 350 microns) were studied for implants fabricated with one, two, and three layers of spherical powder particles and totally porous implants. All implants had a pore volume of 38%-40%. Ten implants were inserted transcortically in the femora of six adult mongrel dogs and were allowed to remain in situ for a period of 12 weeks. Postretrieval mechanical testing and histologic and microradiographic analyses were used to evaluate the implant systems. A statistically significant increase in interface shear strength (p less than .05) was determined as the number of powder particle layers was increased from one and two layers to three layers. However, a decrease in interface strength was determined for totally porous implants (seven to 12 particle layers) below the value for the single-porous-layer implants. Pore size, in the range investigated, was not found to influence the interface attachment strength. Neither pore size nor porous layer thickness was found to affect interface stiffness. Histologic and microradiographic sections revealed extensive mineralized bone growth deep into the pores of all implant types and often extending to the core of the one-, two- and three-layered porous-coated implants. Both mature haversian bone and less mature woven bone were found within the porous structure. Extensive but incomplete bone infiltration was found in the totally porous implants, with the remainder of the porosity filled with macrophage-laden connective tissue. No difference in the histologic response was observed as a function of pore size in any of the implant systems. Active bone labels were present at the 12-week time period, indicating continued bone remodeling.     

Bone ingrowth into weight-bearing porous fiber titanium implants. Mechanical and biochemical correlations

Bone ingrowth into weight-bearing porous fiber Ti-6Al-4V implants in rat tibias was assessed for the amount, composition, and mineralization rate 3, 12, and 26 weeks after implantation. The data were compared with the ipsi- and contralateral metaphyseal controls and related to the ultimate bending stresses of the distal bone/implant interfaces. From the 3rd to the 12th week there was rapid bone ingrowth and also marked decline in mineralization rate of the ingrowing bone. After 12 weeks the implants were macroscopically pervaded by bone. The ultimate bending stresses increased from the 3rd to the 12th week and reached 45% of that of controls after 26 weeks. There was a linear proportionality between the amount of bone ingrowth and interfacial strength but a curvilinear relationship between bone maturity in terms of calcium/hydroxyproline and calcium/phosphorous ratios and interfacial strength. Stepwise multiple regression analysis showed that the interfacial strength depends on the amount and the maturity of the ingrown bone. Compared with the calcium/hydroxyproline ratio, the calcium/phosphorous ratio was an unreliable predictor of interfacial strength.     

Effects of direct currents on bone growth into delrin implants

The delrin Bone Growth Chamber (BGC) which is a dividable implant, was inserted in its assembled form in the tibial metaphysis of the rabbit. The BGC allows a numerical estimation of the bone growth into the implant, based on microradiography and microdensitometry that permits evaluation of direct current (DC) effects on bone regeneration. A test chamber was inserted in one tibia and was stimulated with either 5, 20 or 50 microA for three weeks, while on the contralateral side of the same animal, a control implant was inserted under identical conditions as the test, but was not stimulated. The results showed a significant increase of bone growth with 20 and 50 microA and a tendency towards more bone formation with 5 microA.     

Osseointegration study of porous nitinol versus titanium orthopaedic implants

The functionality of a new metallic interbody fusion implant manufactured out of porous nitinol (PNT) was evaluated in sheep and compared to a conventional titanium (TiAIV) intervertebral cage packed with autologous iliac crest bone. Both device types were implanted at two non-contiguous intervertebral lumbar sites. The objective was to evaluate the osseointegration capacity after 3, 6 and 12 months of implantation in the presence of these two implant types subjected to the same mechanical loads. Two-dimensional radiology, computer tomography and histology were used as techniques of parameter evaluation. The results indicated that PNT obtained a better intervertebral osseointegration capacity compared to the TiAlV cage. The functional difficulties of the titanium implant were related to its instability at the implantation site possibly due to a biofunctionality problem. The biocompatibility of both implants seemed comparable, however.     

