Fine grained osseointegrative coating improves biocompatibility of PEEK in heterotopic sheep model

Meers, Caroline Marie F; Verleye, Gino; Smeets, Dirk; Hauwermeiren, Hadewych Y.R. Van; Loeckx, Dirk; Willems, Karel; Siau, Vincent G.M.G.G.B.; Lauweryns, Philippe

doi:10.14444/2035

Cited by 13 publications

(12 citation statements)

References 14 publications

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“…There indeed is an abundance of research that demonstrated the enhanced osseointegration of Ti coatings, 11,15,18,19 and CaP coatings. 17,45 In contrast, there are only a limited number of clinical studies that explored the use of coated PEEK cages. 15 To the best of our knowledge, there are no clinical studies that explored the use of PEEK cages with a CaP coating in PLIF.…”

Section: Discussionmentioning

confidence: 99%

“…11 There indeed is a surging research interest to enhance the osseointegration of PEEK cages by applying surface treatments and/ or coatings. 8,11,15,[17][18][19][20] Various types of bioactive coatings have been developed to improve upon the limited osseointegration of PEEK, for example, calcium phosphate (CaP), 13,17 hydroxyapatite (HA), 8,11 carbon coatings, 21 and Ti. 8,11,15,18,19 The biological impact of all these coatings has been thoroughly investigated.…”

Section: Introductionmentioning

confidence: 99%

“…13,22 In an attempt to optimize coating characteristics for PEEK cages, PEEK cages with a Ti or CaP nanocoating have been developed. 13,17 The thickness of the nanocoating is orders of magnitude smaller than the typical plasma-sprayed coatings. Kienle et al 13 showed that these nanocoated cages have slightly more wear than uncoated cages, albeit significantly less than Ti plasma-sprayed coatings and well below the limit derived from FDA guidelines.…”

Section: Introductionmentioning

confidence: 99%

“…Kienle et al 13 showed that these nanocoated cages have slightly more wear than uncoated cages, albeit significantly less than Ti plasma-sprayed coatings and well below the limit derived from FDA guidelines. An animal study performed by Meers et al 17 demonstrated that the Ti nanocoating has a beneficial effect on the osseointegration, while preserving the radiolucency and elasticity of the PEEK cages.…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, we used the aforementioned Ti-nanocoated and CaP-nanocoated PEEK cages. 13,17 The aim of this 3-arm multicenter randomized controlled study was primarily to investigate the clinical outcome improvements of the nanocoated PEEK cages compared with those of the normal uncoated PEEK cages, to ascertain the safety and efficacy of the nanocoated PEEK cages. Additionally, the study examined the radiological outcome to assess the osseointegration or fusion rate of the nanocoated PEEK cages versus the uncoated PEEK cages.…”

Section: Introductionmentioning

confidence: 99%

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Randomized Controlled Trial of Posterior Lumbar Interbody Fusion With Ti- and CaP-Nanocoated Polyetheretherketone Cages: Comparative Study of the 1-Year Radiological and Clinical Outcome

et al. 2020

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Background: Polyetheretherketone (PEEK) is a popular material for posterior lumbar interbody fusion (PLIF) cages, although osseointegration remains limited. To optimize PEEK cage characteristics, titanium (Ti) and calcium phosphate (CaP) nanocoatings have been developed with proven mechanical safety. This multicenter randomized controlled trial compared the clinical and radiological outcome parameters of nanocoated and uncoated PEEK cages, up to 1 year after surgery. Methods: Standard open PLIF surgery was performed on 127 patients, randomized in 3 groups: Ti-nanocoated (n ¼ 44), CaP-nanocoated (n ¼ 46), and uncoated PEEK cages (n ¼ 37). Clinical assessments up to 1 year after surgery included visual analogue scales (VASs), Oswestry Disability Index (ODI), and 36-Item Short Form Survey (SF-36). Primary radiological outcome parameters were implant stability and fusion status, assessed by x-ray and computed tomography (CT) scans. Patients, surgeons, and postsurgery analysts were blinded. Results: PLIF surgery with all cage types resulted in significant improvements of clinical outcome parameters, exceeding the minimum clinically important differences. No significant differences in VAS, ODI, or SF-36 scores were found among the 3 groups. One year after the surgery, 65.6% of patients with uncoated PEEK cages achieved definite fusion. Significantly more patients with nanocoated PEEK cages achieved definite fusion: 93.9% for Ti nanocoating (P ¼ .0034) and 88.0% for CaP nanocoating (P ¼ .032). No significant differences in fusion were found between the nanocoated cage types (P ¼ .4318). Conclusions: The similar clinical outcome improvements after 1 year suggest that nanocoated PEEK cages have the same safety and efficacy as the clinically accepted uncoated PEEK cages. Furthermore, nanocoated PEEK cages achieved a better fusion rate than uncoated PEEK cages at the 1-year follow-up. A 5-year follow-up study is warranted to revisit the findings. Clinical Relevance: The safety, efficacy, and enhanced osseointegration of nanocoated PEEK cages were demonstrated. Osseointegration is a significant predictor of positive long-term clinical outcomes and improved implant longevity, implying a clinical added value of nanocoatings. Enhanced osseointegration becomes even more important in minimally invasive spine surgery and in patients at risk for incomplete fusion.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Randomized Controlled Trial of Posterior Lumbar Interbody Fusion With Ti- and CaP-Nanocoated Polyetheretherketone Cages: Comparative Study of the 1-Year Radiological and Clinical Outcome

et al. 2020

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Research and Application of Medical Polyetheretherketone as Bone Repair Material

Zhang

et al. 2023

Macromolecular Bioscience

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Polyetheretherketone (PEEK) can potentially be used for bone repair because its elastic modulus is similar to that of human natural bone and good biocompatibility and chemical stability. However, its hydrophobicity and biological inertness limit its application in the biomedical field. Inspired by the composition, structure, and function of bone tissue, many strategies are proposed to change the structure and functionality of the PEEK surface. In this review, the applications of PEEK in bone repair and the optimization strategy for PEEK's biological activity are reviewed, which provides a direction for the development of multifunctional bone repair materials in the future.

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A comparative study of three biomaterials in an ovine bone defect model

et al. 2020

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Fine grained osseointegrative coating improves biocompatibility of PEEK in heterotopic sheep model

Abstract: Coating of PEEK dowels with a nanocoating of titanium has beneficial effects on adhesion of bone tissue.

Cited by 13 publications

References 14 publications

Randomized Controlled Trial of Posterior Lumbar Interbody Fusion With Ti- and CaP-Nanocoated Polyetheretherketone Cages: Comparative Study of the 1-Year Radiological and Clinical Outcome

Randomized Controlled Trial of Posterior Lumbar Interbody Fusion With Ti- and CaP-Nanocoated Polyetheretherketone Cages: Comparative Study of the 1-Year Radiological and Clinical Outcome

Research and Application of Medical Polyetheretherketone as Bone Repair Material

A comparative study of three biomaterials in an ovine bone defect model

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