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PubMed2002

Complications of motility peg placement for porous hydroxyapatite orbital implants.

AIM: To evaluate the complications associated with pegging of porous hydroxyapatite orbital implants. METHODS: Complications associated with pegging were retrospectively reviewed from the charts of 100 of 133 patients with hydroxyapatite implantation from 1993 to 2000. RESULTS: 48 (48%) of the 100 hydroxyapatite implanted patients who had undergone pegging were found to have problems with their pegs, including discharge (45.8%), peg falling out (20.8%), pyogenic granulomas (16.7%), popping peg (14.6%), hydroxyapatite visible around peg hole (8.3%), part of peg shaft visible (6.2%), peg drilled off centre (6.2%), peg drilled at an angle (4.2%), and excess movement of peg (4.2%). The standard peg fell out statistically more often than the peg and sleeve system (Yates's corrected chi(2), p=0.038). There was a trend towards complications of the peg with use of a standard peg (versus sleeved peg) (p=0.226). CONCLUSIONS: There are several potential complications of pegging. Most complications are minor and can be managed successfully.

Adolescent↗
PubMedDate not supplied

Measurements of the wettability of protein-covered hydroxyapatite surfaces.

We developed a new method (dropping time method, DTM) to investigate the wettability of a surface of a protein layer adsorbed on glass plates in aqueous solution. However, the previous setup of DTM can only be utilized for optically transparent materials. In this study, we have extended the method to optically nontransparent materials such as hydroxyapatite plates. DTM is based on measuring the dropping time of a liquid film along a protein-covered surface when this surface is instantaneously vertically removed from the protein solution. The intensity of the reflected light beam depends on the presence of a liquid film on the surface. This allows to estimate the movement of the liquid film along the sorbent surface. Thus, the extended DTM can be used for determining the wettability of optically nontransparent solid plates. The adsorption behavior of four proteins (albumin, lysozyme, beta-lactoglobulin, ovalbumin) on a hydrophobic hydroxyapatite plate in water was studied by this method. When adsorbed from a protein solution of high concentration, the surfaces of adsorbed proteins, except ovalbumin, were fairly hydrophilic; this hydrophilicity was already attained at the initial stage of the adsorption process. The surface of ovalbumin on hydroxyapatite was more hydrophobic than those of the other proteins, and the hydrophilicity increased with the protein adsorption process. At low protein concentration, the hydrophilicity increased in the course of the adsorption process. The change in hydrophilicity with time depends on the kind of protein. Hen's egg lysozyme is more hydrophilic and the time to reach saturation is shorter than for the other proteins. The processes of increasing hydrophilicity of the surface of human serum albumin, beta-lactoglobulin and ovalbumin are similar. However, for beta-lactoglobulin hydrophobicity at adsorption saturation is stronger than for human serum albumin and ovalbumin. Thus, using DTM it is shown that the hydrophilicity of the surface of adsorbed protein on hydroxyapatite depends strongly on the kind of protein.

Adsorption↗
PubMed2006

Optical imaging of hydroxyapatite in the calcified vasculature of transgenic animals.

OBJECTIVE: To detect the hydroxyapatite component of vascular calcification in vivo so that the process of calcium deposition can be studied in transgenic model systems. METHODS AND RESULTS: We have previously developed a near-infrared fluorescent bisphosphonate derivative that binds with high affinity and specificity to hydroxyapatite, and an intraoperative near-infrared fluorescence imaging system for small animals. Using these tools, and a transgenic mouse strain with homozygous deletion of the matrix GLA protein (Mgp(-/-)), we demonstrate that the hydroxyapatite component of vascular calcification can be detected in vivo with high sensitivity, specificity, and resolution. CONCLUSIONS: The hydroxyapatite component of vascular calcification can be detected optically, in real-time, without sacrifice of the animal. It is now possible to study the earliest events associated with vascular mineralization, at the cell and organ level, and to monitor the process in living animals.

Animals↗
PubMed2004

Use of injectable hydroxyapatite in the secondary setting to restore glottic competence after partial laryngectomy with arytenoidectomy.

