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Zhang C, Chen H, Fan H, Xiong R, He R, Huang C, Peng Y, Yang P, Chen G, Wang F, Yang L. Carpal bone replacement using personalized 3D printed tantalum prosthesis. Front Bioeng Biotechnol 2023; 11:1234052. [PMID: 37965053 PMCID: PMC10642728 DOI: 10.3389/fbioe.2023.1234052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 10/09/2023] [Indexed: 11/16/2023] Open
Abstract
Objective: Scaphoid and lunate fractures have a relatively high incidence rate. Traditional carpectomy and carpal arthrodesis in the treatment of carpal osteonecrosis will lead to many complications. Three-dimensional (3D) printed tantalum has good biocompatibility and can be designed to match the patient's personalized anatomical carpal structure. This study aims to investigate carpal function and prosthesis-related conditions after carpal bone replacement using 3D printed tantalum prostheses. Methods: From July 2020 to January 2022 at our center, seven patients with osteonecrosis of the carpus received carpal bone replacement using 3D printed tantalum prosthesis. The Disability of the Arm, Shoulder and Hand (DASH) score and patient satisfaction, as well as the Mayo Wrist Scores (Cooney method, modified Green, and O'Brien wrist score), were used to evaluate the preoperative and postoperative wrist function of patients. The Visual Analog Scale (VAS) pain scores were also recorded before and after surgery. The angles of flexion, dorsiflexion, ulnar deviation, and radial deviation were measured using an arthrometer. The grip strength and pinch strength of the operated hand after carpal bone replacement and the contralateral healthy carpus were measured using a dynamometer. Radiographs were taken to confirm the condition and complications of the tantalum prosthesis. Results: All seven patients were followed for 19.6 ± 2.7 months. At the last follow-up, the grip strength of the operated wrist joint after carpal bone replacement was 33.4 ± 2.3 kg, the pinch strength was 8.9 ± 0.7 kg, the flexion was 54.6° ± 0.8°, the dorsiflexion was 54.7° ± 1.7°, the ulnar deviation was 34.6° ± 1.9°, and the radial deviation was 25.9° ± 0.8°, all of which showed no statistically significant difference with the contralateral healthy carpus (p > 0.05). There were significant differences in the VAS, DASH, and MAYO scores between the preoperative and the last follow-up (p < 0.01). Patients had reduced postoperative pain and improved wrist function and range of motion (ROM), and the tantalum prostheses were stable. Conclusion: The 3D printed tantalum brings us new hope, not only for hip or knee replacement, but also for joint replacement of other complex anatomical structures, and patients with other irregular bone defects such as bone tumors and deformity, which could realize personalized treatment and precise medicine.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Guangxing Chen
- Center for Joint Surgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - Fuyou Wang
- Center for Joint Surgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - Liu Yang
- Center for Joint Surgery, Southwest Hospital, Army Medical University, Chongqing, China
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Rony L, Aguado E, Verlee B, Pascaretti-Grizon F, Chappard D. Osseointegration of two types of titanium cylinders with geometric or trabecular microarchitecture: A nanotomographic and histomorphometric study. Morphologie 2022; 106:80-91. [PMID: 33812797 DOI: 10.1016/j.morpho.2021.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 06/12/2023]
Abstract
Porous biomaterials promote osseointegration. We have prepared porous titanium cylinders by additive manufacturing from titanium beads. Two types of morphology were tested: cylinders with geometric pores or mimicking trabecular microarchitecture. Cylinders were decontaminated and cleaned by HF/HNO3 to remove unmelted balls. Surgical implantation in ewes was performed under general anesthesia and the animals were housed for 90 and 270days. The femoral condyles were collected and analyzed by nanoCT, embedded in pMMA and analyzed by histomorphometry. No significant difference was found in terms of bone volume or bone/titanium interface between the two types of cylinders. There was no evolution over time except for the mineralization rates which decreased, reflecting the effect of the aging of the animals. The influence of the pores (geometrical or "natural") did not influence osseointegration. HF/HNO3 etching treatments are effective on the outermost surfaces but do not seem to reach the central cavities of the samples. Finally, osseointegration seems to occur only in the few millimeters around the periphery of the implants and does not extend in the center. This is explained by the absence of stress transmission within the very rigid metal cylinders, preventing bone modeling and remodeling.