Influence of disodium (1-hydroxythylidene) diphosphonate on bone ingrowth into porous,titanium fiber-mesh implants

The influence of disodium (1-hydroxythylidene) diphosphonate on the bonding between bone and porous, titanium fiber-mesh implants was studied. Rectangular, porous, titanium fiber-mesh implants (15 × 10 × 2.4 mm) were implanted into the tibial bone of mature male rabbits. The rabbits were divided into six groups. Disodium diphosphonate was administered daily by subcutaneous injection to groups 1–5. Groups 1–4 received doses of 5.0, 2.5, 1.0, and 0.1 mg per kilogram of body weight per day for 8 weeks, respectively. Group 5 received a dose of 5 mg per kilogram of body weight per day for 4 weeks. Group 6 (control group) was given saline injections. At 8 weeks after implantation, the rabbits were killed. The tibiae containing the implants were dissected out and subjected to detachment tests. The failure load, when an implant became detached from the bone or when the bone itself broke, was measured. The interface of the bone and implant was investigated by Giemsa surface staining and contact microradiography. Giemsa surface staining and contact microradiography showed that porous implant bonding to bone tissue was inhibited by a high dose of disodium diphosphonate in groups 1, 2, and 5. Soft tissue was observed at the interface. In groups 3, 4, and 6, bone tissue ingrowth was observed at the interface between the porous implant and bone tissue. Growth of bone into the porous fiber-mesh implant of a cementless prosthesis is possible if a low dose of diphosphonate below 1.0 mg per kilogram of body weight is given subcutaneously     

Autologous osteoblasts enhance osseointegration of porous titanium implants.

The goal of this study was to assess the osseointegration of porous titanium implants by means of coating with autologous osteoblasts. Titanium implants (8 x 5 x 4 mm) having drill channels with diameters of 400, 500, and 600 microm were coated with autologous osteoblasts obtained from spongiosa chips. The implants were inserted into the distal femora of 17 adult Chinchilla Bastard rabbits (group I). Uncoated implants were inserted as controls in the contralateral femur (group II). The animals were sacrificed after 5, 11, and 42 days. Intravital fluorochrome labeling and microradiography were used for the assessment of bone ingrowth into the titanium channels. In both groups, no bone tissue was formed in the channels up to day 5. On day 11, group I exhibited significantly more (p<0.05) bone tissue (19.8+/-14.0% vs. 5.8+/-9.1%) with greater bone-implant contact (13.3+/-15.1% vs. 5.7+/-5.3%, p<0.05) at the channel mouths than group II. Bone tissue was formed mainly between day 15 and 30 in group I, in group II between day 25 and 40. Six weeks after implantation, bone tissue filled on an average 68.8+/-15.1% of the mouths of the drill channels in implants in group I, the filling for group II was 49.8+/-18.1% (p<0.05). The average bone-implant contact at the channel mouths after six weeks was 56.5+/-13.5% in group I, 40.2+/-21.9% in group II (p<0.05). 600-microm channels showed at this time point the best osseous integration (p<0.05). Coating with autologous osteoblasts accelerates and enhances the osseointegration of titanium implants and could be a successful biotechnology for future clinical applications.     

Bioactive porous titanium: an alternative to surgical implants

Abstract:  Porous titanium implants have been used to improve implant–bone attachment by the ingrowth of bone tissue within the porous structure. Despite the efficient bone adhesion of porous titanium implants, chemical bonds are required at bone–implant interface. These implants can become bioactive by a biomimetic precipitation process. The aim of this work was to enhance the bioactivity of pure porous titanium implants by biomimetic process. The samples immersed in a simulated body fluid promoted the nucleation and growth of calcium phosphate (Ca-P) crystals, such as hydroxyapatite (Hap), on the material surface. Scanning electron microscopy, energy dispersive spectroscopy, and Fourier transform infrared spectroscopy analyses revealed that a Ca-P deposition occurred without the need of pretreatments to improve the surface bioactivity. This present study indicates the potential for growing a bone-like Hap layer on porous titanium implants by biomimetic processes.     

