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Evolution of bone mass density for ABG I (blue) and ABG II (red), corresponding to five-year follow-up, in the Gruen zones.
Source publication
More than twenty years ago, hydroxyapatite (HA), calcium phosphate ceramics, was introduced as a coating for cementless hip prostheses. The choice of this ceramic is due to its composition being similar to organic apatite bone crystals. This ceramic is biocompatible, bioactive, and osteoconductive. These qualities facilitate the primary stability a...
Citations
... Previous research has demonstrated promising clinical and radiographic outcomes with HA-coated acetabular implants [29][30][31][32]. Hydroxyapatite shares a similar structure to the organic apatite crystals of native bone and is osteoconductive, providing for long-term fixation of implants [4,7,30,31,33]. ...
... Previous research has demonstrated promising clinical and radiographic outcomes with HA-coated acetabular implants [29][30][31][32]. Hydroxyapatite shares a similar structure to the organic apatite crystals of native bone and is osteoconductive, providing for long-term fixation of implants [4,7,30,31,33]. High porosity and a modulus of elasticity similar to bone lead to improved fixation on acetabular surfaces [4,30,34,35]. Limited literature exists on the combination of high-porosity cups with HA coating, but it has been hypothesized that the high porosity may contribute to initial pressfit stability while the HA coating leads to increased long-term fixation that can be capitalized with additional screw fixation [7,30,31,34]. ...
... Hydroxyapatite shares a similar structure to the organic apatite crystals of native bone and is osteoconductive, providing for long-term fixation of implants [4,7,30,31,33]. High porosity and a modulus of elasticity similar to bone lead to improved fixation on acetabular surfaces [4,30,34,35]. Limited literature exists on the combination of high-porosity cups with HA coating, but it has been hypothesized that the high porosity may contribute to initial pressfit stability while the HA coating leads to increased long-term fixation that can be capitalized with additional screw fixation [7,30,31,34]. As knowledge continues to advance in the orthopaedic industry, long-term outcomes for additively manufactured acetabular implants and cost-benefit analyses are necessary while considering the context of the increased economic burden of revision THA. ...
Background
Additive manufacturing has recently gained popularity and is widely adopted in the orthopaedic industry. However, there is a paucity of literature on the radiographic and clinical outcomes of these relatively novel components. The aim of this study was to assess the 2-year clinical and radiographic outcomes of a specific additive-manufactured acetabular component in primary total hip arthroplasty.
Methods
We performed a retrospective review of 60 patients who underwent primary total hip arthroplasty with the use of the Stryker’s TRIDENT II acetabular component. Evaluation of radiographs was performed at 6 weeks, 1 year, and 2 years postoperatively. Radiographs were evaluated for radiolucencies in Charnley and DeLee zones, signs of biologic fixation, and acetabular inclination and anteversion measurements. Patient-reported outcomes and complications were also obtained.
Results
There were no cases of component loosening or changes in component position during follow-up, with an average follow-up time of 1.7 years. A radiolucent line was identified in one patient in zone 1 at 6 weeks; this was absent at 1 year. Radiographic signs of cup biologic fixation were present in 85% of cases by final follow-up. The average inclination was 45.1 (SD = 4.0), and the average anteversion was 26.9 (SD = 5.2). Patient-Reported Outcomes Measurement Information System scores significantly increased at the final follow-up, and there were no complications in this cohort.
Conclusions
This study demonstrated excellent radiographic and clinical outcomes with this novel additive-manufactured acetabular component at early follow-up. Although longer-term follow-up is warranted, this additively manufactured highly porous titanium acetabular component demonstrated excellent biologic fixation and reliable fixation at mid-term follow-up.
... These constraint conditions are determined by the type of implant anatomical location in the human body. [24] The dynamic load of the average walk plied to the femoral stem from which they were taken [25]. In further analysis, th Ti6Al4V 4500 110 0.32 900 80 ...
... These constraint conditions are determined by the type of implant anatomical location in the human body. [24] The dynamic load of the average walk plied to the femoral stem from which they were taken [25]. In further analysis, th The boundary conditions involve the application of constraints and forces. ...
... The constraint conditions in the design of a femoral prosthesis refer to the restrictions or constraints imposed on the prosthesis to ensure its stability and integration with the surrounding bone. These constraint conditions are determined by the type of implant and its anatomical location in the human body [24]. The dynamic load of the average walk is applied to the femoral stem from which they were taken [25]. ...
