Tibial implants: biomechanical and histomorphometric studies of hydroxyapatite-coated and uncoated stainless steel and titanium screws in long-term ovariectomized sheep.

This study was designed to evaluate osteointegration of HA-coated and uncoated titanium and stainless steel screws in the cortical bone of long-term (24 months) ovariectomized sheep (OVX group), in comparison with Sham-aged sheep (control group). The screws were tested biomechanically (extraction torque) and histomorphometrically (affinity index: Al) 12 weeks after their implantation in tibial diaphyses. Tibial cortical bone parameters showed significant differences between the groups, showing a reduction of the selected parameters in the OVX group. ANOVA showed significant effects for both material and ovariectomy factors on obtained extraction torque (material: F=159.26, p < 0.0005; ovariectomy: F=20.04, p < 0.0005) and Al data (material: F=8.04, p < 0.001; ovariectomy: F=7, 17, p < 0.05). In both groups the extraction torque for coated screws of both materials was significantly higher than for uncoated screws, and uncoated titanium had a better extraction torque than uncoated stainless steel. In the OVX group, the HA-coated stainless steel and titanium Al data were significantly higher than uncoated Al data. In conclusion, the biomechanical and histomorphological results obtained suggest employing HA-coated screws in the presence of osteopenic cortical bone.     

Osteointegration of hydroxyapatite-coated and uncoated titanium screws in long-term ovariectomized sheep.

This study was designed to evaluate the osteointegration of HA-coated and uncoated titanium screws in the cortical bone of long-term (24 months) ovariectomized sheep (OVX group) compared to sham-aged sheep (Control group). At 12 weeks after implantation, the screws were tested biomechanically (extraction torque) and histomorphometrically (affinity index: AI) in both femoral and tibial diaphyses. Cancellous bone status was assessed by iliac crest biopsy. BMD of the L5 vertebra and a histomorphological study of the femoral and tibial shafts were performed to acquire data on cortical bone. A significant difference was found between the OVX and Control groups for BMD (p<0.0005), and a significant reduction in the cancellous bone area was observed in the OVX group. Femoral and tibial cortical bone parameters showed significant differences between the groups. The type of material selected (femurs: p<0.0005; tibiae: p<0.0005) and ovariectomy (femurs: p<0.005; tibiae: p<0.005) had a significant effect on the extraction torque. AI results were related to the presence or absence of ovariectomy (p<0.05) and strictly depended on the material implanted in the femur and tibia (p<0.0005). In conclusion, at implantation OVX sheep showed a significant loss of trabecular and cortical bone versus sham-aged sheep. The biomechanical and histomorphological results achieved suggest employing HA-coated screws in the presence of osteopenic cortical bone.     

Effect of hydroxyapatite coating and polymethylmethacrylate on stainless steel implant-site infection with Staphylococcus epidermidis in a sheep model

We aimed to study the influence of hydroxyapatite (HA) coating and polymethylmethacrylate (PMMA) cement on the risk of development of stainless steel implant-site infection with Staphylococcus epidermidis in a sheep model. Uncoated, HA-coated, and PMMA-cemented stainless steel implants were inserted in the left femur of 30 sheep. For each type of implant, sheep were inoculated with S. epidermidis in the intramedullary canal and one non-inoculated group was used as control. After 6 weeks, infection was evaluated using clinical, radiological, bacteriological, and histological criteria. Radiological and clinical results were normal. Cultures were negative in the control sheep. In the inoculated sheep, interposition tissue and bone cultures were positive in 2 of 6 uncoated, 6 of 6 HA, and 6 of 6 PMMA implants with a mean bacteria count of 5.2 +/- 1.17, 3.5 +/- 0.7, and 3.9 +/- 0.9 log10 cfu/g, respectively (NS), for interposition tissue, and 4 +/- 0.01, 2.9 +/- 0.6, and 2.5 +/- 1.3 log10 cfu/g, respectively (NS) for bone. The polymorphonuclear leukocyte (PMN) score (mean number of PMN per 10 different microscopic high-power fields >or=5) in interposition tissue was >or=3 in 6 of 6 HA, significantly different from uncoated (3 of 6) and PMMA (2 of 6) groups (p = 0.04). The HA and PMMA inoculated groups had a higher infection rate than the uncoated inoculated group (p = 0.06). In this experimental sheep model of S. epidermidis infection at the bone-biomaterial interface, HA seems to be at higher risk of infection compared with uncoated or PMMA-cemented stainless steel, when inoculation is intramedullary and contemporary with implantation.     

