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Huang H, Liu X, Wang J, Suo M, Zhang J, Sun T, Wang H, Liu C, Li Z. Strategies to improve the performance of polyetheretherketone (PEEK) as orthopedic implants: from surface modification to addition of bioactive materials. J Mater Chem B 2024; 12:4533-4552. [PMID: 38477504 DOI: 10.1039/d3tb02740f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
Polyetheretherketone (PEEK), as a high-performance polymer, is widely used for bone defect repair due to its homogeneous modulus of elasticity of human bone, good biocompatibility, excellent chemical stability and projectability. However, the highly hydrophobic surface of PEEK is biologically inert, which makes it difficult for cells and proteins to attach, and is accompanied by the development of infections that ultimately lead to failure of PEEK implants. In order to further enhance the potential of PEEK as an orthopedic implant, researchers have explored modification methods such as surface modification by physical and chemical means and the addition of bioactive substances to PEEK-based materials to enhance the mechanical properties, osteogenic activity and antimicrobial properties of PEEK. However, these current modification methods still have obvious shortcomings in terms of cost, maneuverability, stability and cytotoxicity, which still need to be explored by researchers. This paper reviews some of the modification methods that have been used to improve the performance of PEEK over the last three years in anticipation of the need for researchers to design PEEK orthopedic implants that better meet clinical needs.
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Affiliation(s)
- Huagui Huang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China.
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, People's Republic of China
- Division of Energy Materials (DNL22), Dalian Institute of Chemical Physics, Chinese Academy of Sciences, Dalian, China.
| | - Xin Liu
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China.
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, People's Republic of China
| | - Jinzuo Wang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China.
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, People's Republic of China
| | - Moran Suo
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China.
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, People's Republic of China
| | - Jing Zhang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China.
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, People's Republic of China
| | - Tianze Sun
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China.
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, People's Republic of China
| | - Honghua Wang
- Division of Energy Materials (DNL22), Dalian Institute of Chemical Physics, Chinese Academy of Sciences, Dalian, China.
| | - Chengde Liu
- Department of Polymer Science & Materials, Dalian University of Technology, Dalian, People's Republic of China.
| | - Zhonghai Li
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, People's Republic of China.
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, People's Republic of China
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Bai Z, Zhao Y, Cui C, Yan J, Qin D, Tong J, Peng H, Liu Y, Sun L, Wu X, Li B, Li X. Multifaceted Materials for Enhanced Osteogenesis and Antimicrobial Properties on Bioplastic Polyetheretherketone Surfaces: A Review. ACS OMEGA 2024; 9:17784-17807. [PMID: 38680314 PMCID: PMC11044237 DOI: 10.1021/acsomega.4c00923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/05/2024] [Accepted: 03/12/2024] [Indexed: 05/01/2024]
Abstract
Implant-associated infections and the increasing number of bone implants loosening and falling off after implantation have become urgent global challenges, hence the need for intelligent alternative solutions to combat implant loosening and falling off. The application of polyetheretherketone (PEEK) in biomedical and medical therapy has aroused great interest, especially because its elastic modulus close to bone provides an effective alternative to titanium implants, thereby preventing the possibility of bone implants loosening and falling off due to the mismatch of elastic modulus. In this Review, we provide a comprehensive overview of recent advances in surface modifications to prevent bone binding deficiency and bacterial infection after implantation of bone implants, starting with inorganics for surface modification, followed by organics that can effectively promote bone integration and antimicrobial action. In addition, surface modifications derived from cells and related products of biological activity have been proposed, and there is increasing evidence of clinical potential. Finally, the advantages and future challenges of surface strategies against medical associated poor osseointegration and infection are discussed, with promising prospects for developing novel osseointegration and antimicrobial PEEK materials.
