Histological and mechanical comparison of hydroxyapatite-coated cobalt-chrome and titanium implants in the rabbit femur

Tribological and corrosion performance of the plasma-sprayed conformal ceramic coating on selective laser melted CoCrMo alloy

Ceramic implants have superior performance due to the excellent wear resistance and biocompatibility. However, the poor machinability limits their applications. Plasma sprayed ceramic coating on the additively manufactured metal substrate not only provides a 3-dimensional conformal implant coating and but also forms a highly wear-resistant surface layer. In this paper, three types of ceramic coatings of Al₂O_3, ZrO₂, and Al₂O₃-ZrO₂ composite have been fabricated by atmosphere plasma spray on the CoCrMo alloy substrate prepared by selective laser melting (SLM). It has been found that the Al₂O₃-ZrO₂ composite coating has better corrosion and wear resistance compared with the ceramic coating (Al₂O_3, ZrO₂) and the CoCrMo substrate. The adhesion strength between the Al₂O₃-ZrO₂ composite coating and the substrate reaches 238 MPa. In addition, the wear and corrosion resistance increase with wear progression for all the fabricated ceramic coatings. The highly dense microstructure, fewer microcracks, and the amorphous phases are deterministic factors responsible for the superior tribological and corrosion performance of the Al₂O₃-ZrO₂ composite coating. The fabrication route has been proved very promising to manufacture high-performance implants with ceramic coating.

Nanostructured tantala as a template for enhanced osseointegration

The goal of current dental and orthopedic biomaterials research is to design implants that induce controlled and guided tissue growth, and rapid healing. In addition to acceleration of normal wound healing phenomena, these implants should result in the formation of a characteristic interfacial layer with adequate biomechanical properties. To achieve these goals, however, a better understanding of events at the bone-material interface is needed, as well as the development of new materials and approaches that promote osseointegration. Here we present novel nanostructured nanoarrays from tantala that can promote cell adhesion and differentiation. Our results suggest that tantala nanotube arrays enhance osteoblast cell adhesion, proliferation and differentiation. The routes of fabrication of tantala nanotube arrays are flexible and cost-effective, enabling realization of desired platform topologies on existing non-planar orthopedic implants.

XPS study on the use of 3-aminopropyltriethoxysilane to bond chitosan to a titanium surface

Chitosan, a biopolymer found in the exoskeletons of shellfish, has been shown to be antibacterial, biodegradable, osteoconductive, and has the ability to promote organized bone formation. These properties make chitosan an ideal material for use as a bioactive coating on medical implant materials. In this study, coatings made from 86.4% de-acetylated chitosan were bound to implant-quality titanium. The chitosan films were bound through a three-step process that involved the deposition of 3-aminopropyltriethoxysilane (APTES) in toluene, followed by a reaction between the amine end of APTES with gluteraldehyde, and finally, a reaction between the aldehyde end of gluteraldehyde and chitosan. Two different metal treatments were examined to determine if major differences in the ability to bind chitosan could be seen. X-ray photoelectron spectroscopy (XPS) was used to examine the surface of the titanium metal and to study the individual reaction steps. The changes to the titanium surface were consistent with the anticipated reaction steps, with significant changes in the amounts of nitrogen, silicon, and titanium that were present. It was demonstrated that more APTES was bound to the piranha-treated titanium surface as compared to the passivated titanium surface, based on the amounts of titanium, carbon, nitrogen, and silicon that were present. The metal treatments did not affect the chemistry of the chitosan films. Using toluene to bond APTES on titanium surfaces, rather than aqueous solutions, prevented the formation of unwanted polysiloxanes and increased the amount of silane on the surface for forming bonds to the chitosan films. Qualitatively, the films were more strongly attached to the titanium surfaces after using toluene, which could withstand the ultrahigh vacuum environment of XPS, as compared to the aqueous solutions, which were removed from the titanium surface when exposed to the ultrahigh vacuum environment of XPS.