Biomaterials in spinal fixation. An experimental animal study to improve the performance

Different pedicle screws were biomechanically and morphologically studied and compared through the use of an animal model to determine their efficacy and resistance in spinal fixation. The principal objective was to compare biomechanical and histomorphological aspects of HA-coated screws to uncoated ones. Fourty-eight cylindrical transpedicular self-tapping screws divided into three groups of sixteen each were employed; Group A: stainless steel screws; Group B: titanium screws; Group C: HA-coated titanium screws. The screws were implanted bilaterally and randomly into the L3, L4, and L5 pedicles of eight adult mongrel sheep. The final insertion torque was measured in all the implants. After one and four months, upon euthanization, four samples per group were extracted from the surrounding bone and the screw extraction torque was measured. The remaining samples were examined and processed for histological and histomorphological evaluations. No differences were observed at one month among the extraction torque of the three groups. After four months the only significance between insertion and extraction values was for the HA group, i.e. p=0.001. Comparing the extraction torque values of the three groups after four months of healing, the HA-coated group showed a greater than twofold increase (p<0.0005). No differences were observed at one month among the percentages of bone-implant contact in the three groups. After four months the percentage was significant only for the C group (p<0.0005). At four months a correlation was found between the morphological and the biomechanical data of group C (p<0.0005). The use of hydroxyapatite-coated screws could act as an effective method to improve the bone-implant interface, thus obtaining a strong fixation of the implant independently of the arthrodesis achieved with bone graft.     

Comparative in vivo evaluation of porous and dense duplex titanium and hydroxyapatite coating with high roughnesses in different implantation environments

Ti (PG60) and Ti plus HA (HPG60) dense coatings with ultrahigh roughness (Ra: 74 +/- 8 microm and 53 +/- 18 microm, respectively) were compared to high Ti (Ti60) and Ti plus HA (HT60) high roughened porous coatings (Ra: 40 +/- 7 microm and 36 +/- 3 microm, respectively). Surfaces were implanted in cortical and trabecular bone of young adult (YOUNG), aged (AGED) and estrogen-deficient sheep (OVX) and analyzed by means of histology, histomorphometry and push-out tests 3 months after implantation. A significantly lower value in affinity index (AI) of PG60 when compared to TI60 (p < 0.01) was observed in cortical bone. In trabecular bone, lower values in AI were found in TI60 and PG60 when compared to their HA-coated surfaces (p < 0.0005). Bone ingrowth (BI) of TI60 and PG60 was significantly lower than that of the HA-coated surfaces in trabecular bone (p < 0.05). Significantly lower values in BI in OVX sheep in comparison to YOUNG sheep in both cortical and trabecular bone were observed (p < 0.05). Data showed that high roughness and Ti and HA-coated surfaces are suitable for aged and osteoporotic patients. HA coatings represent the most successful strategy in trabecular bone.     