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Affiliation(s)
- Ziyang Bai
- Shanxi
Medical University School and Hospital of Stomatology, Taiyuan, Shanxi 030001, China
- Shanxi
Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, Shanxi 030001, China
| | - Yifan Zhao
- Shanxi
Medical University School and Hospital of Stomatology, Taiyuan, Shanxi 030001, China
- Shanxi
Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, Shanxi 030001, China
| | - Chenying Cui
- Shanxi
Medical University School and Hospital of Stomatology, Taiyuan, Shanxi 030001, China
- Shanxi
Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, Shanxi 030001, China
| | - Jingyu Yan
- Shanxi
Medical University School and Hospital of Stomatology, Taiyuan, Shanxi 030001, China
- Shanxi
Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, Shanxi 030001, China
| | - Danlei Qin
- Shanxi
Medical University School and Hospital of Stomatology, Taiyuan, Shanxi 030001, China
- Shanxi
Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, Shanxi 030001, China
| | - Jiahui Tong
- Shanxi
Medical University School and Hospital of Stomatology, Taiyuan, Shanxi 030001, China
- Shanxi
Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, Shanxi 030001, China
| | - Hongyi Peng
- Shanxi
Medical University School and Hospital of Stomatology, Taiyuan, Shanxi 030001, China
- Shanxi
Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, Shanxi 030001, China
| | - Yingyu Liu
- Shanxi
Medical University School and Hospital of Stomatology, Taiyuan, Shanxi 030001, China
- Shanxi
Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, Shanxi 030001, China
| | - Lingxiang Sun
- Shanxi
Medical University School and Hospital of Stomatology, Taiyuan, Shanxi 030001, China
- Shanxi
Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, Shanxi 030001, China
| | - Xiuping Wu
- Shanxi
Medical University School and Hospital of Stomatology, Taiyuan, Shanxi 030001, China
- Shanxi
Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, Shanxi 030001, China
| | - Bing Li
- Shanxi
Medical University School and Hospital of Stomatology, Taiyuan, Shanxi 030001, China
- Shanxi
Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, Shanxi 030001, China
| | - Xia Li
- Shanxi
Medical University School and Hospital of Stomatology, Taiyuan, Shanxi 030001, China
- Shanxi
Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, Shanxi 030001, China
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Su YH, Wu PK, Wu MH, Wong KW, Li WW, Chou SH. Comparison of the Radiographic and Clinical Outcomes Between Expandable Cage and Static Cage for Transforaminal Lumbar Interbody Fusion: A Systematic Review and Meta-Analysis. World Neurosurg 2023; 179:133-142. [PMID: 37579991 DOI: 10.1016/j.wneu.2023.08.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 08/06/2023] [Accepted: 08/07/2023] [Indexed: 08/16/2023]
Affiliation(s)
- Yu-Hsiang Su
- Department of Education, China Medical University Hospital, Taichung, Taiwan
| | - Po-Kuan Wu
- Department of Orthopaedics, Chi Mei Medical Center, Tainan, Taiwan
| | - Meng-Huang Wu
- Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; TMU Biodesign Center, Taipei Medical University, Taipei, Taiwan; Department of Orthopaedics, Taipei Medical University Hospital, Taipei, Taiwan
| | - Kin-Weng Wong
- Department of Orthopaedics, Chi Mei Medical Center, Tainan, Taiwan; Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Wen-Wei Li
- Department of Orthopaedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Shih-Hsiang Chou
- Department of Orthopaedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Departments of Orthopedics, School of Post-Baccalaureate Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Orthopaedic Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Liao TY, King PC, Zhu D, Crawford RJ, Ivanova EP, Thissen H, Kingshott P. Surface Characteristics and Bone Biocompatibility of Cold-Sprayed Porous Titanium on Polydimethylsiloxane Substrates. ACS Biomater Sci Eng 2023; 9:1402-1421. [PMID: 36813258 DOI: 10.1021/acsbiomaterials.2c01506] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
