The Journal of Bone and Joint Surgery (American). 2008;90:1090-1100.
doi:10.2106/JBJS.G.00415
© 2008 The Journal of Bone and Joint Surgery, Inc.
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Enhanced Gap Filling and Osteoconduction Associated with Alendronate-Calcium Phosphate-Coated Porous Tantalum

Donald S. Garbuz, MD, MHSc, FRCSC1, Youxin Hu, MASc2, Winston Y. Kim, MD1, Ke Duan, PhD2, Bassam A. Masri, MD, FRCSC1, Thomas R. Oxland, PhD, PEng3, Helen Burt, PhD4, Rizhi Wang, PhD, PEng2 and Clive P. Duncan, MD, FRCSC1

1 Division of Adult Lower Limb Reconstruction and Oncology, Department of Orthopaedics, University of British Columbia, Room 3114, 910 West 10th Avenue, Vancouver, BC V5Z 4E3, Canada. E-mail address for D.S. Garbuz: garbuz{at}shaw.ca. E-mail address for W.Y. Kim: wjykim{at}hotmail.com. E-mail address for B.A. Masri: bas.masri{at}vch.ca. E-mail address for C.P. Duncan: Clive.Duncan{at}vch.ca
2 Department of Materials Engineering, University of British Columbia, 309-6350 Stores Road, Vancouver, BC V6T 1Z4, Canada. E-mail address for Y. Hu: eugenehu{at}interchange.ubc.ca. E-mail address for K. Duan: keduan{at}interchange.ubc.ca. E-mail address for R. Wang: rzwang{at}interchange.ubc.ca
3 Division of Orthopaedic Engineering Research, Departments of Orthopaedics and Mechanical Engineering, 556-828 West 10th Avenue, Vancouver, BC V5Z 1L8, Canada. E-mail address: toxland{at}interchange.ubc.ca
4 Faculty of Pharmaceutical Sciences, University of British Columbia, 2146 East Mall, Vancouver, BC V6T 1Z3, Canada. E-mail address: burt{at}interchange.ubc.ca
Investigation performed at the University of British Columbia, Vancouver, British Columbia, Canada

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from the National Sciences and Engineering Research Council of Canada, Zimmer, Inc., Canada Research Chairs, and the Killam Trust. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Background: Porous tantalum has been shown to be effective in achieving bone ingrowth. However, in some circumstances, bone quality or quantity may be insufficient to allow adequate bone ingrowth. We hypothesized that local delivery of alendronate from porous tantalum would enhance the ability of the tantalum to achieve bone ingrowth when there is a gap between the implant and bone. We evaluated the effect of alendronate-coated porous tantalum on new bone formation in an animal model incorporating a gap between the implant and bone.

Methods: A cylindrical porous tantalum implant was implanted in the distal part of each femur in eighteen rabbits (a total of thirty-six implants) and left in situ for four weeks. Three types of porous tantalum implants were inserted: those with no coating (the control group), those with microporous calcium phosphate coating, and those coated with microporous calcium phosphate and alendronate. Subcutaneous fluorescent labeling was used to track new bone formation. Bone formation was analyzed with backscattered electron microscopy and fluorescent microscopy of undecalcified samples.

Results: The relative increases in the mean volume of gap filling, bone ingrowth, and total bone formation in the group treated with the porous tantalum implants coated with calcium phosphate and alendronate were 143% (p < 0.001), 259% (p < 0.001), and 193% (p < 0.001), respectively, compared with the values in the control group treated with the uncoated porous tantalum implants. The percentage of the length of the implant that was in contact with new bone in the group treated with the calcium phosphate and alendronate coating was increased by an average of 804% compared with the percentage in the group treated with the uncoated implants.

Conclusions: The study demonstrated significantly enhanced filling of the bone-implant gap and bone ingrowth in association with the porous tantalum implants coated with calcium phosphate and alendronate.

Clinical Relevance: The addition of an alendronate-delivery surface coating would enhance biological fixation of a tantalum implant and promote the healing of bone defects and thus address the clinical problem of revision joint replacement in the face of bone loss.


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