Hydroxyapatite cement is a calcium phosphate putty, approved by the US Food and Drug Administration, that solidifies in 20 minutes and gains bone-like stability after 4 to 6 hours. It has been used for craniofacial reconstruction, spinal stabilization, and ossicular reconstruction. This is the first report of use of injectable hydroxyapatite to rebuild soft and hard tissue defects of the larynx after partial laryngeal surgery. Hydroxyapatite was injected in 4 patients to address glottic incompetence after partial laryngectomy. The patients were dependent on tracheotomy and/or gastrostomy tubes. Some had failed prior corrective surgeries. All of the operations were performed endoscopically and gave immediate improvement of glottic incompetence. All 4 patients reported improved symptoms. Three were able to have gastrostomy tubes removed, 1 was decannulated, and 1 had improved voice. In conclusion, hydroxyapatite injection is a technically simple procedure to restore glottic competence that may obviate the need for an open procedure.

Biocompatible Materials↗
PubMed2003

Correction of large (>25 cm(2)) cranial defects with "reinforced" hydroxyapatite cement: technique and complications.

INTRODUCTION: Hydroxyapatite cement is both biocompatible and osteoconductive, and it lacks significant toxic or immunogenic properties, making it an ideal substrate for the repair of cranial defects. However, with its putty-like composition, the repair of large cranial defects can be difficult because significant settling occurs as the cement hardens. We describe a technique in which we use hydroxyapatite cement, reinforced with tantalum mesh and titanium miniplates, for the repair of large (>25 cm(2)) cranial defects. METHODS: After the margins of the cranioplasty are delineated, tantalum mesh is placed under the edges of the defect. Titanium miniplate single-hole bars are used to criss-cross the defect and are then secured to the surrounding bone with screws. The mesh is secured to the bars with 28-gauge stainless steel wire. Hydroxyapatite cement is applied in the defect and contoured appropriately. RESULTS: We performed nine cranioplasties in eight patients ranging in age from 1.5 to 35 years (mean, 12.2 +/- 10.1 yr). The reasons for cranioplasty included cranial defect from prior trauma (n = 4), fibrous dysplasia (n = 2), infected bone flaps (n = 2), and tumor (n = 1). The cranioplasties ranged in size from 40 to 196 cm(2) (mean, 128.3 +/- 56.9 cm(2)). Follow-up ranged from 2 to 33 months (mean, 11.4 +/- 12.8 mo). Two cranioplasty constructs were removed at 1 and 3 months postoperatively owing to infection. CONCLUSION: The use of hydroxyapatite cement with mesh and miniplates provides internal structural support and increased stability of the construct. Although this technique provides an excellent cosmetic result and no evidence to date of bony resorption, the rate of infection is alarmingly high in these large constructs.

Adolescent↗
PubMed1998

Hydroxyapatite augmentation of the porous coating improves fixation of tibial components. A randomised RSA study in 116 patients.

In a single-blind, randomised series of knee replacements in 116 patients, we used radiostereometric analysis (RSA) to measure micromotion in three types of tibial implant fixation for two years after knee replacement. We compared hydroxyapatite-augmented porous coating, porous coating, and cemented fixation of the same design of tibial component. At one to two years, porous-coated implants migrated at a statistically significantly higher rate than hydroxyapatite-augmented or cemented implants. There was no significant difference between hydroxyapatite-coated and cemented implants. We conclude that hydroxyapatite augmentation may offer a clinically relevant advantage over a simple porous coating for tibial component fixation, but is no better than cemented fixation.

Aged↗
PubMed2002

Histomorphometric analysis of rat alveolar wound healing with hydroxyapatite alone or associated to BMPs.