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Affiliation(s)
- L Rony
- GEROM - Groupe Etudes Remodelage Osseux et bioMatériaux, LabCom NextBone, Univ-Angers, IRIS-IBS Institut de Biologie en Santé, 49933 Angers, France
| | - E Aguado
- GEROM - Groupe Etudes Remodelage Osseux et bioMatériaux, LabCom NextBone, Univ-Angers, IRIS-IBS Institut de Biologie en Santé, 49933 Angers, France; ONIRIS, Ecole Vétérinaire de Nantes, 44307 Nantes Cedex 3, France
| | - B Verlee
- SIRRIS Liège Science Park, Rue du bois St Jean 12, 4102 Seraing, Belgium
| | - F Pascaretti-Grizon
- GEROM - Groupe Etudes Remodelage Osseux et bioMatériaux, LabCom NextBone, Univ-Angers, IRIS-IBS Institut de Biologie en Santé, 49933 Angers, France
| | - D Chappard
- GEROM - Groupe Etudes Remodelage Osseux et bioMatériaux, LabCom NextBone, Univ-Angers, IRIS-IBS Institut de Biologie en Santé, 49933 Angers, France; SCIAM, Service Commun d'Imagerie et Analyses Microscopiques, IRIS-IBS Institut de Biologie en Santé, Univ-Angers, 49933 Angers Cedex, France.
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Fokter SK, Gubeljak N, Punzón-Quijorna E, Pelicon P, Kelemen M, Vavpetič P, Predan J, Ferlič L, Novak I. Total Knee Replacement with an Uncemented Porous Tantalum Tibia Component: A Failure Analysis. MATERIALS 2022; 15:ma15072575. [PMID: 35407908 PMCID: PMC8999729 DOI: 10.3390/ma15072575] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/22/2022] [Accepted: 03/30/2022] [Indexed: 11/16/2022]
Abstract
Porous tantalum has been extensively used in orthopaedic surgery, including uncemented total knee arthroplasty (TKA). Favourable results were reported with earlier monobloc tibial components and the design evolved to modular implants. We aimed to analyse possible causes for extensive medial tibia bone loss, resulting in modular porous tantalum tibia baseplate fracture after primary TKA. Retrieved tissue samples were scanned with 3 MeV focused proton beam for Proton-Induced X-ray Emission (micro-PIXE) elemental analysis. Fractographic and microstructural analysis were performed by stereomicroscopy. A full 3D finite-element model was made for numerical analysis of stress-strain conditions of the tibial baseplate. Histological examination of tissue underneath the broken part of the tibial baseplate revealed dark-stained metal debris, which was confirmed by micro-PIXE to consist of tantalum and titanium. Fractographic analysis and tensile testing showed that the failure of the tibial baseplate fulfilled the criteria of a typical fatigue fracture. Microstructural analysis of the contact surface revealed signs of bone ingrowth in 22.5% of the surface only and was even less pronounced in the medial half of the tibial baseplate. Further studies are needed to confirm the responsibility of metal debris for an increased bone absorption leading to catastrophic tibial tray failure.
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Affiliation(s)
- Samo K. Fokter
- Department of Orthopaedics, University Medical Centre Maribor, Ljubljanska 5, 2000 Maribor, Slovenia;
- Correspondence: ; Tel.: +386-41-772102
| | - Nenad Gubeljak
- Faculty of Mechanical Engineering, University of Maribor, Smetanova 17, 2000 Maribor, Slovenia; (N.G.); (J.P.); (L.F.)
| | - Esther Punzón-Quijorna
- Department of Low and Medium Energy Physics F2, Jožef Stefan Institute, Jamova 39, 1000 Ljubljana, Slovenia; (E.P.-Q.); (P.P.); (M.K.); (P.V.)
| | - Primož Pelicon
- Department of Low and Medium Energy Physics F2, Jožef Stefan Institute, Jamova 39, 1000 Ljubljana, Slovenia; (E.P.-Q.); (P.P.); (M.K.); (P.V.)
| | - Mitja Kelemen
- Department of Low and Medium Energy Physics F2, Jožef Stefan Institute, Jamova 39, 1000 Ljubljana, Slovenia; (E.P.-Q.); (P.P.); (M.K.); (P.V.)
| | - Primož Vavpetič
- Department of Low and Medium Energy Physics F2, Jožef Stefan Institute, Jamova 39, 1000 Ljubljana, Slovenia; (E.P.-Q.); (P.P.); (M.K.); (P.V.)
| | - Jožef Predan
- Faculty of Mechanical Engineering, University of Maribor, Smetanova 17, 2000 Maribor, Slovenia; (N.G.); (J.P.); (L.F.)