Arthroplasty is commonly performed to treat advanced osteoarthritis or other degenerative joint conditions; however, it can also be considered for young patients with severe joint damage that significantly limits their functionality and quality of life. Young patients are still at risk of aseptic mobilization and bone resorption due to the phenomenon of stress shielding that causes an uneven distribution of tensions along the femoral contact surface prosthesis. This phenomenon can be limited by choosing the material of the prosthesis appropriately or by varying its stiffness, making sure that its mechanical behavior simulates that of the femur as much as possible. The aim of this study is to evaluate the mechanical strength of a prosthesis optimized both in shape and material and compare the results with a standard titanium prosthesis. Methods: Through three-dimensional modeling and the use of finite element method (FEM) software such as ANSYS, the mechanical behavior of traditional prosthesis and prosthesis optimized topologically respecting the ASTM F2996-13 standard. Results: With topological optimization, there is a stress reduction from 987 MPa to 810 MPa with a mass reduction of 30%. When carbon fiber is used, it is possible to further reduce stress to 509 MPa. Conclusions: The reduction in stress on the femoral stem allows an optimal distribution of the load on the cortical bone, thus decreasing the problem of stress shielding.
... Longer-term clinical results are still awaited with great interest. Additional details on this topic can be found in the references [32,179,304,340,1135,1136]. ...
The present overview describes various production techniques for biocompatible calcium orthophosphate (abbreviated as CaPO4) deposits (coatings, films and layers) on the surfaces of various types of substrates to impart the biocompatible properties for artificial bone grafts. Since, after being implanted, the grafts always interact with the surrounding biological tissues at the interfaces, their surface properties are considered critical to clinical success. Due to the limited number of materials that can be tolerated in vivo, a new specialty of surface engineering has been developed to desirably modify any unacceptable material surface characteristics while maintaining the useful bulk performance. In 1975, the development of this approach led to the emergence of a special class of artificial bone grafts, in which various mechanically stable (and thus suitable for load-bearing applications) implantable biomaterials and artificial devices were coated with CaPO4. Since then, more than 7500 papers have been published on this subject and more than 500 new publications are added annually. In this review, a comprehensive analysis of the available literature has been performed with the main goal of finding as many deposition techniques as possible and more than 60 methods (double that if all known modifications are counted) for producing CaPO4 deposits on various substrates have been systematically described. Thus, besides the introduction, general knowledge and terminology, this review consists of two unequal parts. The first (bigger) part is a comprehensive summary of the known CaPO4 deposition techniques both currently used and dis-continued/underdeveloped ones with brief descriptions of their major physical and chemical principles coupled with the key process parameters (when possible) to inform readers of their existence and remind them of the unused ones. The second (smaller) part includes fleeting essays on the most important properties and current biomedical applications of the CaPO4 deposits with an indication of possible future developments.
... The PC implants have a pore size ranging from 100 to 400 micrometers (mm), optimal for bone ingrowth process [10]. The thickness of the hydroxyapatite coating is typically between 50 and 155 mm [44]. In contrast, GB implants typically have less surface irregularity, ranging from 3 to 5 mm, which favous bone on-growth rather than in-growth [10]. ...
Background:
Periprosthetic femoral fractures (PFFs) remain a major concern following cementless total hip arthroplasty (THA). This study aimed to evaluate the association between different types of cementless tapered stems and the risk of postoperative PFF.
Methods:
A retrospective review of primary THAs performed at a single center from January 2011 to December 2018 included 3,315 hips (2,326 patients). Cementless stems were classified according to their design. The incidence of PFF was compared between flat taper porous-coated stems (type A), rectangular taper grit-blasted stems (type B1), and quadrangular taper hydroxyapatite-coated stems (type B2). Multivariate regression analyses were performed to identify independent factors related to PFF. The mean follow-up duration was 61 months (range, 12 to 139). Overall, 45 (1.4%) postoperative PFFs occurred.
Results:
The incidence of PFF was significantly higher in type B1 stems than in type A and type B2 stems (1.8 vs. 0.7 vs. 0.7%; P=0.022). Additionally, more surgical treatments (1.7 vs. 0.5 vs. 0.7%; P=0.013) and femoral revisions (1.2 vs. 0.2 vs. 0%; P=0.004) were required for PFF in type B1 stems. After controlling for confounding variables, older age, diagnosis of hip fracture, and use of type B1 stems were significant factors associated with PFF.
Conclusion:
Type B1 rectangular taper stems were found to have higher risks for postoperative PFF and PFF requiring surgical management than type A and type B2 stems in THA. Femoral stem geometry should be considered when planning for cementless THA in elderly patients who have compromised bone quality.