An evaluation of skeletal attachment to LTI pyrolytic carbon, porous titanium, and carbon-coated porous titanium implants

Porous titanium, carbon-coated porous titanium, and low-temperature isotropic (LTI) pyrolytic carbon transcortical implants were placed in the femora of mongrel dogs. Mechanical and histologic analyses were performed in specimens that remained in situ for six months. Qualitative histologic results indicated that the bone formed a direct appositional interface with as-deposited LTI carbon. The bone tissue response to the two systems with porous coatings was similar. Both systems showed little fibrous tissue interposition and a high degree of mineralized bone ingrowth. The ingrown bone was well organized. However, there was some evidence that the ingrown bone mineral differed significantly from the bulk bone mineral. The only difference between carbon-coated and uncoated porous systems was a significant increase in the percentage of bone ingrowth, with carbon-coated specimens having a 4% increase in bone volume. The strength of appositional attachment to LTI carbon was shown to be at least one order of magnitude weaker than bone ingrowth attachment to the porous systems. The interface shear stiffness of the two porous systems was equivalent; however, the attachment shear strength of bone growth into carbon-coated porous titanium was significantly increased compared with that of bone growth into the uncoated porous titanium. Correlation of the percentage of bone ingrowth and pushout strength was also found to be statistically significant, suggesting that the presence of the carbon coating enhanced bone ingrowth, which resulted in significantly increased shear strengths.     

Quantitative analysis of tissue growth into human porous total hip components

Histologic and radiographic analysis was performed on 36 porous-coated total hip components (22 femoral and 14 acetabular) retrieved from 30 patients. The average patient age was 53.0 years (range, 28-78 years) for femoral components and 56.9 years (range, 28-78 years) for acetabular components. The average time in situ was 13.6 months (range, 2-36 months) for femoral components and 5.5 months (range, 1-18 months) for acetabular components. Fourteen implants were retrieved for instability or dislocation, 12 for late infection, and 8 for persistent pain, and 2 were retrieved after the patient died. Radiographs were reviewed for Singh index, heterotopic bone, implant fit, subsidence, and presence of lucent and sclerotic zones. Histologic and microradiographic sections of the implant and adherent tissue were examined for type, amount, and anatomic distribution of tissue ingrowth. Four femoral stems had no bone ingrowth, 10 had minimal bone growth into the available pore volume (less than 2%), 3 had moderate bone ingrowth (2-5%), and 5 had more extensive bone ingrowth (5-10%). Bone ingrowth tended to occur where the implant made direct contact with the endosteal cortical surface and was rarely seen in proximal metaphyseal bone. Bone ingrowth was completely absent in eight acetabular components, minimal (less than 2%) in three, moderate (2-5%) in two, and more extensive (5-10%) in one and tended to occur adjacent to fixation pegs, spikes, or screws. Radiographic or clinical findings were unreliable in predicting the presence or extent of bone ingrowth in either femoral or acetabular components.     

Enhancement of bone growth into porous intramedullary implants using non-invasive low intensity ultrasound.

An in vivo study was designed to determine if non-invasive low intensity ultrasound could enhance bone growth into porous intramedullary implants. Fully porous intramedullary rods were implanted bilaterally into the ulnae of six dogs. In each dog, one ulna served as a control and the other was treated with 20 min of daily ultrasound stimulation for 6 consecutive weeks. Analysis of serial transverse sections indicated an average of 119% more bone growth into the ultrasound-treated implants compared with the contralateral controls (P < 0.001). In each of the 6 dogs, there was a significantly greater amount of bone ingrowth on the ultrasound-stimulated side. These data indicate a clear potential for externally applied ultrasound therapy to augment biological fixation.     

Investigation of the process intergrowth of bone tissue into the hole in titanium implants (Experimental research)

