Hydroxyapatite and fluorapatite coatings for fixation of weight loaded implants

Cementless Total Knee Arthroplasty: A State-of-the-Art Review

» The demographic profile of candidates for total knee arthroplasty (TKA) is shifting toward younger and more active individuals.» While cemented fixation remains the gold standard in TKA, the interest is growing in exploring cementless fixation as a potentially more durable alternative.» Advances in manufacturing technologies are enhancing the prospects for superior long-term biological fixation.» Current research indicates that intermediate to long-term outcomes of modern cementless TKA designs are comparable with traditional cemented designs.» The selection of appropriate patients is critical to the success of cementless fixation techniques in TKA.» There is a need for high-quality research to better understand the potential differences and relative benefits of cemented vs. cementless TKA systems.

New Horizons of Cementless Total Knee Arthroplasty

BACKGROUND

Considering the increasing number of young and active patients needing TKA, orthopedic surgeons are looking for a long-lasting and physiological bond for the prosthetic implant. Multiple advantages have been associated with cementless fixation including higher preservation of the native bone stock, avoidance of cement debris with subsequent potential third-body wear, and the achievement of a natural bond and osseointegration between the implant and the bone that will provide a durable and stable fixation.

DISCUSSION

Innovations in technology and design have helped modern cementless TKA implants to improve dramatically. Better coefficient of friction and reduced Young's modulus mismatch between the implant and host bone have been related to the use of porous metal surfaces. Moreover, biologically active coatings have been used on modern implants such as periapatite and hydroxyapatite. These factors have increased the potential for ingrowth by reducing micromotion and increasing osteoconductive properties. New materials with better biocompatibility, porosity, and roughness have been introduced to increase implant stability.

CONCLUSIONS

Innovations in technology and design have helped modern cementless TKA implants improve primary stability in both the femur and tibia. This means that short-term follow-up are comparable to cemented. These positive prognostic factors may lead to a future in which cementless fixation may be considered the gold-standard technique in young and active patients.

The influence of hydroxyapatite coating on continuous migration of a Zweymuller-type hip stem: a double-blinded randomised RSA trial with 5-year follow-up

BACKGROUND AND PURPOSE

Adding hydroxyapatite to a stem to enhance ingrowth is a matter of debate, even less is known about the long-term effect on stability by adding hydroxyapatite (HA). Continuous migration in the first 2-5 years is an indicator of failed osteointegration or pending failure, enhancing the risk of loosening within 10 years after initial surgery. We performed a double-blinded randomised RSA trial with 5-year follow-up, to compare and analyse migration characteristics of the hydroxyapatite uncoated (HA-) and hydroxyapatite coated (HA+) Zweymuller-type hip stem.

PATIENTS AND METHODS

In this single-centre prospective randomised controlled trial 51 patients were randomised to receive either a HA- or a HA+ Zweymuller-type hip stem during total hip replacement. After 5 years, 35 patients were still eligible for follow-up evaluation. The migration pattern was measured by use of radio stereometric analysis (RSA) images up to 2 years to evaluate short-term migration, additionally RSA images were obtained 5 years postoperatively to assess late-term and continuous migration. Furthermore, the improvement of clinical outcome was analysed by HSS and HOOS ADL and pain subscales preoperative and after 5 years.

RESULTS

After initial settling of the implant, no significant migration occurred up to 5 years post-surgery for HA+ as well as HA- prostheses. Continuous migration within the 2-5 years' time interval was not observed for both HA+ nor the HA- group in all directions (p < 0.05). No significant difference between both groups was observed (p < 0.10). In both groups the HHS and HOOS improved significantly at 5 years compared to baseline for both groups. Improvement was not altered by the hydroxyapatite coating. No significant difference between both groups was observed (p > 0.58).

CONCLUSIONS

Addition of a hydroxyapatite coating did not influence the migration 5 years postoperatively for the Zweymuller-type hip stem.Clinical Trial Protocol number: NL 23524.048.08.

In Vitro and In Vivo Osteogenic Activity of Titanium Implants Coated by Pulsed Laser Deposition with a Thin Film of Fluoridated Hydroxyapatite

To enhance biocompatibility, osteogenesis, and osseointegration, we coated titanium implants, by krypton fluoride (KrF) pulsed laser deposition, with a thin film of fluoridated hydroxyapatite (FHA). Coating was confirmed by scanning electron microscopy (SEM) and scanning probe microscopy (SPM), while physicochemical properties were evaluated by attenuated reflectance Fourier transform infrared spectroscopy (ATR-FTIR). Calcium deposition, osteocalcin production, and expression of osteoblast genes were significantly higher in rat bone marrow mesenchymal stem cells seeded on FHA-coated titanium than in cells seeded on uncoated titanium. Implantation into rat femurs also showed that the FHA-coated material had superior osteoinductive and osseointegration activity in comparison with that of traditional implants, as assessed by microcomputed tomography and histology. Thus, titanium coated with FHA holds promise as a dental implant material.

Does hydroxyapatite coating enhance ingrowth and improve longevity of a Zweymuller type stem? A double-blinded randomised RSA trial

INTRODUCTION

An ongoing discussion is whether using a hydroxyapatite coating enhances the ingrowth and longevity of a femoral stem in total hip arthroplasty. The best way to predict speed of ingrowth and long-term outcome is by evaluating micromotion by radiostereometric analysis. To study the effect of hydroxyapatite (HA) coating on the migration of the SL-PLUS hip stem, we performed a prospective double blind randomised controlled trial comparing the early migration of the hydroxyapatite (HA)-coated SL-PLUS stem compared to the Standard (non-coated) SL-PLUS stem.

PATIENTS AND METHODS

51 patients were randomly assigned to receive either an uncoated or a HA-coated femoral component during total hip replacement. RSA images were obtained direct postoperatively and at 6 weeks, 12 weeks, 6 months, 12 months and 24 months. HOOS scores were obtained preoperative and at final follow-up.

