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Wang X, Zhou K, Li Y, Xie H, Wang B. Preparation, modification, and clinical application of porous tantalum scaffolds. Front Bioeng Biotechnol 2023; 11:1127939. [PMID: 37082213 PMCID: PMC10110962 DOI: 10.3389/fbioe.2023.1127939] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/22/2023] [Indexed: 04/07/2023] Open
Abstract
Porous tantalum (Ta) implants have been developed and clinically applied as high-quality implant biomaterials in the orthopedics field because of their excellent corrosion resistance, biocompatibility, osteointegration, and bone conductivity. Porous Ta allows fine bone ingrowth and new bone formation through the inner space because of its high porosity and interconnected pore structure. It contributes to rapid bone integration and long-term stability of osseointegrated implants. Porous Ta has excellent wetting properties and high surface energy, which facilitate the adhesion, proliferation, and mineralization of osteoblasts. Moreover, porous Ta is superior to classical metallic materials in avoiding the stress shielding effect, minimizing the loss of marginal bone, and improving primary stability because of its low elastic modulus and high friction coefficient. Accordingly, the excellent biological and mechanical properties of porous Ta are primarily responsible for its rising clinical translation trend. Over the past 2 decades, advanced fabrication strategies such as emerging manufacturing technologies, surface modification techniques, and patient-oriented designs have remarkably influenced the microstructural characteristic, bioactive performance, and clinical indications of porous Ta scaffolds. The present review offers an overview of the fabrication methods, modification techniques, and orthopedic applications of porous Ta implants.
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Affiliation(s)
| | | | | | - Hui Xie
- *Correspondence: Hui Xie, ; Benjie Wang,
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HENRICSON A, UNDÉN A, CARLSSON Å, JEHPSSON L, ROSENGREN B. Outcomes of trabecular metal total ankle replacement: a longitudinal observational cohort study of 239 consecutive cases from the Swedish Ankle Registry. Acta Orthop 2022; 93:689-695. [PMID: 35919022 PMCID: PMC9348131 DOI: 10.2340/17453674.2022.4387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Information on outcomes after some modern total ankle replacement (TAR) designs is scarce. We therefore examined outcomes after trabecular metal (TM) TAR in Sweden by use of data from the national registry. PATIENTS AND METHODS On December 31, 2020, 239 primary TM TARs had been reported to the Swedish Ankle Registry. We analyzed prosthesis survival probability, using exchange or permanent extraction of components as endpoint for 239 protheses with mean follow-up of 2.2 years (0.1-6.6), risk of revision, as well as patient-reported outcome measures (SEFAS/EQ-5D/EQ-VAS) and satisfaction with surgery. RESULTS 7/239 prostheses (3%) had been revised by December 31, 2020. We found an overall prosthesis survival probability of 95% (95% CI 89-98) after 3 years. 2 years after surgery 81% of the answering patients were satisfied or very satisfied with surgery and patients reported median SEFAS 36 (max 48), EQ-5D 0.90 (max 1), and EQ-VAS 80 (max 100). INTERPRETATION We found short- to mid-term outcomes after TM TAR to be at least as good as after other TAR designs regarding prosthesis survival and patient-reported satisfaction.
