[Silicate coating of cemented titanium-based shafts in hip prosthetics reduces high aseptic loosening].
OBJECTIVE
For cemented hip prostheses, all requirements can be fulfilled by using forged Co/Cr/Mo stems. Co/Cr/Mo alloys, however, are contraindicated for allergy sufferers. For these patients, a cemented prosthesis made of titanium (alloy) would be indicated. Cemented stems from titanium (alloy), depending on the geometry of the prosthesis and its specific surface texture, however, may have loosening rates which are clinically not tolerable. In comparison to Co/Cr/Mo alloys, the greater roughness in conjunction with lesser abrasion resistance of titanium-based alloys leads to high loosening rates caused by abrasion. On the other hand, the greater surface roughness permits good mechanical retention of bone cement to the surface. Good mechanical retention enhances migration behaviour and reduces micromotions. However, there is no stable hydrolytic bond between bone cement and metallic surface; intermediate-term debonding between metal and bone cement is predictable. This debonding results in relative movements, consequently in wear particles which have their origin both from the rough metallic surface and from the PMMA cement. The roughness of the metallic surface operates as emery and with that, a rubbing wear from the PMMA.


METHODS
For the above reasons, a low or moderate roughness is essential for easily abradable implants such as shafts made of titanium (alloy) because low roughness provides a fail-safe running function in case of debonding. Thus, one must allow for inappropriate migration behaviour accompanied by greater micromotions due to insufficient mechanical retention in the case of low roughness. This can be accomplished by a silicate layer coating applied to the metal shaft surface via electrochemical "ECD" or physical vapour deposition "PVD". For analysis, specimens (screws for pull-out, cones for push-out tests) were sand-blasted, so that roughnesses between Ra = 0.8 microm (Rz = 4 microm) and Ra = 2.0 microm (Rz = 9 microm) were generated.


RESULTS
The bond strengths observed in tensile tests for roughnesses of Ra = 1.7 mm were always well above 25 MPa for all periods of hydrolytic load. Therefore, the investigation shows that surfaces of moderate roughness (Ra = 1.7 microm), however coated, provide a steady retention. Cave-in and micromotions should widely be prevented.


CONCLUSIONS
The abrasion, which is a consequence of and reason for debonding and loosening at the same time, should be avoidable if the bonding of cement on the metallic shaft is stabilised with the help of a suitable chemical bond system.
Marx
R
R
Klinik für Zahnärztliche Prothetik, Lehr- und Forschungsgebiet Werkstoffkunde, Universitätsklinikum Aachen. marx@rwth-aachen.de
Faramarzi
R
R
Jungwirth
F
F
Kleffner
B V
BV
Mumme
T
T
Weber
M
M
Wirtz
D C
DC
D001696:Biomechanical Phenomena; D001843:Bone Cements; D020099:Coated Materials, Biocompatible; D019544:Equipment Failure Analysis; D005839:Gentamicins; D006622:Hip Prosthesis; D006801:Humans; D008768:Methylmethacrylates; D016348:Osseointegration / Q000502:physiology; D019904:Polymethyl Methacrylate; D011183:Postoperative Complications / Q000209:etiology*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D017640:Silicates; D013499:Surface Properties; D014025:Titanium
D001843:Bone Cements; D020099:Coated Materials, Biocompatible; D005839:Gentamicins; D008768:Methylmethacrylates; D017640:Silicates; C030159:gentamicin-polymethylmethacrylate bead; C035124:CMW cement; D019904:Polymethyl Methacrylate; D014025:Titanium