Abstract
BackgroundIn joint prosthetic surgery, various methods are used to provide implant stability. We used an injectable bone substitute, composed of calcium sulfate/hydroxyapatite, as bone defect filler to stabilize a tibia prosthesis in an experimental rabbit model. The aim of the study was to investigate and compare the stability of prosthetic fixation with and without the use of an injectable bone substitute.MethodsSixteen rabbits were used and the tibia prostheses were implanted bilaterally, one side with the prosthesis alone and the other side with the prosthesis and calcium sulfate/hydroxyapatite (Cerament™). The rabbits were randomly divided into two groups and euthanized after 6 and 12 weeks, respectively. The prosthesis was extracted measuring the pull-out force in an Instron tester, and the bone surrounding the former prosthesis site was analyzed by histology, histomorphometry, and micro-computed tomography.ResultsAt 6 weeks no difference in maximum pull-out force was found between the prostheses fixed with or without Cerament™. At 12 weeks the maximum pull-out force for the prostheses with Cerament™ was significantly higher than that for the prostheses without Cerament™ (p = 0.04). The maximum pull-out force at 12 weeks was significantly higher than that at 6 weeks for the prostheses fixed with Cerament™ (p = 0.03) but not for the prostheses without.ConclusionWe conclude that early prosthesis-bone interface strength is not influenced by a bone substitute. However, during remodeling, the bone substitute might provide improved mechanical support for the prosthesis. The results support further studies of the use of injectable calcium sulfate/hydroxyapatite in fixation of prosthetic joint implants.
Highlights
The gold standard for restoring bone defects is still considered to be autologous bone graft
The selection of an appropriate bone graft is influenced by the size of the bone defect, the biological prerequisites of the bone graft site, and whether the graft is required for structural support
We used injectable calcium sulfate/hydroxyapatite bone substitute [5,6] containing (1) a fast-resorbing calcium sulfate, allowing for a fast replacement of the bone substitute with new-forming bone [7], and (2) a hydroxyapatite component acting as a long-term osteo conductive matrix embedded into the forming bone tissue [8,9], providing mechanical support for the prosthesis during remodeling. We evaluate this biphasic material in a primary tibia prosthesis model in rabbits, a model previously used to study morsellized bone graft [10]
Summary
The gold standard for restoring bone defects is still considered to be autologous bone graft. In primary and revision arthroplasties, alternatives include allografts, bone cement, or the use of longstemmed prostheses [1,2]. Alternatives have been tried defects in order to provide stability and support during the whole remodeling period. The selection of an appropriate bone graft is influenced by the size of the bone defect, the biological prerequisites of the bone graft site, and whether the graft is required for structural support. Various methods are used to provide implant stability. We used an injectable bone substitute, composed of calcium sulfate/hydroxyapatite, as bone defect filler to stabilize a tibia prosthesis in an experimental rabbit model. The aim of the study was to investigate and compare the stability of prosthetic fixation with and without the use of an injectable bone substitute
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