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Affiliation(s)
- Anders HENRICSON
- Department of Orthopedics, Falu Central Hospital and Center of Clinical Research Dalecarlia, Falun
| | - Alexandra UNDÉN
- Department of Radiology, Skåne University Hospital, Malmö,Department of Clinical Sciences Malmö (IKVM), Lund University
| | - Åke CARLSSON
- Department of Clinical Sciences Malmö (IKVM), Lund University,Department of Orthopedics, Skåne University Hospital, Malmö, Sweden
| | - Lars JEHPSSON
- Department of Clinical Sciences Malmö (IKVM), Lund University,Department of Orthopedics, Skåne University Hospital, Malmö, Sweden
| | - Björn ROSENGREN
- Department of Clinical Sciences Malmö (IKVM), Lund University,Department of Orthopedics, Skåne University Hospital, Malmö, Sweden
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Komnos G, Banios K, Kolonia K, Poultsides LA, Petinaki E, Sarrou S, Zintzaras E, Karachalios T. Do trabecular metal and cancellous titanium implants reduce the risk of late haematogenous infection? An experimental study in rabbits. Hip Int 2021; 31:766-773. [PMID: 32460572 DOI: 10.1177/1120700020928891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
AIM This study evaluated the late resistance to haematogenous contamination by microbial pathogens of implants and bone-implant interface and the development of late clinical infection when cementless components with different surface or structural properties are implanted. MATERIAL AND METHODS 50 adult male New Zealand white rabbits were divided into 5 groups of 10 animals each. In Group A smooth titanium, in Group B grit blasted titanium, in Group C HA-coated titanium, in Group D trabecular metal and in group E cancellous titanium rods were implanted in the right proximal tibia. Four weeks later, 1 ml of inoculum of a standardised CA-MRSA strain (3 × 108 cfu/ml) was injected through a femoral artery catheter (groups B, C, D, E) while in group A, 1 ml of sterile saline was injected in a similar way (control group). Subjects were killed 8 weeks after the initial procedure and 3 samples of each tibial specimen were subjected to conventional cultures and PCR studies. RESULTS The number of the specimens (conventional cultures and PCR studies) contaminated by the standardized pathogen was as follows: Group A: 0/10, Group B: 7/10, Group C: 6/10, Group D; 5/10 and Group E: 5/10. Comparing the number of colony form units isolated from the implant samples, Group B (GB titanium) showed statistically significantly higher values (Mann-Whitney test) compared to Group C (p = 0.044), Group D (p = 0.040) and Group E (p = 0.038). Local active infection was observed in 6 animals: 3 in Group B; 1 in Group C, 1 in Group D, and 1 in Group E. CONCLUSIONS Modern cementless implants (trabecular metal and cancellous titanium) showed a lower risk of implant contamination and late clinical haematogenous infection.
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Affiliation(s)
- George Komnos
- Orthopaedic Department, School of Health Sciences, Faculty of Medicine of University of Thessalia, University General Hospital, Larissa, Greece
| | - Konstantinos Banios
- Orthopaedic Department, School of Health Sciences, Faculty of Medicine of University of Thessalia, University General Hospital, Larissa, Greece
| | | | | | - Efthimia Petinaki
- Microbiology Department, School of Health Sciences, Faculty of Medicine of University of Thessalia, University General Hospital, Larissa, Greece
| | - Styliani Sarrou
- Microbiology Department, School of Health Sciences, Faculty of Medicine of University of Thessalia, University General Hospital, Larissa, Greece
| | - Elias Zintzaras
- Department of Biostatistics and Clinical Bioinformatics, School of Health Sciences, Faculty of Medicine of University of Thessalia, University General Hospital, Larissa, Greece
| | - Theofilos Karachalios
- Orthopaedic Department, School of Health Sciences, Faculty of Medicine of University of Thessalia, University General Hospital, Larissa, Greece
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Huang G, Pan ST, Qiu JX. The Clinical Application of Porous Tantalum and Its New Development for Bone Tissue Engineering. MATERIALS (BASEL, SWITZERLAND) 2021; 14:2647. [PMID: 34070153 PMCID: PMC8158527 DOI: 10.3390/ma14102647] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/06/2021] [Accepted: 05/13/2021] [Indexed: 12/13/2022]
Abstract
Porous tantalum (Ta) is a promising biomaterial and has been applied in orthopedics and dentistry for nearly two decades. The high porosity and interconnected pore structure of porous Ta promise fine bone ingrowth and new bone formation within the inner space, which further guarantee rapid osteointegration and bone-implant stability in the long term. Porous Ta has high wettability and surface energy that can facilitate adherence, proliferation and mineralization of osteoblasts. Meanwhile, the low elastic modulus and high friction coefficient of porous Ta allow it to effectively avoid the stress shield effect, minimize marginal bone loss and ensure primary stability. Accordingly, the satisfactory clinical application of porous Ta-based implants or prostheses is mainly derived from its excellent biological and mechanical properties. With the advent of additive manufacturing, personalized porous Ta-based implants or prostheses have shown their clinical value in the treatment of individual patients who need specially designed implants or prosthesis. In addition, many modification methods have been introduced to enhance the bioactivity and antibacterial property of porous Ta with promising in vitro and in vivo research results. In any case, choosing suitable patients is of great importance to guarantee surgical success after porous Ta insertion.
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Affiliation(s)
| | | | - Jia-Xuan Qiu
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China; (G.H.); (S.-T.P.)
