Abstract
Titania bone cement (TBC) reportedly has excellent in vivo bioactivity, yet its osteoconductivity in synovial fluid environments and bone-bonding ability in osteoporosis have not previously been investigated. We aimed to compare the osteoconductivity of two types of cement in a synovial fluid environment and determine their bone-bonding ability in osteoporosis. We implanted TBC and commercial polymethylmethacrylate bone cement (PBC) into rabbit femoral condyles and exposed them to synovial fluid pressure. Rabbits were then euthanized at 6, 12, and 26 weeks, and affinity indices were measured to evaluate osteoconductivity. We generated a rabbit model of osteoporosis through bilateral ovariectomy (OVX) and an 8-week treatment with methylprednisolone sodium succinate (PSL). Pre-hardened TBC and PBC were implanted into the femoral diaphysis of the rabbits in the sham control and OVX + PSL groups. Affinity indices were significantly higher for TBC than for PBC at 12 weeks (40.9 ± 16.8% versus 24.5 ± 9.02%) and 26 weeks (40.2 ± 12.7% versus 21.2 ± 14.2%). The interfacial shear strength was significantly higher for TBC than for PBC at 6 weeks (3.69 ± 1.89 N/mm2 versus 1.71 ± 1.23 N/mm2) in the OVX + PSL group. These results indicate that TBC is a promising bioactive bone cement for prosthesis fixation in total knee arthroplasty, especially for osteoporosis patients.
Highlights
Published: 27 February 2021Cemented total knee arthroplasty (TKA) is a prevalent surgery for knee deformities, but many issues remain unsolved
High-magnification scanning electron microscope (SEM) revealed that Titania bone cement (TBC) directly contacted bone at 26 weeks
Stevenel’s blue and van Gieson’s picrofuchsin double staining showed bone formation and contact around the cement to be of the same level in rabbits of both TBC and polymethylmethacrylate bone cement (PBC)
Summary
Published: 27 February 2021Cemented total knee arthroplasty (TKA) is a prevalent surgery for knee deformities, but many issues remain unsolved. There is always an intervening fibrous tissue, possibly leading to subsequent aseptic loosening [2,3,4,5]. To solve this issue, various types of bioactive bone cement have been developed [6,7,8,9]. PMMA cement containing bioactive titania fillers (TBC) has been demonstrated to have excellent osteoconductivity and bone-bonding ability in animal studies [10,11,12,13], and TBC has been demonstrated to have an excellent bone-bonding ability in canine total hip arthroplasty (THA) [14]. It was reported that titania with a specific crystal phase could form hydroxyapatite on the surface [15], and TBC exposed titania fillers on its surface, leading to direct bone-bonding [10]
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