Relative effects of wound healing and mechanical stimulus on early bone response to porous‐coated implants

Hollister, Scott J.; Guldberg, Robert E.; Kuelske, Cheryl L.; Caldwell, Nancy J.; Richards, Mark; Goldstein, Steven A.

doi:10.1002/jor.1100140422

Cited by 32 publications

(35 citation statements)

References 27 publications

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“…The initially accelerated bone ingrowth phase has therefore been attributed to the regional acceleratory phenomenon, the injury response to the surgical trauma and implant insertion. This appears to be in line with the observations of other researchers, who also have attributed the early increase in bone apposition or ingrowth to the regional acceleratory phenomenon [36,37,60]. During the 3-month accelerated bone ingrowth phase, newly formed bone filled approximately 48% of total available pore space of the P 2 structure, increasing the stability of the device.…”

Section: Discussionsupporting

confidence: 91%

Progression of Bone Ingrowth and Attachment Strength for Stability of Percutaneous Osseointegrated Prostheses

Jeyapalina

Beck

Bloebaum

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Percutaneous osseointegrated prosthetic (POP) devices have been used clinically in Europe for decades. Unfortunately, their introduction into the United States has been delayed, in part due to the lack of data documenting the progression of osseointegration and mechanical stability.Questions/purposes We determined the progression of bone ingrowth into porous-coated POP devices and established the interrelationship with mechanical stability. Methods After amputation, 64 skeletally mature sheep received a custom porous-coated POP device and were then randomized into five time groups, with subsequent measurement of percentage of bone ingrowth into the available pore spaces (n = 32) and the mechanical pullout force (n = 32). Results Postimplantation, there was an accelerated progression of bone ingrowth (*48% from 0 to 3 months) producing a mean pullout force of 5066 ± 1543 N. Subsequently, there was a slower but continued progression of bone ingrowth (*23% from 3 to 12 months) culminating with a mean pullout force of 13,485 ± 1855 N at 12 months postimplantation. There was a high linear correlation (R = 0.94) between the bone ingrowth and mechanical pullout stability. Conclusions This weightbearing model shows an accelerated progression of bone ingrowth into the porous coating; the amount of ingrowth observed at 3 months after surgery within the porous-coated POP devices was sufficient to generate mechanical stability. Clinical Relevance The data document progression of bone ingrowth into porous-coated POP devices and establish a strong interrelationship between ingrowth and pullout strength. Further human data are needed to validate these findings.

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Section: Discussionsupporting

confidence: 91%

Progression of Bone Ingrowth and Attachment Strength for Stability of Percutaneous Osseointegrated Prostheses

Jeyapalina

Beck

Bloebaum

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…[10][11][12][13] In vivo intermittent compressive loading via a hydraulic bone chamber stimulated bone matrix synthesis in trabecular bone of the canine tibial and femoral metaphyses. 14 While clearly showing adaptive changes in bone to loading, the morbidity of this model limited its broader application.…”

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confidence: 99%

Trabecular bone adaptation to loading in a rabbit model is not magnitude‐dependent

Yang¹,

Willie²,

Beach³

et al. 2013

Journal Orthopaedic Research

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Although mechanical loading is known to influence trabecular bone adaptation, the role of specific loading parameters requires further investigation. Previous studies demonstrated that the number of loading cycles and loading duration modulate the adaptive response of trabecular bone in a rabbit model of applied loading. In the current study, we investigated the influence of load magnitude on the adaptive response of trabecular bone using the rabbit model. Cyclic compressive loads, producing peak pressures of either 0.5 or 1.0 MPa, were applied daily (5 days/week) at 1 Hz and 50 cycles/day for 4 weeks post-operatively to the trabecular bone on the lateral side of the distal right femur, while the left side served as an nonloaded control. The adaptive response was characterized by microcomputed tomography and histomorphometry. Bone volume fraction, bone mineral content, tissue mineral density, and mineral apposition rate (MAR) increased in loaded limbs compared to the contralateral control limbs. No load magnitude dependent difference was observed, which may reflect the critical role of loading compared to the operated, nonloaded contralateral limb. The increased MAR suggests that loading stimulated new bone formation rather than just maintaining bone volume. The absence of a dose-dependent response of trabecular bone observed in this study suggests that a range of load magnitudes should be examined for biophysical therapies aimed at augmenting current treatments to enhance long-term fixation of orthopedic devices. Keywords: trabecular bone; bone adaptation; rabbit; microcomputed tomography; mechanical stimulation Mechanical loading plays a central role in skeletal development and maintenance via both modeling and remodeling processes. 1-3 Throughout life the skeleton adapts by changing bone mass and architecture to the functional demands placed on it by mechanical stimuli. In cortical bone, loading must be dynamic rather than static to elicit an anabolic response 4 and adaptive remodeling is preferentially responsive to short periods of strain change. 5 For example, high-magnitude strains, varied by regulating the applied load 6-8 and strain rate, 9 enhanced cortical bone mass.Age-related bone loss, disuse-related bone loss, bone healing, and osseointegration around implants are all intimately coupled with the mechanical loading environment in trabecular bone. Despite the importance of studies on cortical diaphyseal bone adaptation to mechanical loading, prevention and treatment of osteoporosis and osteoarthritis requires investigation of trabecular bone adaptation. In addition, important questions remain concerning trabecular bone functional adaptation to a variety of loading parameters.Well-controlled and minimally invasive experimental models of loading in trabecular bone have been difficult to develop. [10][11][12][13] In vivo intermittent compressive loading via a hydraulic bone chamber stimulated bone matrix synthesis in trabecular bone of the canine tibial and femoral metaphyses. 14 While clearl...

