Reducing the Risk of Impaired Bone Apposition to Titanium Screws with the Use of Fibroblast Growth Factor-2-apatite Composite Layer Coating

Overview

Journal J Orthop Surg Res

Publisher Biomed Central

Specialty Orthopedics

Date 2017 Jan 7

PMID 28057033

Citations 4

Authors

Kengo Fujii

Atsuo Ito

Hirotaka Mutsuzaki

Shinji Murai

Yu Sogo

Yuki Hara

Masashi Yamazaki

Affiliations

Soon will be listed here.

Abstract

Background: Loosening of screws is a common problem in orthopedic and maxillofacial surgery. Modifying the implant surface to improve the mechanical strength of screws has been tried and reported. We developed screws coated with fibroblast growth factor-2 (FGF-2)-apatite composite layers. We then showed, in a percutaneous external fixation model, that this composite layer had the ability to hold and release FGF-2 slowly, thereby reducing the risk of pin tract infection of the percutaneous external fixation. The objective of the current study was to clarify the effect of FGF-2-apatite composite layers on titanium screws on bone formation around the screw.

Methods: We analyzed samples of previously performed animal experiments. The screws were coated with FGF-2-apatite composite layers by immersing them in supersaturated calcium phosphate solutions containing FGF-2. Then, the uncoated, apatite-coated, and FGF-2-apatite composite layer-coated screws were implanted percutaneously in rabbits. Finally, using inflammation-free histological sections, we histomorphometrically assessed them for the presence of bone formation. Weibull plot analysis was then applied to the data.

Results: On average, screws coated with FGF-2-apatite composite layers showed a significantly higher bone apposition rate than the uncoated or apatite-coated screws. Although the difference in the average bone apposition rate was small, the FGF-2-apatite composite layers produced a significant, marked reduction in the incidence of impaired bone formation around the screw compared with the incidence in the absence of FGF-2 (uncoated and apatite-coated screws). The probability of resulting in a bone apposition rate equal to or less than 63.75%, for example, is 3.5 × 10 for screws coated with the FGF-2-apatite composite layers versus 0.05 for screws in the absence of FGF-2.

Conclusions: FGF-2-apatite composite layer coating significantly reduced the risk of impaired bone apposition to the screw. Thus, it is feasible to use titanium screws coated with FGF-2-apatite composite layers as internal fixation screws to decrease the risk of loosening.

Citing Articles

Assessing and Managing Primary Hyperparathyroidism and Fracture Risk in England: A Survey of Medical Professionals.

Song K, Vijjhalwar R, Aye M, Comninos A, Schini M, Abbas A J Endocr Soc. 2025; 9(2):bvae225.

PMID: 39876875 PMC: 11772554. DOI: 10.1210/jendso/bvae225.

Safety and Osteointegration of Titanium Screws Coated with a Fibroblast Growth Factor-2-Calcium Phosphate Composite Layer in Non-Human Primates: A Pilot Study.

Matsumoto Y, Mutsuzaki H, Hara Y, Nagashima K, Okano E, Yanagisawa Y J Funct Biomater. 2023; 14(5).

PMID: 37233371 PMC: 10219525. DOI: 10.3390/jfb14050261.

Clinical Trial for the Safety and Feasibility of Pedicle Screws Coated with a Fibroblast Growth Factor-2-Apatite Composite Layer for Posterior Cervical Fusion Surgery.

Nagashima K, Hara Y, Mutsuzaki H, Totoki Y, Okano E, Mataki K J Clin Med. 2023; 12(3).

PMID: 36769595 PMC: 9917677. DOI: 10.3390/jcm12030947.

Safety of terminally gamma-ray-sterilized screws coated with fibroblast growth factor 2-calcium phosphate composite layers in non-human primates.

Matsumoto Y, Mutsuzaki H, Nagashima K, Hara Y, Yanagisawa Y, Okano E J Artif Organs. 2022; 26(3):192-202.

PMID: 35941264 DOI: 10.1007/s10047-022-01352-1.

Bioactivity Evaluation of Biphasic Hydroxyapatite Bone Substitutes Immersed and Grown with Supersaturated Calcium Phosphate Solution.

Yamaguchi Y, Matsuno T, Miyazawa A, Hashimoto Y, Satomi T Materials (Basel). 2021; 14(18).

PMID: 34576367 PMC: 8468353. DOI: 10.3390/ma14185143.

References

Upasani V, Farnsworth C, Tomlinson T, Chambers R, Tsutsui S, Slivka M . Pedicle screw surface coatings improve fixation in nonfusion spinal constructs. Spine (Phila Pa 1976). 2009; 34(4):335-43. DOI: 10.1097/BRS.0b013e318194878d. View

Sanden B, Olerud C, Petren-Mallmin M, Johansson C, Larsson S . The significance of radiolucent zones surrounding pedicle screws. Definition of screw loosening in spinal instrumentation. J Bone Joint Surg Br. 2004; 86(3):457-61. DOI: 10.1302/0301-620x.86b3.14323. View

Lee J, Yang J, Hong J, Jung U, Yang H, Lee I . Early bone healing onto implant surface treated by fibronectin/oxysterol for cell adhesion/osteogenic differentiation: in vivo experimental study in dogs. J Periodontal Implant Sci. 2014; 44(5):242-50. PMC: 4216401. DOI: 10.5051/jpis.2014.44.5.242. View