SEM and 3D synchrotron radiation micro-tomography in the study of bioceramic scaffolds for tissue-engineering applications

Different biomaterials have been proposed as scaffolds for the delivery of cells and/or biological molecules to repair or regenerate damaged or diseased bone tissues. Particular attention is being given to porous bioceramics that mimic trabecular bone chemistry and structure. Chemical composition, density, pore shape, pore size, and pore interconnection are elements that have to be considered to improve the efficiency of these biomaterials. Commonly, two-dimensional (2D) systems of analysis such as scanning electron microscope (SEM) are used for the characterization and comparison of the scaffolds. Unfortunately, these systems do not allow a complete investigation of the three-dimensional (3D) spatial structure of the scaffold. In this study, we have considered two different techniques, that is, SEM and 3D synchrotron radiation (SR) micro-CT to extract information on the geometry of two hydroxyapatite (HA) bioceramics with identical chemical composition but different micro-porosity, pore size distribution, and pore interconnection pathway. The two scaffolds were obtained with two different procedures: (a) sponge matrix embedding (scaffold FB), and (b) foaming (scaffold EP). Both scaffolds showed structures suitable for tissue-engineering applications, but scaffold EP appeared superior with regard to interconnection of pores, surface on which the new bone could be deposited, and percentage of volume available to bone deposition.

A comparison of ProOsteon, DBX, and collagraft in a rabbit model

Many bone graft substitutes (BGSs) have been developed and are commercially available. These products differ in the tailoring of their properties, including size, form, osteoconductivity, osteoinductivity, and resorption kinetics. Differential enhancement of these properties may optimize the performance of these materials for varying applications. BGSs offer an opportunity to lessen morbidity of harvesting and use of autogenous and/or allograft bone. The purpose of this study is to quantitatively compare the magnitude of bony ingrowth and biodegradation of different commercially available BGS materials in a rabbit femoral defect model. BGSs from each of three classes (ceramic (ProOsteon), demineralized bone matrix (DBX), and composite (Collagraft)) were implanted in cylindrical defects in bilateral femoral condyles of 12 adult New Zealand White rabbits. Each of the three BGS materials and the empty controls were compared. The specimens were harvested at 3 months postimplantation for radiographic and histologic evaluation. Histomorphometry yielded resorption of graft material remaining in the index defect. Magnitude of bony ingrowth was assessed based on an 8-bit 256 densitometry model. Histomorphometric analysis of the data demonstrated statistical differences in the resorption and magnitude of bony ingrowth of the three BGS materials. The three BGS were significantly different for ingrowth (p = 0.046) when using the Wilcoxon Test. The ceramic graft material averaged 47% bony ingrowth. Rabbit-based DBX material showed extensive osseous ingrowth (35%) and the composite graft material demonstrated significant bony ingrowth (56%). The control, as anticipated, showed the least amount of bony ingrowth (29%). Fisher's Exact Test yielded statistical differences (p = 0.0003) when comparisons for resorption were conducted. An ideal BGS material should be biocompatible, be able to withstand the local load environment for a given application, degrade in concert with bony replacement, and be both osteoinductive and osteoconductive. This in-vivo, head-to-head comparison of three commercially available BGS materials in an animal model compares these characteristics and demonstrates differences between them, which may act as a guide in the use of these products in human applications.

Improved bone-screw interface with hydroxyapatite coating: an in vivo study of loaded pedicle screws in sheep

STUDY DESIGN

An in vivo sheep model with loaded pedicle screws was used, wherein each animal served as its own control.

OBJECTIVES

To examine the effects of hydroxyapatite (HA) coating on the bone-to-implant interface in loaded spinal instrumentations.

SUMMARY OF BACKGROUND DATA

Spinal instrumentation improves the healing rate in spinal fusion, but screw loosening constitutes a problem. HA coating of other implants has resulted in favorable effects on the bone-to-implant interface.

METHODS

Nine sheep were operated on with destabilizing laminectomies at two levels: L2-L3 and L4-L5. Each level was stabilized separately with a four-screw instrumentation. Uncoated screws (stainless steel) or the same type of screws coated with plasma-sprayed HA were used in either the upper or the lower instrumentation in a randomized fashion. The animals were killed at 6 or 12 weeks after surgery. The specimens were embedded in resin, ground to approximately 10 microm, and stained with toluidine blue. Histomorphometric evaluation was carried out in a Leitz Aristoplan (Wetzlar, Germany) light microscope equipped with a Leitz Microvid unit.

RESULTS

The average percentage of bone-to-implant contact after 6 weeks was 69 +/- 10 for the HA-coated screws and 18 +/- 11 for the uncoated screws (P < 0.03), and after 12 weeks 64 +/- 31 (HA-coated) and 9 +/- 13 (uncoated, P < 0.02). The average bone volume in the area close to the screw was significantly higher for the HA-coated screws at both 6 and 12 weeks.

