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

The purpose of this study was to compare hydroxyapatite (HA)-coated titanium (Ti) and HA-coated cobalt-chrome (CoCr) implants in the distal femur of the rabbit by evaluating bone apposition and interfacial shear strength. Bilateral cylindrical implants with a plasma sprayed 50-microns thick HA coating were press-fit into the metaphyseal cancellous bone of the lateral femoral condyles in a transverse fashion, and the animals were sacrificed at 2, 4, and 8 weeks postimplantation. Mechanical strength of the interface between HA and bone was measured using the pushout method. For histologic analysis, the fractional linear extent of bone apposition was quantitated. No differences were found in the interfacial shear strength between the Ti and CoCr at any time period. The amount of bone apposition increased significantly at each time interval for both substrate metals, but there were no significant differences between the two substrates at any of the time periods studied. The HA-coated CoCr implants performed in a similar manner to the HA-coated Ti implants, both mechanically and histologically, suggesting that HA-coated CoCr implants deserve further study as a viable alternative to Ti for the biological fixation of total joint components in orthopaedic surgery.     

Mechanical and histological evaluation of amorphous calcium phosphate and poorly crystallized hydroxyapatite coatings on titanium implants

The effect of amorphous calcium phosphate (Ca/P) and poorly crystallized (60% crystalline) hydroxyapatite (HA) coatings on bone fixation to "smooth" and "rough" (Ti-6A1-4V powder sprayed) titanium-6Al-4V (Ti) implants was investigated. Implants were evaluated histologically, mechanically, and by scanning electron microscopy (SEM) after 4 and 12 weeks of implantation in a rabbit transcortical femoral model. Histological evaluation of amorphous vs. poorly crystallized HA coatings showed significant differences in bone apposition (for rough-coated implants only) and coating resorption (for smooth- and rough-coated implants) that were increased within cortical compared to cancellous bone. The poorly crystallized HA coatings showed most degradation and least bone apposition. Mechanical evaluation, however, showed no significant differences in push-out shear strengths between the two types of coatings evaluated. Differences between 4 and 12 weeks were significant for coating resorption and push-out shear strength but not for bone apposition. Significant enhancement in interfacial shear strengths for bioceramic coated as compared to uncoated implants were seen for smooth-surfaced implants (3.5-5 times greater) but not for rough-surfaced implants at 4 and 12 weeks. Rough implants showed greater mean interfacial strengths than uncoated smooth implants at 4 and 12 weeks (seven times greater) and to coated smooth implants at 12 weeks only (two times greater). Mechanical failure of the bone/coating/implant interface consistently occurred within the bone, even in the case of the poorly crystallized HA coatings, which had almost completely resorbed on rough implants. These results suggest that once early osteointegration is achieved biodegradation of a bioactive coating should not be detrimental to the bone/coating/implant fixation.     

Resorption of hydroxyapatite and fluorapatite coatings in man. An experimental study in trabecular bone

The clinical use of hydroxyapatite (HA) coating is controversial especially in regard to the long-term performance of the coating and the effects of resorption. In each of 15 consenting patients we inserted two implants, coated with either HA or fluorapatite (FA) into the iliac crest. They were harvested at a mean of 13.6 +/- 0.6 months after surgery. Histological examination showed that bone ongrowth on the HA-coated implants was significantly greater (29%) than that on the FA-coated implants. When bone was present on the coating surface the HA coating was significantly thicker than the FA coating. When bone marrow was present, the HA coating was significantly thinner than the FA coating. The reduction in coating thickness when covered by bone or bone marrow was 23.1 +/- 9.7 microm for HA and 5.1 +/- 1.7 microm for FA (p < 0.01) suggesting that FA is more stable than HA against resorption by bone marrow. The findings suggest that in man the osteoconductive properties of HA coating are superior to those of FA. Resorption rates for both coatings were approximately 20% of the coating thickness per year. Bone ongrowth appears to protect against resorption whereas bone marrow seems to accelerate resorption. No adverse reaction was seen in the surrounding bone.     

