Resurfacing of the humeral head: An analysis of the bone stock and osseous integration under the implant

Schmidutz, Florian; Sprecher, Christoph M.; Milz, Stefan; Gohlke, Frank; Hertel, R.; Braunstein, Volker

doi:10.1002/jor.22902

Cited by 18 publications

(23 citation statements)

References 39 publications

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“…In this case, the BIC index of 32% compares favorably with previously published data for non‐infected shoulder prosthesis of other types, without porous tantalum. The value described in this study is higher than the mean of 20.5 ± 5.8% SD observed in retrieved resurfacing prosthetic components implanted in the proximal humerus …”

Section: Discussioncontrasting

confidence: 71%

“…These values consider only the open cell structure available to ingrowth, the metallic structure already being deduced. This is at least comparable to the mean 9.2% ± 3.2% SD relative bone area observed in the proximal humerus of retrieved non‐porous resurfacing prosthetic components . The open cell structure of the porous tantalum however offers space for tissue ingrowth, not only ongrowth, possibly reinforcing anchorage of the implant through interdigitation with the surrounding cancellous bone.…”

Section: Discussionsupporting

confidence: 70%

“…While bone density values are only known for the proximal humerus, not the glenoid, the bone ingrowth observed into the porous tantalum was good and certainly higher to the values observed in osteoporotic bone . The relative bone area observed in native bone of the proximal humerus varies greatly in adults, ranging 10–30% . Lower values are observed in case of osteoporosis, and then the cancellous bone is primarily affected .…”

Section: Discussionmentioning

confidence: 91%

“…One section was first subject to surface etching with 1% formic acid and then stained with a heated 15% Giemsa solution (Fluka, Sigma‐Aldrich Chemie, Buchs, Switzerland), rinsed with distilled water, counterstained with a 1% Eosin solution (Sigma‐Aldrich Chemie, Buchs, Switzerland), and finally differentiated and air dried. This section was microscopically photographed on an AxioTech microscope (Carl Zeiss, Munich, Germany) with combined transmitted and reflected illumination as previously described to reduce slice thickness artefacts . Bone implant contact as well as bone density were analyzed with a color image analysis system (AxioVision V 4.8.2. and KS400, Carl Zeiss, Munich, Germany).…”

Section: Methodsmentioning

confidence: 99%

“…Bone implant contact as well as bone density were analyzed with a color image analysis system (AxioVision V 4.8.2. and KS400, Carl Zeiss, Munich, Germany). The measurements determined the relative bone area (area covered by bone/total open area of the porous structure) and quantified the amount of bone at the interface (bone implant contact (BIC) index, length at the interface with direct bone contact/total length of the interface) . The BIC is determined along a straight line at the interface between the implant and bone, and does not consider the porosity of the material.…”

Section: Methodsmentioning

confidence: 99%

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Successful bony integration of a porous tantalum implant despite longlasting and ongoing infection: Histologic workup of an explanted shoulder prosthesis

et al. 2018

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Infection associated with an implant is a complication feared in surgery, as it leads to loosening and dysfunction. This report documents an unexpected good bony integration of a porous tantalum shoulder prosthesis despite infection. A shoulder prosthesis with a porous tantalum glenoidal base plate was retrieved after 3 years of ongoing infection with Staphylococcus spp. Methyl-methacrylate embedded sections of the retrieved glenoidal component were analyzed by optical and scanning electron beam microscopy (SEM). Bone ongrowth and ingrowth were quantified. Bone had formed at the implant surface and within the open cell structure of the porous tantalum. The bone implant contact index was 32%. The bone ingrowth or relative bone area within the open structure was 8.2%, respectively 11.9% in the outer 50% of the thickness. Due to the section thickness, bone ongrowth could best be documented in SEM. Despite long-lasting and ongoing infection, the glenoidal base plate of the prosthesis showed good bony integration upon removal. The bone ingrowth into the porous tantalum was comparable to the values previously reported for the undersurface of retrieved proximal humerus resurfacing implants. Good integration of the implant however did not solve the problem of infection, and related morbidity. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 2924-2931, 2018.

