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Abstract The present status of skeletal fixation of permanent orthopedic implants by poly(methyl methacrylate) (PMMA) is discussed. It is proposed that alternatives to the acrylic cement can improve the skeletal fixation. The present paper is concerned with the fixation method by bone ingrowth into pores of the implant surface. Two different implantation models have been designed to investigate the influence of load bearing upon ingrowth in surface pores of the implant: intramedullary nails as a means of fixation of a femoral pseudarthrosis and hinged knee prostheses. In each animal, implants with identical material characteristics (pore size, density, and thickness of the porous layer) but different loading conditions were used: one implant was “statically” loaded, the other “dynamically.” This procedure allows the evaluation of ingrowth with regard to load bearing only. Two different mean pore sizes, viz., 87 and 110 μm, have been used with the two models. After an 8 week implantation period, bone ingrowth was evident for the statically loaded implants. Calcified tissue ingrowth was, however, not observed in the dynamically loaded implants. The discrepancy in bone ingrowth behavior between the statically and the dynamically loaded implants has been attributed to 1) the gross movement or the micromovement existing at the bone prosthesis interface and 2) the fact that the critical mean pore size for ingrowth with static loading is smaller than the one with dynamic loading. The experimental implantations allow still another conclusion: the results suggest that designs of present clinical prostheses fixed by bone cement cannot be used with the alternative fixation by bone ingrowth unless the deisgn has been changed in a fundamental way. Mechanical factors as well as the phenomenology of bone ingrowth fixation account for this conclusion.
Ducheyne et al. (Tue,) studied this question.