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A common method to derive both qualitative and quantitative data to evaluate osseointegration of implants is histomorphometry. The present study describes a new image reconstruction algorithm comparing the results of bone-to-implant contact (BIC) evaluated by means ofµCT with histomorphometry data. Custom-made conical titanium alloyed (Ti6Al4V) implants were inserted in the distal tibial bone of female Sprague-Dawley rats. Different surface configurations were examined: Ti6Al4V implants with plasma-polymerized allylamine (PPAAm) coating and plasma-polymerized ethylenediamine (PPEDA) coating as well as implants without surface coating. After six weeks postoperatively, tibiae were explanted and BIC was determined byµCT (3D) and afterwards by histomorphometry (2D). In comparison to uncoated Ti6Al4V implants demonstrating low BIC of 32.4% (histomorphometry) and 51.3% (µCT), PPAAm and PPEDA coated implants showed a nonsignificant increase in BIC (histomorphometry: 45.7% and 53.5% andµCT: 51.8% and 62.0%, resp.). Mean BIC calculated byµCT was higher for all surface configurations compared to BIC detected by histomorphometry. Overall, a high correlation coefficient of 0.70 (p<0.002) was found between 3D and 2D quantification of BIC. TheμCT analysis seems to be suitable as a nondestructive and accurate 3D imaging method for the evaluation of the bone-implant interface.

Implant osseointegration can currently only be assessed reliably post mortem. A novel method that relies on the principle of acoustic sound analysis was developed to enable examination of the longitudinal progress of osseointegration. The method is based on a magnetic sphere inside a hollow cylinder of the implant. By excitation using an external magnetic field, collision of the sphere inside the implant produces a sound signal. Custom-made titanium implants equipped thusly were inserted in each lateral femoral epicondyle of 20 New Zealand White Rabbits. Two groups were investigated: Uncoated, machined surface versus antiadhesive surface; and calcium phosphate-coated surface versus antiadhesive surface. The sound analysis was performed postoperatively and weekly. After 4 weeks, the animals were euthanized, and the axial pull-out strengths of the implants were determined. A significant increase in the central frequency was observed for the loose implants (mean pull-out strength 21.1 ± 16.9 N), up to 6.4 kHz over 4 weeks. In comparison, the central frequency of the osseointegrated implants (105.2 ± 25.3 N) dropped to its initial value. The presented method shows potential for monitoring the osseointegration of different implant surfaces and could considerably reduce the number of animals needed for experiments. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 32:606–612, 2014.

Hintergrund Die Therapie einer infizierten Huftendoprothese wird zunehmend zu einem wirtschaftlichen Problem. Die zusatzlichen Therapiekosten sind in den Diagnosis-Related Groups (DRG) nur unzureichend abgebildet. Ziel ist zu klaren, ob eine Kostendeckung durch das DRG-System in Deutschland moglich ist und in welchem Rahmen sich eine Uber- bzw. Unterdeckung bewegt.

Ceramics have increasingly been used since the 1970s in total joint arthroplasty, providing constant improvements in material properties. Nowadays, different ceramics (alumina, zirconia, and new composite materials) are available as bearing surfaces. Ceramic materials offer reduced wear rates at articulating surfaces because of their excellent friction properties, which support longevity of endoprosthetic implants. In total hip arthroplasty, long-term clinical studies confirm the advantageous properties of ceramic materials providing low risk of implant failure. In total knee arthroplasty, ceramics revealed superior experimental data concerning low wear rates as well as promising results of the first clinical applications.

Implant infections remain feared and severe complications after total hip replacement. An even higher rate of periprosthetic infections can be observed after revision surgery in comparison to primary total hip replacement. An additional threat for patients with artificial joints arises from the fact that bacteria resistant to a multitude of antibiotics are encountered with increasing frequency in the hospital setting.Among these the enterobacteria producing extended spectrum β-lactamases (ESBL) are the second most frequent group of multiresistant pathogens. ESBLs are enzymes which possess the ability to hydrolyse third and fourth generation cephalosporins resulting in a distinctive resistance against these antibiotics. Even though ESBLs were first described in the early 1980’s and now represent pathogens of utmost importance in intensive care units, they have been hardly considered in orthopedic and trauma surgery.In the present manuscript we provide an overview of the epidemiology and diagnostics of ESBL-expressing bacteria and demonstrate the difficulties in managing implant-associated infections with resistant bacteria. Furthermore, we emphasize the importance of recognizing ESBL-positive bacteria as increasingly important pathogens which require special precautions and treatment. Clinical evaluations suggest that ESBLs in orthopedic and trauma surgery are not a rare phenomenon any more.

The purpose of this study was to compare different methods of evaluating the version of a metallic acetabular cup from plain radiographs and to compare them regarding their accuracy, inter- and intra-observer reliability. Conventional anterior–posterior radiographs were taken of a phantom-model at different defined ante- and retroversion angles of the acetabular cup. The version angles of the acetabular cup were derived according to four different established methods from the radiographs by five independent examiners. We were able to determine the radiographic version with the greatest accuracy according to a modified technique of Pettersson et al. Furthermore, we found the highest intra- and inter-observer reliability using this technique. A modified technique of Pettersson et al. broadens the spectrum of applicability for the radiographic evaluation of the version angle of metal-backed acetabular cups in comparison to the originally introduced method. In clinical practice, however, the significance of deriving the cup position from standard radiographs should not be over-estimated and therefore a computed tomography should be performed in certain critical cases.

