Abstract
We present the new fixation method for RHA (resurfacing hip arthroplasty) endoprostheses by means of the biomimetic multispiked connecting scaffold (MSC-Scaffold). Such connecting scaffold can generate new type of RHA endoprostheses, that is stemless and fixed entirely without cement. The preprototypes of this MSC-Scaffold were manufactured with modern additive laser additive technology (SLM). The pilot surgical implantations in animal model (two laboratory swine) of MSC-Scaffold preprototypes have showed after two months neither implant loosening, migration, and nor other early complications. From the results of performed histopathological evaluation of the periscaffold spikes bone tissue and 10-day culture of human osteoblasts (NHOst) we can conclude that (1) the scaffolding effect was obtained and (2) to improve the osseointegration of the scaffold spikes, their material surface should be physicochemically modified (e.g., with hydroxyapatite). Some histopathological findings in the periscaffold domain near the MSC-Scaffold spikes bases (fibrous connective tissue and metallic particles near the MSC-Scaffold spikes bases edges) prompt considering the necessity to optimize the design of the MSC-Scaffold in the regions of its interspike space near the spikes bases edges, to provide more room for new bone formation in this region and for indispensable post-processing (glass pearl blasting) after the SLM manufacturing.
Highlights
It is estimated that about 1.3 million endoprostheses are implanted in the world yearly [1]
Numerous osteoblasts on bone trabeculae surfaces were noted in periscaffold bone tissue histological sections prepared from bone fragments containing implants harvested in the 6th week after the surgery, which means that the osteogenesis process is still running (Figure 10)
The worldwide accepted standard fixation method for resurfacing hip arthroplasty (RHA) endoprostheses is a hybrid technique consisting in fixing the short-stem femoral component with cement in combination with an uncemented acetabular component
Summary
It is estimated that about 1.3 million endoprostheses are implanted in the world yearly [1]. The main indication for joint replacement is the degenerative disease of articular cartilage (osteoarthrosis, osteoarthritis (OA)). The treatment of choice is the ill-joint replacement with endoprosthesis, that is, the arthroplasty. Because of the degenerated articular cartilage, removed during the hip arthroplasty is this damaged cartilage and, some (often large) part the healthy periarticular trabecular bone of the head and the neck of the femur. Removed cartilage and bone tissue are replaced by a metal artificial joint construction—see the commonly used longstem endoprostheses of hip or other joints. Due to the significant differences (10–100x higher) in values of the elastic parameters of endoprostheses metal alloys compared with those of cancellous bone, the bone surrounding the endoprostheses practically does not transfer in the periarticular bone region mechanical loads (stress shielding phenomenon)—it results in nonphysiological load transmission and in atrophy and extensive destruction of surrounding periprosthetic bone, loosening and migration of elements of endoprostheses, and even bone fractures [3]
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