Parathyroid Hormone Treatment Increases Fixation of Orthopedic Implants with Gap Healing: A Biomechanical and Histomorphometric Canine Study of Porous Coated Titanium Alloy Implants in Cancellous Bone

Parathyroid hormone (PTH) administered intermittently is a bone-building peptide. In joint replacements, implants are unavoidably surrounded by gaps despite meticulous surgical technique and osseointegration is challenging. We examined the effect of human PTH(1–34) on implant fixation in an experime...

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Bibliographic Details
Published in:	Calcified tissue international 2011-04, Vol.88 (4), p.294-303
Main Authors:	Daugaard, Henrik, Elmengaard, Brian, Andreassen, Troels, Bechtold, Joan, Lamberg, Anders, Soballe, Kjeld
Format:	Article
Language:	eng
Subjects:	Alloys Animals Biochemistry Biomechanical Phenomena Biomechanics Biomedical and Life Sciences Bone (cancellous) Bone and Bones - pathology Bone healing Bone histomorphometry Bone implants Bones Cell Biology Coated Materials, Biocompatible - pharmacology Dogs Endocrinology Energy Hormones Hormones - metabolism Integration Joints Life Sciences Male Materials Testing Original Research Orthopedics Orthopedics - methods Osseointegration Parathyroid hormone Parathyroid Hormone - therapeutic use Porosity Prostheses and Implants Stress, Mechanical Thyroid gland Tibia Tibia - pathology Titanium Titanium alloys Transplants & implants
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Summary:	Parathyroid hormone (PTH) administered intermittently is a bone-building peptide. In joint replacements, implants are unavoidably surrounded by gaps despite meticulous surgical technique and osseointegration is challenging. We examined the effect of human PTH(1–34) on implant fixation in an experimental gap model. We inserted cylindrical (10 × 6 mm) porous coated titanium alloy implants in a concentric 1-mm gap in normal cancellous bone of proximal tibia in 20 canines. Animals were randomized to treatment with PTH(1–34) 5 μg/kg daily. After 4 weeks, fixation was evaluated by histomorphometry and push-out test. Bone volume was increased significantly in the gap. In the outer gap (500 μm), the bone volume fraction median (interquartile range) was 27% (20–37%) for PTH and 10% (6–14%) for control. In the inner gap, the bone volume fraction was 33% (26–36%) for PTH and 13% (11–18%) for control. At the implant interface, the bone fraction improved with 16% (11–20%) for PTH and 10% (7–12%) ( P = 0.07) for control. Mechanical implant fixation was improved for implants exposed to PTH. For PTH, median (interquartile range) shear stiffness was significantly higher (PTH 17.4 [12.7–39.7] MPa/mm and control 8.8 [3.3–12.4] MPa/mm) ( P
ISSN:	0171-967X 1432-0827