In vivo assessment of bone ingrowth potential of three-dimensional e-beam produced implant surfaces and the effect of additional treatment by acid etching and hydroxyapatite coating

The bone ingrowth potential of three-dimensional E-beam-produced implant surfaces was examined by histology and compared to a porous plasma-sprayed control. The effects of acid etching and a hydroxyapatite (HA) coating were also evaluated by histology. Specimens were implanted in the distal femur of 10 goats. Histological analysis of bone ingrowth was performed 6 weeks after implantation. The E-beam-produced surfaces showed significantly better bone ingrowth compared to the plasma-sprayed control. Additional treatment of the E-beam surface structures with a HA coating, further improved bone ingrowth potential of these structures significantly. Acid etching of the E-beam structures did not influence bone ingrowth significantly. In conclusion, the HA-coated, E-beam-produced structures are promising potential implant surfaces.     

In vivo biocompatibility and mechanical study of novel bone-bioactive materials for prosthetic implantation.

Two epoxy materials with or without adhesively bonded hydroxyapatite (HA) coatings were studied for their biocompatibility and mechanical pushout strength using in vivo implantation in the rabbit lower femur for a duration of 10 days to 6 months. Both were two-part epoxies cured at room temperature for 24 h, with material 1 (Ampreg 26; SP Systems Limited, Cowes, UK) postcured at 110 degrees C (Tg approximately 80 degrees C) and Material 2 (CG5052; Ciba Geigy Limited, Cambridge, UK) at 125 degrees C (Tg approximately 120 degrees C). Implantation in dead rabbit bone was performed to provide mechanical baseline levels. Polymethylmethacrylate (PMMA) and conventionally HA-coated titanium alloy (Ti-6Al-4V) were used as control materials. In the biological study, different fluorescent dyes were used to label newly formed bone. After 6 weeks of implantation, results from mechanical pushout tests showed that the interfacial shear strength (ISS) values were significantly higher than for dead bones with each of the different implants (p < .01-.001). HA-coated material 2 showed a significantly higher ISS value than the uncoated material (p < .05) after 6 weeks' implantation. However, the ISS value for the uncoated material 2 was significantly higher than for PMMA controls (p < .05). No significant differences in the ISS values were shown between HA-coated materials 1 and 2 and Ti-6Al-4V on in vivo implantation for 6 weeks. Failure points of the pushout test from the three HA-coated materials were defined by scanning electron microscopy. Specimens implanted with both HA-coated epoxies were fractured within the HA-coatings or the bone, while with HA-coated Ti-6Al-4V cracked between the coating and metal implant. The percentage of bone in contact with the implant surface was obtained by image analysis which showed that there were no significant differences between different materials after short time implantation (up to 6 week). Long-term implantation of the HA-coated material 2 showed that the percentage of bone contact had increased from 52.8+/-1.1% (6 week) to 80.0+/-0.3% (3 months) (p < .01) and remained at 81.0+/-0.8% (6 months). Measurements of bone mineralization rate (BMR) showed that after 3 weeks of implantation, there were no significant differences between PMMA and uncoated materials 1 and 2. After 6 weeks, the BMRs in animals implanted with either HA-coated material 1 or 2 were significantly higher than with HA-coated Ti-6Al-4V (p < .05-.0001 in both cases), but with HA-coated material 2 was lower than with this material uncoated (p < .05-.001). No significant differences were found between the two HA-coated epoxy materials. In addition, there were always lower BMRs during the third week of implantation than other periods regardless of biomaterial implanted. The study indicated that the adhesively bonded HA-coated novel epoxy materials were superior to conventional plasma-sprayed Ti-6Al-4V implants with respect to both BMR and bone integration with the implant surfaces. Adhesively bonded HA-coated epoxy materials had similar ISS values to HA-coated Ti-6Al-4V, but the former failed within the bone and coating, while the latter showed splitting between coating and metal.     