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Merle C, Innmann MM, Westhauser F, Sadoghi P, Renkawitz T. [What are the benefits of patient-specific reconstruction in total hip replacement?]. DER ORTHOPADE 2021; 50:287-295. [PMID: 33751196 DOI: 10.1007/s00132-021-04087-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/04/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND The success of primary total hip replacement (THR) is predominately determined by the primary stability of the implant and the restoration of the patient-specific joint biomechanics. The three-dimensional (patho-) anatomy, size, geometry, and shape of the acetabulum and proximal femur is highly variable in patients with advanced hip osteoarthritis. Accurate preoperative planning is an essential prerequisite for all replacement procedures. CURRENT SITUATION Current data demonstrates clinical advantages for patient-specific reconstruction of functional joint geometry via surrogate parameters (offset and leg length). Frequently cited "target zones" for the positioning and orientation of the cup are increasingly in the focus of scientific discussion, as individually adjusted target zones for implant positioning allow for a potential reduction of impingement risk. Patients with spinal fusions or pathologic spinopelvic alignment require that particular attention be paid to patient-specific preoperative preparation, the surgical technique, and implant selection in order to reduce the risk of postoperative instability.
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Affiliation(s)
- Christian Merle
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland.
| | - Moritz M Innmann
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - Fabian Westhauser
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - Patrick Sadoghi
- Universitätsklinik für Orthopädie und Traumatologie, Medizinische Universität Graz, Graz, Österreich
| | - Tobias Renkawitz
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
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Brodie EG, Robinson KJ, Sigston E, Molotnikov A, Frith JE. Osteogenic Potential of Additively Manufactured TiTa Alloys. ACS APPLIED BIO MATERIALS 2021. [DOI: 10.1021/acsabm.0c01450] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Erin G. Brodie
- Department of Materials Science and Engineering, Monash University, Clayton, Victoria 3800, Australia
- Monash Centre for Additive Manufacturing (MCAM), 11 Normanby Road, Nottinghill, Victoria 3168, Australia
| | - Kye J. Robinson
- Department of Inorganic and Analytical Chemistry, University of Geneva, Quai Ernest-Ansermet 30, CH-1211 Geneva, Switzerland
| | - Elizabeth Sigston
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria 3800, Australia
- Department of Otolaryngology, Head and Neck Surgery, Monash Health, Clayton, Victoria 3168, Australia
| | - Andrey Molotnikov
- Department of Materials Science and Engineering, Monash University, Clayton, Victoria 3800, Australia
- Monash Centre for Additive Manufacturing (MCAM), 11 Normanby Road, Nottinghill, Victoria 3168, Australia
- RMIT Centre for Additive Manufacturing, School of Engineering, RMIT University, 3001 Melbourne, Australia
| | - Jessica E. Frith
- Department of Materials Science and Engineering, Monash University, Clayton, Victoria 3800, Australia
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Wojtowicz R, Henricson A, Nilsson KG, Crnalic S. Uncemented monoblock trabecular metal posterior stabilized high-flex total knee arthroplasty: similar pattern of migration to the cruciate-retaining design - a prospective radiostereometric analysis (RSA) and clinical evaluation of 40 patients (49 knees) 60 years or younger with 9 years' follow-up. Acta Orthop 2019; 90:460-466. [PMID: 31210081 PMCID: PMC6746276 DOI: 10.1080/17453674.2019.1626097] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Uncemented monoblock cruciate retaining (CR) trabecular metal (TM) tibial components in total knee arthroplasty (TKA) work well in the long-term perspective in patients ≤ 60 years. Younger persons expect nearly normal knee flexion after TKA, but CR implants generally achieve less knee flexion compared with posterior stabilized (PS) implants. Cemented PS implants have higher revision rate than CR implants. Can an uncemented monoblock PS TM implant be used safely in younger patients? Patients and methods - 40 patients (49 knees) age ≤ 60 years with primary (20 knees) or posttraumatic osteoarthritis (OA) were operated with a high-flex TKA using an uncemented monoblock PS TM tibial component. Knees were evaluated with radiostereometric analysis (RSA) a mean 3 days (1-5) postoperatively, and thereafter at 6 weeks, 3 months, 1, 2, 5, and 9 years. Clinical outcome was measured with patient-related outcome measures (PROMs). Results - The implants showed a pattern of migration with initial large migration followed by early stabilization lasting up to 9 years, a pattern known to be compatible with good long-term results. Clinical and radiological outcome was excellent with 38 of the 40 patients being satisfied or very satisfied with the procedure and bone apposition to the entire implant surface in 46 of 49 knees. Mean knee flexion was 130°. 1 knee was revised at 3 months due to medial tibial condyle collapse. Interpretation - The uncemented monoblock PS TM implant works well in younger persons operated with TKA due to primary or secondary OA.