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“…However, the effects of mechanical load have been shown to be minimal compared to the stimulus of fracture healing in well-fixed porous coated implants. 13 Randomization of implants within each animal and among the animals in any experiment is a crucial factor. The three by three Latin Square used to distribute the implant surface textures among the time periods, combined with the placement of contralateral controls at every level give the present study a powerful design.…”

Section: Discussionmentioning

confidence: 99%

Three-dimensional printing and porous metallic surfaces: A new orthopedic application

Melican

Zimmerman

Dhillon³

et al. 2001

J. Biomed. Mater. Res.

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As-cast, porous surfaced CoCr implants were tested for bone interfacial shear strength in a canine transcortical model. Three-dimensional printing (3DP) was used to create complex molds with a dimensional resolution of 175 microm. 3DP is a solid freeform fabrication technique that can generate ceramic pieces by printing binder onto a bed of ceramic powder. A printhead is rastered across the powder, building a monolithic mold, layer by layer. Using these 3DP molds, surfaces can be textured "as-cast," eliminating the need for additional processing as with commercially available sintered beads or wire mesh surfaces. Three experimental textures were fabricated, each consisting of a surface layer and deep layer with distinct individual porosities. The surface layer ranged from a porosity of 38% (Surface Y) to 67% (Surface Z), whereas the deep layer ranged from 39% (Surface Z) to 63% (Surface Y). An intermediate texture was fabricated that consisted of 43% porosity in both surface and deep layers (Surface X). Control surfaces were commercial sintered beaded coatings with a nominal porosity of 37%. A well-documented canine transcortical implant model was utilized to evaluate these experimental surfaces. In this model, five cylindrical implants were placed in transverse bicortical defects in each femur of purpose bred coonhounds. A Latin Square technique was used to randomize the experimental implants left to right and proximal to distal within a given animal and among animals. Each experimental site was paired with a porous coated control site located at the same level in the contralateral limb. Thus, for each of the three time periods (6, 12, and 26 weeks) five dogs were utilized, yielding a total of 24 experimental sites and 24 matched pair control sites. At each time period, mechanical push-out tests were used to evaluate interfacial shear strength. Other specimens were subjected to histomorphometric analysis. Macrotexture Z, with the highest surface porosity, failed at a significantly higher shear stress (p = 0.05) than the porous coated controls at 26 weeks. It is postulated that an increased volume of ingrown bone, resulting from a combination of high surface porosity and a high percentage of ingrowth, was responsible for the observed improvement in strength. Macrotextures X and Y also had significantly greater bone ingrowth than the controls (p = 0.05 at 26 weeks), and displayed, on average, greater interfacial shear strengths than controls, although they were not statistically significant.

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Relative effects of wound healing and mechanical stimulus on early bone response to porous‐coated implants

Cited by 32 publications

References 27 publications

Progression of Bone Ingrowth and Attachment Strength for Stability of Percutaneous Osseointegrated Prostheses

Progression of Bone Ingrowth and Attachment Strength for Stability of Percutaneous Osseointegrated Prostheses

Trabecular bone adaptation to loading in a rabbit model is not magnitude‐dependent

Three-dimensional printing and porous metallic surfaces: A new orthopedic application

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