| | - Luka Ferlič
- Faculty of Mechanical Engineering, University of Maribor, Smetanova 17, 2000 Maribor, Slovenia; (N.G.); (J.P.); (L.F.)
| | - Igor Novak
- Department of Orthopaedics, University Medical Centre Maribor, Ljubljanska 5, 2000 Maribor, Slovenia;
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Rony L, Aguado E, Verlee B, Pascaretti-Grizon F, Chappard D. Microarchitecture of titanium cylinders obtained by additive manufacturing does not influence osseointegration in the sheep. Regen Biomater 2021; 8:rbab021. [PMID: 34188953 PMCID: PMC8226111 DOI: 10.1093/rb/rbab021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/19/2021] [Accepted: 04/25/2021] [Indexed: 12/15/2022] Open
Abstract
Large bone defects are a challenge for orthopedic surgery. Natural (bone grafts) and synthetic biomaterials have been proposed but several problems arise such as biomechanical resistance or viral/bacterial safety. The use of metallic foams could be a solution to improve mechanical resistance and promote osseointegration of large porous metal devices. Titanium cylinders have been prepared by additive manufacturing (3D printing/rapid prototyping) with a geometric or trabecular microarchitecture. They were implanted in the femoral condyles of aged ewes; the animals were left in stabling for 90 and 270 days. A double calcein labeling was done before sacrifice; bones were analyzed by histomorphometry. Neither bone volume, bone/titanium interface nor mineralization rate were influenced by the cylinder's microarchitecture; the morphometric parameters did not significantly increase over time. Bone anchoring occurred on the margins of the cylinders and some trabeculae extended in the core of the cylinders but the amount of bone inside the cylinders remained low. The rigid titanium cylinders preserved bone cells from strains in the core of the cylinders. Additive manufacturing is an interesting tool to prepare 3D metallic scaffolds, but microarchitecture does not seem as crucial as expected and anchoring seems limited to the first millimeters of the graft.
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Affiliation(s)
- Louis Rony
- GEROM-Groupe Etudes Remodelage Osseux et bioMatériaux, LabCom NextBone, Univ-Angers, IRIS-IBS Institut de Biologie en Santé, 49933 Angers, France
| | - Eric Aguado
- GEROM-Groupe Etudes Remodelage Osseux et bioMatériaux, LabCom NextBone, Univ-Angers, IRIS-IBS Institut de Biologie en Santé, 49933 Angers, France
| | - Bruno Verlee
- SIRRIS Liège Science Park, Rue du bois St Jean 12, Seraing 4102, Belgium
| | - Florence Pascaretti-Grizon
- GEROM-Groupe Etudes Remodelage Osseux et bioMatériaux, LabCom NextBone, Univ-Angers, IRIS-IBS Institut de Biologie en Santé, 49933 Angers, France
| | - Daniel Chappard
- GEROM-Groupe Etudes Remodelage Osseux et bioMatériaux, LabCom NextBone, Univ-Angers, IRIS-IBS Institut de Biologie en Santé, 49933 Angers, France
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Bencharit S, Morelli T, Barros S, Seagroves JT, Kim S, Yu N, Byrd K, Brenes C, Offenbacher S. Comparing Initial Wound Healing and Osteogenesis of Porous Tantalum Trabecular Metal and Titanium Alloy Materials. J ORAL IMPLANTOL 2019; 45:173-180. [PMID: 30663941 DOI: 10.1563/aaid-joi-d-17-00258] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Porous tantalum trabecular metal (PTTM) has long been used in orthopedics to enhance neovascularization, wound healing, and osteogenesis; recently, it has been incorporated into titanium alloy dental implants. However, little is known about the biological responses to PTTM in the human oral cavity. We have hypothesized that, compared with conventional titanium alloy, PTTM has a greater expression of genes specific to neovascularization, wound healing, and osteogenesis during the initial healing period. Twelve subjects requiring at least 4 implants in the mandible were enrolled. Four 3 × 5mm devices, including 2 titanium alloy tapered screws and 2 PTTM cylinders, were placed in the edentulous mandibular areas using a split-mouth design. One device in each group was trephined for analysis at 2 and 4 weeks after placement. RNA microarray analysis and ingenuity pathway analysis were used to analyze osteogenesis gene expression and relevant signaling pathways. Compared to titanium alloy, PTTM samples exhibited significantly higher expressions of genes specific to cell neovascularization, wound healing, and osteogenesis. Several genes-including bone morphogenic proteins, collagens, and growth factors-were upregulated in the PTTM group compared to the titanium alloy control. PTTM materials may enhance the initial healing of dental implants by modifying gene expression profiles.
