title: Thein vivoeffect of a porous titanium alloy flange with hydroxyapatite, silver and fibronectin coatings on soft-tissue integration of intraosseous transcutaneous amputation prostheses.
abstract: OBJECTIVE
  The Intraosseous Transcutaneous Amputation Prosthesis (ITAP) may improve quality of life for amputees by avoiding soft-tissue complications associated with socket prostheses and by improving sensory feedback and function. It relies on the formation of a seal between the soft tissues and the implant and currently has a flange with drilled holes to promote dermal attachment. Despite this, infection remains a significant risk. This study explored alternative strategies to enhance soft-tissue integration.
  
  
  METHODS
  The effect of ITAP pins with a fully porous titanium alloy flange with interconnected pores on soft-tissue integration was investigated. The flanges were coated with fibronectin-functionalised hydroxyapatite and silver coatings, which have been shown to have an antibacterial effect, while also promoting viable fibroblast growthin vitro.The ITAP pins were implanted along the length of ovine tibias, and histological assessment was undertaken four weeks post-operatively.
  
  
  RESULTS
  The porous titanium alloy flange reduced epithelial downgrowth and increased soft-tissue integration compared with the current drilled flange. The addition of coatings did not enhance these effects.
  
  
  CONCLUSIONS
  These results indicate that a fully porous titanium alloy flange has the potential to increase the soft-tissue seal around ITAP and reduce susceptibility to infection compared with the current design. Cite this article:Bone Joint J2017;99-B:393-400.
authors.affiliation: Centre for Biomedical Engineering, Institute of Orthopaedics and Musculoskeletal Science, Division of Surgery and Interventional Science, University College London, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK.
authors.forename: M
authors.initials: M
authors.lastname: Chimutengwende-Gordon
authors.affiliation: Centre for Biomedical Engineering, Institute of Orthopaedics and Musculoskeletal Science, Division of Surgery and Interventional Science, University College London, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK.
authors.forename: C
authors.initials: C
authors.lastname: Pendegrass
authors.affiliation: Centre for Biomedical Engineering, Institute of Orthopaedics and Musculoskeletal Science, Division of Surgery and Interventional Science, University College London, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK.
authors.forename: G
authors.initials: G
authors.lastname: Blunn
mesh_terms: D000497:Alloys; D000672:Amputation Stumps; D000818:Animals; D001186:Artificial Limbs / Q000009:adverse effects; D020099:Coated Materials, Biocompatible; D017886:Durapatite; D005353:Fibronectins; D008422:Materials Testing / Q000379:methods; D016348:Osseointegration; D016062:Porosity; D011474:Prosthesis Design; D017755:Prosthesis Fitting / Q000379:methods*; D016459:Prosthesis-Related Infections / Q000517:prevention & control; D012756:Sheep; D012834:Silver; D013499:Surface Properties; D014025:Titanium
chemical_list: D000497:Alloys; D020099:Coated Materials, Biocompatible; D005353:Fibronectins; D012834:Silver; D017886:Durapatite; D014025:Titanium
keywords: Amputation; Prosthesis; Soft-tissue integration; Transcutaneous