A review of ceramic coatings for implant fixation.

The present series of eight studies was performed in order to investigate the effect of various clinically relevant factors on bone ingrowth in relation to hydroxyapatite (HA) and titanium-alloy (Ti) coating when subjected to pathological and mechanical conditions mimicking the clinical situation. HA- and Ti-coated implants were inserted into the femoral condyles of mature dogs and one study was performed on humans. The observation period ranged from 4 to 52 weeks, and the results were evaluated by mechanical push-out testing, histomorphometric analysis, polarized light microscopy, UV fluorescence microscopy and collagen analysis. There were no complications related to the operative procedures, and all dogs were killed according to the original time schedule. Two studies focused on in vivo mechanisms and factors influencing resorption of HA coating. The overall conclusions from these studies are that HA coatings do resorb in vivo, that micromotion accelerates resorption, and that resorbed HA is partly replaced by newly formed bone, suggesting that implants fixation is durable. The other studies focused on the significance of mechanical stabilization and loading conditions of the implant immediately after surgery. From these studies, it can be concluded that HA-coating has a positive effect on bone-implant fixation in various situations, i.e., under stable loaded conditions and under unstable mechanical conditions. The most striking effect of HA coating was that it enhanced bone growth across a gap around the implant both during stable and unstable mechanical conditions; it even converted a motion-induced fibrous membrane to bony anchorage.