A variant of the cold spray (CS) technique was applied for the functionalization of polymer-based materials such as polydimethylsiloxane (PDMS) to improve the extent of mammalian cell interactions with these substrates. This was demonstrated by the embedment of porous titanium (pTi) into PDMS substrates using a single-step CS technique. CS processing parameters such as gas pressure and temperature were optimized to achieve the mechanical interlocking of pTi in the compressed PDMS to fabricate a unique hierarchical morphology possessing micro-roughness. As evidenced by the preserved porous structure, the pTi particles did not undergo any significant plastic deformation upon impact with the polymer substrate. The thickness of the particle embedment layer was determined, by cross-sectional analysis, ranging from 120 μm to over 200 μm. The behavior of osteoblast-like cells MG63 coming into contact with the pTi-embedded PDMS was examined. The results showed that the pTi-embedded PDMS samples promoted 80-96% of cell adhesion and proliferation during the early stages of incubation. The low cytotoxicity of the pTi-embedded PDMS was confirmed, with cell viability of the MG63 cells being above 90%. Furthermore, the pTi-embedded PDMS facilitated the production of alkaline phosphatase and calcium deposition in the MG63 cells, as demonstrated by the higher amount of alkaline phosphatase (2.6 times) and calcium (10.6 times) on the pTi-embedded PDMS sample fabricated at 250 °C, 3 MPa. Overall, the work demonstrated that the CS process provided flexibility in the parameters used for the production of the modified PDMS substrates and is highly efficient for the fabrication of coated polymer products. The results obtained in this study suggest that a tailorable porous and rough architecture could be achieved that promoted osteoblast function, indicating that the method has promise in the design of titanium-polymer composite materials applied to biomaterials used in musculoskeletal applications.
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Affiliation(s)
- Tzu-Ying Liao
- School of Science, Computing & Engineering Technologies, Swinburne University of Technology, Hawthorn, Victoria 3122, Australia
- Australian Research Council (ARC) Training Centre in Surface Engineering for Advanced Materials (SEAM), Swinburne University of Technology, Hawthorn, Victoria 3122, Australia
- CSIRO Manufacturing, Clayton, Victoria 3168, Australia
| | - Peter C King
- Australian Research Council (ARC) Training Centre in Surface Engineering for Advanced Materials (SEAM), Swinburne University of Technology, Hawthorn, Victoria 3122, Australia
- CSIRO Manufacturing, Clayton, Victoria 3168, Australia
| | - Deming Zhu
- School of Science, Computing & Engineering Technologies, Swinburne University of Technology, Hawthorn, Victoria 3122, Australia
| | - Russell J Crawford
- Australian Research Council (ARC) Training Centre in Surface Engineering for Advanced Materials (SEAM), Swinburne University of Technology, Hawthorn, Victoria 3122, Australia
- College of STEM, School of Science, RMIT University, Melbourne, Victoria 3000, Australia
| | - Elena P Ivanova
- Australian Research Council (ARC) Training Centre in Surface Engineering for Advanced Materials (SEAM), Swinburne University of Technology, Hawthorn, Victoria 3122, Australia
- College of STEM, School of Science, RMIT University, Melbourne, Victoria 3000, Australia
| | - Helmut Thissen
- Australian Research Council (ARC) Training Centre in Surface Engineering for Advanced Materials (SEAM), Swinburne University of Technology, Hawthorn, Victoria 3122, Australia
- CSIRO Manufacturing, Clayton, Victoria 3168, Australia
| | - Peter Kingshott
- School of Science, Computing & Engineering Technologies, Swinburne University of Technology, Hawthorn, Victoria 3122, Australia
- Australian Research Council (ARC) Training Centre in Surface Engineering for Advanced Materials (SEAM), Swinburne University of Technology, Hawthorn, Victoria 3122, Australia
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Surface Treatments of PEEK for Osseointegration to Bone. Biomolecules 2023; 13:biom13030464. [PMID: 36979399 PMCID: PMC10046336 DOI: 10.3390/biom13030464] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/24/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
