Comparative study in vivo of the osseointegration of 3D-printed and plasma-coated titanium implants

Stanislav Bondarenko; Volodymyr Filipenko; Nataliya Ashukina; Valentyna Maltseva; Gennadiy Ivanov; Iurii Lazarenko; Dmytro Sereda; Ran Schwarzkopf

doi:10.5312/wjo.v14.i9.682

Comparative study in vivo of the osseointegration of 3D-printed and plasma-coated titanium implants

World J Orthop. 2023 Sep 18;14(9):682-689. doi: 10.5312/wjo.v14.i9.682.

Authors

Stanislav Bondarenko¹, Volodymyr Filipenko², Nataliya Ashukina³, Valentyna Maltseva³, Gennadiy Ivanov⁴, Iurii Lazarenko⁵, Dmytro Sereda⁶, Ran Schwarzkopf⁷

Affiliations

¹ Department of Joint Pathology, Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine, Kharkiv 61024, Ukraine. bondarenke@gmail.com.
² Department of Joint Pathology, Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine, Kharkiv 61024, Ukraine.
³ Laboratory of Connective Tissue Morphology, Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine, Kharkiv 61024, Ukraine.
⁴ Experimental Pathology, Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine, Kharkiv 61024, Ukraine.
⁵ Department of Traumatology, Military medical clinical center of the Central region, Vinnytsia 21018, Ukraine.
⁶ Department of Surgery, Odesa city hospital 11, Odesa 65006, Ukraine.
⁷ Hospital for Joint Diseases, NYU Langone Orthopedic Hospital, NY 10003, United States.

Abstract

Background: Total hip arthroplasty is a common surgical treatment for elderly patients with osteoporosis, particularly in postmenopausal women. In such cases, highly porous acetabular components are a favorable option in achieving osseointegration. However, further discussion is needed if use of such acetabular components is justified under the condition of normal bone mass.

Aim: To determine the features of osseointegration of two different types of titanium implants [3-dimensional (3D)-printed and plasma-coated titanium implants] in bone tissue of a distal metaphysis in a rat femur model.

Methods: This study was performed on 20 white male laboratory rats weighing 300-350 g aged 6 mo. Rats were divided into two groups of 10 animals, which had two different types of implants were inserted into a hole defect (2 × 3 mm) in the distal metaphysis of the femur: Group I: 3D-printed titanium implant (highly porous); Group II: Plasma-coated titanium implant. After 45 and 90 d following surgery, the rats were sacrificed, and their implanted femurs were extracted for histological examination. The relative perimeter (%) of bone trabeculae [bone-implant contact (BIC%)] and bone marrow surrounding the titanium implants was measured.

Results: Trabecular bone tissue was formed on the 45^th day after implantation around the implants regardless of their type. 45 d after surgery, group I (3D-printed titanium implant) and group II (plasma-coated titanium implant) did not differ in BIC% (83.51 ± 8.5 vs 84.12 ± 1 .73; P = 0.838). After 90 d, the BIC% was higher in group I (87.04 ± 6.99 vs 81.24 ± 7.62; P = 0.049), compared to group II. The relative perimeter of the bone marrow after 45 d did not differ between groups and was 16.49% ± 8.58% for group I, and 15.88% ± 1.73% for group II. Futhermore, after 90 d, in group I the relative perimeter of bone marrow was 1.4 times smaller (12.96 ± 6.99 vs 18.76 ± 7.62; P = 0.049) compared to the relative perimeter of bone marrow in group II.

Conclusion: The use of a highly porous titanium implant, manufactured with 3D printing, for acetabular components provides increased osseointegration compared to a plasma-coated titanium implant.

Keywords: 3-dimensional printing; Femur; Hip arthroplasty; Microscopy; Porosity; Rats.