Keiichi Kawanabe

Apatite layer-coated titanium for use as bone bonding implants

For development of thin bioactive coatings on metal implants, a dense and uniform apatite layer was coated onto titanium (Ti) implants in situ by using a new biomimetic method, which is composed of apatite nucleation and growth steps in simulated body fluid (SBF). Analysis of the coatings by thin film X-ray diffraction and scanning electron microscopy-energy dispersive X-ray microanalysis (SEM-EMPA) before implantation showed that its characteristics were very similar to those of natural bone. The coated and uncoated rectangular plates were bilaterally implanted into the tibial proximal metaphyses of rabbits. After 6, 10 and 25 weeks post-implantation, the bone bonding and bone formation at the bone-implant interfaces were evaluated by a detachment test and undecalcified histological examination. Mechanical testing in tension showed that the failure load of apatite layer-coated Ti implants was significantly higher than that of uncoated control at each time period (all P < 0.001). Histologically, it was shown that bone was deposited directly onto the apatite coating without any intervening soft tissue, while in the paired controls, interpositional soft tissue was seen at the bone-implant interface. By SEM-EPMA, a uniform calcium- and phosphorus-rich layer was detected between the coated implants and bone, but not in uncoated controls at either earlier or later time periods. The results indicate that the apatite layer deposited on Ti in situ may significantly increase the bone bonding strength by providing a bioactive surface, which allows for an early bone apposition to the implant. In addition, the apatite layer-coated Ti produced by the biomimetic process may fulfil the requirements of favourable thin coatings and strong adhesion at the metal-coating interface.

Metallosis due to impingement between the socket and the femoral neck in a metal-on-metal bearing total hip prosthesis. A case report.

Late loosening of a total hip component due to osteolysis may result from polyethylene wear. For the metal-on-metal prostheses that have recently been developed, the Metasul bearing (Sulzer Medica, Winterthur, Switzerland)—which is fitted into the Muller prosthesis (Protek AG, Bern, Switzerland), the Zweymuller prosthesis (AlloPro AG, Baar, Switzerland), and other prostheses—is the most common metal-on-metal articulation. The risk of debris-related loosening may be reduced with the use of this bearing10. We report the case of a patient who had severe metallosis caused by wear of the neck of the femoral component from impingement with the rim of the acetabular component of a metal-on-metal prosthesis. This complication can occur at any time postoperatively and may not be associated with symptoms or other problems. A seventy-two-year-old woman was seen at our clinic in November 1996 because of pain in the right thigh. She had been managed with a total hip arthroplasty with a Zweymuller metal-on-metal prosthesis at another institution in November 1995. The acetabular component was a Weber Metasul cup (Sulzer Medica) made of cobalt-chromium-nickel-molybdenum alloy and polyethylene, and it was fixed with cement. The femoral component was a Zweymuller stem (AlloPro AG) made of Ti-6Al-4V, and it was fixed without cement. The radiograph showed that the inclination angle of the socket was 47 degrees and the stem was inserted in a neutral position. The socket was in minimum anteversion or retroversion (Fig. 1). There was a demarcation line that was more than one millimeter wide in zone 1 of DeLee and Charnley3. The apparent radiographic density of the proximal aspect of the femur was relatively low, which was consistent with stress-shielding. Osteolysis was suspected in the calcar and the greater trochanter. The right lower limb was about two centimeters longer than the left lower limb, and the …

Mechanical and biological properties of two types of bioactive bone cements containing MgO-CaO-SiO2-P2O5-CaF2 glass and glass-ceramic powder.