CONCLUSIONS

HA coating improved the bone-to-implant interface significantly, indicating that HA coating can become useful for improving the purchase of pedicle screws.

A bone replaceable artificial bone substitute: cytotoxicity, cell adhesion, proliferation, and alkaline phosphatase activity

Cellular toxicity, cell adhesion and proliferation, and alkaline phosphatase (ALP) activity were investigated for an artificial bone substitute composed of heated carbonate apatite (CAp) and Type I atelocollagen (AtCol) extracted from bovine tail skins (88/12 in %wt/wt). To enhance the intramolecular crosslinking between collagen molecules, the CAp-AtCol substitutes were irradiated by ultraviolet rays (wave length 254 nm) at 4 degrees C for 4 h or vacuum dried at 150 degrees C for 2 h. Cytotoxicity tests by a direct contact method and an extract dilution method revealed that the CAp-AtCol substitutes were cytocompatible for balb 3T3 fibroblasts. Osteoblast adhesion studies demonstrated that the substitute disks composed of 980 degrees C-heated CAp and AtCol were significantly more adhesive for osteoblasts than those of 1,200 degrees C-sintered CAp and AtCol (p < 0.05). Proliferation studies showed that the number of osteoblasts grown in the media containing substitutes of 980 degrees C-heated CAp and AtCol was statistically higher than grown in those of 1,200 degrees C-sintered CAp and AtCol after 5 days (p < 0.05). It was found that osteoblasts grown in the substitutes of 980 degrees C-heated CAp and AtCol only expressed similar ALP activity to the controls. These results suggested that the substitutes consisting of 980 degrees C-heated CAp and AtCol show more favorable interactions with osteoblasts than those of 1,200 degrees C-sintered CAp and AtCol.

Osteoconduction in large macroporous hydroxyapatite ceramic implants: evidence for a complementary integration and disintegration mechanism

Large, cylindrical implants of a porous calcium phosphate ceramic ("hydroxyapatite" starting material, HAC) were used to replace far greater than critical-sized sections of the midshaft of sheep tibiae and retrieved at 2 and 9 months; external fixation was used in the first 5 months. Excellent clinical function of these implants was reported in a previous study. The material retrieved was embedded in PMMA, and blocks were sectioned and surfaces were polished and carbon coated prior to study using digital backscattered electron (BSE) imaging. Detailed scanning electron microscopy study of the pattern of osseointegration of the implanted material at early (2 months) and late (9 months) timepoints revealed a previously unrecognized pattern of integration/disintegration of this implant material in tandem with bone growth. We conclude that bone adaptation to the HAC leads to its fracture and that the newly generated surfaces are equally osteoconductive. This leads to a self-propagating, self-annealing system in which defects in the HAC are mended by intercalation of bone.

Bone ingrowth to implant surfaces in an inflammatory arthritis model

Many studies have shown enhanced bone apposition to implants coated with hydroxyapatite, but the optimum implant texture, especially in abnormal trabecular bone, is unclear. The purpose of this project was to evaluate the histological and mechanical properties of cylindrical implants with three different surface textures that were placed in the cancellous bone of the distal femur of the rabbit after the production of an inflammatory knee arthritis. The three implant surfaces included a beaded surface (Group A), a beaded surface coated with hydroxyapatite (Group B), and a smooth surface coated with hydroxyapatite (Group C). The right knees of 36 rabbits were injected with carrageenan twice a week for 2 weeks. Then bilateral implantations were performed, with 12 rabbits in each group receiving identical implants in the right and left knees. The rabbits were killed 6 weeks after surgery. Mechanical (push-out test) and histomorphometric analyses were performed to determine the quality and quantity of bone ingrowth. In Group A, there was virtually no direct contact (a 20-60-microm clearance) between the bone and the beaded surfaces. Direct contact between the bone and the implant surfaces was seen in Groups B and C. The thickness and number of trabeculae were smaller on the arthritic side than on the control side for all groups but were not different between groups for either the control or the arthritic side. Mechanical testing showed that the shear strength of the interface was weaker on the arthritic side in all groups. The results suggest that inflammatory arthritis induced by carrageenan may influence the quality of local bone (osteopenic changes) and hence compromise the bone apposition and mechanical stability of the interface between the implant and bone.