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Affiliation(s)
- Sompop Bencharit
- 1 Departments of General Practice and Oral and Maxillofacial Surgery, School of Dentistry and Department of Biomedical Engineering, School of Engineering, Virginia Commonwealth University, Richmond, Va
| | - Thiago Morelli
- 2 Department of Periodontology, School of Dentistry, University of North Carolina, Chapel Hill, NC
| | - Silvana Barros
- 2 Department of Periodontology, School of Dentistry, University of North Carolina, Chapel Hill, NC
| | - Jackson T Seagroves
- 3 Department of Prosthodontics, School of Dentistry, University of North Carolina, Chapel Hill, NC
| | - Steven Kim
- 4 Curriculum in Oral Biology, School of Dentistry, University of North Carolina, Chapel Hill, NC
| | - Ning Yu
- 4 Curriculum in Oral Biology, School of Dentistry, University of North Carolina, Chapel Hill, NC
| | - Kevin Byrd
- 4 Curriculum in Oral Biology, School of Dentistry, University of North Carolina, Chapel Hill, NC
| | - Christian Brenes
- 5 Department of General Dentistry, Dental College of Georgia, Augusta University, Augusta, Ga
| | - Steven Offenbacher
- 2 Department of Periodontology, School of Dentistry, University of North Carolina, Chapel Hill, NC
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Kukreja MM, Swanson TV. Can tibial tantalum cones eventually eliminate the adjuvant use of metallic augments for AORI type 2B/3 metaphyseal defects??-A novel surgical technique and case series. Int J Surg Case Rep 2018; 53:200-206. [PMID: 30412920 PMCID: PMC6226596 DOI: 10.1016/j.ijscr.2018.09.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 09/17/2018] [Accepted: 09/18/2018] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND For extensive metaphyseal defects, the use of tantalum cones is usually combined with adjuvant stems which may be cemented/cementless and metallic bone augments for additional stability. A Tibial baseplate-Cone construct with proud tibial cones and without metallic augments has been described for AORI type 2B/3 tibial defects. METHODS A case series analysis of 6 patients with AORI type 3 defects treated with unstepped proud Tantalum tibial metaphyseal cones without metallic wedges/full width augments. A follow-up analysis done with clinico-radiographic interpretation. RESULTS 100% osteointegration noted in final radiographs of all patients at an average follow-up of 4.1 years. Preoperative average ROM/KSS of 75/49 improved to postoperative ROM/KSS of 104/79. Outcomes were interpreted as excellent in 50% of cases and good in the remaining 50%. CONCLUSION The "Tibial base plate-cone without augments (BCCA)"type of a construct may offer a valid long term advantage over the Tibial base plate-Augment-Cone combination in massive tibial bone defects. Simply building up the tantalum cone to the native joint line position by increasing cone height can exclude use of augments or wedges.
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Affiliation(s)
- Mohit M Kukreja
- Swanson Hip and Knee Center of Excellence and Research Institute Desert Orthopaedic Center, Las Vegas, NV, USA; Desert Orthopedic Center & Swanson Hip/Knee Research Foundation, 2800 E.Desert Inn, Suit 100, Las Vegas, NV, 89121, USA.
| | - Todd V Swanson
- Swanson Hip and Knee Center of Excellence and Research Institute Desert Orthopaedic Center, Las Vegas, NV, USA; Desert Orthopedic Center & Swanson Hip/Knee Research Foundation, 2800 E.Desert Inn, Suit 100, Las Vegas, NV, 89121, USA.
