Osseointegration of a hydroxyapatite-coated multilayered mesh stem

The role of hydroxyapatite coating in joint replacement surgery - Key considerations

The use of a porous hydroxyapatite (HA) coating has definitively increased the durability and biocompatibility of joint replacement prostheses (JRP) since its introduction. This article will contextualise the properties of porous HA and relate these characteristics to its clinical function. Novel strategies to encourage osseointegration will also be explored, alongside their clinical relevance. All major literature databases were scrutinised for literature relevant to the scope of our review. The role of Hydroxyapatite was evaluated, alongside further strategies to augment bone ingrowth. HA coatings remain the most optimal coating for widespread clinical use. Advantages are conferred due to the method of application, the tribology and the biocompatibility of the material. Further strategies are available to augment bone ingrowth, pertaining to biological modifications and implantation of external factors. An evaluation of the literature has described the relative long term performance of the HA coated JRPs both in isolation and when compared with cemented prosthesis. Metanalyses have shown HA coated JRPs to perform as well as cemented prosthesis in terms of survivability over both short and long term follow ups. Concerning strategies to augment osseointegration, consideration should be given to form and function of the coating surface, as this provides the basis for cell adherence, proliferation, and differentiation.

The effects of plasma electrolytically oxidized layers containing Sr and Ca on the osteogenic behavior of selective laser melted Ti6Al4V porous implants

Surface biofunctionalization is frequently applied to enhance the functionality and longevity of orthopedic implants. Here, we investigated the osteogenic effects of additively manufactured porous Ti6Al4V implants whose surfaces were biofunctionalized using plasma electrolytic oxidation (PEO) in Ca/P-based electrolytes with or without strontium. Various levels of Sr and Ca were incorporated in the oxide layers by using different current densities and oxidation times. Increasing the current density and oxidation time resulted in thicker titanium oxide layers and enhanced the release of Ca²⁺ and Sr²⁺. Biofunctionalization with strontium resulted in enhanced pore density, a thinner TiO₂ layer, four-fold reduced release of Ca²⁺, and mainly anatase phases as compared to implants biofunctionalized in electrolytes containing solely Ca/P species under otherwise similar conditions. Different current densities and oxidation times significantly increased the osteogenic differentiation of MC3T3-E1 cells on implants biofunctionalized with strontium, when the PEO treatment was performed with a current density of 20 A/dm² for 5 and 10 min as well as for a current density of 40 A/dm² for 5 min. Therefore, addition of Sr in the PEO electrolyte and control of the PEO processing parameters represent a promising way to optimize the surface morphology and osteogenic activity of future porous AM implants.

Evaluation of Patient-Specific Cranial Implant Design Using Finite Element Analysis

BACKGROUND

Various studies have investigated the load-bearing capacity of patient-specific cranial implants. However, little attention has been given to the evaluation of the design of ceramic-titanium (CeTi) implants.

METHODS

A biomechanical evaluation of 3 patient-specific cranial implants was performed using finite element analysis.

RESULTS

The results of the analyses allowed the identification of the implant regions as well as the magnitudes of the maximum stresses on, and displacements along, these regions after traumatic impact. The analyses also showed that polyether ether ketone cranial implants offer inferior brain and neurocranial protection due to their high flexibility and local peak stresses at the bone-screw interface. In contrast, CeTi implants were able to evenly distribute the stresses along the interface and thus reduced the risk of neurocranial fracture. The scaffold structure at the border of these implants reduced stress shielding and enhanced bone ingrowth. Moreover, brain injuries were less likely to occur, as the CeTi implant exhibits limited deflection.

CONCLUSIONS

From the finite element analyses, CeTi cranial implants appear less likely to induce calvarial fractures with a better potential to protect the brain under impact loads.

