http://sistemas.eel.usp.br/docentes/arquivos/2166002/1234Nb/Geetha-review2009.pdf

Ti based biomaterials, the ultimate choice for orthopaedic implants – A review

Background
The Danish National Patient Registry (DNPR) is one of the world’s oldest nationwide hospital registries and is used extensively for research. Many studies have validated algorithms for identifying health events in the DNPR, but the reports are fragmented and no overview exists.

/pdf/the-danish-national-patient-registry-a-review-of-content-1tblzc3eff.pdf

The Danish National Patient Registry: a review of content, data quality, and research potential.

Plasma-surface modification (PSM) is an effective and economical surface treatment technique for many materials and of growing interests in biomedical engineering This article reviews the various common plasma techniques and experimental methods as applied to biomedical materials research, such as plasma sputtering and etching, plasma implantation, plasma deposition, plasma polymerization, laser plasma deposition, plasma spraying, and so on The unique advantage of plasma modification is that the surface properties and biocompatibility can be enhanced selectively while the bulk attributes of the materials remain unchanged Existing materials can, thus, be used and needs for new classes of materials may be obviated thereby shortening the time to develop novel and better biomedical devices Recent work has spurred a number of very interesting applications in the biomedical field This review article concentrates upon the current status of these techniques, new applications, and achievements pertaining to biomedical materials research Examples described include hard tissue replacements, blood contacting prostheses, ophthalmic devices, and other products

/pdf/plasma-surface-modification-of-biomaterials-32bh4oj0o2.pdf

Plasma-surface modification of biomaterials

Platelet-rich fibrin (PRF) belongs to a new generation of platelet concentrates geared to simplified preparation without biochemical blood handling. In this initial article, we describe the conceptual and technical evolution from fibrin glues to platelet concentrates. This retrospective analysis is necessary for the understanding of fibrin technologies and the evaluation of the biochemical properties of 3 generations of surgical additives, respectively fibrin adhesives, concentrated platelet-rich plasma (cPRP) and PRF. Indeed, the 3-dimensional fibrin architecture is deeply dependent on artificial clinical polymerization processes, such as massive bovine thrombin addition. Currently, the slow polymerization during PRF preparation seems to generate a fibrin network very similar to the natural one. Such a network leads to a more efficient cell migration and proliferation and thus cicatrization.

/pdf/platelet-rich-fibrin-prf-a-second-generation-platelet-2xcx5nqnua.pdf

Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part I: technological concepts and evolution.

Understanding and controlling the bone-implant interface

https://onlinelibrary.wiley.com/doi/pdf/10.1002/jor.1100100216

Tissue ingrowth into titanium and hydroxyapatite-coated implants during stable and unstable mechanical conditions

The success of bone ingrowth into porous coated implants depends on several factors which can be separated into five main groups: implant related factors, such as design of implant, surface structure and pore characteristics. status of host bone bed, such as underlying disease (rheumatoid arthritis, osteoporosis), available bone stock, use of drugs and surgical technique. mechanical stabilization and loading conditions applied on the implant. adjuvant therapies such as bone grafting and HA coating which might enhance the amount of bone ingrowth. remodeling of periprosthetic bone. Once bone ingrowth has occurred, maintenance of bony anchorage depends on bone remodeling at the interface. The present series of studies were performed in order to investigate the effect of some of these factors on bone ingrowth in relation to hydroxyapatite (HA) and titanium alloy (Ti) coating when subjected to pathological and mechanical conditions mimicking the clinical situation. HA- and Ti-coated implants were inserted into the femoral condyles of mature dogs. The observation period ranged from 4 to 16 weeks, and the results were evaluated by mechanical push-out testing, histomorphometric analysis, polarized light microscopy, UV fluorescence microscopy, collagen analysis and transmission electron microscopy (microanalysis). There were no complications related to the operative procedures and all dogs were terminated according to the original time schedule. Host bone related factors were studied in the initial experiments. First, the effect of a gap between bone and implant was studied and compared with press-fit insertion. The HA-coating yielded superior effect on bone ingrowth compared to Ti in situations where the implant was surrounded by a gap and also where the implants were inserted in press-fit. Gaps of 1 mm and 2 mm around the implant were bridged by bone around HA implants whereas significantly less amounts of bone filled the gap around Ti implants. The gap-healing capacity of bone was increased even at a relatively great distance (400 microns) from the HA surface. This finding indicates that the osteoconductive effect of HA is not limited to the bone forming capacity on the surface of the implant. A positive gradient of newly formed bone was found towards the HA-coating, this gradient not being found towards the Ti-coating. In order to investigate the significance of arthritic bone changes (osteopenia) on fixation of porous coated implants we adopted the Carragheenin-induced gonarthritis model resulting in substantial bone loss as determined by CT-scanning.(ABSTRACT TRUNCATED AT 400 WORDS)

https://www.tandfonline.com/doi/pdf/10.3109/17453679309155636

Hydroxyapatite ceramic coating for bone implant fixation. Mechanical and histological studies in dogs.