Several materials and techniques have been proposed to improve alveolar wound healing and decrease loss of bone height and thickness that normally follow dental extraction. The objective of this research was the histologic analysis of bone morphogenetic proteins implanted into dental alveoli of rats after extraction. A total of 45 adult male Wistar rats were divided into three groups of 15 animals each: control (no treatment), implanted with pure hydroxyapatite (HA, 3 mg) and implanted with hydroxyapatite plus bone morphogenetic proteins (HA/BMPs, 3 mg). Five animals from each group were sacrificed at 7, 21 and 42 days after extraction for the histometric analyses of the osteoconductive potential of hydroxyapatite associated or not with BMPs. After dissection, fixation, decalcification and serial microtomy of 6-micron thick sections, the samples were stained with hematoxylin-eosin for histologic and histometric analyses. Both HA and HA/BMPs caused a delay in wound healing compared to control animals, evaluated by the percentage of bone tissue in the alveoli. The treatment with HA/BMPs had the greatest delay at 21 days, even though it produced values similar to the control group at 42 days. The materials did not improve alveolar repair in the normal period of wound healing and the association of HA/BMPs did not have osteoconductive properties with granulated hydroxyapatite as the vehicle.

Alveolar Bone Loss↗
PubMed1993

Microscopic and chemical analysis of bone-hydroxyapatite interface in a human retrieved implant. A case report.

The aim of the present study was a histological and chemical analysis of the bone-hydroxyapatite interface in a retrieved human implant. The implant was cut in two: one half was processed for light microscopy with the cutting grinding system, and the other for SEM analysis with EDX and a cathodoluminescence system. Bone maintained an intimate contact with the hydroxyapatite and the bonding of the hydroxyapatite with the metal was very strong. An analysis of the interface from a double staining (basic fuchsin and von Kossa) showed a non-mineralized matrix, interposed between hydroxyapatite and bone in many areas. It is possible that different microscopic features are present in different areas of the interface, however, intimate contact was observed 6 months after insertion of the implant.

Calcium↗
PubMed1995

The effect of operative fit and hydroxyapatite coating on the mechanical and biological response to porous implants.

UNLABELLED: Femoral intramedullary implants were constructed by threading 4.0-millimeter-thick disks with a titanium-alloy (Ti-6Al-4V) porous bead coating onto a two-millimeter-diameter threaded rod. Each porous-coated disk, which was 6.0, 8.0, 9.0, or 10.0 millimeters in diameter, was separated by a two-millimeter-thick acrylic disk with a diameter of ten millimeters. Implants with and without a hydroxyapatite coating of twenty-five micrometers were inserted into fifteen skeletally mature adult mongrel dogs. The femoral canal was sequentially reamed bilaterally to a ten-millimeter diameter, resulting in uniform initial implant-bone interface gaps of 0.0, 0.5, 1.0, and 2.0 millimeters. Each animal received paired hydroxyapatite-coated and uncoated implants. Three animals each were killed at four, eight, twelve, twenty-four, and fifty-two weeks after the implantation. The harvested femora were sectioned through the acrylic spacers, transverse to the long axis, to produce individual push-out test specimens for mechanical testing. Characteristics of interface attachment were determined with test fixtures that supported the surrounding bone to within 150 micrometers of the interface. Histological sections were prepared, and the amount of bone within the porous structure and the amount of the original gap that was filled with new bone were quantified with a computerized video image-analysis system. Mechanical attachment strength and bone ingrowth were found to increase with the time after implantation and with a decrease in the size of the gap. Placement of the implant in proximal (cancellous) compared with distal (cortical) locations had no significant effect on the strength of attachment, bone ingrowth, or gap-filling. However, implants with a large initial gap (1.0 or 2.0 millimeters) demonstrated greater attachment strength in cancellous bone than in cortical bone. With a few exceptions, hydroxyapatite-coated implants with an initial gap of 1.0 millimeter or less demonstrated significantly increased mechanical attachment strength and bone ingrowth at all time-periods. Interface attachment strengths were positively correlated with bone ingrowth, the time after implantation, the use of a hydroxyapatite coating, and decreasing initial gap size. CLINICAL RELEVANCE: Initial implant-bone apposition is thought to be a prerequisite for good biological fixation. This apposition is often not achieved because of the design of the implant or instruments and the operative technique. Poor initial fit during the operation may decrease the longevity of the implant. The results of the present study indicate that attachment strength and bone ingrowth are significantly affected by gaps in the interface, particularly those of more than 1.0 millimeter.(ABSTRACT TRUNCATED AT 400 WORDS)

Alloys↗
PubMed1996

Hydroxyapatite-coated femoral stems. A matched-pair analysis of coated and uncoated implants.