RESULTS

RSA evaluation demonstrated significant migration up to 3 months postoperatively in both groups. After initial setting no significant migration was observed. There was no significant difference in migration between the HA-coated group and the uncoated group. Both Harris Hip Score (HHS) and HOOS domain scores (pain and ADL) significantly improved compared to baseline at 24 months after surgery in both treatment groups (p<0.001 for all comparisons). Improvement did not differ significantly between the 2 groups.

CONCLUSIONS

At 2 years follow-up, the HA-coated and uncoated Zweymuller type, distal fitting stem do not show different migration patterns.

Does hydroxyapatite coating of uncemented cups improve long-term survival? An analysis of 28,605 primary total hip arthroplasty procedures from the Nordic Arthroplasty Register Association (NARA)

OBJECTIVE

It is unclear whether hydroxyapatite (HA) coating of uncemented cups used in primary total hip arthroplasty (THA) improves bone ingrowth and reduces the risk of aseptic loosening. We therefore investigated survival of different uncemented cups that were available with or without HA coating.

METHOD

We investigated three different cup types used with or without HA coating registered in the Nordic Arthroplasty Register Association (NARA) database that were inserted due to osteoarthritis (n = 28,605). Cumulative survival rates and adjusted hazard ratios (HRs) for the risk of revision were calculated.

RESULTS

Unadjusted 13-year survival for cup revision due to aseptic loosening was 97.9% (CI: 96.5-99.4) for uncoated and 97.8% (CI: 96.3-99.4) for HA-coated cups. Adjusted HRs were 0.66 (CI 0.42-1.04) for the presence of HA coating during the first 10 years and 0.87 (CI 0.14-5.38) from year 10-13, compared with uncoated cups. When considering the endpoint cup revision for any reason, unadjusted 13-year survival was similar for uncoated (92.5% [CI: 90.1-94.9]) and HA-coated (94.7% [CI: 93.2-96.3]) cups. The risk of revision of any component due to infection was higher in THA with HA-coated cups than in THA with uncoated cups (adjusted HR 1.4 [CI 1.1-1.9]).

CONCLUSIONS

HA-coated cups have a similar risk of aseptic loosening as uncoated cups, thus the use of HA coating seems to not confer any added value in terms of implant stability. The risk of infection seemed higher in THA with use of HA-coated cups, an observation that must be investigated further.

Influence of Post-deposition Heating Time and the Presence of Water Vapor on Sputter-coated Calcium Phosphate Crystallinity

Extensive research suggested that calcium phosphate (CaP) coatings on titanium implants are essential for early bone response. However, the characterization of CaP crystallinity and the means to control coating crystallinity are not well-established. In this study, the effect of a 400°C heat treatment for 1, 2, or 4 hours, and in the presence or absence of water vapor, on CaP crystallinity was investigated. Scanning electron microscopy indicated dense as-sputtered coatings. Increase in coating crystallinity was observed to be consistent with the increasing number of PO4 peaks observed as a result of different heat treatments. In addition, x-ray diffraction analyses indicated amorphous as-sputtered coatings, whereas crystalline CaP coatings in the range of 0-85% were observed after different post-deposition heat treatments. It was concluded that the presence of water vapor and post-deposition heat treatment time significantly affect the crystallinity of CaP coatings, which may ultimately affect bone healing.

Biomineral/Agarose Composite Gels Enhance Proliferation of Mesenchymal Stem Cells with Osteogenic Capability

Hydroxyapatite (HA) or calcium carbonate (CaCO₃) formed on an organic polymer of agarose gel is a biomaterial that can be used for bone tissue regeneration. However, in critical bone defects, the regeneration capability of these materials is limited. Mesenchymal stem cells (MSCs) are multipotent cells that can differentiate into bone forming osteoblasts. In this study, we loaded MSCs on HA- or CaCO₃-formed agarose gel and cultured them with dexamethasone, which triggers the osteogenic differentiation of MSCs. High alkaline phosphatase activity was detected on both the HA- and CaCO₃-formed agarose gels; however, basal activity was only detected on bare agarose gel. Bone-specific osteocalcin content was detected on CaCO₃-formed agarose gel on Day 14 of culture, and levels subsequently increased over time. Similar osteocalcin content was detected on HA-formed agarose on Day 21 and levels increased on Day 28. In contrast, only small amounts of osteocalcin were found on bare agarose gel. Consequently, osteogenic capability of MSCs was enhanced on CaCO₃-formed agarose at an early stage, and both HA- and CaCO₃-formed agarose gels well supported the capability at a later stage. Therefore, MSCs loaded on either HA- or CaCO₃-formed agarose could potentially be employed for the repair of critical bone defects.

Hydroxyapatite coating does not improve uncemented stem survival after total hip arthroplasty!

BACKGROUND AND PURPOSE

It is still being debated whether HA coating of uncemented stems used in total hip arthroplasty (THA) improves implant survival. We therefore investigated different uncemented stem brands, with and without HA coating, regarding early and long-term survival.

PATIENTS AND METHODS

We identified 152,410 THA procedures using uncemented stems that were performed between 1995 and 2011 and registered in the Nordic Arthroplasty Register Association (NARA) database. We excluded 19,446 procedures that used stem brands less than 500 times in each country, procedures performed due to diagnoses other than osteoarthritis or pediatric hip disease, and procedures with missing information on the type of coating. 22 stem brands remained (which were used in 116,069 procedures) for analysis of revision of any component. 79,192 procedures from Denmark, Norway, and Sweden were analyzed for the endpoint stem revision. Unadjusted survival rates were calculated according to Kaplan-Meier, and Cox proportional hazards models were fitted in order to calculate hazard ratios (HRs) for the risk of revision with 95% confidence intervals (CIs).