Polymers, in general, and Poly (Ether-Ether-Ketone) (PEEK) have emerged as potential alternatives to conventional osseous implant biomaterials. Due to its distinct advantages over metallic implants, PEEK has been gaining increasing attention as a prime candidate for orthopaedic and dental implants. However, PEEK has a highly hydrophobic and bioinert surface that attenuates the differentiation and proliferation of osteoblasts and leads to implant failure. Several improvements have been made to the osseointegration potential of PEEK, which can be classified into three main categories: (1) surface functionalization with bioactive agents by physical or chemical means; (2) incorporation of bioactive materials either as surface coatings or as composites; and (3) construction of three-dimensionally porous structures on its surfaces. The physical treatments, such as plasma treatments of various elements, accelerated neutron beams, or conventional techniques like sandblasting and laser or ultraviolet radiation, change the micro-geometry of the implant surface. The chemical treatments change the surface composition of PEEK and should be titrated at the time of exposure. The implant surface can be incorporated with a bioactive material that should be selected following the desired use, loading condition, and antimicrobial load around the implant. For optimal results, a combination of the methods above is utilized to compensate for the limitations of individual methods. This review summarizes these methods and their combinations for optimizing the surface of PEEK for utilization as an implanted biomaterial.
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Cai Z, Qu X, Zhao Y, Yuan Z, Zheng L, Long T, Yao Q, Yue B, Wang Y. Preliminary Study on Immediate Postoperative CT Images and Values of the Modular Polyetheretherketone Based Total Knee Arthroplasty: An Observational First-in-Human Trial. Front Surg 2022; 9:809699. [PMID: 35237649 PMCID: PMC8882580 DOI: 10.3389/fsurg.2022.809699] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/24/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is now frequently performed and is highly successful. However, patient satisfaction after TKA is often difficult to achieve. Because of the presence of metallic prosthetic knee joints, there is a lack of imaging tools that can accurately assess the patient's postoperative prosthetic position, soft tissue impingement, and periprosthetic bone density after TKA. We conducted a clinical trial of the world's first totally modular polyetheretherketone (PEEK) TKA and determined the bone density values in the stress concentration area around the prosthesis based on postoperative computed tomography data to reconstruct a three-dimensional model of the PEEK prosthetic knee joint after implantation. Based on the model, the overhang of the prosthesis was measured at various locations on the prosthesis. METHODS All patients who underwent PEEK-based TKA were postoperatively assessed with radiography and computed tomography (CT). Hounsfield units (HUs) for the different components of the quantitative CT assessment were measured separately. RESULTS Ten patients (nine female and one male) aged 59-74 (mean 66.9, median 67) years were included. The HU values were as follows: PEEK prosthesis mean 182.95, standard deviation (SD) 4.90, coefficient of variation (CV) 2.68; polyethylene mean -89.41, SD 4.14, CV -4.63; lateral femoral osteochondral mean 192.19, SD 55.05, CV 28.64; lateral tibial osteochondral mean 122.94, SD 62.14, CV 42.86; medial femoral osteophyte mean 180.76, SD 43.48, CV 24.05; and medial tibial osteophyte mean 282.59, SD 69.28, CV 24.52. Analysis of the data at 1, 3, and 6 months showed that the mean PE (p = 0.598) and PEEK (p = 0.916) measurements did not change with the time of measurement. There was a decrease in bone mineral density in the lateral tibia at 3 months (p = 0.044). Otherwise, there was no significant change in bone density in other regions (p = 0.124-0.803). There was no overhang in all femoral prostheses, whereas there were two cases of overhang in tibial prostheses. Overhang measurements do not differ significantly across time points. The overhang measurements were not significantly different at all time points (p = 0.186-0.967). CONCLUSION PEEK knee joint prosthesis has excellent CT compatibility. The change in periprosthetic bone volume during the follow-up period can be determined using the HU value after CT scan, while the prosthesis position can be assessed. This assessment may potentially guide future improvements in knee prosthesis alignment techniques and artificial knee prosthesis designs.