Histological comparison of early wound healing following dense hydroxyapatite granule grafting and barrier placement in surgically-created bone defects neighboring implants

The purpose of this study was to examine early wound healing following grafting of dense hydroxyapatite granules (HA granules) and barrier placement in surgically-created bone defects surrounding implants. Eight healthy adult dogs with an average weight of 15 kg were used in this study. Thirty-two bone defects measuring 4 mm x 4 mm were removed with a surgical bur to form continuous bucco-lingual bone defects and 32 implants (16 titanium [Ti]) and 16 hydroxyapatite-coated [HA]) were then placed into the defects. Four implant groups were created: 1) grafting HA; 2) covering with an expanded polytetrafluoroethylene (ePTFE) membrane; 3) grafting HA and covering with ePTFE membrane; and 4) control (no treatment). Animals were sacrificed 28 days after surgery. Histological sections revealed large amounts of newly-formed bone in all bone defects surrounding the implants treated with ePTFE membranes alone. Fibrous encapsulation of HA granules was observed in the defects of the HA granules grafting group. In the group with grafting of HA granules and covering with ePTFE membranes, small amounts of bone tissue were observed among HA granules, but most HA granules were surrounded with fibrous tissue. Bone defects were completely filled with connective tissue in the control group. There were no differences in the histological findings between Ti and HA-coated implants in all cases. Histomorphometric data disclosed that the presence of HA granules in the bone defects significantly arrested bone formation. Our study suggests that the grafting of dense HA into bone defects surrounding implants will result in fibrous healing during the early healing stage.     

Effect of acetaldehyde generated from ethanol by ADH-transfected CHO cells on their membrane fatty acid profiles

Unloaded cylindrical grit-blasted titanium (Ti-6A-4V) implants (6 x 10 mm) coated with hydroxyapatite ceramic were inserted into the proximal part of the humerus of 20 skeletally mature Labrador dogs. The implants were initially surrounded by a 2 mm gap. In 10 dogs, HA-coated implants without growth factor were inserted in one humerus and implants with 0.3 microgram rhTGF-beta 1 adsorbed onto the HA coating were inserted in the contralateral humerus. In another group of 10 dogs, a dose of 3.0 micrograms rhTGF-beta 1 was tested in a similar design. All dogs were killed at 6 weeks after treatment. Results were evaluated by histomorphometry and mechanical push-out testing. Bone ongrowth was increased by one third, using the 0.3 mg rhTGF-beta 1 stimulation. Bone volume in the gap and mechanical testing showed no statistically significant differences between control and rhTGF-beta 1 stimulated implants. RhTGF-beta 1 only moderately enhanced bone ongrowth to hydroxyapatite-coated implants.     

The mechanical behavior of LTI carbon dental implants

LTI pyrolytic carbon blade-type dental implants consisting of a graphite substrate and an LTI pyrolytic carbon coating have a strength that increases with the coating thickness. For implants having a coating thickness of about 0.03 in., average fracture loads of about 1500 lb and 230 lb were obtained in axial compressive loading and eccentric loading (e.g., axial compressive loading plus a bending moment), respectively. Depending on the type of loading, the maximum stresses in the graphite substrate were calculated to be very close to its compressive or tensile fracture strength. Also studied was the effect of a variety of defects on the overall strength of the implants.     