The response of bone to nanocrystalline hydroxyapatite-coated Ti13Nb11Zr alloy in an animal model

An in vivo study was carried out on uncoated and hydroxyapatite (HA)-coated nanostructured Ti13Nb11Zr alloy in comparison with high-grade Ti6Al4V, to investigate the effect of the different surfaces on osteointegration rate. A highly effective method to obtain a fast biomimetic deposition of a thin layer of nanocrystalline HA was applied to coat both substrates. Cylindrical pins were implanted in rabbit cortical bone and evaluated at 4 and 12 weeks by histomorphometry and microhardness tests. The results confirmed the ability of the slightly supersaturated Ca/P solution to induce a fast deposition of nanocrystalline HA on Ti alloys' surfaces. HA-coated Ti13Nb11Zr had the highest osteointegration rate at 4 and 12 weeks. Both HA-coated surfaces showed an affinity index significantly higher than those of native surfaces at 4 weeks (Ti13Nb11Zr+HA: 37%; Ti6Al4V+HA: 26%). Microhardness test showed a significantly higher bone mineralization index of HA-coated Ti13Nb11Zr in comparison with that of HA-coated Ti6Al4V surface. The study suggests that the HA coating on both alloys enhances bone response around implants and that there is a synergic effect of Ti-Nb-Zr alloy with the HA coating on bone remodeling and maturation.     

Different patterns of bone fixation with hydroxyapatite and resorbable CaP coatings in the rabbit tibia at 6, 12, and 52 weeks

Applying bioactive coatings on orthopedic implants can increase the fixation and long-term implant survival. In our study, we compared a resorbable electrochemically deposited calcium phosphate coating (Bonit?) to a thin (40 μm) plasma-sprayed hydroxyapatite (HA) coating, applied on grit-blasted screw-shaped Ti-6Al-4V implants in the cortical region of rabbit tibia, implanted for 6, 12, and 52 weeks. The removal torque results demonstrated stronger bone-to-implant fixation for the HA than Bonit-coated screws at 6 and 12 weeks. After 52 weeks, the fixation was in favor of the Bonit-coated screws, but the difference was statistically insignificant. Coat flaking and delamination of the HA with multinucleated giant cell activity and bone resorption observed histologically seemed to preclude any significant increase in fixation comparing the HA implants at 6 versus 12 weeks and 12 versus 52 weeks. The Bonit-coated implants exhibited increasing fixation from 6 to 12 weeks and from 12 to 52 weeks, and the coat was resorbed within 6 weeks, with minimal activity of multinucleated giant cells or bone resorption. A different fixation pattern was observed for the two coatings with a sharper but time limited increase in fixation for the HA-coated screws, and a slower but more steadily increasing fixation pattern for the Bonit-coated screws. The side effects were more serious for the HA coating and limiting the expected increase in fixation with time.     

Differential healing response of bone adjacent to porous implants coated with hydroxyapatite and 45S5 bioactive glass

This study tested the hypothesis that the rate and the extent of bone formation adjacent to porous, coated Ti-6Al-4V implants are differentially affected by the type of bioactive ceramic coating. Forty-eight rabbits received cylindrical Ti-6Al-4V intramedullary distal femoral implants bilaterally. Implants for the right limbs were coated with 45S5 Bioglass (45S5). Implants used for the left limbs either were coated with tricalcium phosphate/hydroxyapatite (HA) or were left uncoated as controls (CTL). The 45S5-coated implants histologically and biomechanically were compared to HA-coated and CTL implants at 4, 8, 12, and 16 weeks. After 12 and 16 weeks of healing, more bone and thicker trabeculae were measured histomorphometrically within the implant pores for the 45S5-coated implants compared to the HA-coated and CTL implants (p < 0.05). With time the HA-coated and CTL groups exhibited a significant decline in percent of bone and of trabecular thickness (p < 0.05) while the 45S5-coated implants did not. Biomechanical analyses indicated similar shear strengths for all treatment groups. In summary, 45S5-coated implants exhibited greater bone ingrowth compared to HA-coated and CTL implants, and they maintained their mechanical integrity over time.     