Functionality-packed additively manufactured porous titanium implants

The holy grail of orthopedic implant design is to ward off both aseptic and septic loosening for long enough that the implant outlives the patient. Questing this holy grail is feasible only if orthopedic biomaterials possess a long list of functionalities that enable them to discharge the onerous task of permanently replacing the native bone tissue. Here, we present a rationally designed and additive manufacturing (AM) topologically ordered porous metallic biomaterial that is made from Ti-6Al-4V using selective laser melting and packs most (if not all) of the required functionalities into a single implant. In addition to presenting a fully interconnected porous structure and form-freedom that enables realization of patient-specific implants, the biomaterials developed here were biofunctionalized using plasma electrolytic oxidation to locally release both osteogenic (i.e. strontium) and antibacterial (i.e. silver ions) agents. The same single-step biofunctionalization process also incorporated hydroxyapatite into the surface of the implants. Our measurements verified the continued release of both types of active agents up to 28 days. Assessment of the antibacterial activity in vitro and in an ex vivo murine model demonstrated extraordinarily high levels of bactericidal effects against a highly virulent and multidrug-resistant Staphylococcus aureus strain (i.e. USA300) with total eradication of both planktonic and adherent bacteria. This strong antibacterial behavior was combined with a significantly enhanced osteogenic behavior, as evidenced by significantly higher levels of alkaline phosphatase (ALP) activity compared with non-biofunctionalized implants. Finally, we discovered synergistic antibacterial behavior between strontium and silver ions, meaning that 4-32 folds lower concentrations of silver ions were required to achieve growth inhibition and total killing of bacteria. The functionality-packed biomaterial presented here demonstrates a unique combination of functionalities that make it an advanced prototype of future orthopedic biomaterials where implants will outlive patients.

Comparative analysis of osseointegration in various types of acetabular implant materials

BACKGROUND

There is a lack of comparative data on osseointegration (BIC) of acetabular cup surfaces in hip arthroplasty in both normal bone mineral density and in conditions of osteoporosis.

AIM

To compare osseointegration of acetabular implants with various types of surfaces in an animal model with normal and osteoporotic bone tissue.

MATERIAL AND METHODS

The study was performed on 60 rats. To simulate osteoporosis ovariectomy was performed in 30 animals. Thirty healthy rats served as controls. In standardised defects of the distal metadiaphysis of the femur we implanted: porous tantalum Trabecular Metal (A), Trabecular Titanium (B), Titanium with Gription coating (C), Stiktite (D), and Tritanum (E). Bone apposition (osseointegration) was defined as all areas of direct "bone-to-implant contact" (BIC).

RESULTS

No qualitative morphological differences in the evaluation of BIC around different implant types was seen in normal rats and rats with osteoporosis. Connective tissue areas around implants were larger in rats with osteoporosis. Morphometric studies showed that the highest BIC were seen in implants A and B, both in healthy animals ([72.00 ± 3.48]% and [67.46 ± 1.69]%) and ones with osteoporosis ([59.19 ± 2.10]% and [53.36 ± 2.57]%). BIC was (60.10 ± 2.05)%, (60.26 ± 2.36)%, and (61.78 ± 2.27)% around implants C, D and E in healthy rats, respectively. BIC in osteoporosis was (45.39 ± 2.37)%, (47.81 ± 2.41)% and (42.10 ± 1.44)%, respectively.

CONCLUSION

Our study showed that the evaluated implants have good BIC features. Furthermore, based on histomorthometry and histology, Porous tantalum Trabecular Metal (A) and Trabecular Titanium (B) implants exhibit higher BIC with bone tissue.