Effects of guided bone regeneration around commercially pure titanium and hydroxyapatite-coated dental implants. II. Histologic analysis

The purpose of this study was to determine which treatment of a large osseous defect adjacent to an endosseous dental implant would produce the greatest regeneration of bone and degree of osseointegration: barrier membrane therapy plus demineralized freeze-dried bone allograft (DFDBA), membrane therapy alone, or no treatment. The current study histologically assessed changes in bone within the healed peri-implant osseous defect. In a split-mouth design, 6 implants were placed in edentulous mandibular ridges of 10 mongrel dogs after preparation of 6 cylindrical mid-crestal defects, 5 mm in depth, and 9.525 mm in diameter. An implant site was then prepared in the center of each defect to a depth of 5 mm beyond the apical extent of the defect. One mandibular quadrant received three commercially pure titanium (Ti) screw implants (3.75 x 10 mm), while the contralateral side received three hydroxyapatite (HA) coated root-form implants (3.3 x 10 mm). Consequently, the coronal 5 mm of each implant was surrounded by a circumferential defect approximately 3 mm wide and 5 mm deep. The three dental implants in each quadrant received either DFDBA (canine source) and an expanded polytetrafluoroethylene membrane (ePTFE), ePTFE membrane alone, or no treatment which served as the control. Clinically, the greatest increase in ridge height and width was seen with DFDBA/ePTFE. Histologically, statistically significant differences in defect osseointegration were seen between treatment groups (P < 0.0001: DFDBA/ePTFE > ePTFE alone > control). HA-coated implants had significantly greater osseointegration within the defect than Ti implants (P < 0.0001). Average trabeculation of newly formed bone in the defect after healing was significantly greater for HA-coated implants than for titanium (P < 0.0001), while the effect on trabeculation between treatments was not significantly different (P = 0.14). Finally, there were significantly less residual allograft particles in defect areas adjacent to HA-coated implants than Ti implants (P = 0.0355). The use of HA-coated implants in large size defects with DFDBA and ePTFE membranes produced significantly more osseointegration histologically than other treatment options and more than Ti implants with the same treatment combinations. The results of this study indicate that, although the implants appeared osseointegrated clinically after 4 months of healing, histologic data suggest that selection of both the implant type and the treatment modality is important in obtaining optimum osseointegration in large size defects.     

真空等离子喷涂HA/Ta复合涂层

羟基磷灰石(HA)具有良好的生物相容性和骨传导能力,采用等离子体喷涂技术在钛合金等金属基材上制备的HA涂层材料已在临床医学上被广泛使用。但是,HA涂层与钛合金基材之间较低的结合强度影响了植入物在体内的长期使用。本文采用真空等离子体技术制备钽(Ta)掺杂的HA涂层,以期在保持其良好生物学性能的同时提高其结合强度。HA/Ta复合涂层的微观形貌、元素组成和相组成由SEM及配套的能谱仪(EDS)和XRD分析技术表征。按ASTMC-633标准对涂层的结合强度进行了测试。将涂层试样浸泡于模拟体液中以评估其生物活性。结果表明:Ta增强HA涂层具有粗糙的表面和层状结构,其结合强度随着Ta含量的增加而增加。掺60%Ta(H4T6)涂层的结合强度达到37.2MPa,约为HA涂层的1.9倍。模拟体液浸泡试验显示,掺钽HA涂层表面形成了类骨磷灰石,表明具有良好的生物活性。     

Histological and biomechanical analysis of bone and interface reactions around hydroxyapatite-coated intramedullary implants of different stiffness: a pilot study on the goat

We hypothesized that reduced stem stiffness of orthopaedic implants contributes to a high risk of loosening, since interface stresses and relative motions may exceed a tolerable range. To study this hypothesis, three types of load-bearing implant with different stiffnesses were inserted into the tibia of the goat. Histological analysis was performed of bone repair after insertion of the implant, bone ingrowth, interface disruption and loosening. A finite element model of the configuration provided the quantitative range of interface stresses and relative motions for the present experiment. The implants were made out of stainless steel, hollow titanium and a thin titanium core covered with a polyacetal coating. The stiffness ratios of these implants were approximately 10:4:1, respectively. All implants were coated with a layer of hydroxyapatite (HA) in order to minimize the possible biological effects of the different implant materials. Irrespective of the type of implant, there was a repair phase that lasted 6-12 weeks. The stiff implants functioned well. Large areas of bone bonding to the HA layer were found after the repair phase at 12 weeks postoperatively. After 24 weeks, some signs of loosening were observed. More loosening occurred with the hollow titanium and polyacetal implants, mainly during the repair phase. Three hollow titanium and three polyacetal coated implants survived this period, and were killed after 24 weeks. The integrity of the HA layer at the bone-implant interface of the titanium implants was good. In the polyacetal implants, the repair reaction of the cortical bone was incomplete. Bone ingrowth into HA was largely lacking. In conclusion, we found significant differences in the repair and interface reactions around implants of different stiffness. Stiff implants showed favourable initial interface conditions for bone ingrowth. Intermediate and flexible implants provoked unfavourable interface conditions for initial bone ingrowth. The finite element study showed that the flexible stems produce larger micromotions and higher interface stresses at the bone-prosthesis interface than the stiff stems, indicating an explanation for the histological findings.     

