Enhanced osseointegration of porous titanium scaffold implanted with preload: an experiment study in rabbits / Osteointegración mejorada de malla de titanio poroso implantada con precarga: un estudio experimental en conejos

Porous titanium alloy scaffold was widely used in treating bone defect caused by traumatic injury and osteomyelitis, which was incapable of self-healing. The implantation of scaffold produced stress shielding thereby forming osteolysis. The objective of this study was to analysis trabecular morphological features of osseointegrated bone. 14 New Zealand rabbits were divided into two groups, surgery group and healthy control group. 7 rabbits in surgery group were selected to perform 3D printed porous titanium alloy scaffold implantation surgery with preload at the defect of femoral condyle for osseointegration. The other 7 rabbits in control group were feed free. After 90 days healing, femoral condyles were extracted to perform micro-CT scanning with hydroxyapatite calibration phantom. Mean bone mineral density (BMD), bone volume fraction (BV/TV), BS/TV (bone surface area ratio), Tb.Th (thickness of trabeculae), Tb.N (number of trabeculae), Tb.Sp (trabecular separation) and DA (degree of anisotropy) were calculated from micro-CT images. The results revealed that osseointegration inside and at the surface of scaffolds worked well from grey values of micro-CT images. After 12 weeks healing, mean bone mineral densities (BMD) in surgery group and healthy control group were calculated as 800±20mg/cm3 and 980±90mg/cm3, respectively. This revealed that the strength of trabeculae in surgery group might lower than that in the healthy group. Trabecular morphological parameters test showed that trabecular morphological parameters at the surface of scaffolds in the surgery group deteriorated significantly. It was found from micro-CT images that ingrowth bone was filled with pores of scaffold. Overall, the effect of osseointegration was promoted through the change of mechanical micro-environment in the scaffold region. Overall, preload could improve osseointegration effect in the long-term after surgery. However, the trabecular morphology in the surgery group was deteriorated, which might bring secondary fracture risk again.

La malla de aleación de titanio poroso se usó ampliamente en el tratamiento de defectos óseos causados por lesiones traumáticas y osteomielitis. El implante de la malla generó una protección contra el estrés, formando así osteolisis. El objetivo de este estudio fue analizar las características morfológicas trabeculares del hueso osteointegrado. Se dividieron 14 conejos (Neozelandeses) en dos grupos, grupo cirugía y grupo control saludable. Se seleccionaron 7 conejos en el grupo de cirugía para realizar una implantación de mallas de aleación de titanio poroso, impresas en 3D con precarga en el defecto del cóndilo femoral para la osteointegración. Los 7 conejos restantes del grupo control se mantuvieron sin alimentación. Después de 90 días de curación, se extrajeron los cóndilos femorales para realizar una exploración por micro-CT con un espectro de calibración de hidroxiapatita. Se calcularon a partir de imágenes de micro-CTDensidad mineral ósea media (DMO), fracción de volumen óseo (BV / TV), BS / TV (relación de área de superficie ósea), Tb.Th (espesor de trabéculas), Tb.N (número de trabéculas), Tb.Sp (trabecular separación) y DA (grado de anisotropía). Los resultados revelaron que la osteointegración dentro y en la superficie de los andamios funcionó bien a partir de los valores grises de las imágenes de micro-CT. Después de 12 semanas de curación, las densidades medias de minerales óseos (DMO) en el grupo cirugía y en el grupo control sano se calcularon como 800 ± 20 mg/cm3 y 980 ± 90 mg/cm3, respectivamente. Esto reveló que la fuerza de las trabéculas en el grupo de cirugía podría ser menor que la del grupo sano. La prueba de parámetros morfológicos trabeculares mostró que en el grupo de cirugía, la superficie de las mallas, se deterioraron significativamente. Se descubrió a partir de imágenes de microCT que el hueso en crecimiento estaba lleno de poros de andamio. En general, el efecto de la osteointegración se promovió mediante el cambio del microambiente mecánico en la región de la malla. En general, la precarga podría mejorar el efecto de osteointegración a largo plazo después de la cirugía. Sin embargo, la morfología trabecular en el grupo de cirugía se deterioró, lo que podría traer un nuevo riesgo de fractura secundaria.

Expression of BMP II by human osteoblasts cultivated on dense or porous titanium / Expressão da BMP II por osteoblastos humanos cultivados sobre titânio denso ou poroso

Objective: Modifications of titanium have been described as an important tool improving bone repair and boneimplant contact. The aim of this research was to quantified the expression of the morphogenetic bone protein II (BMP II) produced by human cells with osteoblast differentiation, after cultured over dense or porous samples of pure titanium grade II. Material and Methods: The experimental groups were: control group, dense titanium, porosity of 33.79% and porosity of 41,79% (n=36). The samples were produced by powder metallurgy technique. Mesenquimal steam cells isolated from alveolar bone of healthy donors were stimulated to differentiate, assuming an osteoblastic phenotype, by supplemented medium and plated over the samples. After 7 and 14 days, the RNA was collected to perform reverse transcriptase polymerase chain reaction (RT-PCR) in real time. Data was analysed by t-Student and ANOVA tests. The porosity, the pore morphology and interconnection were evaluated by Scanning Electron Microscopy (SEM). Results: Total porosity (obtained after apply dimensions and density formulas) and surface porosity (SEM) presented significant differencesamong the groups. For the group of total porosity of 33.79%, the superficial porosity was 32.5% (± 7.74%) and for the group of 41.79%, the superficial porosity was 37.4% (± 7.95%), significantly lower. The expression of BMP II was similar in all groups. Conclusion: The present study demonstrated that powder metallurgy has a reduced ability to standardize the porosity in the samples and that the porosity does not interfere in the cellular response of BMP II production, an important inducer of osteoblastic differentiation. (AU)

Objetivo: As modificações do titânio são descritas como importantes ferramentas na melhora do reparo ósseo no contato osso implante. O objetivo deste estudo foi quantificar a expressão da proteína óssea morfogênica II (BMP II) por células humanas com diferenciação osteoblastica, quando cultivadas sobre amostras de titânio puro grau II, denso ou poroso. Material e Métodos: Os grupos experimentais foram: controle, titânio denso, titânio de maior porosidade e titânio de menor porosidade, sendo que, as amostras foram confeccionadas pela técnica da metalurgia do pó. As células isoladas de doadores saudáveis foram plaqueadas sobre as amostras. Após 7 e 14 dias, o RNA foi extraído das células. A qualidade e integridade do RNA foram analisadas qualitativamente por eletroforese e quantitativamente por espectrofotômetro. O cDNA foi confeccionado e a foi utilizada técnica de reação em cadeia da polimerase (PCR) em tempo real. Os dados foram utilizados para quantificação relativa, e o gene constitutivo foi a BetaActina. A morfologia e a interligação dos poros foram comprovadas por Microscopia Eletrônica de Varredura (MEV). Resultados: A porosidade superficial (MEV) teve diferença significativa em relação a porosidade obtida analisando-se volume e massa das amostras. Para o grupo 3,79%, a superficial foi de 32,5% (±7,74%) e para o grupo 41,79% a porosidade superficial foi de 37,4% (±7,95%), significativamente menor. A expressão da BMP II foi semelhante em todos os grupos. Conclusão: Concluiu-se a metalurgia do pó tem reduzida capacidade de padronização da porosidade das amostras por ela confeccionas e que a porosidade não interfere na resposta celular de produção da BMP II, importante indutor de diferenciação osteoblastica.(AU)