Chemical implant fixation using hydroxyl-apatite coatings. The development of a human total hip prosthesis for chemical fixation to bone using hydroxyl-apatite coatings on titanium substrates

Abstract

Sintered hydroxyl-apatite implants form very tight bonds with living bone but are susceptible to fatigue failure. Plasma-sprayed apatite coatings on titanium substrates overcome the fatigue problem. The static tensile substrate bond strength of the apatite coating is in excess of 85 megapascals (MPa) (12,000 psi). In a plug implant study designed to discount mechanical retention, a bone bonding shear strength of 64 MPa (9280 psi) was achieved, comparable to the strength of cortical bone. Histologic sections confirm the close bonding between apatite coating and living bone. In a canine total hip arthroplasty study, the apatite-coated implants proved far superior to the uncoated controls. Uncoated prostheses were surrounded by fibrous tissue and were easily extracted from the femur at any postoperative time. The apatite-coated implants were rigidly fixed within three weeks with demonstrable bone formation up to the implant surface. Bony defects up to 2 mm in depth were filled with bone within six weeks. The hypothetical mechanism of bone bonding is chemical. Hydroxyl-apatite coatings permit an implant fixation far superior to current methods using either cemented or cementless techniques. The plan is to study a human total hip prosthesis with hydroxyl-apatite coating for chemical fixation to bone.