Fifty-two pairs of patients who had had a total hip arthroplasty with a porous-coated femoral implant were studied in a retrospective, matched-pair analysis. Half of the patients had received a femoral component coated with hydroxyapatite and the other half (the controls), an identical component but without hydroxyapatite. The patients were matched for age, sex, weight, diagnosis, Charnley class, operative approach, and duration of follow-up. Identical uncoated hemispherical acetabular implants were used in both groups. At the time of follow-up, at a mean of 2.2 years (range, two to 3.4 years) after the operation, the mean Charnley scores for pain, function, and motion were 5.6, 5.5, and 5.6 points, respectively, in the group that had received a hydroxyapatite-coated femoral component and 5.6, 5.6, and 5.6 points, respectively, in the group that had received a non-coated component; none of these differences were significant (p = 0.86, 0.89,, and 0.80, respectively). There were no revisions in either group. Radiographs indicated stable fixation in both groups and no differences in the radiographic parameters of loosening between the two groups. Within the relatively short time-frame of this study, there appeared to be no clinical or radiographic advantage to the use of hydroxyapatite in primary total hip arthroplasties. However, these results should be considered as preliminary. Longer follow-up may reveal unrecognized advantages or disadvantages.

Adult↗
PubMed2003

Medial opening-wedge high tibial osteotomy with use of porous hydroxyapatite to treat medial compartment osteoarthritis of the knee.

BACKGROUND: The aims of this study were to investigate the results of opening-wedge high tibial valgus osteotomy in patients with medial compartment osteoarthritis of the knee and to examine the usefulness of hydroxyapatite wedges as the supporting material. METHODS: Medial opening-wedge osteotomy was performed in twenty-one osteoarthritic knees in eighteen patients who had a mean age of 66.6 years. The mean duration of follow-up was 78.6 months. A medial transverse osteotomy was performed proximal to the tibial tuberosity, with the most lateral 10% of the tibia left intact. The medial side of the osteotomy site was opened to the desired angle of correction. Two hydroxyapatite wedges of the same size (5.0, 7.5, or 10.0 mm) were inserted into the opened osteotomy site along with bone grafts, and the fragments were fixed with two plates. The angle of correction could be adjusted by altering the direction of wedge insertion. The goal was to achieve a final standing alignment of 10 degrees of anatomical valgus angulation. RESULTS: All patients had pain relief and improvement in walking ability after the osteotomy. The mean knee and function scores of the American Knee Society were 60.2 +/- 5.3 and 48.1 +/- 10.4 points, respectively, before the osteotomy and 94.3 +/- 7.3 and 93.1 +/- 9.8 points, respectively, at the time of the final follow-up. Limb alignment, expressed as the standing femorotibial angle, was corrected from 180 degrees +/- 2.9 degrees preoperatively to 169.7 degrees +/- 3.7 degrees (10.3 degrees of anatomical valgus angulation) at the time of the latest follow-up. There were no cases of recurrence of varus deformity or collapse of the hydroxyapatite wedges. CONCLUSIONS: After a mean duration of follow-up of 6.6 years, we found that the medial opening-wedge osteotomy of the proximal part of the tibia provided satisfactory clinical results for patients with osteoarthritis of the knee. Use of the porous hydroxyapatite wedges resulted in no collapse or subsidence at the osteotomy site. LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series [no, or historical, control group]). See p. 2 for complete description of levels of evidence.

Aged↗
PubMed2004

Comparison of proximal porous-coated and grit-blasted surfaces of hydroxyapatite-coated stems.

