Schreiner U, Schulze A, Scheller G, Apruzzese C, Schwarz M L
Orthopädisch-Unfallchirurgisches Zentrum, Universitätsklinikum Mannheim, Theodor-Kutzer-Ufer 1, Mannheim.
Z Orthop Unfall. 2012 Feb;150(1):32-9. doi: 10.1055/s-0031-1280030. Epub 2011 Oct 18.
A stable osseointegration of an alumina-matrix-composite-ceramic (AMC) could facilitate the use of a thin-walled monoblock acetabular cup for hip arthroplasty with large ball-heads providing advantages like reduced risk of dislocation. The aim of the pilot study was to examine the osseointegration of porous-coated alumina-matrix-composite-ceramic-monoblock cups after implantation in a sheep model.
The porous coated AMC-ceramic cups were taken out after a healing period of 8 and 52 weeks after unilateral implantation in 5 and 6 sheep, respectively. The osseointegration was analysed histomorphologically and histomorphometrically by representative serial sections after dying according to Masson-Goldner. The examination was stratified according the pole and the rim areas as a press-fit cup with an extended rim was used. Two animals had a hip dislocation after 8 weeks and these animals were excluded from the study and replaced.
The cups were appraised as stable in the bony bed. Histologically, the rim area of the acetabular cup showed a higher osseointegration rate than the pole area. The rate of osseointegration in total was 3% after 8 weeks and 7% after 52 weeks. The rim area furnished 5.1% after 8 and 8.6% after 52 weeks. At the pole the osseointegration was 1,2% after 8 and 5.5% after 52 weeks. No significant differences were seen between both assessed time periods regarding the osseointegration rates. The bone showed an interlocking aspect with the pores of the coating as bony tissue was determined in the pores.
The presented pilot study revealed a stable osseointegration of porous-coated AMC-ceramic monoblock cups one year after surgery in a weight-bearing animal model. Interlocking of bone and porous coating may provide a stable osseointegration in the presence of low osseointegration rates, whose enhancement seems to be preferable.
氧化铝基复合陶瓷（AMC）实现稳定的骨整合有助于在髋关节置换术中使用带有大尺寸球头的薄壁整体式髋臼杯，具有降低脱位风险等优势。本初步研究的目的是在绵羊模型植入后，检查多孔涂层氧化铝基复合陶瓷整体式髋臼杯的骨整合情况。
在分别对5只和6只绵羊进行单侧植入后，经过8周和52周的愈合期，取出多孔涂层的AMC陶瓷杯。根据马森 - 戈德纳染色法，通过代表性连续切片对骨整合进行组织形态学和组织形态计量学分析。由于使用的是带有延伸边缘的压配杯，检查按极区和边缘区进行分层。两只动物在8周后发生髋关节脱位，这些动物被排除在研究之外并进行替换。
髋臼杯在骨床中被评估为稳定。组织学上，髋臼杯的边缘区骨整合率高于极区。8周时骨整合率总计为3%，52周时为7%。边缘区8周时为5.1%，52周时为8.6%。极区8周时骨整合率为1.2%，52周时为5.5%。在两个评估时间段之间，骨整合率未见显著差异。骨与涂层孔隙呈现互锁状态，因为在孔隙中确定有骨组织。
本初步研究表明，在负重动物模型中，多孔涂层AMC陶瓷整体式髋臼杯在术后一年实现了稳定的骨整合。在骨整合率较低的情况下，骨与多孔涂层的互锁可能提供稳定的骨整合，提高骨整合率似乎更可取。
