Osseointegration: a review of the fundamentals for assuring cementless skeletal fixation

Abstract

Direct skeletal fixation, termed osseointegration, has expanded in the last century and includes use in total joint replacements, the edentulous mandible and maxilla, and percutaneous osseointegrated prosthetics. Although it is well known that titanium and bone have the ability to form a durable bone-implant interface, new applications have emerged in the field of orthopedics, which requires a more thorough assessment of the literature. This review aims to introduce the basic biological principles for attaining osseointegration and discusses the major factors for assuring successful cementless fixation.

Evaluation of the milling technique on the component‐bone interface in the TATE elbow

“…Only the lateral aspect of the humeral component achieved interface gap values consistently less than 50 μm, which is in line with recommendations for arthroplasty in man . Applying proximal or distal force to the milling arm significantly increased the interface gap for most of the angles that were measured on all component aspects other than the medial humerus.…”

“…In another study, a bone‐implant gap exceeding 500 μm had a negative impact on osseointegration . A review article advises a bone‐implant gap of < 50 μm to limit fibrous tissue formation in man . To the best of the authors' knowledge, studies evaluating the effect of bone‐implant gap on osseointegration of cementless implants in dogs are lacking.…”

TI-6AL-4V alloy and β-tricalcium phosphate-based systems for in vitro study of mesenchymal stem cell functions at implant–tissue interface

“…Ingrowth and direct structural and functional integration of new bone tissue with the surface of the implant is defined as osseointegration [26][27][28]. This process, which includes a series of biological events resembling direct fracture healing, mainly relies on the proper functions of MSC [29].…”

Rehabilitation programs after the implantation of transfemoral osseointegrated fixations for bone-anchored prostheses: a systematic review protocol

“…[50,67,68] Isaacson and Jeyapalina presented a review introducing the basic biological principles for attaining osseointegration and discusses the major factors for assuring successful cementless fixations. [69] More recently, Van Eck et al performed the first attempt to systematically review clinical outcomes of boneanchored prostheses and confirmed that this method of attachment can result in a good quality of life and patient reported outcomes. [57] Need for a systematic comparative analysis of rehabilitation programs By definition, the success of bone-anchored prostheses relates to surgical procedures and subsequent rehabilitation programs.…”

“…An initial limited search of Medline/Pubmed has been undertaken to identify articles on this topic, followed by analysis of the text words contained in the titles and abstracts, and of the index terms used to describe these articles. [8,19,57,68,69] This informed the development of a search strategy including identified keywords and index terms which will be tailored for each information source. Furthermore, individual search strategy will be done for each database following using specific descriptors.…”