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Affiliation(s)
- Radoslaw Wojtowicz
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden;
| | | | - Kjell G Nilsson
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden; ,Correspondence:
| | - Sead Crnalic
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden;
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Coating of Sandblasted and Acid-Etched Dental Implants With Tantalum Using Vacuum Plasma Spraying. IMPLANT DENT 2018; 27:202-208. [PMID: 29394178 DOI: 10.1097/id.0000000000000727] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE The objective was to prepare tantalum (Ta)-coated sandblasted and acid-etched (SLA) dental implants using vacuum plasma spraying (VPS) and to analyze their morphologies. MATERIALS AND METHODS Twelve SLA implants were coated with Ta using VPS. The topographies of the coatings and Ta/SLA surface interfaces were examined using scanning electron microscopy. The thickness at 4 locations for 6 Ta-coated and 6 uncoated SLA implants and pore sizes of the neck, central, and root areas of Ta-coated implants were measured. SPSS v20.0 was used for statistical analysis. RESULTS The Ta coatings were rough and consisted of pitted structures with various pore sizes; no cracks were observed. The Ta/SLA surface interface was tightly bonded. The 95% confidence interval of the Ta coating thickness was (114.0759, 129.3574). The maximal pore diameter was concentrated at 200 to 400 nm. CONCLUSION SLA dental implants were successfully coated with Ta using VPS. The nanoporous structure of these implants may facilitate osseointegration compared with uncoated SLA implants.
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Mutsuzaki H, Watanabe A, Kinugasa T, Ikeda K. Radiolucent lines are decreased at 3 years following total knee arthroplasty using trabecular metal tibial components. J Int Med Res 2018; 46:1919-1927. [PMID: 29557268 PMCID: PMC5991252 DOI: 10.1177/0300060518757927] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To analyse location and frequency, and change over time, of radiolucent lines (RLLs) around trabecular metal tibial components in total knee arthroplasty (TKA). Methods Osteoarthritic knees in patients who had undergone TKA were retrospectively evaluated via analysis of RLLs on anteroposterior and lateral X-rays obtained at 2 and 6 months, and 1, 2 and 3 years following TKA. Results In 125 osteoarthritic knees from 90 patients (mean age, 75.0 ± 6.2; 21 male/69 female), frequency of RLLs around trabecular metal tibial components was generally highest at 2 and 6 months, and 1 year following TKA, then gradually decreased over the 3-year follow-up. Frequency of RLLs around trabecular metal tibial components was greater at the tip of the two pegs, particularly the medial peg, and around the pegs, versus other zones. No postoperative revisions were performed for loosening. Conclusions Over 3 years following TKA, RLLs were most frequently observed up to 1 year, then gradually decreased. RLLs were significantly more frequent in the medial peg zone and zones close to the medial peg than in other zones.
