title: In vitro testing of femoral impaction grafting with porous titanium particles: a pilot study.
abstract: The disadvantages of allografts to restore femoral bone defects during revision hip surgery have led to the search for alternative materials. We investigated the feasibility of using porous titanium particles and posed the following questions: (1) Is it possible to create a high-quality femoral graft of porous titanium particles in terms of graft thickness, cement thickness, and cement penetration? (2) Does this titanium particle graft layer provide initial stability when a femoral cemented stem is implanted in it? (3) What sizes of particles are released from the porous titanium particles during impaction and subsequent cyclic loading of the reconstruction? We simulated cemented revision reconstructions with titanium particles in seven composite femurs loaded for 300,000 cycles and measured stem subsidence. Particle release from the titanium particle grafts was analyzed during impaction and loading. Impacted titanium particles formed a highly interlocked graft layer. We observed limited cement penetration into the titanium particle graft. A total mean subsidence of 1.04 mm was observed after 300,000 cycles. Most particles released during impaction were in the phagocytable range (< 10 microm). There was no detectable particle release during loading. Based on the data, we believe titanium particles are a promising alternative for allografts. However, animal testing is warranted to investigate the biologic effect of small-particle release.
authors.affiliation: Orthopaedic Research Laboratory, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands. r.aquarius@orthop.umcn.nl
authors.forename: René
authors.initials: R
authors.lastname: Aquarius
authors.forename: Luc
authors.initials: L
authors.lastname: Walschot
authors.forename: Pieter
authors.initials: P
authors.lastname: Buma
authors.forename: Berend Willem
authors.initials: BW
authors.lastname: Schreurs
authors.forename: Nico
authors.initials: N
authors.lastname: Verdonschot
mesh_terms: D019644:Arthroplasty, Replacement, Hip; D001696:Biomechanical Phenomena; D001843:Bone Cements; D018786:Bone Substitutes; D005269:Femur / Q000601:surgery*; D006622:Hip Prosthesis; D066298:In Vitro Techniques; D008422:Materials Testing; D010316:Particle Size; D010865:Pilot Projects; D011474:Prosthesis Design; D014025:Titanium; D014184:Transplantation, Homologous
chemical_list: D001843:Bone Cements; D018786:Bone Substitutes; D014025:Titanium