Osteointegration of bioactive glass-coated and uncoated zirconia in osteopenic bone: an in vivo experimental study

In elderly and osteoporotic patients an age-related loss of osteoinductivity could be the biological cause of implant failure regardless of the high quality of the implanted device. yttria stabilized tetragonal zirconia (YSTZ), either coated with the bioactive glass named RKKP bioglaze (RKKP) or uncoated, was implanted in the distal femurs of sham-operated and ovariectomized female rats. Animals were sacrificed at 30 and 60 days. Histomorphometry and microhardness tests were performed to assess osteointegration rate as well as bone quality around the implants. Significant decreases (p < 0.0005) in trabecular bone volume, BV/TV (41%), trabecular bone surface BS/TV (33%), trabecular thickness Tb.Th (20%), and trabecular number Tb.N (32%), together with a significant increase in trabecular separation Tb.Sp (184%), were found for the osteopenic rats compared with the sham-operated rats. At both experimental times the RKKP coating ensured a better osteointegration rate with higher AI values than the uncoated YSTZ, even when osteopenic rats were used (48% at 30 days and 12% at 60 days). No differences were observed at the bone-biomaterial interfaces for either material when comparing sham-operated with osteopenic rats. The present results demonstrate that the RKKP bioactive glass used as a coating ensures a high osteointegration rate even in osteoporotic bone, which is already visible from postoperative day 30 and is still apparent on day 60.     

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.     

Measurement of insertion torque of tapered external fixation pins: A comparison between two experimental models.

The aim of this study was to compare an in vitro versus an ex vivo experimental model to test the insertion torque of two different types of external fixation pins. A torque measuring machine was developed in order to perform accurate measurements. Forty tapered pins made of stainless steel were utilized. Half of the pins were plasma-spray coated with hydroxyapatite (HA) and the other half remained uncoated. For the in vitro model 20 cylinders were used that were made of synthetic polymer according to ASTM standards. For the ex vivo model 10 fresh femora harvested from adult sheep were used. All the pins were implanted after predrilling, and insertion torque was measured. Statistical analysis of the in vitro versus the ex vivo model showed significant differences in both coated (p < 0. 0005) and uncoated (p = 0.002) external fixation pins. These results may be due to the surface roughness that caused significant friction between the HA coating and the polyvinylchloride in the in vitro model. The significant difference between the in vitro and ex vivo results lead us to state that the in vitro model does not realistically simulate the behavior of external fixation pins implanted in bone.     

Simple coating with fibronectin fragment enhances stainless steel screw osseointegration in healthy and osteoporotic rats

Metal implants are widely used to provide structural support and stability in current surgical treatments for bone fractures, spinal fusions, and joint arthroplasties as well as craniofacial and dental applications. Early implant-bone mechanical fixation is an important requirement for the successful performance of such implants. However, adequate osseointegration has been difficult to achieve especially in challenging disease states like osteoporosis due to reduced bone mass and strength. Here, we present a simple coating strategy based on passive adsorption of FN7-10, a recombinant fragment of human fibronectin encompassing the major cell adhesive, integrin-binding site, onto 316-grade stainless steel (SS). FN7-10 coating on SS surfaces promoted α5β1 integrin-dependent adhesion and osteogenic differentiation of human mesenchymal stem cells. FN7-10-coated SS screws increased bone-implant mechanical fixation compared to uncoated screws by 30% and 45% at 1 and 3 months, respectively, in healthy rats. Importantly, FN7-10 coating significantly enhanced bone-screw fixation by 57% and 32% at 1 and 3 months, respectively, and bone-implant ingrowth by 30% at 3 months compared to uncoated screws in osteoporotic rats. These coatings are easy to apply intra-operatively, even to implants with complex geometries and structures, facilitating the potential for rapid translation to clinical settings.     