The purpose of total hip replacement (THR) is the restoration of a painless functioning hip joint with the main focus on the biomechanical properties. Advances in surgical techniques and biomaterial properties currently allow predictable surgical results in most patients. Despite the overwhelming success of this surgical procedure, the debate continues surrounding the optimal choice of implants and fixation. Femoral and acetabular implants with varying geometries and fixation methods are currently available. Problems inherent with acrylic bone cement, however, have encouraged surgeons to use alternative surfaces to allow biologic fixation. Optimal primary and secondary fixation of cementless hip stems is a precondition for long-term stability. Important criteria to achieve primary stability are good rotational and axial stability by press-fit fixation. The objective of the cementless secondary fixation is the biological integration of the implant by bony ingrowth. Nevertheless, current investigations show excellent results of cementless fixation even in older patients with reduced osseous quality. The main advantages of cementless fixation include biological integration, reduced duration of surgery, no tissue damage by cement polymerization and reduction of intraoperative embolisms. In comparison to cemented THR both, cementless sockets and stems provide good long-term results.

In total joint replacement much effort has been made to reduce implant loosening. We investigated different implant coatings (copper integrated titanium dioxide (TiO2–Cu), titanium nitride (TiN), plasma polymerized allylamine (PPAAm), and calcium phosphate (CaP)) regarding the adhesion strength and wear resistance. Standardized scratch and adhesive tests were applied. Abrasive wear was measured with artificial bone and bone cement using a special testing machine. All tested coatings have higher bonding strengths than the 22 N/mm2 required for medical implant surface coatings by ASTM standard 4711-F. Using bone cement, wear testing revealed higher wear rates in most cases. Polished surfaces reduce the amount of wear, whereas rough surfaces highly increase the wear rate due to three-body wear, especially ceramic surfaces. In general, the application of bone cement in conjunction with modified implant surfaces can lead to an increase in wear rate.

Derzeit mussen in den ersten 10 Jahren nach Implantation durchschnittlich etwa 10 % aller Huft- und Knieendoprothesen ausgetauscht werden. Eine Revision ist meist infolge aseptischer oder septischer Lockerung der Implantate erforderlich. Zur verbesserten Osteointegration werden Implantate fur die Orthopadische Chirurgie heute zunehmend beschichtet. Beschichtungen mussen biokompatibel sein und hohen mechanischen Anforderungen gerecht werden. Hierbei spielen die Haftfestigkeit und die Abriebbestandigkeit der Schichten eine Schlusselrolle. In der vorliegenden Arbeit werden Methoden zur experimentellen Bestimmung dieser Parameter mittels verschiedener Verfahren exemplarisch an zwei innovativen Implantatbeschichtungen (TiN und TiO2-Cu) vorgestellt. Zur Ermittlung der Haftfestigkeit wurden unterschiedliche, standardisierte Verfahren verwendet. Dazu zahlten der Dornbiegeversuch, die Ritzprufung und der Stirnzugversuch. Die Abriebbestandigkeit wurde in einem speziellen Prufstand nach 1,5 Mio Lastzyklen ermittelt. Die Untersuchungen zeigten, dass die beiden getesteten TiN- und TiO2-Cu-Schichten haftfest und abriebbestandig waren. Mit den genannten Verfahren lassen sich die Haftfestigkeit und die Abriebbestandigkeit von bioaktiven, verschleismindernden oder anti-allergenen Oberflachenbeschichtungen fur Endoprothesen zuverlassig bestimmen. Methods for the mechanical characterisation of modified implant surfaces in orthopaedic surgery Nowadays, on average approximately 10 % of all hip and knee endoprostheses have to be exchanged within the first 10 years. Implant revision is often necessary following aseptic or septic loosening. Hence, today implants for orthopaedic surgery are increasingly being coated for better osseointegration. Coatings have to be biocompatible and meet high mechanical requirements, whereby the adhesive strength and the abrasive wear resistance of the coatings take on a key role. This study presents different methods to asses these parameters experimentally using two innovative coatings (TiN, TiO2-Cu) exemplary. The adhesive bonding strength of the coatings was investigated using different standardised methods, such as the arbour bending test, scratch test and the standard adhesive test. Wear resistance was determined after 1.5 million cycles in a special testing machine. The investigations showed for both coatings, TiN and TiO2-Cu, good adhesive strength and wear resistance. The adhesive strength and wear resistance of bio-active, wear reducing or anti-allergenic surface coatings can be determined reliably using the above-mentioned methods.

By means of plasma polymerization, positively charged, nanometre-thin coatings can be applied to implant surfaces. The aim of the present study was to quantify the adhesion of human bone cells in vitro and to evaluate the bone ongrowth in vivo, on titanium surfaces modified by plasma polymer coatings. Different implant surface configurations were examined: titanium alloy (Ti6Al4V) coated with plasma-polymerized allylamine (PPAAm) and plasma-polymerized ethylenediamine (PPEDA) versus uncoated. Shear stress on human osteoblast-like MG-63 cells was investigated in vitro using a spinning disc device. Furthermore, bone-to-implant contact (BIC) was evaluated in vivo. Custom-made conical titanium implants were inserted at the medial tibia of female Sprague-Dawley rats. After a follow-up of six weeks, the BIC was determined by means of histomorphometry. The quantification of cell adhesion showed a significantly higher shear stress for MG-63 cells on PPAAm and PPEDA compared to uncoated Ti6Al4V. Uncoated titanium alloyed implants showed the lowest BIC (40.4%). Implants with PPAAm coating revealed a clear but not significant increase of the BIC (58.5%) and implants with PPEDA a significantly increased BIC (63.7%). In conclusion, plasma polymer coatings demonstrate enhanced cell adhesion and bone ongrowth compared to uncoated titanium surfaces.