RESULTS

Unadjusted 10-year survival with the endpoint revision of any component for any reason was 92.1% (CI: 91.8-92.4). Unadjusted 10-year survival with the endpoint stem revision due to aseptic loosening varied between the stem brands investigated and ranged from 96.7% (CI: 94.4-99.0) to 99.9% (CI: 99.6-100). Of the stem brands with the best survival, stems with and without HA coating were found. The presence of HA coating was not associated with statistically significant effects on the adjusted risk of stem revision due to aseptic loosening, with an HR of 0.8 (CI: 0.5-1.3; p = 0.4). The adjusted risk of revision due to infection was similar in the groups of THAs using HA-coated and non-HA-coated stems, with an HR of 0.9 (CI: 0.8-1.1; p = 0.6) for the presence of HA coating. The commonly used Bimetric stem (n = 25,329) was available both with and without HA coating, and the adjusted risk of stem revision due to aseptic loosening was similar for the 2 variants, with an HR of 0.9 (CI: 0.5-1.4; p = 0.5) for the HA-coated Bimetric stem.

INTERPRETATION

Uncemented HA-coated stems had similar results to those of uncemented stems with porous coating or rough sand-blasted stems. The use of HA coating on stems available both with and without this surface treatment had no clinically relevant effect on their outcome, and we thus question whether HA coating adds any value to well-functioning stem designs.

Formation of nanostructured fluorapatite via microwave assisted solution combustion synthesis

Fluorapatite (FA) has potential applications in dentistry and orthopedics, but its synthesis procedures are time consuming. The goal of the present study is to develop a quick microwave assisted solution combustion synthesis method (MASCS) for the production of FA particles. With this new processing, FA particles were successfully synthesized in minutes. Additionally, unique structures including nanotubes, hexagonal crystals, nanowhiskers, and plate agglomerates were prepared by controlling the solution composition and reaction time. In particular, the as-synthesized FA nanotubes presented a "Y" shape inner channel along the crystal axis. It is supposed that the channel formation is caused by the crystal growth and removal of water soluble salts during processing. The as-synthesized FA nanotubes showed good cytocompatibility, the cells cultured with a higher FA concentration demonstrated greater growth rate. With this new and easily applied MASCS processing application, FA nanoparticles have increased potential in dental and orthopedic applications.

Hydroxyapatite, fluor-hydroxyapatite and fluorapatite produced via the sol-gel method: dissolution behaviour and biological properties after crystallisation

Hydroxyapatite (HA), fluor-hydroxyapatite (FHA) with varying levels of fluoride ion substitution and fluorapatite (FA) were synthesised by the sol-gel method as possible implant coating or bone-grafting materials. Calcium nitrate and triethyl phosphite were used as precursors under an ethanol-water based solution. Different amounts of ammonium fluoride were incorporated for the preparation of the FHA and FA sol-gels. After heating and powdering the sol-gels, dissolution behaviour was assessed using ion chromatography to measure Ca(2+) and PO4 (3-) ion release. Biological behaviour was assessed using cellular proliferation with human osteosarcoma cells and alamarBlue™ assay. Statistical analysis was performed with a two way analysis of variance and post hoc testing with a Bonferroni correction. Increasing fluoride substitution into an apatite structure decreased the dissolution rate. Increasing the firing temperature of the HA, FHA and FA sol-gels up to 1,000 °C decreased the dissolution rate. There was significantly higher cellular proliferation on highly substituted FHA and FA than on HA or Titanium. The properties of an implant coating or bone grafting material can be tailored to meet specific requirements by altering the amount of fluoride that is incorporated into the original apatite structure. The dissolution behaviour can further be altered by the temperature at which the sol-gel is fired.

Evaluating of bone healing around porous coated titanium implant and potential systematic bias on the traditional sampling method

INTRODUCTION

The mechanical properties of bone can largely be explained by bone density and the anisotropic orientation of the trabecular bone. The type of trabecular structure plays an important role in determining the mechanical properties of cancellous bone. Gap-healing and implant fixation could be affected by the various quality and quantity of bone in the local environment. Thus, implant fixation in one part might differ from the other part of the implant. This study aimed to investigate the influence of the sampling method on data evaluation.

MATERIAL AND METHODS

Titanium alloy implants (Biomet Inc.) of 10mm in length and 6mm in diameter were inserted bilaterally into the proximal humerus of 8 skeletally mature sheep. Thus two implants with a concentric gap of 2mm were implanted in each sheep. The gap was filled with allograft. Standardised surgical procedure was used. At sacrifice, 6 weeks after surgery, both proximal humeri were harvested. The specimens were randomized to superficial or profound groups. In the superficial group, mechanical testing or histological analysis was carried out on the superficial part of the implant. In the profound group, the mechanical testing or histological analysis was performed on the profound part of the implant.

RESULT

The mechanical fixation, bone volume and bone ongrowth showed no statistically significant differences. Mechanical test demonstrated a slight tendency to increased strength and failure energy were observed in the superficial group. Histomorphomety revealed bone ongrowth was slightly increased and volume fraction was decreased in the profound group.

CONCLUSION

Histological analysis and mechanical testing can be applied to the superficial or profound part of the implant.

CHARACTERIZATION AND EVALUATION OF TITANIUM SUBSTRATES COATED WITH GELATIN/HYDROXYAPATITE COMPOSITE FOR CULTURING RAT BONE MARROW DERIVED MESENCHYMAL STROMAL CELLS

Titanium (Ti) is widely used for making tissue engineering implants, due to its good corrosion resistance, biocompatibility and mechanical properties. However, bare Ti does not integrate well with natural bone tissue and releases ions and particles that are harmful to the extracellular matrix. To overcome these problems, the Ti substrate could be coated with various biocompatible materials including a composite of gelatin and hydroxyapatite (HA). However, few have characterized and evaluated the coating of gelatin/HA on Ti substrate and its effect on bone related cells. In this study, samples of Ti substrate coated with gelatin/HA composite were fabricated with gelatin concentration ranging from 0 to 200 mg/L. The porous surface structure of gelatin/HA composite formed on the Ti substrate was then examined and characterized for its composition and topography by X-ray diffraction (XRD), scanning electron microscopy (SEM), atomic force microscopy (AFM), and image processing and analysis software (ImageJ), respectively. Subsequently, rat bone marrow-derived mesenchymal stromal cells (BMMSC) were cultured on the surface of gelatin/HA composite on Ti substrate, and evaluated for cell morphology, proliferation, and osteo-differentiation using SEM, MTT assay, and alkaline phosphatase (ALP) assay, respectively. It is shown that gelatin enhanced binding of HA onto Ti substrate, and the topography of the porous surface structures was influenced by gelatin concentration only for the large pore sizes. Furthermore, the results indicate that the porous surface structures of gelatin/HA on Ti substrate promoted proliferation and osteo–differentiation as compared to the naked pure Ti substrate, particularly on that with concentration of gelatin at 100 mg/L. These findings, taken together, suggest that Ti substrate can be coated with different porous surface structures of gelatin/HA composite with gelatin solution of different concentrations. Such coated Ti substrates can promote cytocompitibility and osteo-differentiation of BMMSC, and thus may be of potential in development of implants and devices for bone tissue engineering.