Biomechanical and histomorphometric investigations on two morphologically differing titanium surfaces with and without fluorohydroxyapatite coating: an experimental study in sheep tibiae

The influence of fluorohydroxyapatite (FHA) coating and surface roughness of Ti6Al4V implants on bone response was investigated. Uncoated and FHA-coated screws with lower (LR and LR+FHA; Ra: 5.7+/-0.2 microm) and higher (HR and HR+FHA; Ra: 21.8+/-0.9 microm) surface roughness, were inserted into the diaphyses of 8 sheep tibiae. Twelve weeks after implantation, extraction torque and bone-to-implant contact were evaluated. The smoothest surfaces showed an improved extraction torque and significant differences were observed between LR and HR (-24.6%, p<0.0005), LR and HR+FHA (-30.7%, p<0.0005), LR+FHA and HR (-17.4%, p<0.005), and LR+FHA and HR+FHA (-24.0%, p<0.005). The bone-to-implant contact data paralleled the biomechanical data: the smoother the surface, the greater the bone-to-implant contact. Significant (p<0.0005) decreases in bone-to-implant contact were observed between LR+FHA and HR (-24.2%), and between LR+FHA and HR+FHA (-29.2%). The current findings suggest that LR surfaces significantly improve the osteointegration rate of implanted cortical screws independently of the FHA coating.     

Correlative experimental animal and human clinical retrieval evaluations of hydroxyapatite (HA)-coated and non-coated implants in orthopaedics and dentistry

Retrieval analyses disclosed in vivo dissociation of HA in orthopaedic acetabular components, but excellent bone ingrowth into intact HA coatings on dental retrievals. Initial healing and the bone interface between HA-coated and non-coated implants in the posterior maxilla (Mx) and mandible (Md) was assessed in an animal model using light microscopy (LM), including confocal (CM) and Nomarski (NM) microscopy. Seventy-two implants (36 HA-coated; 36 non-coated) were placed into jaws of six dogs; half after extraction, half after 3 months healing. Animals were euthanized 3 months postimplantation. All implants osseointegrated; however, preliminary morphometry showed higher BCL for HA-coated (51%) than non-coated implants (44%) in the Mx (p < 0.05). BCL for HA-coated Md implants was not significantly higher (64%) than non-coated implants (62%). Bone closely apposed both implant types; however, LM suggested a more intimate association with HA coatings. Serial sections disclosed a reddish coating on the HA, possibly analogous to oral tissue proteoglycans, which was not visible with non-coated implants. This material was continuous with similar material coating endosteum, osteoid regions, and osteocyte (Os) lacunae close to the implant. An interdigitating canaliculi network allowed communication between interfacial Os and Os deeper within the bone. Data suggest HA offers enhanced initial bone fixation in the Mx, and that adequate bone exists for non-coated implant stability in the Md. No HA dissociation was seen with implants in the animal study, which was consistent with retrieved human HA dental implants.     

Biological performance of biomimetic calcium phosphate coating of titanium implants in the dog mandible

The aim of the present study was to analyze the in vivo effect of biomimetic calcium phosphate coating of titanium implants on periimplant bone formation and bone-/implant contact. Five types of implants were used: 1) Ti6Al4V implants with a polished surface; 2) Ti6Al4V implants with collagen coating; 3) Ti6Al4V implants with a mineralized collagen layer; 4) Ti6Al4V implants with sequential coating of hydroxyapatite (HA) and collagen; and 5) Ti6Al4V implants with HA coating only. All implants had square cross sections with an oblique diameter of 4.6 mm and were inserted press fit into trephine burr holes of 4.6 mm in the mandibles of ten beagle dogs. The implants of five animals each were evaluated after a healing period of 1 month and 3 months, respectively, during which time sequential fluorochrome labeling of bone formation had been performed. Bone formation was evaluated by morphometric measurement of the newly formed bone around the implants and the percentage of implant bone contact. After 1 month, there was a significantly higher percentage of mean bone/implant contact in the HA-coated implants compared to those with polished surface and those with the collagen-coated surface. After 3 months, these differences were not present anymore. Bone apposition was significantly higher next to implants with sequential HA/collagen coating compared to polished surfaces and mineralized collagen layer. It is concluded that biomimetic coating of titanium implants with HA has shown the clearest trend to increase bone-implant contact in the early ingrowth period. The addition of collagen to an HA coating layer may hold some promise when used as sequential HA/collagen coating with mineralized collagen as the surface layer.     