In this study two types of bioactive bone cement containing either MgO-CaO-SiO2-P2O5-CaF2 glass (type A) or glass-ceramic powder (type B) were made to evaluate the effect of the crystalline phases on their mechanical and biological properties. Type A bone cement was produced from glass powder and bisphenol-a-glycidyl methacrylate (BIS-GMA) resin, and type B from glass-ceramic powder containing apatite and wollastonite crystals and BIS-GMA resin. Glass or glass-ceramic powder (30, 50, 70, and 80 by wt %) was added to the cement. The compressive strength of type A (153-180 MPa) and B (167-194 MPa) cement were more than twice that of conventional polymethylmethacrylate (PMMA) cement (68 MPa). Histological examination of rat tibiae showed that all the bioactive cements formed direct contact with the bone. A reactive layer was seen at the bone-cement interface. In specimens with type A cement the reactive layer consisted of two layers, a radiopaque outer layer (Ca-P-rich layer) and a relatively radiolucent inner layer (low-calcium-level layer). With type B cement, although the Ca-P-rich layer was seen, the radiolucent inner layer was absent. Up to 26 weeks there was progressive bone formation around each cement (70 wt %) and no evidence of biodegradation. The mechanical and biological properties of the cements were compared with those of a previously reported bone cement containing MgO-free CaO-SiO2-P2O5-CaF2 glass powder (designated type C).

Operative treatment of hip impingement caused by hypertrophy of the anterior inferior iliac spine

A 30-year-old man presented with pain and limitation of movement of the right hip. The symptoms had failed to respond to conservative treatment. Radiographs and CT scans revealed evidence of impingement between the femoral head-neck junction and an abnormally large anterior inferior iliac spine. Resection of the hypertrophic anterior inferior iliac spine was performed which produced full painless restoration of function of the hip. Hypertrophy of the anterior inferior iliac spine as a cause of femoro-acetabular impingement has not previously been described.

A new cementless total hip arthroplasty with bioactive titanium porous-coating by alkaline and heat treatment: Average 4.8-year results

A method has been developed for creating a bioactive coating on titanium by alkaline and heat treatment, and shown that it forms a thin layer of hydroxyapatite (HA) on the surface of implants when soaked in simulated body fluid. A series of 70 cementless primary total hip arthroplasties using this coating technique on a porous titanium surface was performed, and followed up the patients for a mean period of 4.8 years. There were no instances of loosening or revision, or formation of a reactive line on the porous coating. Although radiography just after operation showed a gap between the host bone and the socket in over 70% of cases, all the gaps disappeared within a year, indicating the good osteoconduction provided by the coating. Alkaline-heat treatment of titanium to provide a thin HA coating has several advantages over plasma-spraying, including no degeneration or absorption of the HA coating, simplicity of the manufacturing process, and cost effectiveness. In addition, this method allows homogeneous deposition of bone-like apatite within a porous implant. Although this was a relatively short-term study, treatment that creates a bioactive surface on titanium and titanium alloy implants has considerable promise for clinical application.

Treatment of osteomyelitis with antibiotic-soaked porous glass ceramic

We have developed a new drug delivery system using porous apatite-wollastonite glass ceramic (A-W GC) to treat osteomyelitis. A-W GC (porosity, 70% and 20% to 30%), or porous hydroxyapatite (HA) blocks (porosity 35% to 48%) used as controls, were soaked in mixtures of two antibiotics, isepamicin sulphate (ISP) and cefmetazole (CMZ) under high vacuum. We evaluated the release concentrations of the antibiotics from the blocks. The bactericidal concentration of ISP from A-W GC was maintained for more than 42 days, but that from HA decreased to below the detection limit after 28 days. The concentrations of CMZ from both materials were lower than those of ISP. An in vivo study using rabbit femora showed that an osseous concentration of ISP was maintained at eight weeks after implantation. Osteoconduction of the A-W GC block was good. Four patients with infected hip arthroplasties and one with osteomyelitis of the tibia have been treated with the new delivery system with excellent results.