High survival rate of hydroxyapatite-coated hip prostheses100 consecutive hips followed for 10 years

We followed 100 consecutive primary total hip replacements with a proximal hydroxyapatite coating for 10 years. No patient was lost to follow-up. 29 patients (32 hips) died before the 10-year follow-up was done; none of their hips had been revised. Thigh pain on activity occurred in 3 hips. We found no radiographic signs of loosening of the femoral components. In course of time the location of dense bone around the femoral stem, which would suggest implant/bone stress transfer, moved distally in 51 of 67 stems after 10 years. No linear or distal osteolysis occurred around the stem. Revision of 1 stem was performed because of thigh pain, but it was found fixed to bone proximally, while 3 cups were revised because of acetabular osteolysis. The 10-year survival of the stem and cup, using revision or pending revision as endpoint, was 100% (95% CI: 99-100) and 97% (95% CI: 94-99), respectively.

Bioactive nanocomposite coatings of collagen/hydroxyapatite on titanium substrates

Collagen/hydroxyapatite (HA) nanocomposite thin films containing 10, 20, and 30 wt.% HA were prepared on commercially pure titanium substrates by the spin coating of their homogeneous sols. All of the nanocomposite coatings having a thickness of approximately 7.5 microm exhibited a uniform and dense surface, without any obvious aggregation of the HA particles. A minimum contact angle of 36.5 degrees was obtained at 20 wt.% HA, suggesting that these coatings would exhibit the best hydrophilicity. The in vitro cellular assays revealed that the coating treatment of the Ti substrates favored the adhesion of osteoblast-like cells and significantly enhanced the cell proliferation rate. The cells on the nanocomposite coatings expressed much higher alkaline phosphatase (ALP) levels than those on the uncoated Ti substrates. Increasing the amount of HA resulted in a gradual improvement in the ALP activity. The nanocomposite coatings on Ti substrates also exhibited much better cell proliferation behaviors and osteogenic potentials than the conventional composite coatings with equivalent compositions, demonstrating the greater potential of the former as implant materials for hard tissue engineering.

Dissolution of human teeth-derived hydroxyapatite

We have been interested in human teeth which consist of hydroxyapatite (HA), but do not degrade for a long time. In order to overcome dissolution and mechanical degradation of man-made HA, biologically derived hydroxyapatite (BHA) ceramics were prepared from human teeth and their dissolving behavior was investigated in distilled water for 3-14 days and compared with an artificial HA made of synthetic HA powder. BHA ceramics were prepared by calcining freshly extracted human teeth at 900 degrees C and followed by sintering at 1200 degrees C for 2 h. All detectable peaks in the artificial HA are identical to HA lattice planes, whereas BHA consisted of a mixture of HA and beta-tricalcium phosphate (TCP). Although the artificial HA was expected to be stable in water, the surface dissolution initiated at grain boundaries followed by generated many separated grains and their associated pores. On the other hand, BHA showed that definite grains considered as beta-TCP were predominantly dissolved and the grains were separated from the matrix leaving pores. In the mean time, the rest region, mainly consisting of HA, did not show any evidence of dissolution. It indicates that BHA showed rather stable grain boundaries and lack of excessive dissolution in liquid environment.

Osteogenic protein-1 increases the fixation of implants grafted with morcellised bone allograft and ProOsteon bone substitute: an experimental study in dogs

Impacted bone allograft is often used in revision joint replacement. Hydroxyapatite granules have been suggested as a substitute or to enhance morcellised bone allograft. We hypothesised that adding osteogenic protein-1 to a composite of bone allograft and non-resorbable hydroxyapatite granules (ProOsteon) would improve the incorporation of bone and implant fixation. We also compared the response to using ProOsteon alone against bone allograft used in isolation. We implanted two non-weight-bearing hydroxyapatite-coated implants into each proximal humerus of six dogs, with each implant surrounded by a concentric 3 mm gap. These gaps were randomly allocated to four different procedures in each dog: 1) bone allograft used on its own; 2) ProOsteon used on its own; 3) allograft and ProOsteon used together; or 4) allograft and ProOsteon with the addition of osteogenic protein-1. After three weeks osteogenic protein-1 increased bone formation and the energy absorption of implants grafted with allograft and ProOsteon. A composite of allograft, ProOsteon and osteogenic protein-1 was comparable, but not superior to, allograft used on its own. ProOsteon alone cannot be recommended as a substitute for allograft around non-cemented implants, but should be used to extend the volume of the graft, preferably with the addition of a growth factor.

Fluorine-substituted hydroxyapatite scaffolds hydrothermally grown from aragonitic cuttlefish bones

Porous hydroxyapatite scaffolds with different levels of fluorine substitution (46% and 85%) on the OH sites were produced via hydrothermal transformation of aragonitic cuttlefish bones at 200 degrees C and calcination at temperatures up to 1200 degrees C. The increasing level of F substitution reduces the kinetics and probably the yield of the reaction. The incorporation of F in the lattice of hydroxypatite caused a lowering of the unit cell volume due to reduction of the length of the a-axis. The crystallites formed were close in size to bone-like apatite and were orientated along the a-axis rather than the c-axis. There was evidence of AB-type carbonated apatite.