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Section: Discussioncontrasting

confidence: 71%

Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 91%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 3 more Smart Citations

Successful bony integration of a porous tantalum implant despite longlasting and ongoing infection: Histologic workup of an explanted shoulder prosthesis

et al. 2018

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In vitro and in vivo evaluation of the osseointegration capacity of a polycarbonate‐urethane zirconium‐oxide composite material for application in a focal knee resurfacing implant

van Hugten,

Jeuken,

Asik

et al. 2024

J Biomedical Materials Res

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Currently available focal knee resurfacing implants (FKRIs) are fully or partially composed of metals, which show a large disparity in elastic modulus relative to bone and cartilage tissue. Although titanium is known for its excellent osseointegration, the application in FKRIs can lead to potential stress‐shielding and metal implants can cause degeneration of the opposing articulating cartilage due to the high resulting contact stresses. Furthermore, metal implants do not allow for follow‐up using magnetic resonance imaging (MRI).To overcome the drawbacks of using metal based FKRIs, a biomimetic and MRI compatible bi‐layered non‐resorbable thermoplastic polycarbonate‐urethane (PCU)‐based FKRI was developed. The objective of this preclinical study was to evaluate the mechanical properties, biocompatibility and osteoconduction of a novel Bionate® 75D ‐ zirconium oxide (B75D‐ZrO2) composite material in vitro and the osseointegration of a B75D‐ZrO2 composite stem PCU implant in a caprine animal model. The tensile strength and elastic modulus of the B75D‐ZrO2 composite were characterized through in vitro mechanical tests under ambient and physiological conditions. In vitro biocompatibility and osteoconductivity were evaluated by exposing human mesenchymal stem cells to the B75D‐ZrO2 composite and culturing the cells under osteogenic conditions. Cell activity and mineralization were assessed and compared to Bionate® 75D (B75D) and titanium disks. The in vivo osseointegration of implants containing a B75D‐ZrO2 stem was compared to implants with a B75D stem and titanium stem in a caprine large animal model. After a follow‐up of 6 months, bone histomorphometry was performed to assess the bone‐to‐implant contact area (BIC). Mechanical testing showed that the B75D‐ZrO2 composite material possesses an elastic modulus in the range of the elastic modulus reported for trabecular bone. The B75D‐ZrO2 composite material facilitated cell mediated mineralization to a comparable extent as titanium. A significantly higher bone‐to‐implant contact (BIC) score was observed in the B75D‐ZrO2 implants compared to the B75D implants. The BIC of B75D‐ZrO2 implants was not significantly different compared to titanium implants. A biocompatible B75D‐ZrO2 composite approximating the elastic modulus of trabecular bone was developed by compounding B75D with zirconium oxide. In vivo evaluation showed an significant increase of osseointegration for B75D‐ZrO2 composite stem implants compared to B75D polymer stem PCU implants. The osseointegration of B75D‐ZrO2 composite stem PCU implants was not significantly different in comparison to analogous titanium stem metal implants.

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Radiolucency in stemless shoulder arthroplasty is associated with an imaging phenomenon

et al. 2017

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Stemless humeral implants show comparable midterm clinical results compared to stemmed components. Recently, radiolucencies around the metaphyseal seating of humeral stemless implants were reported on postoperative radiographs. It is controversial whether they are attributable to bone resorption. We hypothesized these radiolucencies result from imaging artifacts. Seven cadaveric specimens (three male and four female) were first radiographed and then scanned with CT. A stemless humeral component of current design was implanted in each specimen. After implantation, all specimens were radiographed with different exposure settings. The implant was removed, and the specimens were scanned with CT again. Pre- and post-implantation radiographs and CT scans were compared. The mean Hounsfield units (HU) at the humeral resection plane from the pre-implantation CT were correlated with the diameter of the radiolucent halo on the post-implantation radiographs. A symmetric radiolucent halo of variable diameters occurred on all radiographs after implantation when an automatic exposure control was used. The halo disappeared in all specimens when the tube voltage was reduced. Lower CT-values (HU) before the implantation resulted in greater halos on the radiograph after implantation. Symmetric radiolucent halos can result from imaging artifacts, which is most likely due to radiation scatter. The halos can be minimized by reducing the tube voltage. The halo effect appears to be pronounced in bones with decreased density. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2040-2050, 2017.

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Resurfacing of the humeral head: An analysis of the bone stock and osseous integration under the implant

Cited by 18 publications

References 39 publications

Successful bony integration of a porous tantalum implant despite longlasting and ongoing infection: Histologic workup of an explanted shoulder prosthesis

Successful bony integration of a porous tantalum implant despite longlasting and ongoing infection: Histologic workup of an explanted shoulder prosthesis

In vitro and in vivo evaluation of the osseointegration capacity of a polycarbonate‐urethane zirconium‐oxide composite material for application in a focal knee resurfacing implant

Radiolucency in stemless shoulder arthroplasty is associated with an imaging phenomenon

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