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Affiliation(s)
- Hirotaka Mutsuzaki
- 1 Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences, Ami, Inashiki, Ibaraki, Japan.,2 Department of Orthopaedic Surgery, Ichihara Hospital, Ozone, Tsukuba, Ibaraki, Japan
| | - Arata Watanabe
- 2 Department of Orthopaedic Surgery, Ichihara Hospital, Ozone, Tsukuba, Ibaraki, Japan
| | - Tomonori Kinugasa
- 2 Department of Orthopaedic Surgery, Ichihara Hospital, Ozone, Tsukuba, Ibaraki, Japan
| | - Kotaro Ikeda
- 2 Department of Orthopaedic Surgery, Ichihara Hospital, Ozone, Tsukuba, Ibaraki, Japan
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Abstract
Background and purpose - Total knee replacement (TKR) in younger patients using cemented components has shown inferior results, mainly due to aseptic loosening. Excellent clinical results have been reported with components made of trabecular metal (TM). In a previous report, we have shown stabilization of the TM tibial implants for up to 5 years. In this study, we compared the clinical and RSA results of these uncemented implants with those of cemented implants. Patients and methods - 41 patients (47 knees) aged ≤ 60 years underwent TKR. 22 patients (26 knees) received an uncemented monoblock cruciate-retaining (CR) tibial component (TM) and 19 patients (21 knees) received a cemented NexGen Option CR tibial component. Follow-up examination was done at 10 years, and 16 patients (19 knees) with TM tibial components and 17 patients (18 knees) with cemented tibial components remained for analysis. Results - 1 of 19 TM implants was revised for infection, 2 of 18 cemented components were revised for knee instability, and no revisions were done for loosening. Both types of tibial components migrated in the first 3 months, the TM group to a greater extent than the cemented group. After 3 months, both groups were stable during the next 10 years. Interpretation - The patterns of migration for uncemented TM implants and cemented tibial implants over the first 10 years indicate that they have a good long-term prognosis regarding fixation.
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Affiliation(s)
- Anders Henricson
- Department of Orthopaedics and Center for Clinical Research, Falu General Hospital, Falun;,Correspondence:
| | - Kjell G Nilsson
- Institution of Surgical and Perioperative Sciences, Department of Orthopaedics, Umeå University, Umeå, Sweden
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Hanzlik JA, Day JS, Rimnac CM, Kurtz SM. Is There A Difference in Bone Ingrowth in Modular Versus Monoblock Porous Tantalum Tibial Trays? J Arthroplasty 2015; 30:1073-8. [PMID: 25743106 PMCID: PMC4469529 DOI: 10.1016/j.arth.2015.01.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 12/10/2014] [Accepted: 01/11/2015] [Indexed: 02/01/2023] Open
Abstract
Contemporary total knee designs incorporating highly porous metallic surfaces have demonstrated promising clinical outcomes. However, stiffness differences between modular and monoblock porous tantalum tibial trays may affect bone ingrowth. This study investigated effect of implant design, spatial location and clinical factors on bone ingrowth. Three modular and twenty-one monoblock retrieved porous tantalum tibial trays were evaluated for bone ingrowth. Nonparametric statistical tests were used to investigate differences in bone ingrowth by implant design, tray spatial location, substrate depth and clinical factors. Modular trays (5.3 ± 3.2%) exhibited higher bone ingrowth than monoblock trays (1.6 ± 1.9%, P = 0.032). Bone ingrowth in both designs was highest in the initial 500 μm from the surface. Implantation time was positively correlated with bone ingrowth for monoblock trays.
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Affiliation(s)
- Josa A. Hanzlik
- Implant Research Center, Drexel University, 3401 Market Street. Suite 345, Philadelphia, PA 19104
| | - Judd S. Day
- Implant Research Center, Drexel University, 3401 Market Street. Suite 345, Philadelphia, PA 19104,Exponent, Inc., 3401 Market Street, Philadelphia, PA 19104
| | - Clare M. Rimnac
- Othopaedic Retrieval Analysis Laboratory, Case Western Reserve University, Cleveland, OH
| | - Steven M. Kurtz
- Implant Research Center, Drexel University, 3401 Market Street. Suite 345, Philadelphia, PA 19104,Exponent, Inc., 3401 Market Street, Philadelphia, PA 19104
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Lewallen EA, Riester SM, Bonin CA, Kremers HM, Dudakovic A, Kakar S, Cohen RC, Westendorf JJ, Lewallen DG, van Wijnen AJ. Biological strategies for improved osseointegration and osteoinduction of porous metal orthopedic implants. TISSUE ENGINEERING PART B-REVIEWS 2014; 21:218-30. [PMID: 25348836 DOI: 10.1089/ten.teb.2014.0333] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The biological interface between an orthopedic implant and the surrounding host tissue may have a dramatic effect upon clinical outcome. Desired effects include bony ingrowth (osseointegration), stimulation of osteogenesis (osteoinduction), increased vascularization, and improved mechanical stability. Implant loosening, fibrous encapsulation, corrosion, infection, and inflammation, as well as physical mismatch may have deleterious clinical effects. This is particularly true of implants used in the reconstruction of load-bearing synovial joints such as the knee, hip, and the shoulder. The surfaces of orthopedic implants have evolved from solid-smooth to roughened-coarse and most recently, to porous in an effort to create a three-dimensional architecture for bone apposition and osseointegration. Total joint surgeries are increasingly performed in younger individuals with a longer life expectancy, and therefore, the postimplantation lifespan of devices must increase commensurately. This review discusses advancements in biomaterials science and cell-based therapies that may further improve orthopedic success rates. We focus on material and biological properties of orthopedic implants fabricated from porous metal and highlight some relevant developments in stem-cell research. We posit that the ideal primary and revision orthopedic load-bearing metal implants are highly porous and may be chemically modified to induce stem cell growth and osteogenic differentiation, while minimizing inflammation and infection. We conclude that integration of new biological, chemical, and mechanical methods is likely to yield more effective strategies to control and modify the implant-bone interface and thereby improve long-term clinical outcomes.