Investigation of the bioactivity and biocompatibility of different glass interfaces with hydroxyapatite, fluorohydroxyapatite and 58S bioactive glass

The current review investigates the bioactivity of different glass interfaces created on thin glass cover slips as substrates. The interfaces studied are plain glass, functionalized glass using 0.5 M and 5 M of sodium hydroxide (NaOH) for 24 hrs, and glass coated with bioactive 58S Bioglass (58S). A biomimetic method, involving the exposure of the three interfaces to 1.5 times simulated body fluid (SBF) tests the bioactivity of the interfaces via creation of layer of Hydroxyapatite (HA). Fluorinated SBF will precipitate fluorine doped HA (FHA) on a bioactive interface. Higher concentration of 1.5 times of SBF used in this study intended to accelerate the formation of HA and FHA layer over the substrate. HA and FHA is found to be precipitated on the thinly coated 58S. This paper, study also the thin film coatings of three forms of bioceramics - bioactive 58S, HA and FHA. The study, also proposes to draw a relation between the morphology of HA particles with duration of exposure to SBF, the effects of fluorine on the morphology and the cell interaction with bioactive 58S, HA and FHA interfaces using pre-differentiated osteoblastic MC3T3 cells. The analysis of cells in this study is confined to three parameters that include the attachment, proliferation and viability of cells. Tests employed for the analysis of the thin film coating of HA and FHA is restricted to qualitative X-Ray Diffraction and quantitative Field Emission Scanning Electron Microscope. Other mechanical tests such as shear test are not used to test the mechanical properties of this thin layer, due to the fact that the thin film is too thin for such analysis.

Bond-coating in plasma-sprayed calcium-phosphate coatings

The influence of bond-coating on the mechanical properties of plasma-spray coatings of hydroxyatite on Ti was investigated. Plasma-spray powder was produced from human teeth enamel and dentine. Before processing the main apatite coating, a very thin layer of Al2O3/TiO2 was applied on super clean and roughened, by Al2O3 blasting, Ti surface as bond-coating. The experimental results showed that bond-coating caused significant increase of the mechanical properties of the coating layer: In the case of the enamel powder from 6.66 MPa of the simple coating to 9.71 MPa for the bond-coating and in the case of the dentine powder from 6.27 MPa to 7.84 MPa, respectively. Both tooth derived powders feature high thermal stability likely due to their relatively high content of fluorine. Therefore, F-rich apatites, such those investigated in this study, emerge themselves as superior candidate materials for calcium phosphate coatings of producing medical devices. The methods of apatite powder production and shaping optimization of powder particles are both key factors of a successful coating. The methods used in this study can be adopted as handy, inexpensive and reliable ways to produce high quality of powders for plasma spray purposes.

Early bone in-growth ability of alumina ceramic implants loaded with tissue-engineered bone

To enhance early bonding of an alumina ceramic implant to bone, we evaluated a method of seeding the implant surface with bone marrow mesenchymal cells that differentiated to osteoblasts and bone matrix prior to implantation. The usefulness of the method was evaluated in Japanese white rabbits. In our study, an alumina ceramic test piece loaded with differentiated osteoblasts and bone matrix by a tissue engineering technique was implanted into rabbit bones. Three weeks after the procedure, evaluation of mechanical bonding and histological examination were performed. Histological examination of the noncell-loaded implant surfaces showed no bone infiltration into the implant gap. However, the cell-loaded implant surfaces exhibited new bone infiltration into the implant gap with mechanical bonding. In the mechanical test, the average failure load was 0.60 kgf for the noncell-loaded side and 1.49 kgf for the cell-loaded side. Preculturing mesenchymal cells on the surface of the alumina ceramic prior to implantation increased the debonding strength by two and half times. The present findings indicate early bonding between the implant and bone three weeks after the procedure.

Tissue engineered ceramic artificial joint--ex vivo osteogenic differentiation of patient mesenchymal cells on total ankle joints for treatment of osteoarthritis

Total joint arthroplasty is the common treatment of severe cases of osteoarthritis. However, complications involving failure of the bone-prosthesis interface are significant, especially in ankle arthroplasty. To prevent this complication, we attempted a tissue engineering approach using the mesenchymal cells of the patient. We collected a small amount of fresh bone marrow cells from the patient's iliac crest and expanded the number of mesenchymal cells. We then applied the mesenchymal cells to a ceramic ankle prosthesis and cultured them to form an osteoblasts/bone matrix on the prosthesis. We used tissue engineered prostheses on three patients suffering from ankle arthritis and followed their progress for at least 2 years. Follow-up X-ray examinations revealed early radiodense appearance (bone formation) around the cell-seeded areas of the prostheses about 2 months after the operation after which a stable host bone-prosthesis interface was established. All patients showed high clinical scores after the operation and did not exhibit inflammatory reactions. These preliminary results indicate that the tissue engineering approach using autologous cultured marrow mesenchymal cells might prevent aseptic loosening of the total ankle arthroplasty.

Fluor-hydroxyapatite sol–gel coating on titanium substrate for hard tissue implants

Hydroxyapatite (HA) and fluor-hydroxyapatite (FHA) films were deposited on a titanium substrate using a sol-gel technique. Different concentrations of F- were incorporated into the apatite structure during the sol preparation. Typical apatite structures were obtained for all coatings after dipping and subsequent heat treatment at 500 degrees C. The films obtained were uniform and dense, with a thickness of approximately 5 microm. The dissolution rate of the coating layer decreased with increasing F- incorporation within the apatite structure, which demonstrates the possibility of tailoring the solubility by a functional gradient coating of HA and FHA. The cell proliferation rate on the coating layer decreased slightly with increasing F- incorporation. The alkaline phosphatase (ALP) activity of the cells on all the HA and FHA coated samples showed much higher expression levels compared to pure Ti. This confirmed the improved activity of cell functions on the substrates with the sol-gel coating treatment.