Selective laser melting porous metallic implants with immobilized silver nanoparticles kill and prevent biofilm formation by methicillin-resistant Staphylococcus aureus

Implant-associated infection and limited longevity are two major challenges that orthopedic devices need to simultaneously address. Additively manufactured porous implants have recently shown tremendous promise in improving bone regeneration and osseointegration, but, as any conventional implant, are threatened by infection. In this study, we therefore used rational design and additive manufacturing in the form of selective laser melting (SLM) to fabricate porous titanium implants with interconnected pores, resulting in a 3.75 times larger surface area than corresponding solid implants. The SLM implants were biofunctionalized by embedding silver nanoparticles in an oxide surface layer grown using plasma electrolytic oxidation (PEO) in Ca/P-based electrolytes. The PEO layer of the SLM implants released silver ions for at least 28 days. X-ray diffraction analysis detected hydroxyapatite on the SLM PEO implants but not on the corresponding solid implants. In vitro and ex vivo assays showed strong antimicrobial activity of these novel SLM PEO silver-releasing implants, without any signs of cytotoxicity. The rationally designed SLM porous implants outperformed solid implants with similar dimensions undergoing the same biofunctionalization treatment. This included four times larger amount of released silver ions, two times larger zone of inhibition, and one additional order of magnitude of reduction in numbers of CFU in an ex vivo mouse infection model.

Mechanistic contribution of electroconductive hydroxyapatite–titanium disilicide composite on the alignment and proliferation of cells

We elucidate here the mechanistic contribution of a novel electroconductive hydroxyapatite-20 wt.% titanium disilicide (HA–TiSi2) composite system in favorably modulating osteoblast functions in relation to the monolithic HA. The higher electrical conductivity of HA–TiSi2 (σDC ∼ 67.117 ± 3.57 S/m) in comparison to glass sample effectively guided the electroactive myoblast, leading to their significant alignment and proliferation. This favorable behavior is attributed to the formation of small electrochemical cells between HA and TiSi2 phase, which produce a small electric field, directing the electroactive myoblast to migrate and grow in a particular direction. In contrast, no impact of TiSi2 on osteoblast function was observed because of their inability to respond to small electric field. However, the in vitro bioactivity in simulated body fluid indicated the nucleation and growth of apatite crystals. Moreover, in the context of load-bearing capability, the presence of 20 wt.% TiSi2 in HA led to increase in the fracture toughness by ∼100%. This study underscores the effectiveness of HA–TiSi2 in favorably modulating the cellular activity, myoblast in particular.

In vivo study of the early bone-bonding ability of Ti meshes formed with calcium titanate via chemical treatments

Alkali and heat (AH) treatment forming sodium titanate has been shown to connect bioinert Ti metal and bone tissue. Artificial joints treated with this method have achieved extensive clinical application. Recently a new chemical treatment of Alkali-Calcium-Heat-Water (ACaHW) treatment forming calcium titanate was proposed. Notably, the apatite-forming ability of this treatment is greater than that of AH treatment, as verified in vitro. However, the early bone-bonding abilities of the two treatments have not been compared in vivo. To simulate clinical application, we treated a commercially pure Ti (Cp-Ti) mesh implant with AH or ACaHW. Then, using mechanical and histological methods, we compared the bone-bonding abilities of the two treatments early during the implantation process (2-4 weeks); untreated Cp-Ti mesh was used as a control. Because the mesh structure might influence bone-bonding ability, we compared these bonding abilities with values obtained at 4 and 8 weeks using a Cp-Ti implant with a plate structure. In the mesh group, histological comparisons at 2 and 3 weeks indicated that ACaHW treatment resulted in a bone-bonding ability similar to that of AH treatment; ACaHW exhibited a greater bonding ability than AH at 4 weeks. However, in tests of the plate group at later time points, such differences were not apparent. The results obtained here indicate that during the early stage of embedment, ACaHW treatment of Cp-Ti mesh implants yields a higher bone-bonding ability than AH treatment, thus providing a positive reference for future clinical applications.