Effects of molinate on growth of five freshwater species of phytoplankton

Hemiarthroplasty is one method used to treat osteoarthritic joints. Often, however, an adverse response of the articular cartilage to the metal implants occurs. The purpose of this study was to evaluate and compare the response of a surgically created defect to pyrolytic carbon and cobalt-based alloy hemiarthroplasties. The cartilage on the lateral side of the tibial plateau of a canine knee joint was abraded to create a full-thickness defect. Two small holes were drilled into the exposed subchondral bone. Next, either a carbon or metal implant was placed in the lateral femoral condyle. The implantation period was 1 year. Histologic examination of the tibial defects revealed a smooth bony surface for both implant groups. In addition, there was no evidence of a residual adverse inflammatory response nor of a significant increase in subchondral bone formation for either group. Surface cracks resulting from the presence of the implant were seen in 14% of the carbon implant specimens and in 100% of the metal implants. Fibrocartilage regeneration was seen in 86% of the carbon implants and in 25% of the metal implants. Thus the carbon appears to be better tolerated mechanically compared to wrought cobalt-chromium alloy. Pyrolytic carbon shows promise for use in hemiarthroplasty.     

Determination of celiprolol and oxprenolol in human plasma by high-performance liquid chromatography and the analytical error function

One concern about the fixation of HA-coated implants is the possible disintegration of the surface, with the migration of HA granules into the joint space, producing third-body wear. We report a study of six revisions of HA-coated polyethylene RM cups at 9 to 14 years after successful primary arthroplasty. In all six hips, we found HA granules embedded in the articulating surface of the polyethylene, with abrasive wear of the cup and the metal femoral head. The cup had loosened in four hips and three showed severe osteolysis of the proximal femur. Third-body wear due to HA particles from implant coating may produce severe clinical problems with few early warning signs. Further clinical, radiological and histological observations are needed to determine the possible incidence of this late complication in the various types of coating of a variety of substrates.     

Formation of Hydroxyapatite Coating on Anodic Titanium Dioxide Nanotubes via an Efficient Dipping Treatment

Hydroxyapatite (HA) depositions on metallic biomedical implants have been widely applied to generate bioactive surfaces in simulated biological environments. Meanwhile, highly ordered TiO₂ nanotubes obtained via anodization have attracted increasing interest for biomedical applications. However, the capability to grow HA coating on TiO₂ nanotubes at room temperature remains problematic. In this study, we applied a dipping treatment for biomimetic formation of an adhesive HA coating on titanium dioxide nanotubes. The coatings formed using this procedure did not require high-temperature annealing or high supersaturation of the simulated biological condition. The as-formed TiO₂ nanotubes on titanium were treated using several dip-and-dry steps, through which the TiO₂ nanotubes were filled and covered with calcium phosphate nucleation sites. The specimens readily grew HA once immersed in the original simulated biological fluid (SBF) after little more than 12 hours. The carbonated HA coating was formed with 10-??m thickness after 4 days of immersion, while only a few calcium phosphate particles were observed on annealing TiO₂ nanotubes immersed in the same solution for the same duration. Tensile testing showed that the bonding strength between HA coating and substrate was 27.2 ± 1.6 MPa. This treatment dramatically improved efficiency for promoting HA formation on anodic TiO₂ nanotubes at room temperature.     

