The Optimum Pore Size for the Fixation of Porous-Surfaced Metal Implants by the Ingrowth of Bone

Bobyn, J. D.; Pilliar, Robert M.; Cameron, Hugh U.; Weatherly, G. C.

doi:10.1097/00003086-198007000-00045

Cited by 710 publications

(369 citation statements)

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“…Porous tantalum is widely used in total hip reconstruction [4], especially for treatment of severe acetabular bone loss during revision hip arthroplasty [4,5,30,37,41]. High volumetric porosity (average 80%), fully interconnected pores, and a low modulus of elasticity (3 GPa) similar to cancellous bone all enhance the potential for bone ingrowth and allow for a more physiologic load transfer with diminished stress shielding [3,8]. Multiple studies have shown that tantalum cones provide stable fixation in the treatment of severe bone deficiencies in total knee revision during the short-term with documented osseointegration [9,18,21,23,24,26,[34][35][36]42], however, longer-term followup is needed to determine the durability of these reconstructions.…”

Section: Introductionmentioning

confidence: 99%

Tantalum Cones Provide Durable Mid-term Fixation in Revision TKA

Martino

Santis

Sculco

et al. 2015

Clin Orthop Relat Res

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Background Multiple studies have reported favorable short-term outcomes using tantalum cones to reconstruct massive bone defects during revision TKA. However, longer-term followup is needed to determine the durability of these reconstructions. Questions/purposes We wished to determine the midterm (1) reoperation rates for septic and aseptic causes, (2) radiologic findings of osseointegration, and (3) clinical outcomes based on the Knee Society score in patients who underwent revision knee arthroplasty with tantalum cones for severe bone loss. Methods We retrospectively evaluated records of 18 patients (18 knees) who underwent revision knee arthroplasty with use of tantalum cones between 2005 and 2008; the primary indications for use of this approach were to reconstruct massive bone defects classified as Anderson Orthopaedic Research Institute Types 2B and 3. During this period, all defects of this type were treated with this approach and no cones were used for more-minor defects. A total of 26 cones (13 tibial and 13 femoral) were implanted. There were 12 female and six male patients with a mean age of 73 years (range, 55-84 years) at the time of revision. The indication for the revision included aseptic loosening (five patients) and second-stage reimplantation for deep infection (13 patients). Patients were followed for a mean of 6 years (range, 5-8 years). No patient was lost to followup. Clinical and radiographic outcomes were assessed with the Knee Society clinical rating system and radiographic evaluation system.

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Section: Introductionmentioning

confidence: 99%

Tantalum Cones Provide Durable Mid-term Fixation in Revision TKA

Martino

Santis

Sculco

et al. 2015

Clin Orthop Relat Res

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“…We evaluated the in vivo performance of 19 human postmortem-retrieved clinically successful primary knee systems to better understand the biologic principles of skeletal fixation and the use of autograft bone chips in a unique porous-coated implant design. Previous studies [9,10,12,13,16] had not attempted to compare the amount of bone ingrowth with the amount of periprosthetic or host bone to understand connectivity with the skeleton. We therefore asked the following three questions: (1) Did the amount of bone ingrowth exceed the amount of periprosthetic and host bone with the addition of autograft bone chips?…”

Section: Discussionmentioning

confidence: 99%

Does Using Autograft Bone Chips Achieve Consistent Bone Ingrowth in Primary TKA?

Bloebaum

Koller

Willie

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background Cementless fixation remains controversial in TKA due to the challenge of achieving consistent skeletal attachment. Factors predicting durable fixation are not clearly understood, but we presumed bone ingrowth could be enhanced by the quantity of host bone and application of autograft bone chips. Questions/purposes We asked: (1) Did the amount of bone ingrowth exceed the amount of periprosthetic and host bone with the addition of autograft bone chips?(2) Did the amount of bone ingrowth increase with implantation time? And (3) did osteolysis along the porous-coated interface and screw tracts progress with implantation time? Methods We measured the amount of bone in the porouscoated, periprosthetic, and host bone regions in 19 postmortem retrieved cementless primary total knee implants. The amount of bone in apposition to the implant surface, and alternatively lysed bone, was analyzed radiographically to assess the progression of osteolysis. Results While bone ingrowth tended to be less than periprosthetic and host bone in all three components, it was only significantly less in the patellar component. Bone ingrowth increased in all three components over time, but progression of osteolysis did not. Conclusions Even after long-term followup, the amount of bone ingrowth did not surpass host bone levels, suggesting the amount of a patient's host bone is a limiting factor in the amount of bone ingrowth achievable for this cementless design. It remains unknown whether compromised osteopenic bone could achieve the amount of bone attachment necessary to provide durable fixation over time.

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“…An specific type of porosity is required in order to promote new bone formation infiltrated in the coating. A minimum pore size of approximately fifty micrometers is necessary for the growth of mineralized bone into a porous structure 9 . This size is needed for blood to penetrate the porous structure to allow the growing of the bone at depth of more than ≅100 µm.…”

Section: State-of-artmentioning

confidence: 99%

“…This size is needed for blood to penetrate the porous structure to allow the growing of the bone at depth of more than ≅100 µm. The optimum pore size required for implant fixation is considered to be in the range of 50-400 µm 9 and pore volume fraction usually in the range of 30 and 40% 10 . This condition represents a compromise between maintaining the coating strength and providing adequate pore size for tissue ingrowth.…”

Section: State-of-artmentioning

confidence: 99%

Porous Structure Characterization in Titanium Coating for Surgical Implants

Oliveira

Pereira

Cairo³

2002

Mat. Res.

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Powder metallurgy techniques have been used to produce controlled porous structures, such as the porous coatings applied for dental and orthopedic surgical implants, which allow bony tissue ingrowth within the implant surface improving fixation. This work presents the processing and characterization of titanium porous coatings of different porosity levels, processed through powder metallurgy techniques. Pure titanium sponge powders were used for coating and Ti-6Al-7Nb powder metallurgy rods were used as substrates. Characterization was made through quantitative metallographic image analysis using optical light microscope for coating porosity data and SEM analysis for evaluation of the coating/substrate interface integrity. The results allowed optimization of the processing parameters in order to obtain porous coatings that meet the requirements for use as implants.

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The Optimum Pore Size for the Fixation of Porous-Surfaced Metal Implants by the Ingrowth of Bone

Cited by 710 publications

References 0 publications

Tantalum Cones Provide Durable Mid-term Fixation in Revision TKA

Tantalum Cones Provide Durable Mid-term Fixation in Revision TKA

Does Using Autograft Bone Chips Achieve Consistent Bone Ingrowth in Primary TKA?

Porous Structure Characterization in Titanium Coating for Surgical Implants

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