In previous studies, we have demonstrated a fibrocartilaginous membrane around hydroxyapatite-coated implants subjected to micromovement in contrast to the fibrous connective tissue which predominates around similarly loaded titanium alloy implants. In the present study, in mature dogs, we investigated the effect of immobilising titanium (Ti)- or hydroxyapatite (HA)-coated implants already surrounded by a movement-induced fibrous membrane and compared the results with those of similar implants in which continuous micromovement was allowed to continue. The implants were inserted in the medial femoral condyles of 14 dogs and subjected to 150 microns movements during each gait cycle. After four weeks (when a fibrous membrane had developed), half the implants were immobilised to prevent further micromovement. The dogs were killed at 16 weeks and the results were evaluated by push-out tests and histological analysis. The continuously loaded Ti-coated implants were surrounded by a fibrous membrane, whereas bridges of new bone anchored the HA-coated implants. The immobilised implants were surrounded by bone irrespective of the type of coating. Push-out tests of the continuously loaded implants showed better fixation of those with HA coating (p < 0.001). The immobilised Ti-coated implants had four times stronger fixation than did continuously loaded Ti-coated implants (p < 0.01) but there was no equivalent difference between the two groups of HA-coated implants. The amount of bone ingrowth was greater into immobilised HA-coated implants than into immobilised Ti-coated implants (p < 0.01). Two-thirds of the HA coating had been resorbed after 16 weeks of implantation, but 25% of this resorbed HA had been replaced by bone.(ABSTRACT TRUNCATED AT 250 WORDS)

Hydroxyapatite coating converts fibrous tissue to bone around loaded implants

Background Postoperative pain after total knee arthroplasty (TKA) can be difficult to manage and may delay recovery. Recent studies have suggested that periarticular infiltration with local anesthetics may improve outcome.Methods 80 patients undergoing TKA under spinal anesthesia were randomized to receive continuous femoral nerve block (group F) or peri- and intraarticular infiltration and injection (group I). Group I received a solution of 300 mg ropivacaine, 30 mg ketorolac, and 0.5 mg epinephrine by infiltration of the knee at the end of surgery, and 2 postoperative injections of these substances through an intraarticular catheter.Results More patients in group I than in group F could walk < 3 m on the first postoperative day (29/39 vs. 7/37, p < 0.001). Group I also had significantly lower pain scores during activity and lower consumption of opioids on the first postoperative day. No differences between groups were seen regarding side effects or length of stay.Interpretation Peri- and intraarticular ...

https://ccme.osu.edu/RSSeriesBrochure/22599%20-%20Comparison%20of%20peri%20and%20intraarticular%20analgesia.pdf

Comparison of peri- and intraarticular analgesia with femoral nerve block after total knee arthroplasty: a randomized clinical trial.

Structural allograft healing is limited because of a lack of vascularization and remodeling. To study this we developed a mouse model that recapitulates the clinical aspects of live autograft and processed allograft healing. Gene expression analyses showed that there is a substantial decrease in the genes encoding RANKL and VEGF during allograft healing. Loss-of-function studies showed that both factors are required for autograft healing. To determine whether addition of these signals could stimulate allograft vascularization and remodeling, we developed a new approach in which rAAV can be freeze-dried onto the cortical surface without losing infectivity. We show that combination rAAV-RANKL- and rAAV-VEGF-coated allografts show marked remodeling and vascularization, which leads to a new bone collar around the graft. In conclusion, we find that RANKL and VEGF are necessary and sufficient for efficient autograft remodeling and can be transferred using rAAV to revitalize structural allografts.

/pdf/remodeling-of-cortical-bone-allografts-mediated-by-adherent-ifkcwm2kib.pdf

Kjeld Søballe

Papers

Tissue ingrowth into titanium and hydroxyapatite-coated implants during stable and unstable mechanical conditions

Hydroxyapatite ceramic coating for bone implant fixation. Mechanical and histological studies in dogs.

Hydroxyapatite coating converts fibrous tissue to bone around loaded implants

Comparison of peri- and intraarticular analgesia with femoral nerve block after total knee arthroplasty: a randomized clinical trial.

Remodeling of cortical bone allografts mediated by adherent rAAV-RANKL and VEGF gene therapy