Titanium-interlayer Mediated Hydroxyapatite Coating on Polyetheretherketone: A Prospective Study in Patients with Single-level Cervical Degenerative Disc Disease

Abstract

Currently, there are limited reports regarding investigation of the biological properties of polyetheretherketone (PEEK) coated with titanium (Ti) and hydroxyapatite (HA) in human. The objective of this study is to evaluate the in vivo response of the PEEK cages coated with Ti and HA versus uncoated PEEK cages after anterior cervical discectomy and fusion (ACDF) in patients with single-level cervical degenerative disc disease (CDDD). Twenty-four patients with PEEK cages coated with Ti and HA (PEEK/Ti/HA group) were matched one-to-one with patients with uncoated PEEK cages (PEEK group) based on age, gender, and operative segment. All patients had been followed up for more than 2 years. Radiological assessments included intervertebral height (IH), C2-7 angle(C2-7a), segmental alignment (SA), and fusion rate. Clinical parameters included Visual Analogue Scale (VAS) and Japanese Orthopedic Association (JOA) scores. There was no statistical difference in SA, IH, and C2-7a between the two groups before and after surgery and all these parameters were restored postoperatively. The fusion rate of PEEK/Ti/HA group was significantly higher than PEEK group at 3-month post-operation (87.5% vs. 62.5%). At the last follow-up, the fusion rate of the both groups achieved 100%. The VAS and JOA scores were comparable between two groups and improved postoperatively. In conclusion, in patients with single-level ACDF, PEEK cage coated with Ti and HA provided a higher fusion rate than uncoated PEEK cage at 3-month post-operation, while both of the two cages could achieve solid osseous fusion at the last follow up. Compared with the uncoated PEEK cage, PEEK/Ti/HA cage yielded similar favorable segmental and overall cervical lordosis, IH, and clinical outcomes after the surgery.

A novel nanohydroxyapatite/polyamide-66 cage for reducing the subsidence rate after single-level anterior cervical discectomy and fusion: a comparative study of 7-year follow-up

“…All surgeries for all patients in this study were accomplished by the same surgeon and by following standard surgical procedures [4,16]. All procedures were performed in supine position and through a transverse skin incision on the right side of the neck.…”

Modification of polyetheretherketone implants: From enhancing bone integration to enabling multi-modal therapeutics

“…Henceforward, PEEK has received increasing interest in the biomedical field owning to its outstanding performances in mechanical strength [12], thermal/chemical stability [13], and nontoxicity [14]. Nowadays, PEEK is of great interest as an alternative material to the commonly used Ti and its alloys [10], and are seeing increasing applications in biomedical devices such as intervertebral fusion device [15], fixation devices [16], skull [17], knee joints [18], hip joints [19], dental implants [20], etc. Fig 1 and Table 1 provide a brief summary on the recent applications of PEEK in the field.…”

“…Intervertebral fusion device, Reproduced with permission. [15] Copy right 2020 Springer Nature; Fixation devices, Reproduced with permission. [16] Copy right 2020 Elsevier; skull repair, Reproduced with permission.…”

Surface modifications to promote the osteoconductivity of ultra‐high‐molecular‐weight‐polyethylene fabrics for a novel biomimetic artificial disc prosthesis: An in vitro study

“…22,23 Several in vivo studies have shown an increase in bone ingrowth for implants coated with HA or CaP. 24,25 However, there are also concerns with plasma-sprayed coatings. Some studies have shown there is a risk of delamination of the coating from the surface of the implant, resulting in clinical implant failure due to the micromotion caused by debris and loose particles.…”

“…The implant surface can also be chemically altered by applying calcium phosphate (CaP) and hydroxyapatite (HA) coatings, which allow for a chemical bonding between the implant and bone surfaces due to the chemical similarities of bone and CaP and HA 22,23 . Several in vivo studies have shown an increase in bone ingrowth for implants coated with HA or CaP 24,25 . However, there are also concerns with plasma‐sprayed coatings.…”