Abstract
Direct energy deposition (DED) technology has gained increasing attention as a new implant surface technology that replicates the porous structure of natural bones facilitating osteoblast colonization and bone ingrowth. However, concerns have arisen over osteolysis or chronic inflammation that could be caused by Cobalt-chrome (CoCr) alloy and Titanium (Ti) nanoparticles produced during the fabrication process. Here, we evaluated whether a DED Ti-coated on CoCr alloy could improve osteoblast colonization and osseointegration in vitro and in vivo without causing any significant side effects. Three types of implant CoCr surfaces (smooth, sand-blasted and DED Ti-coated) were tested and compared. Three cell proliferation markers and six inflammatory cytokine markers were measured using SaOS2 osteoblast cells. Subsequently, X-ray and bone histomorphometric analyses were performed after implantation into rabbit femur. There were no differences between the DED group and positive control in cytokine assays. However, in the 5-bromo-2′-deoxyuridine (BrdU) assay the DED group exhibited even higher values than the positive control. For bone histomorphometry, DED was significantly superior within the 1000 µm bone area. The results suggest that DED Ti-coated metal printing does not affect the osteoblast viability or impair osseointegration in vitro and in vivo. Thus, this technology is biocompatible for coating the surfaces of cementless total knee arthroplasty (TKA) implants.
Highlights
Total knee arthroplasty (TKA) is a common procedure in orthopedics for treating end-stage osteoarthritis of the knee joint
The current cementless TKA implants are still limited by the lack of appropriate cell adhesion and osseointegration, leading to reduced lifespan of the implant [2,3,4]
The success of cementless TKA depends on biological and mechanical stability [2]
Summary
Total knee arthroplasty (TKA) is a common procedure in orthopedics for treating end-stage osteoarthritis of the knee joint. The current cementless TKA implants are still limited by the lack of appropriate cell adhesion and osseointegration, leading to reduced lifespan of the implant [2,3,4]. These are hurdles for widespread use of cementless TKA. The success of cementless TKA depends on biological (osseointegration between the implant and bone) and mechanical (rigid primary fixation, high stress shield) stability [2]. In the presence of micro-motion, an inflammatory reaction and fibrous tissue may develop rather than the ideal bony ingrowth, leading to aseptic loosening and mechanical failure of TKA [5]. Recent efforts have highlighted the importance of surface topography of materials and composites to better mimic the surface features of natural bone with biologically active porous coatings such as hydroxyapatite [2,3,6]
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