Co-blasting of titanium surfaces with an abrasive and hydroxyapatite to produce bioactive coatings: Substrate and coating characterisation

The aim of this work is to assess the influence of two blast media on the deposition of hydroxyapatite onto a titanium substrate using a novel ambient temperature coating technique named CoBlast. CoBlast was developed to address the problems with high temperature coating techniques. The blasting media used in this study were Al2O3 and a sintered apatite powder. The prepared and coated surfaces were compared to plasma sprayed hydroxyapatite on the same substrates using the same hydroxyapatite feedstock powder. X-ray diffraction analysis revealed the coating crystallinity was the same as the original hydroxyapatite feedstock powder for the CoBlast samples while evidence of amorphous hydroxyapatite phases and β-TCP was observed in the plasma sprayed samples. The blast media type significantly influences the adhesive strength of the coating, surface roughness of both the substrate and coating and the microstructure of the substrate. The coating adhesion increased for the CoBlasted samples from 50 MPa to 60 MPa for sintered apatite powder and alumina, respectively, while plasma spray samples were significantly lower (5 MPa) when tested using a modified pull-test. In conclusion, the choice of blast medium is shown to be a key parameter in the CoBlast process. This study indicates that sintered apatite powder is the most suitable candidate for use as a blast medium in the coating of medical devices.

The effect of adhesive strength of hydroxyapatite coating on the stability of hydroxyapatite-coated prostheses in vivo at the early stage of implantation

INTRODUCTION

With the increase in joint revision surgery after arthroplasty, defects of hydroxyapatite (HA)-coated prostheses have been observed increasingly often. These defects adversely affect the prosthetic stability in vivo. This study has analyzed the potential effect of the adhesive strength of HA coating on the stability of HA-coated prostheses in vivo after its implantation.

MATERIAL AND METHODS

Sixty experimental rabbits were divided into HA- and Ti-coated groups. HA-coated prostheses were implanted into the bilateral epicondyle of rabbits femurs. Ti-coated prostheses were implanted as control. At different time points(4, 9, and 15 weeks) after implantation, bone tissue samples were fetched out respectively for histomorphometric analysis. Push-out testing was used to detect the ultimate shear strength at the bone-prosthesis interface. Scanning electron microscope (SEM) observation and energy-dispersive X-ray spectroscopy (EDX) analysis were used to observe the changes in surface composition of the prostheses after the ultimate shear strength testing. The coating adhesive strength of two kinds of coatings were also examined by scratch testing.

RESULTS

Hydroxyapatite coating has an obvious advantage in facilitating osteogenesis and its plays a critical role in the stability of prostheses. However, the ultimate shear strength of HA-coated prostheses is much lower than that of Ti-coated implants (p < 0.01). Further study has demonstrated that the stability of HA-coated prostheses in vivo is affected by the relatively low adhesive strength between coating and substrate.

CONCLUSIONS

Obvious advantage in facilitating osteogenesis around HA-coated prostheses is not the only factor that determines the stability of prostheses in vivo.

The development of a scanning strategy for the manufacture of porous biomaterials by selective laser melting

Porous structures are used in orthopaedics to promote biological fixation between metal implant and host bone. In order to achieve rapid and high volumes of bone ingrowth the structures must be manufactured from a biocompatible material and possess high interconnected porosities, pore sizes between 100 and 700 microm and mechanical strengths that withstand the anticipated biomechanical loads. The challenge is to develop a manufacturing process that can cost effectively produce structures that meet these requirements. The research presented in this paper describes the development of a 'beam overlap' technique for manufacturing porous structures in commercially pure titanium using the Selective Laser Melting (SLM) rapid manufacturing technique. A candidate bone ingrowth structure (71% porosity, 440 microm mean pore diameter and 70 MPa compression strength) was produced and used to manufacture a final shape orthopaedic component. These results suggest that SLM beam overlap is a promising technique for manufacturing final shape functional bone ingrowth materials.