Sol–gel derived fluor-hydroxyapatite biocoatings on zirconia substrate

Fluor-hydroxyapatite (FHA) film was coated on a zirconia (ZrO(2)) substrate by a sol-gel method. An appropriate amount of F ions was incorporated into the hydroxyapatite (HA) during the preparation of the sols. The apatite phase began to crystallize after heat treatment at 400 degrees C, and increased in intensity above 500 degrees C. No decomposition was detected by X-ray diffraction analyses up to 800 degrees C, which illustrates the high thermal stability of the FHA films. The films showed a uniform and dense morphology with a thickness of approximately 1 microm after a precisely controlled heat treatment process. These FHA films adhered firmly to the zirconia substrate, representing notable adhesion strengths of approximately 70 MPa after heat treatment above 500 degrees C. The dissolution rate of the FHA coating layer varied according to the heat treatment temperature, which was closely related to the film crystallinity. The dissolution rate of the FHA film was lower than that of the HA film, suggesting the possibility of a functional gradient coating of HA and FHA. The MG63 cells seeded onto the FHA films proliferated in a similar manner to those seeded onto pure HA ceramic and a plastic control.

Hydroxyapatite and fluor-hydroxyapatite layered film on titanium processed by a sol-gel route for hard-tissue implants

A double-layered coating, consisting of a hydroxyapatite (HA) outer film and a fluor-hydroxyapatite (FHA) inner film, was produced on a Ti substrate by a sol-gel route to improve the biocompatibility and functionality of the system. Dissolution behavior of and in vitro cellular responses to the layered film were investigated. Calcium nitrate and triethyl phosphite were used for calcium and phosphate precursors, respectively, and ammonium fluoride was added as a fluorine-ion source for FHA. The FHA layer was deposited on Ti by spin coating and subsequent heat treatment at 550 degrees C for 30 min in air, and then the HA layer was laid down over the FHA-coated Ti under the same conditions. After heat treatment, characteristic apatite structures and phases were developed on both FHA and HA films. The cross-section view of the HA/FHA film clearly showed a double-layered structure on Ti with each layer approximately 0.6-0.8-microm thickness. The coating layer was highly uniform and dense, and adhered to Ti substrate strongly with an adhesion strength of about 40 MPa. The in vitro solubility of the HA/FHA layered film in a physiological solution was between that of HA and FHA pure film, and the dissolution profile was quite biphasic, that is, an initial rapid period and a slowdown with increasing time, reflecting the gradient solubility of the fast HA outer structure/slow FHA inner structure. The human osteoblast-like HOS TE85 cells cultured on the HA/FHA layered film attached, spread, and grew favorably. The proliferation rate of the cells on the layered film was significantly higher (considered at p < 0.05 for n = 6) than that on Ti substrate and was similar to that on pure HA film. The alkaline phosphatase (ALP) activity and osteocalcin (OC) produced by the cells on the layered film were significantly higher (considered at p < 0.05 for n = 6) than those on Ti substrate. Moreover, the ALP and OC levels of cells on the layered film showed the trends of HA outer/FHA inner structure with respect to culture period, that is, HA initially and FHA later. These observations suggest that the HA/FHA layered film on Ti obtained by a sol-gel route possesses gradient functionality in terms of solubility and cellular responses, and find that those parameters can be tailored for specific use in hard-tissue implants.

Effect of post-deposition heating temperature and the presence of water vapor during heat treatment on crystallinity of calcium phosphate coatings

In this study, radiofrequency sputtered calcium phosphate (CaP) coatings were evaluated after 1h post-deposition heat treatment at either 350 degrees C, 400 degrees C, 450 degrees C, 500 degrees C or 600 degrees C in the presence or absence of water vapor. X-ray diffraction analyses indicated the as-sputtered coatings to be amorphous. With different post-deposition heat treatments used, in this study, crystallinity of CaP coatings was observed to be in the range of 0-68%. The 400 degrees C and 450 degrees C heat-treated CaP coatings in the absence of water vapor were poorly crystalline, exhibiting a crystallinity of 2+/-1%. In comparison to heat treatments at 450 degrees C in the absence of water vapor, the presence of water vapor at 450 degrees C heat treatment resulted in a significant increase in coating crystallinity. However, this effect was not observed at higher temperatures. A coating crystallinity of 60-68% was observed for coatings heat treated at 450 degrees C in the presence of water vapor, and at 500 degrees C and 600 degrees C in the presence or absence of water vapor. In addition, increases in the degree of coating crystallinity were observed to be consistent with the increasing number of PO(4) peaks observed as a result of different post-deposition heat treatments. It was concluded that the presence of water vapor at 450 degrees C post-deposition heat treatment significantly affect the crystallinity of CaP coatings, whereas an increase to temperature higher than 450 degrees C and in the presence of water vapor has no significant effect on crystallinity.

Cementless Mallory Head HA-coated femoral prosthesis in primary total hip arthroplasty: Clinical and radiological results of a four to nine year prospective study

We prospectively studied 152 hips in 126 patients with a proximally porous and hydroxyapatite coated double tapered straight femoral prosthesis. The follow-up period was 4.2 to 9.6 years. All but two prostheses showed osseo-integration. The mean Harris hip score (HHS) increased from 40 to 92 points and 97% of the patients had no or only mild pain. Limping and the use of walking aids decreased substantially after the operation. The morphology of positive bone remodelling with either endosteal bone formation or periosteal bone formation was correlated with the stem fit in the medullary canal (p=0.0001). Negative bone remodelling features could not be demonstrated. There was no correlation between the clinical parameters and the radiological phenomena. (Hip International 2002; 4: 345-56).

Osseointegration of hydroxyapatite-coated and noncoated Ti6Al4V implants in the presence of local infection: a comparative histomorphometrical study in rabbits

A study was designed to investigate the osseointegration of titanium implants, either noncoated or coated with hydroxyapatite (HA), into rabbit tibiae in the presence of local infection compared with osseointegration in the absence of local infection. HA-coated or noncoated Ti cylinders were implanted into both tibiae of 32 rabbits (New Zealand Whites). Before implantation the left tibia was contaminated with different quantities of Staphylococcus aureus (10(2)-10(5) CFU). Four weeks after surgery the tibiae were explanted and prepared for microbiological and histomorphometrical examination. Histomorphometrical data, as a representation of implant fixation, were obtained by measuring the percentage of bone around the implants (within a radius of 1 mm from the outer diameter of the implants) and the percentage of the circumference of the implant that was in direct contact with bone. Histomorphometry revealed, in particular for the HA implants, a relationship between the inoculum concentration and/or the presence or absence of infection with the bone contact at the distal implant side. This confirms a relationship between peri-implant infection and bone contact or remodeling. HA-coated implants developed, in the presence of bacteria, more easily a more severe infection than noncoated Ti implants, and we show in the present study that local infection will influence histomorphometrical parameters (bone-implant contact) that determine implant fixation. Precautions to prevent contamination (asepsis) and/or infection (perioperative antibiotics) are even more important for the highly biocompatible HA-coated implant.