An investigation of the effects of hydroxyapatite coatings on the fixation strength of cortical screws

Hydroxyapatite (HA) are commonly applied to orthopaedic implants for acceleration of osteointegration and so overcoming the loosening problems such as in cortical screws. Electrophoretic deposition (EPD) of hydroxyapatite was applied for coating of cortical screws in this work. The effects of hydroxyapatite-coated and uncoated cortical screws on insertion and extraction torque were investigated through in vivo experiments. Three groups of screws were undertaken: first group with no coating, second group coated with HA and the third group coated with HA+interlayer, a synthetic calcium silicate compound. Five sheep were operated, and 60 cortical (20 x 3) screws from those of groups were implanted in cortical femurs to observe the effect of HA and interlayer on screws. Results show that as an alternative to plasma spray coating method, the EPD process enables to produce a quick, easy, cheap and uniform adjustable coating layer. Also from biomechanical and SEM examinations, HA coating by EPD method of cortical screws resulted in extremely improved fixation with reduced risk of loosening problem.     

Comparison of new bone formation, implant integration, and biocompatibility between RGD-hydroxyapatite and pure hydroxyapatite coating for cementless joint prostheses--an experimental study in rabbits

This is the first work to report on additional Arginin-Glycin-Aspartat (RGD) coating on precoated hydroxyapatite (HA) surfaces regarding new bone formation, implant bone contact, and biocompatibility compared to pure HA coating and uncoated stainless K-wires. There were 39 rabbits in total with 6 animals for the RGD-HA and HA group for the 4 week time period and 9 animals for each of the 3 implant groups for the 12 week observation. A 2.0 K-wire either with RGD-HA or with pure HA coating or uncoated was placed into the intramedullary canal of the tibia. After 4 and 12 weeks, the tibiae were harvested and three different areas of the tibia were assessed for quantitative and qualitative histology for new bone formation, direct implant bone contact, and formation of multinucleated giant cells. Both RGD-HA and pure HA coating showed statistically higher new bone formation and implant bone contact after 12 weeks than the uncoated K-wire. There were no significant differences between the RGD-HA and the pure HA coating in new bone formation and direct implant bone contact after 4 and 12 weeks. The number of multinucleated giant did not differ significantly between the RGD-HA and HA group after both time points. Overall, no significant effects of an additional RGD coating on HA surfaces were detected in this model after 12 weeks.     

The effect of hydroxyapatite coating on bony ingrowth into grooved titanium implants

This study was undertaken to investigate the relative importance of a hydroxyapatite (HA) coating and the macrotexture of titanium implants to the quality of bony ingrowth and fixation. Various types of titanium cylinders were implanted into the cancellous bone of the intercondylar region of the distal femur of the dog. The animals were sacrificed at intervals post-implantation and the implants were evaluated histologically for amount of bony ingrowth and mechanically by the means of a push-out test. Our results demonstrated that when grooved titanium implants are used, the addition of HA coating significantly improved the biologic fixation. In addition, a groove depth of 1 mm was found to give significantly better fixation than 2 mm. When compared to implants with traditional, beads-coated porous surfaces, HA-coated grooved titanium implants were found to show better fixation at 4 weeks after implantation, but, significantly inferior fixation at 12 weeks after implantation. We concluded that while a groove depth of 1 mm was optimal in HA-coated, grooved titanium implants, they remain inferior to beads-coated titanium implants with respect to longer-term fixation. More research needs to be addressed at improving the macrotexture environment of grooved implants to enhance long-term bony ingrowth.