Selective Laser Melting: a regular unit cell approach for the manufacture of porous, titanium, bone in-growth constructs, suitable for orthopedic applications

In this study, a novel porous titanium structure for the purpose of bone in-growth has been designed, manufactured and evaluated. The structure was produced by Selective Laser Melting (SLM); a rapid manufacturing process capable of producing highly intricate, functionally graded parts. The technique described utilizes an approach based on a defined regular unit cell to design and produce structures with a large range of both physical and mechanical properties. These properties can be tailored to suit specific requirements; in particular, functionally graded structures with bone in-growth surfaces exhibiting properties comparable to those of human bone have been manufactured. The structures were manufactured and characterized by unit cell size, strand diameter, porosity, and compression strength. They exhibited a porosity (10-95%) dependant compression strength (0.5-350 Mpa) comparable to the typical naturally occurring range. It is also demonstrated that optimized structures have been produced that possesses ideal qualities for bone in-growth applications and that these structures can be applied in the production of orthopedic devices.

Implanting hydroxyapatite-coated porous titanium with bone morphogenetic protein-2 and hyaluronic acid into distal femoral metaphysis of rabbits

OBJECTIVE

To assess the osseointegration capability of hydroxyapatite-coated porous titanium with bone morphogenetic protein-2 (BMP-2) and hyaluronic acid to repair defects in the distal femur metaphysis in rabbits.

METHODS

Porous titanium implants were made by sintering titanium powder at high temperature, which were coated with hydroxyapatite by alkali and heat treatment and with BMP-2 combined with bone regeneration materials. And hyaluronic acid was further used as delivery system to prolong the effect of BMP-2. The implants were inserted into the metaphysis of the distal femur of rabbits. The animals were killed at 6, 12 and 24 weeks to accomplish histological and biomechanical analyses.

RESULTS

According to the result of histological analysis, the osseointegration in BMP-2 group was better than that of the HA-coated porous titanium group. In push-out test, all the samples had bigger shear stress as time passed by. There was statistical difference between the two groups in 6 and 12 weeks but not in 24 weeks.

CONCLUSION

Hydroxyapatite-coated porous titanium with BMP-2 and hyaluronic acid has a good effect in repairing defects of distal femur in rabbits, which is a fine biotechnology for future clinical application.

Self-assembled monolayer films of phosphonates for bonding RGD to titanium

Modification of the implant surface with the Arg-Gly-Asp tripeptide (RGD) putatively facilitates osteoblast attachment for improved implant fixation in the laboratory. We compared the histomorphometric and mechanical performance of titanium implants coated with RGD using a novel interface of self-assembled monolayers of phosphonates (RGD/SAMP) and implants coated with RGD using the more conventional thiolate-gold interface (RGD/thiolate-gold). We hypothesized RGD/SAMP-coated implants would show greater bone ongrowth and implant fixation than RGD/thiolate-gold-coated ones. We implanted an RGD/SAMP-coated implant in one femur and an RGD/thiolate-gold-coated in the contralateral femur of 60 rats. At 2, 4, and 8 weeks after implantation, 10 rats were sacrificed for histologic evaluation and another 10 for biomechanical testing. Bone-implant ongrowth and implant force-to-failure of the two implants were similar at all times. Although RGD/SAMP-coated implants did not show superior bone ongrowth and implant fixation, RGD/SAMP-coated implants have at least equally good histomorphometric and mechanical in vivo performance as RGD/thiolate-gold-coated ones. Additional in vivo characterization of self-assembled monolayer films of phosphonates as interface to bond RGD to titanium is needed to explore its full potential and seems justified based on the results of this study.

Anatase Coating Improves Implant Osseointegration In Vivo

Titanium is the gold standard among materials used for prosthetic devices because of its good mechanical and chemical properties. When exposed to oxygen, titanium becomes an oxide that is biocompatible and able to induce osseointegration. There are three allotropic forms of titanium dioxide: brookite, rutile, and anatase. Anatase can be prepared as a colloidal suspension and then used to coat surfaces. Anatase coating (AC) can potentially have specific biologic effects. We test the effect of AC on bone throughout an in vivo study by using dental implants covered with AC and then inserted in rabbit tibia. The histologic analysis has demonstrated that 1) bone growth is more evident around AC fixtures than in controls and 2) a more mature bone is present in the periimplant AC surface than in controls. Therefore, we have demonstrated that AC enhances implant osseointegration.