BACKGROUND: It remains controversial whether a proximal porous coating is superior to a grit-blasted surface with regard to providing femoral stem fixation in total hip arthroplasty. We examined the hypothesis that a proximal porous coating would provide better fixation than would a fully grit-blasted surface of otherwise identical proximally hydroxyapatite-coated stems. METHODS: In a prospective study, seventeen patients (thirty-four hips) underwent bilateral sequential total hip replacement with the Anatomic Porous Replacement at the same operation. A proximally porous-coated femoral stem was implanted on one side, and a stem of the same design but with a proximal grit-blasted surface was implanted in the contralateral hip. A proximal hydroxyapatite coating was applied to the metallic substrate of both stems. The patients were followed for a mean 2.5 years and then were assessed radiographically and clinically with the Harris hip score. RESULTS: With the numbers available, no significant clinical or radiographic differences were found between the two cohorts. Thirty of the thirty-four hips had an excellent result, two were rated good, and two were rated fair. All hips had stable osseous fixation of the stem radiographically. The two types of stems were associated with the same pattern of adaptive bone-remodeling. CONCLUSIONS: In the first two years following total hip arthroplasty, hydroxyapatite-coated proximally porous-coated femoral stems do not provide fixation that is superior to that provided by hydroxyapatite-coated grit-blasted stems. LEVEL OF EVIDENCE: Therapeutic study, Level II-1 (prospective cohort study). See Instructions to Authors for a complete description of levels of evidence.

Adult↗
PubMed1996

Generation and use of recombinant human bone sialoprotein and osteopontin for hydroxyapatite studies.

Bone sialoprotein (BSP) and osteopontin (OPN) are two extracellular bone matrix proteins that have the ability to modulate the growth of hydroxyapatite in vitro. Studies of BSP/OPN hydroxyapatite interactions in the past have been directed toward the identification of essential structural elements that allow these two proteins to modulate hydroxyapatite growth. However, these studies are limited by the finite quantities of purified extracellular matrix proteins. I have utilized a recombinant E. coli expression system to obtain milligram quantities of human bone sialoprotein and human osteopontin that may be used to study extracellular matrix protein interactions with hydroxyapatite.

Durapatite↗
PubMed1998

A study on the promotion and suppression of demineralization of human dental hard tissues and hydroxyapatite.

Demineralization of human dental enamel and dentine and their analogue compound, hydroxyapatite, was examined by using pH-metry to measure the time-courses of neutralization of acetate, formate, lactate or propionate buffer solution or of acidification of EDTA solution. The extent of neutralization by enamel, dentine and hydroxyapatite was different for each acid but increased in the same order: propionate, acetate, lactate and formate. This order was consistent with that of the K values of these acids. The pH-metry was used to determine the influences of sodium chloride and sucrose on demineralization of enamel, dentine and hydroxyapatite by acetate, formate, lactate and propionate and by EDTA. The demineralization by these bioorganic acids was suppressed by sucrose but promoted by sodium chloride, except that the demineralization of enamel by acetate and propionate was little affected. The demineralization of enamel, dentine and hydroxyapatite by EDTA was little affected by sucrose but promoted by sodium chloride. The promotive effect of sodium chloride on demineralization may be due to the increasing of solubility product by this salt and the suppressive effect of sucrose may be due to the formation of a calcium saccharate formed from the sucrose reacted with calcium on the surface of apatite crystal and/or the reduction of solubility product by the sucrose. In this study, it was also ascertained that the use of pH-metry made it possible to determine easily the demineralization.

Acetic Acid↗
PubMed1994

A new porous hydroxyapatite ceramic prepared by cold isostatic pressing and sintering synthesized flaky powder.

A new porous hydroxyapatite ceramic was prepared by cold isostatic pressing and sintering of the flaky powder, that was synthesized through two-stage hydrolysis of brushite; (1) a structural change into the apatite structure and (2) a compositional increase in Ca/P ratio, according to the method of Monma and Kamiya. The appearance of the synthesized powder resembled the flaky shape of the starting materials and its average particle size was about 15 microns. This powder consisted of fine needle crystals, which had a tendency to grow into the larger grains, but the powder was highly resistant to sintering under the usual heating conditions at 1200 degrees C. Porous hydroxyapatite blocks and granules were prepared by cold isostatic pressing and sintering a pellet consisting of the hydroxyapatite powder and spherical polymer beads. The product showed a 70% apparent porosity with spherical pores, ranging from 100-200 microns in size, and most pores were interconnected. These properties were ascribed to the effect of cold isostatic pressing on the hydroxyapatite powders with the flaky shape.