Shea T, Laun J, Gonzalez-Blohm S, Doulgeris J, Lee 3rd W, Aghayev K . Designs and techniques that improve the pullout strength of pedicle screws in osteoporotic vertebrae: current status. Biomed Res Int. 2014; 2014:748393. PMC: 3958762. DOI: 10.1155/2014/748393. View

Kim S, Suh D, Yun Y, Lee J, Park K, Chung J . Local delivery of alendronate eluting chitosan scaffold can effectively increase osteoblast functions and inhibit osteoclast differentiation. J Mater Sci Mater Med. 2012; 23(11):2739-49. DOI: 10.1007/s10856-012-4729-9. View

Kocak T, Cakir B, Reichel H, Mattes T . Screw loosening after posterior dynamic stabilization--review of the literature. Acta Chir Orthop Traumatol Cech. 2010; 77(2):134-9. View

Sanden B, Olerud C, Johansson C, Larsson S . Improved extraction torque of hydroxyapatite-coated pedicle screws. Eur Spine J. 2001; 9(6):534-7. PMC: 3611423. DOI: 10.1007/s005860000180. View

Lee S, Hahn B, Kang T, Lee M, Choi J, Kim M . Hydroxyapatite and collagen combination-coated dental implants display better bone formation in the peri-implant area than the same combination plus bone morphogenetic protein-2-coated implants, hydroxyapatite only coated implants, and uncoated.... J Oral Maxillofac Surg. 2013; 72(1):53-60. DOI: 10.1016/j.joms.2013.08.031. View

Qiu Z, Chen C, Wang X, Lee I . Advances in the surface modification techniques of bone-related implants for last 10 years. Regen Biomater. 2016; 1(1):67-79. PMC: 4668999. DOI: 10.1093/rb/rbu007. View

10.

Inoue G, Ueno M, Nakazawa T, Imura T, Saito W, Uchida K . Teriparatide increases the insertional torque of pedicle screws during fusion surgery in patients with postmenopausal osteoporosis. J Neurosurg Spine. 2014; 21(3):425-31. DOI: 10.3171/2014.5.SPINE13656. View

11.

Wang X, Ito A, Sogo Y, Li X, Tsurushima H, Oyane A . Ascorbate-apatite composite and ascorbate-FGF-2-apatite composite layers formed on external fixation rods and their effects on cell activity in vitro. Acta Biomater. 2009; 5(7):2647-56. DOI: 10.1016/j.actbio.2009.03.020. View

12.

Sogo Y, Ito A, Onoguchi M, Oyane A, Tsurushima H, Ichinose N . Formation of a FGF-2 and calcium phosphate composite layer on a hydroxyapatite ceramic for promoting bone formation. Biomed Mater. 2008; 2(3):S175-80. DOI: 10.1088/1748-6041/2/3/S16. View

13.

Hasegawa T, Inufusa A, Imai Y, Mikawa Y, Lim T, An H . Hydroxyapatite-coating of pedicle screws improves resistance against pull-out force in the osteoporotic canine lumbar spine model: a pilot study. Spine J. 2005; 5(3):239-43. DOI: 10.1016/j.spinee.2004.11.010. View

14.

Galbusera F, Volkheimer D, Reitmaier S, Berger-Roscher N, Kienle A, Wilke H . Pedicle screw loosening: a clinically relevant complication?. Eur Spine J. 2015; 24(5):1005-16. DOI: 10.1007/s00586-015-3768-6. View

15.

Wang J, Aspenberg P . Basic fibroblast growth factor promotes bone ingrowth in porous hydroxyapatite. Clin Orthop Relat Res. 1996; (333):252-60. View

16.

Wittenberg R, Shea M, Swartz D, Lee K, White 3rd A, Hayes W . Importance of bone mineral density in instrumented spine fusions. Spine (Phila Pa 1976). 1991; 16(6):647-52. DOI: 10.1097/00007632-199106000-00009. View

17.

Gao Y, Luo E, Hu J, Xue J, Zhu S, Li J . Effect of combined local treatment with zoledronic acid and basic fibroblast growth factor on implant fixation in ovariectomized rats. Bone. 2008; 44(2):225-32. DOI: 10.1016/j.bone.2008.10.054. View

18.

Yu J, Li K, Zheng X, He D, Ye X, Wang M . In vitro and in vivo evaluation of zinc-modified ca-si-based ceramic coating for bone implants. PLoS One. 2013; 8(3):e57564. PMC: 3590211. DOI: 10.1371/journal.pone.0057564. View

19.

Tsurushima H, Marushima A, Suzuki K, Oyane A, Sogo Y, Nakamura K . Enhanced bone formation using hydroxyapatite ceramic coated with fibroblast growth factor-2. Acta Biomater. 2010; 6(7):2751-9. DOI: 10.1016/j.actbio.2009.12.045. View

20.

Mueller C, Thorwarth M, Schmidt M, Schlegel K, Schultze-Mosgau S . Comparative analysis of osseointegration of titanium implants with acid-etched surfaces and different biomolecular coatings. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011; 112(6):726-36. DOI: 10.1016/j.tripleo.2011.01.004. View