Osteointegration of orthopaedic devices.
The different properties of bone must be considered in order to understand the relation between orthopaedic devices and bone. The epi-/metaphyseal areas are defined by their rigidity, their high vascularity and their quick remodelling process. In contrast, the diaphyses of bone are rather elastic and built of dense, scarcely vascularised bone presenting slow remodelling. Implants can integrate by pure mechanical contact without real affinity to bone or, alternatively, they can favour ongrowth of bone, provided that they are osteoconductive. Amongst different bone substitutes, only some of them are absorbable. Only derivates of bone may present the property of osteoinduction, which is the power to create new bone in any region of the body. Orthopaedic devices are characterised by their shape, their stiffness or elasticity and by the characteristic properties of material. They may be osteoconductive such as titanium alloys and some ceramics, allowing integration in bone. Alternatively, other materials such as steel, CoCr alloys and PMMA cements remain separated from bone by a tiny layer of collagen. The surface structure influences the quality of integration. The integration of implants depends on the mutual interaction of the material with the tissue on the implantation site. All implants undergo fatiguing which can lead to fracture of the implant. All implant-bone contacts are threatened by granulation tissue mainly formed because of wear products, infection and other reasons.
Orthopaedic Clinic Lucerne, Hirslanden Clinic St. Anna, St. Annastreet 32, 6006, Lucerne, Switzerland. peter.ochsner@hin.ch
Peter E
PE
Ochsner
D001696:Biomechanical Phenomena / Q000502:physiology; D018786:Bone Substitutes; D006801:Humans; D009984:Orthopedic Fixation Devices; D019736:Prostheses and Implants; D016459:Prosthesis-Related Infections
D018786:Bone Substitutes
J Biomed Mater Res. 1977 Mar;11(2):157-64
140168
Int Orthop. 2001;25(2):77-80
11409456
N Engl J Med. 2004 Oct 14;351(16):1645-54
15483283
J Bone Joint Surg Am. 2002 Dec;84(12):2123-34
12473698
J Bone Joint Surg Am. 2001;83-A Suppl 2 Pt 2:98-103
11712842
Lancet. 1961 May 27;1(7187):1129-32
15898154
J Bone Joint Surg Br. 2010 Nov;92(11):1515-21
21037345
J Bone Joint Surg Am. 2006 Jul;88(7):1481-5
16818973
Arch Orthop Trauma Surg. 1988;107(4):195-202
3408311
Experientia. 1963 Nov 15;19:593-5
14101523
Orthopedics. 1994 May;17(5):433-40
8036187
Arch Orthop Trauma Surg. 1988;107(5):293-300
3052361
Clin Orthop Relat Res. 1990 Jan;(250):8-26
2403497
Arch Orthop Trauma Surg. 2008 Jul;128(7):745-50
18214506
J Bone Joint Surg Am. 2006 Jun;88(6):1258-65
16757759
Arch Orthop Trauma Surg. 1990;109(6):314-6
2073449
Open Orthop J. 2008 Apr 25;2:66-78
19506701
J Trauma. 1984 Aug;24(8):742-6
6471139
Clin Orthop Relat Res. 1970 Sep-Oct;72:46-68
5459808