Salkeld Samantha L, Patron Laura P, Lien Joan C, Cook Stephen D, Jones Deryk G
Fellowship of Orthopaedic Researchers, 320 Metairie Hammond Highway, Suite 406, Metairie, LA, 70005, USA.
Department of Sports Medicine and Cartilage Restoration, Ochsner Sports Medicine Institute, Jefferson, LA, USA.
J Orthop Surg Res. 2016 Dec 1;11(1):155. doi: 10.1186/s13018-016-0488-5.
Osteochondral defects continue to be a clinical treatment challenge, and when left untreated, may cause pain and functional impairment. Pyrolytic carbon is a unique isotropic biomaterial used in heart valve and small joint replacements due to its excellent wear properties and biocompatibility with bone and articular cartilage. Therefore, a proposed solution is to utilize a focal pyrolytic carbon hemiarthroplasty implant as an alternative resurfacing treatment strategy for isolated cartilage lesions.
A canine model (n = 9) was used to evaluate the in vivo histologic response and function of a pyrolytic carbon implant replacing a full-thickness osteochondral defect in the medial femoral condyle (MFC) of the knee. The gross appearance and histologic results were compared to an identical cobalt-chromium (Co-Cr) alloy implant placed in a defect in the contralateral MFC and evaluated up to 52 weeks.
Extensive bone incorporation to the stem portion was observed for both implant types. The total mean histologic score for the cartilage of the MFC surrounding the pyrolytic carbon implants was significantly improved compared to that of the Co-Cr alloy implants at all evaluation periods (p < 0.05). Histologic grading and gross observations at 52 weeks for pyrolytic carbon implants were similar to those of Co-Cr alloy implants at 24 weeks. At 24 weeks, the mean total histologic score for Co-Cr alloy implants was 11.6 ± 0.7 (0-16 range point; 16 = normal appearance), while at 52 weeks, the mean total score for the pyrolytic carbon implants was 11.7 ± 1.3. Mean total histologic score of opposing medial tibia cartilage for the pyrolytic carbon implants was superior to that of the Co-Cr alloy group at all evaluation periods and significantly improved over the Co-Cr alloy implant group at 24 weeks (p = 0.001) and 52 weeks (p < 0.001).
Use of a pyrolytic carbon implant for reconstruction of a focal cartilage defect demonstrated effective implant fixation and superior in vivo response compared to an identical Co-Cr alloy implant.
骨软骨缺损仍然是临床治疗中的一项挑战，若不进行治疗，可能会导致疼痛和功能障碍。热解碳是一种独特的各向同性生物材料，因其出色的耐磨性能以及与骨骼和关节软骨的生物相容性，被用于心脏瓣膜和小关节置换。因此，一种提议的解决方案是利用局灶性热解碳半关节成形术植入物，作为孤立性软骨损伤的一种替代性表面置换治疗策略。
使用犬类模型（n = 9）来评估热解碳植入物替代膝关节内侧股骨髁（MFC）全层骨软骨缺损后的体内组织学反应和功能。将大体外观和组织学结果与放置在对侧MFC缺损处的相同钴铬（Co-Cr）合金植入物进行比较，并评估长达52周的时间。
两种植入物类型均观察到骨与柄部的广泛融合。在所有评估期，与Co-Cr合金植入物相比，热解碳植入物周围MFC软骨的总平均组织学评分均有显著改善（p < 0.05）。热解碳植入物在52周时的组织学分级和大体观察结果与Co-Cr合金植入物在24周时相似。在24周时，Co-Cr合金植入物的总平均组织学评分为11.6 ± 0.7（0 - 16分范围；16 = 正常外观），而在52周时，热解碳植入物的总平均评分为11.7 ± 1.3。在所有评估期，热解碳植入物相对的内侧胫骨软骨的总平均组织学评分均优于Co-Cr合金组，且在24周（p = 0.001）和52周（p < 0.001）时显著优于Co-Cr合金植入物组。
与相同的Co-Cr合金植入物相比，使用热解碳植入物重建局灶性软骨缺损显示出有效的植入物固定和更好的体内反应。