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.

Osteoconductive coatings for total joint arthroplasty

Osteoconductive calcium phosphate coatings for total joint arthroplasty have been in clinical use since the mid1980s. The basic principles involved and basic science evidence for the efficacy of osteoconductive coatings were examined. Hydroxyapatite coatings provide consistent and better filling with bone of the gaps and spaces around cementless joint components after surgery as compared with porous-coated implant surfaces, resulting in better implant stability. Of all the calcium phosphate coatings, hydroxyapatite coatings have had the most widespread application in hip arthroplasty. Their clinical advantages over more conventional implant surfaces are evident in primary and revision hip arthroplasties. A clinical survival rate in the author's series of 97% at a minimum of 11 years followup for the femoral component in a young active patient population (average age, 53 years) was obtained with no mechanical failures. The average polyethylene wear rate in this group was 0.129 mm/year. In a similar group of young patients with revision arthroplasty using hydroxyapatite-coated femoral components, an 11-year survival rate of 93% was obtained. Histologic analysis of specimens retrieved at autopsy confirmed the excellent bony fixation of components. Advantages of the more recent biomimetic hydroxyapatite coatings were examined.

The optimal fixation of the cementless acetabular component in primary total hip arthroplasty

The optimal fixation of the acetabular component in primary total hip arthroplasty remains controversial. Long-term follow-up studies show that significant loosening rates occur with cemented acetabular components and that these problems persist despite attempts to improve cementing technique. Cementless acetabular components that rely on biologic fixation can have lower rates of radiographic loosening at 10 years compared with cemented acetabular components. Although revision rates for both modes of fixation are largely equivalent at 10 years, the superior radiographic performance of cementless acetabular components at 10 years suggests that biologic fixation through bone ingrowth may provide more durable long-term implant survival compared with cemented fixation. Osteolysis is the major obstacle to long-term cementless acetabular component survival. Potential future options that may inhibit osteolysis include decreasing bone resorption that results from debris-stimulated foreign body response through the use of medications; decreasing the number of particles generated by using alternative bearing surfaces; and improving bone ingrowth, particularly through the use of growth factors and improved implant materials and designs.

Biological performance of calcium phosphate films formed on commercially pure Ti by electron-beam evaporation

Thin and defect-free calcium phosphate films with a Ca/P ratio of 1.62 were formed by electron-beam evaporation. The as-deposited films had average bonding strengths to the metal implants of 64.8 MPa and the dissolution rates of 47.5 nm/h in isotonic saline solutions. The interface mechanical characteristics and histology of the as-machined, as-blasted, and calcium phosphate coating on the machined surfaces of commercially pure titanium were investigated. After a healing period of 12 weeks, the implants were unscrewed with a torque gauge instrument at the day of sacrifice. The coated sample showed a removal torque of 48.5 Ncm (SD 5.4) compared to 32.3 Ncm (SD 2.91) for the uncoated implant with the same surface roughness, and 47.3 Ncm (SD 5.8) for the grit blasted screw. The histomorphometric analyses of the calcium-phosphate-coated implants revealed a mean of 52.4% (SD 6.3) as the highest bone to implant contact.

The hydroxyapatite-ABG hip system: 5- to 7-year results from an international multicentre study. The International ABG Study Group

A proximally hydroxyapatite (HA)-coated hip prosthesis designed for proximal stem bonding and stress transfer was studied in a consecutive series of 398 patients in an ongoing, prospective multicenter study. Follow-up was 5 to 7 years. The clinical results were excellent with a mean preoperative Merle d'Aubigné score of 8.5 and 17.3 at 5 years. Only mild thigh pain not necessitating analgesics or a walking stick was reported in 3.6% at 5 years. Three cups and 3 stems had to be revised, all before the 2-year assessment and mainly for technical reasons. No components needed revision after 2 years. The 5-year HA-coated component survival was 99.2%. Serial radiographs showed excellent osseointegration, which was independent of pre-existing bone stock. The rate of radiographic bone remodeling was highest during the first 3 years, and positive bone remodeling (bone formation) preceded negative bone remodeling (bone resorption). The concept of transitional load transfer from proximal to distal could be acknowledged, with proximal load transfer highest in 77%. The combination of anatomic stem design with distal overreaming and proximal HA coating was thought to be the reason for these excellent results. Proximal circumferential osseointegration seems to be real because no linear or distal osteolysis was observed.

Stem cell technology and bioceramics: from cell to gene engineering

Mesenchymal stem cells reside in bone marrow and, when these cells are incorporated into porous ceramics, the composites exhibit osteo-chondrogenic phenotypic expression in ectopic (subcutaneous and intramuscular) or orthotopic sites. The expressional cascade is dependent upon the material properties of the delivery vehicle. Bioactive ceramics provide a suitable substrate for the attachment of the cells. This is followed by osteogenic differentiation directly on the surface of the ceramic, which results in bone bonding. Nonbioactive materials show neither surface-dependent cell differentiation nor bone bonding. The number of mesenchymal stem cells in fresh adult bone marrow is small, about one per one-hundred-thousand nucleated cells, and decreases with donor age. In vitro cell culture technology can be used to mitotically expand these cells without the loss of their developmental potency regardless of donor age. The implanted composite of porous ceramic and culture-expanded mesenchymal stem cells exhibits in vivo osteo-chondrogenic differentiation. In certain culture conditions, these stem cells differentiate into osteoblasts, which make bone matrix on the ceramic surface. Such in vitro prefabricated bone within the ceramic provides immediate new bone-forming capability after in vivo implantation. Prior to loading of the cultured, marrow-derived mesenchymal stem cells into the porous ceramics, exogenous genes can be introduced into these cells in culture. Combining in vitro manipulated mesenchymal stem cells with porous ceramics can be expected to effect sufficient new bone-forming capability, which can thereby provide tissue engineering approaches to patients with skeletal defects in order to regenerate skeletal tissues.

