[PVD-silicoating before cementation of zirconia-based knee prostheses effects better cement adhesion and lower aseptic loosening rates].
OBJECTIVE
CoCrMo alloys are contraindicated for allergy patients. For these patients, cemented or uncemented prostheses made of titanium alloy are indicated. Uncemented prostheses, however, have low primary retention, particularly the tibial components of knee joint prostheses because of the lack of a positive locking. Therefore, for knee replacement cemented CoCrMo prostheses may be suitable also for allergy sufferers if these are masked by ZrN or TiNbN layers. Alternatively the CoCrMo alloy may be replaced by high-strength oxide ceramics. For adhesion of bone cement to the ceramic surface, however, only inefficient mechanical retention spots are exposed as compared with a metal surface. Undercuts generated by corundum blasting, although highly efficient on a CoCrMo surface, are not such efficient centres on a ceramic surface due to its brittleness. Therefore, the mechanical component of retention is significantly reduced. When specific adhesion between bone cement and surface does not exist due to physical and chemical forces, the hydrolytic stability will be insufficient. Micromotions are promoted and early aseptic loosening is predictable. Silicoating of the ceramic surface will allow specific adhesion and can result in better hydrolytic stability of bonding.


METHODS
In order to evaluate the effectiveness of silicoating the bond strengths of blasted (mean size of corundum grains 50 µm) and silicate layered alumina-toughened zirconia (ATZ) surfaces were compared with "as fired" surfaces by utilising TiAlV probes (diameter 6 mm) for traction-adhesive strength testing. Samples machined out of CoCrMo alloy were utilised for reference. After preparing the samples for traction-adhesive strength testing (sequence: substrate, silicate and silane, protective lacquer [PolyMA], bone cement, TiAlV probe) they were aged up to 360 days at 37 °C in Ringer's solution.


RESULTS
The bond strengths observed for all ageing intervals were well above 20 MPa and much higher and more hydrolytically stable for blasted and silicate-layered compared with "as fired" ATZ samples.


CONCLUSIONS
Silicoating may be effective for achieving a high initial bond strength of bone cement on surfaces of oxide ceramics and also suitable to stabilise bond strength under hydrolytic conditions as present in the human body. Activation by low grain size corundum (mean grain size 50 µm) seems to be effective for activation without deteriorating the bending strength of the ceramics investigated. Due to the proposed layer system migration, micromotions and debonding should be widely reduced or even eliminated.
CC&A Ltd., ZBMT Aachen, Pauwelsstraße 17, Aachen. marx@rwth-aachen.de
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Marx
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Faramarzi
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Oberbach
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Begand
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Grätz
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Wirtz
D000268:Adhesiveness; D001843:Bone Cements / Q000737:chemistry*; D002484:Cementation / Q000379:methods*; D020099:Coated Materials, Biocompatible / Q000737:chemistry*; D019544:Equipment Failure Analysis; D006801:Humans; D007593:Joint Instability / Q000209:etiology* / Q000517:prevention & control; D007720:Knee Prosthesis / Q000009:adverse effects*; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000209:etiology* / Q000517:prevention & control; D015040:Zirconium / Q000737:chemistry*
D001843:Bone Cements; D020099:Coated Materials, Biocompatible; D015040:Zirconium; C028541:zirconium oxide