Ceramics↗
PubMed1999

Hydroxyapatite fully coated conic hip prosthetic stem: a long term animal study.

The purpose of this paper is to evaluate in an animal model the long term results obtained with a prosthetic stem fully coated with hydroxyapatite. The cup was manufactured in polyethylene and was cemented. Six arthroplasties were performed in six sheep. After twelve months, the animals were euthanized and the femurs were harvested and processed for undecalcified sectioning. Twelve cross sections were cut perpendicularly to the longitudinal stem axis. Sections one to five corresponded to the area of the stem which, at the time of surgery, had a full initial contact between the bone and the prosthesis; sections six to ten corresponded to the area of the stem which, at the time of surgery, had a gap from 0 to 2 mm between the bone and the prosthesis; sections eleven and twelve had an initial gap larger than 2 mm. At one year after implantation, in the sections one to five, morphological analyses showed extensive direct contact between the bone and the hydroxyapatite coating. Bone prosthesis contact was lower in the sections six to ten. No contact was seen in sections eleven and twelve. Comparing bone to prosthesis contact of each subsequent section, from proximal to distal, the difference becomes significant with section five compared to section six (p < 0.00005). No detachment of the hydroxyapatite coating from the metallic substrate was observed in any section. In conclusion, this study shows that a conic shaped femoral stem, fully coated with hydroxyapatite gives very good histological and histomorphometric results at one year. Prosthesis osteointegration showed to be influenced by the initial bone to prosthesis contact. No direct bone to prosthesis contact was achieved if the initial bone to prosthesis gap was larger than 2 mm.

Animals↗
PubMed2000

[Complications of hydroxyapatite orbital implants in children: a series of 105 cases].

PURPOSE: To describe the complications encountered using hydroxyapatite as an orbital implant in the pediatric population after enucleation, and try to define the risk factors for their occurrence. MATERIAL: and methods: Retrospective review of charts of children who underwent enucleation with placement of an hydroxyapatite implant between January 1991 and 1998. Complications and their type (conjunctival, extrusion, eyelids complications) have been specifically looked for. A statistical analysis trying to isolate the risks factors was performed. RESULTS: 105 implants have been used during this period with 26.7% of complications appearing during a median followup of 22 months. Extrusion of the implant was observed in 1.9% of the cases, a chronic conjunctival erosion in 15%, a conjunctival lesion without erosion in 4.75% and no eyelid lesion could be seen. Treatment (medical or surgical) achieved 75% good results. No risk factor could be found. CONCLUSION: Hydroxyapatite orbital implants were initially thought to have no or few complications. More recently, chronic erosions in particular were described. Little data exists on the pediatric population. Our series confirms that complications occur and that they are comparable to the adult population. Nevertheless the hydroxyapatite orbital implant seems better tolerated than other porous or non porous implants and warrants its use.

Adult↗
PubMed1997

Prosthodontic treatment for patients with large mandibular defects; porous hydroxyapatite grafts.

It is difficult for both prosthodontists and their patients with large marginal defects to achieve a satisfactory prosthodontic result, because retention, support, and stability of the prosthesis are limited and recovery of esthetics is unsatisfactory owing to large mandibular defects. Alveolar ridge augmentation therapy is performed to compensate for such problems. We have experienced a good prognosis of prosthodontic treatment for over 10 years in two patients with large marginal defects of the partially edentulous mandible, who had undergone grafting of porous hydroxyapatite blocks to their bone defects. It has been reported that porous hydroxyapatite blocks are unsuitable for edentulous patients, because the mucosa covering the hydroxyapatite block is too thin and delicate to support dentures. We, therefore, designed the denture to prevent concentration of occlusal stress on the mucosa. In both of these two cases, we achieved recovery of occlusal function and esthetics by affixing denture to the large marginally resected defect augmented with a graft of porous hydroxyapatite block.

Adult↗