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Rolvien T, Barbeck M, Wenisch S, Amling M, Krause M. Cellular Mechanisms Responsible for Success and Failure of Bone Substitute Materials. Int J Mol Sci 2018; 19:E2893. [PMID: 30249051 PMCID: PMC6213546 DOI: 10.3390/ijms19102893] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 09/17/2018] [Accepted: 09/20/2018] [Indexed: 12/13/2022] Open
Abstract
Bone grafts, i.e., autologous, allogeneic or synthetic bone substitute materials play an increasing role in reconstructive orthopedic surgery. While the indications and materials differ, it is important to understand the cellular mechanisms regarding their integration and remodeling, which are discussed in this review article. Osteoconductivity describes the new bone growth on the graft, while osteoinductivity represents the differentiation of undifferentiated cells into bone forming osteoblasts. The best case is that both mechanisms are accompanied by osteogenesis, i.e., bone modeling and remodeling of the graft material. Graft incorporation is mediated by a number of molecular pathways that signal the differentiation and activity of osteoblasts and osteoclasts (e.g., parathyroid hormone (PTH) and receptor activator of nuclear factor κβ ligand (RANKL), respectively). Direct contact of the graft and host bone as well as the presence of a mechanical load are a prerequisite for the successful function of bone grafts. Interestingly, while bone substitutes show good to excellent clinical outcomes, their histological incorporation has certain limits that are not yet completely understood. For instance, clinical studies have shown contrasting results regarding the complete or incomplete resorption and remodeling of allografts and synthetic grafts. In this context, a foreign body response can lead to complete material degradation via phagocytosis, however it may also cause a fibrotic reaction to the bone substitute. Finally, the success of bone graft incorporation is also limited by other factors, including the bone remodeling capacities of the host, the material itself (e.g., inadequate resorption, toxicity) and the surgical technique or preparation of the graft.
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Affiliation(s)
- Tim Rolvien
- Department of Orthopedics, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
| | - Mike Barbeck
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
| | - Sabine Wenisch
- Institute of Veterinary Anatomy, Histology and Embryology, Justus Liebig University of Giessen, 35385 Giessen, Germany.
| | - Michael Amling
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, 22529 Hamburg, Germany.
| | - Matthias Krause
- Department of Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
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Wahl P, Sprecher CM, Brüning C, Meier C, Milz S, Gautier E, Fintan Moriarty T. Successful bony integration of a porous tantalum implant despite longlasting and ongoing infection: Histologic workup of an explanted shoulder prosthesis. J Biomed Mater Res B Appl Biomater 2018; 106:2924-2931. [PMID: 30199602 DOI: 10.1002/jbm.b.34174] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 01/25/2018] [Accepted: 05/13/2018] [Indexed: 01/30/2023]
Abstract
Infection associated with an implant is a complication feared in surgery, as it leads to loosening and dysfunction. This report documents an unexpected good bony integration of a porous tantalum shoulder prosthesis despite infection. A shoulder prosthesis with a porous tantalum glenoidal base plate was retrieved after 3 years of ongoing infection with Staphylococcus spp. Methyl-methacrylate embedded sections of the retrieved glenoidal component were analyzed by optical and scanning electron beam microscopy (SEM). Bone ongrowth and ingrowth were quantified. Bone had formed at the implant surface and within the open cell structure of the porous tantalum. The bone implant contact index was 32%. The bone ingrowth or relative bone area within the open structure was 8.2%, respectively 11.9% in the outer 50% of the thickness. Due to the section thickness, bone ongrowth could best be documented in SEM. Despite long-lasting and ongoing infection, the glenoidal base plate of the prosthesis showed good bony integration upon removal. The bone ingrowth into the porous tantalum was comparable to the values previously reported for the undersurface of retrieved proximal humerus resurfacing implants. Good integration of the implant however did not solve the problem of infection, and related morbidity. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 2924-2931, 2018.
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Affiliation(s)
- Peter Wahl
- Division of Orthopaedic and Trauma Surgery, Cantonal Hospital, Winterthur, Switzerland.,Department of Septic Surgery, BG Trauma Centre, Frankfurt, Germany
| | | | | | - Christoph Meier
- Division of Orthopaedic and Trauma Surgery, Cantonal Hospital, Winterthur, Switzerland
| | - Stefan Milz
- Institute of Anatomy, Ludwig-Maximilians-University, Munich, Germany
| | - Emanuel Gautier
- Department of Orthopaedic Surgery, HFR Fribourg-Cantonal Hospital, Fribourg, Switzerland
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Gebauer M, Gehrke T, Jakobs O. [The use of tantalum cones for reconstruction of bone defects in revision total knee arthroplasty]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2015; 27:17-23. [PMID: 25648256 DOI: 10.1007/s00064-014-0332-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 11/06/2014] [Accepted: 11/25/2014] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Revision arthroplasty of the knee is often associated with substantial femoral and/or tibial bone loss. Tantalum cones are used to reconstruct these defects and to improve initial stability. This requires an implantation in the "press-fit" technique with maximum contact to the host bone. INDICATIONS Tantalum cones may be used in grade 2-3 femoral and/or tibial defects according to the AORI (Anderson Orthopedic Research Institute) classification system. CONTRAINDICATIONS There are no contraindications described. SURGICAL TECHNIQUE After removal of the implant and cement remnants, bone defects have to be evaluated. A tantalum cone which adequately fills the bone defect is implanted using the "press-fit" technique. If necessary, saving resection of surplus bone to fit the cone properly. Gaps between the cone and the host bone are filled with cancellous bone in "impaction-bone-grafting" technique to increase the area of contact. Fitting the revision knee prosthesis and fixing with the use of bone cement. POSTOPERATIVE MANAGEMENT Postoperative physiotherapy is adjusted to the result of the reconstruction. In most cases with stable reconstruction, mobilization with full weight-bearing and the use of two crutches can be performed. Additional bone grafting may require a partial weight-bearing regimen for postoperative mobilization. Physiotherapy to improve range of motion is performed starting on postoperative day 1. RESULTS Several studies reported promising midterm results (observation period about 36 months) after implantation of tantalum cones in revision knee arthroplasty. There is consistent evidence for stable osteointegration of the cones. The main intraoperative complication is fracture of the host bone during impaction of the cones.