Estimation of volume referent bone turnover in the otic capsule after sequential point labeling

Using fluorochrome labeling and a newly validated method for bone turnover estimation, we determined absolute values for canine perilabyrinthine bone remodeling. The overall capsular bone turnover was found to be 2.1% per year, compared to 13.9% per year for the neighboring cranial bones and 7.4% per year for the humerus compacta. This gross 2.1% per year conceals a vast range, from 0.13% per year for the innermost perilymphatic zone, through a centrifugal increment toward 8% to 10% per year in the periphery. The underlying individual bone remodeling units exhibit a similar centrifugal pattern in numerical density and size. These findings indicate an inhibition of remodeling, seemingly emanating from the perilymphatic spaces, and affecting both the activation of osteoclasts and the extent of resorption by the osteoclasts. These values satisfactorily explain the preservation of such fetal remnants as the globuli ossei, the interglobular spaces, and the skein bone. In humans, local ineffective inhibition of bone resorption may play a role in the initiation of otosclerosis.

Effect of osteoblastic culture conditions on the structure of poly(DL-lactic-co-glycolic acid) foam scaffolds

Poly(DL-lactic-co-glycolic acid) (PLGA) foams are an osteoconductive support that holds promise for the development of bone tissue in vitro and implantation into orthopedic defects. Because it is desirable that foams maintain their shape and size, we examined a variety of foams cultured in vitro with osteoblastic cells. Foams were prepared with different porosities and pore sizes by the method of solvent casting/porogen leaching using 80, 85, and 90 wt% NaCl sieved with particle sizes of 150-300 and 300-500 microm and characterized by mercury intrusion porosimetry. Foams seeded with cells were found to have volumes after 7 days in static culture that decreased with increasing porosity: the least porous exhibited no change in volume while the most porous foams decreased by 39 +/- 10%. In addition, a correlation was observed between decreasing foam volume after 7 days in culture and decreasing internal surface area of the foams prior to seeding. Furthermore, foams prepared with the 300-500 microm porogen had lower porosities, greater mean wall thicknesses between adjacent pores, and larger volumes after 7 days in culture than those prepared with the smaller porogen. Two culture conditions for maintaining cells, static and agitated (in a rotary vessel), were found to have similar influences on foam size, cell density, and osteoblastic function for 7 and 14 days in culture. Finally, we examined unseeded foams in aqueous solutions of pH 3.0, 5.0, and 7.4 and found no significant decrease in foam size with degradation. This study demonstrates that adherent osteoblastic cells may collapse very porous PLGA foams prepared by solvent casting/particulate leaching: a potentially undesirable property for repair of orthopedic defects.

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.

Implant fixation by bone ingrowth

The term osseointegration referred originally to an intimate contact of bone tissue with the surface of a titanium implant; the term bone ingrowth refers to bone formation within an irregular (beads, wire mesh, casting voids, cut grooves) surface of an implant. The section dealing with the historical background describes the development of macroporous, microporous, and textured surfaces with an emphasis on the evolution of porous and textured metal surfaces. The principal requirements for osseointegration and bone ingrowth are systematically reviewed as follows: i) the physiology of osseointegration and bone ingrowth, including biomaterial biocompatibility with respect to cellular and matrix response at the interface; ii) the implant surface geometry characteristics; iii) implant micromotion and fixation modes; and iv) the implant-bone interface distances. Based on current methods of bone ingrowth assessment, this article comparatively reviews and discusses the results of experimental studies with the objective of determining local and systemic factors that enhance bone ingrowth fixation.

Integration of press-fit implants in cortical bone: a study on interface kinetics

The early healing phase of hard tissue implants is important to their long-term success. Problems during this phase can result in a so-called primary biological failure. In 24 New Zealand white rabbits, the healing in cortical bone of noncoated TiAlV and cpTi cylinders and of TiAlV cylinders plasma-spray-coated with hydroxyapatite (HA) of fluorapatite (FA) was investigated histologically and histomorphometrically after 3, 7, 14, and 28 days. Histomorphometry consisted of bone contact measurements and the use of a new semi quantitative scoring system that discriminated various tissues in contact with the implant. The results demonstrated that the most important parameter in initial implant healing is the bone itself and not the characteristics of the implanted material. For all implants, healing was characterized by a sequence of hematoma formation, bone resorption, and new bone formation where the initial press-fit situation revealed more bone-implant contact than after 7 and 14 days. There were only minor differences between the implant types: the new bone formation directly on the implant surface was qualitatively histologically superior to the CaP-coated implants, but this could be confirmed with the scoring method only for the HA-coated implants. It is concluded that initial press-fit fixation in cortical bones is not an end situation; rather, what happens is that as a result of interface remodeling, early postoperatively implant integration in the bone will decrease temporarily prior to a subsequent phase of new bone formation.

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 microm 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.

Volume-referent bone turnover estimated from the interlabel area fraction after sequential labeling

In the compact bony otic capsule remodeling is low, and bone remodeling units are distributed centrifugally in relation to inner ear tissues and spaces. Fluorochrome-labeled bone remodeling units are scarce, abortive, and tortuous with no uniform direction of movement. This study presents a method for the estimation of volume-referent bone turnover based on measurements of the fractional area between labels after sequential labeling with osteofluorochromes. The applicability of this method is tested against a classical quantification method in undecalcified cortical specimens from the canine humerus, where both methods can be used. The estimate of bone turnover derived from the new sequential labeling in eight dogs is 7.4% (SEM 2.1%) per year and the classic estimate derived from calculations of the formative osteonal area and the formative period yields 6.9% (SEM 2.1%) per year. Agreement is sufficient to justify future measurements of absolute bone turnover in sequentially labeled perilabyrinthine bone.