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首页> 美国卫生研究院文献>Materials >New Insights into Osteointegration and Delamination from a Multidisciplinary Investigation of a Failed Hydroxyapatite-Coated Hip Joint Replacement
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New Insights into Osteointegration and Delamination from a Multidisciplinary Investigation of a Failed Hydroxyapatite-Coated Hip Joint Replacement

机译：从多学科调查失败的羟基磷灰石覆盖髋关节更换的多学科调查中的新洞察力和分层

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Hydroxyapatite (HA) coatings have become very popular in uncemented total hip arthroplasty (THA). Analysis of retrievals and tissue samples from an HA-coated femoral stem, which failed within 14 months after THA, provides exceptional insights into the failure mechanism, as well as the process of osteointegration of such an implant. Methods: Retrievals were photo-documented. Samples were examined by micro-computed tomography, X-ray diffraction (XRD) and embedded in polymethylmethacrylate for histology. Results: The coating had partially delaminated. The sandblasted surface of the stem was partially polished by the delaminated HA coating, indicating failure before revision. In the tissue samples, the HA coating was well integrated by newly formed bone trabeculae. No adverse biological reaction was observed. XRD analysis showed that residues of the HA coating were still present and could clearly be differentiated from the surrounding bone. Preferential orientation of the HA crystallites could be identified within the newly formed bone, representing a potential mechanical weakness induced either by physiologic strain or by the coating. Conclusion: current HA coatings, relatively thick and made of high crystallinity HA, may be prone to delamination, as also seen in our study. Recent efforts have aimed towards thinner (<1 μm) coatings with nanocrystalline HA structures that possibly relate to lower delamination risks. However, the question arises if HA coatings are beneficial since sandblasted non-coated stems offer similar results without the risk of delamination. XRD not only permits differentiation between the HA from the coating and the HA of the ongrown bone, it also provides new insights into the microstructure of this newly formed bone.
机译：羟基磷灰石（HA）涂层在未发布的总髋关节置换术（THA）中变得非常流行。从HA涂层股骨茎中的检索和组织样本分析，该股骨茎在THA后14个月内失败，提供了对失效机制的特殊洞察力，以及这种植入物的骨翘曲的过程。方法：检索是照片记录的。通过微计算断层扫描，X射线衍射（XRD），并嵌入在聚甲基丙烯酸甲酯中进行组织学检查样品。结果：涂层部分分层。茎的喷砂表面由分层的HA涂层部分抛光，在修改之前表明失败。在组织样品中，通过新形成的骨小梁，HA涂层整合。没有观察到不利的生物反应。 XRD分析表明，HA涂层的残留物仍然存在，并且可以清楚地与周围骨分化。可以在新形成的骨内鉴定HA微晶的优先取向，代表通过生理菌株或通过涂层诱导的潜在机械弱点。结论：目前的HA涂层，相对厚并由高结晶度HA制成，可能易于分层，如我们研究中也可以看到。最近的努力旨在较薄（<1μm）涂层，其中纳米晶的HA结构可能与较低的分层风险相关。然而，如果HA涂层有益，则出现问题，因为喷砂未涂覆的茎提供类似的结果而没有分层的风险。 XRD不仅允许HA之间的涂层与甲型骨骼的HA之间的差异，而且还提供了新形成的骨骼的微观结构的新见解。

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