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Affiliation(s)
- M Gebauer
- Abteilung für Gelenkchirurgie, HELIOS ENDO-Klinik Hamburg, Holstenstr. 2, 22767, Hamburg, Deutschland,
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Liu Y, Bao C, Wismeijer D, Wu G. The physicochemical/biological properties of porous tantalum and the potential surface modification techniques to improve its clinical application in dental implantology. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2015; 49:323-329. [PMID: 25686956 DOI: 10.1016/j.msec.2015.01.007] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Revised: 12/11/2014] [Accepted: 01/04/2015] [Indexed: 02/05/2023]
Abstract
More rapid restoration and more rigid functionality have been pursued for decades in the field of dental implantology. Under such motivation, porous tantalum has been recently introduced to design a novel type of dental implant. Porous tantalum bears interconnected porous structure with pore size ranging from 300 to 600μm and a porosity of 75-85%. Its elastic modulus (1.3-10GPa) more closely approximates that of natural cortical (12-18GPa) and cancellous bone (0.1-0.5GPa) in comparison with the most commonly used dental materials, such as titanium and titanium alloy (106-115GPa). Porous tantalum is highly corrosion-resistant and biocompatible. It can significantly enhance the proliferation and differentiation of primary osteoblasts derived from elderly people than titanium. Porous tantalum can allow bone ingrowth and establish not only osseointegration but also osseoincorporation, which will significantly enhance the secondary stability of implants in bone tissue. In this review, we summarize the physicochemical, mechanical and biological properties of porous tantalum. We further discuss the performance of current tantalum dental implants and present the methodologies of surface modifications in order to improve their biological performance.
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Affiliation(s)
- Yindong Liu
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Chongyun Bao
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
| | - Daniel Wismeijer
- Department of Oral Implantology and Prosthetic Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), MOVE Research Institute Amsterdam, VU University Amsterdam and University of Amsterdam, Amsterdam, The Netherlands
| | - Gang Wu
- Department of Oral Implantology and Prosthetic Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), MOVE Research Institute Amsterdam, VU University Amsterdam and University of Amsterdam, Amsterdam, The Netherlands.
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Schmitz HCR, Klauser W, Citak M, Al-Khateeb H, Gehrke T, Kendoff D. Three-year follow up utilizing tantal cones in revision total knee arthroplasty. J Arthroplasty 2013; 28:1556-60. [PMID: 23664075 DOI: 10.1016/j.arth.2013.01.028] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 01/04/2013] [Accepted: 01/25/2013] [Indexed: 02/01/2023] Open
Abstract
There still is no consensus on the treatment of choice in revision knee arthroplasty associated with severe femoral and/or tibial bone loss. A total of 44 patients underwent revision knee arthroplasty procedures using porous tantalum cones (TM cones) to reconstruct tibial and/or femoral bone defects. At latest follow up after 37 months (32-48), 38 patients remained in the study. Tibial and femoral bone loss was categorized according to the AORI-Classification. The average preoperative KSS improved from 34 (range, 6-90) to 63 points (range, 7-90 points). The VAS improved from 7.5 to 4.8. Two patients required a re-revision due to aseptic loosening. There was no correlation between the different types of knee prosthesis implanted. Our study shows favourable clinical and radiological outcomes using TM cones in managing significant bone loss in revision total knee surgery.
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