IntroductionDespite the use of modern implants, complications such as nonunion and avascular necrosis of the femoral head are observed in femoral neck fractures (FNF). We have created a new perforated I-beam implant for FNF osteosynthesis and developed a new osteosynthesis philosophy based not only on the mechanical and biomechanical interaction of the bone-implant system, but also on the interaction of the biological properties of the bone and the implant.The purpose of the work is to study the interaction of the biological process of the bone - its regeneration (germination) of bone tissue into the holes of the implant.Materials and methodsThe experiment was carried out on fourteen Chinchilla rabbits in accordance with all international standards. A perforated implant specially made of titanium (ChM, Poland) was surgically implanted into the proximal femur.The implant measurements were as follows: length – 6 mm, width – 3 mm, thickness – 2 mm, 2 holes with a diameter of 2 mm. The 14 rabbits were divided into 7 groups. After 1, 2, 3, 4, 5, 10 and 12 weeks the animals were withdrawn from the experiment according to the standard rules in sequential order. The preparations were placed in a formalin solution and sent to the pathomorphology laboratory (CITO, Russia) for histological studies.ResultsWeekly histopathological studies revealed a gradual transition from the organization of a hematoma to the formation of mature bone tissue in the holes of the implants. The titanium implant is bioinert and did not cause any visible reactions from the bone tissue. Simultaneous integration of vascular proliferation and newly formed bone tissue into the implant holes were revealed. On 10–12-week preparations, the formation of trabecular structures of mature bone tissue was revealed in the holes of the implants and elements of adipose and bone marrow tissue were observed. Macroscopic examination of 4–5-week preparations showed almost complete filling of the holes with bone tissue. On 10–12-week preparations, the bone tissue in the holes of the implants did not differ from the bone tissue surrounding the implant. The processes of formation of mature bone tissue in the holes of the implants were similar to the processes of physiological bone healing (regeneration) at the fracture site.ConclusionsThe obtained results show the following: 1.The titanium implant is bioinert and does not cause any visible reactions from the bone tissue; 2. There is a gradual process of formation of new vessels, and then the formation of new bone tissue in the holes of the implant instead of the one damaged during implantation.Thus, the results of this experiment indirectly confirm our assumption that a perforated implant for FNF osteosynthesis will participate not only in the mechanical and biomechanical interaction of the bone-implant system, but will also include the 3rd element in this system - the biological properties of the bone itself. We assume that these properties of the new implant will increase blood flow in the femoral neck and partially replenish the volume of bone tissue destroyed during osteosynthesis which does not occur with FNF osteosynthesis by any of the known implants.     

Bone formation in porous implants of delrin and commercially pure titanium

Summary Clinicians have been using implants made by titanium or delrin with varying results. In this study dividable implants, bone growth chambers (BGC), of titanium and delrin were inserted into the rabbit tibia. The ingrowth of hard tissue into a canal in the implant was evaluated after 3 weeks by microradiography and numerically determined by computer analysis. Results showed that bone ingrowth into titanium implants was significantly larger than into delrin implants (P < 0.005). The possible reasons for this are discussed.This study was supported by grants from the Swedish Medical Research Council (B 84-12P-6475-02) and B 84-12X-6533-02), King Gustaf V Jubilee Foundation, Trygg-Hansa Research Fund, the Gothenburg Medical Society, and the Greta and Einar Askers Foundation.     

Effects of indomethacin on biologic fixation of porous-coated titanium implants

The effect of perioperative administration of indomethacin on attachment strength and bone growth into porous-coated titanium implants was evaluated in the canine transcortical plug model. Various drug administration protocols simulating clinical use of indomethacin were studied. These included chronic treatment (starting 2 weeks prior to surgery), treatment immediately after surgery, and treatment 3, 6, 9, and 18 weeks following surgery. Indomethacin therapy was continued until sacrifice at 3, 6, 12, 18, or 24 postoperative weeks. Push-out testing was performed to determine the maximum bone—implant interface shear strength, and quantitative histologic analysis was used to determine percentage of bone ingrowth. When indomethacin was administered chronically or immediately after surgery, a statistically significant decrease in bone—implant interface attachment strength was seen at 3 postoperative weeks but not at later periods. No adverse effect was observed in any group after the 3-week period. Quantitative histologic analysis demonstrated no significant differences in percentage bone ingrowth among any of the treatment protocols at 3 or 6 weeks after surgery. No significant difference was observed between any of the groups at 18 or 24 weeks. The results of this study suggest that perioperative administration of indomethacin does not significantly affect attachment strength or bone ingrowth into porous-coated implants except at early periods, in which cases a transient decrease in attachment strength occurs.