Abstract
The success of osseointegrated transcutaneous prostheses depends on a soft-tissue seal forming at the skin-implant interface in order to prevent infection. Current designs include a flange with drilled holes or a subdermal barrier with a porous coating in an attempt to promote soft-tissue attachment. However, the soft-tissue seal is not reliably achieved despite these designs and infection remains a significant problem. This study investigated soft-tissue integration into fully porous titanium alloy structures with interconnected pores. The study aimed to determine the effect of altering pore and strut size combinations on soft-tissue ingrowth into porous titanium alloy structures in vivo. It was hypothesized that implants with a more open porous structure with larger pore sizes would increase soft-tissue ingrowth more than less open porous structures. Porous titanium alloy cylinders were inserted into sheep paparaspinal muscles (n = 6) and left in situ for four weeks. A histological assessment of soft-tissue ingrowth was performed. Percentage soft-tissue pore fill, cell nuclei density and blood vessel density were quantified. The results showed that larger pore sizes were supportive of soft-tissue ingrowth. A structure with a pore size of 700μm and a strut size of 300μm supported revascularisation to the greatest degree. A flange with this structure may be used in future studies of osseointegrated transcutaneous prostheses in order to enhance the soft-tissue seal.
Highlights
In the United Kingdom, the number of new referrals to prosthetic services annually has increased from 4957 in 2007 to 5988 in 2011[1]
Ponader et al [9] suggest successful infiltration with bone tissue can be achieved with a pore diameter of 450μm, which is significantly smaller than the 1000μm and 700μm diameter pores successful in this study
The results from this study allow soft-tissue infiltration to be optimised as a function of pore and strut diameter
Summary
In the United Kingdom, the number of new referrals to prosthetic services annually has increased from 4957 in 2007 to 5988 in 2011[1]. Amputees are fitted with a socket, to which an artificial limb is attached. The stump-socket interface may cause problems that restrict socket use. Uneven pressure distribution over the stump may lead to pain, tissue abrasion, pressure sores, necrosis and limb disuse. The unnatural microbial environment allows the development of infection [2,3].
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