... A hydroxyapatite-based layer was used to mimic implant-bone interfaces resulting from uncemented implants comprising (worldwide used) hydroxyapatite coatings [42]. The preparation of this mineral-organic matrix component was performed considering the composition of human bone [12,43]. The gelatin (denatured collagen) was selected as a binder of the hydroxyapatite particles due to its adhesiveness and plasticity [44]. ...
The world population growth and average life expectancy rise have increased the number of people suffering from non-communicable diseases, namely osteoarthritis, a disorder that causes a significant increase in the years lived with disability. Many people who suffer from osteoarthritis undergo replacement surgery. Despite the relatively high success rate, around 10% of patients require revision surgeries, mostly because existing implant technologies lack sensing devices capable of monitoring the bone–implant interface. Among the several monitoring methodologies already proposed as substitutes for traditional imaging methods, cosurface capacitive sensing systems hold the potential to monitor the bone–implant fixation states, a mandatory capability for long-term implant survival. A multifaceted study is offered here, which covers research on the following points: (1) the ability of a cosurface capacitor network to effectively monitor bone loosening in extended peri-implant regions and according to different stimulation frequencies; (2) the ability of these capacitive architectures to provide effective sensing in interfaces with hydroxyapatite-based layers; (3) the ability to control the operation of cosurface capacitive networks using extracorporeal informatic systems. In vitro tests were performed using a web-based network sensor composed of striped and interdigitated capacitive sensors. Hydroxyapatite-based layers have a minor effect on determining the fixation states; the effective operation of a sensor network-based solution communicating through a web server hosted on Raspberry Pi was shown. Previous studies highlight the inability of current bone–implant fixation monitoring methods to significantly reduce the number of revision surgeries, as well as promising results of capacitive sensing systems to monitor micro‑scale and macro‑scale bone–interface states. In this study, we found that extracorporeal informatic systems enable continuous patient monitoring using cosurface capacitive networks with or without hydroxyapatite-based layers. Findings presented here represent significant advancements toward the design of future multifunctional smart implants.
... The difference between the HA coating and the other two coatings is that with the extension of the implantation time, the coating is gradually absorbed, the bone tissue occupies the original position of the HA coating, and the prosthesis is closely connected with the bone. Currently, there is no strong evidence for the absorption process of HA coating, but researchers generally accept such a hypothesis [22]. That is, the inflammatory response in the early stage of implantation can dissolve a small amount of HA coating with low crystallinity [23] and release calcium ions, and calcium ions can be added to the remaining HA coating to inhibit coating loss [24]. ...
... Sariali et al. [46] found a 100% survival rate for anatomic cementless prostheses, which used the aseptic loosening of the prosthesis revision as the end point. Herrera et al. [22] reported the results of a surgical follow-up observation to evaluate the use of more than 4000 cementless HA coating hip prostheses since 1990 and found that the 10-year follow-up survival rate exceeded 97%. All these results confirm the long-term stability of the HA coating prosthesis. ...
With advances in materials science and biology, there have been continuing innovations in the field of artificial joint prostheses. Cementless prostheses have the advantages of long service life, easy revision, and good initial stability and are widely used in artificial joint replacement. Coatings are the key to cementless prostheses and are at the heart of their excellent functionality. This article mainly studies the clinical application of hydroxyapatite (HA) coating, standard porous coating represented by Porocoat coating, and new high-porosity coating represented by Gription coating. The clinical application and biological functionalization of different artificial joint prosthesis surface coatings are clarified, and it provides a reference for the clinical selection and development of different prosthesis surface coating materials.
... While it is easy to apply electrodes on bulk samples, the same is not true for the coatings. One of the challenges, among others, is related to the fact that the industrial deposition process used to produce the Hap coatings, the plasma spray process, creates coatings with micrometric surface roughnesses, making the use of pressure electrodes challenging [17]. Also, using painted or sputtered electrodes is not applicable, because the bioactivity would be hindered in vivo. ...
Hydroxyapatite is applied as a coating on orthopedic and dental implants. It directly bonds with bone tissue, improving the implant integration. In vivo biological studies have shown that charged hydroxyapatite may take half the time to bond with bone tissue, compared to non-charged hydroxyapatite. However, there is a challenge: how to charge the coatings? Conventional thermoelectrical poling is not applicable. In this work, a solution is proposed: the corona triode charging. It is demonstrated the possibility of achieving a large and stable negative charge density on hydroxyapatite pellets. The corona discharge has a promising potential in orthopedics and oral implantology.