In vitro studies on the effect of cleaning methods on different implant surfaces

The effect of specific cleaning procedures was examined on the surfaces of 3 implant types with different coatings and shapes (plasma sprayed [PS]; hydroxyapatite coated [HA] implants; and smooth titanium surface screws) using a scanning electron microscope. Each implant was treated for 60 seconds per instrument with one of 6 different hygiene measures: plastic curet, metal curet, diamond polishing device, ultrasonic scaler, air-powder-water spray with sodium hydrocarbonate solution, and chlorhexidine 0.1% solution rinse. The air-powder-abrasive system, chlorhexidine rinse, and curettage with a plastic instrument caused little or no surface damage in all but the hydroxyapatite-coated fixtures. Therefore, these 3 methods were tested to determine their cleaning efficacy in a second clinical study, which did not include the HA-coated fixture. Two implants were placed on the facial aspects of both upper molar regions using individual acrylic plates. Thus, 2 fixtures on each side were examined in each patient. The examination revealed that only the sodium hydrocarbonate spray yielded a clean fixture without damage to the implant surface. In a third stage, which imitated the clinical procedure of the second approach, the cell growth of mouse-fibroblasts on implant surfaces was examined after cleaning the surface with plastic scaler and the air-abrasive system, which represents the least damaging and most effective methods. In contrast to the implant surfaces treated with plastic scalers, mostly vital cells were found on implants sprayed with the air-abrasive system.     

Hydroxyapatite-coated implants: a case for their use

The information on which this article is based comprises a small fraction of the large database compiled from the DICRG study. These results represent the early performance for HA implants (up to 36 months). The study has been ongoing for 6 years, and there are more than 2,000 implants with 4-year data and 1,500 with 5-year data. These data are similar to the 36-month data, and when they are eventually released, they are likely to reinforce the results reported here. Meanwhile, the evidence presented in this article, along with other corroborating studies cited in the introduction, are sufficient grounds to reach the following conclusion: The ideal implant design and material is one that is easy to use, requires average skills, involves minimal bone trauma, presents a biocompatible contact surface, and produces a high rate of survival in most patients. Based on 36-month survival in the DICRG study, HA-coated implants appeared to satisfy these basic requirements better than the other implants used in the study. HA-coated implants were placed in the most challenging bone types and jaw region, in patients with compromised medical histories, by dentists with different training, skills, and experience, under less than ideal clinical conditions, and still showed the highest survival rates of all implants at every point in the treatment up to 36 months.     

Plasma sprayed hydroxyapatite coatings on titanium substrates. Part 1: Mechanical properties and residual stress levels

Heat treatment and the introduction of a Ti bond coat have been applied to hydroxyapatite (HA) coatings sprayed using different plasma powers and gas mixtures. Attempts were made in this way to achieve optimal coating properties for orthopaedic implants. In particular, the effects on the degree of crystallinity, the adhesion, the OH ion content and the purity were evaluated. Heat treatment at 700 C for 1 h in air proved to be effective in increasing the crystallinity, regaining the OH- ion and removing other non-HA compounds, although it caused a significant decrease in the degree of adhesion (interfacial fracture toughness) for those specimens sprayed at high powers. This heat treatment was found to induce significant transformation of amorphous HA to the crystalline form, while not detrimentally changing the properties of the underlying Ti-6Al-4V substrates. Precoating with a 100 microm Ti layer increased the adhesion of the HA coatings on Ti-6Al-4V substrates, primarily by providing a rougher surface and promoting better mechanical interlocking. Changes in coating properties during immersion in biological fluids were also studied and were found to depend critically on the chemical composition of the fluids. Small precipitates formed on the coating surfaces when immersed in Ringers solution. These might account for the apparent drop in the degree of crystallinity when measured using X-ray diffraction. A significant drop in the interfacial adhesion was found for those coatings sprayed at high powers. This could be offset by prior precoating with a titanium bond coat and suitable heat treatment. In summary, the following processing sequence is suggested in order to achieve optimum coating properties: precoating the substrate with a layer of Ti (approximately 100 microm), spraying HA at a sufficiently high-power level (depending on particle size and gas mixture) and heat treatment at 700 degrees C for 1 h in air.     

