The interface of bone microstructure and an innovative coating: an X-ray diffraction study

Evaluation of bone healing enhancement by lyophilized bone grafts supplemented with platelet gel: A standardized methodology in patients with tibial osteotomy for genu varus

Orthopedic practice may be adversely affected by an inadequate bone repair that might compromise the success of surgery. In recent years, new approaches have been sought to improve bone healing by accelerating the rate of new bone formation and the maturation of the matrix. There is currently great interest in procedures involving the use of platelet gel (PG) to improve tissue healing, with satisfactory results both in vitro and in maxillofacial surgery. Otherwise, to our knowledge, only a preliminary clinical study was undertaken in the orthopedic field [Kitoh et al., Bone 2004;35:892-898] and the efficacy of PG is still controversial. Our paper focuses on the effect on bone regeneration by adding PG to lyophilized bone chips used for orthopedic applications. The clinical model and the laboratory methodology were standardized. As a clinical model, we employed the first series of patients of a randomized case-control study undergoing high tibial osteotomy (HTO) for genu varus. Ten subjects were enrolled: in 5 patients lyophilized bone chips supplemented with PG were inserted during tibial osteotomy (group A); 5 patients were used as a control (group B) and lyophilized bone chips without gel were applied. Forty-five days after surgery, computed tomography scan guided biopsies of grafted areas were obtained and the bone maturation was evaluated by a standardized methodology: the osteogenic and angiogenic processes were semi-quantitatively characterized by using histomorphometry, and the mineral component of the lyophilized and host bone was analyzed by using X-ray diffraction technique with sample microfocusing and microradiography. Lyophilized bone with PG seems to accelerate the healing process, as shown by new vessel formation and deposition of newly formed bone, with no evidence of inflammatory cell infiltrate, when compared with lyophilized bone without gel. On the contrary, lyophilized bone undergo a resorption process, and a fibrous tissue often fills the spaces between chips. A histiocytic/giant-cell reaction is sometimes present. Otherwise, no differences have been found concerning microstructure. Our findings show the reliability of the methodology used to monitor early bone repair. The completion of the study and the evaluation of the ultimate clinical outcome are necessary in order to verify PG in vivo effects in orthopedic surgery.

Titanium release from implants prepared with different surface roughness

OBJECTIVES

There may be a risk of greater ion release for surface-enlarged implants than conventionally turned components. The major aim of the present paper was to investigate whether a correlation exists between ion release and a surface roughness relevant for today's commercial implants. Other aims were to compare ion release after two insertion times and concentration in bone tissue as a function of distance from the implant surface.

MATERIAL AND METHODS

Lactic acid aqueous solution (pH=2.3) and phosphate-buffered saline were used for the in vitro investigation. For the in vivo investigation, synchrotron radiation X-ray fluorescence (SRXRF) spectroscopy and secondary ion mass spectroscopy (SIMS) were performed 12 weeks and 1 year after implantation in rabbit tibiae.

RESULTS

The average height deviation (S(a)) was 0.7, 1.27, 1.43 and 2.21 microm, respectively, for the four surfaces investigated. No difference in ion release was found in vitro. In vivo, SRXRF demonstrated slightly higher values for the roughest surface up to a distance of 400 microm from the implant surface; thereafter no difference was found. SIMS demonstrated no difference in ion release for the roughest and smoothest surfaces, but slightly more titanium in bone tissue after 1 year than after 12 weeks. Titanium rapidly decreased with distance from the implant surface.

CONCLUSION

At a level relevant for commercial oral implants, no correlation was found between increasing roughness and ion release, neither in vitro nor in vivo.

Influence of fluorapatite on the properties of thermally sprayed hydroxyapatite coatings

Thermally sprayed hydroxyapatite has been the widely used on orthopaedic prosthesis to induce bone growth and facilitate bone attachment. However, hydroxyapatite has a greater affinity for the formation of an amorphous phase in the thermally sprayed coating that results in the release of excessive amount of mineral ions from the implant coating leading to a saturated environment in the immediate vicinity of the bone cells. Fluorapatite however is highly crystalline and offers the potential for lower mineral ion release by dissolution. Thus study investigates the influence of fluorapatite in a thermally sprayed hydroxyapatite coating. Mechanical blends of fluorapatite with hydroxyapatite were thermally sprayed, characterized with X-ray diffraction, SEM, FTIR, optical microscopy for microstructure, roughness and tested for solubility. Cathodoluminescence microscopy was used to examine the resorbed coating surface. Fluorapatite coatings crystallized more readily and produce a greater coating roughness. The roughness in fluorapatite coatings arises from less flattened droplets that show a tendency for finger formation. Addition of fluorapatite increases coating crystallinity. The use of slower resorbing fluorapatite produces less particle release which favors improved osseointegration. Less change in the surface topography during resorption can be used to an advantage to control the coating surface presented to cells and extra cellular matrix proteins.

Biologic effects of surface roughness and fluorhydroxyapatite coating on osteointegration in external fixation systems: an in vivo experimental study

The concomitant influence of surface roughness and fluorhydroxyapatite (FHA) coating of titanium (Ti) implants on bone response was investigated. For this purpose, titanium screw-shaped implants with a lower degree (Y371) and a higher degree (TiPore300) of surface roughness, coated with FHA and uncoated, were transversally inserted into the diaphyses of sheep tibiae for 12 weeks. Four sheep received Y371 (group A) and Y371 + FHA (group B) screws and four sheep received TiPore300 (group C) and TiPore300 + FHA (group D) screws. For each type of material, the morphology and microstructure of implant-facing bone were evaluated. The host bone of each tibia was used as a control. In all groups the bone tissue did not reach a complete maturation. The higher degree of roughness, perhaps due to an excessive irregularity of the surface, induced the worst osteointegration: a fibrous tissue layer between screw and new bone tissue was often present. Nevertheless, as viewed by XRD, no crystallographic change of the apatite lattice was observed in any of the implants. In contrast, the microhardness value, an index of bone mineralization, was higher in the uncoated screws and decreased progressively in the following order: group C > group A > group B > group D. The association of plasma spraying with roughness treatment constitutes a complex system that seems to interfere with bone mineralization. A chemical change of the surface, perhaps with more Ti release or more coating degradation, could be responsible for such impairment. The authors emphasize the necessity for simultaneous evaluation of surface topography and chemistry as well as an improvement in plasma-spraying and post-processing techniques and in standard procedures for materials characterization.

Detachment of titanium and fluorohydroxyapatite particles in unloaded endosseous implants

The shape, surface composition and morphology of orthopaedic and endosseous dental titanium implants are key factors to achieve post-surgical and long-term mechanical stability and enhance implant osteointegration. In this study a comparison was made between 12 titanium screws, plasma-spray-coated with titanium powders (TPS), and 12 screws with an additional coating of fluorohydroxyapatite (FHA-Ti). Screws were implanted in the femoral and tibial diaphyses of two mongrel sheep and removed with peri-implant tissues 12 weeks after surgery. The vibrational spectroscopic, ultrastructural and morphological analyses showed good osteointegration for both types of implants in host cortical bone. The portion of the FHA-Ti implants in contact with the medullary canal showed a wider area of newly formed peri-implant bone than that of the TPS implants. Morphological and EDAX analyses demonstrated the presence of small titanium debris in the bone medullary spaces near the TPS surface, presumably due to the friction between the host bone and the implant during insertion. Few traces of titanium were detected around FHA-Ti implants, even if smaller FHA debris were present. The present findings suggest that the FHA coating may act as a barrier against the detachment of titanium debris stored in the medullary spaces near the implant surface.