... To provide the previous mentioned stability, an implant must be ductile, strong, stiff, sustain different mechanical demands and, most importantly, be non-toxic (Hayes & Richards, 2010). Implant stability is of critical importance since, unappropriated fitting to the fracture is associated to micromotions that lower the amount of new bone and potentially leads to the formation of fibrous tissue and consequent implant loosening (Herrera et al., 2015). ...
Multifunctional polymeric coatings containing drug delivery vehicles can play a key role in preventing/reducing biofilm formation on implant surfaces. Their requirements are biocompatibility, good adhesion, and controllable drug release. Although cellulose acetate (CA) films and membranes are widely studied for scaffolding, their applications as a protective coating and drug delivery vehicle for metal implants are scarce. The reason is that adhesion to stainless steel (SS) substrates is non-trivial. Grinding SS substrates enhances the adhesion of dip-coated CA films while the adhesion of electrospun CA membranes is improved by an electrosprayed chitosan intermediate layer. PMMA microcapsules containing daptomycin have been successfully incorporated into CA films and fibres. The released drug concentration of 3 x10⁻³ mg/mL after 120 minutes was confirmed from the peak luminescence intensity under UV radiation of simulated body fluid (SBF) after immersion of the fibres.
... Fink et al (14) reports a cumulative survival rate of the Former Link V-type acetabular cup of 94,5% after 5 years, 88,1% after 10 years and 70,2% after 15 years concluding that the length of follow-up resulting in proximal bone resorption, most cementless stems are coated only proximally. The combination of a tapered titanium stem with an extensive coating may increase fixation with harmonious stress distribution (28,29). ...
... Many studies confirmed the long-term stability of HA-coated prostheses. Herrera et al (28) reported a survival rate at 10 years follow-up of 97.1% in ABG I while a mean of 11.3 years follow-up was 98.30% in ABG II and Sariali et al (29) in 2012, reported that the survivorship of anatomic cementless stem SPS was 100%. ...
This study investigates the clinical and radiological results of a tapered femoral stem (Corail®) and uncemented threaded acetabular cups (Tropic®) and in addition an analysis of the complications and retrieved implants was conducted. Between January 1990 and September 1998, 301 total hips arthroplasties in 268 patients were implanted. 78 patients (87 hips) had died and 9 patients (12 hips) had been lost to follow-up, leaving at the time of the latest follow-up 180 patients (202 hips). The mean age at surgery was 56,1 (27-75) years. Of the 154 unrevised hips, the median Harris and Merle d´Aubigne and Postel hip scores were 83,3 points and 15,3 points respectively at the latest follow-up. The median follow-up time was 16.9 years (10,4-25). No femoral component was revised for aseptic loosening ; osteolysis was observed in the 9,5% of the implants (13 stems). 48 hips (23%) were revised and 27 cups (56,2%) needed revision surgery because of massive polyethylene wear. Pelvic osteolysis was found out in 80 cups (58,8%). 87 hips (63,9%) showed signs of a progressive wear of the liner, more than 2mm in 48 hips. Kaplan-Meier survivorship analysis at 15 years follow-up was 81.2% with revision for any reason (85.8% for mechanical or radiographic loosening). High rates of polyethylene wear and the high prevalence of pelvic osteolysis are serious matters in these types of implants with high rates of revision at 15 years follow-up so we decided to abandon the concept of a threaded cup design in favor of a press-fit acetabular cup.
... Based on the review of various coating methods that have been done, the best coating method that produced good characterisation of HA coating on stainless steel is obtained by plasma spraying method while the worse characterisation of fabricated stainless steel is obtained by sol-gel coating. The HA coating thickness produced by plasma spraying is 50 m which is advisable in biomedical implantation because coats less than 50 m thick are quickly dissolved, and coats more than 50 m may suffer delamination [138]. Moreover, the HA deposition was uniform while it covered the entire surface of stainless steel foam. ...
Metallic biomaterials such as 316L stainless steel (SS316L) are widely used as an implant to replace the function of damaged bone, especially in hip or knee applications. However, many of them fail during a short period or have complications. The biocompatibility issues are the main factor that caused this failure. Thus, coating the SS316L with bioactive and biocompatible material is one of the promising techniques to enhance the biocompatibility and lifetime of the implant. This paper provides an overview of the SS316L foam coated hydroxyapatite (HA). Various methods of HA coating such as sol-gel, dip coating, electrophoretic deposition, plasma spraying, and pulse laser deposition applied on SS316L foam and their coating characteristics were investigated based on recent literature. SS316L foam coated HA using different coating methods were compiled and their basic properties were reported. Therefore, this paper will benefit future works on SS316L foam coated HA in a biomedical application.
