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Apostu D, Berechet B, Oltean-Dan D, Mester A, Petrushev B, Popa C, Gherman ML, Tigu AB, Tomuleasa CI, Barbu-Tudoran L, Benea HRC, Piciu D. Low-Molecular-Weight Heparins (LMWH) and Synthetic Factor X Inhibitors Can Impair the Osseointegration Process of a Titanium Implant in an Interventional Animal Study. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1590. [PMID: 36363548 PMCID: PMC9694659 DOI: 10.3390/medicina58111590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/25/2022] [Accepted: 10/31/2022] [Indexed: 08/30/2023]
Abstract
Background and objectives: Cementless total hip arthroplasty is a common surgical procedure and perioperative thromboprophylaxis is used to prevent deep vein thrombosis or pulmonary embolism. Osseointegration is important for long-term implant survival, and there is no research on the effect of different thromboprophylaxis agents on the process of osseointegration. Materials and Methods: Seventy rats were allocated as follows: Group I (control group), Group II (enoxaparin), Group III (nadroparin), and Group IV (fondaparinux). Ovariectomy was performed on all subjects, followed by the introduction of an intramedullary titanium implant into the femur. Thromboprophylaxis was administered accordingly to each treatment group for 35 days postoperatively. Results: Group I had statistically significantly lower anti-Xa levels compared to treatment groups. Micro-CT analysis showed that nadroparin had lower values compared to control in bone volume (0.12 vs. 0.21, p = 0.01) and percent bone volume (1.46 vs. 1.93, p = 0.047). The pull-out test showed statistically significant differences between the control group (8.81 N) compared to enoxaparin, nadroparin, and fondaparinux groups (4.53 N, 4 N and 4.07 N, respectively). Nadroparin had a lower histological cortical bone tissue and a higher width of fibrous tissue (27.49 μm and 86.9 μm) at the peri-implant area, compared to control (43.2 μm and 39.2 μm), enoxaparin (39.6 μm and 24 μm), and fondaparinux (36.2 μm and 32.7 μm). Conclusions: Short-term administration of enoxaparin, nadroparin, and fondaparinux can reduce the osseointegration of titanium implants, with nadroparin having the most negative effect. These results show that enoxaparin and fondaparinux are preferred to be administered due to a lesser negative impact on the initial implant fixation.
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Affiliation(s)
- Dragos Apostu
- Department of Orthopedics, Traumatology and Pediatric Orthopaedics, University of Medicine and Pharmacy Cluj-Napoca, 400347 Cluj-Napoca, Romania
| | - Bianca Berechet
- Department of Gastroenterology, “Octavian Fodor” Institute of Gastroenterology and Hepatology, 400347 Cluj-Napoca, Romania
| | - Daniel Oltean-Dan
- Department of Orthopedics, Traumatology and Pediatric Orthopaedics, University of Medicine and Pharmacy Cluj-Napoca, 400347 Cluj-Napoca, Romania
| | - Alexandru Mester
- Department of Oral Health, University of Medicine and Pharmacy Cluj-Napoca, 400012 Cluj-Napoca, Romania
| | - Bobe Petrushev
- Department of Gastroenterology, “Octavian Fodor” Institute of Gastroenterology and Hepatology, 400347 Cluj-Napoca, Romania
| | - Catalin Popa
- Department of Materials Science and Engineering, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania
| | - Madalina Luciana Gherman
- Experimental Center, University of Medicine and Pharmacy Cluj-Napoca, 400012 Cluj-Napoca, Romania
| | - Adrian Bogdan Tigu
- Research Center for Advanced Medicine—MedFuture, Department of Translational Medicine, University of Medicine and Pharmacy Cluj-Napoca, 400347 Cluj-Napoca, Romania
| | - Ciprian Ionut Tomuleasa
- Department of Hematology, University of Medicine and Pharmacy Cluj-Napoca, 400012 Cluj-Napoca, Romania
- Department of Hematology, Ion Chiricuta Clinical Cancer Center, 400015 Cluj-Napoca, Romania
- Medfuture Research Center for Advanced Medicine, University of Medicine and Pharmacy Cluj-Napoca, 400012 Cluj-Napoca, Romania
| | - Lucian Barbu-Tudoran
- Electron Microscopy Center, Faculty of Biology and Geology, Babes-Bolyai University, 400006 Cluj-Napoca, Romania
| | - Horea Rares Ciprian Benea
- Department of Orthopedics, Traumatology and Pediatric Orthopaedics, University of Medicine and Pharmacy Cluj-Napoca, 400347 Cluj-Napoca, Romania
| | - Doina Piciu
- Nuclear Medicine Department, University of Medicine and Pharmacy Cluj-Napoca, 400012 Cluj-Napoca, Romania
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