Porous titanium-coated polyetheretherketone implants exhibit an improved bone–implant interface: an in vitro and in vivo biochemical, biomechanical, and histological study
Received 21 July 2018
Accepted for publication 18 September 2018
Published 29 October 2018 Volume 2018:11 Pages 391—402
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Amy Norman
Peer reviewer comments 2
Editor who approved publication: Dr Scott Fraser
Boyle C Cheng,1 Sravanthi Koduri,1 Charles A Wing,2 Natalie Woolery,3 Daniel J Cook,1 Robert C Spiro2,3
1Neuroscience Institute, Allegheny Health Network, Pittsburgh, PA 15212, USA; 2Research and Development, Aesculap Implant Systems, LLC, Breinigsville, PA 18031, USA; 3Research and Development, Aesculap Biologics, LLC, Breinigsville, PA 18031, USA
Purpose: Spinal interbody fusion cages are designed to provide immediate stabilization for adjoining vertebrae and ideally enable bony ingrowth to achieve successful integration. For such an implant, cells must be able to attach, move, grow, and differentiate on its surface. These cellular interactions are dependent on how the implant surface enables the coating and binding of blood and tissue fluid proteins that support cell adhesion. The purpose of this study was to evaluate the in vitro and in vivo osteoblast cell–implant surface interactions that result in osseointegration onto a surface composed of plasma-sprayed titanium on a polyetheretherketone (PEEK) substrate or titanium-coated PEEK (Ti-PEEK) (PlasmaporeXP®) as compared to uncoated PEEK implants.
Materials and methods: The influence of the Ti-PEEK surface modification on the biochemical, biomechanical, and histological properties at the bone–implant interface is demonstrated both in vitro using simulated bone-forming cell culture experiments and in vivo using a 12- and 24-week ovine implant model.
Results: Osteoblast-like cells attached to the Ti-PEEK surface upregulated early bone-forming activity as measured by an increase in transcription and translation of ALP and BMP-2 when compared to cells on PEEK. Similarly, a significant increase in new bone formation, bony apposition, and pullout strength was demonstrated on Ti-PEEK implants when compared to PEEK implants at 12 and 24 weeks in an ovine implant in vivo model.
Conclusion: The study shows that the Ti-PEEK surface demonstrated enhanced osseointegrative properties compared to PEEK both in vitro and in vivo.
Keywords: porous titanium, implant coating, osteoblast differentiation, osseointegration, pullout test, sheep
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