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Affiliation(s)
- Zhengyu Cai
- Department of Bone and Joint Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Department of Orthopedics, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xinhua Qu
- Department of Bone and Joint Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Department of Orthopedics, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yaochao Zhao
- Department of Bone and Joint Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Department of Orthopedics, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhiguo Yuan
- Department of Bone and Joint Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Department of Orthopedics, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Liangjun Zheng
- Department of Bone and Joint Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Department of Orthopedics, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Teng Long
- Department of Bone and Joint Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Department of Orthopedics, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qiuying Yao
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Bing Yue
- Department of Bone and Joint Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Department of Orthopedics, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - You Wang
- Department of Bone and Joint Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Department of Orthopedics, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Zhu C, He M, Mao L, Yang H, Hu B, Zhang L, Feng G, Liu L, Song Y. Titanium interlayer-mediated hydroxyapatite-coated polyetheretherketone cage in transforaminal lumbar interbody fusion surgery. BMC Musculoskelet Disord 2021; 22:918. [PMID: 34724952 PMCID: PMC8561990 DOI: 10.1186/s12891-021-04803-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 10/19/2021] [Indexed: 02/08/2023] Open
Abstract
Background The variance in clinical responses to polyetheretherketone (PEEK) cages with titanium (Ti) and hydroxyapatite (HA) coatings (PEEK-Ti-HA cages) is still not clear. In this study, we aimed to evaluate the radiographic and clinical outcomes of patients undergoing TLIF using PEEK-Ti-HA cages with a particular focus on fusion rate. Methods A prospective and nonrandomized study was conducted to compare the outcomes of PEEK-Ti-HA cages (group A, n = 32) and uncoated PEEK cages (group B, n = 32). The follow up time was at least 2 years. The radiographic assessments included the regional lordosis (RL), disc height (DH), and fusion rate. The clinical indexes included the Japanese Orthopedic Association (JOA) scores and visual analog scale (VAS) scores (back and leg). Results No significant differences were found in the pre- and postoperative RL and DH between Group A and Group B. And RL and DH, even if there were any variance initially, were restored not long after surgery in both groups. Though Group A had a significantly higher fusion rate than group B at 3 months post-surgery (93.7% vs. 75.0%), the fusion rates for the two groups reached the same level (100%) when it comes to the final follow-up. Additionally, differences of VAS and JOA scores for the two groups in general approximate. Conclusions PEEK-Ti-HA cages, in contrast with uncoated PEEK cages, produced a better fusion rate at 3 months after single-level TLIF. The fusion rates of both groups could get 100% at the final follow-up. PEEK-Ti-HA cages could achieve similar RL, DH, JOA scores and VAS scores in comparison with uncoated PEEK cages post-surgery.
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Affiliation(s)
- Ce Zhu
- Department of Orthopedics Surgery and Orthopedics Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, China.,Department of Spine Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Miaomiao He
- Analytical & Testing Center, Sichuan University, Chengdu, China
| | - Lili Mao
- Department of Ultrasound, Hospital of Traditional Chinese Medicine Affiliated to Southwest Medical University, Luzhou, China
| | - Huiliang Yang
- Department of Orthopedics Surgery and Orthopedics Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, China
| | - Bowen Hu
- Department of Orthopedics Surgery and Orthopedics Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, China
| | - Li Zhang
- Analytical & Testing Center, Sichuan University, Chengdu, China
| | - Ganjun Feng
- Department of Orthopedics Surgery and Orthopedics Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, China
| | - Limin Liu
- Department of Orthopedics Surgery and Orthopedics Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, China.
| | - Yueming Song
- Department of Orthopedics Surgery and Orthopedics Research Institute, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, Sichuan, China.
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