Formation of a nanostructure and properties of titanium rods during equal-channel angular pressing CONFORM followed by drawing

Severe plastic deformation by equal-channel angular pressing according to the Conform schedule (ECAP-Conform) is used for the first time to produce long titanium rods in a nanostructured state. As a result of ECAP-Conform followed by drawing, the ultimate strength of Grade 4 titanium increases to 1350 MPa, and its yield strength increases to 1300 MPa at a high retained plasticity. The high efficiency and output of the ECAP-Conform method allow the development (on its basis) of a commercial technology for the production of high-strength nanostructured titanium, which is a promising material for medical implants.     

大气等离子喷涂和超音速火焰喷涂制备的CoMoCrSi涂层组织结构和性能

本文采用大气等离子(APS)和超音速火焰(HVOF)两种喷涂工艺制备了高硬度、高结合强度CoMoCrSi耐磨涂层,并进行了性能和成本对比分析。结果表明,通过参数优化后,APS制备的CoMoCrSi涂层硬度86HR15N,464HV300gf,结合强度45MPa;HVOF制备的CoMoCrSi涂层硬度89HR15N,699HV300gf,结合强度69MPa。HVOF制备的CoMoCrSi涂层,组织和各项性能均优于APS。XRD检测显示HVOF涂层为非晶态,APS则为晶态和非晶态,这可能与两种喷涂方式不同冷速有关。非晶态组织的出现,也可印证涂层性能的优异。APS生产效率为HVOF的2倍,每小时喷涂成本为HVOF的80%。两种工艺各有优势,可针对不同应用环境和需求选择合适的工艺。     

热解碳结构对炭/炭复合材料摩擦磨损性能的影响

通过控制化学气相沉积(CVD)工艺条件,得到粗糙层、光滑层、过渡层等几种具有不同微观结构的热解碳。金相观察、摩擦磨损性能的测试结果表明:热解碳的微观结构对炭/炭复合材料的摩擦磨损性能有重大影响;粗糙层结构的炭/炭复合材料摩擦因数高,热稳定性好,是一种优良的摩擦材料;光滑层结构的炭/炭复合材料摩擦因数低,磨损小,可以用作耐磨材料。     

Development of a nurse-managed, school-based health center

Discusses the possibility of using dense unresorbable hydroxyapatite (HA) ceramics as synthetic osteoplastic material. Analyzes the results of follow-up of 11 patients with congenital and posttraumatic deformations of the facial skull. Interventions in these patients involved implantation of HA-based ceramic blocks used for both contour plasty and for replacing bone defects. Describes methods of surgery with combined use of HA implants and fixing devices from titanium which serve to fix bone fragments and ceramic blocks.     

Rapid bone resorption adjacent to hydroxyapatite-coated implants

This paper describes rapid bone resorption in the peri-implantitis of HA implants based on both our clinical observations of and histological research on extracted dense hydroxyapatite (HA) implants. The surfaces of extracted HA implants were rough, although they were smooth at fixture placement. Plaque formed on the necks of the implants, whereas little plaque was seen on the bottoms. The plaque consisted of cocci and rods, including filamentous bacteria. Few spirochetes were observed. Although surrounding bone was formed rapidly around the HA implant, bone thickness gradually decreased compared with the titanium implant. These facts suggest that the rigid biointegration of HA with the thin surrounding bone--that is, the overstressing of the bone--causes rapid bone resorption rather than plaque accumulation on HA.