Development of bioactive bone cement and its clinical applications

This paper is a summary of already published papers on the bioactive bone cement (BA cement) which consists of CaO-SiO2-P2O5-MgO-CaF2 (AW glass-ceramic) powder and bisphenol-a-glycidyl methacrylate (Bis-GMA) resin. Two types of BA cement, dough and injection type, were prepared by changing their chemical compositions slightly. They harden in a few minutes exhibiting much lower curing temperature than PMMA cement. They have significantly higher compressive, bending, and tensile strengths than PMMA cement and have a character of bonding directly with bone in 4-8 weeks in vivo. Intercalary prosthetic replacement of the femur and total prosthetic replacement of the hip were performed in dogs using either PMMA cement or BA cement. Mechanical tests demonstrated that fixation strengths of these prostheses with BA cement increased with time and were significantly greater than those with PMMA cement tested at any time. Results of histological examinations showed direct bonding between BA cement and bone, and that the bone trabeculae around BA cement mantle grew with time, while with PMMA cement an intervening soft tissue layer was always observed at the cement-bone interface. BA cement was used in a few aged patients to install a hip prosthesis either in cases of revision or femoral neck fracture. The longest follow-up period of the patient is 4 yrs. The patients have been doing well with no adverse effect of the cement to date.

Quantitative comparison of osteoconduction of porous, dense A-W glass-ceramic and hydroxyapatite granules (effects of granule and pore sizes).

The osteoconductive potentials of dense, small porous and large porous apatite- and wollastonite-containing glass-ceramic (A-W GC) granules of various sizes implanted in rat tibiae were evaluated quantitatively, by determining their affinity indices. The average affinity indices of all types of A-W GC were high. The dense A-W GC granules had the highest values (97.0+/-5.5%), followed by the large porous (87.1+/-8.4%) and then the small porous granules (79.0+/-8.4%). There were no significant differences among the osteoconductive potentials of the different sizes of each form of A-W GC granule. The osteoconductive potentials of four types of commercially available porous hydroxyapatite (HA) granules were compared with those of the small porous A-W GC granules, using the affinity index and the proportion of newly formed bone relative to that of the granules in the bone defect. The values of the former parameter for three types of HA and those of the latter for four were significantly inferior to those of A-W GC. The difference between the osteoconductive potentials of A-W GC and HA was considered to be related to the rate of surface apatite layer formation.

Effects of A-P translation and rotation on the wear of UHMWPE in a total knee joint simulator

We developed a three-channel total knee joint simulator and studied the effect of tibial anterior-posterior translation and internal/external rotation on the wear of polyethylene tibial inserts in total knee replacements (Anatomic Graduated Component knees). The wear rate was the lowest in experiment (Exp.) 1, without translation and rotation [1.74 mg/million (mg/Mc) cycles]. In Exp. 2, with +/-5 degrees tibial rotation added, the wear rate increased to 10.6 mg/Mc. In Exp. 3, with rotation and -12 mm tibial translation added, the wear rate was 15.1 mg/Mc, whereas in Exp. 4, with rotation and +12 mm tibial translation, the wear rate was 18.7 mg/Mc. Internal/external rotation and anterior-posterior translation added a 6- to 11-fold increase in the wear rates of tibial knee inserts. The shapes of the tibial wear tracks were rectangular and the area of the track increased when rotation and translation were added.

Effect of alumina femoral heads on polyethylene wear in cemented total hip arthroplasty

We examined the behaviour of alumina ceramic heads in 156 cemented total hip arthroplasties, at a minimum follow-up of eight years. They were divided into three groups according to the size of the femoral head; 22, 26, and 28 mm. We measured polyethylene wear radiologically using a computer-aided technique. The linear wear rate of polyethylene sockets for the 28 mm heads was high (0.156 mm/year), whereas those for the 22 and 26 mm heads were relatively low (0.090 and 0.098 mm/year, respectively). Moreover, the surface roughness data of retrieved femoral heads clearly showed maintenance of an excellent surface finish of the current alumina. We conclude that the alumina ceramic femoral heads currently used are associated with a reduced rate of polyethylene wear.