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Trabecular metal in total knee arthroplasty associated with higher knee scores: a randomized controlled trial. Clin Orthop Relat Res 2013; 471:3543-53. [PMID: 23884802 PMCID: PMC3792268 DOI: 10.1007/s11999-013-3183-4] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 07/10/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Porous tantalum is an option of cementless fixation for TKA, but there is no randomized comparison with a cemented implant in a mid-term followup. QUESTIONS/PURPOSES We asked whether a tibial component fixed by a porous tantalum system might achieve (1) better clinical outcome as reflected by the Knee Society Score (KSS) and WOMAC Osteoarthritis Index, (2) fewer complications and reoperations, and (3) improved radiographic results with respect to aseptic loosening compared with a conventional cemented implant. METHODS We randomized 145 patients into two groups, either a porous tantalum cementless tibial component group (Group 1) or cemented conventional tibial component in posterior cruciate retaining TKA group (Group 2). Patients were evaluated preoperatively and 15 days, 6 months, and 5 years after surgery, using the KSS and the WOMAC index. Complications, reoperations, and radiographic failures were tallied. RESULTS At 5-year followup the KSS mean was 90.4 (range, 68-100; 95% CI, ± 1.6) for Group 1, and 86.5 (range, 56-99; 95% CI, ± 2.4) for Group 2. The effect size, at 95% CI for the difference between means, was 3.88 ± 2.87. The WOMAC mean was 15.1 (range, 0-51; 95% CI, ± 2.6) for the Group 1, and 19.1 (range, 4-61; 95% CI, ± 2.9) for Group 2. The effect size for WOMAC was -4.0 ± 3.9. There were no differences in the frequency of complications or in aseptic loosening between the two groups. CONCLUSIONS Our data suggest there are small differences between the uncemented porous tantalum tibial component and the conventional cemented tibial component. It currently is undetermined whether the differences outweigh the cost of the implant and the results of their long-term performance.
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Hanzlik JA, Day JS. Bone ingrowth in well-fixed retrieved porous tantalum implants. J Arthroplasty 2013; 28:922-7. [PMID: 23518432 PMCID: PMC3664095 DOI: 10.1016/j.arth.2013.01.035] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 12/01/2012] [Accepted: 01/31/2013] [Indexed: 02/01/2023] Open
Abstract
While first generation porous coatings have had clinical success, aseptic loosening remains a leading cause of revision. The purpose of this study was to investigate the reasons for revision and to assess the amount of bone ingrowth in retrieved porous tantalum components. In a prospective multicenter retrieval program, 76 porous tantalum acetabular shells, 5 femoral stems, 7 patellas and 36 tibial trays were collected from revision surgeries. A subset of the implants was analyzed for bone ingrowth. The main reason for revision was infection for acetabular shells (1.4 years implantation time) and instability for tibial trays (1.8 years implantation time). Two of the thirty primary surgery acetabular shells and one of the thirty-six primary surgery tibial trays were revised for implant loosening. We observed full depth penetration of bone into the porous tantalum layer for the acetabular shells and femoral stems.
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Affiliation(s)
- Josa A. Hanzlik
- Implant Research Center, Drexel University, 3401 Market Street. Suite 345, Philadelphia, PA 19104
| | - Judd S. Day
- Implant Research Center, Drexel University, 3401 Market Street. Suite 345, Philadelphia, PA 19104,Exponent, Inc., 3401 Market Street, Philadelphia, PA 19104
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