Bone ingrowth into porous silicon nitride
ABSTRACT Achieving solid skeletal attachment is a requirement for the clinical success of orthopedic implants. Porous or roughened surfaces and coatings have been developed and used with mixed success to achieve attachment due to bone ingrowth. Silicon nitride is a high performance ceramic whose strength, imaging properties, and biocompatibility make it a candidate material for orthopedic implants. A porous form of silicon nitride, cancellous-structured ceramic (CSC), has been developed. CSC is a nonresorbable, partially radiolucent porous structure that can be bonded to orthopedic implants made of silicon nitride to facilitate skeletal attachment. The purpose of this study was to quantify the extent and rate of bone ingrowth into CSC in a large animal model. Cylindrical implants were placed bilaterally using staged surgeries in the medial femoral condyle of six sheep. Condyles were retrieved after 3 and 6 months in situ and prepared for examination of bone growth under SEM. Bone grew into CSC to extents and at rates similar to those reported for other titanium porous surfaces in studies involving large animals and postmortem retrievals in humans. Bone ingrowth was observed at depths of penetration greater than 3 mm in some implants after only 12 weeks in situ. Bone ingrowth into CSC is a viable method for achieving skeletal attachment.
SourceAvailable from: Prashanth J Rao[Show abstract] [Hide abstract]
ABSTRACT: The clinical outcome of lumbar spinal fusion is correlated with achievement of bony fusion. Improving interbody implant bone on-growth and in-growth may enhance fusion, limiting pseudoarthrosis, stress shielding, subsidence and implant failure. Polyetheretherketone (PEEK) and titanium (Ti) are commonly selected for interbody spacer construction. Although these materials have desirable biocompatibility and mechanical properties, they require further modification to support osseointegration. Reports of extensive research on this topic are available in biomaterial-centric published reports; however, there are few clinical studies concerning surface modification of interbody spinal implants. The current article focuses on surface modifications aimed at fostering osseointegration from a clinician's point of view. Surface modification of Ti by creating rougher surfaces, modifying its surface topography (macro and nano), physical and chemical treatment and creating a porous material with high interconnectivity can improve its osseointegrative potential and bioactivity. Coating the surface with osteoconductive materials like hydroxyapatite (HA) can improve osseointegration. Because PEEK spacers are relatively inert, creating a composite by adding Ti or osteoconductive materials like HA can improve osseointegration. In addition, PEEK may be coated with Ti, effectively bio-activating the coating.Orthopaedic Surgery 05/2014; 6(2). DOI:10.1111/os.12098
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ABSTRACT: Ceramic preforms with randomly distributed particles as reticulated porous structure which are generally used for metal infiltration as reinforcement, membranes, catalyst supports etc. Preforms are characterized by open porosity making possible their infiltration by liquid metal alloys. In this work, quartz powders using carbon black as a reducing agent were used for alpha Si3N4 powders synthesis through a carbothermal reduction and nitridation (CRN) process. The CRN process was carried out under nitrogen flow at 1,450 °C for 4 h. At high temperatures, carbon as reducing agent reacts with the oxygen of SiO2, and the resulting metallic silicon compounds with nitrogen gas to obtain silicon nitride powder. The reacted powders were used to obtain reticulated ceramic by replica method. The powders containing various bentonite ratios were mixed in water to prepare slurry. The slurry was infiltrated into a polyurethane sponge. A high porous ceramic foam (preform) structure was achieved after burn out of the sponge. All ceramic preforms were sintered to increase stiffness (in the temperature range 900–1,350 °C). The sintered ceramic foams were subjected to compressive tests. The scanning electron microscopy was used to examine the reticulated ceramic foam structure, and X-ray diffraction analysis was performed to determine phases.Journal of Porous Materials 12/2013; 20(6). DOI:10.1007/s10934-013-9736-9 · 1.32 Impact Factor
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ABSTRACT: Anterior cervical discectomy with interbody fusion cages is considered the standard surgical procedure in patients with cervical disc herniation. However, PEEK or metal cages have some undesirable imaging characteristics, leading to a search for alternative materials not creating artifacts on images; silicon nitride ceramic. Whether patients treated with silicon nitride ceramic cages have similar functional outcome as patients treated with PEEK cages is not known. We present the design of the CASCADE trial on effectiveness of ceramic cages versus PEEK cages in patients with cervical disc herniation and/or osteophytes.Methods/design: Patients (age 18--75 years) with monoradicular symptoms in one or both arms lasting more than 8 weeks, due to disc herniation and/or osteophytes, are eligible for the trial. The study is designed as a randomized controlled equivalence trial in which patients are blinded to the type of cage for 1 year. The total follow-up period is 2 years. The primary outcome measure is improvement in the Neck and Disability Index (NDI). Secondary outcomes measures include improvement in arm pain and neck pain (VAS), SF-36 and patients' perceived recovery. The final elements of comparison are perioperative statistics including operating time, blood loss, length of hospital stay, and adverse events. Lateral plane films at each follow-up visit and CT scan (at 6 months) will be used to judge fusion and the incidence of subsidence. Based on a power of 90% and assuming 8% loss to follow-up, 100 patients will be randomized into the 2 groups. The first analysis will be conducted when all patients have 1 year of follow-up, and the groups will be followed for 1 additional year to judge stability of outcomes. While the new ceramic cage has received the CE Mark based on standard compliance and animal studies, a randomized comparative study with the golden standard product will provide more conclusive information for clinicians. Implementation of any new device should only be done after completion of randomized controlled effectiveness trials.BMC Musculoskeletal Disorders 08/2013; 14(1):244. DOI:10.1186/1471-2474-14-244 · 1.90 Impact FactorThis article is viewable in ResearchGate's enriched formatRG Format enables you to read in context with side-by-side figures, citations, and feedback from experts in your field.