Current methods of preventing aseptic loosening and improving osseointegration of titanium implants in cementless total hip arthroplasty: a review

Abstract

Hip osteoarthritis is the most common joint disorder, and is represented by a degenerative process, resulting in pain and functional impairment. If conservative treatment for hip osteoarthritis fails, the only remaining option is hip arthroplasty. Despite good survival of implants, loosening of components is the most common complication. This leads to revision surgeries, which are technically demanding, expensive, and result in a low satisfaction rate. Uncemented hip replacements require proper osseointegration for increased survival. Physical characteristics of implants include biocompatibility, Young’s modulus of elasticity, strength, and corrosion resistance, and each influence fixation of implants. Moreover, implant surface treatments, pore size, pore density, and femoral stem design should be appropriately selected. Patients’ optimization of obesity, osteoporosis, cardiovascular disease, psychotic disorders, and smoking cessation are associated with a higher survival of implants. Surgical factors, such as approach, drilling and rasping, acetabular bone coverage, acetabular cup positioning, and implant size, also affect survival of implants. Avoiding drugs, which may impair osseointegration of implants, and having an appropriate rehabilitation protocol are important. Future directions include anabolic and anti-catabolic bone-acting drugs to enhance osseointegration of implants. Comprehensive knowledge of the factors mentioned above is important for preventing aseptic loosening, with important socioeconomic consequences.

Crystal Structure Evolution, Microstructure Formation, and Properties of Mechanically Alloyed Ultrafine-Grained Ti-Zr-Nb Alloys at 36≤Ti≤70 (at. %)

“…However, the most important remains a significant reduction in their Young modulus comparing to pure titanium. These properties limit the stress shielding effect and increase the osteointegration which should be also stimulated by the porosities in these materials [52]. The obtained results are between 67.9 (Ti30Zr34Nb) and 84.6 (Ti14Zr16Nb) which makes their modulus near about twice lower than that of commercially pure titanium.…”

Combined Infection Control and Enhanced Osteogenic Differentiation Capacity on Additive Manufactured Ti‐6Al‐4V are Mediated via Titania Nanotube Delivery of Novel Biofilm Inhibitors

“…[ 65 ] Ideally, an optimal titanium implant surface would promote the osteogenic differentiation of host osteoprogenitor cells and then direct bone apposition, as opposed to fibroblastic cell morphology and resultant fibrous tissue encapsulation. [ 21,62,67 ] Cell proliferation and differentiation processes are expected to be an inverse relationship, that is, great differentiation usually coincides with reduced/arrested proliferation. [ 62 ] This is in line with our proliferation and differentiation results.…”

The Potential of a Nanostructured Titanium Oxide Layer with Self-Assembled Monolayers for Biomedical Applications: Surface Properties and Biomechanical Behaviors

“…The SAMs-coated surfaces exhibited a decrease in stiffness as a consequence of the formation of the bisphosphonate monolayer, which could disperse stress concentration, hence decreasing the stress shielding effect [40]. The formation of stress shielding can cause a loss of bone tissue around the implant and poor osseointegration [41][42][43]. Accordingly, the PUA-SAM/TiO sample is believed to prevent the stress shielding effect and possess better in vivo bone regeneration ability in comparison to the control sample and the other SAMs-coated samples.…”