Carbon fiber-reinforced polyetheretherketone (CF/PEEK) is a thermoplastic composite biomaterial exhibiting properties suitable for load-bearing orthopedic implants. However, the hydrophobic surface of CF/PEEK implants induces the deposition of a peri-implant fibrous tissue capsule preventing bone apposition. However, if bone apposition was improved, the use of CF/PEEK in orthopedics could be increased as it has many advantages compared with metallic implants. In this study, CF/PEEK screws were coated with titanium (Ti) using two different techniques, namely vacuum plasma spraying (VPS) and physical vapor deposition (PVD) with uncoated screws as controls. These coatings were characterized and implanted in a loaded sheep tibia model. In the characterization of the screw surfaces using microscopy techniques, the uncoated screws were seen to have an irregular surface. The PVD coating appeared smooth and consistent, whereas the VPS coating appeared to be a rough coating with some inhomogeneities, which did not cover the entire surface area. Nevertheless, in the ex vivo analysis the VPS-coated screws had a screw removal torque which was statistically greater than uncoated and PVD-coated screws (p ≤ 0.002 for both comparisons). Additionally, the VPS-coated screws had a statistically higher bone contact area than the uncoated screws (p = 0.006), whereas no statistical difference was detected between VPS and PVD coating types (p = 0.11). Thereby illustrating that Ti coating of CF/PEEK screws significantly improve bone apposition and removal torque compared with uncoated CF/PEEK screws.

Two calcium phosphate cements, one monophasic and the other biphasic, have been used as bone void filler in a sheep model. The cements were injected into a slot defect in the proximal tibia and into a cylindrical defect in the distal femur. In this study, we focused on the resorption pattern of the two cement formulations and the subsequent biologic reaction. Bone remodeling occurred synchronously with the resorption of the implant material in a creeping substitution process. Cracks and pores in the monophasic cement were filled with osseous tissues. The biphasic cement showed faster resorption of the matrix. The more slowly resorbing granules were surrounded by newly grown bone, thus providing an inverse scaffold for cancellous bone regeneration. In highly loaded areas, the long-term support function of the fixation appears to be critical. Because cortical bridging of the defects was seen in only one case, it can be concluded that calcium-phosphate cements are preferentially suitable as cancellous bone substitute materials.

Soft tissue-implant adhesion is often required for implant integration into the body; however, in some situations, the tissue is required to glide freely over an implant. In the case of distal radius fracture treatment, current literature describes how titanium and its alloys tend to lead to more intra-tendon inflammatory reactions compared with stainless steel. This leads to tendon-implant adhesion and damage possibly causing limited palmar flexion and even tendon rupture. The goal of this study was to analyze the effect of different surface polishings of titanium and titanium molybdenum implants on soft tissue reactions in vivo, with the aim to prevent direct soft tissue adhesion. Using a nonfracture model, to allow for study of the soft-tissue-implant surface interactions only, six surface variants of the same plate design were implanted onto the tibia of 24 New Zealand white rabbits and left in situ for 12 weeks. Results indicate that paste polished commercially pure titanium and titanium molybdenum alloy had the least soft tissue adhesion, with the concomitant development of a soft tissue capsule. Surface topography did not appear influence the thickness of the connective tissue surrounding the plate. Therefore, suitable surface polishing could be applied to plates for clinical use, where free gliding of tissues is required.

This study investigated the quality and quantity of healing of a bone defect following intramedullary reaming undertaken by two fundamentally different systems; conventional, using non-irrigated, multiple passes; or suction/irrigation, using one pass. The result of a measured re-implantation of the product of reaming was examined in one additional group. We used 24 Swiss mountain sheep with a mean tibial medullary canal diameter between 8 mm and 9 mm. An 8 mm 'napkin ring' defect was created at the mid-diaphysis. The wound was either surgically closed or occluded. The medullary cavity was then reamed to 11 mm. The Reamer/Irrigator/Aspirator (RIA) System was used for the reaming procedure in groups A (RIA and autofilling) and B (RIA, collected reamings filled up), whereas reaming in group C (Synream and autofilling) was performed with the Synream System. The defect was allowed to auto-fill with reamings in groups A and C, but in group B, the defect was surgically filled with collected reamings. The tibia was then stabilised with a solid locking Unreamed Humerus Nail (UHN), 9.5 mm in diameter. The animals were killed after six weeks. After the implants were removed, measurements were taken to assess the stiffness, strength and callus formation at the site of the defect. There was no significant difference between healing after conventional reaming or suction/irrigation reaming. A significant improvement in the quality of the callus was demonstrated by surgically placing captured reamings into the defect using a graft harvesting system attached to the aspirator device. This was confirmed by biomechanical testing of stiffness and strength. This study suggests it could be beneficial to fill cortical defects with reaming particles in clinical practice, if feasible.

20This study aimed to characterize the nociceptive withdrawal reflex (NWR) and to define the 21 nociceptive threshold in 25 healthy, non-medicated experimental sheep in standing posture. 22Electrical stimulation of the dorsal lateral digital nerves of the right thoracic and the pelvic limb 23 was performed and surface-electromyography (EMG) from the deltoid (all animals) and the 24 femoral biceps (18 animals) or the peroneus tertius muscles (7 animals) was recorded. The 25 behavioural reaction following each stimulation was scored on a scale from 0 (no reaction) to 5 26 (strong whole body reaction). A train-of-five 1 ms constant-current pulse was used and current 27 intensity was stepwise increased until NWR threshold intensity was reached. The NWR 28 threshold intensity (I t ) was defined as the minimal stimulus intensity able to evoke a reflex with 29 a minimal Root-Mean-Square amplitude (RMS A ) of 20 µV, a minimal duration of 10 ms and a 30 minimal reaction score of 1 (slight muscle contraction of the stimulated limb) within the time 31 window 20 to 130 ms post-stimulation. Based on this value, further stimulations were 32 performed below (0.9I t ) and above threshold (1.5I t and 2I t ). The stimulus-response curve was 33 described. Data are reported as medians and interquartile ranges. 34At the deltoid muscle I t was 4.4 mA (2.9-5.7) with an RMS A of 62 µV (30-102